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Pharm > Introduction to Antibiotics > Flashcards

Introduction to Antibiotics Flashcards

1
Q

substances produced by various species of microorganisms that suppress the growth or destroy other microorganisms.

A

Antibiotics

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2
Q

What type anitbiotics directly kill bacteria. No functioning immune system required.

A

bactericidal

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3
Q

What type antibiotic requires an immune system to eliminate the pathogen?

A

Bacteriostatic

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4
Q

Do antibiotics fall neatly into bactericidal or bacteriostatic categories?

A

No, sometimes they can change at different doses

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5
Q

Do you want to combine bacteriostatic and bactericidal antibiotics?

A

No

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6
Q

What 4 types of antibiotics inhibit cell wall synthesis?

A

Penicillins
Cephalosporins
Bacitracin
Vancomycin

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7
Q

Do antibiotics only target pathogenic bacteria?

A

No- they can destroy normal flora as well leading to opportunistic infections

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8
Q

What are 2 main examples of bacterias that take over when you kill off normal flora.

A

Candida

Clostridium difficile

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9
Q

What antibiotics are part of the beta lactam antibiotics?

A

Penicillins
Cephalosporins
Carbapenems
Monobactrams

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10
Q

What are 4 agents that inhibit cell wall synthesis?

A 
Penicillins
Cephalosporins
Cycloserine
Vancomycin
Bacitracin
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11
Q

What is an agent that acts directly on the cell membrane of the microorganism affecting permeability and leading to leakage of intracellular compounds.

A

Detergents (polymyxin)

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12
Q

What are the 2 ways antibiotics are used?

A

As an empirical therapy (broad spectrum)

As definitive therapy (choose selective therapy)

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13
Q

Why do you not want to continue broad spectrum antibiotics?

A

Will build resistance much faster

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14
Q

When should you get a culture?

A

Before starting antibiotic therapy

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15
Q

WIll you ever choose a bacteriostatic medication in an individual with a compromised immune system?

A

No, always choose bactericidial

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16
Q

Why does natural resistance occur?

A

Antibiotics fail to reach the target
Decreased permeability for cells that need to act on nucleic acid
lactamases deactivate beta-lactams

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17
Q

What does MRSA stand for?

A

Methicillin-resistant staphylococcus aureus

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18
Q

WHat are examples of 2 antibiotic resistance conditions.

A

MRSA

Mycobacteria tuberculosis

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19
Q

Why do cell wall inhibitors work so well?

A

Our cells don’t have walls so it targets cells that aren’t ours

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20
Q

What do cell wall inhibitors need to work?

A

Dividing bacteria (so don’t want to give something that also slows growth with it)

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21
Q

What is within the beta lactam compounds?

A 
Penicillins
Cephalosporins
Carbapenems
Monobactams
Beta lactamase inhibitors
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22
Q

What is the beta lactam rings unstable to?

A

pH

beta-lactamases

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23
Q

What do the beta lactam drugs do in our bodies?

A

Undergo acetylation in our body

undergo a covalent bond with trans-peptidase

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24
Q

What 2 things are beta-lactam antibiotics generally?

A

Bactericidal

most active against growing organisms

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25
Q

What category are penicillins for pregnancy?

A

Category B (safe)

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26
Q

What was the original penicillin?

A

Penicillin G

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27
Q

Do beta lactam antibiotics work on organisms with no cell wall?

A

No

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28
Q

What is the most common way a beta lactam antibiotic develops resistance?

A

Develops beta-lactamase

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29
Q

What are the three ways for penicillins resistance?

A

inactivation by beta-lactamas
modification of PBP target
impaired penetration of drug to target PBP

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30
Q

What are the 2 types of penicillins?

A

Penicillin G or V

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31
Q

What kind of bacteria do Penicillin G and V work against?

A

Gram-positive cocci (except staphylococcus)

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32
Q

What type environment are beta lactam unstable in?

A

Acid environment

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33
Q

Can penicillin G be given orally?

