Lecture 8-Antimicrobials Flashcards
The lowest concentration of antibiotic required to prevent growth is the ___
minimum inhibitory concentration (MIC)
The lowest concentration of antibiotic required to kill bacteria is the ___
minimum bactericidal concentration (MBC)
You can compare MICs of different antibiotics to each other–T/F?
False–cannot compare MICs of different antibiotics to each other
You can, however, compare MIC of one single antibiotic to different organisms (i.e.: MIC of cipro for klebsiella vs. pseudomonas)
Bacterial sensitivity–disc diffusion technique–multiple discs of antibiotic are placed on an inoculated growth medium; antibiotic diffuses outward from the discs; antibiotic susceptibility is determined by the ___ around each disc
antibiotic susceptibility is determined by the radius around each disc
What is the difference between bactericidal and bacteriostatic?
Bactericidal = kills the bacteria
Bacteriostatic = stops the bacteria from replicating (but does not kill the existing bacteria)
Penicillins, cephalosporins, aminoglycosides, vancomycin, quinolone, aztreonam, imipenem, bacitracin, and polymyxins are all bacteri___
bactericidal
Tetracyclines, chloramphenicol, eryrthromycin, clindamycin, sulfonamides, and trimethoprim are all bacteri___
bacteriostatic
Narrow-spectrum antibiotics kill ___ (many/few) bacteria
few bacteria
examples = penicillin G, erythromycin, clindamycin
Broad-spectrum antimicrobials kill ___ (many/few) bacteria
many bacteria
examples = ampicillin, cephalosporins, ahminoglycosides, tetracyclines, chloramphenicol, quinolones
Time-dependent killing = antibiotics that increase their rate of microbial killing with concentrations up to ___x MIC
4x MIC
Time-dependent killing–greater concentrations ___ (do/do not) kill bacteria faster or in greater numbers
greater concentrations do NOT kill bacteria faster or in greater numbers
Time-dependent killing–clinical efficacy is related to the duration for which these levels are maintained–T/F?
True
What (3) antibiotic classes demonstrate time-dependent killing?
- Beta-lactams
- Monobactams (aztreonam)
- Macrolides (erythromycin, clindamycin)
Continuous infusion of time-dependent killing antibiotics ___ (has/has not) shown to be more effective than intermittent boluses
continuous infusion of time-dependent killing antibiotics has NOT shown to be more effective than intermittent boluses
What term describes the following?–some antibiotics continue to suppress the growth of bacteria even after the antibiotic is no longer detectable
Post Antibiotic Effect (PAE)
PAE is demonstrated virtually for all antimicrobials–T/F?
True
PAE can be ___ (increased/decreased) in acidic, infected media
decreased
During the PAE phase, bacteria are ___ (more/less) susceptible to killing by leukocytes–this is known as what?
During the PAE phase, bacteria are MORE susceptible to killing by leukocytes–this is known post antibiotic leukocyte effect
What is the judicious use of antibiotics to reduce resistance development?
Antimicrobial stewardship
(2) types of antibiotic resistance–___ and ___
intrinsic and acquired
___ (intrinsic/acquired) resistance is natural resistance to the antimicrobial
Intrinsic resistance is natural resistance to the antimicrobial
___ (intrinsic/acquired) resistance reflects a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective
Acquired resistance reflects a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective
What are some ways that acquired antibiotic resistance can occur?–___ (increased/decreased) permeability; ___ (increased/decreased) efflux pumps; ___activation; ___ of the antimicrobial target
decreased permeability; increased efflux pumps; inactivation; modification of the antimicrobial target
The majority of nosocomial (hospital-acquired) infections are ___, ___, and ___ infections
urinary, respiratory, and blood infections
2018 CDC data–1 in ___ hospitalized patients will develop an infection
1 in 31 hospitalized patients
Nosocomial infections are highly associated with the use of ___
devices–i.e.: ventilator, vascular access catheter, urethral catheter
Nosocomial infections occur due to breakdown or bypass of normal host defenses and clearance mechanisms–T/F?
True
Different devices support various microorganisms differently–T/F?
True
Rate of central line related infections (from highest risk location to lowest risk location)
Femoral > IJ > Subclavian
Antibiotic impregnated catheters may decrease bacteremia, but this is not shown to be true in all studies–T/F?
True
Clostridium difficile is now known as ___
Clostridioides difficile
What provokes C. difficile disease? How?
