KNOW THIS SHIT Flashcards
1
Q
What is the MOA for all Beta-Lactam antibiotics? What three things are absolutely necessary for these antibiotics to work?
A
Bind to PBP → interferes with cell wall integrity → cell lysis
- Must have ACTIVE GROWTH, PBPS and AUTOLYSINS
2
Q
What makes G- different from G+?
A
Both contain a layer of peptidoglycan but G- also has an extra outer membrane
3
Q
What is transpeptidation of peptidoglycan?
A
Forms links between amino acid side chains on NAM molecules
4
Q
What is the main MOR for Penicillin?
A
Penicillinase binds to beta-lactam ring on the antibiotic and hydrolyzes it, inactivating the antibiotic
5
Q
What is the primary toxicity for PCNs?
A
Hypersensitivity
6
Q
What is the advantage of using Penicillinase-Resistance PCN over the other three PCNs (besides that it works against Penicillinase…)?
A
Hepatic metabolism so can be used if there is poor kidney function
7
Q
Which group of antibiotics is the most effective against G+?
A
PCNs specifically Natural Penicillins
8
Q
What is the DOC for MSSA? What are the three medications in this group?
A
Penicillinase-Resistance PCNs
- Nafcillin
- Dicloxacillin
- Oxacillin
9
Q
What group of antibiotics cannot be used to treat MRSA? What is the one medication exception to this?
A
NO BETA-LACTAMS can treat MRSA
- Exception: Ceftaroline
10
Q
What is the DOC for Lysteria infections? What are the two medications in this group?
A
Extended-Spectrum PCNs
- Ampicillin
- Amoxicillin
11
Q
What is the spectrum of Antipseudomonal PCNs?
A
Extended-Spectrum PCNs plus some G- (including Pseudomonas)
12
Q
What is the primary DOC/use for Antipseudomonal PCNs? What are the two medications in this group?
A
Pseudomonas aeruginosa
- Piperacillin
- Ticarcillin
13
Q
Beta-lactamase inhibitors can be added to which two groups of PCNs (and which four medications specifically)? What does this allow for?
A
Extended-Spectrum PCNs
- Ampicillin
- Amoxicillin
Antipseudomonal PCNs
- Piperacillin
- Ticarcillin
Provides further extended spectrum
14
Q
What group of antibiotics is always combined with Antipseudomonal PCNs?
A
Aminoglycosides
15
Q
What group of antibiotics is the DOC for Streptococcus pneumoniae?
A
PCNs
16
Q
What two groups of antibiotics or medications are the DOC for Group A Streptococcus?
A
- PCNs
- Clindamycin
17
Q
What group of anitbiotics is DOC for S. aureus?
A
PCNs
18
Q
What is the DOC for Listeria infections?
A
Ampicillin
19
Q
What is the DOC for early Lyme disease (besides Doxycycline)?
A
Amoxicillin
20
Q
What is the advantage of using a Cephalosporin over a PCN?
A
7-methyl group of Cephalosporins increases their resistance to B-lactamases
21
Q
Which two Cephalosporin generations are very similar to each other in terms of spectrum? What is their spectrum?
A
1 and 2 both have good G+ activity with some G-
22
Q
What is the DOC for surgical prophylaxis?
A
Cefazolin
23
Q
Which three G- organisms are the 1st and 2nd generation Cephalosporins a DOC for?
A
- E. coli
- Klebsiella
- Proteus
24
Q
What are the two possible DOC for Neisseria gonorrheae?
A
- Ceftriaxone
- Cefpodoxime
25
Which two 3rd generation Cephalosporins have good CNS penetration?
- Ceftriaxone
| - Cefotaxime
26
Which two Cephalosporins are considered alternatives to PCN when treating Pseudomonas?
Aminoglycosides +
- Ceftazadime
- Cefepime
27
Which Cephalosporins has the broadest coverage? Why is this important in terms of use?
Cefepime (Maxipime)
| - Can be used empirically
28
What is the DOC for late stage Lyme disease?
Ceftriaxone
29
What two diseases is Ceftaroline effective against that many medications are not?
- MRSA
| - VRSA
30
Which two groups of antibiotics or medications can exhibit a disulfarim-like reaction? What should be avoided?
Avoid EtOH use with...
- Cephalosporins
- Metronidazole
31
Which group of antibiotics exhibits synergistic nephrotoxicity when combined with Aminoglycosides?
Cephalosporins
32
What type of toxicity are you concerned about with PCN and Cephalosporins?
Cross-sensitivity
| - If allergic to PCN, 10% chance you are also allergic to Cephalosporins
33
Which group of antibiotics/medication is considered a good alternative to PCN (if allergy) due to no cross-sensitivity with other beta-lactams?
Monobactams (Aztreonam)
34
What inhibitor must be given with Imipenem? Why?
Cilastin must be given with Imipenem because without it, Imipenem is rapidly inactivated by renal tubule dihydropepdidases
35
What is the DOC for Beta-Lactamase producing Enterobacter infections?
