Lecture 3 highlights: Antibiotics Flashcards
Only stuff he talked abt in class
1) Name an inflammatory marker
2) List 3 general reasons for therapy failure
1) C-reactive protein
2) Drug factors, host factors, or pathogen factors
1) What must be required of an antibiotic to be converted from IV to PO?
2) When can you convert a pt from IV to PO antibiotics?
3) Briefly explain how you decide on an antibiotic treatment
1) High bioavailability* w/clear equivalence
2) Afebrile for 24 hours
3) Start broad, then narrow (from empiric, to broad, to directed)
Name the 4 categories of antibiotics that attack cell wall synthesis
1) Beta-lactams
2) Vancomycin
3) Bacitracin
4) Cell membrane (polymyxins)
Name 5 groups within the Beta-lactam category
1) Penicillins
2) Cephalosporins
3) Carbapenems
4) Monobactams
List the 3 ways antibiotics can attack nucleic acid synthesis, and what’s in each category
1) Folate synthesis: sulfonamides and trimethoprim
2) DNA gyrase: quinolones
3) RNA polymerase: rifampin
What are the 2 ways bacteria can attack protein synthesis?
1) 50s subunit
2) 30s subunit
1) What antibiotics attack the 50s subunit?
2) Which attack the 30s subunit?
1) Macrolides, clindamycin, linezolid
2) Tetracyclines, aminoglycosides
Name a B-lactam with good G+ coverage
Penicillin G/Penicillin VK
Group A and B strep resistance limits the efficacy of what?
Penicillin G/Penicillin VK
Describe the coverage of Aminopenicillins (amoxicillin/ampicillin)
Enterococcus; slightly more aerobic G- coverage than penicillin G/VK
1) Name some Antistaphyloccal penicillins
2) What are the effective against?
1) Nafcillin/oxacillin/dicloxacillin
2) Methicillin sensitive Staphylococcus aureus (MSSA)
1) Name an Antipseudomonal penicillin
2) What do they have improved coverage against? Name a species in particular
1) Piperacillin-tazobactam
2) Improved gram-negative coverage; Pseudomonas
List the 2 Natural Penicillins, how they can be taken (IV/IM/PO, etc), and a species they’re effective against
1) Penicillin G (IV & IM) & Penicillin V (PO)
2) Treponema pallidum
1) List the Penicillinase Resistant Penicillins and how they can be taken (IV/IM/PO, etc)
2) What bacteria do they target?
1) Methicillin, Nafcillin (IV), Oxacillin (IV), Dicloxacillin (PO)
2) Mouth anaerobes
List the 4 main categories of penicillins
1) Penicillin G/Penicillin VK
2) Aminopenicillins (amoxicillin/ampicillin)
3) Antistaphyloccal penicillins (nafcillin/oxacillin/dicloxacillin)
4) Antipseudomonal penicillins (piperacillin/piperacillin-tazobactam)
What are the side effects of penicillins?
GI upset, diarrhea, rash/allergic reactions, seizures with accumulation
1) List 2 aminopenicillins and their routes
2) What is it the DOC for?
3) Which one of this is the DOC for listeria with meningitis?
4) Describe their coverage
1) Ampicillin (IV & PO) Amoxicillin (PO)
2) Susceptible enterococci
3) Ampicillin
4) Same G+ aerobes as PCN, and aerobic G negatives Ecoli, Proteus, H. influenzae
Aminopenicillins + B-lactamase inhibitor
1) What are the two kinds and their routes?
2) What do they cover that amp/ amox don’t?
3) What do they cover that other penicillins don’t?
1) Ampicillin/ sulbactam (IV), Amoxicillin/ clavulanate (PO)
2) MSSA/MSSE
3) Same as above + B. fragilis
1) List the 2 extended spectrum penicillins
2) Describe their G- coverage
1) Piperacillin (IV), Ticarcillin (IV)
2) Most aerobic gram negatives, including pseudomonas
1) List the 2 Extended Spectrum + β-lactamase inhibitor penicillins
2) What aerobic G+ do they cover?
