which carbapenem is Very resistant to beta-lactamase? - Imipenem/cilastin (combo drug) - Meropenem

- Imipenem/cilastin (combo drug) (normally carbapenems aren’t but this is a combo drug)

exam 1a drugs COPY Flashcards by Garrett Anderson

antibiotics or antivirals?

MOA: inhibit cell wall synthesis or DNA/RNA disruption?

penicillin
cephalosporins
carbapenems
vancomycin

Antibiotics/antimicrobials
MOA: Inhibit cell wall synthesis

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beta lactam antibiotics (treats bacterial infections for bacteria that doesn’t produce beta lactamase (enzyme)?

PCN
cephalosporins
carbapenems
vancomycin

PCN
cephalosporins
carbapenems

vancomycin = glycopeptide antibiotic

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s/e for PCN or cephalosporins?

Urticaria - hives
Pruritis
Angioedema – swelling

PCN

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which PCN is
- least toxic
- half life 30 min (with good kidney function)
- works on gram + and -
- works on anaerobic bacteria
- can be combined with vancomycin

nafcillin or G & V?

natural

G and V

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which PCN is
- not broken down by the penicillinase enzyme, which some bacteria produce to resist the effects of penicillin (penicillinase resistant)
- IV only

nafcillin or amoxicillin?

nafcillin (penicillinase resistant)

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which PCN is
- Common treatment for infections = ear, nose, throat, GU, skin
- Very common in peds
- PO only
- less side effects

amoxicillin or ampicillin?

amoxicillin (PCN: aminopenicillin)

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which has less side effects amoxicillin or ampicillin?

amoxicillin

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which PCN is
- broad spectrum
- side effects - diarrhea and rash
route = PO, IV
- renal sensitive
- can be combined with sulbactam to treat resistant bacteria

amoxicillin or ampicillin?

ampicillin (PCN: aminopenicillin)

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the 2 PCN: aminopenicillin drugs are

amoxicillin and ampicillin

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which PCN is
- Widest spectrum
- good for pseudomonas infection
- ALWAYS give with beta lactamase inhibitor
- Affects platelet function
- Monitor for renal dysfunction

piperacillin or amoxicillin?

PCN: extended spectrum
piperacillin

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which beta lactam abx is

Low toxicity
poor oral absorption
side effects:
Diarrhea
Abdominal cramps
Rash
Pruritis
Redness
Edema

PCN or cephalosporins?

cephalosporins

PCN side effects = just skin

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which generations:

cefazolin
cephalexin

cefuroxime
cefotetan

Ceftriaxone
Ceftazidime
Cefotaxime

Cefepime

Ceftaroline

1st
cefazolin
cephalexin

2nd
cefuroxime
cefotetan

3rd
Ceftriaxone
Ceftazidime
Cefotaxime

4th
Cefepime

5th
Ceftaroline

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which cephalosporins generation

gram +
staph infection s
non-enterococcal strep infection s

common for surgical prophylaxis

PO or IV

1st
Cephalexin
Cefazolin - (IV only), common for surgical prophylaxis

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which cephalosporins generation

gram +
gram –

_________ doesn’t work on anerobic bacteria

route = PO or IV

2nd generation
Cefotetan
Cefuroxime - doesn’t work on anerobic bacteria

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which cephalosporins generation

gram –
gram + (much less activity)

route = IV, IM, PO

_______________ - Works for pseudomonas (common bacterium)

_____________- Able to cross BBB (works on meningitis, other CNS infections)
- Do not give to pts with liver failure
- Extremely long acting
- 1 dose per day

3rd generation
Ceftriaxone
Ceftazidime
Cefotaxime

Ceftazidime - Works for pseudomonas (common bacterium)

Ceftriaxone - Able to cross BBB (works on meningitis, other CNS infections)
- Do not give to pts with liver failure
- Extremely long acting
- 1 dose per day

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which cephalosporins generation

Gram –
Gram +
Broad spectrum
UTI, skin infection, pneumonias
Cross BBB

4th generation
Cefepime

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which cephalosporins generation

MRS
MSSA
Some VRSA/VISA
No Enterobacter, pseudomonas, ESBL, klebsiella coverage

Renally dosed medication - mainly excreted from the body through the kidneys. dosage and frequency must be adjusted based on a patient’s kidney function.

