Pharm 2: Block 3 Flashcards by brandon lovin

What drugs can cause nephrotoxicity?

What drugs cause photosensitivity?

What drug causes C Diff?

Aminoglycosides
Vancomycin

Quinolones, Tetracyclines, Suflonamides

Clindamycin

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What drugs are better with concentration-dependent killing?

What drugs are better with time-dependent killing?

Aminoglycosides

Penicillins, Cephalosporins

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What is an example of common synergism?

Penicillin or Aminoglycoside= bacteria inibition

Penicillin and Aminoglycoside= bacteria death

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What is the MOA of penicillin?

What is the MOA of aminoglycosides?

Cell wall inhibitor

Protein synthesis inhibition

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What surgical prophylaxis is needed if only the skin is being damaged?

What prophylaxis is needed if hollow, viscous organs are going to be damaged?

What is used for colorectal surgery?

Strep, Staph

Gram negative rods, Enterococci

Broad spectrum an/aerobic

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What prophylaxis is used for surgical wound infections?

What microbes are these ABX used against?

Cefazolin,
If PT has allergy against beta lactam= Clindamycin

Staph A, Gram-neg rods

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What drugs are used for surgical abdominal infections?

What microbes are these ABX against?

Cefoxitin, Cefotetan, Ertapenam, Cefazolin w/ Metronidazole

Gram-neg bacilli and anaerobes

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Why is Metronidazole added to Cefazolin against surgical abdominal infections?

What group of ABX are cell wall synthesis inhibitors?

Gram-pos coverage, no anaerobe
Metron for anaerobic coverage

B-Lactamans: Carbapenems, Cephalosporins, monobactams, Penicillins
Other: bacitracin, Fosfomycin, Vancomycin

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What ABX is a DNA gyrase inhibitor?

Which one is an RNA polymerase inhibitor?

Fluoroquinolones

Rifampin

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What ABXs are protein synthesis inhibitors?

Aminoglycosides
Chloramphenicol
Clindamycin
Macrolides
Mupirocin
Strepogramins
Tetracyclines

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What ABX are Cell membrane inhibitors?

What ABX are folate synthesis inhibitors?

Amphotericin
Ketoconazole
Colisin
Daptomycin
Polymixin

Sufonamides
Trimethoprim

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Which ABX is almost completely absorbed after oral consumption and shouldn’t be used for GI infections?

Penicillin is safe in pregnancy and also have ability to penetrate into ?

Amoxicillin

CSF

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All B-lactams of the penicillin class are renally excreted except?

What is the common and two rare s/es of penicillin use?

Nafcillin
Dicloxacillin
Oxacillin

Common: diarrhea
Rare: nephrotoxicity, C Diff

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What is the MOA of B-lactamases?

What happens when the R group of B-lactams are changed/added to?

interfere w/ last step of bacterial cell wall synthesis- Transpeptidation and Cross-linkage- causing instability/lysis

Broader Gram-neg coverage

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What is the only drug approved for the treatment of early or late syphilis?

1st generation penicillin are AKA ? and used for ?

Penicilin G Benzathine

Natural penicillin
T Pallidum and most Strep species infections

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How are penicillins excreted?

What are the first generation penicillin?

Renally via tubular secretion and glomerular filtration

Natural Penicilin:
Pen G
Pen V
Pen G Benzathine
Pen G Procaine

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1st Generation penicillin is good for use against ? but poor against ?

Good: Syphilli , Strep spp., Pneumoccocal pneumonia
Bad: everything else

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What is the DOC for C Perfringen Gangrene?

What are the 5 anti-staph penicillins?

1st Gen Penicillin

Methicillin
Nafcillin
Oxacillin
Cloxacillin
Dicloxacillin

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Dicloxacillin is for ? use and has ? special consideration?

Minor soft/skin Staph infections

Preg Cat B
Take on empty stomach

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Nafcillin and Oxacillin are used against ? and have what special considerations?

Severe Staph infections0 osteomyelitis, joint/skin infection

Preg Cat B

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What are the Aminopenicillin meds?

What is the benefit of using these meds?

Amoxicillin
Ampicillin

Provides gram-neg coverage but no anti-microbial effect. Only offers ABC prot
ection

Amoxicillin is used for ?

Ampicillin is used for ?

URT infection
Endocarditis prophylaxis
Ulcer from H Pylori

Meningitis
Comm Acquired pneumonia
Endocarditis

Why are ampicillin and aminoglycosides routinely used in combo?

Why are B-Lactamase inhibitors used?

PCN ability to destroy cell wall allows entry of aminoglycoside into cell

Structurally similar to BL but no ABX activity. Provide extended spctrum of PCNs

What are the 3 BL inhibitors combo’d w/ PCNs

Claculanic Acid
Sulbactam
Tazobactam

What drug combo is used for Otitis media resistant to Amoxicillin Why is this specific combo used?

Amoxicillin/Clavulanate Added coverage for BL producing H Influenza, M Catarrhalis, and Staph A

What all can Amoxicillin/Clavulanate be used to Tx?

