exam 1a drugs COPY Flashcards
antibiotics or antivirals?
MOA: inhibit cell wall synthesis or DNA/RNA disruption?
penicillin
cephalosporins
carbapenems
vancomycin
Antibiotics/antimicrobials
MOA: Inhibit cell wall synthesis
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
s/e for PCN or cephalosporins?
- Urticaria - hives
- Pruritis
- Angioedema – swelling
PCN
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
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)
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)
which has less side effects amoxicillin or ampicillin?
amoxicillin
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)
the 2 PCN: aminopenicillin drugs are
amoxicillin and ampicillin
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
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
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
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
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
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
which cephalosporins generation
- Gram –
- Gram +
- Broad spectrum
- UTI, skin infection, pneumonias
- Cross BBB
4th generation
Cefepime
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
which beta lactam abx are these drugs?
Imipenem/cilastin (combo drug)
Meropenem
Carbapenems
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
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)
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)
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
which carbapenem has more coverage
Imipenem/cilastin or Meropenem?
Imipenem/cilastin
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
