ID I: Antibacterials by Drug Class Flashcards
1
Q
Name aminoPCNs
A
amoxicillin (Amoxil); amoxicillin-clavulanate (Augmentin); ampicillin; ampicillin-sulbactam (Unasyn)
2
Q
Coverage of aminoPCNs
A
strep, enterococci, h.flu, neisseria, proteus, e.coli, klebsiella (HNPEK), gm+ anaerobes (mouth flora)
*beta-lactamase inhibitor combo active against MSSA, more resistant HNPEK, B. fragilis (gm- anaerobe)
3
Q
Storage of reconstituted aminoPCNs
A
Refrigerated
4
Q
Common SE of PCNs
A
GI upset, diarrhea, rash, seizures w/accumulation
5
Q
Name natural PCNs
A
penicillin (Pen VK); penicillin G benzathine (Bicillin L-A); pen G benzathine + pen G procaine (Bicillin C-R); penicillin G aqueous (Pfizerpen-G)
6
Q
Coverage of natural PCNs
A
strep, enterococci, gm+ anaerobes (mouth flora)
*increasing resistance to strep pneumo
7
Q
Storage of reconstituted PCNs
A
Refrigerate
8
Q
Counseling PCNs
A
Take on empty stomach
9
Q
MOA of PCNs
A
beta-lactam: inhibit bacterial cell wall synthesis by binding to PBPs to prevent transpeptidation of peptidoglycan synthesis in cell wall
*time-dependent; cidal
10
Q
Name anti-pseudomonal/extended-spectrum PCNs
A
pipercillin-tazobactam (Zosyn); ticarcillin-clavulanate (Timentin)
11
Q
Coverage of anti-pseudomonal/extended-spectrum PCNs
A
strep, MSSA, enterococci, gm+ anaerobes (mouth flora), more resistant HNPEK, citrobacter, acinetobacter, providencia, enterobacter, seratia (CAPES), pseudomonas, gm- anaerobes (b. fragilis)
12
Q
Name anti-staph PCNs
A
nafcillin, oxacillin, dicloxacillin, methacillin
13
Q
Coverage of anti-staph PCNs
A
strep, MSSA
*NO enterococcus or gm- coverage
14
Q
Renal dosing for anti-staph PCNs
A
DOES NOT require renal adjustment
15
Q
MOA of cephalosporins
A
beta lactam: inhibit cell wall synthesis
*time-dependent; cidal
16
Q
Name 1st gen cephalosporins
A
cefadroxil; cefazolin (Ancef); cephalexin (Keflex)
17
Q
Coverage of 1st gen cephalosporins
A
strep, MSSA, proteus, e. coli, klebsiella, gm+ anaerobes (mouth flora)
*preferred for MSSA
18
Q
Renal dosing for PCNs
A
Require dose adjustment
19
Q
Renal dosing for cephalosporins
A
Require dose adjustment
*EXCEPT ceftriaxone
20
Q
Storage of reconstituted cephalosporins
A
Refrigerate
*EXCEPT cefdinir
21
Q
Common SE of cephalosporins
A
GI upset, diarrhea, rash, seizures w/accumulation
22
Q
Name 2nd gen cephalosporins
A
cefaclor (Ceclor); cefprozil (Cefzil); cefuroxime (Ceftin); cefotetan (Cefotan); cefoxitin (Mefoxin)
23
Q
Coverage of 2nd gen cephalosporins
A
1st gen activity + HNPEK
*cefotetan & cefoxitin have activity against gm- anaerobes (b. fragilis)
24
Q
Special counseling w/cefotetan
A
Increased risk of bleeding and N/V w/alcohol ingestion
25
Name 3rd gen cephalosporins - group 1
cefdinir (Omnicef); cefditoren (Spectracef); cefixime (Suprax); cefpodoxime (Vantin); ceftibuten (Cedax); ceftriaxone (Rocephin); cefotaxime (Claforan)
26
Coverage of 3rd gen cephalosporins - group 1
strep (more resistant strep pneumo and strep viridans), MSSA, more resistant HNPEK, gm+ anaerobes (mouth flora)
27
Ceftriaxone pearls
Causes hyperbilirubinemia in neonates; do not use w/ calcium containing IV products
*Does NOT require renal dose adjustment
28
Name 3rd gen cephalosporins - group 2
ceftazidime (Fortaz); ceftazidime-avibactam (Avycaz); ceftolozane-tazobactam (Zerbaxa)
29
