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NAPLEX > ID I: Antibacterials by Drug Class > Flashcards

ID I: Antibacterials by Drug Class Flashcards

1
Q

Name aminoPCNs

A

amoxicillin (Amoxil); amoxicillin-clavulanate (Augmentin); ampicillin; ampicillin-sulbactam (Unasyn)

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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)

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3
Q

Storage of reconstituted aminoPCNs

A

Refrigerated

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4
Q

Common SE of PCNs

A

GI upset, diarrhea, rash, seizures w/accumulation

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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)

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6
Q

Coverage of natural PCNs

A

strep, enterococci, gm+ anaerobes (mouth flora)

*increasing resistance to strep pneumo

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7
Q

Storage of reconstituted PCNs

A

Refrigerate

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8
Q

Counseling PCNs

A

Take on empty stomach

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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

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10
Q

Name anti-pseudomonal/extended-spectrum PCNs

A

pipercillin-tazobactam (Zosyn); ticarcillin-clavulanate (Timentin)

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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)

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12
Q

Name anti-staph PCNs

A

nafcillin, oxacillin, dicloxacillin, methacillin

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13
Q

Coverage of anti-staph PCNs

A

strep, MSSA

*NO enterococcus or gm- coverage

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14
Q

Renal dosing for anti-staph PCNs

A

DOES NOT require renal adjustment

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15
Q

MOA of cephalosporins

A

beta lactam: inhibit cell wall synthesis

*time-dependent; cidal

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16
Q

Name 1st gen cephalosporins

A

cefadroxil; cefazolin (Ancef); cephalexin (Keflex)

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17
Q

Coverage of 1st gen cephalosporins

A

strep, MSSA, proteus, e. coli, klebsiella, gm+ anaerobes (mouth flora)

*preferred for MSSA

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18
Q

Renal dosing for PCNs

A

Require dose adjustment

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19
Q

Renal dosing for cephalosporins

A

Require dose adjustment

*EXCEPT ceftriaxone

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20
Q

Storage of reconstituted cephalosporins

A

Refrigerate

*EXCEPT cefdinir

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21
Q

Common SE of cephalosporins

A

GI upset, diarrhea, rash, seizures w/accumulation

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22
Q

Name 2nd gen cephalosporins

A

cefaclor (Ceclor); cefprozil (Cefzil); cefuroxime (Ceftin); cefotetan (Cefotan); cefoxitin (Mefoxin)

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23
Q

Coverage of 2nd gen cephalosporins

A

1st gen activity + HNPEK

*cefotetan & cefoxitin have activity against gm- anaerobes (b. fragilis)

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24
Q

Special counseling w/cefotetan

A

Increased risk of bleeding and N/V w/alcohol ingestion

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25
Q

Name 3rd gen cephalosporins - group 1

A

cefdinir (Omnicef); cefditoren (Spectracef); cefixime (Suprax); cefpodoxime (Vantin); ceftibuten (Cedax); ceftriaxone (Rocephin); cefotaxime (Claforan)

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26
Q

Coverage of 3rd gen cephalosporins - group 1

A

strep (more resistant strep pneumo and strep viridans), MSSA, more resistant HNPEK, gm+ anaerobes (mouth flora)

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27
Q

Ceftriaxone pearls

A

Causes hyperbilirubinemia in neonates; do not use w/ calcium containing IV products

*Does NOT require renal dose adjustment

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28
Q

Name 3rd gen cephalosporins - group 2

A

ceftazidime (Fortaz); ceftazidime-avibactam (Avycaz); ceftolozane-tazobactam (Zerbaxa)

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29
Q

Coverage of 3rd gen cephalosporins - group 2

A

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)

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30
Q

Name 4th gen cephalosporin

A

cefepime (Maxipime)

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31
Q

Coverage of 4th gen cephalosporin

A

strep, MSSA, HPNEK, CAPES, pseudomonas

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32
Q

Name 5th gen cephalosporin

A

ceftaroline fosamil (Teflaro)

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33
Q

Coverage of 5th gen cephalosporin

A

strep, MRSA, more resistant HPNEK,

*NO pseudomonas activity

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34
Q

Special reconstitution requirements for PCNs

A

Amp + Unasyn only compatible w/ NS

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35
Q

MOA of carbapenems

A

beta-lactam: inhibits cell wall synthesis

*time-dependent; cidal

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36
Q

Name carbapenems

A

doripenem (Doribax); imipenem-cilastatin (Primaxin); meropenem (Merrem); ertapenem (Invanz)

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37
Q

Coverage of carbapenems

A

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
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38
Q

Renal dosing for carbapenems

A

Require dose adjustment

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39
Q

SE of carbapenems

A

Seizures w/ higher doses or pts w/ renal impairment

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40
Q

MOA of monobactams

A

inhibits cell wall synthesis

  • time-dependent
  • used when beta-lactam allergy present
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41
Q

