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Spring Pharm Block 4 > FR Review 5 - Antibiotics > Flashcards

FR Review 5 - Antibiotics Flashcards

1
Q

What is the most pathogenic Gram neg bacteria?

A

Pseudomonas

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2
Q

What is the most pathogenic Gram pos bacteria?

A

Enterococcus

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3
Q

What was the first abx and what bacteria does it cover?

A

PCN –> covers Gram pos bacteria

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4
Q

What abx treats syphilis and how is it administered?

A

Benzathine LA - Thick suspension given IM in gluteus maximus (painful injection)

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5
Q

PCN remains the drug of choice for what common infection?

A

Strep Throat (Group A Streprococcus)

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6
Q

What drug can be administered for syphilis if a patient has a PCN allergy?

A

doxycycline

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7
Q

List the PCNs used to treat staphylococcus (MSSA) and state how they are administered.

A

IV: Methicillin, Oxacillin, Nafcillin
PO: Cloxacillin, Dicloxacillin

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8
Q

What drugs can be used to treat MRSA and which is most common?

A

Most common: IV Vancomycin
Other: Ceftaroline (only cephalosporin that treats MRSA), PO Bactrim for community acquired MRSA. PO Linezolid for hospital acquired MRSA, topical Mupirocin to decolonize MRSA

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9
Q

What are the two amino penicillins and what is the difference between the two?

A

Ampicillin: low Vd - must be taken on empty stomach
Amoxicillin: high Vd

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10
Q

What infections are covered by amoxicillin?

A

Everything PCN covers other than MSSA plus three Gram neg organisms - E. Coli (UTIs), H. Flu (CAP, otitis media, sinusitis), M. Cat. (sinusitis)

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11
Q

What infections are covered by ampicillin? (2 zebras)

A

Enetrococcus and Listeria (Neonatal Meningitis)

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12
Q

What is the mechanism of action of a beta lactamase inhibitor?

A

Beta lactamase chews up beta lactam abx. Beta lactamase inhibitors keep the abx around longer.

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13
Q

List two combination drugs that have a beta lactamase inhibitor and state how they are administered.

A

Augmentin: Amoxicillin + Clavulanic Acid - PO
Unasyn: Ampicillin + Sulbactam - IV

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14
Q

What two drug classes are highly antigenic and how is this clinically relevant?

A

PCNs and sulfa drugs –> when someone says they have an allergy to these drugs, we believe them.

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15
Q

What is the main difference between PCN and Extended Spectrum PCNs?

A

PCNs cover Gram pos while Extended Spectrum PCNs suck at Gram pos infections but cover Gram neg, including pseudomonas. They are always combined with a beta lactamase inhibitor and are IV only.

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16
Q

List two combination Extended Spectrum PCN and state which is most commonly used.

A

Timentin: Ticarcillin + Clavulonate
Zosyn: Piperacillin + Tazobactam –> most used because it it better at pseudamonas.

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17
Q

How are cephalosporins related to PCNs and what is the clinical significance?

A

Cephalosporins, like PCNs, are beta lactams meaning there can be cross reactivity between the two.

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18
Q

List the drug options for the treatment of pseudomonas (worst gram negative).

A
  1. Extended-spectrum PCNs (IV)
  2. Ceftazidime and Cefepime (IV)
  3. Ciprofloxacin (PO)
  4. All carbapenams except ertepenam
  5. Aminoglycosides (IV) use as adjunct
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19
Q

List two 1st generation cephalosporins and state the use of each.

A

Cefazolin: IV admin to cover MSSA in PCN allergy
Cephalexin: PO cephalosporin

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20
Q

What do 2nd generation cephalosporins cover?

A

Hodge-podge of gram pos and neg.

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21
Q

Name two third generation cephalosporins and state what they cover.

A

ceftriaxone (gonorrhea, meningitis, and late Lyme –> qd dosing) and ceftazidime (covers pseudamonas)

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22
Q

Name a 4th generation cephalosporin and what does it cover?

A

cefepime –> covers pseudamonas

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23
Q

Name a 5th generation cephalosporin and what does it cover?