Coverage of 3rd gen cephalosporins - group 2
ceftazidime: little gm+ activity, but increased gm- activity, including pseudomonas
Zerbaxa: carbapenem-resistant enterobacteriaceae (CRE)
Zerbaxa & Avycaz: extended coverage of MDR gm- rods (HNPEK, pseudomonas)
30
Name 4th gen cephalosporin
cefepime (Maxipime)
31
Coverage of 4th gen cephalosporin
strep, MSSA, HPNEK, CAPES, pseudomonas
32
Name 5th gen cephalosporin
ceftaroline fosamil (Teflaro)
33
Coverage of 5th gen cephalosporin
strep, MRSA, more resistant HPNEK,
*NO pseudomonas activity
34
Special reconstitution requirements for PCNs
Amp + Unasyn only compatible w/ NS
35
MOA of carbapenems
beta-lactam: inhibits cell wall synthesis
*time-dependent; cidal
36
Name carbapenems
doripenem (Doribax); imipenem-cilastatin (Primaxin); meropenem (Merrem); ertapenem (Invanz)
37
Coverage of carbapenems
BROAD w/ activity against most gm+ and gm-, including ESBLs
* No coverage against MRSA, VRE, c. difficile or steno
* Ertapenem: no activity against pseudomonas, acinetobacter or enterococcus
38
Renal dosing for carbapenems
Require dose adjustment
39
SE of carbapenems
Seizures w/ higher doses or pts w/ renal impairment
40
MOA of monobactams
inhibits cell wall synthesis
* time-dependent
* used when beta-lactam allergy present
41
Name monobactams
aztreonam (Azactam), Cayston (inhaled, for CF pts)
42
Coverage of monobactams
NO gm+; more resistant HPNEK, pseudomonas
43
Renal dosing of monobactams
Require dose adjustment
44
MOA of aminoglycosides (AGs)
inhibit protein synthesis by binding to 30s and 50s ribosomal subunits causing defective cell membrane
*concentration-dependent; exhibit post-antibiotic effect
45
Name AGs
gentamicin; tobramycin (inhaled - TOBI, Bethkis); amikacin; streptomycin
46
BBW for AGs
nephrotoxicity, ototoxicity, neuromuscular blockade, respiratory paralysis
47
Coverage of AGs
Mainly gm-, including pseudomonas
* gent & streptomycin are used for synergy when treating gm+ cocci
* amikacin has broadest spectrum of activity
48
Renal dosing of AGs
Require dose adjustment
49
Monitoring of AGs
Monitor peaks and troughs
*Extended-interval dosing or traditional dosing
50
MOA of quinolones
inhibit DNA topoisomerase IV and DNA gyrase, which prevents supercoiling of DNA and promotes breakage of DNA
*concentration-dependent; cidal
51
Name quinolones
ofloxacin; norfloxacin (Noroxin); ciprofloxacin (Cipro); levofloxacin (Levaquin, Quixin eye drops); gatifloxacin (Zymaxid eye drops); moxifloxacin (Avelox, Vigamox eye drops); gemifloxacin (Factive); finafloxacin (Xtoro ear drops)
52
Coverage of quinolones
BROAD including: gm+, gm- and atypicals
"Respiratory quinolones" = gemi, levo, and moxi - extended coverage of strep pneumo and atypicals
cipro + levo: enhanced gm- coverage, including pseudomonas
moxi: enhanced gm+ and anaerobic coverage
53
BBW for quinolones
Tendon inflammation &/or rupture
54
SE of quinolones
QT prolongation, peripheral neuropathy, CNS effects (seizures, increased ICP), hypo/hyperglycemia, increased LFTs, photosensitivity, GI upset/diarrhea
*Avoid use in children d/t risk of arthropathy
55
Renal dosing of quinolones
Require dose adjustment
56
Storage of reconstituted quinolones
DO NOT refrigerate
57
Counseling with quinolones
Take 2 hours before or 6 hours after taking antacids, vitamins, dairy products, etc.