Name monobactams

A

aztreonam (Azactam), Cayston (inhaled, for CF pts)

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42
Q

Coverage of monobactams

A

NO gm+; more resistant HPNEK, pseudomonas

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43
Q

Renal dosing of monobactams

A

Require dose adjustment

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44
Q

MOA of aminoglycosides (AGs)

A

inhibit protein synthesis by binding to 30s and 50s ribosomal subunits causing defective cell membrane

*concentration-dependent; exhibit post-antibiotic effect

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45
Q

Name AGs

A

gentamicin; tobramycin (inhaled - TOBI, Bethkis); amikacin; streptomycin

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46
Q

BBW for AGs

A

nephrotoxicity, ototoxicity, neuromuscular blockade, respiratory paralysis

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47
Q

Coverage of AGs

A

Mainly gm-, including pseudomonas

  • gent & streptomycin are used for synergy when treating gm+ cocci
  • amikacin has broadest spectrum of activity
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48
Q

Renal dosing of AGs

A

Require dose adjustment

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49
Q

Monitoring of AGs

A

Monitor peaks and troughs

*Extended-interval dosing or traditional dosing

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50
Q

MOA of quinolones

A

inhibit DNA topoisomerase IV and DNA gyrase, which prevents supercoiling of DNA and promotes breakage of DNA

*concentration-dependent; cidal

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51
Q

Name quinolones

A

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)

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52
Q

Coverage of quinolones

A

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

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53
Q

BBW for quinolones

A

Tendon inflammation &/or rupture

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54
Q

SE of quinolones

A

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

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55
Q

Renal dosing of quinolones

A

Require dose adjustment

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56
Q

Storage of reconstituted quinolones

A

DO NOT refrigerate

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57
Q

Counseling with quinolones

A

Take 2 hours before or 6 hours after taking antacids, vitamins, dairy products, etc.

Photosensitivity

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58
Q

Special reconstitution requirements for ertapenem

A

ONLY with NS

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59
Q

Oral to IV conversion for levofloxacin

A

1:1

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60
Q

MOA of macrolides

A

bind the 50s ribosomal subunit which inhibits RNA-dependent protein synthesis

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61
Q

Name the macrolides

A

azithromycin (Z-Pak, Zithromax, AzaSite eye drops); clarithromycin (Biaxin); erythromycin (EES, EryPed, Erythrocin)

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62
Q

SE of macrolides

A

QT prolongation (highest risk w/ EES), hepatotoxicity, GI upset

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63
Q

Coverage of macrolides

A

atypicals - legionella, chlamydia, mycoplasma; h. flu, mycobacterium

azith: better gm- coverage compared to EES
clarith: better gm+ coverage

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64
Q

Storage of reconstituted macrolides

A

Refrigerate EES suspension w/ sulfisoxazole

DO NOT refrigerate clarithromycin liquid or azithromycin liquid

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65
Q

Renal dosing of macrolides

A

NO dose adjustment for azith or EES

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66
Q

MOA of tetracyclines

A

binds 30s ribosomal subunit, inhibiting protein synthesis

*static

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67
Q

Name the tetracyclines

A

doxycycline (Adoxa, Atridox, Doryx, Monodox, Vibramycin); minocycline (Minocin, Soldyn); tetracycline

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68
Q

SE of tetracyclines

A

photosensitivity, N/V/D, rash

*Avoid use in children

69
Q

Renal dosing of tetracyclines

A

ONLY tetracycline requires dose adjustment

70
Q

Coverage of tetracyclines

A

gm+: staph, strep, enterococcus, nocardia, bacillus, propionibacterium

gm-: h. flu, Moraxella, atypicals

other: spirochetes, rickettsiae, bacillus anthracis, treponema pallidum

71
Q

Counseling w/ tetracyclines

A

Separate from antacids, vitamins or dairy products by 2 hours before or 4 hours after

72
Q

MOA of sulfonamides

A

interferes w/ folic acid synthesis via inhibition of DHFA formation

*cidal in combo w/ trimethoprim

73
Q

Name sulfonamides

A

sulfamethoxazole-trimethoprim (Bactrim, Septra, Sulfatrim)

74
Q

Coverage of sulfonamides

A

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
Q

SE of sulfonamides

A

N/V/D, rash (SJS/TEN), crystalluria, photosensitivity, increase K+, hypoglycemia

*Avoid use in pts w/sulfa allergy, infants

76
Q

Dosing of sulfonamides

A

Dosed based on trimethoprim component;

sulfmethoxazole:trimethoprim 5:1

77
Q

Renal dosing of sulfonamides

A

Require dose adjustment

78
Q

Storage of sulfonamides

A

DO NOT refrigerate suspension or reconstituted IV

79
Q

Special reconstitution requirements

A

Compatible ONLY w/ D5W

80
Q

MOA of vancomycin (glycopeptide)