Imipenem
36
What is the primary side effect of Imipenem? What is a very similar, but less risky alternative?
Seizures
| - Use Meropenem instead
37
What is the DOC for MRSA?
Vancomycin (IV)
38
What is the DOC for C. difficile?
Vancomycin (oral)
39
What is the MOA for Vancomycin?
Binds to terminal D-ala (different from PBP)
40
What are the three primary toxicities associated with Vancomycin?
- Ototoxicity
- Nephrotoxicity
- Red man syndrome
41
What is the MOA for Fosfomycin?
Prevents NAG to NAM reduction
42
What is the primary use for Fosfomycin? Why is it not considered the DOC for this use?
UTI in women
- Bactrim then Cipro are DOC for UTIs because Fosfomycin also acts on other parts of the body, not just the urinary tract
43
What is the MOA for Bacitracin?
Inhibits transport across cell membrane
44
What are the two antibiotic groups that act on the 30s ribosomal subunit during inhibition of protein synthesis (exceptions to the 50s rule)?
- Aminoglycosides
| - Tetracyclines
45
What is the one antibiotic group that is bactericidal during inhibition of protein synthesis (exception to static rule)?
Aminoglycosides
46
Of the three Macrolides, which is the most toxic?
Erythromycin
47
What is the DOC for Neisseria meningitidis?
Penicillin G
48
What two antibiotic groups or medications are DOC for E. coli, Klebsiella and Proteus?
- 1st, 2nd gen Cephalosporins
| - Bactrim
49
Of the three Macrolides, which is most toxic for prolonged QT? Which are best?
Azithromycin
| - Erythromycin = Clarithromycin are best
50
Of the three Macrolides, which is most toxic for diarrhea? Which is best?
Erythromycin
| - Clarithromycin is best
51
Of the three Macrolides, which two are most toxic for drug interactions?
- Erythromycin
| - Clarithromycin
52
What is the primary toxicity associated with Telithromycin?
Hepatotoxicity
53
What is the DOC for osteomyelitis?
Clindamycin
54
What is the DOC for Toxic Shock Syndrome? What three medications should it be combined with?
Clindamycin
| - Use with Vancomycin, Nafcillin or 1st gen Cephalosporin
55
When should you STOP use of Clindamycin? What medication should then be started?
CDAD or C. diff overgrowth occurs
| - Begin oral Vancomycin
56
What is the only condition that Telithromycin is still used to treat? What is the preferred option over Telithromycin?
CAP
| - Levofloxacin or PCN preferred
57
Is Clindamycin primarily bacteriostatic or bactericidal? Can this change?
Primarily bacteriostatic
| - Can be bactericidal depending on concentration or susceptibility
58
What two medications are typically bacteriostatic independently, unless combined to be used synergistically (becoming bactericidal)?
Dalfopristin + Quinupristin
| - Static but when combined, become bactericidal
59
What MOA group of antibiotics becomes bactericidal when combined together?
IPS
| - Two IPS = cidal
60
What is the primary concern when using Linezolid?
It is an inhibitor of MOA
61
Patients with either of these two things should avoid use of Linezolid...
- Pheochromocytoma
- Drugs that increase MOAs (antidepressants)
Linezolid is an MOA inhibitor so if present, MOAs will not be eliminated properly and will instead accumulate
62
What is important to know about the group of Aminoglycosides (different from all other antibiotics we learned about...)
IT IS BIG IN 2 WAYS...
- Large size and polar: requires oxygen/active transport
- Many different uses
63
Knowing that Aminoglycosides are large in size, what does this tell you about their spectrum?
Requires oxygen/active transport because so large/polar so...
- ONLY WORKS AGAINST AEROBES (also G-)
64
What are the two primary toxicities associated with Aminoglycosides? How can this toxicity be affected?
- Ototoxicity
- Nephrotoxicity
Toxicity is dependent on time and concentration of drug
65
What is the only antibiotic group that irreversibly inhibits protein synthesis? What does this say about the group?
Aminoglycosides irreversibly inhibit protein synthesis
| - Bactericidal!!!
66
What is the DOC for Tularemia, Bubonic plague and TB?
Aminoglycosides
67
Why must PCN be combined with Aminoglycosides to be effective against Pseudomonas or Enterococci?
PCN opens cell wall and Aminoglycosides lyses cell
68
What group of antibiotics exhibits resistance within its own group?
Aminoglycosides
69
Chloramphenicol is broad spectrum with 100% CNS penetration, so why isn't it used more?
VERY toxic...
70
What concentration dependent adverse effect is Chloramphenicol associated with? Why is this concentration dependent?
Bone marrow suppression
| - Effects stop when medication dose is altered/stopped
71
What non-concentration dependent adverse effect is Chloramphenicol associated with?
Fatal aplastic anemia
72
What antibiotic is associated with grey baby syndrome?
