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HII > First Aid- Antimicrobials > Flashcards

First Aid- Antimicrobials Flashcards

1
Q

Penicillin G, V

A

Prototypical beta lactams

Clinical use: Mostly used for gram positives (s. pneumoniae, s. pyogenes, actinomyces). Also used for gram negative cocci (mainly meningitidis) and spirochetes (mainly T. pallidum). Bactericidal

Mechanism of Resistance: Beta-lactamases, mutations in PBP

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2
Q

Penicillinase-Sensitive Penicillin’s

A

Amoxicillin, ampicillin, aminopenicillins

Clinical use: Same as penicillin, just broader spectrum. HHEELPSS kill enterococci. (E. pylori, H. influenzae, E. Coli, enterococci, Listeria monocytogenes, proteus mirabilis, salmonella, shigella)

Resistance: Penicillinase, a type of beta lactamase

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3
Q

Penicillin-resistant Penicillin

A

Dicloxacillin, nafcillin, oxacillin

Mechanism: Same as penicillin, but a narrow spectrum and penicillinase resistant due to large, bulky R group

Clinical Use: Staphylococcus aureus, except MRSA (use naf for staph)

Resistance: MRSA has an altered penicillin-binding site

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4
Q

Antipseudomonal penicillins

A

Piperacillin (pip-tazo), ticarcillin (ticarcillin-clavulanate)

Mechanism: Same as penicillin, but penicillinase sensitive, so use with beta lactamase inhibitor

Clinical Use: Gram negative coverage, p. aeruginosa, and acinetobacter

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5
Q

1st generation cephalosporins

A

Cefazolin, cephalexin

Mechanism: Beta lactam drugs that are less susceptible to penicillinases

Clinical Use: Gram positive cocci, proteus mirabilis, e. coli, klebsiella pneumoniae (+PECK).

Cephazolin is used before surgery to prevent s. aureus skin infection

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6
Q

2nd Generation Cephalosporins

A

Cefaclor, cefoxitine, cefuroxime, cefotetan (2nd Graders wear fake fox fur to tea parties)

Clinical Use: H. influenzae, Enterobacter aerogenes, Neisseria spp, Serratia marcescens, proteus mirabilis, E. Coli, klebsiella (HENS PEcK)

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7
Q

3rd Generation cephalosporins

A

Ceftriaxone, cefotaxime, cefpodoxime, ceftazidime

Clinical Use: serious gram negative infections infections that are resistant to other beta lactams

Ceftazidime can treat pseudomonas

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8
Q

4th Generation cephalosporins

A

Cefepime

Clinical use: Gram negative organisms, with increased activity against pseudomonas and gram positive organisms

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9
Q

5th Generation cephalosporins

A

Ceftaroline

Clinical Use: Broad gram positive and negative coverage; unlike 1st-4th generation cephalosporins, ceftaroline covers MRSA and enterococcus faecalis. Does not cover pseudomonas

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10
Q

Cephalosporin Adverse Effects

A

Autoimmune hemolytic anemia, disulfiram-like reaction, vitamin K deficiency

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11
Q

Beta-Lactamase Inhibitors

A

Clavulanic Acid, Avibactam, Sulbactam, Tazobactam (CAST)

Amoxicillin-clavulanate, ceftazidime-avibactam, ampicillin-sulbactam, piperacillin-tazobactam (CAST A CAP)

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12
Q

Carbapenems

A

Doripenem, Imipenem, Meropenem, Ertapenem

Mechanism: Bactericidal beta-lactams. Broad spectrum, beta lactamase resistant. Always administered with cilastatin to prevent renal inactivation

Clinical Use: Gram positive cocci; gram negative rods and anaerobes. Wide spectrum and significant side effect limit use to life threatening infections (DIME antibiotics are given when there is a 10/10 [life-threatening] infection

Mechanism of resistance: Carbapenemases

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13
Q

Monobactams

A

Aztreonam

Mechanism of action: Beta lactams

Clinical use: Gram negative rods only. No activity against gram positive rods or anaerobes. Usually non-toxic, so can be used for penicillin-allergic patients and those with renal insufficiency that cannot tolerate aminoglycosides

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14
Q

Vancomycin

A

Inhibits cell wall peptidoglycan formation by binding to the D-Ala-D-Ala portion of the cell wall precursors

Clinical use: Gram positive bugs only. For serious, multidrug resistant organisms, such as MRSA, s. epidermidis, some enterococcus species, and c. diff

Adverse Effects: They are NOT trouble Free (Nephrotoxicity, Ototoxicity, Thrombophlebitis (inflammatory process that causes blood clot), diffuse flushing (red-man syndrome)

Mechanism of Resistance: Changes an alanine to lactate

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15
Q

What are the different protein synthesis inhibitors?

