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Pharmacology > Exam 5: Antimicrobials > Flashcards

Exam 5: Antimicrobials Flashcards

1
Q

mechanisms of drug resistance

A

not enough drug, structure change in drug target, drug antagonist, drug inactivation (enzyme produced from microbe)

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2
Q

superinfection

A

new infection that appears during the course of tx of primary infection

difficult to treat - typically resistant
yeast infection example

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3
Q

selection of abx

A

identify organism
drug sensitivity
host factors - functioning immune sys? allergies? site of infection? foreign body (cath)?

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4
Q

empiric therapy

A

abx selection based on initial presentation and common microbes found with the problem

ex. guy comes in immediately after getting a cut

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5
Q

acute therapy

A

lab -> cult/sent, abx started immediately with broad-spectrum abx

ex. guy comes in days later and with swollen, red leg (worry for sepsis)

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6
Q

tx principles

A

monitor first dose
patient ed - no sharing and complete course

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7
Q

major ADRs

A

hypersensitivity, superinfections, organ toxicities (ear, liver, kidney)

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8
Q

situations for prophylactic abx tx

A

UTI, COPD, pre-op, dental procedures, bacterial endocarditis, bites/wounds/STD exposures, neutropenic, labor and delivery

not abx but vaccines also

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9
Q

gram positive examples

A

cocci - staph, strep
bacilli - mycobacterium, antracis

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10
Q

gram negative examples

A

pseudomonas - gonorrhea, h. pylori, salmonella

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11
Q

drug therapy for UTIs

A

*Trimethoprim/sulfamethoxazole (first line)Bactrim
*Nitrofurantoin(first line)
* Fosfomycin (first line)

*Phenazopyridine (Pyridium) –> AZO, not abx

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12
Q

enzymes needed for HIV replication

A

reverse transcriptase, protease, integrase

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13
Q

HAART

A

highly active antiretroviral therapy for HIV/AIDs CD4 count <500

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14
Q

penicillin

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

narrow (PCN G) to broad spectrum (amoxicillin) to extended spectrum (piperacillin)

ADRs: common hypersensitivity (anaphylaxis), GI, interfere w/ contraceptives

no PO - stomach acid, can’t penetrate gram neg walls, inactivated by penicillinase

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15
Q

ampicillin/amoxicillin

A

broad spectrum (worry about super infections)

use: gram + or - (e. coli)

ADRs: rash, GI upset

commonly used with other abx to inhibit beta-lactamase (augmentin ex)

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16
Q

beta-lactamases

A

bacteria that resist penicillin through enzymes that inactivate the beta-lactam ring of the drug

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17
Q

cephalosporins

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

broad spectrum and more effective with higher gen (against gram -)

minimal ADRs - cross allergy to PCN, superinfections, poor GI absorption (IV/IM)

implications: no alcohol (Disulfiram-like), promotes bleeding (warfarin), C.diff concerns

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18
Q

different generations of cephalosporins

A

1st Generation; Cefazolin (Ancef) ; Cephalexin (Keflex)

2nd Gen: Cefuroxime (Ceftin); Cefaclor (Ceclor)

3rd Gen: Ceftriaxone (Rocephin); Ceftazidine (Fortaz)

4th Gen: Cefipime (Maxipime)-

5th Gen: Ceftaroline (Teflaro)- Effective: MRSA and VRSA

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19
Q

imipenem

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

broad spectrum - gram + and -; only IV

resists beta-lactamases

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20
Q

vancomycin

A

MOA: inhibitor of cell wall synthesis (binds to precursors of cell wall)

use: severe C. diff or MRSA

ADRs: nephrotoxic (peak/trough/creatinine), ototoxic, rapid infusion -> “red man syndrome”

widely used in hospital, only IV infusion (thrombophlebitis), SLOW IV push

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21
Q

tetracylclines

A

broad spectrum, bacteriostatic, gram +/-, mostly 2nd line r/t resistance
-cycline (doxy)