Antibiotic therapy, including prophylaxis…it alters normal bowel flora
Pathogenesis of C. diff–typically ___-mediated; bacteremia with C. diff is extremely ___ (rare/common)
toxin-mediated–enterotoxin A, cytotoxin B; bacteremia with C. diff is extremely rare
Diagnosis of C. diff is confirmed by detection of one of the ___
toxins
C. diff spores are extremely hearty and impervious to antibiotic therapy, resulting in a 10% relapse rate in successfully treated patients–T/F?
True
Treatment of C. diff = oral ___
oral vancomycin
Dificid (fidaxomicin) is another antibiotic that can be used to treat C. diff with similar cure rates as Vancomycin and reduced recurrence for moderate to severe infection–T/F?
True
In patients with ongoing original infection [the infection that they had before getting C. diff]…treat the infection with appropriate ___-spectrum antibiotics; continue C. diff therapy also and extend the C. diff therapy course for ___ to ___ days after the completion of the other antibiotics
In patients with ongoing original infection [the infection that they had before getting C. diff]…treat the infection with appropriate broad-spectrum antibiotics; continue C. diff therapy also and extend the C. diff therapy course for 5 to 10 days after the completion of the other antibiotics
Treatment course of C. diff is usually ___ to ___ days
Treatment course of C. diff is usually 10 to 14 days
In the future, C. diff ___ (can/cannot) be provoked with subsequent antibiotic courses because of the presence of latent ___
In the future, C. diff can be provoked with subsequent antibiotic courses because of the presence of latent spores
C. diff risk factors–anti___ use; ___ suppressant therapy; inappropriate ___ and ___ techniques
antimicrobial use; acid suppressant therapy; inappropriate hand washing and cleaning techniques
Surgical antibiotic prophylaxis ___ (is/is not) usually necessary to continue past the 1st post-op day
Surgical antibiotic prophylaxis is NOT usually necessary to continue past the 1st post-op day
For surgical antibiotic prophylaxis, usually use what antibiotic class?
1st generation cephalosporin–cefazolin
Low cost, broad spectrum, low incidence of allergic reactions
Wound classification–classes __-__
classes I-IV
Class I = ___; ___traumatic, no break in ___ technique; ___, ___, and ___ tracts not entered
Class I = clean
- atraumatic
- no break in sterile technique
- respiratory, GI, and GU tracts not entered
Class II = ___; surgery in areas known to harbor ___; ___ spillage of contents
Class II = clean-contaminated
- surgery in areas known to harbor bacteria
- no spillage of contents
Class III = ___; major break in ___ technique; surgery on ___ wounds; gross ___ spillage; entrance into an infected ___ or ___ tract
Class III = contaminated
- major break in sterile technique
- surgery on traumatic wounds
- gross GI spillage
- entrance into an infected biliary or GU tract
Class IV = ___; infection existed ___ the surgery, i.e.: old wound with devitalized tissue, perforated viscera
Class IV = dirty-infected; infection existed before the surgery, i.e.: old wound with devitalized tissue, perforated viscera
Surgical prophylaxis recommendations for clean wounds–___ species most common; ___ (need/no need) for prophylaxis for some clean procedures, Gm(+) coverage with ___
Surgical prophylaxis recommendations for clean wounds–Staphylococcal species most common; no need for prophylaxis for some clean procedures, Gm(+) coverage with cefazolin
Surgical prophylaxis recommendations for clean-contaminated and contaminated wounds–administer ___ antibiotics; also for ___ and most ___ tract procedures
Surgical prophylaxis recommendations for clean-contaminated and contaminated wounds–administer prophylactic antibiotics; also for hysterectomies and most urinary tract procedures
Surgical prophylaxis recommendations for patients at high or moderate risk undergoing procedures involving infected tissues or receiving prosthetic cardiac valves–include anti___coccal antibiotics for cellulitis and osteomyelitis; coverage for ___ (active/inactive) infections
include antistaphylococcal antibiotics for cellulitis and osteomyelitis; coverage for active infections
Efficacy of prophylaxis for fungal infection is difficult to prove–T/F?
True
Diagnosis of invasive candidal infection is difficult to prove even with modern blood culture techniques because it is difficult to distinguish between candidal colonization and invasion–T/F?
True
Some agree with the use of pre-emptive therapy with fluconazole in certain clinical situations–T/F?
