Pharm: ABX Flashcards by Brian Boyarsky

Be careful about giving PCN to patients with this disorder…

Epilepsy / neurotoxic

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4 methods of PCN resistance

B-lactamase
PBP modification (MRSA)
Increased efflux (P-glycoprotein)
Decrease penetration (porins)

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DOC: Syphillis

PCN G Benzathine

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DOC: prevention rheumatic fever

PCN G

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PO PCN vs. IV PCN

PCN G: IV

PCN V: PO

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Which anti-staph PCN is a good choice for patients in renal failure? Why?

Nafcillin (excreted in the bile)

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First-line treatment of staph endocarditis in patients without artifical heart valves.

Anti-Staph PCN (MNDO)

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AE: Methicillin

IS nephritis (not used clinically)

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AE: Nafcillin

Neutropenia

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AE: Oxacillin

Hepatitis

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Mechanism of MRSA resistance

Altered PBP

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Which PCN can/should be taken on a full stomach?

Amoxicillin

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Which extended spectrum PCN is associated with C. diff?

Ampicillin

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What hypersensitivity-type reaction is caused by the extended spectrum PCN’s? What is the actual reason?

Maculopapular rash

* ABX therapy given for a viral infection

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Which PCN are resistant to beta-lactamase?

Anti-staph PCN (MNDO)

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DOC: Empiric treatment of infectious endocarditis

PCN (Vanco) + AG (gentamicin)

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Which are the anti-pseudomonal PCN’s? Which one is excreted in the bile?

Peperacillin*
Ticarcillin
Carbenicillin

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Which extended spectrum PCN is excreted in the bile?

Ampicillin

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DOC: endocarditis prophylaxis in dental procedures

Amoxicillin

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AE: ticarcillin

Hemeatologic toxicity

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Which PCN is used for the treatment of febrile neutropenia?

Anti-pseudomonals

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Which beta-lactams are used solely for the treatment of gram negative aerobic infections?

Monobactam (Aztreonam)

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What are the AE’s of aztreonam?

Skin rash, elevated transaminase, vertigo, GI

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What are the 3 beta-lactamase inhibitors?

Sulbactam (Ampicillin) = Unasyn
Clavulinic acid (Amoxicillin) = Augmentin
Tazobactam (Piperacillin) = Zosyn

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DOC: Pseudomonas in CF patient (Think: inhalation)

Aztreonam

Are carbapenems active against MRSA?

Which carbapenem must be administered with cilistatin? Why?

Imipenem: metabolized to a nephrotoxic metabolite by a dihyrdroxy-peptidase

AE: imipenem

Seizures, GI, allergy

MOA: Vancomycin. Mode of Resistance?

D-ala -- D-ala; prevent cell wall synthesis | R: D-ala -- D-lac

AE: Vancomycin

Fever/Chills/Phlebitis Red man syndrome Ototoxicity Nephrotoxicity

Treatment of C. diff

1. Metronidazole 2. PO Vanco 3. Fidaxomicin

Spectrum of usage for Vancomycin: G+ and/or G-

Gram-positive only

PO CS

Cephalexin (1) Cefaclor (2) Cefixime (3)

Non-renally excreted CS

Ceftriaxone (3) | Cefoperazone (3)

First generation CS

Cefazolin (surgical prophylaxis) | Cephalexin

Are first generation cephaolosporins resistant to staph penicillinase?

Yes

Which CS is a good PCN G substitute?

1st generation CS

Which CS are similar to Ampicillin/Amoxicillin

2nd generation CS: Cefaclor, cefoxitin, cefotetan, cefamandole

CS are inactive against:

Listeria, Atypicals [Chlymadia, Mycoplasma, Acentobacter], MRSA (except ceftaroline), Enterococci

Which CS for uncomplicated sinusitis, otitis, LRT infections

2nd generation CS: Cefaclor, cefoxitin, cefotetan, cefamandole

CS for CNS/joint Lyme disease

Ceftriaxone

CS for meningitis &/or meningitis prophylaxis

Ceftriaxone

Drugs for meningitis prophylaxis in exposed individuals (3)

Ceftriaxone, Cipro, Rifampin

DOC: gonorrhea

Ceftriaxone

DOC: chlamydia

Doxycycline

CS febrile neutropenia

Cefepime

Why should you not give ceftriaxone in pregnancy?

