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Pharm Flashcards

1
Q

What is a bacteriocidal agent?

A

kills the bacteria

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2
Q

What is a bacteriostatic agent?

A

inhibits the growth

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3
Q

What is the spectrum of activity?

A

narrow-specific organisms

broad-multiple organisms

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4
Q

What is synergy?

A

action of one drug enhanced by another
trimethoprim/sulfamethoxazole (becomes bacteriocidal)
penicillin/aminoglycoside

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5
Q

What is antagonism?

A

decreased action of one drug by another

combining static and cidal

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6
Q

What is post antibiotic effect?

A

killing after exposure

aminoglycosides and fluroquinolones

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7
Q

What is concentration dependent killing?

A

dependent on peak concentration
goal is 10x MIC
quinolones aminoglycosides

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8
Q

What is time dependent killing?

A

amount of time the concentration stays about the MIC (40-50%)
beta lactam antibiotics

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9
Q

What are the gram positive bugs?

A

strep
staph
enterococcus

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10
Q

What are the piddly bugs?

A 
Haemophillis
morexella
morganella
shigella
salmonella
neisseria
providencia
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11
Q

What are the fence bugs?

A

proteus
e. coli
klebsiella

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12
Q

What are the SPACE bugs?

A 
seratia
pseudomonas
acinetobacter 
citrobacter
enterobacter
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13
Q

What are the atypicals?

A

chlamydia
mycoplasma
legionella

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14
Q

What are the anaerobes?

A

peptostreptococcus (mouth)
bacteriodes (small intestine)
clostridium (colon)

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15
Q

What is the mechanism of action for penicillin?

A

blocks crosslinking of adjacent peptidoglycan strands

PBP (peptidoglycan transpeptidase)

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16
Q

Where will penicillin not be distributed?

A

poor distribution to brain, CSF, prostate

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17
Q

What are the possible hypersensitivity reactions and what are they mediated by?

A

anaphylaxis-IgE
rash-IgG or IgM
maculopapular rash is most common

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18
Q

What are the other adverse reactions from penicillin?

A

interstitial nephritis

pseudomembranous colitis

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19
Q

What are the antistaphylococcal penicillins?

A

methicillin, oxacillin, nafcillin

dicloxacillin, cloxacillin (PO)

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20
Q

What are the aminopenicillins and what do they cover?

A

ampicillin or amoxicillin
allow penetration of gram negative cell walls
Strep, entero, through PEK

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21
Q

What are the carboxypenicillins and what do they cover?

A

Carbenicillin/ticarcillin

covers strep, PEK, SPACE bugs

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22
Q

When would you not give ticarcillin and why not?

A

patient with CHF due to Na overload

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23
Q

What are the ureidopenicillins and what do they cover?

A

mezlocillin/piperacillin
Strep, entero
PEK, SPACE

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24
Q

What coverage does a beta lactamase inhibitor add?