A

inhibits cell wall synthesis by blocking polymerization by binding to the D-ala-D-ala portion of cell wall precursor

*cidal

81
Q

Brand of vanco

A

Vancocin

82
Q

Coverage of vanco

A

staph (MRSA), strep, enterococci, c. difficile

*No VRE activity

83
Q

SE of vanco

A

Red man syndrome, nephrotoxicity, ototoxicity, myelosuppresion

84
Q

Monitoring w/ vanco

A

Trough before 4th dose

Target for PNA, endocarditis, osteomyelitis, meningitis, bacteremia: 15-20mcg/mL

Target for other infections: 10-15mcg/mL

85
Q

Renal dosing for vanco

A

Requires dose adjustment

*NO dose adjustment for po vanco

86
Q

Storage after reconstitution of vanco

A

Refrigerate

87
Q

MOA of lipoglycopeptides

A

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
Q

Name lipoglycopeptides

A

telavancin (Vibativ); Oritavancin (Orbactiv); dalbavancin (Dalvance)

89
Q

Coverage of lipoglycopeptides

A

staph (MRSA), strep, c. difficile

Oritavancin: e. faecalis (NO VRE)

90
Q

SE of telavancin

A

falsely increase PT/INR, red man syndrome, metallic taste, QT prolongation

91
Q

BBW of telavancin

A

teratogen, nephrotoxicity, increased mortality vs. vanco in pts w/mod-to-severe renal impairement (CrCl

92
Q

Renal dosing of lipoglycopeptides

A

Require dose adjustment

93
Q

Special reconstitution requirements of lipoglycopeptides

A

dalbavancin & oritavancin: compatible ONLY w/ D5W

94
Q

MOA of daptomycin

A

cyclic lipopeptide that binds to cell membrane and causes rapid depolarization, inhibiting all intracellular replication processes, including protein synthesis

*concentration-dependent; cidal

95
Q

Coverage of daptomycin

A

staph (MRSA), enterococcus (VRE)

96
Q

Brand name of daptomycin

A

Cubicin

97
Q

Monitoring of daptomycin

A

CPK level weekly, muscle pain/weakness

98
Q

Renal dosing of daptomycin

A

Requires dose adjustment

99
Q

SE of daptomycin

A

myopathy, N/V/D, falsely increase PT/INR

100
Q

Special PK of daptomycin

A

DO NOT USE to treat PNA d/t inactivation in the lungs by surfactant

101
Q

MOA of oxazolidinones

A

bind the 50s ribosomal subunit inhibiting translation and protein synthesis

*static

102
Q

Coverage of oxazolidinones

A

staph (MRSA), strep, enterococcus (VRE)

103
Q

Name oxazolidinones

A

linezolid (Zyvox); tedizolid (Sivextro)

104
Q

CI of linezolid

A

Concurrent use or within 2 weeks of MAOIs

105
Q

SE of oxazolidinones

A

Peripheral and optic neuropathy, hypoglycemia, serotonin syndrome, HA, N/D

Linezolid: duration-related myelosuppression

106
Q

MOA of streptogramins

A

binds the 50s ribosomal subunit inhibiting protein synthesis

*cidal

107
Q

Name the (only) streptogramin

A

quinupristin/dalfopristin (Synercid)

108
Q

Coverage of Synercid

A

staph (MRSA), enterococcus, (covers VRE e. faecium ONLY)

109
Q

Renal dosing of Synercid

A

NO adjustment required

110
Q

SE of Synercid

A

Arthralgias/myalgias, infusion reactions (edema & pain), phlebitis, hyperbilirubinemia, increase CPK levels

111
Q

Special reconstitution requirements of Synercid

A

Compatible ONLY w/ D5W

112
Q

MOA of polymixins

A

cationic detergent that damages bacterial cytoplasmic membrane causing leaking of intracellular substances and cell death

*concentration-dependent; cidal

113
Q

Name polymixins

A

Colistimethate or colistin (ColyMycin); polymixin B

114
Q

Coverage of polymixins

A

enterobacter, e. coli, klebsiella, pseudomonas

*Used primarily in MDR gm- infections and used in combo d/t increasing resistance

115
Q

Renal dosing of polymixins

A

Require dose adjustment

116
Q

BBW of polymixin B

A

dose-dependent nephrotoxicity, neurotoxicity (can cause respiratory paralysis)

117
Q

SE of polymixins

A

Nephrotoxicity, neurologic disturbances (dizziness, HA, oral parethesia, vertigo)

118
Q

Storage requirements of oxazolidinones

A

DO NOT refrigerate linezolid

119
Q

Oral to IV linezolid dosing

A

1:1

120
Q

Oral to IV dosing of doxy & mino

A

1:1

121
Q

Oral to IV dosing of bactrim

A

1:1

122
Q

MOA of tigecycline

A

binds 30s ribosomal subunit inhibiting protein synthesis (related to tetracyclines)