A

No, because it isn’t stable in acid

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34
Q

What anaerobes species do penicillin G or V work against?

A

bacteroides species

fusebacterium species

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35
Q

What are some gram negatives that penicillins work against?

A 
E. Coli
H. influenzae
N. gonorrhoeae
Treponema pallidium
and susceptible pseudomonas species
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36
Q

What are some infections that you treat with penicillins?

A

upper and lower respiratory tract
throat
skin
GU tract

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37
Q

What are penicillins used for prophylaxis for?

A

Dental procedures for those at risk of endocarditis
Gonorrhea or syphilis exposure
rheumatic rever

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38
Q

What are the 2 drugs within aminopenicillins?

A

Ampicillin

amoxicillin

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39
Q

What do aminopenicillins act on?

A

activity of Pen G plus improved covered of gram-negative cocci and Enterobacteriaceae

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40
Q

What is a problem with aminopenicillins?

A

A lot of the bacteria these are used to treat have develop beta lactamase activity.

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41
Q

What can you do to make aminopenicillins more effect on beta lactamse bacteria?

A

Add with beta-lactamase inhibitors

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42
Q

What is ampicillin combined with to make Unasyn?

A

sulbactam (a beta lactamase inhibitor)

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43
Q

What is found in augmentin?

A

amoxicillin + clavulanic acid (beta lactamase inhibitor)

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44
Q

What 2 types of bacteria do the combination of aminopenicillins and beta lactamase inhibitors work well against?

A

H. influenzae

Klebsiella sp.

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45
Q

What are three penicillinase- resistant penicillins? These drugs won’t work against MRSA

A

nafcillin
oxacillin
dicloxacillin

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46
Q

What is another name for penicillinase-resistant penicillins?

A

Antistaphylococcal penicillins

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47
Q

What are 3 antipseudomonal penicillins?

A

piperacillin
ticaricillin
carbenicillin (PO)

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48
Q

What do antipseudomonal penicillins treat?

A

Activity of Pen G pluse greater gram negative coverage including pseudomonas
coverage against- H. influenzae and Klebsiella
No covereaerd against treponema palladium or actinomyces

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49
Q

How can antipseudomonal penicillins treat gram-negative infections?

A

Combine with aminoglycosides

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50
Q

What is the only way piperacillin is available?

A

In combination with tazobactam (Zosyn)

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51
Q

What is the only way ticarcillin is found?

A

With clavulanic acid (Timentin)

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52
Q

What are three beta-lactamase inhibitors?

A

Clavulanic acid
sulbactam
tazobactam

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53
Q

The additional of beta-lactamase inhibitors helps to cover what?

A

H. flu
staph
moraxella catarrhalis

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54
Q

What penicillins are oral only?

A

Penicillin V

Amoxicillin w/ or w/o clavulanic acid

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55
Q

What type of penicillins are available PO and IV?

A

Nafcillin

Ampicillin

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56
Q

What penicillins are available IV only ?

A

ANtipseudomonal penicillins= piperacillin w/ or w/o tazobactam

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57
Q

What is a depot injection?

A

IM injection intended to be released overtime

58
Q

What drug is given as a depot form and is drug of choice for syphilis?

A

Penicillin G

59
Q

can many penicillins be administered orally?

A

No

60
Q

What does food do to penicillins?

A

Decrease absorption of available oral penicillins

61
Q

What ares do penicillins poorly penetrate to?

A

Eye
CNS
prostate

62
Q

What is the only time where penicillins get into the CNS?

A

when meninges are inflamed

63
Q

Are penicillins metabolized?

A

No, most are not just eliminated via kidney

64
Q

How are pencillins eliminated?

A

Through kidney- filtered (10%) and actively secreted (90%) into the urine

65
Q

What can block active secretion?

A

Probenecid

66
Q

When do doses of penicillins need to be adjusted?

A

Renal insufficiency

67
Q

What is serum sickness?

A

Urticaria, rash, fever, angioedema from penicillins

68
Q

What are 2 idiosyncratic rxns of penicillins?