A

30s Inhibitors

  • Aminoglycosides
  • Tetracyclines
  • Tigecycline

50s Inhibitors

  • Chloramphenicol
  • Clindamycin
  • Macrolides
  • Linezolid

Buy ATT 30, CCEL (macrolides, the e is for erythromycin) at 50

All bacteriostatic, except aminoglycosides (bactericidal) and linezolid (variable)

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16
Q

Aminoglycosides

A

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin (Mean [amino acids] GNATS caNNOT kill anaerobes

Clinical Use: Severe gram - rod infections. Synerginistic with beta lactams. Neomycin is used in bowel surgeries

Mechanism: Bactericidal; irreversibly bind the 30s subunit

Adverse Effects: Nephrotoxicity, Neuromuscular blockade, Ototoxicity, Teratogenicity

17
Q

Tetracyclines

A

Tetracycline, doxycycline, minocycline

Clinical Use: Mycoplasma pneumoniae, borrelia burgdorferi. Chlamydia and Rickettsia, due to it’s ability to accumulate intracellularly. Community acquired MRSA

18
Q

Tigecycline

A

Clinical use: Broad gram negative and positive coverage. MRSA, VRA and other multi-drug resistant organisms. Infections that require deep tissue penetration

19
Q

Chloramphenicol

A

Clinical Use: Meningitis (caused by haemophilus influenzae, neisseria meningitidis, streptococcus pneumoniae) and rickettsial diseases (e.g., Rocky Mountain spotted fever)

Adverse Effects: Anemia

Mechanism of Resistance: Plasmid-encoded acetyltransferase inactivates the drug

20
Q

Clindamycin

A

Clinical Use: Anaerobic infections (ex: Bacteroides spp, clostridium pefringes) in aspiration pneumonia, lung abscess, oral infections. Also effective against invasive group A streptococcal infection

Adverse effects: C. diff, fever, diarrhea

Note: It treats anaerobic infections above the diaphragm, while metronidazole treats anaerobic infections below the diaphragm.

21
Q

Linezolid

A

Clinical Use: Gram positive species, including MRSA and VRE

Adverse effects: serotonin syndrome, peripheral neuropathy, bone marrow suppression

22
Q

Macrolides

A

Azithromycin, clarithromycin, erythromycin

Clinical Use: Atypical pneumonias (mycoplasma, chlamydia, legionella), STI (chlamydia), gram positive cocci (streptococcal infections in patients allergic to penicillin)

Adverse Effects: MACRO (Motility issues, arrhythmia, cholestatic hepatitis, rash, eOsinophilia)

23
Q

Polymixins

A

Colistin (Polymixin E), polymyxin B

Mechanism: Cation polypeptides bind to the phospholipids on the cell membrane of gram negative bacteria, disrupting the membrane

Clinical Use: Salvage therapy for multi-drug resistant gran negative bacteria (P. aeruginosa, e. coli, k. pneumoniae). Part of neosporin/topical triple antibiotic treatments

Adverse Effects: Nephrotoxicity, neurotoxicity

24
Q

Antimycobacterial therapy

A

M. tuberculosis–> Rifampin, Isoniazid, pyrazinamide, ethambutol (RIPE for treatment)

25
Q

Rifamycins

A

Rifampin, rifabutin

Mechanism of action: Inhibits DNA dependent RNA polymerase

Clinical Use: Mycobacterium tuberculosis;

Adverse effects: Minor hepatotoxicity

26
Q

Isoniazid

A

Mechanism of Action: Inhibits synthesis of mycolic acid, part of the cell wall of mycobacteria

Clinical Use: Both a m. tuberculosis prophylactic and treatment

Adverse effects: INH- Injures Neurons and Hepatocytes.

27
Q

Pyrazinamide

A

Mechanism: unknown

Clinical Use: M. tuberculosis

28
Q

Ethambutol

A

Mechanism: Inhibits the carbohydrate polymerization of mycobacterium by blocking arabinotransferase

Clinical Use: Mycobacterium tuberculosis

29
Q

Streptomycin

A

Mechanism: Aminoglycoside, inhibiting the 30s subunit

Clinical Use: m. tuberculosis

30
Q

Sulfonamides

A

Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine

Mechanism: Inhibits folate synthesis. Bacteriostatic, but bactericidal when combined with trimethoprim

Clinical Use: Gram positive, gram negative, nocardia. SMX-TMP for simple UTI

31
Q

Trimethoprim

A

Inhibits dihydrofolate reductase. Bacteriostatic

Clinical Use: Used with sulfamethoxazole to cause sequential block of folate synthesis. This combination is used for UTI’s, shigella and salmonella

32
Q

Fluoroquinolones

A

Ciprofloxacin, enoxacin, norfloxacin, ofloxacin;

Respiratory fluoroquinolones: Gemifloxacin, levofloxacin, moxifloxacin

Mechanism: Inhibits DNA gyrase and topoisomerase IV. Bactericidal

Clinical Use: Gram negative rods of urinary and GI tract (including pseudomonas). Must not be taken with antacids

33
Q

Daptomycin

A

Mechanism: Lipopeptide that disrupts cell membranes of gram positive cocci by creating transmembrane channels

Clinical Use: S. aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE. NOT used for pneumonia. Daptomyskin is used for skin infections

34
Q

Metronidazole

A

Mechanism: Forms toxic free radicals in bacterial cells that damage the DNA

Clinical Use: Giardia, entamoeba, trichomonas, gardnerella vaginalis, anaerobes (Bacteroides, c.difficle) Can be used to treat h. pylori instead of amoxicillin in case of penicillin allergy. GET GAP

HII (7 decks)

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