*static

123
Q

Brand name of tigecycline

A

Tygacil

124
Q

Coverage of tigecycline

A

staph (MRSA), enterococcus (VRE), anaerobic, atypicals, most gm- except: pseudomona, proteus, and providencia

125
Q

Indications of tigecycline

A

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
Q

SE of tigecycline

A

N/V/D, hepatotoxicity, pancreatitis, photosensitivity

*Avoid use in children

127
Q

MOA of chloramphenicol

A

reversibly binds 50s ribosomal subunit inhibiting protein synthesis

*cidal

128
Q

Coverage of chloramphenicol

A

gm+, gm-, anaerobes, atypicals

*Rarely used d/t SE

129
Q

BBW of cholramphenicol

A

Serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia, granulocytopenia)

130
Q

SE of chloramphenicol

A

Myelosupression, gray syndrome (circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma and death)

131
Q

Renal dosing of chloramphenicol

A

NO adjustment required

132
Q

Monitoring of chloramphenicol

A

CBC at baseline and every 2 days during tx, serum drug concentrations

133
Q

MOA of telithromycin

A

binds to 50s ribosomal subunit inhibiting protein synthesis

*concentration-dependent; related to macrolides

134
Q

Brand name of telithromycin

A

Ketek

135
Q

Coverage of telithromycin

A

strep (including macrolide-resistant strains), some anaerobic, atypical

*Approved for CAP ONLY

136
Q

BBW of telithromycin

A

Contraindicated in pts w/ myasthenia gravis d/t respiratory failure

137
Q

Renal dosing of telithromycin

A

Requires dose adjustment

138
Q

SE of telithromycin

A

Acute hepatic failure, QT prolongation, visual disturbances, N/V/D

139
Q

MOA of lincosamides

A

reversibly binds to 50s ribosomal subunit inhibiting protein synthesis

*static

140
Q

Name of lincosamides

A

clindamycin (Cleocin), ClindaMax, Evoclin)

141
Q

Coverage of clindamycin

A

most aerobic and anaerobic gm+, including some CA-MRSA)

*NO enterococcus activity

142
Q

Renal dosing of clindamycin

A

DO NOT require adjustment

143
Q

SE of clindamycin

A

N/V/D, c. difficile-associated colitis (BBW)

144
Q

Storage of clindamycin liquid

A

DO NOT refrigerate

145
Q

MOA of metronidazole & tinidazole

A

cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis

*cidal

146
Q

Brand names of metronidazole & tinidazole

A

metronidazole (Flagyl, MetroGel); tinidazole (Tindamax)

147
Q

Coverage of metro & tinidazole

A

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
Q

SE of metro & tinidazole

A

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
Q

Renal dosing of metro & tinidazole

A

NO adjustment required

150
Q

Oral to IV conversion of metronidazole

A

1:1

151
Q

Storage of metronidazole liquid

A

DO NOT refrigerate

152
Q

MOA of fidaxomicin

A

inhibits RNA polymerase resulting in inhibition of protein synthesis and cell death

*cidal

153
Q

Brand name of fidaxomicin

A

Dificid

154
Q

Coverage of fidaxomicin

A

c. difficile

155
Q

SE of fidaxomicin

A

N/V, abdominal pain, GI bleeding, anemia

156
Q

MOA of rifaximin

A

inhibits RNA synthesis by binding to bacterial DNA-dependent RNA polymerase

*cidal

157
Q

Brand name of rifaximin

A

Xifaxan

158
Q

Coverage of rifaximin

A

e. coli

159
Q

Indications of rifaximin

A

TD, HE, IBS-D

160
Q

SE of rifaximin

A

peripheral edema, dizziness, HA, flatulence, N, rash

161
Q

MOA of fosfomycin

A

inhibits cell wall synthesis by activating the enzyme pyruval transferase

*cidal

162
Q

Brand name of fosfomycin

A

Monurol

163
Q

Coverage of fosfomycin

A

e. coli (ESBL), e. faecalis (VRE)

164
Q

SE of fosfomycin

A

HA, N/D

165
Q

MOA of nitrofurantoin

A

bacterial cell wall inhibitor

*cidal

166
Q

Brand name of nitrofurantoin

A

Macrobid, Macrodantin, Furadantin

167
Q

CI of nitrofurantoin

A

CrCl

168
Q

SE of nitrofurantoin

A

Brown urine discoloration, GU upset, HA, optic neuritis, hepatotoxicity, hemolytic anemia, peripheral neuropathy, pulmonary toxicity

169
Q

Coverage of nitrofurantoin

A

e. coli, klebsiella, enterobacter, staph, enterococcus (VRE)

NAPLEX (8 decks)

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