Route = IV only

5th generation
Ceftaroline

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which beta lactam abx are these drugs?

Imipenem/cilastin (combo drug)
Meropenem

Carbapenems

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which beta lactam abx is this

Broadest spectrum of ALL antibiotics
Last resort medication
s/e Drug induced seizure
Route = IV only Over 60 mins

Carbapenems
- Imipenem/cilastin (combo drug)
- Meropenem

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which carbapenem is Very resistant to beta-lactamase?

Imipenem/cilastin (combo drug)
Meropenem

Imipenem/cilastin (combo drug) (normally carbapenems aren’t but this is a combo drug)

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which carbapenem is this
- MOST broad spectrum of all
- BBB and meninges
- Complicated infections
- Very resistant to beta-lactamase
- Watch for seizures (especially in OA and in combo with other meds that can induce seizures)
- Route = IV only

Imipenem/cilastin or Meropenem?

Imipenem/cilastin (combo drug)

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which carbapenem is this

Less coverage compared to imipenem/cilastin
Gram +
Gram –
Aerobes
Anaerobes

side effects
- Rash
- Diarrhea
- Less seizure activity

Doesn’t degrade in kidneys

Imipenem/cilastin or Meropenem?

Meropenem

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which carbapenem has more coverage
Imipenem/cilastin or Meropenem?

Imipenem/cilastin

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whats the only glycopeptide antibiotic with MOA Cell wall disruption we learned?

vancomycin

which antibiotic is this? - Gram + - MRSA - PCN resistant pneumococcus - doesn’t work on CNS infections PO - C. diff - Pseudomembranous colitis Toxic – - Ototoxicity – hearing (reversible) - Thrombocytopenia - Nephrotoxic – watch use with other kidney affecting drugs - Watch with neuromuscular blockades (paralyzers) - Redman syndrome - Kidneys eliminate drug Reduce dose for renal dysfunction - Infuse slow and long or redman syndrome can occur

vancomycin

which antibiotic causes - Flushing - Rash - Pruritis - Urticaria - Tachycardia - Hypotension when infused too fast?

vancomycin (red man syndrome)

antibiotics or antivirals? MOA: inhibit cell wall synthesis or DNA/RNA disruption? Aminoglycosides: Gentamycin Amikacin Tobramycin Lincosamides: Clindamycin Macrolides: Erythromycin Azithromycin Tetracyclines: Tetracycline Doxycycline Minocycline Fluoroquinolones: Ciprofloxacin Levofloxacin Sulfonamides : Sulfamethoxale + trimethoprim (combo drug called Bactrim) Nitroimidazoles: Metronidazole

Antimicrobials/antibiotics MOA: DNA/RNA disruption

Gentamycin Amikacin Tobramycin are these Aminoglycosides or Lincosamides?

Aminoglycosides

which abx is this? Amnioglycosides or gentamycin? - Gram – - Gram + (with other antibiotics for best effect) - Complicate infections - UTI - Peritonitis - Endocarditis - PNA - Osteomyelitis - DM related infection side effects - Severe - Nephrotoxicity (reversible) - Ototoxicity (permanent) - Requires peak and trough to monitor therapeutic drug levels - Transition from 3x/day to 1x/day dosing

Aminoglycosides: Gentamycin Amikacin Tobramycin

which aminoglycoside has these additional side effects - Severe respiratory distress - CNS – confusion, depression, disorientation, numbness and tingling - Cochlear damage all of them have these s/e - Severe - Nephrotoxicity (reversible) - Ototoxicity (permanent) Gentamycin, Amikacin, or Tobramycin?

gentamycin

which abx is this? Lincosamides: Clindamycin or Macrolides: Erythromycin, Azithromycin? Bactericidal or bacteriostatic (depends on drug concentration) works on - Chronic bone infection - GU tract infection - Intraabdominal infections - Anaerobic PNU - Septicemia - Serious skin infections - Prophylaxis for endocarditis side effects - Deadly pseudomembranous colitis - Monitor for use with neuromuscular blockade meds - Monitor levels (very toxic) Route = PO, IV Wont work on VRE, CRE, etc.