Chloramphenicol
73
What antibiotic has 100% CNS penetration?
Chloramphenicol
74
What three groups of antibiotics or medications are associated with toxicity/contraindicated in children?
- Ceftriaxone
- Sulfa drugs
- Chloramphenicol
75
What is the concern for using Ceftriaxone on neonates/children?
Bilirubin displacement
76
What is the concern for using Sulfa drugs on neonates/children?
Kernicterus (bilirubin displacement)
77
What is the concern for using Chloramphenicol on neonates/children?
Grey baby syndrome
78
What are the two DOC for H. pylori? What one drug must be combined with either of these?
Tetracyclines or Azithromycin
| - Combined with Metronidazole
79
What two groups of antibiotics are the DOC for Chlamydia?
- Tetracyclines
| - Macrolides (Azithromycin, Erythromycin)
80
What two groups of antibiotics or medications are the DOC for Mycoplasma pneumoniae?
- Tetracyclines
| - Erythromycin
81
What is the primary MOR for Tetracyclines? What is important to note about this in terms of cross resistance?
Efflux pumps
| - There is NO cross-resistance across class (if resistant to one, can still try the other two)
82
What is the primary toxicity associated with Tetracyclines? What other group of antibiotics also exhibit this toxicity?
Chelation with supplements (calcium, iron): causes decreased absorption
- Also Fluoroquinolones
83
What are three important adverse effects associated with Tetracyclines?
- Bone discoloration
- Tooth discoloration
- Photosensitivity
84
What is the MOA for Fluoroquinolones?
Target DNA gyrase or topoisomerase (DNA cannot uncoil to replicate)
85
What are the two DOC for UTIs?
- Bactrim
| - Ciprofloxacin
86
What is the DOC for P. aeruginosa?
Antiseudomonal PCN + aminoglycoside
87
What is the DOC for prostatitis?
Ofloxacin
88
What is the DOC for community-acquired pneumonia (CAP)?
Levofloxacin
89
Which two medications from the Fluoroquinolones group are effective against anaerobes?
- Moxifloxacin
| - Gemifloxacin
90
Which medication from the Fluoroquinolones group is only ocular application?
Gatifloxacin
91
What is the unique adverse effect associated with Fluoroquinolones?
Achilles tendon rupture
92
What are the four most significant toxicities associated with Fluoroquinolones?
- Tendon rupture
- Prolonged QT interval
- Photosensitivity
- Cartilage erosion
93
What is the primary contraindication associated with Fluoroquinolones?
Children less than 18 years due to cartilage erosion
94
What is the spectrum of Metronidazole?
ONLY anaerobes
95
What is the 2nd DOC for C. diff after oral Vancomycin?
Metronidazole
96
Which antibiotic is associated with a metallic taste when taken orally?
Metronidazole
97
What three conditions must be met in order for a medication to be considered effective against UTIs?
- Renally cleared
- Concentrate in urine (only cidal in UT)
- Active in acidic pH
98
What two organisms have built resistant against Nitrofurantoin? How do they do this?
Proteus organisms and Pseudomonas organisms
| - Increase urine pH so abx is ineffective
99
Which antibiotic turns urine brown?
Nitrofurantoin
100
What antibiotic is associated with hemolytic anemia or G6PD deficiency in children?
Nitrofurantoin
101
What antibiotic is associated with pulmonary fibrosis in the elderly?
Nitrofurantoin
102
When taking Methenamine, what organ must be functioning properly? Why?
Need good liver function to properly eliminate ammonia
| - Methenamine decomposes to formaldehyde and ammonia
103
With use of Methenamine, if ammonia is not properly eliminated, what might this result in?
Encephalopathy (CNS side effects)
104
What is the MOA for Bactrim?
Sulfamethoxazole + Trimethoprim target folic acid at two points in pathway (each drug works synergistically at each part of pathway)
105
What are the three most significant toxicities associated with Sulfa drugs?
- Hypersensitivity
- SJS
- Kernicterus
106
What is the MOA for Daptomycin?
Binds to lipid bilayer and causes depolarization → cell death
107
What is the MOA for Mupirocin?
Inhibits production of charged isoleucine transfer
108
What is the primary application used for Mupirocin? What disease might it be used to treat?
Topical for nose or skin
| - Can treat Impetigo
109
What is the MOA for Polymyxins? What is their spectrum?
Binds to lipid A
| - G- only because lipid A is only found on outer membranes which are only in G-
110
What medication are Polymyxins often combined with?
Neomycin
111
In what two populations are Tetracyclines contraindicated?
- Pregnancy
| - Children under 8
112
In what population are Ketolides contraindicated?
Patients with Myasthesnia Gravis
113
In what two populations are Fluoroquinolones contraindicated?
- Pregnant
| - Children under age 18 (due to cartilage erosion)
114
In what two populations are Streptogramins contraindicated?
- Pregnant/breastfeeding
| - Children