A

interstitial nephritis

hemolytic anemia

69
Q

What is a big secondary infection with pencillins?

A

vaginal candidiasis

70
Q

What can happen with oxacillin?

A

hepatitis

71
Q

What is a side effect that can occur w/ nafcillin?

A

Neutropenia

72
Q

What drugs do you not want to give with PCNs?

A

TCN or other bacteriostatic agents

73
Q

anti-pseudomonal PCNs can affect ______ metabolism.

A

Warfarin

74
Q

Cephalosporins are structurally similar to what?

A

penicillins

75
Q

What is the mechanism of ceaphalosporins?

A

Bactericidial

inhibit bacterial cell-wall syntehsis

76
Q

How many generations of cephalosporins are there?

A

5 generation

77
Q

What category are cephalosporins in pregnancy?

A

Category B

78
Q

What are the three ways you can get resistance to cephalosporins?

A

Mutations in PBP
production of beta-lactamases
alteration in cell-membrane porins in gram-negative bacteria

79
Q

What are 1st generation cephalosporins similar to?

A

antistaph + aminopenicillins

80
Q

What bacteria are 1st generation ceaphlosporins good for?

A

Aerogib gram-psoitive
above the diaphgram anaerobes
community acquired gram-negative organism coverage

81
Q

What is the IV ceaphlosporin first generation?

A

Cefazolin (ancef)

82
Q

What is the PO 1st generation cephalosporin?

A

Cephalexin (Keflex)

83
Q

What is a huge prophylactic antibiotic for surgeries?

A

Cefazolin (Ancef)

84
Q

What are 1st gen cephalosporins used for?

A

Septic arthritis
skin infections
acute otitis media

85
Q

What are 2 classes within the second generation of cephalsporin?

A

Those with added gram-negative coverage

those with added anerobic coverage

86
Q

What generation is better for gram positive? (ceaphlosporins)?

A

1st generation cephalosporins

87
Q

What generation cephalosporin is better for gram negative?

A

2nd generation cephalosporins

88
Q

What do 3rd generation cephalosporins have expanded coverage for?

A

Gram-negative coverage

penetration of BBB

89
Q

What are 3 3rd generation cephalosporins that are avaliable PO?

A

cefpodoxine (vantin)
Cefdinir (omnicef)
Cefixime (suprax)

90
Q

What is a 3rd generation cephalosporin that also has increased anti-pseudomonal coverage?

A

Ceftazidime (fortaz)

91
Q

What do you use 3rd generation cephalosporins for?

A 
Penicillin resistant pneumococcus
meningitis
penumonia in children and adults
sepsis
peritonitis
UTI, skin infections, osteomyelitis
N. gonorrhae
92
Q

What is a 4th generation cephalosporin?

A

Cefepime (maxipime) IM/ IV

93
Q

What are 4th generation ceaphlosporins good against (bacteria type)?

A

Gram-positive, gram-negative

anaerobic coverage

94
Q

what do 4th generation cephalosporins treat?

A

intra-abdominal infection
respiratory tract infections
skin infections

95
Q

What is a drug in the 5th generation of cephalosporin?

A

Ceftobiprole medocaril

96
Q

What are 5th generation cephalosporins used for?

A

Treatment against MRSA

97
Q

Do most cephalosporins have an oral admin option?

A

Yes

98
Q

how are cephalosporins eliminated?

A

kidney

99
Q

what cephalosporin (3rd generation) can lead to cholelithiasis?

A

ceftriaxone

100
Q

What drug class can blood dyscrasias (idiosyncratic)?

A

cephalosporins

101
Q

What 2 antibiotics (cephalosporin) have methylthiotetrazole side chains?

A

cefoperazone

ceftotetan

102
Q

What can happen is someone take alcohol with cefoperazone and cefotetan?

A

disulfiram-like rxn with alcohol injection
Large amount of vomitting
hypoprothombinemia due to inference of synthesis of vitamin-K dependent clotting factors (concern with hemophiliacs or those on warfarin)

103
Q

When will you get increased levels of cephalosporin serum levels?