Can displace bilirubin from albumin and cause kernicterus

Usage of ceftaroline

3rd generation + MRSA

Usage of cefepime

3rd generation + 1st generation g+ | UTI, febrile neutropenia, intra-abdominal infections

AE: Daptomycin. | What drug should be D/C'ed?

Increase CPK (d/c statin)

Why can't bacitracin be used systemically?

Neprotoxicity

MOA Daptomycin

Binds to membrane via Ca-dependent insertion of lipid tail; results in depolarization of cell membrane with K efflux and cell death

How is fosfomycin excreted?

Bile

DOC: Chlamydia

Tetracycline

DOC: Lyme

Tetracycline

DOC: Anthrax

Tetracycline

DOC: RMSF

Tetracycline

DOC: H. pylori

Tetracycline

DOC: Malaria

Tetracycline

DOC: Plague

Tetracycline

DOC: Tularemia/Brucella

Tetracycline

DOC: Syphillis with a PCN allergy

Tetracycline

DOC: severe acne, rosacea

Tetracycline

DOC: empiric outpatient CAP

Doxycycline

AE: tetracyclines

Discolored teeth (studnted growth), photosensitivity, GI, liver, renal, dizziness, vertigo, TERATOGENIC

How is doxycycline excreted?

Bile

DOC: eradication of meningococcal carrier state

Minocycline

Use: Mupirocin

Apply topically/intranasal to eradicate MRSA

Use: Fidaxomycin

C. diff treatment

Drugs used for anaerobic infections above and below the diaphragm.

Above: Clindamycin Below: Metronidazole

Use: Streptogramins

Gram positive cocci (drug resistant) | * Quinupristin, dalfopristin

2 antibiotic classes with long post-antibiotic effects

1. Aminoglycosides | 2. Streptogramins

2 major side effects of chloramphenicol

1. Bone marrow toxicity (AA) | 2. Gray baby syndrome (cyanosis)

DOC: empiric treatment of meningitis

1. Vancomycin | 2. Ceftriaxone

DOC: meningitis prophylaxis in exposed individuals

1. Ceftriaxone 2. Cipro 3. Rifampin

DOC: enterococcal endocarditis

1. Vancomycin | 2. Aminoglycoside

These cations (Mg, Ca, Fe) bind to this drug and prevent its absorption.

Tetracycline

Which drug has a black box warning: drug increases mortality?

Tigecycline

DOC: empiric treatment of septicemia, nosocomial RTI, complicated UTI, endocarditis

Aminoglycoside

DOC: Yersinia pestis

Streptomycin

Which antibiotic can be used to treat hepatic encepalopathy?

Neomycin (and lactulose - creates acidic environment to trap ammonia)

AE: aminoglycosides

Ototoxicity, nephrotoxicity, pregnancy, NO MYASTHENIA GRAVIS

DOC: empiric treatment M. pneumonia

Macrolides

Prophylaxis of endocarditis in a patient with a severe PCN allergy

Clindamycin

T/F Macrolides lead to QT prolongation

True

Spectrum of activity streptogramins

Gram positive cocci only

Major AE's Linezolid

Weak inhibitor of MAO Myelsupression Optic and peripheral neuropathy

DOC: UC UTI, PCP, Nocardi, Toxo

Cotrimoxazole

DOC: Outpatient CAP

Doxycycline + ML | Alternative: RFQ or B-lactam + ML

DOC: PCN resistant S. pna

Ceftriaxone, FQ | Alternative: Vancomycin, Linezolid, SG

DOC: PCN sensitive S. pna

PCN, Amoxicillin | Alternative: CS, Clindamycin, FQ, ML, Bactrim

DOC: non-beta lactamase producing H. flu

Amoxicillin

DOC: beta lactamase producing H. flu

CS, Augmentin

DOC: M. pna/C. pna

Tetracycline or ML | Alt: RFQ

DOC: Legionella

FQ, ML | Allternative: Doxy, Bactrim