Lincosamides: Clindamycin

which abx is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline? Bactericidal or bacteriostatic (depends on drug concentration) Inhibit protein synthesis by binding to ribosomes “YUCK” drugs bc of severe GI s/e works on - URI - LRI - Skin infection s - Soft tissue infections - STI - Legionnaires, listeria, mycoplasma PNU

Macrolides: Erythromycin, Azithromycin

Do not take on empty stomach – severe GI upset!! Do not take with food – decreases absorption Macrolides: Erythromycin vs Azithromycin

E - Do not take on empty stomach – severe GI upset!! A - Do not take with food – decreases absorption

Macrolides: Erythromycin vs Azithromycin Has beneficial effect on gastroparesis (a condition characterized by delayed gastric emptying) - Hypomotility refers to a decrease in the movement of the digestive tract - Stimulates gastric motility: _________ can stimulate the muscles in the stomach wall to contract more forcefully - Improves gastric emptying: By increasing stomach motility,

Erythromycin

Macrolides: Erythromycin vs Azithromycin - Broad spectrum - Does not cross BBB - Has beneficial effect on gastroparesis Route - PO – oral absorption is not great - IV – painful - Topical - Ophthalmic Do not take on empty stomach – severe GI upset!! Lots of drug/drug interactions

Erythromycin Antimicrobial MOA: DNA/RNA disruption

Macrolides: Erythromycin vs Azithromycin Differs structurally from other macrolides Has some advantages in coverage compared to - Tissue penetration - Long duration of action Less GI upset compared to Do not take with food – decreases absorption

Azithromycin Antimicrobial MOA: DNA/RNA disruption

Macrolides: Erythromycin vs Azithromycin which has some advantages in coverage? which has less GI upset?

both Azithromycin

which class of abx do these belong to Doxycycline Minocycline Tetracyclines or Fluoroquinolones ?

Tetracyclines: Tetracycline Doxycycline Minocycline

which class/drugs is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline? Bacteriostatic Inhibit protein synthesis by binding to ribosomes Broad spectrum Major resistance has developed works on - Tick diseases - Chlamydia - Trichomonas - Cholera - PID - Mycoplasma PNU - Acne s/e - Tooth enamel hypoplasia and discoloration of teeth in fetus and children - Photosensitivity - Many others Contraindications - Pregnant or nursing - Kids < 8

Tetracyclines: Tetracycline, Doxycycline, Minocycline

which abx is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline? s/e - Tooth enamel hypoplasia and discoloration of teeth in fetus and children - Photosensitivity - Many others Contraindications - Pregnant or nursing - Kids < 8

Tetracyclines: Tetracycline, Doxycycline, Minocycline tetracyclines = TEETH

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline s/e - Teeth damage - (kids < 8) - n/v/d - headache - photosensitivity - dizzy - anaphylaxis - angioedema Route = PO only - Absorption isn’t great even when fasting - Giving higher dose decreases amount absorbed Drug will concentrate in/on - Bone - Liver - Tumor - Spleen - Teeth!! (causes damage to kids < 8)

Tetracycline (class and drug name)

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline work on - chlamydial infection - mycoplasma infection - prophylaxis for STI - acne - skin infections

Doxycycline

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline - Neisseria meningitides – meningococcus is a bacterium that can cause bacterial meningitis, a serious infection of the lining of the brain and spinal cord. - Decreases s/s of rheumatoid arthritis - ER form for acne = solodyn

Minocycline

which abx is this - Fluoroquinolones: Ciprofloxacin, Levofloxacin or Sulfonamides : Sulfamethoxale + trimethoprim (combo drug called Bactrim) Broad spectrum PO good absorption works on - Gram – - Some gram +

Fluoroquinolones: Ciprofloxacin, Levofloxacin

which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this? Prolonged post-antibiotic effects – concentrated in the neutrophils - continued antimicrobial activity of ___________ even after its serum levels have fallen below the minimum inhibitory concentration (MIC). This means that the antibiotic can still effectively kill bacteria even after it is no longer detectable in the blood. - ability to concentrate in neutrophils, a type of white blood cell that plays a crucial role in the immune system.