MOA: inhibits protein synthesis -> blocks mRNA translation

use: anthrax, chlamydia, cholera, acne, h. pylori, periodontal disease

ADRs: GI irritation, binds to calcium -> teeth trouble, superinfections, hepatotoxic, nephrotoxic, photosensitive, **teratogenic

interactions: chelates w/ metal ions (avoid calcium, iron, magn, alumin, zinc) -> 2 hours apart

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22
Q

erythromycin

A

macrolide - broad spectrum, bacteriostatic (inhibits protein synthesis)

use: bordetella pertussis, w/other abx for pna and chlamydia, resp & skin infx

ADRs: very safe, GI effects, **QT prolongation

Interactions: antidysrythmics, hepatic enzyme inhibitor (incr. levels of other drugs)

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23
Q

azithromycin/clarithromycin

A

easier dosing than erythro (Qday or BID) and help with resistance to erythro

24
Q

clindamycin

A

broad spectrum, bacteriostatic (inhibits protein synthesis)

limited to anerobic infx (does not cross BBB) -> severe strep A and gangrene (c. perfrigens)
abdominal and pelvic infx

**big risk for C. diff

25
Q

C. diff tx

A

IV replacement, electrolyte management, vancomycin

drugs to slow GI motility should not be used

26
Q

linezolid

A

**MDROs - reserved for VRE and MRSA

ADRs: diarrhea, N/V, HA, **myelosuppression (monitor CBC)

27
Q

aminoglycosides

A

narrow spectrum, bactericidal
Gentamicin, amikacin, tobramycin, neomycin

use: aerobic gram- bacilli - used in GI for rapid affect

only IM/IV - highly polar (not absorbed in GI and doesn’t cross BBB)

ADRs: ototoxicity and nephrotoxicity **need trough levels, skeletal muscle relaxation and neuromyo blockade (paralysis + resp depress)

28
Q

sulfonamides & trimethoprim

A

Tri-metho-prim / Sulfa-methoxazole (Bactrim; Septra) -> **UTIs

MOA: Disrupt synthesis tetrahydrofolate -> derivative of folic acid

ADRs: hypersensitivity (mild to severe Stevens-Johnson syndrome-flu-like & blisters), hemolytic anemia, kernicterus, renal injury w/ crystalluria

29
Q

fluoroquinolones

A

-floxacin (cipro, levo)

broad spectrum, uses: resp, UTI, GI, skin/bone, prevent anthrax exposure

MOA: disrupt DNA replication & cell division

ADRs: GI, CNS, superinfection, photosens, tendons, QT prolong, hypoglycemia

decreased levels by dairy, antacids
increases levels of warfarin and theophylline *monitor for tox

30
Q

metronidazole

A

(Flagyl) abx and antiprotozoal - only anaerobic orgs, broad spectrum

GI, GU, CNS, bone, joint infx - prophylactic for surgeries

IV = slow, PO = metallic taste/GI upset

ADR: CNS (HA/dizzy/seiz), rash, Stevens johnson, GI upset

no alcohol (Disulfiram-like)

31
Q

bacitracin

A

MOA: Inhibits cell wall synthesis > cell lysis and > cell death

only topical, gram +, skin infx - lots of combo meds

32
Q

nitrofurantoin

A

(Macrobid) broad spectrum
uncomplicated, lower UTIs -> prophylactic

ADRs: GI upset, pulm (hypersensitivity), heme (CBC), hepatotoxic, peripheral neuropathy, birth defects, CNS

Implications: Monitor renal function, UOP, BMs, respiratory status, CBCs, liver function
take w/ food, no driving, dizzy/drowsy, increase fluids

33
Q

phenazopyridine

A

urinary analgesic (Azo)

MOA: acts locally in urinary tract mucosa to produce analgesic and relief from S/S

bright orange urine -> invalidates UA results, need culture

34
Q

Amphotericin B

A

broad spectrum antifungal, highly toxic (IV, no PO), used for systemic fungal infx

increases permeability of cell membrane (fungistatic and cidal)

