Exam II Antimicrobials General Flashcards
What are the types of Beta-Lactams?
Penicillins
Cephalosporins
Monobactams
Carbapenems
What are the types of penicillins ranked from least to most coverage?
Naturally occurring Penicillins
Aminopenicillins
Penicilinase Sensitive Penicillins
Antipseudomonal Penicillins
How do Bacteria resist Penicillin?
Bacteria change the confirmation sites at the penicillin-binding protein.
Bacteria create enzyme (penicillinase, or beta-lactamase) to destroy beta-lactam antibiotics.
Do Carbapenems have any significant ADRs and DDIs?
Imipenem is coformulated with cilastatin to protect the kidneys from it’s nephrotoxic metabolite (inhibits dehydropeptidase)
Meropenem causes a fast and rapid decrease in Valproic acid
Doripenem is least susceptible for MDR, GNR and Pseudomonas beta-lactamase
What drugs to use with Penicillin allergy?
Allergies caused by sidechains
Cephalosporin 3rd Gen < 0.5% chance of cross reacting
Cephalosporin 1st or 2nd Gen 2% chance of cross reacting
Carbapenem < 1% chance of cross reacting
How do you test Dose Antibiotics?
Test Dose = 1/10th of the target dose
Ex. Test Dose 100 mg of Cefepime
Target Dose 1000 mg Cefepime
How do Glycopeptides work?
Inhibit Penicillin binding protein from cross linking peptidoglycan.
Effective to overcome beta-lactamase or penicillinase mutations.
When would you administer PO Vancomycin?
For CDiff
How do Tetracyclines work?
Inhibit protein synthesis by preventing tRNA binding to the 30s ribosomal subunit.
How do Fluoroquinolones work?
Inhibit both DNA gyrase and Topoisomerase IV.
Prevent bacterial from replicating DNA
Renal Concerns
Fluoroquinolone ADRs
How do Macrolides work?
Inhibit Protein synthesis by preventing tRNA binding at the 50s ribosomal subunit.
What DDIs are you concerned about with non Z-pack macrolides?
CYP interactions
How does Clindamycin work?
Inhibit protein synthesis by preventing tRNA binding to 50s ribosomal subunit.
What are the ADEs associated with Clindamycin?
Nausea, GI upset, multiple dosing a day.
How does Metronidazole work?
Inhibits DNA synthesis by causing strand breakage.
What ADEs does Metronidazole
Peripheral Neuropathy, GI intolerance, metallic taste
How does SMX / TMP (Bactrim) work?
Inhibits formation of nucleic acids needed for DNA synthesis/replication.
SMX inhibits dihydropteroate
Trimethoprim inhibits dihydrofolate reductase
How do Aminoglycosides work?
Irreversibly bind with 30s subunit, causing the mRNA to be misread.
What are the two methods of dosing Aminoglycosides?
Once Daily (preferred)
Peak dose extended interval
Conventional
Small doses more frequently allowing for Renal monitor etc.
How do you determine the Extended dosing interval of AMinoglycosides?
Use the Hartford Nomogram. Frequency-based off drug level at certain time points posts dosage.
What needs to be monitored in conventional dosing of Aminoglycosides?
Peaks and Troughs
This is the dosing used for Synergy.
How does Nitrofurantoin Work?
Metabolized within the Bacterial Cell to reactive intermediates that destroy DNA and ribosomal Proteins.
How do Oxazolidinones work?
Bind the 50s ribosome inhibits the ability for 30s ribosome to bind. Does not allow protein synthesis to occur.
