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UI 607 Antimicrobials > Final > Flashcards

Final Flashcards

1
Q

What is the activity of ALL beta lactams?

A

bactericidal, time dependent, PAE

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2
Q

How are ALL beta lactams metabolized and excreted?

A

no metabolism, renal elimination

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3
Q

What two adverse effects are associated with beta lactams?

A

type A - GI toxicity

tybe B - allergies +++, cross reactivity

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4
Q

What are the two aminopenicillins?

A

amoxicillin and ampicillin

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5
Q

What are the two Beta lactamase resistant penicillins? (anti staphylococcal)

A

methicillin, oxacillin

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6
Q

What are the two extended spectrum penicillins?

A

ticarcillin, piperacillin

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7
Q

What group of beta lactams has a “eagle effect”?

A

penicillins

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8
Q

What is the difference in spectrum between basic penicillins and aminopenicillins?

A

aminos have more aerobic gram - spectrum (both do pasteurella)

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9
Q

What benefits are achieved by combining penicillins and aminoglycosides?

A

increased penetration of aminoglycosides inside bacteria, additive or synergistic effect

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10
Q

What can penicillin be degraded by? (3)

A

GI amidases and acidity (poor oral absorption)

bacterial Beta lactamases

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11
Q

What two penicillins have increased oral bioavailability?

A

aminopenicillins and penicillin V

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12
Q

What two drugs can increase the half life of penicillins?

A

procaine and benzathine

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13
Q

What group of penicillins should never be used empirically?

A

anti-pseudomonal penicillins (extended spectrum)

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14
Q

What are the 3 generations of cephalexin drugs we need to know?

A

1st - cephalexin
2nd - cefuroxime
3rd - ceftiofur, cefovecin

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15
Q

What are the spectrums for each gen of cephalosporins?

A

1st - Gram + aerobic and anaerobic and beta lactamase +, modest gram - (but not gr - beta lactamse +)
2nd - mmore gram - (decreased gr +)
3rd - even more gram - (decreased gr +)

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16
Q

What cephalosporin has a very long half life for dogs and cats?

A

cefovecin (convenia)

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17
Q

What are the adverse reactions of cephalosporins?

A

A - GI toxicity, nephrotoxicity

B - common, cross reactivity

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18
Q

What group of drugs are carbapaems and monobactams?

A

beta lactams

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19
Q

What is a carbapenem drug?

A

imipenem

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20
Q

What is a monobactam drug?

A

aztreonam

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21
Q

What is the spectrum of carbapenems?

A

gram + and -, aerobes, anaerobes, beta lactamse +

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22
Q

What is the spectrum of monobactams?

A

most gram - (some beta lactamase +)

NOT active against gram +

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23
Q

What are the three peptide antibiotics?

A

glycopeptides - vancomycin
polymyxin B
bacitracin

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24
Q

What is the activity of glycopeptides?

A

bactericidal

both time and concentration dependent

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25
Q

What is the spectrum of vancomycin?

A

only gram + aerobes and anaerobes

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26
Q

What is the route of administration of vancomycin? How is it metabolized?

A

IV

not metabolized, renal excretion

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27
Q

What is the MOA of polymyxin?

A

disrupts cell membrane and anti-endotoxin effect

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28
Q

What is the activity of polymyxin B?

A

bactericidal, concentration dependent

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29
Q

What is the spectrum of polymyxin B?

A

only Gram - aerobes and anerobes including pseudomonas

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30
Q

When should systemic use of polymyxin B be indicated?

A

low doses for endotoxin activity

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31
Q

What group is Streptomycin?

A

aminoglycoside

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32
Q

What group is erythromycin?

A

macrolide

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33
Q

What group is spiramycin?

A

macrolide

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34
Q

What group is tulathromycin?

A

macrolide

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35
Q

What group is tylosin and tilmicosin?

A

macrolide

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36
Q

What group is spectinomycin?

A

aminoglycoside

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37
Q

What group is neomycin and gentamicin?

A

aminoglycoside

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38
Q

What group is amikacin?

A

aminoglycoside

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39
Q

What does the MOA of aminoglycosides depend on?

A

oxygen (does not do anaerobes)

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40
Q

What is the activity of aminoglycosides?

A

bactericidal (only protein synthesis that is)
concentration dependent
PAE

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41
Q

What is the spectrum of aminoglycosides?

A

gram -, only in aerobic conditions

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42
Q

What can aminoglycosides be synergistic with? What is the exception?

A

any wall or membrane disruptor but chemically incompatible with penicillins

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43
Q

What is the preferred admin route of aminoglycosides? What is the exception?

A

parenteral (exception: neomycin)

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44
Q

What things can inactivate aminoglycosides?

A 
inactivated by acids (stomach, pus, drugs)
divalent cations (Mg, Ca)
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45
Q

What is the activity of tetracyclines?

A

bacteriostatic, time dependent

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46
Q

What can inactivate tetracyclines?

A

di and trivalent cations - Ca, Mg, Al, Fe

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47
Q

How are tetracyclines metabolized? What is the exception?