Photosensitivity
58
Special reconstitution requirements for ertapenem
ONLY with NS
59
Oral to IV conversion for levofloxacin
1:1
60
MOA of macrolides
bind the 50s ribosomal subunit which inhibits RNA-dependent protein synthesis
61
Name the macrolides
azithromycin (Z-Pak, Zithromax, AzaSite eye drops); clarithromycin (Biaxin); erythromycin (EES, EryPed, Erythrocin)
62
SE of macrolides
QT prolongation (highest risk w/ EES), hepatotoxicity, GI upset
63
Coverage of macrolides
atypicals - legionella, chlamydia, mycoplasma; h. flu, mycobacterium
azith: better gm- coverage compared to EES
clarith: better gm+ coverage
64
Storage of reconstituted macrolides
Refrigerate EES suspension w/ sulfisoxazole
DO NOT refrigerate clarithromycin liquid or azithromycin liquid
65
Renal dosing of macrolides
NO dose adjustment for azith or EES
66
MOA of tetracyclines
binds 30s ribosomal subunit, inhibiting protein synthesis
*static
67
Name the tetracyclines
doxycycline (Adoxa, Atridox, Doryx, Monodox, Vibramycin); minocycline (Minocin, Soldyn); tetracycline
68
SE of tetracyclines
photosensitivity, N/V/D, rash
*Avoid use in children
69
Renal dosing of tetracyclines
ONLY tetracycline requires dose adjustment
70
Coverage of tetracyclines
gm+: staph, strep, enterococcus, nocardia, bacillus, propionibacterium
gm-: h. flu, Moraxella, atypicals
other: spirochetes, rickettsiae, bacillus anthracis, treponema pallidum
71
Counseling w/ tetracyclines
Separate from antacids, vitamins or dairy products by 2 hours before or 4 hours after
72
MOA of sulfonamides
interferes w/ folic acid synthesis via inhibition of DHFA formation
*cidal in combo w/ trimethoprim
73
Name sulfonamides
sulfamethoxazole-trimethoprim (Bactrim, Septra, Sulfatrim)
74
Coverage of sulfonamides
gm+: staph (MRSA); decreasing activity against strep pneumo and group A strep
gm-: h. flu, proteus, e. coli, klebsiella, enterobacter, shigella, salmonella, steno
opportunistic pathogens: nocardia, pneumocystis, toxoplasmosis
*No pseudomonas, enterococci, atypical or anaerobic coverage
75
SE of sulfonamides
N/V/D, rash (SJS/TEN), crystalluria, photosensitivity, increase K+, hypoglycemia
*Avoid use in pts w/sulfa allergy, infants
76
Dosing of sulfonamides
Dosed based on trimethoprim component;
| sulfmethoxazole:trimethoprim 5:1
77
Renal dosing of sulfonamides
Require dose adjustment
78
Storage of sulfonamides
DO NOT refrigerate suspension or reconstituted IV
79
Special reconstitution requirements
Compatible ONLY w/ D5W
80
MOA of vancomycin (glycopeptide)
inhibits cell wall synthesis by blocking polymerization by binding to the D-ala-D-ala portion of cell wall precursor
*cidal
81
Brand of vanco
Vancocin
82
Coverage of vanco
staph (MRSA), strep, enterococci, c. difficile
*No VRE activity
83
SE of vanco
Red man syndrome, nephrotoxicity, ototoxicity, myelosuppresion
84
Monitoring w/ vanco
Trough before 4th dose
Target for PNA, endocarditis, osteomyelitis, meningitis, bacteremia: 15-20mcg/mL
Target for other infections: 10-15mcg/mL
85
Renal dosing for vanco
Requires dose adjustment
*NO dose adjustment for po vanco
86
Storage after reconstitution of vanco
Refrigerate
87
MOA of lipoglycopeptides
Inhibit cell wall synthesis by blocking polymerization of peptidoglycan by binding to the D-ala-D-ala portion of the cell wall AND disrupting membrane potential and changing cell permeability d/t presence of lipophilic side chain
*concentration-dependent; cidal
88
Name lipoglycopeptides
telavancin (Vibativ); Oritavancin (Orbactiv); dalbavancin (Dalvance)
89
