Pharm 2: Block 3 Flashcards
What drugs can cause nephrotoxicity?
What drugs cause photosensitivity?
What drug causes C Diff?
Aminoglycosides
Vancomycin
Quinolones, Tetracyclines, Suflonamides
Clindamycin
What drugs are better with concentration-dependent killing?
What drugs are better with time-dependent killing?
Aminoglycosides
Penicillins, Cephalosporins
What is an example of common synergism?
Penicillin or Aminoglycoside= bacteria inibition
Penicillin and Aminoglycoside= bacteria death
What is the MOA of penicillin?
What is the MOA of aminoglycosides?
Cell wall inhibitor
Protein synthesis inhibition
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
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
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
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
What ABX is a DNA gyrase inhibitor?
Which one is an RNA polymerase inhibitor?
Fluoroquinolones
Rifampin
What ABXs are protein synthesis inhibitors?
Aminoglycosides Chloramphenicol Clindamycin Macrolides Mupirocin Strepogramins Tetracyclines
What ABX are Cell membrane inhibitors?
What ABX are folate synthesis inhibitors?
Amphotericin Ketoconazole Colisin Daptomycin Polymixin
Sufonamides
Trimethoprim
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
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
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
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
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
1st Generation penicillin is good for use against ? but poor against ?
Good: Syphilli , Strep spp., Pneumoccocal pneumonia
Bad: everything else
What is the DOC for C Perfringen Gangrene?
What are the 5 anti-staph penicillins?
1st Gen Penicillin
Methicillin Nafcillin Oxacillin Cloxacillin Dicloxacillin
Dicloxacillin is for ? use and has ? special consideration?
Minor soft/skin Staph infections
Preg Cat B
Take on empty stomach
Nafcillin and Oxacillin are used against ? and have what special considerations?
Severe Staph infections0 osteomyelitis, joint/skin infection
Preg Cat B
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
