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NAPLEX > ID: Antibiotic Classes > Flashcards

ID: Antibiotic Classes Flashcards

1
Q

B-Lactam MoA/Info

A
  • MoA: Inhibit cell wall synthesis by binding to PBPs and inhibiting final step of peptidoglycan synthesis
  • TIME-dependent (extend inf. times, esp. ES-cillins)
  • Avoid if PCN/B-lactam allergy present
  • Caution if pt is a seizure risk
  • Probenecid increases B-lactam levels
  • *Includes PCN/Cephalosporins/Carbapenems**
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2
Q

B-Lactam Med Notes

A
  • NEVER give Bicillin IV => death
  • Nafcillin is a vesicant, give with central line
  • Ampicillin is diluted in NS ONLY
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3
Q

Cephalosporin Drug Notes

A
  • PO options only in Group 1 third generation and earlier (rest are IV)
  • Ceftin (cefuroxime) comes in IV, IM, and PO
  • CefOtetan and CefOxitin have anaerObic activity (B. fragilis)
  • Ceftriaxone is only med that DOESN’T need renal dose adjustment
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4
Q

Carbapenem Information

A
  • Used for ESBL-producing organisms and Pseudomonas
  • Avoid in B-lactam allergies
  • Caution in seizure risk pts (esp. renal failure)
  • ALL are IV
  • DON’T cover atypicals, MRSA, VRE
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5
Q

Carbapenem Med Information

A
  • ErtAPpenem doesn’t cover PEA: pseudomonas, enterococcus, actinobacter
  • Ertapenem is NS stable only
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6
Q

Aztreonam

A
  • IV only
  • Monobactam
  • Can be used in pts with B-lactam allergy
  • G”-“ coverage including pseudomonas
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7
Q

Aminoglycoside MoA/Info

A
  • MoA: bind to ribosome and interfere with bacterial protein synthesis (leads to defective cell membrane)
  • Cover G”-“ organisms including pseudomonas, synergy for G”+”
  • Traditional and Extended-interval dosing ([higher] given Q24H)
  • Renal and ototoxicity
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8
Q

Traditional vs Extended-Interval

A
  • Traditional: peaks and troughs (<2 mcg/mL), given q8H

- Extended-interval: random intervals/nomograms (On line? go up level), less accumulation/nephrotoxic risk/cost

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9
Q

Quinolones MoA/Information

A
  • MoA: inhibit DNA topoisomerase and DNA gyrase which prevents bacterial DNA coiling (breaks)
  • Boxed warning: tendon rupture!, peripheral neuropathy, use LAST LINE
  • Warning: QT prolongation (avoid mult. prolonging drugs), psychiatric disturbance, photosensitivity
  • DON’T use in kids (effects bones/teeth/etc)
  • Chelates with divalent cations (iron/calcium/etc)
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10
Q

Quinolone Med Info

A
  • Respiratory Quinolones: Moxifloxacin, gemifloxacin, levofloxacin (“my good lungs,” activity against S pneumonia)
  • Moxifloxacin ISN’T renally adjusted; therefore, don’t use for UTIs
  • Antipseudomonals: Levofloxacin, Ciprofloxacin
  • IV:PO 1:1 => moxi and levo
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11
Q

Macrolide MoA/Info

A
  • MoA: binds to 50s ribosome and inhibits RNA-dependent protein synthesis
  • GREAT atypical coverage
  • Important brand/generic drugs to know, all top sellers (Zithromax, Biaxin, E.E.S.)
  • Commonly used for CAP, strep throat, and some others (diff. slide)
  • QT prolongation!
  • Clarithromycin and erythromycin are STRONG CYP3A4i (CI with sim/lovastatin)
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12
Q

Macrolide Med Info

A
  • Azithromycin uses: STIs (chlamydia, gonorrhea), MAC prophylaxis
  • Clarithromycin uses: H. pylori
  • Erythromycin uses: increases gastric mobility
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13
Q

Tetracyclines MoA/Info

A
  • MoA: binds reversibly with 30s ribosome unit
  • Covers CA-MRSA, Rickettsiae disease, STIs, VRE, acne (common use)
  • Know brand names: Vibramycin, Minocin, Solodyn
  • Safety issues: avoid in kids <8 yo (bone/muscle development), photosensitivity, divalent interactions
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14
Q

Tetracycline Med Info

A
  • Doxycycline uses: tick-borne disease, CAP, chlamydia, gonorrhea
  • Doxycycline and minocycline are IV:PO 1:1
  • Minocycline is a DILE risk
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15
Q

Sulfonamide MoA/Med/Info

A
  • MoA: inhibits part of folic acid pathway to stop bacterial folic acid synthesis
  • Main drug: Bactrim (SMX/TMP) - dose based on TMP (5:1 SMX:TMP)
  • Do not use with sulfa allergy
  • Not safe in preggo/BF
  • SJS/TEN risk
  • Don’t use in G6PD deficiency (hemolytic anemia - “+” Coombs)
  • Elevates INR when used with warfarin (inhibitor)
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16
Q

Oral Refrigerated Abx

A

After reconstitution:

  • Penicillin VK
  • Ampicillin
  • Augmentin
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17
Q

Abx to NOT Refrigerate

A
  • Cefdinir (oral)
  • Metronidazole
  • Moxifloxacin
  • Bactrim
18
Q

Abx w/o Renal Adjustments

A
  • Antistaph. penicillins**
  • Ceftriaxone**
  • Clindamycin**
  • Doxycycline
  • Macrolides (azith and erythromycin only)
  • Metronidazole
  • Moxifloxacin**
  • Linezolid**
19
Q