Coverage of lipoglycopeptides
staph (MRSA), strep, c. difficile
Oritavancin: e. faecalis (NO VRE)
90
SE of telavancin
falsely increase PT/INR, red man syndrome, metallic taste, QT prolongation
91
BBW of telavancin
teratogen, nephrotoxicity, increased mortality vs. vanco in pts w/mod-to-severe renal impairement (CrCl
92
Renal dosing of lipoglycopeptides
Require dose adjustment
93
Special reconstitution requirements of lipoglycopeptides
dalbavancin & oritavancin: compatible ONLY w/ D5W
94
MOA of daptomycin
cyclic lipopeptide that binds to cell membrane and causes rapid depolarization, inhibiting all intracellular replication processes, including protein synthesis
*concentration-dependent; cidal
95
Coverage of daptomycin
staph (MRSA), enterococcus (VRE)
96
Brand name of daptomycin
Cubicin
97
Monitoring of daptomycin
CPK level weekly, muscle pain/weakness
98
Renal dosing of daptomycin
Requires dose adjustment
99
SE of daptomycin
myopathy, N/V/D, falsely increase PT/INR
100
Special PK of daptomycin
DO NOT USE to treat PNA d/t inactivation in the lungs by surfactant
101
MOA of oxazolidinones
bind the 50s ribosomal subunit inhibiting translation and protein synthesis
*static
102
Coverage of oxazolidinones
staph (MRSA), strep, enterococcus (VRE)
103
Name oxazolidinones
linezolid (Zyvox); tedizolid (Sivextro)
104
CI of linezolid
Concurrent use or within 2 weeks of MAOIs
105
SE of oxazolidinones
Peripheral and optic neuropathy, hypoglycemia, serotonin syndrome, HA, N/D
Linezolid: duration-related myelosuppression
106
MOA of streptogramins
binds the 50s ribosomal subunit inhibiting protein synthesis
*cidal
107
Name the (only) streptogramin
quinupristin/dalfopristin (Synercid)
108
Coverage of Synercid
staph (MRSA), enterococcus, (covers VRE e. faecium ONLY)
109
Renal dosing of Synercid
NO adjustment required
110
SE of Synercid
Arthralgias/myalgias, infusion reactions (edema & pain), phlebitis, hyperbilirubinemia, increase CPK levels
111
Special reconstitution requirements of Synercid
Compatible ONLY w/ D5W
112
MOA of polymixins
cationic detergent that damages bacterial cytoplasmic membrane causing leaking of intracellular substances and cell death
*concentration-dependent; cidal
113
Name polymixins
Colistimethate or colistin (ColyMycin); polymixin B
114
Coverage of polymixins
enterobacter, e. coli, klebsiella, pseudomonas
*Used primarily in MDR gm- infections and used in combo d/t increasing resistance
115
Renal dosing of polymixins
Require dose adjustment
116
BBW of polymixin B
dose-dependent nephrotoxicity, neurotoxicity (can cause respiratory paralysis)
117
SE of polymixins
Nephrotoxicity, neurologic disturbances (dizziness, HA, oral parethesia, vertigo)
118
Storage requirements of oxazolidinones
DO NOT refrigerate linezolid
119
Oral to IV linezolid dosing
1:1
120
Oral to IV dosing of doxy & mino
1:1
121
Oral to IV dosing of bactrim
1:1
122
MOA of tigecycline
binds 30s ribosomal subunit inhibiting protein synthesis (related to tetracyclines)
*static
123
Brand name of tigecycline
Tygacil
124
Coverage of tigecycline
staph (MRSA), enterococcus (VRE), anaerobic, atypicals, most gm- except: pseudomona, proteus, and providencia
125
Indications of tigecycline
SSTI, intra-abdominal infections, CAP ONLY when other alternatives aren't possible d/t increased risk of mortality (BBW)
*NOT for use in bacteremia (lipophilic)
126
SE of tigecycline
N/V/D, hepatotoxicity, pancreatitis, photosensitivity
*Avoid use in children
127
MOA of chloramphenicol
reversibly binds 50s ribosomal subunit inhibiting protein synthesis