3) What do these cover that the regular extended spectrum penicillins don’t?
1) Extended Spectrum + β-lactamase inhibitor
2) Same as regular ES, plus MSSA, MSSE coverage
-Same as regular ES for G-s
3) Mouth anaerobe + B. fragilis
Describe when you should start renal dosing (PO) for penicillins
1) Amoxicillin: <30ml/ min
2) Ampicillin: <50ml/ min
3) Penicillin (&dicloxacillin): No adjustment needed
1) What is the class trend of cephalosporins?
2) What does ceftazidime cover that other 3rd gen cephalosporins don’t?
1) No activity against Enterococcus or atypicals
2) Pseudomonas
1) 4th gen cephalosporins (cefepime) cover what? What do they not cover?
2) What generation has the opposite coverage?
1) Pseudomonal coverage; no MRSA
2) 5th gen
1) What do 5th gen cephalosporins (ceftaroline) cover?
2) What are the side effects of cephalosporins in general?
1) MRSA coverage; no Pseudomonal
2) GI upset, diarrhea, rash/allergic reactions, seizures with accumulation
1st gen cephalosporins:
1) List the 2 in this category and their modes of administration
2) Out of all cephalosporins, what are they the best at?
3) Describe its efficacy against aerobic gram positives and negatives
4) What abt against anaerobes?
1) Cefazolin (IV) + Cephalexin (PO)
2) Best activity against gram + aerobes
3) G+: Excellent MSSA, MSSE, streptococci
-G-: Weak E coli, Klebsiella, Proteus
4) None
2nd gen cephalosporins (2A):
1) List them (3) and their routes of administration
2) Describe their anaerobic coverage
1) Cefuroxime (PO & IV), Cefprozil (PO), Cefaclor (PO)
2) Mouth anaerobes
2nd gen cephalosporins (2B):
1) What are the 2 meds in this category?
2) What do they cover that doesn’t fit in the G+ or - cateogry?
1) Cefoxitin (IV) and Cefotetan (IV)
2) Mod B. fragilis (increased resistance)
1) List the 3 third generation oral cephalosporins
2) List the 3 third gen IV cephalosporins
1) Cefdinir, Cefixime, Cefpodoxime
2) Cefotaxime, Ceftriaxone
3rd gen IV cephalosporins:
1) Which has a long half life? Explain
2) Which has the addition of pseudomonal coverage?
1) Ceftriaxone has long half-life so Qday dosing usually
2) Ceftazidime
4th gen cephalosporins (Cefepime (IV)):
1) List a unique characteristic
2) Do they cover pseudomonas?
1) More stable to induction resistance with pseudomonas
2) Including Pseudomonas (& most G- aerobes)
5th gen cephalosporins (Ceftaroline (IV)): Describe their aerobic G+ coverage
1) MRSA, VRSA, MSSA/E, Streptococci
2) Minimal activity vs. E. faecalis
List when you should start renal dosing for:
1) Cefdinir
2) Cefuroxime axetil
3) Cephalexin
1) <30 mL/min
2) <30 mL/min
3) 50mL/min
1) What antibiotic class can be appropriately referred to as the “big guns”?
2) Do they cover atypicals? What abt MRSA and VRE?
3) Which of these should not be used in the treatment of pneumonia?
1) Carbapenems
2) NO atypical, MRSA, or VRE coverage
3) Doripenem
Carbapenems:
1) Which has Acinetobacter coverage?
2) Which lacks Pseudomonal and Enterococcal coverage?
1) Imipenem
2) Ertapenem:
Why are carbapenems not super commonly used?
Bad side effects: Diarrhea rash/allergic reactions, seizures with accumulation
Aztreonam (IV) (a type of monobactam):
1) Describe the G+ coverage
2) What abt the G- coverage?
1) NO gram-positive coverage
2) Great gram-negative coverage; incl. Pseudomonas
What are two side effects of monobactams (like aztreonam)?
Rash, GI intolerance
True or false: monobactams can be used with PCN allergy
True
Beta-Lactams: Carbapenems:
1) What does Ertapenem (all IV) have?
