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POD 2 > Pharm > Flashcards

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
Q

What do R1 and R2 provide for a cephalosporin?

A

R1-spectrum of activity

R2-stability and metabolism

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26
Q

What is the mechanism of action of cephalosporin?

A

inhibits crosslinking of peptidoglycan strands

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27
Q

What are the adverse reactions of cephalosporins?

A

hypersensitivity
bleeding-NMTT interacts with alcohol
serum sickness

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28
Q

What are the drug interactions of cephalosporins?

A

warfarin

probenecid

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29
Q

What are the first generation cephalosporins and what do they cover?

A

cephalexin and cefazolin (used for surgery)

cover staph, strep, Piddly, E. coli

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30
Q

What are the second generation cephalosporins and what do they cover?

A

cefuroxime

staph, strep through PEK

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31
Q

What cephalosporins cover anaerobes?

A

cefotetan, cefoxitin

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32
Q

What are the third generation cephalosporins and what do they cover?

A

strep and SACE for ceftriaxone

ceftazidime for antipseudomonal

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33
Q

What are the fourth generation cephalosporins and what do they cover?

A

cefepime, ceftaroline

cover strep, staph, and SPACE

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34
Q

What is unique about the metabolism of imipenem?

A

metabolized by dehydropeptidase 1

give cilastin to decrease renal metabolism

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35
Q

What are the adverse reactions of carbapenems?

A

seizures

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36
Q

What is the spectrum of coverage for carbapenems?

A

DIM-all gram +, SPACE, anaerobes

Ertapenem does not cover enterococcus

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37
Q

What is aztreonam and when should it be used?

A

monobactam, gram negative coverage only

use with penicillin allergies

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38
Q

What is the mechanism of action for aminoglycosides?

A

re-arrange outer membrane
energy dependent uptake
binds 30s leading to misreading of mRNA

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39
Q

What is unique about aminoglycosides?

A

exhibit concentration dependent PAE

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40
Q

What are the adverse reactions of aminoglycosides?

A

nephrotoxicity

ototoxicity-8th cranial nerve

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41
Q

What do aminoglycosides cover?

A

gram negative through SPACE

staph and enterococcus

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42
Q

What is neomycin used for?

A

surgical prophylaxis for abdominal procedures

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43
Q

When should peaks and troughs be obtained and why?

A

4th dose, steady state has been achieved

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44
Q

What is the mechanism of action of vancomycin?

A

inhibits peptidoglycan by complexing with D-alanyl D-alanine precursor

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45
Q

What are the adverse reactions of vancomycin?

A

red man syndrome-decrease infusion rate

nephrotoxicity and ototoxicity

46
Q

What is the spectrum of action for vancomycin?

A

Gram positives

-use for c. diff or implantation of prosthetic devices

47
Q

What is the mechanism of action for quinupristin/dalfopristin?

A

quinupristin inhibits chain formation resulting in early termination
dalfopristin inhibits peptide elongation
-individually static but cidal in combination

48
Q

What is the spectrum of action for quin/dalfo?

A

MRSA, VRE (not good against faecalis)
anaerobes
requires PICC line

49
Q

What is the mechanism of action for linezolid?

A

bind to 23s of 50s

50
Q

What is the spectrum of action for linezolid?

A

MRSA, VRE, PCN strep pneumo

51
Q

What are the adverse reactions for linezolid?

A

superinfection

mitochondrial toxicity

52
Q

What are the drug interactions for linezolid?

A

MAOI or SSRI can lead to serotonin storm :)

53
Q

When should mucpirocin be used?

A

eradicate MRSA from the nose

54
Q

What is the spectrum of action for colistin?

A

SPACE bug

55
Q

What is unique about fosfomycin?

A

UTIs only

given once

56
Q

What is unique about tigecycline?

A

cannot treat bacteremia

higher all cause mortality

57
Q

What is the spectrum of action for tigecycline?

A

MRSA/VRE
Gram negatives
Anaerobes

58
Q

What is unique about daptomycin?

A

cannot treat pneumonia because it is inactivated by pulmonary surfactant

59
Q

What are the adverse reactions for daptomycin?

A

rhadbomyolosis-monitor CPK

eosinophilia pneumonia

60
Q

What is unique about telavancin?

A

derivative of vancomycin
may cause red man syndrome
QT prolongation

61
Q

What is the mechanism of action for sulfonamides?

A

compete with PABA for dihydropterate synthetase

62
Q

When should sulfonamides be prescribed?

A

UTIs

63
Q

What are the adverse reactions of sulfonamides?

A

Steven Johnson Syndrome, Erythema multiform, photosensitivity
crystalluria (check hydration status)
kernicterus when given during last month of pregnancy

64
Q

What is the mechanism of action for trimethoprim?

A

inhibits dihydrofolate reductase to prevent the formation of tetrahydrofolic acid

65
Q

When should trimethoprim not be prescribed?