Ciprofloxacin

which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this? works on - UTI - STI - LRI, URI - Gonorrhea - Minimal penetration of BBB/CSF - Rapid and slow growing organisms - Anthrax – infection with bacillus anthracis s/e arthropathy – joint disease Route = PO, IV, topical avoid in young and old patients (< 18 and > 60) Prolonged post-antibiotic effects ability to concentrate in neutrophils

Ciprofloxacin

which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this? - most widely used of this class - broad spectrum (but only requires 1x/day dosing) - less resistant side effects - CNS disorders w/ predisposition to seizures - Kidney failure - Prolongation of QT interval - Photosensitivity route = - PO – 100% bioavailability - IV

Levofloxacin

which abx is this - Fluoroquinolones: Ciprofloxacin, Levofloxacin or Sulfonamides: Sulfamethoxale + trimethoprim (combo drug called Bactrim) - MOA: Prevents the synthesis of folic acid needed for DNA synthesis - bacteriostatic works on - UTI - Respiratory infections - Salmonella - Shigellosis - HIV s/e Photosensitivity Check for sulfa allergy

Sulfonamides: Sulfamethoxale + trimethoprim (combo drug called Bactrim)

which abx is this - Lincosamides: Clindamycin or Nitroimidazoles: Metronidazole? - Inhibits DNA synthesis works on - Crohns disease - C Diff - Anaerobic activity only - Antiprotozoal - used to treat infections caused by protozoa - antibacterial s/e - n/v - xerostomia – dry mouth - vaginal candidiasis – yeast infection Do not take with alcohol - Toxic - No alcohol 24 hr before med - No alcohol 36 hr after med

Nitroimidazoles: Metronidazole

antibiotics or antivirals? Acyclovir Oseltamivir ganciclovir

antivirals (non-HIV)

antivirals for herpes = flu = cytomegalovirus (CMV) = Acyclovir ganciclovir Oseltamivir

herpes = acyclovir flu = oseltamivir cytomegalovirus (CMV) = ganciclovir

treat with abx or antiviral? which one? works on - HSV 1 – oral - HSV 2 – genital - VZV – shingles and chicken pox - Initial infection - Recurrent infection

antiviral herpes = acyclovir

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir MOA - Interferes with: viral nucleic acid synthesis, regulation, or DNA/RNA - Prevents: virus from binding to cells so virus cant get into cells to replicate - Stimulates: the body’s immune system to kill the virus works on - herpes - HSV 1 – oral - HSV 2 – genital - VZV – shingles and chicken pox - Initial infection - Recurrent infection s/e - GI distress - Renal impairment - Seizures - ITP - Tissue necrosis (if IV not patent) Route = PO, topical, IV Not a cure!! But helps decrease symptom severity, duration, and frequency

herpes = acyclovir

treat with abx or antiviral? which one? - Influenza A - Some action against influenza B - Prophylaxis - Active disease (if given within 48 hrs of onset of s/s) - Swine flu

antiviral oseltamivir = flu

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir Stops neuraminidases in influenza viruses (enzymes produced by influenza virus that plays a crucial role in the viral life cycle, particularly in the release of new virus particles from infected cells) works on - flu - Influenza A - Some action against influenza B - Prophylaxis - Active disease (if given within 48 hrs of onset of s/s) - Swine flu s/e - n/v - seizures - renal impairment Usually only give to elderly and immunocompromised patients after known exposure to influenza A and B Route = PO only

Oseltamivir

treat with abx or antiviral? which one? cytomegalovirus (CMV) - common herpesvirus that infects most people at some point in their lives. While it usually causes no symptoms in healthy individuals, CMV can be serious for people with weakened immune systems or newborns.

antiviral ganciclovir

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir Inhibits viral DNA polymerases = stops replication works on cytomegalovirus (CMV) Don’t give with antibiotic/antimicrobial imipenem-cilastin (carbapenem) = seizure potential Watch kidney function if giving with other nephrotoxic drugs Only given to immunocompromised patients - AIDS - Immunosuppression - Transplants Not a cure!! But it helps control it Route = IV, PO BLACK BOX WARNINGS 1. Hematologic toxicity 2. Fertility impairment 3. Fetal toxicity 4. Carcinogenesis

ganciclovir

which antiviral has these BLACK BOX WARNINGS 1. Hematologic toxicity 2. Fertility impairment 3. Fetal toxicity 4. Carcinogenesis Acyclovir, ganciclovir, Oseltamivir

ganciclovir