*cidal
128
Coverage of chloramphenicol
gm+, gm-, anaerobes, atypicals
*Rarely used d/t SE
129
BBW of cholramphenicol
Serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia, granulocytopenia)
130
SE of chloramphenicol
Myelosupression, gray syndrome (circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma and death)
131
Renal dosing of chloramphenicol
NO adjustment required
132
Monitoring of chloramphenicol
CBC at baseline and every 2 days during tx, serum drug concentrations
133
MOA of telithromycin
binds to 50s ribosomal subunit inhibiting protein synthesis
*concentration-dependent; related to macrolides
134
Brand name of telithromycin
Ketek
135
Coverage of telithromycin
strep (including macrolide-resistant strains), some anaerobic, atypical
*Approved for CAP ONLY
136
BBW of telithromycin
Contraindicated in pts w/ myasthenia gravis d/t respiratory failure
137
Renal dosing of telithromycin
Requires dose adjustment
138
SE of telithromycin
Acute hepatic failure, QT prolongation, visual disturbances, N/V/D
139
MOA of lincosamides
reversibly binds to 50s ribosomal subunit inhibiting protein synthesis
*static
140
Name of lincosamides
clindamycin (Cleocin), ClindaMax, Evoclin)
141
Coverage of clindamycin
most aerobic and anaerobic gm+, including some CA-MRSA)
*NO enterococcus activity
142
Renal dosing of clindamycin
DO NOT require adjustment
143
SE of clindamycin
N/V/D, c. difficile-associated colitis (BBW)
144
Storage of clindamycin liquid
DO NOT refrigerate
145
MOA of metronidazole & tinidazole
cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis
*cidal
146
Brand names of metronidazole & tinidazole
metronidazole (Flagyl, MetroGel); tinidazole (Tindamax)
147
Coverage of metro & tinidazole
metronidazole: anaerobes, protozoal infections - effective for bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, c. difficile, intra-abdominal infections
tinidazole: used in giardiasis, amebiasis, trichomoniasis, bacterial vaginosis
148
SE of metro & tinidazole
CNS effects (seizures, aseptic meningitis, encephalopathy), N/V/D, metallic taste
*DO NOT use with alcohol or propylene glycol-containing products during tx or 3 days after
149
Renal dosing of metro & tinidazole
NO adjustment required
150
Oral to IV conversion of metronidazole
1:1
151
Storage of metronidazole liquid
DO NOT refrigerate
152
MOA of fidaxomicin
inhibits RNA polymerase resulting in inhibition of protein synthesis and cell death
*cidal
153
Brand name of fidaxomicin
Dificid
154
Coverage of fidaxomicin
c. difficile
155
SE of fidaxomicin
N/V, abdominal pain, GI bleeding, anemia
156
MOA of rifaximin
inhibits RNA synthesis by binding to bacterial DNA-dependent RNA polymerase
*cidal
157
Brand name of rifaximin
Xifaxan
158
Coverage of rifaximin
e. coli
159
Indications of rifaximin
TD, HE, IBS-D
160
SE of rifaximin
peripheral edema, dizziness, HA, flatulence, N, rash
161
MOA of fosfomycin
inhibits cell wall synthesis by activating the enzyme pyruval transferase
*cidal
162
Brand name of fosfomycin
Monurol
163
Coverage of fosfomycin
e. coli (ESBL), e. faecalis (VRE)
164
SE of fosfomycin
HA, N/D
165
MOA of nitrofurantoin
bacterial cell wall inhibitor
*cidal
166
Brand name of nitrofurantoin
Macrobid, Macrodantin, Furadantin
167
CI of nitrofurantoin
CrCl
168
SE of nitrofurantoin
Brown urine discoloration, GU upset, HA, optic neuritis, hepatotoxicity, hemolytic anemia, peripheral neuropathy, pulmonary toxicity
169
Coverage of nitrofurantoin
e. coli, klebsiella, enterobacter, staph, enterococcus (VRE)