A

no metabolism, mixed liver and renal elimination.

Doxycycline = 100% eliminated by liver

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48
Q

What is the activity of macrolides?

A

bacteriostatic, time dependent, anti inflammatory, GI prokinetic

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49
Q

What is the spectrum of macrolides?

A

extra and intracellular bacteria

aerobic Gram +, mycoplasma (#1 option)

50
Q

What can be antagonistic with macrolides?

A

other protein synthesis inhibitors

51
Q

How are macrolides metabolized?

A

inactivated by CYP450

liver elimination

52
Q

What macrolide can cause cardiotoxicity when used parenterally?

A

tilmicosin

53
Q

What group is clindamycin and pirlimycin?

A

lincosamide

54
Q

What is the activity of lincosamides?

A

time dependent and bacteriostatic

55
Q

What is the spectrum of lincosamides?

A

extra and intracellular bacteria
mainly Gram +, aerobes and anaerobes
limited against gr -

56
Q

How are lincosamides metabolized?

A

inactivated by CYP450, mixed elimination

57
Q

What are the three adverse effects with lincosamides

A

GI upset
peripheral neuromuscular blockade
cardiac depression effect

58
Q

What antibiotic group is known as the “penicillin alternative”?

A

lincosamides (gram + anaerobes like penicillins) and intracellular

59
Q

What is the activity of phenicols?

A

bacteriostatic, time dependent

60
Q

What is the spectrum of phenicols?

A

extra and intracellular
gram + and -
aerobes and anaerobes
(4 quadrants!)

61
Q

How are phenicols metabolized?

A

metabolized by glucoronidation, inhibitor of drug metabolism, liver elimination

62
Q

What are the two adverse rxns of chloramphenicol?

A

bone marrow toxicity, gi toxicity

63
Q

What group of antibiotics is a DNA replication inhibitor?

A

quinolones

64
Q

What group of antibiotics are DNA damaging agents?

A

nitroimidazoles

65
Q

What are the four drugs that are fluoroquinolones?

A

enrofloxacin, ciprofloxacin, marbofloxacin, orbafloxacin (all are -floxacins)

66
Q

What drug is the active metabolite of enrofloxacin?

A

ciprofloxacin

67
Q

What is the activity of quinolones? What other drug group is similar in activitiy?

A

bactericidal, concentration dependent

aminoglycosides are also

68
Q

What is the spectrum of fluoroquinolones?

A

extra and intracellular bacteria
most aerobic Gr -
inactive against anaerobes

69
Q

How are fluoroquinolones absorbed?

A

well orally, but decreased by di and trivalent cations

70
Q

How are fluoroquinolones metabolized?

A

little to no metabolism (exception: enrofloxacin)

mainly renal elimination

71
Q

What are the five type A adverse reactions of fluoroquinolones? Are there any Type B?

A

phototoxicity, retinal degeneration, neurotoxicity, articular damage in growing animals, tendon/ligament toxicity
B - relatively common, cross reactivity

72
Q

What are the clinical uses of the three dose ranges of fluoroquinolones?

A

low - bacteria is sensitive
middle - potentially resistant
high - immunocompromised, pseudomonas

73
Q

What are the three nucleic acid disruptors?

A

fluoroquinolones, rifampin, metronidazole

74
Q

What is the activity of rifampin?

A

bactericidal, concentration dependent

75
Q

What is the spectrum of rifampin?

A

extra and intracellular
most aerobic gram +
variable for gram -
obligate anaerobes are resistant

76
Q

How is rifampin metabolized?

A

liver deacytylation, P450 and PGP inducer, liver elimination

77
Q

What are the three adverse rxns of rifampin?

A

hepatotoxicity, bone marrow toxicity, teratogenecity

78
Q

Which drug undergoes bioactivation in anaerobic conditions?

A

metronidazole

79
Q

What is the activity of metronidazole?

A

bactericidal, time or conc dependent

only active in anaerobic conditions

80
Q

What is the spectrum of metronidazole?

A 
extra and intracellular
most anaerobes (aerobes when in anaerobic environment)
Gram - and gram +
81
Q

How is metronidazole metabolized?

A

liver, mixed hepatic and renal elimination

82
Q

What are the 3 adverse rxns of metronidazole?

A

gi toxicity, neurotoxicity (reversible), carcinogenic/teratogenic

83
Q

What can be used to improve palatability of metronidazole?

A

ester benzoate compounded formulations - but off label use

84
Q

What are the three metabolism inhibitor drugs?

A

sulfonamides, diaminopyrimidines, nitrofurans

85
Q

What is the activity of sulfonamides and diaminopyramidines?

A

bacteriostatic, time dependent

86
Q

What can decrease sulfonamide activity?

A

pus and necrotic tissues

87
Q

What is the spectrum of sulfonamides?

A

extracellular
gr + and -
NOT active against anaerobes
some protozoa

88
Q

How are sulfonamides metabolized?