True
Issue with antifungal prophylaxis is complicated by Fluconazole-resistant ___ emerging
Fluconazole-resistant C. albicans emerging
Prophylactic antibiotic administration is initiated within ___ minutes prior to the surgical incision
120 minutes prior to the surgical incision
Ancef is initiated within ___ minutes prior to the surgical incision
Ancef is initiated within 60 minutes prior to the surgical incision
Vanco is initiated within ___ minutes prior to the surgical incision
Vanco is initiated within 120 minutes prior to the surgical incision
JAMA surgery 2019–increasing duration of antimicrobial prophylaxis was associated with higher odds of acute ___ injury and ___ infection in a duration-dependent fashion
increasing duration of antimicrobial prophylaxis was associated with higher odds of acute kidney injury and C. diff infection in a duration-dependent fashion
JAMA surgery 2019–extended duration of antibiotic prophylaxis (3 days, 5 days post-op) ___ (did/did not) lead to additional SSI reduction
extended duration (3 days, 5 days post-op) did NOT lead to additional SSI reduction
Antibiotic medications by class–beta-___; ___sporins; ___bactams, ___penems; ___lides; ___quinolones; ___cyclines; ___glycosides
- beta-lactams
- cephalosporins
- monobactams, carbapenems
- macrolides
- fluoroquinolones
- tetracyclines
- aminoglycosides
What (4) antibiotic classes are beta-lactams?
- Penicillin
- Cephalosporins
- Carbapenem
- Monobactam
Beta-lactams bind to the ___; they are ___ inhibitors
Beta-lactams bind to the penicillin binding protein (PBP); they are cell wall synthesis inhibitors
What enzyme causes penicillin resistance?
B-lactamase–breaks a bond in the B-lactam ring of penicillin to disable the molecule
Bacteria with B-lactamase can resist the effects of ___ and other ___ antibiotics
can resist the effects of penicillin and other B-lactam antibiotics (cephalosporins, carbapenem, monobactam)
What can be added to penicillin antibiotics to prevent resistance?
A beta-lactamase inhibitor
(3) beta-lactamase inhibitors = ___bactam, ___bactam, ___ acid
sulbactam, tazobactam, clavulanic acid
Penicillins end in -___
-cillin
Examples = penicillin ampicillin, amoxicillin, piperacillin, ticarcillin, oxacillin, nafcillin, dicloxacillin, methicillin
Zosyn = ___ + ___
piperacillin + tazobactam
Penicillin ___ (is/is not) stable to beta lactamase
Penicillin is NOT stable to beta lactamase (have to add a beta-lactamase inhibitor to it)
Penicillin is effective in treating strep __ and __; ___
Strep A and B; treponema pallidum (syphilis)
Side effects of penicillin–hyper___; ___ upset; ___rrhea; ___ reaction
hypersensitivity; GI upset; diarrhea; Jarisch-Herxheimer reaction
What is Jarisch-Herxheimer reaction? What antibiotic may cause it?
high fevers, rash, similar to Rocky Mountain spotted fever; penicillin may cause it
Penicillin is often used before ___ procedures
dental procedures (lots of strep in the mouth)
If someone has a penicillin allergy, what are the next antibiotic choices? ___ or ___
vancomycin or cleocin
Clinical Infectious Diseases October 2017–patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of ___-line perioperative antibiotics
attributable to the receipt of second-line perioperative antibiotics
Because people with penicillin allergy will often receive vancomycin or cleocin instead–vanco only covers gram positive infections (staph, strep); cleocin has some broad spectrum coverage but doesn’t really cover some of the common bacteria that cause SSIs
MRSA and C. diff rates are ___ (lower/higher) in patients with a reported penicillin allergy because they have higher use of ___-spectrum antibiotics
MRSA and C. diff rates are higher in patients with a reported penicillin allergy because they have higher use of broad spectrum antibiotics
What antibiotic has the highest rates of resultant C. Diff infection?
Cleocin
Pencillins, when given alone, ___ (are/are not) stable to beta-lactamase
Penicillins, when given alone, are NOT stable to beta-lactamase
Penicillins with beta lactamase inhibitors ___ (do/do not) cover MRSA
Penicillins with beta lactamase inhibitors do NOT cover MRSA
Ticarcillin +/- Clavulanate (Timentin) causes what electrolyte abnormalities?–___natremia, ___kalemia
hypernatremia, hypokalemia
Piperacillin +/- Tazobactam (Zosyn) side effects–prolonged ___ time; ___kalemia; ___penia at high doses
prolonged bleeding time; hypokalemia; neutropenia at high doses
Cephalosporin antibiotics are bacteri___
bactericidal–cell wall synthesis inhibitors, beta lactam ring
Cephalosporin MOA is the same as ___
penicillins
Cephalosporins are ___ (more/less) susceptible to penicillinases (ESBLs)
Cephalosporins are less susceptible to penicillinases (ESBLs)
So cephalosporins are more effective against bacteria with beta lactamase
ESBL = extended spectrum beta lactamase
Spectrum of action of cephalosporins is based on ___
generation
How many generations of cephalosporins are there?