**safety alert
ADRs: infusion reactions, nephrotoxic, hypokalemia, bone marrow suppress., liver failure, arrythmias, phlebitis

monitor creatinine and electrolytes

35
Q

fluconazole

A

broad spectrum antifungal w/ lower tox, PO or IV

inhibits liver enzymes (inc other meds)

systemic mycoses and candidiasis

ADRs: N/V/D, abd pain, HA, stevens johnson synd

36
Q

other -azoles

A

itraconazole = liver inj and card suppress
ketaconazole = hepatotoxic

37
Q

Caspofungin

A

echinocandins

MOA: disrupts biosynthesis of cell wall

IV only

Use: systemic infx that are intolerant/unresponsive to other meds

38
Q

Nystatin

A

polyene abx

MOA: alters cell membrane permeability

topical or PO - mild GI upset and rare rash

39
Q

acyclovir

A

antiviral - PO, topical, IV

MOA: Inhibits viral replication by suppressing synthesis of viral DNA

herpes simplex & varicella

ADRs: n/v, HA, dizzy, skin irritant, phlebitis, reversible nephrotoxicity

implications: lower dose for renal impairment

40
Q

ganciclovir

A

synthetic antiviral - IV, PO, topical

only approved for cytomegalovirus in immunocompromised

ADRs: **black box warning - granulo and thrombocytopenia, teratogenic, carcinogenic

implications: lower dose for renal, monitor CBC

41
Q

interferon alfa

A

MOA: block viral entry into cells by binding to receptor cells

use: hepatitis - SQ or IM

ADRs: flu-like sumptoms, depression, SI, GI, alopecia

42
Q

ribavirin

A

unclear MOA - use HEP C

broad spectrum antiviral, PO

ADRs: hemolytic anemia, teratogenic, flu-like, autoimmune disorders w/interferon

43
Q

simeprevir/grazoprevir

A

protease inhibitors

MOA: protease=enzyme required for replication

HEP C

ADRs: hepatic inj, photosen, rash

take w/ food

44
Q

daclatasvir & sofosbuvir

A

NS5A & NS5B inhibitors

used w/ other hep C drugs

ADR: HA, fatigue, lots of drug inter.

45
Q

lamivudine

A

MOA: inhibits viral DNA synthesis for Hep B and HIV

ADR: lactic acidosis, hepatomegaly, pancreatitis

46
Q

oseltamivir

A

Tamiflu

grab more from book *

47
Q

remdesivir

A

EUA for covid

shorter recovery time, not sufficient to help mortality

48
Q

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NNRTI)

A

MOA: suppress synthesis of viral DNA by reverse transcriptase

**black box: fatal lactic acidosis w/ hepatic steatosis

49
Q

zidovudine

A

NRTI
no longer used other than perinatal transmission

(Retrovir or AZT)

ADR: **black box - severe anemia, neutropenia, lactic acidosis w/ hepatomegaly, myopathy

50
Q

abacavir

A

NRTI
(Aizgen or ABC)

ADRs: **same black box as other NRTIs, hypersensitivity, MI

no alcohol

51
Q

lopinavir/ritonavir

A

Protease inhibitor

most effective antiretroviral - reduces HIV viral count to undetectable

ADRs: ^BGL, lipodystrophy, hyperlipid, dec. card contract, hepatotoxicity

lots of drug interactions

52
Q

raltegravir

A

Integrase stand transfer inhibitors (INSTIs)

MOA: stops action of integrase so HIV DNA is NOT integrated into the T cell’s DNA. HIV daughter cells are not made

ADRs: relatively well tolerated, watch liver enzymes, insomnia

53
Q

enfuvirtide

A

Fusion inhibitors - block entry into CD4 T cells

used for infx resistant to other drugs

54
Q

maraviroc

A

CCR5 antagonists - 50-60% of HIV strains must bind with CCR5 to enter cell

also used when resistant

55
Q

common OIs w/ HIV/AIDs

A

** greatest risk <200 CD4

Pneumocystis carinii (jiroveci) pneumonia – Bactrim (TMP/SMZ)
Cytomegalovirus retinitis (CMV) – Ganciclovir
M. tuberculosis – 4-Drug for TB;
Cryptococcal meningitis – Amphotericin B
HSV or VZV - Acyclovir
Candidiasis – “azole”

56
Q

abx for common infx

A

Staph -
C. diff - clindamycin

Pharmacology (12 decks)

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