Fiser.06.Antibiotics Flashcards
1
Q
What does an antiseptic do?
A
kills and inhibits organisms in the body
2
Q
what does a disinfectant do?
A
kills & inhibits organisms on inanimate objects
3
Q
what does sterilization do?
A
kill all organisms
4
Q
what does betadine (iodophor) kill and not kill?
A
good for GPCs / GNRs; bad for fungi
5
Q
what does chlorhexidine (Hibiclens) kill?
A
good for GPCs, GNRs, and fungi
6
Q
what is the MOA of penicillin?
A
inhibits cell wall synthesis
7
Q
what is the MOA of cephalosporins?
A
inhibits cell wall synthesis
8
Q
what is the MOA of carbapenems?
A
inhibits cell wall synthesis
9
Q
what is the MOA of monobactams?
A
inhibit cell wall synthesis
10
Q
what is the MOA of vancomycin?
A
inhibits cell wall synthesis
11
Q
what is the MOA of tetracycline?
A
inhibits 30S ribosome and protein synthesis
12
Q
what is the MOA of aminoglycosides? (tobramycin / gentamicin)
A
inhibits 30S ribosome and protein synthesis
13
Q
what is the MOA of linezolid?
A
inhibits 30S ribosome and protein synthesis
14
Q
what is the MOA of erythromycin?
A
inhibits 50S ribosome = reduced protein synthesis
15
Q
what is the MOA of clindamycin
A
inhibits 50S ribosome = reduced protein synthesis
16
Q
what is the MOA of Synercid (dalfopristin / quinupristin)
A
inhibits 50S ribosome = reduced protein synthesis
17
Q
what is the MOA of quinolones?
A
inhibits DNA helicase (DNA gyrase)
18
Q
what is the MOA of rifampin?
A
inhibits RNA polymerase
19
Q
what is the MOA of flagyl?
A
produces O2 radicals –> DNA breaks
20
Q
what is the MOA of sulfonamides?
A
PABA analogue (para-aminobenzoic acid) = reduced purine synthesis
21
Q
what is the MOA of trimethoprim?
A
inhibits dihydrofolate reductase = reduced purine synthesis
22
Q
what is the difference between bacteriostatic and bactericidal antibiotics?
A
bactericidal abx kill bacteria directly. Bacteriostatic abx stop bax from growing
23
Q
is tetracycline bacteriostatic or bactiricidal?
A
bacteriostatic
24
Q
is clindamycin bacteriostatic or bactericidal?
A
bacteriostatic
25
is erythromycin bacteriostatic or bactericidal? why?
bacteriostatic b/c it has reversible ribosomal binding
26
is Bactrim bacteriostatic or bactericidal?
bacteriostatic
27
are aminoglycosides bacteriostatic or bactericidal? why?
bacteriocidal b/c irreversible ribosomal binding
28
what enzyme is expressed in penicillin-resistant bacteria?
beta lactamase
29
what is the MC mechanism of abx resistance?
transfer of plasmids
30
what is the MOA of resistance in MRSA
mutation of cell wall binding protein
31
what is the mechanism of resistance of VRE?
mutation in a cell wall binding protein
32
what is the mechanism of resistance to gentamicin?
modified enzymes = reduced active transport of gentamicin into bacteria
33
what are the appropriate peak and trough levels of vancomycin?
peak: 20-40 ug/mL
trough: 5-10 ug/mL
34
what are the peak and trough levels for gentamicin?
peak: 6-10 ug/mL
trough: <1ug/mL
35
what is the dosing modification for an abx peak being too high?
decrease the amount of each dose
36
what is the dosing modification for an abx trough being too high?
reduce frequency of doses, which will increase the time between doses
37
name six bugs covered by PCN
strep (GPCs); syphilis; neisseria meningitides (GPRs); clostridium perfringens (GPRs); beta hemolytic strep; anthrax
38
what two GPCs are PCN ineffective against?
staphylococcus & enterococcus
39
what GPCs are oxacillin & nafcillin effective against?
anti-staph
40
what bax are ampicillin & amoxicillin effective against? (7)
same as PCN + enterococcus:
| strep; syphilis; neisseria meningitides; clostridium perfringens; beta hemolytic strep; anthrax
41
what is covered by Unasyn (ampicillin/sublacatam) & Augmentin (amoxicillin / clavulanate)
Broad Spectrum - GPCs (staph/strep/enterococcus);
GNRs;
+/- anaerobic coverage
42
What are 3 bugs are Unasyn (ampicillin/sublactam)/ Augmentin(amoxicillin/clavulanate) ineffective against?
pseudomonas;
acinetobacter;
serratia
43
What is the MOA of sublactam
beta lactamase inhibitor
44
what is the MOA of clavulanic acid?
beta lactamase inhibitor
45
what are four bugs are ticarcillin & piperacillin effective against?
pseudomonas (anti-pseudomonal PCN);
enterics;
acinetobacter;
serratia
46
what are two adverse effects of ticarcillin & piperacillin
inhibits platelets; high salt load
47
what is the generic name of Timentin?
ticarcillin / clavulanic acid
48
what is the generic name for Unasyn?
ampicillin / sublactam
49
What is the generic name for Augmentin?
amoxicillin / clavulanate
50
What is the generic name for Zosyn?
piperacillin / tazobactam
51
what is covered by Timentin or Zosyn?