5 generations–1st to 5th
As you go up in generation of cephalosporins, you lose gram ___ coverage and gain gram ___ coverage
As you go up in generation of cephalosporins, you lose gram positive coverage and gain gram negative coverage
___ generation cephalosporins = cefazolin, cephalexin
1st generation
___ generation cephalosporins = cefaclor, cefoxitin, cefprozil, cefuroxime, loracarbef
2nd generation
___ generation cephalosporins = cefotaxime, cefpodoxime, ceftazidime, ceftibutne, ceftriaxone
3rd generation
___ generation cephalosporins = cefepime
4th generation
___ generation cephalosporins = ceftobiprole, ceftaroline
5th generation
Half-life of ancef is ___ hours
1.8 hours
If procedure is going beyond ___ hours, need to redose ancef
If procedure is going beyond 4 hours, need to redose ancef
Cephalexin (keflex) and cefazolin (ancef) are both ___ eliminated
renally eliminated
Cefazolin (ancef) is generally safe–T/F?
True
3rd generation cephalosporins have even less gram ___ activity but have an extended gram ___ spectrum
3rd generation cephalosporins have even less gram positive activity but have an extended gram negative spectrum
Ceftazidime and cefoperazone [3rd generation cephalosporins] are anti-___
anti-pseudomonal
Which 3rd generation cephalosporins cross the BBB and can be used to treat meningitis?
Ceftriaxone (rocephin); cefotaxime (claforan)
Classes of cephalosporins can be used interchangeably–T/F?
False–cannot switch between classes for treatment
What 3rd generation cephalosporin has significant biliary excretion?
Cefotaxime (Claforan)
Ceftazidime (Fortaz) is a ___ generation cephalosporin; it covers most gram ___ with good ___ coverage
Ceftazidime (Fortaz) is a 3rd generation cephalosporin; it covers most gram negatives with good pseudomonas coverage
Ceftazidime (Fortaz) [3rd gen cephalosporin] + avibactam (beta lactamase inhibitor) offers significant gram ___ coverage and is usually reserved to treat ___
Ceftazidime (Fortaz) + avibactam offers significant gram negative coverage and is usually reserved to treat MDROs–multidrug resistant organisms
Ceftriaxone (Rocephin) is a ___ generation cephalosporin; it covers ___ better than most 3rd gens and most ___; covers most gram ___; ___ (does/does not) cover pseudomonas
Ceftriaxone (Rocephin) is a 3rd generation cephalosporin; it covers staph better than most 3rd gens and most strep; covers most gram negatives; does NOT cover pseudomonas
Max dose of ceftriaxone (rocephin) per day = ___ grams
4 grams/day
Side effects of ceftriaxone (rocephin) = ___ and biliary ___, particularly in young children; precipitates with ___ if running in the same IV line
diarrhea and biliary sludging, particularly in young children; precipitates with calcium if running in the same IV line
Main differences between ceftazidime (fortaz) and ceftriaxone (rocephin)–fortaz covers more gram ___, better ___ coverage; rocephin has more gram ___ coverage (not as good as 1st and 2nd generation cephalosporins), ___ (does/does not) cover pseudomonas
fortaz covers more gram negatives, better pseudomonas coverage; rocephin has more gram positive coverage (not as good as 1st and 2nd generation cephalosporins), does not cover pseudomonas
Ceftaroline (Teflaro) is a ___ generation cephalosporin; covers ___; gram ___ bacteria; has broad-spectrum activity against gram ___ bacteria
Ceftaroline (Teflaro) is a 5th generation cephalosporin; covers MRSA; gram positive bacteria; has broad-spectrum activity against gram negative bacteria
Cefiderocol (Fetroja) is a ___ generation cephalosporin; it is the first cephalosporin to cover ___
Cefiderocol (Fetroja) is a 5th generation cephalosporin (just came out in 2020); it is the first cephalosporin to cover Acinetobacter baumannii complex
Carbapenems–imipenem/cilastatin (primaxin) … cilastatin ___ (is/is not) a beta-lactamase inhibitor
cilastatin is NOT a beta-lactamase inhibitor
What does cilastatin do?–it inhibits ___ enzyme from breaking down imipenem
Cilastatin inhibits dihydropeptidase enzyme from breaking down imipenem
Imipenem/cilastatin (primaxin) has a high risk of ___
seizures
Primaxin [imipenem/cilastatin] + relebactam = ___, reserved for ___ gram negative infections in the ___ and ___
Primaxin [imipenem/cilastatin] + relebactam = recarbrio, reserved for MDRO gram negative infections in the urine and abdomen
Carbapenems are best to treat ___
ESBLs–extended spectrum beta lactamases
Meropenem is a ___; it has a ___ (lower/higher) incidence of seizures than imipenem
Meropenem is a carbapenem; it has a lower incidence of seizures than imipenem
Primaxin vs. meropenem–primaxin has ___ (better/worse) coverage, ___ (lower/higher) risk of seizures; meropenem has (better/worse) coverage, ___ (lower/higher) risk of seizures
Primaxin has better coverage, higher risk of seizures; meropenem has worse coverage, lower risk of seizures
Ertapenem (Invanz) has a ___ (low/high) seizure risk
low seizure risk
What is one monobactam antibiotic?