A

liver, mixed liver and renal elimination

89
Q

What are the three Type A reactions associated with sulfonamides?

A

thyroid inhibition, KCS, and nephrotoxicity

90
Q

What group of drugs are trimethoprim and ormetoprim?

A

diaminopyramidines

91
Q

What is the difference in spectrum of sulfonamides and diaminopyramidines?

A

diaminos can go intracellular

92
Q

How are diaminopyramidines metabolized?

A

liver, eliminated in liver

93
Q

What is the type A reaction associated with diaminopyramidines?

A

folate deficiency –> blood cytopenia

94
Q

What are the three potentiated sulfonamides combinations?

A

Sulfamethoxazole - trimepthoprim
sulfadiazine - trimepthoprim
sulfadimethoxine - ormetoprim

95
Q

What is the spectrum of nitrofurans?

A

extracellular gr + and - aerobes and anaerobes, and protozoa

96
Q

How is nitrofuran eliminated?

A

liver metabolism (bioactivation to active drug) then very rapid renal elimination

97
Q

What are the three choices of drug for mycoplasma?

A
  1. macrolides
  2. tetracyclinse
  3. phenicols
98
Q

What three drug groups have an anti-inflammatory effect?

A

tetras, macrolides, fluoroquinolones

99
Q

What 5 drugs cause GI toxicity?

A 
o	Beta lactams
o	Tetracyclines
o	Macrolides
o	Phenicols
o	metronidazole
100
Q

What drugs should not be used first line or empirically?

A 
o	Cephalosporins
o	Monobactams
o	Imipenems
o	Extended spectrum penicillins
o	Vancomycin
o	Fluoroquinolones
o	nitrofurans
101
Q

What drugs are nephrotoxic?

A 
o	Cephalosporins
o	Vancomycin
o	Polymyxin B
o	Bacitracin
o	Aminoglycosides
o	Sulfonamides
102
Q

What drugs are cardiotoxic?

A 
o	Tilmicosin (macrolide)
o	Lincosamides
103
Q

What drugs are neurotoxic?

A

o Polymyxin B
o Lincosamides
o Fluoroquinolones
o metronidazole

104
Q

What drug groups do mostly gram +?

A 
	Older penicillins
	Macrolides
	Glycopeptides (vancomycin)
	Bacitracin
	rifampin
105
Q

What drug groups do mostly Gr - ?

A

 Aminoglycosides
 Fluoroquinolones
 Polymyxin B

106
Q

What drug strictly only does anaerobes?

A

metronidazole

107
Q

What three drug groups are concentration dependent?

A

 Polymyxin B
 Aminoglycosides
 Nucleic acid disruptors (except metronidazole = both)

108
Q

What drug groups are bacteriostatic?

A 
	Tetracyclines
	Macrolides
	Lincosamides
	Phenicols
	Sulfonamides
	Diaminopyramidines
109
Q

What drug can be bacteriostatic or bacteriocidal depending on the bacteria?

A

nitrofurans

110
Q

What two drugs are both time and concetration dependent?

A

vancomycin and metronidazole

111
Q

What two drug groups have PAE?

A

beta lactams and aminoglycosides

112
Q

What three drug groups are inactivated by acid?

A

o Penicillins
o Aminoglycosides
o Macrolides

113
Q

What 5 drug groups do intracellular bacteria?

A 
o	Tetracyclines
o	Macrolides
o	Lincosamides
o	Phenicols
o	Fluoroquinolones
o	diaminopyramidines
114
Q

What are the legal restrictions for antibiotics in FA?

A

o Vancomycin
o Voluntary against aminoglycoside extralabel use
o Chloramphenicol
o rifampin
o Florfenicol – labeled use for FA
o Fluoroquinolones – labeled use only for FA
o Metronidazole
o No extra label use in lactating dairy cattle
o nitrofurans

115
Q

What three drug groups have good extracellular distribution?

A

beta lactams, sulfonamides, aminoglycosides

116
Q

What drug groups have good CNS distribution even without inflammation?

A 
sulfonamides
diaminopyrimidines
metronidazole
rifampin
chloramphenicol
117
Q

What drug groups have deep tissue distribution?

A

diaminos, polymyxin, tetras, macrolides, lincosamides, fluoroquinolones, metronidazole

118
Q

What 6 drug groups get excreted renally unchanged?

A

Blactams, glycopeptides, polymyxin, aminoglycosides, fluoroquinolones, nitrofurantoin, tetracyclines

119
Q

What 5 drug groups can lose efficacy locally because of pus or aerobic/anaerobic conditions?

A

penicillins = pus, acidity, eagle effect
fluoroquinolones, tetracyclines, - cations, excess local
sulfonamides, - PABA analog rich environment
aminoglycosides, - anaerobic
metronidazole - aerobic

120
Q

What two drug groups are P450 inhibitors/substrates?

A

macrolides and chloramphencol

121
Q

What drug is a P450 inducer and PGP inducer?

A

rifampin

UI 607 Antimicrobials (2 decks)

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