Lecture 3 highlights: Antibiotics Flashcards by Morgan Evans

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Name the 4 categories of antibiotics that attack cell wall synthesis

1) Beta-lactams
2) Vancomycin
3) Bacitracin
4) Cell membrane (polymyxins)

How well did you know this?

Not at all

Perfectly

Name 5 groups within the Beta-lactam category

1) Penicillins
2) Cephalosporins
3) Carbapenems
4) Monobactams

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the 2 ways bacteria can attack protein synthesis?

1) 50s subunit
2) 30s subunit

How well did you know this?

Not at all

Perfectly

1) What antibiotics attack the 50s subunit?
2) Which attack the 30s subunit?

1) Macrolides, clindamycin, linezolid
2) Tetracyclines, aminoglycosides

How well did you know this?

Not at all

Perfectly

Name a B-lactam with good G+ coverage

Penicillin G/Penicillin VK

How well did you know this?

Not at all

Perfectly

Group A and B strep resistance limits the efficacy of what?

Penicillin G/Penicillin VK

How well did you know this?

Not at all

Perfectly

Describe the coverage of Aminopenicillins (amoxicillin/ampicillin)

Enterococcus; slightly more aerobic G- coverage than penicillin G/VK

How well did you know this?

Not at all

Perfectly

1) Name some Antistaphyloccal penicillins
2) What are the effective against?

1) Nafcillin/oxacillin/dicloxacillin
2) Methicillin sensitive Staphylococcus aureus (MSSA)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

What are the side effects of penicillins?

GI upset, diarrhea, rash/allergic reactions, seizures with accumulation

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

1) List the 2 extended spectrum penicillins
2) Describe their G- coverage

1) Piperacillin (IV), Ticarcillin (IV)
2) Most aerobic gram negatives, including pseudomonas

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Describe when you should start renal dosing (PO) for penicillins

1) Amoxicillin: <30ml/ min
2) Ampicillin: <50ml/ min
3) Penicillin (&dicloxacillin): No adjustment needed

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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?

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

Lecture 3 highlights: Antibiotics Flashcards

Only stuff he talked abt in class (85 cards)