Aztreonam
Aztreonam has same MOA as ___; it is ___-spectrum
Aztreonam has same MOA as carbapenems; it is narrow-spectrum
Vancomycin inhibits ___ formation; disrupts cell wall ___; bacteri___; ___ (concentration/time) dependent
Vancomycin inhibits peptidoglycan formation; disrupts cell wall synthesis; bactericidal; concentration dependent
Vanco is given PO to treat ___ only; usually is given IV for treatment of other infections
Vanco is given PO to treat C. diff only; usually is given IV for treatment of other infections
If you take vanco orally, it does not leave the GI tract–T/F?
True
Vancomycin ___ (is/is not) a beta lactam
Vancomycin is not a beta lactam
Beta lactams are ___ (time/concentration) dependent
Beta lactams are time dependent
Vancomycin is ___ (time/concentration) dependent
Vancomycin is concentration dependent
Vancomycin offers ___ (broad/narrow) spectrum gram ___ (positive/negative) coverage
Vancomycin offers broad spectrum gram positive coverage
Treats staph, strep, enterococci, C. diff
Vancomycin is ___ eliminated
renally
Side effects of vanco = ___ syndrome; ___toxicity; ___toxicity; ___penia
Red-Man syndrome; nephrotoxicity; ototoxicity; thrombocytopenia
New guidelines for serious infections dose vanco based on the ___
AUC–area under the curve
Vanco weight based dosing–___mg/kg
15 mg/kg
1 g usually does not cut it as a loading dose
Linezolid (Zyvox) inhibits protein synthesis by binding ___S ribosomal subunit of the ___S ribosome to prevent the formation of a functional ___S initiation complex
Linezolid (Zyvox) inhibits protein synthesis by binding 23S ribosomal subunit of the 50S ribosome to prevent the formation of a functional 70S initiation complex
Linezolid (Zyvox) is bacter___ against enterococci and staph; bacteri___ against most strep
Linezolid (Zyvox) is bacteriostatic against enterococci and staph; bactericidal against most strep
Linezolid (Zyvox) offers ___ (broad/narrow) gram ___ (positive/negative) coverage against MRSA, VRE, enterococci faecalis and faecium
Linezolid (Zyvox) offers broad gram positive coverage against MRSA, VRE, enterococci faecalis and faecium
Side effects of linezolid (Zyvox)–___suppression–___emia, ___penia, ___penia, ___penia…check CBC; drug interaction with ___, potential for ___ syndrome
myelosuppression–anemia, leukopenia, pancytopenia, thrombocytopenia…check CBC; drug interaction with MAO (monoamine oxidase), potential for serotonin syndrome
What should you do if a person is on an SSRI and is going to be started on linezolid (Zyvox)?
