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Pharmacology > Lecture 16: Antibiotics Part 2 > Flashcards

Lecture 16: Antibiotics Part 2 Flashcards

1
Q

Are all DNA synthesis agents bactericidal or bacteriostatic?

A

Bactericidal

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2
Q

What do all fluoroquinolones end in?

A

Floxacin

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3
Q

What are the main 3 FQs used in clinical practice?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin

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4
Q

What is the MOA of a FQ?

A

Inhibits bacterial DNA topoisomerase and gyrase, promoting DNA breakage

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5
Q

What is unique about the spectrum of an FQ?

A

Atypical coverage

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6
Q

If I want anaerobic coverage in an FQ, which one would I choose?

A

Moxifloxacin

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7
Q

When I see respiratory FQs, what am I referring to?

A

Levofloxacin, Moxifloxacin, and Gemifloxacin.

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8
Q

When I see antipseudomonal FQs, what am I referring to?

A

Levofloxacin, Ciprofloxacin

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9
Q

What do FQs generally lack coverage of?

A

Staph A

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10
Q

What is the novel FQ that can cover MRSA?

A

Delafloxacin

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11
Q

What is the major concern when prescribing an FQ to the elderly?

A

CNS effects.

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12
Q

Which FQ does not have QT prolongation concerns?

A

Delafloxacin

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13
Q

What bacterial GI effect is heavy FQ use associated with?

A

C. Diff diarrhea

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14
Q

What is the BBW of an FQ?

A

Tendonitis/Tendon rupture

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15
Q

What is the MOA of metronidazole?

A

Cause loss of DNA helical structure and strand breakage

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16
Q

What drug class is metronidazole?

A

Nitroimidazole

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17
Q

What is the coverage of metronidazole?

A

Anaerobes only

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18
Q

What is metronidazole often combined with?

A

Levofloxacin, since levofloxacin has poor anaerobic coverage.

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19
Q

What is the BBW of metronidazole?

A

Carcinogen!!
DO NOT DRINK WITH ALCOHOL

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20
Q

How many weeks of metronidazole therapy do I start to see CNS toxicity?

A

4 weeks

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21
Q

What kind of drug-drug interactions does metronidazole have?

A

Increase warfarin and lithium
Decreased by phenobarbital and phenytoin, and increased by cimetidine

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22
Q

What is the MOA of rifampin?

A

Inhibits beta-subunit of DNA-dependent RNA polymerase

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23
Q

What is rifampin’s main clinical use regarding staphylococcus?

A

Used as synergistic therapy. It prevents staph A from sticking to prosthetics like heart valves or limbs.

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24
Q

What are the 3 bacteria rifampin is mainly used for?

A

Staphylococcus
Mycobacterium
Neisseria

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25
Q

What is the main side effect that I need to counsel patients about regarding rifampin?

A

Red-orange staining for body fluids!

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26
Q

What are the side effects of extended rifampin usage > 4 weeks?

A

Hematologic effects (Thrombocytopenia, leukopenia, and granulocytopenia)

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27
Q

What should I always do when attempting to order rifampin?

A

Drug interaction check!!!!!

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28
Q

What medications does rifampin have proven interference with?

A

Oral contraceptives.

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29
Q

What are the two folate antagonists?

A

Sulfamethoxazole
Trimethoprim

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30
Q

What bacteria are the folate antagonists the drug of choice for?

A

Stenotrophomonas maltophilia

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31
Q

What are folate antagonists known for causing more frequently than most other abx? (side effect)

A

SJS/TEN
Steven johnson syndrome
Toxic epidermis necrolysis

AKA RASH

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32
Q

What hypersensitivity reaction should I be wary about regarding folate antagonists?

A

Sulfa allergies.

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33
Q

What kind of drugs should I be wary about when adding a folate antagonist?

A

Any drug that can cause hyperkalemia as well.

34
Q

What kind of patients must avoid folate antagonists?

A

G6PD deficiency

35
Q

What are the protein inhibitors?

A

30S:
Tetracyclines
Glycylcyclines

30S & 50S:
Aminoglycosides

50S:
Macrolides
Lincosamides
Streptogrammins
Oxazolidinones

36
Q

Are protein inhibitors bacteriostatic or bactericidal?

A

Bacteriostatic, aka inhibition of growth but does not kill bacteria.

37
Q

What are the 3 tetracycline drugs?

A

Tetracycline
Doxycycline
Minocycline

38
Q

What can tetracyclines cover that is significant?

A

Atypicals!

39
Q

What drug can treat MDR acinetobacter?

A

Minocycline

40
Q

What are tetracyclines absolutely contraindicated in?

A

Pregnant women and children < 8 yo because of teeth discoloration (permanent)

41
Q

Which of the tetracyclines is the most well-tolerated?

A

Doxycycline

42
Q

What causes impaired absorption of tetracyclines?