A

With co-administration with probenecid

104
Q

What is the most broad spectrum class of beta-lactam class of antibiotics (gram +, gram - coverage)? resistant to many beta-lactamases

A

Carbapenems

105
Q

What are the three carbapnems?

A

ertapnem
imipenem-cilastin
meropenem

106
Q

what should you reserve carbapenems be saved for?

A

Very severe infections

107
Q

How is meropenem different from the other 2 carbapenems?

A

Greater activity against gram-negative
intra-abdominal infections
used for meningitis > 3 months of age

108
Q

how are carbapenems administered?

A

parenterally

109
Q

how are carbapenems excreted?

A

renally

110
Q

What 2 drugs have cross-sensitivity to penicillins?

A

Carbapenem

cephalosporin

111
Q

What carbapenem reduces valproic acid levels?

A

Meropenem

112
Q

What category in pregnancy is mereopenem and ertapenem

A

category B

113
Q

What category in pregnancy is imipenem/ cilastin?

A

Category C (means you consider risk vs. benefit)

114
Q

What is the only monobactam available in the US?

A

Aztreonam (azactam)

115
Q

What is the spectrum of monobactams?

A

gram-negative rods

116
Q

Do monobactams have cross reactivity with PCN?

A

No

117
Q

What can you use monobactams for?

A

Gram-negative infections

pneumonia, soft-tissue infections, UTI, intra-abdominal and pelvic infections

118
Q

Do monobactams distribute to the meningens?

A

yes

119
Q

How are monobactams excreted?

A

Kidneys

120
Q

What category are monobactams?

A

Category B

121
Q

Can monobactams be used in children?

A

Yes over 9 months

122
Q

What is a cell wall inhibitor that is restricted to use as a secondary anti-tubercular drug?

A

Cycloserine

123
Q

What are some ADRs of cycloserine?

A

CNS toxicity- reversible w/ pyridoxine

renal impairment will accelerate toxicity

124
Q

why is cycloserine restricted for use?

A

highly susceptible to resistance

125
Q

Does vancomycin act on the same site as beta-lactams?

A

No, but has same effect on cell wall synthesis

126
Q

What are some bacteria that are resistant to vancomycin?

A

E. faecium (VRE)

some MRSA strains

127
Q

What is vancomycin used to treat (resistant bacteria)

A

MRSA (but they are becoming more resistant)

128
Q

What type bacteria does vancomycin work against?

A

Gram positive

129
Q

What do we reserve vancomycin for?

A

Patients allergic to beta-lactams suffering from serious gram positive infections
Infections resulting from MRSA

130
Q

When is the only time you give vancomycin PO?

A

If the patient has C. Diff

131
Q

If vancomycin absorbed when given orally?

A

No

132
Q

When can vancomycin get into the CNS?

A

When the meninges are inflamed

133
Q

How is vancomycin metabolized and excreted?

A

Not metabolized, but 90% renal excretion

134
Q

What is vancomycin half life directly dependent on?

A

ClCr

135
Q

When do you need a dosage adjustment for vancomycin?

A

Marked renal insufficiency

136
Q

What is the main indication for vancomycin?

A

MRSA or Staph Epi
includes endocarditis, sepsis, osteomyelitis, wound infections
also for pencillin resistant pneumococcus

137
Q

What can happen if vancomycin is given too quicky?

A

Red man syndrome. Fix by slowing down infusion rate

138
Q

What are 2 main adverse events of vancomycin? (also seen in aminoglycosides)

A

ototoxicity (non-reversible)

nephrotoxicity (reversible)

139
Q

When is bacitracin nephrotoxic?

A

When given systemically, this is why its limited to topical use

140
Q

Is bacitracin absorbed when given orally?

A

No, so can be used to irrigate GI

141
Q

What are the components of Missouri irrigation solution?

A

Neomycin
Polymyxin
Bacitracin

Pharm (29 decks)

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