Broad Spectrum:
GPCs: Staph / Strep / Enterococcus;
GNRs: enterics, pseudomonas, acinetobacter, serratia;
anaerobes
52
Name two adverse effects of Timentin / Zosyn
inhibit platelets; high salt load
53
How frequent is Zosyn dosing?
qid (q6hr)
54
Name two first generation cephalosporins
cefazolin (Ancef); cephalexin (Keflex)
55
what do first-generation cephalosporins cover?
GPCs (staph and strep)
56
What bacteria is first-generation cephalosporins ineffective against?
enterococcus
57
what body cavity is not penetrated by first-generation cephalosporins?
does not penetrate CNS
58
which first-generation cephalosporin has the longest T1/2 & is best for prophylaxis?
Ancef (cefazolin)
59
Name 3 second-generations cephalosporins
cefoxitin (Mefoxin);
cefotetan (Apatef / Cefotan);
cefuroxime (Ceftin / Zinacef)
60
Which covers staph better, first or second-generation cephalosporins?
first-generation cephalosporins have better staph coverage
61
What do second-generation cephalosporins cover?
GPCs, GNR, +/- anaerobic coverage
62
What are second-generation cephalosporins ineffective against? (4)
enterococcus; pseudomonas; acinetobacter; serratia
63
are second-generation cephalosporins effective against community-acquired or nosocomial GNRs?
only against community-acquired GNRs
64
Which second-generation cephalosporins have the longest T1/2 and are the best for prophylaxis?
cefotetan
65
Name 4 third-generation cephalosporins
ceftriaxone (Rocephin); ceftazidime (Fortaz/Tazicef);
| cefepime (Maxipime); cefotaxime (Claforan)
66
What are third-generation cephalosporins effective against?
Mostly GNRs +/- anaerobic coverage; Pseudomonas, Acinetobacter, Serratia (all GNRs)
67
What one bacteria are third-generation cephalosporins ineffective against?
Enterococcus
68
Name two adverse effects of third generation cephalosporins
cholestatic jaundice; gallbladder sludge (CTX)
69
What is covered by aztreonam (Monobactam)?
GNRs: pseudomonas, acinetobacter, serratia
70
Name two carbapenems
meropenem, imipenem
71
What drugs are carbapenems paired with and why?
cilastatin - prevents renal hydrolysis of the drug, thereby increasing T1/2 of the abx
72
What do carbapenems cover?
Broad Spectrum: GPCs, GNRs, anaerobes
73
What three bugs are carbapenems ineffective against?
MEP: MRSA, Enterococcus, Proteus
74
Name 1 adverse effect of carbapenems
seizures
75
What does Bactrim cover?
GNRs +/- GPCs
76
What four bugs are Bactrim ineffective against?
Enterococcus; Pseudomonas; Acinetobacter; Serratia
77
Name 4 adverse effects of Bactrim
teratogenic; allergic reactions (sulfa);
| renal damage; Steven-Johnson Syndrome (erythema multiforme)
78
What is the adverse effect of Bactrim in G6PD-deficient patients?
hemolysis
79
Name three quinolones
ciprofloxacin; levofloxacin; norfloxacin
80
What do quinolones cover?
Some GPCs, mostly GNRs (pseudomonas, acinetobacter, Serratia)
81
What bacteria are quinolones ineffective against?
Enterococcus
82
What percent of MRSA are sensitive to quinolones?
40%
83
Which version of quinolones are more effective: PO or IV?
both are equally effective
84
How frequently is ciprofloxacin dosed?
BID
85
How frequently is levofloxacin (Levaquin) dosed?
qdaily
86
name two aminoglycosides
gentamicin, tobramycin
87
What do aminoglycosides cover?