A

Vitamins, such as products with Ca, Fe, Mg, Al, or Zinc.

43
Q

What drug is a glycylcycline?

A

Tigecycline (tiger!)

44
Q

What is the common clinical use of tigecycline?

A

Second-line.

Note:
Very broad spectrum agent.

45
Q

What is unique about the PK of tigecycline?

A

Rapid tissue periphery distribution.
This means it is also useless for bacteremia.

46
Q

What is the main adverse effect that took tigecycline off primary use?

A

GI effects (30%!!!)

47
Q

What is unique about the new tetracyclines’ coverage?

A

Cover atypicals!

48
Q

What are the two new tetracyclines?

A

Omadacycline
Eravacycline

49
Q

What are the 3 aminoglycosides?

A

Gentamicin
Tobramycin
Amikacin

50
Q

Why are aminoglycosides commonly used in combination?

A

Monotherapy can cause resistance to build up very fast. They also don’t have great G+ coverage.

51
Q

What toxicity should I be wary about in aminoglycosides? why?

A

Nephrotoxicity, because they build up in the urine.

52
Q

What is the new aminoglycoside?

A

Plazomicin

53
Q

What is the spectrum of plazomicin?

A

S. Aureus + MRSA
CRE

54
Q

What are the 3 macrolides?

A

Erythromycin
Azithromycin
Clarithromycin

ACE mycins

55
Q

What is unique about the coverage of macrolides?

A

Atypical coverage!

56
Q

Why is erythromycin generally not used as an ABX anymore?

A

GI side effects.

57
Q

Why do we prefer azithromycin among the macrolides?

A

No interaction with CYP 3A4.

58
Q

What drugs should I avoid when using macrolides?

A

QT prolonging drugs
warfarin

59
Q

What are the two treatments for C. Diff?

A

Vancomycin + Fidaxomicin

60
Q

What is the MOA of fidaxomicin?

A

Inhibits RNA synthesis via RNA polymerase inhibition

61
Q

What drug is a lincosamide?

A

Clindamycin

62
Q

What is the boxed warning for clindamycin?

A

Pseudomembranous colitis

63
Q

What drug is a streptogrammin?

A

Quinupristin-dalfopristin

64
Q

Why do we not use streptogrammin anymore?

A

Myalgia

65
Q

What drugs are oxazolidinones?

A

Linezolid
Tedizolid

66
Q

What is significant about oxazolidinones?

A

G+ only, includes MRSA and VRE.

One of only 2 drugs? that is reliable for VRE treatment.

67
Q

What is the most common adverse reaction with linezolid usage > 2 weeks?

A

Thrombocytopenia
Myelosuppression

68
Q

What adverse reaction can occur with linezolid usage > 4 weeks?

A

IRREVERSIBLE peripheral neuropathy! and optic neuropathy.

69
Q

Why is unique about the PK of linezolid?

A

PO bioavailability is the same as IV.

70
Q

What is an interaction that we should still counsel pts about regarding linezolid?

A

Serotonin syndrome (which is proven to be not be the case anymore)

71
Q

What drug is a pleuromutilin?

A

Lefamulin

72
Q

What is significant about the spectrum of lefamulin?

A

Atypical coverage

73
Q

What drugs are lefamulin CId with?

A

QT prolonging drugs

74
Q

What is the MOA of nitrofurantoin?

A

Reduced by flavoproteins to active intermediates that may inactivate or damage ribosomal proteins, DNA and RNA

75
Q

What is unique about the MOA of nitrofurantoin?

A

ONLY active in urine! Needs CrCl > 30

76
Q

What is the main use of nitrofurantoin? Why?

A

E. Coli causing UTIs in elderly because it is well-tolerated and works only in urine.

77
Q

What disease is caused by long-term use of nitrofurantoin?

A

Pulmonary fibrosis

78
Q

What is the MOA of fosfomycin?

A

Interferes with bacterial cell wall synthesis by inhibiting enolpyruvyl transferase.

Active in urine only.

79
Q

Why is fosfomycin not used frequently even though it has a broad spectrum?

A

G- bacteria can produce products that inactivate fosfomycin.

80
Q

Describe the treatment modality for pseudomonas aeruginosa.

A

Empiric double-coverage.

Choose one of the beta lactams:
ES penicllin: Pip-tazo
3rd gen cephalosporin: Ceftazidime 4th gen cephalosporin: Cefepime Carbapenems: Doripenem, Imipenem-cilastatin, meropenem
Monobactam: aztreonam (Doripenem no longer used clinically.

Then

Choose one of the FQs or aminoglycosides:
Antipseudomonal FQs: Ciprofloxacin, Levofloxacin
Aminoglycosides: Amikacin, Tobramycin, Gentamicin

Note:
FQs are preferred over aminoglycosides due to nephrotoxicity.

Pharmacology (14 decks)

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