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pharmacology > first lecture- intro - vanco > Flashcards

first lecture- intro - vanco Flashcards

1
Q

gram positive cocci

A

staph
strep
entero

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2
Q

gram pos anaerobes (two categories)

A

cocci: (found in mouth)
-peptostrep
-pepto
—
bacilli:
-C. diff
-C perfringens

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3
Q

gram neg bacilli

A

enterobacteriaceae i.e. E.coli
Aneaerobes –> bacteroides fragilis
Aerobes–> pseudo

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4
Q

what is a gram neg bacilli anaerobe

A

bacteroides fragillis

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5
Q

atypical pathogens

A

chlamydia
legionella
mycoplasma pneumoiae

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6
Q

If you see pneumonia and something about the A/C unit what bacteria should you think of?

A

legioneres pneumoniae

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7
Q

what is a sample antibiogram used for

A

shows the population in an area what bacteria mainly sensitive/resistant to by percentages

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8
Q

antibiotic sensitivity testing vs E-test for antibiotic MIC

A

e-test: strips have varying levels of conc. as the zone of conc. increases, the zone of inhibition increases too signifying that the drug works for it

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9
Q

Extended spectrum beta lactamases

A

carbapenems can be the last resource since they’re resistant to the beta lactamase– treat for pseudo (THE BIG GUNS)

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10
Q

they share things in common to overcome abx and be resistant/harder to treat—> bad bacteria

A

Klebsiella spp
E. coli
Psudo
Acinetobacter baumannii

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11
Q

explain concentration dependent vs time dependent

A

conc: the higher the drug concentration given, the greater the killer
has Post-antibiotic effect
time: killing extent remains stable at a particular drug conc., goes below MIC –> NO PAE, have to give drug continuously for it to work

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12
Q

what are beta lactam antibiotics (4)

A
  • penicillin
  • cephalosporin
  • carbapenems
  • monobactams
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13
Q

which antibiotics affect the cell wall and are NOT B lactams

A
  • bacitracin
  • vancomycin
  • daptomycin
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14
Q

beta lactamase inhibitors

A

sulbactam –> ampicillin
tazobactam –> pipercillin
clavulanale/clauvinic acid –> amoxicillin

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15
Q

MOA of betalactamase

A

bacteriacidal

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16
Q

what is the drug of choice for syphillis, gas gangrene, and menigococcus

A

Penicillin G

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17
Q

penicillin G has good coverage for gram + cocci and anaerobic activity EXCEPT

A

has NO staph coverage and no bacteroides coverage

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18
Q

Penicillin G important to monitor for what

A

allergic rxn –> anaphylaxis

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19
Q

why be cautious of giving lipid base via what type of administration?

A

IV bc of embolisms

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20
Q

what is the go to aminopenicillin

A

amoxicillin

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21
Q

what drug decreases effectiveness of oral contraceptives? Explain.

A

estrogens half life usually extends with BC preventing you from getting pregnant. but amoxicillin shortens this and you can accidentally become pregnant

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22
Q

which. drug causes abnl prolongation of prothrombin time when pt is on anticoagulants?

A

increase in bleeding on a pt on Warfarin

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23
Q

what drug has side effects of hepatic dysfxn, jaundice C. Diff infxn, Stevens-Johnson syndrom, TEN, nephritis, anemia

A

Aminopenicillins- i.e. amoxicillin

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24
Q

what are are monitoring levels of penicillins

A

renal, hepatic, platelets

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25
Q

what is a beta lactamase

A

it cleaves ring so it cannot bind to PBP –> making body resistant to penicillin

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26
Q

what is the drug of choice when getting bit by a dog/human?

A

apparently clindamycin too (from kahoot)

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27
Q

what is the drug of choice fro skin tissue and diabetic foot

A

aminopencillin WITH beta-lactamase inhibitors such as AUGMENTIN or unasyn

28
Q

which drug is designed solely* to cover S.auerus (MSSA)

A

penicillinase-resistant Penicillins

-nafcillin, oxacillin, dicloxacillin

29
Q

what is the go to tx for MRSA

A

vancomycin

30
Q

aminopencillin WITH beta-lactamase inhibitors such as AUGMENTIN or unasyn cover for

A

MSSA

31
Q

which penicillin has the most BROAD coverage and whats an important thing that will cover

A 
antipseudomonal penicillin
*piperacillin/tazobactam (Zosyn)*
--
psuedo
---
broad so polymicrobial infxn
32
Q

all PNC are ___ dependent killers

A

time

33
Q

what type of betalactam antibiotic is good for cerebrospinal fluid penetration

A

cephalosporins

34
Q

which betalactam does NOT cover for enterococcus

A

cephalosporins

35
Q

which cephalosporins have antipseudomonal activity

A

3rd: ceftazidime (Forfaz), 4th: cefepime (maxipime), and 5th: Ceftolozane/tanzo (zerbaxa)

36
Q

Which ceph is the black sheep and why?