2) What does it not cover?
3) What is it the DOC for?
1) Elastin bc of vessel damage
2) Pseudomonas, enterococcus, E.faecium
3) ESBL
What beta-lactam carbapenem is not commonly used due to seizure threshold?
Imipenem
True or false: all carbapenems and aminoglycosides listed are IV only
True
Aminoglycosides:
1) What do they primarily cover?
2) What else can they be used for? When and how?
1) Mainly gram negative, including Pseudomonas
2) Synergy dosing for gram positive pathogens
-Streptococcus and Enterococcus usually for infective endocarditis
Aminoglycosides:
1) Side effects?
2) Class trend?
1) Nephrotoxicity, hearing loss, vestibular toxicity
2) Drug therapy monitoring; extended interval dosing
What group of antibiotics is associated with nephrotoxicity and HL?
Aminoglycosides
Aminoglycosides (Gentamicin (IV), Tobramycin (IV), Amikacin (IV), Streptomycin (IV)):
1) What are they toxic to?
2) What is the dosing?
2) Why is synergism used?
4) Which has least pseudomonal resistance? Why?
1) Nephro- and ototoxicity
2) Traditional dosing and extended interval dosing
3) Enhance uptake of AMGs
4) Amikacin; enzyme binding loci
Aminoglycosides:
1) Describe the aerobic G- coverage
2) What atypical bacteria does it cover?
1) Excellent gram negative
2) Mycobacteria
Which macrolide doesn’t inhibit CYPs? Which do?
1) Azithromycin
2) Clarithromycin, erythromycin
Macrolides:
1) List 3
2) What are 4 bacteria they’re effective against?
3) Side effects?
1) Azithromycin, clarithromycin, erythromycin
2) Streptococcus pneumoniae, Haemophilus, Neisseria, and Moraxella
(increasing resistance tho)
3) GI upset, QTc prolongation, hepatotoxicity
Macrolides:
1) List them and how they can be given
2) Which causes a post-antibiotic effect?
3) What stands out about their coverage?
1) Azithromycin (IV & PO), Clarithromycin (PO), Erythromycin (PO & IV)
2) Azithromycin
3) Also covers atypicals
Name a macrolide that needs no renal dose adjustment and no particular renal caution taken
Erythromycin
Macrolides:
1) When does renal dosing for Azithromycin start?
2) What abt for Clarithromycin?
1) Just use caution at <10 mL/min, no dosage adjustment needed
2) <30mL/ min
Fluoroquinolones:
1) List 3 that work for respiratory conditions
2) Which one is used for non-respiratory?
1) Gemifloxacin, levofloxacin, and moxifloxacin
2) Ciprofloxacin
Fluoroquinolones:
1) Delafloxacin particularly covers what 2 things?
2) What are the side effects?
1) P. aeruginosa and MRSA coverage
2) BOXED WARNINGS!! QTc prolongation
-Mental side effects, low blood sugar, disabling side effects, neuropathy
Why do fluoroquinolones have boxed warnings?
QTc prolongation
Fluroquinolones: Ciprofloxacin
1) How can Ciprofloxacin (2nd gen) be administered?
2) What is it most potent against
3) Describe its G+/G- coverage
4) Does it coverage extend to atypicals?
1) Ciprofloxacin (IV and PO)
2) Most potent against pseudomonas
3) Poor G+; excellent gram– including pseudomonas
4) Yes
Name a Fluroquinolone that requires no renal dose adjustment
Moxifloxacin
When does renal dosing for Ciprofloxacin and Levofloxacin start?
50mL/min
Name 2 antibiotics that can be used for Vancomycin-resistant Enterococci (VRE)
Vancomycin-resistant Enterococci (VRE)
Vancomycin (gram positive coverage):
1) Name 3 bacteria it works for via IV
2) Name 1 it treats orally
1) IV: MRSA, Streptococci, Enterococci
2) PO: C diff
Red man syndrome is a risk of infusing what drug too fast?
Vancomycin
List 3 things you should monitor pts for when on vancomycin
Nephrotoxicity, ototoxicity, Red man syndrome
Daptomycin:
1) Describe the scope of coverage
2) What does it not treat?