Hold SSRI to prevent the development of serotonin syndrome because linezolid is a MAOI
Macrolides MOA–bind to the ___S ribosomal subunit targeting ___S ribosomal RNA –> inhibit protein ___ –> bacterio___
bind to the 50S ribosomal subunit targeting 23S ribosomal RNA –> inhibit protein synthesis –> bacteriostatic
Azithromycin (Zithromax) is a ___; half-life is ___ hours, only dose ___ per day; may prolong ___ interval
Azithromycin (Zithromax) is a macrolide; half-life is 68 hours, only dose once per day; may prolong QT interval
Azithromycin (Zithromax) has drug interactions with ___phylline, ___sporine, ___toin, ___mazepine, ___vudine; interactions ___ (are/are not) a CYP3A4 mechanism
theophylline, ciclosporine, phenytoin, carbamazepine, zidovudine (AZT–azidothymidine…drug used to prevent/treat HIV/AIDS); interactions are NOT a CYP3A4 mechanism (so it’s not an inhibitor or inducer of these medications)
Macrolides end in -___
-thromycin
Clarithromycin (Biaxin) may prolong ___ interval, has significant ___ toxicity, same drug interactions as azithromycin but is a potent ___ (inhibitor/inducer) of CYP3A4
Clarithromycin (Biaxin) may prolong QT interval, has significant GI toxicity, same drug interactions as azithromycin but is a potent inhibitor of CYP3A4
Erythromycin is the drug of choice for ___ disease; also used to treat gastro___, alternative to reglan
drug of choice for Legionnaires’ disease; also used to treat gastroparesis, alternative to reglan (because reglan has extrapyramidal side effects)
Erythromycin may cause significant ___ toxicity, may prolong ___ interval, and has CYP3A4 interactions
Erythromycin may cause significant GI toxicity, may prolong QT interval, and has CYP3A4 interactions
Which macrolide has the most drug interactions?
Clarithromycin (Biaxin) because it is a CYP3A4 inhibitor
But all macrolides have CYP3A4 drug interactions
Fluoroquinolones have many drug interactions–___s, ___, ant___, ___, pro___
NSAIDs, warfarin, antacids, amiodarone, probenecid–used to treat gout
How do fluoroquinolone work?–inhibit ___ synthesis
inhibit DNA synthesis
FDA safety communication for fluoroquinolones–black box warning for patients > ___ years
black box warning for patients > 65 years
Avoid in elderly patients > 65 years when other antibiotics are appropriate
High risk of side effects with fluoroquinolones–___itis/___ tendon rupture; ___logic effects; ___glycemia (fatal); ___idity/___ality; ___ prolongation
tendonitis/Achilles tendon rupture; neurologic effects; hypoglycemia (fatal); morbidity/mortality; QT prolongation
Ciprofloxacin (Cipro) is a ___; it treats most gram ___ including P. aeruginosa; drug of choice for bacterial ___ infections
Ciprofloxacin is a fluoroquinolone; it treats most gram negatives including P. aeruginosa; drug of choice for bacterial GI infections (traveler’s diarrhea)
Fluoroquinolones end in -___
-floxacin
Examples = ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin
Main things to know for FQ antibiotics–they can cause ___ prolongation; they cover a lot of gram ___; black box warning for elderly > age ___
they can cause QT prolongation; they cover a lot of gram negatives; black box warning for elderly > age 65
Delafloxacin (Baxdela) is used to treat acute bacterial ___ and ___ structure infections
used to treat acute bacterial skin and skin structure infections
Delafloxacin (Baxdela) is the first fluoroquinolone antibiotic with activity against ___; unlike other FQs, it is not associated with ___ prolongation or ___sensitivity
Delafloxacin (Baxdela) is the first fluoroquinolone antibiotic with activity against MRSA; unlike other FQs, it is not associated with QT prolongation or photosensitivity
Tetracyclines bind irreversibly to the ___S ribosomal subunit; they inhibit ___ synthesis; they are bacter___
Tetracyclines bind irreversibly to the 30S ribosomal subunit; they inhibit protein synthesis; they are bacteriostatic
Side effects of tetracycline antibiotics–___ upset; ___sensitivity; inhibition of ___ growth; ___toxicity; tooth dis___ and enamel ___plasia