Uncomplicated COAS Uncomplicated endocarditis prophylaxis Comm Acquired Pneumo w/ macrolide or doxycycline OtMedia resistant to amoxicillin Acute Bacterial Sinusitis/Pharyngitis/Tonsilitis SSTI

What drug combo is the first line agent for dog/cat bites? What is used for human bites?

Amoxicillin/Clavulanate Early- Amoxicillin/Clavulanate Late- ampicillin/sulbactam PCN allergic- Clindamycin and either Cipro/TMP/SMX

What is the combo Ampicillin/Sulbactam used for?

``` Hospital acquired pneumonia w/ macrolide/quinolone Intra-abdominal infxn SSTi Sepsis Gynecologic infection ```

BL/PCN combos get some anaerobic coverage for ? What two combos does this include?

Abdominal anaerobes Amoxicillin/Clavulanate Ampicillin/Sulbactam

What is the Anit-Pseudomonal PCN combo? What is it used for?

Piperacillin/Tazobactam Combined w/ an aminoglycoside for Tx of P. Aeruginosa BL extends coverage to Staph and Anaerobes

What ABX provide MSSA coverage? What 3 are used for pharyngitis

Dicloxacillin, Ampicillin/Sulbactam, Piperacillin Tazobactam PCN, Anti-Staph, Amino

What ABX are used for upper respiratory infections? What is the only ABX combo in the PCN family providing coverage for pseudomonas?

Aminopenicillin Piperacillin/Tazobactam

PCN drugs require renal adjustment except for ? All cephalosporins are ? and require ? dependent for killing

Anti-staphylococcal Bactericidal Time-dependent

All BL have what end effect and are all ? dependent What adverse derm reaction can occur from Cephalosporin use?

Bactericidal Time-dependent Steven Johnson syndrome

Most cephalosporins are ? cleared and need adjustment except for ?

Renal | Ceftriaxone and Anti-Staph PCN- only 2 in all BL not needing renal adjustment

What is the 1-5 generation names of Cephalosporins?

``` 1st= Cefazolin 2nd= Cefuroxime 3rd= Ceftriaxone 4th= Cefepime 5th= Ceftaroline ```

What microbes can the 1st Generation Cephalosporins be used against? What are they used to Tx?

Gram +: MSSA, Strep No BBB crossing, don't use for CNS infection SSTI, Surgery prophylaxis, MSSA endocarditis

What ABX is a good alternative to anti-staph PCNs?

Caphalosprin 1st Gen

What are the 3 PO 1st Gen Cephalosporins What is the only injectable form and what is it used for?

Cephradine, Cefadroxil, Cephalexin Cefazolin- DOC for pre/post surgery not involving the abdomen

What is the next DOC if PT has PCN or Cephalosporin allergy? What are the only two cephalosporins that provide anaerobic coverage

Clindamyacin Cefoxitin Cefotetan

What are 2nd Generation Cephalosporins used for?

Better Gram Neg coverage- H Influenza, M Catarrhalis, Neisseria Spp

What are the PO 2nd Gen cephalosporins used for? What are the IV 2nd Gen cephalosporins and what are they used for?

Resistant otitis media, pharyngitis Cefuroxime- alt for cat bite Cefoxitin/Cefotetan- pre/post-surgery of the abdomen

What are the 3rd Generation Cephalosporins and what are they used for?

Broad spectrum Some Gram Pos- Strep, Spah coverage Ceftazidime- covers Pseudomonas aeruginosa

What class of Cephalosporins have the strongest association with C Diff? What is unique about the 3rd Generation/

3rd Gen Cephalosporin- Clindamycin Crosses BBB- Ceftriaxone, Cefotaxime, Ceftazidime

What is the DOC for N Gonorrhea infection of the cervix, urethra or rectum? What is an added benefit of this drug and it's potential use?

Ceftriaxone IV Excellent CNS pendetration

What two 3rd Gen Cephalosporins have good CNS penetration and what can they be used for?

Cefotaxime Ceftazidime ``` Severe Gran Neg infection Meningitis Endocarditis Joint infection Nosocomial pneumonia ```

What is the drug combo for treating Gonorrhea/Chlamydia infections?

Ceftriaxone/Azithromycin

What 3rd Gen can't be used in neonates? What is the only drug that's a 4th Gen Cephalosporin?

Ceftriaxone- biliary excretion would cause crystal formation/sludge development Cefepime- broadest spectrum but no anaerobic/MSSA coverage

What is Cefepime used for?

Empiric therapy for febrile neutropenia Nosocomial pneumonia Post neurosurgical meningitis

What is the only 5th Generation Cephalosporin? What is a unique capability for this one?

Ceftaroline MSSA coverage

What are the Cephalosporin combo drugs? Their use is rare so is indicative of ?

Ceftolozane/Tazobactam Ceftazidime/Avibactam Inpatient/very ill PT w/ highly resistant organism and requires approval for use by infectious Dz Dr