A

ceftaroline –> covers MRSA

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24
Q

What two drugs are used to treat chlamydia and gonorrhea?

A

ceftriaxone (gonorrhea)

doxycycline (chlamydia)

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25
Q

What is true about the efficacy and coverage of the carbapenams?

A

Atomic bomb only used in severe infections following consultation with ID –> most cover pseudamonas.

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26
Q

What was the first carbapenam and why is it rarely used?

A

Imipenem - the carbapenam that decreases seizure threshold the most.

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27
Q

What is the only carbapenam that doesn’t cover pseudomonas?

A

Ertapenam

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28
Q

What does vancomycin cover and not cover?

A

Very powerful against gram pos - MRSA and enterococcus. Does NOT cover gram neg.

29
Q

What is Red Man’s Syndrome and how is it resolved?

A

Excess HST release when vancomycin is administered too quickly - slow the infusion rate.

30
Q

What infections do the macrolides cover?

A

Hodge-podge of gram pos and gram neg plus the atypicals (legionella, mycoplasma, some chlamydia)

31
Q

List three macrolides and what is unique about each.

A

Erythromycin: must be dosed qid
Clarithromycin: AE is metallic taste
Azithromycin: previously used w/ ceftriaxone to treat chlamydia and gonorrhea (replaced by doxycycline)

32
Q

What drug is known as a Z-Pack and how is it dosed?

A

Azythromycin - 500mg on day 1 and 250mg x 4 days

33
Q

What infections do the tetracyclines cover?

A

Hodge-podge of gram pos and neg plus tickborne diseases (RMSF and Lyme)

34
Q

In what patients should tetracyclines not be used and why?

A

Pregnant females and kids under 8. It will bind Ca and cause teeth yellowing and deformities.

35
Q

Tetracyclines are chelating agents. What does this mean and how is the effect managed?

A

Binds to heavy metals and then will not absorb. Space administration from ingestion of milk, yogurt, multivitamins, etc.

36
Q

What is minocycline used for?

A 
acne - kills the causative bacteria and has anti-inflammatory properties.
Neisseria Meningitidis (meningococcal meningitis)
37
Q

What is the father of the fluoroquinolones, how is it administered, and what are its uses?

A

Ciprofloxacin (PO) - pseudomonas, chlamydia, and anthrax.

38
Q

What are newer fluoroquinolones commonly used for and what do they not cover? Name two newer flouroqiunolones and state what other drug combination may be used to cover the same infection as these drugs.

A

Cover gram pos - especially in community acquired pneumonia (CAP). No coverage of pseudomonas.
Examples: Ofloxacin and Levofloxacin
Other option for CAP: Augmentin plus azithromycin

39
Q

What is a concerning adverse effect of fluorquinolones and what is its black box warning?

A

AE: QT prolongation

Black Box: tendon ruptures

40
Q

In what patients should fluoroquinolones be avoided and why?

A

Pregnant females and children under 18 because of soft tissue malformation.

41
Q

What do fluoroquinolones have in common with tetracyclines?

A

They are chelators - avoid milk, yogurt, multivitamins.

42
Q

What is the brand name of the combo drug Trimethoprim and Sulfamethoxazole.

A

Bactrim

43
Q

What drug in the Bactrim combination is the IV dosing based on?

A

Trimethoprim –> if the order says 500mg bactrim, we pull 500mg trimethoprim from the vial and whatever amount of sulfamethoxazole comes with it is just along for the ride.

44
Q

Describe the mechanism of action of Bactrim.

A

Bacteria activate folate through several steps and use activated folate to make DNA. Both drugs in Bactrim inhibit a different step in the activation of folate.

45
Q

What severe disease can a sulfa allergic rash rapidly progress to and how is it treated?

A

Stevens Johnson Syndrome –> treated by stopping the offending agent then administering steroids.

46
Q

How do you differentiate a Stevens Johnson rash from a typical drug reaction rash?

A

S-J rash affects the mucus membranes where typical drug rashes do not.