A

patients with folate deficiency (alcoholics, pregnant women)

66
Q

What are the drug interactions for Bactrim?

A

combination sulfa/trimeth

interacts with warfarin and methotrexate

67
Q

What are the adverse reactions from nitrofurantoin?

A

pulmonary symptoms from UTI treatment

68
Q

What is the mechanism of action for methenamine and which bugs are resistant to it?

A

formation of formaldehyde in low pH

no action against proteus due to urease

69
Q

What is the mechanism of action for quinolones?

A

inhibit DNA gyrase (topo II)

exhibit PAE

70
Q

What are the adverse reactions to fluroquinolones?

A

photosensitivity
QT prolongation
CNS-mental status change
tendon rupture

71
Q

What are the drug interactions to fluroquinolones?

A

theophylline
antacids
warfarin

72
Q

What is the spectrum of action for fluroquinolones?

A

Cipro and levo can treat pseudomonas

moxi covers anaerobes, SACE, staph and strep, does not cover UTI because does not reach concentration

73
Q

What is the mechanism of action for tetracylcines?

A

bind to 30s

bacteriostatic

74
Q

Which are cleared hepatically?

A

doxy and minocylcine

75
Q

What are the adverse reactions to tetracyclines?

A

photosensitivity
discoloration of developing teeth
Fanconi-like syndrome for outdated formulation

76
Q

What can be used to trat SIADH?

A

demeclocycline

77
Q

What are the interactions with tetracyclines?

A

divalent and trivalent cations

enhances anti-coagulation of warfarin

78
Q

What does tetra cover?

A

staph and strep
gram negatives
atypicals
rickettsia

79
Q

What is the mechanism of action for macrolides?

A

reversibly binds to 50s

80
Q

What is unique about the distribution of macrolides?

A

distributes in tissues longer than in blood

81
Q

What is unique about the half life of azithromycin?

A

super long-allows for the dosing regimen of 5 days

82
Q

What are the adverse effects of macrolides?

A

cholestatic hepatitis

ototoxicity and QT prolongation

83
Q

What are the drug interactions for macrolides?

A

erythromycin and clarithromycin-inactivate p450

azithro does not interact with p450

84
Q

What do macrolides cover?

A

gram positives
atypicals
azithro and clarithro cover H flu and M cat

85
Q

What is the mechanism of action for clindamycin?

A

bind 50s ribosome

86
Q

What does clinda cover?

A

staph and strep

anaerobes

87
Q

What are the adverse reactions from clinda?

A

C. DIFF

88
Q

What are the adverse reactions from chloramphenicol?

A

aplastic anemia

gray baby syndrome

89
Q

What would you use chloramphenicol for?

A

meningitis

Rickettsia

90
Q

What is the mechanism of action for acyclovir and valacyclovir?

A

phosphorylated via virus thymidine kinase and cell kinase to terminate chain

91
Q

What are the adverse reactions to acyclovir?

A

CNS hallucinations and seizures

nephrotoxicity

92
Q

What is acyclovir used to treat?

A

genital herpes

93
Q

What are the adverse reactions to ganciclovir?

A

CNS behavior changes

neutropenia

94
Q

What is ganciclovir used to treat?

A

CMV retinitis

can be implanted in HIV patients

95
Q

What is penciclovir used to treat?

A

cold sores (HSV 1)

96
Q

What is the mechanism of action for cidofovir?

A

interacts with DNAP

97
Q

What are the adverse reactions to cidovir?

A

nephrotoxic-give saline

second line CMV

98
Q

What is the mechanism of action for foscarnet?

A

competes with pyrophosphate in viral DNAP

99
Q

What are the adverse reactions to foscarnet?

A

nephrotoxic
seizures
first degree AV block

100
Q

What is foscarnet used for?

A

HSV and CMV

second line

101
Q

What are the side effects for interferon?

A

flu like symptoms

personality changes

102
Q

What improves the pharmacokinetics of interferon?

A

pegalated version

103
Q

What is type I interferon used for?

A

alpha-hep B and C

beta-MS

104
Q

What is the mechanism of action for lamivudine?

A

inhibits RT

105
Q

What are the adverse reactions for lamivudine?

A

lactic acidosis and steatosis

106
Q

What is lamivudine used for?

A

Hep B with interferon

107
Q

What is ribavirin used for?

A

RSV or Hep C in combination with interferon (but not really anymore)

108
Q

What is used to treat warts?

A

Imiquimod

109
Q

What is the mechanism of action for amantadine?

A

prevents entry into cell (binds M2)

110
Q

What can amantadine be used to treat?

A

influenza A

111
Q

What is the mechanism of action for osteotamivir?

A

inhibits neuroaminidase for release of virus

112
Q

What can osteotamivir be used to treat?

A

infleunza A and B

POD 2 (5 decks)

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