Empty Stomach Abx

A
  • Ampicillin (oral soln/capsules)
  • Cefibuten susp
  • Levofloxacin oral soln
  • Penicillin VK
  • Rifampin
  • Isoniazid
  • Itraconazole soln
  • Voriconazole
20
Q

1:1 IV:PO Abx

A
  • Levofloxacin (also moxi)
  • Doxy and minocycline
  • Linezolid
  • Metronidazole
  • Bactrim
21
Q

Light Protection during Admin Abx

A
  • Doxycycline

- Micafungin

22
Q

Dextrose only Abx

A
  • Synercid
  • Bactrim
  • Amphotericin B
23
Q

NS Only Abx

A
  • Ampicillin
  • Ampicillin/Sulbactam
  • Ertapenem
  • Daptomycin (RF - water for reconstitution)
24
Q

NS/LR Only Abx

A
  • Caspofungin

- Daptomycin

25
Q

Vancomycin MoA/Info

A
  • MoA: inhibits cell wall synthesis by binding to d-alanine-d-alanine
  • PO: covers C.diff only, QID x 10d
  • 1st line choice for MRSA
  • IV dose: 15-20 mg/kg Q8-12H, TBW!
  • Causes nephro/ototoxicity (adjust for renal failure)
  • Red Man Syndrome: slow inf. rate
  • Don’t use if MIC >= 2
26
Q

Lipoglycopeptides MoA/Info

A
  • Similar MoA and coverage to vanco
  • Approved for skin infections
  • All meds end in “-vancin”
  • All cause red man syndrome
27
Q

Lipoglycopeptide Med Info

A
  • Telavancin approved for HAP/VAP
  • Orita and dalbavancin are single-dose regimens
  • Telavancin warnings: fetal and kidney risk, avoid if CrCl =< 50
  • Don’t use telavancin with UFH or oritavancin w/in 5d of UFH use (related to effects on aPTT/PT/INR)
  • Tela: increases aPTT/PT/INR
  • Orita: increases PT/INR (acute) and aPTT (more chronically, 120 hours)9
28
Q

Daptomycin MoA/Info

A
  • MoA: binds to cell membrane and causes rapid depolarization and inhibits intracellular replication process
  • Brand names: Cubicin +/- RF
  • Similar activity to Vanco: minus C.diff and PLUS VRE
  • Do NOT use for pneumonia (inactivated lung surfactant)
  • Warning: myopathy/rhabdo
  • Compatible with NS or LR (NO dextrose)
29
Q

Oxazolidinones MoA/Info

A
  • MoA: Binds to 50s ribosome to inhibit translation/protein synthesis
  • Coverage similar to vanco + VRE
  • Linezolid (Zyvox) is approved for more indications and is 1:1 IV:PO
  • No MAOi use w/in 14 days (avoid methylene blue and other serotonergic drugs)
  • Myelosuppression and optic neuropathy risk
  • Avoid tyramine-containing foods
30
Q

Synercid MoA/Info

A
  • Quinupristin/Dalfopristin
  • MoA: streptogramin that binds to 50s ribosome to inhibit protein synthesis
  • Poorly tolerated: arthralgias/myalgias, infusion rxns, hyperbilirubiemia
  • D5W compatible ONLY
  • Phlebitis risk => central line only
31
Q

Tigecycline MoA/Info

A
  • MoA: glycylcycline binds to to 30s unit to inhibit protein synthesis (similar to tetracyclines)
  • Covers almost everything’
  • Don’t use in bloodstream infections
  • No activity against “3 Ps:” Proteus, pseudomonas, providencia
  • Yellow-orange color
32
Q

Polymixin Info

A
  • Main meds: polymixin B or colistin (colisimethate sodium)
  • Broad spectrum coverage
  • Complicated dosing
  • Toxicity: nephrotoxicity, neurotoxicity
33
Q

Chloramphenicol

A
  • Broad spectrum coverage
  • Risk for gray syndrome
  • Many blood dyscrasias
34
Q

Cleocin

A
  • Clindamycin
  • MoA: lincosamide that binds to 50s and inhibits protein synthesis
  • Covers anaerobes! and some staph/strep
  • No renal dose adjustment!
  • D-test (positive means don’t take it)
35
Q

Flagyl

A
  • Metronidazole
  • Anaerobic and protozoal infections coverage
  • IV:PO 1:1
  • CI: disulfiram rxn with alcohol, avoid in preggo (esp. 1st trimester)
  • Increases INR (2C9 inhibitor)
36
Q

Dificid

A
  • First-line treatment for C.diff now

- PO only

37
Q

Rifaximin

A
  • Treats E.coli
  • Used for traveler’s diarrhea and IBS with diarrhea
  • Less than 1% absorption
38
Q

Nitrofurantoin

A
  • MacroBID: BID
  • Macrodantin: QID
  • Drug of choice for uncomplicated UTI
  • Avoid w/ G6PD deficiency (hemolytic anemia, Coombs +)
  • Take with food
  • Discolors urine as brown
39
Q

Fosfomycin

A
  • Used for E.Coli, including ESBL and E.faecalis (including VRE)
  • Single-dose regimen
40
Q

Bactroban

A
  • Mupirocin
  • Topical
  • Used to eliminate MRSA in nares
  • Single use tubes, 5d therapy

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