3) What are the 2 most common side effects?
4) What do you need to stop when on this med?
1) Most gram-positive bacteria, incl. VRE
2) NO pneumonia treatment
3) Myopathy, rhabdomyolysis
4) CPK monitoring; stop statin while on therapy
Linezolid/tedizolid:
1) Describe its coverage
2) What drugs does it interact with?
1) VRE coverage (similar to daptomycin)
2) Risk of serotonin syndrome: MAOi/SSRIs
Vancomycin (type of glycopeptide):
1) List the routes of administration
2) What is a unique characteristic? (besides red man syndrome risk)
3) Does it cover MRSA?
4) Describe its aerobic G- coverage
1) Vancomycin (IV & PO)
2) Static against enterococcus
3) Yes
4) None
Telavancin (type of glycopeptide):
1) List the routes of administration
2) What are two unique characteristics?
3) Describe its aerobic G- coverage
1) IV only
2) Metallic taste, BB warning in pregnancy
3) None
Daptomycin (cyclic lipopeptide):
1) List the routes of administration
2) What are two unique characteristics?
3) Does it cover MRSA?
4) Describe its aerobic G- coverage
1) IV only
2) ^ CPK (myopathy). Inactivated by pulmonary surfactants
3) Yes
4) None
Name an antibiotic that’s a nonselective MAOI
Linezolid
What medication can cause bone marrow suppression (Thrombocytopenia)?
Linezolid
Linezolid:
1) List the routes of administration
2) What are three unique characteristics?
1) IV and PO
2) Bone marrow suppression (Thrombocytopenia)
-Nonselective MAOI (concern for serotonin syndrome)
-PO is 100% BioA
Tigecycline:
1) List the routes of administration
2) What can it not be used for and why?
3) Describe its coverage
1) IV only
2) High Vd; cannot be used for bloodstream infections
3) Broad G-; Atypicals
Quinupristin/Dalfopristin: how can it be administered?
IV only (but can cause phlebitis)
What antibiotic is limited use in children < 8 to 12 years old due to teeth discoloration?
Tetracyclines in general, but esp. Doxycycline, (IV & PO)
Tetracyclines:
1) List 3 and how they can be administered
2) List an aerobic G+ they cover
3) What are they the DOC for?
1) Doxycycline, (IV & PO) Minocycline (PO & IV), Tetracycline (PO)
2) CA-MRSA
3) DOC for ticks; covers Atypicals + rickettsia
Sulfonamides (Trimethoprim/ sulfamethoxazole):
1) How can it be administered?
2) What should you do if the pt develops a rash?
3) List a G+ aerobe they cover
4) List some G-s they cover
5) Do they cover anaerobes?
1) IV & PO
2) Do not re-challenge if rash develops
3) A-MRSA, strep (no group A)
4) GN enterics, H. influenzae
5) No
Name a medication that can be used for overgrowth of C.diff
Clindamycin (IV and PO)
Clindamycin (IV and PO):
1) Name an aerobic G+ it covers
2) Does it cover anaerobes?
1) CA-MRSA
2) Yes, anaerobes including B. fragilis
What medication can cause Disulfram reaction with alcohol and leave a metallic taste in mouth? When should it be used?
Metronidazole (IV and PO); only use for anaerobes
What medication should only be used for anaerobes?
Metronidazole (IV and PO)
Do doxycycline, clindamycin, and linezolid need renal dosing?
No
When does renal dosing start for the following?:
1) Tetracycline
2) Sulfamethoxazole / trimethoprim
1) 90mL/min
2) 30mL/min
What are 3 ways to categorize dose optimization?
1) Cp max
2) AUC (area under curve)
3) MIC (minimal inhibitory concentration)
List a Concentration-dependent (Cmax:MIC) group of antibiotics
Aminoglycosides
List 2 exposure-dependent (AUC:MIC) antibiotics
Vancomycin and macrolides
Which antibiotics are time-dependent (Time > MIC)?
Beta-lactams