A

adds staph and anaerobe coverage

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25
What do R1 and R2 provide for a cephalosporin?
R1-spectrum of activity | R2-stability and metabolism
26
What is the mechanism of action of cephalosporin?
inhibits crosslinking of peptidoglycan strands
27
What are the adverse reactions of cephalosporins?
hypersensitivity bleeding-NMTT interacts with alcohol serum sickness
28
What are the drug interactions of cephalosporins?
warfarin | probenecid
29
What are the first generation cephalosporins and what do they cover?
cephalexin and cefazolin (used for surgery) | cover staph, strep, Piddly, E. coli
30
What are the second generation cephalosporins and what do they cover?
cefuroxime | staph, strep through PEK
31
What cephalosporins cover anaerobes?
cefotetan, cefoxitin
32
What are the third generation cephalosporins and what do they cover?
strep and SACE for ceftriaxone | ceftazidime for antipseudomonal
33
What are the fourth generation cephalosporins and what do they cover?
cefepime, ceftaroline | cover strep, staph, and SPACE
34
What is unique about the metabolism of imipenem?
metabolized by dehydropeptidase 1 | give cilastin to decrease renal metabolism
35
What are the adverse reactions of carbapenems?
seizures
36
What is the spectrum of coverage for carbapenems?
DIM-all gram +, SPACE, anaerobes | Ertapenem does not cover enterococcus
37
What is aztreonam and when should it be used?
monobactam, gram negative coverage only | use with penicillin allergies
38
What is the mechanism of action for aminoglycosides?
re-arrange outer membrane energy dependent uptake binds 30s leading to misreading of mRNA
39
What is unique about aminoglycosides?
exhibit concentration dependent PAE
40
What are the adverse reactions of aminoglycosides?
nephrotoxicity | ototoxicity-8th cranial nerve
41
What do aminoglycosides cover?
gram negative through SPACE | staph and enterococcus
42
What is neomycin used for?
surgical prophylaxis for abdominal procedures
43
When should peaks and troughs be obtained and why?
4th dose, steady state has been achieved
44
What is the mechanism of action of vancomycin?
inhibits peptidoglycan by complexing with D-alanyl D-alanine precursor
45
What are the adverse reactions of vancomycin?
red man syndrome-decrease infusion rate | nephrotoxicity and ototoxicity
46
What is the spectrum of action for vancomycin?
Gram positives | -use for c. diff or implantation of prosthetic devices
47
What is the mechanism of action for quinupristin/dalfopristin?
quinupristin inhibits chain formation resulting in early termination dalfopristin inhibits peptide elongation -individually static but cidal in combination
48
What is the spectrum of action for quin/dalfo?
MRSA, VRE (not good against faecalis) anaerobes requires PICC line
49
What is the mechanism of action for linezolid?
bind to 23s of 50s
50
What is the spectrum of action for linezolid?
MRSA, VRE, PCN strep pneumo
51
What are the adverse reactions for linezolid?
superinfection | mitochondrial toxicity
52
What are the drug interactions for linezolid?
MAOI or SSRI can lead to serotonin storm :)
53
When should mucpirocin be used?
eradicate MRSA from the nose
54
What is the spectrum of action for colistin?
SPACE bug
55
What is unique about fosfomycin?
UTIs only | given once
56
What is unique about tigecycline?
cannot treat bacteremia | higher all cause mortality
57
What is the spectrum of action for tigecycline?
MRSA/VRE Gram negatives Anaerobes
58
What is unique about daptomycin?
cannot treat pneumonia because it is inactivated by pulmonary surfactant
59
What are the adverse reactions for daptomycin?
rhadbomyolosis-monitor CPK | eosinophilia pneumonia
60
What is unique about telavancin?
derivative of vancomycin may cause red man syndrome QT prolongation
61
What is the mechanism of action for sulfonamides?
compete with PABA for dihydropterate synthetase
62
When should sulfonamides be prescribed?
UTIs
63
What are the adverse reactions of sulfonamides?
Steven Johnson Syndrome, Erythema multiform, photosensitivity crystalluria (check hydration status) kernicterus when given during last month of pregnancy
64
What is the mechanism of action for trimethoprim?
inhibits dihydrofolate reductase to prevent the formation of tetrahydrofolic acid
65
When should trimethoprim not be prescribed?
patients with folate deficiency (alcoholics, pregnant women)
66
What are the drug interactions for Bactrim?
combination sulfa/trimeth | interacts with warfarin and methotrexate
67
What are the adverse reactions from nitrofurantoin?
pulmonary symptoms from UTI treatment
68
What is the mechanism of action for methenamine and which bugs are resistant to it?
formation of formaldehyde in low pH | no action against proteus due to urease
69
What is the mechanism of action for quinolones?
inhibit DNA gyrase (topo II) | exhibit PAE
70
What are the adverse reactions to fluroquinolones?
photosensitivity QT prolongation CNS-mental status change tendon rupture
71
What are the drug interactions to fluroquinolones?
theophylline antacids warfarin
72
What is the spectrum of action for fluroquinolones?
Cipro and levo can treat pseudomonas | moxi covers anaerobes, SACE, staph and strep, does not cover UTI because does not reach concentration
73
What is the mechanism of action for tetracylcines?
bind to 30s | bacteriostatic
74
Which are cleared hepatically?
doxy and minocylcine
75
What are the adverse reactions to tetracyclines?
photosensitivity discoloration of developing teeth Fanconi-like syndrome for outdated formulation
76
What can be used to trat SIADH?
demeclocycline
77
What are the interactions with tetracyclines?
divalent and trivalent cations | enhances anti-coagulation of warfarin
78
What does tetra cover?
staph and strep gram negatives atypicals rickettsia
79
What is the mechanism of action for macrolides?
reversibly binds to 50s
80
What is unique about the distribution of macrolides?
distributes in tissues longer than in blood
81
What is unique about the half life of azithromycin?
super long-allows for the dosing regimen of 5 days
82
What are the adverse effects of macrolides?
cholestatic hepatitis | ototoxicity and QT prolongation
83
What are the drug interactions for macrolides?
erythromycin and clarithromycin-inactivate p450 | azithro does not interact with p450
84
What do macrolides cover?
gram positives atypicals azithro and clarithro cover H flu and M cat
85
What is the mechanism of action for clindamycin?
bind 50s ribosome
86
What does clinda cover?
staph and strep | anaerobes
87
What are the adverse reactions from clinda?
C. DIFF
88
What are the adverse reactions from chloramphenicol?
aplastic anemia | gray baby syndrome
89
What would you use chloramphenicol for?
meningitis | Rickettsia
90
What is the mechanism of action for acyclovir and valacyclovir?
phosphorylated via virus thymidine kinase and cell kinase to terminate chain
91
What are the adverse reactions to acyclovir?
CNS hallucinations and seizures | nephrotoxicity
92
What is acyclovir used to treat?
genital herpes
93
What are the adverse reactions to ganciclovir?
CNS behavior changes | neutropenia
94
What is ganciclovir used to treat?
CMV retinitis | can be implanted in HIV patients
95
What is penciclovir used to treat?
cold sores (HSV 1)
96
What is the mechanism of action for cidofovir?
interacts with DNAP
97
What are the adverse reactions to cidovir?
nephrotoxic-give saline | second line CMV
98
What is the mechanism of action for foscarnet?
competes with pyrophosphate in viral DNAP
99
What are the adverse reactions to foscarnet?
nephrotoxic seizures first degree AV block
100
What is foscarnet used for?
HSV and CMV | second line
101
What are the side effects for interferon?
flu like symptoms | personality changes
102
What improves the pharmacokinetics of interferon?
pegalated version
103
What is type I interferon used for?
alpha-hep B and C | beta-MS
104
What is the mechanism of action for lamivudine?
inhibits RT
105
What are the adverse reactions for lamivudine?
lactic acidosis and steatosis
106
What is lamivudine used for?
Hep B with interferon
107
What is ribavirin used for?
RSV or Hep C in combination with interferon (but not really anymore)
108
What is used to treat warts?
Imiquimod
109
What is the mechanism of action for amantadine?
prevents entry into cell (binds M2)
110
What can amantadine be used to treat?
influenza A
111
What is the mechanism of action for osteotamivir?
inhibits neuroaminidase for release of virus
112
What can osteotamivir be used to treat?
infleunza A and B

POD 2 (5 decks)

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