GNRs, good for pseudomonas, acinetobacter, serratia
88
What bax are aminoglycosides ineffective against and why?
ineffective against anaerobes because need O2 to function
89
What is the mechanism of resistance of aminoglycosides?
resistance 2/2 modifying enzymes: cause reduced active transport of antibiotics
90
What drug should you add to aminoglycosides to treat enterococcus?
aminoglycosides are synergistic with ampicillin
91
why are beta lactams (ampicillin / amoxicillin) synergistic with aminoglycosides
facilitate aminoglycoside penetration
92
name two adverse effects of aminoglycosides (differentiate between reversible and irreversible side effects)
reversible nephrotoxicity; irreversible ototoxicity
93
name 1 macrolide
erythromycin
94
what does erythromycin cover?
GPCs
95
what two infectious diseases is erythromycin best for treating?
community-acquired PNA, atypical PNA
96
which abx act as a prokinetic or the bowel and how?
erythromycin binds to the motility receptor
97
name 1 adverse effect of PO erythromycin
nausea
98
name 1 adverse effect of IV erythromycin
cholestasis
99
name 1 glycopeptide antibiotics
vancomycin
100
name the class of bax and three specific spp covered by vancomycin
GPCs:
| enterococcus; C dif (PO only); MRSA
101
what is the MOA of vancomycin?
binds cell wall proteins
102
what is the mechanism of resistance of vancomycin
change in cell wall binding protein
103
name four adverse effects of vancomycin
HTN; red man syndrome 2/2 histamine release;
nephrotoxicity;
ototoxicity
104
what is the generic name of Synercid?
quinupristin/dalfopristin
105
what class of bax and 2 spp does synercid cover?
GPCs: MRSA, VRE
106
name 1 oxazolidinone abx
linezolid (Zyvox)
107
What class of bax and 2 spp. does Linezolid cover?
GPCs: MRSA, VRE
108
What two classes of bax are covered by clindamycin?
anaerobes, some GPCs
109
name 1 AE of tetracycline
tooth discoloration in children
110
what two classes of bax and two spp are covered by tetracycline?
GPCs, GNRs, syphilis, Clostridium perfringens
111
what 1 infection is clindamycin particularly good for?
aspiration PNA
112
name 1 AE of clindamycin
pseudomemranous colitis
113
what class of bax is covered by Flagyl (metronidazole)
anaerobes
114
name 2 adverse effects of Flagyl
disulfiram-like reaction; peripheral neuropathy with long-term use
115
what is the MOA of amphotericin?
bind sterols in the wall; alter membrane permeability
116
name 5 AEs of amphotericin
nephrotoxicity; fever; hypokalemia; hypotension; anemia
117
does the liposomal formulation of amphotericin have more or fewer side effects?
liposomal type has fewer AEs
118
what is the MOA for voriconazole / itraconazole?
inhibit ergosterol synthesis which is needed for the cell membrane
119
what is the MOA of anidulafungin (Eraxis)?
inhibits synthesis of cell wall glucan
120
what antifungal should you add for a patient with prolonged fever on BS abx
itraconazole
121
what is the antifungal for invasive aspergillosis?
voriconazole
122
what is the antifungal used for candidemia
anidulafungin (Eraxis)
123
what is the tx for fungal sepsis other than candida and aspergillosis?
liposomal amphotericin
124
name the four drugs used to tx TB
isoniazid, rifamipin, pyrazinamide, ethambutol
125
what is the MOA of isoniazid and what drug does it need to be co-administered with?
inhibits mycolic acid, needs to be administered with pyridoxine
126
name two AEs of isoniazid
B6 deficiency; hepatotoxicity
127
what is the MOA of rifampin
inhibits RNA polymerase
128
name 3 AES of rifampin
hepatotoxicity; GI sx; high rates of resistance
129
name 1 AE of pyrazinamide
hepatotoxicity
130
name 1 AE of ethambutol
retrobulbar neuritis
131
what is the MOA of acyclovir?
inhibits viral DNA-polymerase
132
what does acyclovir treat? (2)
HSV, EBV
133
what is the MOA of ganciclovir?
inhibits viral DNA polymerase
134
what does ganciclovir treat?
CMV
135
name 2 AEs of ganciclovir
bone marrow suppression; CNS toxicity
136
what abx can lead to superinfection?
broad spectrum abx
137
name 6 abx effective against enterococcus
vancomycin; timentin; zosyn; ampicillin; amoxicillin; ampicillin + gentamicin
138
name 6 classes of abx effective against pseudomonas, acinetobacter, and serratia
ticarcillin/piperacillin; timetin/zosyn; third generation cephalosporins; aminoglycosides (gentamicin/tobramycin); meropenem / imipenem; fluoroquinolones
139
Which bug requires double coverage?
pseudomonas
140
why are perioperative abx administered?
to prevent SSI
141
when do perioperative abx need to be administered relative to the incision?
within 1 hour prior to incision