Side effects of tetracycline antibiotics–GI upset, photosensitivity; inhibition of bone growth; hepatotoxicity; tooth discoloration (yellow teeth) and enamel hypoplasia
Tetracycline antibiotics inhibit bone growth during ___ and ___ trimesters through the age of ___
inhibit bone growth during 2nd and 3rd trimesters through the age of 8
Doxycycline (Vibramycin) has excellent tissue ___, including into the ___; causes permanent tooth ___; rare but fatal ___toxicity; drug interactions with ___farin, ___toin, ___pine, oral ___
Doxycycline (Vibramycin) has excellent tissue distribution, including into the CNS; causes permanent tooth discoloration; rare but fatal hepatotoxicity; drug interactions with warfarin, phenytoin, carbamazepine, oral contraceptives
Aminoglycosides irreversibly bind ___S ribosomal subunit; also interfere with ___ and ___ cross bridging between cells at membrane level, causing cell wall damage (not as significant as beta lactams or vanco); bacter___
Aminoglycosides irreversibly bind 30S ribosomal subunit; also interfere with Ca and Mg cross bridging between cells at membrane level, causing cell wall damage (not as significant as beta lactams or vanco); bactericidal
Aminoglycosides are ___ and ___toxic, prolong ___ blockade
Aminoglycosides are oto and nephrotoxic, prolong neuromuscular blockade
Amikacin is an aminoglycoside used to treat ___
tuberculosis
Gentamicin (Garamycin) is an ___; treats most gram ___ including pseudo___, S. ___, ___cocci; when used for gram positive, use with a ___
Gentamicin (Garamycin) is an aminoglycoside; treats most gram negatives including pseudomonas, S. aureus, enterococci; when used for gram positive, use with a beta lactam (cell wall destruction agent)
Gentamicin is the most ___ spectrum of aminoglycosides and is the easiest to dose
Gentamicin is the most broad spectrum of aminoglycosides and is the easiest to dose
Need to check ___ of aminoglycosides; want to prevent ___toxicity and ___toxicity
Need to check levels of aminoglycosides; want to prevent nephrotoxicity and ototoxicity
Trimethoprim/sulfamethoxazole (Bactrim, Septra) are 2 bacter___ antibiotics, which = ___
Trimethoprim/sulfamethoxazole (Bactrim, Septra) are 2 bacteriostatic antibiotics, which = bactericidal
Bactrim affects ___ synthesis to starve out bacteria so that it can’t create new DNA
Bactrim affects folic acid synthesis to starve out bacteria so that it can’t create new DNA
Resistance to Bactrim is ___ (increasing/decreasing)
increasing…especially E. coli UTIs
Bactrim is an alternative to vanco to treat ___ and ___
MRSA and VRSA
Side effects of Bactrim–___cytopenia, ___penia, ___penia, ___ syndrome
pancytopenia, neutropenia, thrombocytopenia, Stevens Johnson Syndrome
Bactrim is a ___ antibiotic, so take ___ allergies seriously
Bactrim is a sulfonamide antibiotic, so take sulfa allergies seriously
Nitrofurantoin (Macrobid, Macrodantin) is used to treat ___ pathogens
urinary pathogens
Side effects of nitrofurantoin (Macrobid, Macrodantin)–___/___; ___; ___; ___ache; ___ness; ___ion; peripheral ___itis; ___ complications; ___ damage; ___ dyscrasias
nausea/vomiting; rash; itch; headache; dizziness; confusion; peripheral neuritis; pulmonary complications; hepatic damage; blood dyscrasias
Clindamycin (Cleocin) is used to treat ___ (aerobes/anaerobes), specifically ___ bacteria
Clindamycin (Cleocin) is used to treat anaerobes, specifically gut bacteria
Clindamycin (Cleocin) has the highest ___ risk; and can cause prolonged ___ blockade
Clindamycin (Cleocin) has the highest C. diff risk; and can cause prolonged neuromuscular blockade
Metronidazole (Flagyl) is used to treat all ___ (aerobes/anaerobes)
Metronidazole (Flagyl) is used to treat all anaerobes–both bacterial and protozoa
Metronidazole (Flagyl) is ___ (time/concentration) dependent
Metronidazole (Flagyl) is concentration dependent
Side effects of metronidazole = ___titis, peripheral ___pathy; ___taxia; ___ion; ___pathy; ___ors
pancreatitis, peripheral neuropathy; ataxia; confusion; encephalopathy; tremors
What happens if you drink alcohol while taking flagyl?
Disulfiram like reaction–alcohol withdrawal symptoms
Flagyl interacts with what blood thinner?