47
Q

What bacteria is Bactrim most efficacious against and what disease does this bacteria cause?

A

E. Choli –> UTIs. Typically we prescribe 3-5 days of Bactrim for an uncomplicated UTI. Complicated UTIs get 7-10 days of Bactrim.

48
Q

Describe how Bactrim is useful in HIV patients.

A

Bactrim covers PCP. When an HIV Pt’s CD4 count falls < 200, we prescribe Bactrim prophylaxis against PCP pneumonia.

49
Q

Describe the use of Bactrim and other sulfa drugs in pregnancy.

A

Don’t use sulfa drugs in pregnancy. Sulfa drugs displace bilirubin from albuminin in the fetus causing hyperbilirubinemia, leading to Kernicterus (mental retardation).

50
Q

What is a side effect of sulfa drugs and how do we treat it?

A

Photosensitivity –> use sun block that protects against UVA and UVB rays.

51
Q

What bacteria do metronidazole cover?

A

anaerobes, trichomonas, and giarrhdea (dirty water).

52
Q

Describe the mechanism that prevents people on metranidazole from consuming alcohol.

A

ETOH (via alcohol dehydrogenase) is broken down to Acetal Aldehyde which is then (via Aldehyde Dehydrogenase) broken down into CO2, H2O, and Acetyl CoA. Metranidazole inhibits aldehyde dehydrogenase. Acetyl aldehyde then builds up causing rash, nausea, and vomiting.

53
Q

What bacteria does Clindamycin cover?

A

Gram pos and anaerobes –> no Gram neg coverage

54
Q

What medical specialty loves clindamycin and why?

A

Dentists - used for dental abscesses bc clinda penetrates and covers anaerobes.

55
Q

What abx is most likely to cause of C. Diff and why?

A

Clindamycin - it kills anaerobes (kills normal gut flora)

56
Q

By what route is mupirocin administered and for what condition is it commonly used?

A

Topical only - de-colonize people that are colonized with MRSA. Colonization in nares mostly.

57
Q

What is unique about linezolid’s kinetics and how is this clinically relevant?

A

Near 100% bioavailability when given PO. Essentially the PO version of Vancomycin. May allow for out-patient treatment of hospital acquired MRSA.

58
Q

What are the AEs of linezolid and what is the clinical relevance of each?

A

Thrombocytopenia - must monitor platelets

Weak MAOI - caution when administering with SSRIs

59
Q

What bacteria do aminoglycosides cover?

A

Gram neg including pseudamonas with SOME coverage of enterococcus.

60
Q

How are aminoglycosides typically used in the treatment of pseudamonas?

A

As an add-on agent if you want to double cover for pseudamonas.

61
Q

What are the AEs of aminoglycosides?

A

Nephrotoxicity and Ototoxicity

62
Q

What are the two most commonly used amoniglycosides? What is another aminoglycoside?

A

Gentamicin and Tobramycin - most common

Neomycin - other

63
Q

By what route are amininoglycsides administered and why? Why else is this clinically relevant to their use?

A

IV - very hydrophilic, so not absorbed PO. Also means they have poor CNS and urinary penetration.

64
Q

By what routes are Neomycin available and why only those? What is neomycin used for?

A

Topical: ingredient in Neosporin
PO: used for hepatic encephalopathy and GI infections
Too toxic to be given IV

65
Q

What is the mechanism by which neomycin is used for hepatic encephalopathy?

A

Much of the ammonia (causes hep enceph) that gets in the blood is produced by bacteria in the colon. Neomycin decreases colon bacteria and thereby decreases ammonia production.

66
Q

What is the primary use of rifaximin and what else might it be used to treat?

A

Traveler’s diarrhea caused by E. Coli, Giardia, etc.

May also be used to treat hepatic encephalopathy.

67
Q

What is the primary use of Nitrofurantoin?

A

UTIs - in pregnancy and prophylactically in nursing homes.

68
Q

What is a strange AE of Nitrofurantoin?

A

Long term use can cause pulmonary fibrosis.

Spring Pharm Block 4 (17 decks)

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