A

ceftazidimine (forfaz); treats for psudomonas but it gains FAST resistance against it so not preferred

37
Q

compare cefepime (maxipime) with piperacillin/tazobactam (Zosyn)

A

both antipseudo

  • zosyn covers anaerobes and enterococci
  • cefepime does NOT cover anaerobes and enterococci
38
Q

which betalactam has mostly renal elimination

A

cephalosporins

39
Q

which drug is gram pos, some gram neg coverage and is mainly given before surgeries to prevent infection

A

1st gen: cefazolin (ancef)

40
Q

what cepholosporin is the go to aka the GOAT that has good strep coverage aka given to pt with fever/sepsis

A

3rd gen: ceftriaxone (rocephin) IV and cefdinir (omnicef) PO

41
Q

what drug would you not give the first 30 days of life

A

3rd gen: ceftriaxone (rocephin

42
Q

what drug would you give to a neonate with fever/sepsis; what gen is this

A

3rd gen: cefotaxime (claforan) IV

43
Q

why is ceftriaxone (rocephin) convenient

A

time dependent drug but long enough half life that just needs to be given once a day
- no need to worry about renal dosing

44
Q

what type of bacteria are gut flora killers

A

anaerobes in gram neg

45
Q

define empiric coverage

A

broad spectrum to narrow once culture results are given to treat infxn

46
Q

what is neutropenic fever and what would you give to treat?

A

4th gen ceph: Cefepime (Maxipime)

- its when pt is immunosuppresssed and cant fight fever on own

47
Q

which cephalosporin covers for MRSA

A

community acquired pneumonia where MRSA develops

48
Q

what does monobactam cover

A

gram neg

  • pseudomonas aeurginosa
  • enterobacteriacea activity
49
Q

all of the carbapenems cover for pseudomonas except

A

ertapenem

50
Q

which medication should be monitored when there is renal failure causing seizures

A

Imipenem

51
Q

what are the most broad spectrum beta lactam

A

carbapenems BIG GUNS

52
Q

which betalactam is resistant to hydrolysis from B lactamase, drug of choice for (ESBL) and MDR

A

carbapenems

53
Q

carbaoebens hace ___ penetration

A

CNS, good for meningitis

54
Q

what is the MOA for vancomycin

A

binds to 2 D-Ala directly on peptide to block cross-linking

difficult to develop a resistance

55
Q

if vancomycin is not a beta lactam abx then it is

A

glycopeptide antibiotic

56
Q

vancomycin is such a large structure so it does not absorb via ____ administration and need to be given ____

A

orally and need to be given IV (systemically)

57
Q

when is the only time vancomycin will be given by mouth

A

when treating for C.diff

58
Q

vancomycin generally covers

A

gram positive

59
Q

vancomycin is given to treat

A 
MRSA
pen allergies infxns
C diff
endocarditis, osteomyelitis 
surgical prophylaxis (allergy)
60
Q

when would you give a low trough vs a high trough of vancomycin

A

depending on the site of infection youd choose a concentration
i.e. IV vanco is systemic so when treating for bacteremia itll go directly into bloodstream so dont need high troughs vs meningitis or pneumonia, it needs higher troughs to penetrate those sites of infxns
—
low trough when the MIC is low,
high mic may need alternative theray

61
Q

loading dose is given when…

A

to rapidly reach target trough

62
Q

whats critical elimination for vancomycin

A

renal clearance

63
Q

vancomycin has high toxicity where thus needs to be monitored?

A

otoxicity

nephrotoxicity

64
Q

what can be a reaction when infusing vancomycin too quickly?

A

Red Man Syndrome

65
Q

what is the trough for vancomycin

A

3-4 doses

pharmacology (2 decks)

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