Coumadin
Quinupristin/Dalfopristin (Synercid) (30/70) are bacter___ individually but together are bacter___
Quinupristin/Dalfopristin (Synercid) (30/70) are bacteriostatic individually but together are bactericidal
Quinupristin/Dalfopristin (Synercid) (30/70) should be given via ___ due to significant phlebitis
should be given via central line due to significant phlebitis
Side effects of Quinupristin/Dalfopristin (Synercid) (30/70)–___gias, ___gias, ___ (increased/decreased) LFTs; CYP3A4 ___ (inhibitor/inducer)
myalgia, arthralgias, increased LFTs; CYP3A4 inhibitor
Side effects of Daptomycin (Cubicin)–___/___ pain; ___gias; ___ (increased/decreased) CPK; ___ache; ___nia; ___ upset; ___; ___ (increased/decreased) LFTs
limb/muscle pain; myalgias; increased CPK; headache; insomnia; GI upset; rash; increased LFTs
Rifampin and Rifabutin, when used as monotherapy, can cause rapid ___
Rifampin and Rifabutin, when used as monotherapy, can cause rapid resistance
Rifampin and Rifabutin are potent ___ (inhibitors/inducers) of the CYP 450 system with significant interactions
Rifampin and Rifabutin are potent inducers of the CYP 450 system with significant interactions
Rifampin and Rifabutin can rarely cause ___toxicity, ___ body fluids
Rifampin and Rifabutin can rarely cause hepatotoxicity, orange-red body fluids
Rifampin and Rifabutin are used mostly to treat ___ and if a ___ has developed on a prosthetic
Rifampin and Rifabutin are used mostly to treat TB and if a biofilm has developed on a prosthetic
What (3) antibiotics are OK to use in pregnant patients?
- Penicillins
- Cephalosporins
- Erythromycin
What (2) antibiotics should only be used in pregnancy if necessary?
- Aminoglycosides
- Isoniazid–usually only used to prevent or treat TB
What antibiotics should be avoided completely in pregnancy?–___dazole, ___cillin, ___fampin, ___prim, ___lones, ___cyclines
metronidazole, ticarcillin, rifampin, trimethoprim, fluoroquinolones, tetracyclines
Tetracycline in pregnant women is associated with acute ___ of the liver, ___titis, and possible ___ injury
Tetracycline in pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury
Canadian Population Study 11/2017–cleocin, doxycycline, FQs, macrolides, phenyoxymetylPCN = ___ (increased/decreased) risk of congenital malformations, risk of organ specific malfunctions; ___ (higher/lower) risk if used first trimester
increased risk of congenital malformations, risk of organ specific malfunctions; higher risk if used first trimester
Canadian Population Study 11/2017–___cillin, ___sporins, ___bid = no increased risk of congenital malformations/organ specific malfunctions
amoxicillin, cephalosporins, Macrobid = no increased risk of congenital malformations/organ specific malfunctions
Antivirals–Acyclovir (Zovirax) and Valacyclovir (Valtrex) ___ (induce/inhibit) viral DNA polymerases
inhibit viral DNA polymerases
Side effects of Acyclovir (Zovirax) and Valacyclovir (Valtrex)–infrequent ___; ___ache; ___ea; ___nations; ___ors; ___ation; kidney ___
infrequent malaise; headache; nausea; hallucinations; tremors; agitation; kidney stones
What antiviral medication is an option for those unresponsive to previous antiviral agents?
Foscarnet
Amphoteracin B–anti___; half-life ___ hours; side effects = ___ failure; infusion ___; ___kalemia and ___ wasting; ___emia
antifungal; half-life 24 hours; side effects = renal failure; infusion reactions; hypokalemia and magnesium wasting; anemia
Besides amphoteracin B, what other antibiotics cause hypokalemia?
penicillins–Piperacillin +/- tazobactam (zosyn), Ticarcillin +/- Clavulanate (Timentin)
Fluconazole (Diflucan) is fungi___; side effect = rare ___toxicity; drug interactions d/t CYP___
Fluconazole (Diflucan) is fungistatic; side effect = rare hepatotoxicity; drug interactions d/t CYP3A4
Itraconazole (Sporanox) is fungi___; side effects = ___/___, ___kalemia, ___ (increased/decreased) LFTs
Itraconazole (Sporanox) is fungistatic; side effects = nausea/vomiting, hypokalemia, increased LFTs
Voriconazole (Vfend) has severe drug interactions–T/F?
True
Side effects of voriconazole (Vfend) = ___/___; ___ (increased/decreased) LFTs, ___ vision, ___
nausea/vomiting; increased LFTs; blurred vision; rash
Echinocandin antifungals are fungi___ against yeast, fungi___ against molds; used to treat ___ and ___
Echinocandin antifungals are fungicidal against yeast, fungistatic against molds; used to treat Aspergillus and Candida
Examples = caspofungin (Cancidas); micafungin (Mycamine); anidulafungin (Eraxis)
