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Pharm- Antimicrobials 10/05 Flashcards

1
Q

Ampicillin, Drug Class

A

Penicillin; Aminopenicillin

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2
Q

Ampicillin, Spectrum

A

extended-spectrum; extends beyond gram-positive to gram-negative (Haemophilus influenzae, Escherichia coli, Proteus mirabilis), Listeria monocytogenes, susceptible meningococci, enterococci
“HEELP”

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3
Q

Ampicillin, MOA

A

Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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4
Q

Ampicillin, ADR

A

Nausea, vomiting, diarrhea
Allergic reactions (0.7-10%)
Anaphylaxis (0.004-0.04%)
Pseudomembranous colitis

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5
Q

Amoxicillin, Drug Class

A

Penicillin; Aminopenicillin

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6
Q

Amoxicillin, Spectrum

A

extended-spectrum; extends beyond gram-positive to gram-negative (Haemophilus influenzae, Escherichia coli, Proteus mirabilis), Listeria monocytogenes, susceptible meningococci, enterococci
“HEELP”

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7
Q

Amoxicillin, MOA

A

Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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8
Q

Amoxicillin, ADR

A

Nausea, vomiting, diarrhea
Allergic reactions (0.7-10%)
Anaphylaxis (0.004-0.04%)
Pseudomembranous colitis

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9
Q

Ceftriaxone, Drug Class

A

3rd generation cephalosporin, b-lactam

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10
Q

Ceftriaxone, Spectrum

A

less active against gram-positive, more active against Enterobacteriaceae (although resistance increasing due to B-lactamase producing strains)
“KEPSH”, don’t “tri” anything crazy –> gonorrhea

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11
Q

Ceftriaxone, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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12
Q

Ceftriaxone, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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13
Q

Ceftazidime, Drug Class

A

3rd generation cephalosporin, b-lactam

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14
Q

Ceftazidime, Spectrum

A

less active against gram-positive, more active against Enterobacteriaceae (although resistance increasing due to B-lactamase producing strains)
“KEPSH”

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15
Q

Ceftazidime, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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16
Q

Ceftazidime, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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17
Q

Cefepime, Drug Class

A

4th generation cephalosporin, penicillin

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18
Q

Cefepime, Spectrum

A

Extends beyond 3rd generation, useful in serious infections in hospitalized patients. Effective against Pseudomonas.

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19
Q

Cefepime, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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20
Q

Cefepime, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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21
Q

Meropenem, Drug Class

A

Carbapenem, b-lactam

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22
Q

Meropenem, Spectrum

A

Aerobes and anaeorbes; gram-positive, Enterobacteriaceae, Pseudomonas, Acinetobacter. Stenotrophomonas maltophilia is resistant.
“meroPEAnem” = pseudomonas, enterobacteriaceae, acinetobacter

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23
Q

Meropenem, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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24
Q

Meropenem, ADR

A

Nausea/vomiting (1-20%)
Seizures (1.5%)
Hypersensitivity

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25
Q

Ertapenem, Drug Class

A

Carbapenem, b-lactam

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26
Q

Ertapenem, Spectrum

A

Aerobes and anaeorbes; gram-positive, Enterobacteriaceae, Pseudomonas, Acinetobacter. Stenotrophomonas maltophilia is resistant.
“meroPEAnem” = pseudomonas, enterobacteriaceae, acinetobacter

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27
Q

Ertapenem, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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28
Q

Ertapenem, ADR

A

Nausea/vomiting (1-20%)
Seizures (1.5%)
Hypersensitivity

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29
Q

B-lactamase inhibitor prototypes

A

Ampicillin-sulbactam
Amoxicillin-clavulanic acid
Piperacillin-tazobactam

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30
Q

Ampicillin-sulbactam, Drug Class

A

B-lactamase inhibitor

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31
Q

Ampicillin-sulbactam, MOA

A

prevent destruction of B-lactam antibiotics

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32
Q

Amoxicillin-clavulanic acid, Drug Class

A

B-lactamase inhibitor

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33
Q

Aminopenicillin prototypes

A

Ampicillin

Amoxicillin

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34
Q

Cephalosporin prototypes

A

Cefriaxone, Ceftazidime

Cefepime

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35
Q

Carbapenem prototoypes

A

Meropenem

Ertapenem

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36
Q

Glycopeptide prototype

A

Vancomycin

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37
Q

Vancomycin, Drug Class

A

Glycopeptide

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38
Q

Vancomycin, Spectrum

A

Broad gram-positive coverage [S. aureus (including MRSA), S. epidermidis (including MRSE), Streptococci, Bacillus, Corynebacterium spp, Actinomyces, Clostridium]
ABCcDerm’SS = Actinomyces, Bacillus, Clostridium, Corynebacterium, S. epidermidis, S. aureus & Streptococci

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39
Q

Vancomycin, MOA

A

Inhibits cell wall synthesis; binds to D-alanyl-D-alanine of cell wall precursor units

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40
Q

Vancomycin, ADR

A

Macular skin rash, chills, fever, rash
Red-man syndrome (histamine release): extreme flushing, tachycardia, hypotension
Ototoxicity
Nephrotoxicity

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41
Q

Respiratory Fluoroquinolone prototoype

A

Levofloxacin

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42
Q

Levofloxacin, Drug Class

A

Fluoroquinolone (respiratory)

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43
Q

Levofloxacin, Spectrum

A

E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp

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44
Q

Levofloxacin, MOA

A

Concentration-dependent; Targets bacterial DNA gyrase & topoisomerase IV
“FLOOR IT” = concentration dependent, give it everything you’ve got!

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45
Q

Levofloxacin, ADR

A

GI (3-17%): mild nausea, vomiting, abdominal discomfort
CNS (0.9-11%): mild headache, dizziness, delirium, rare hallucinations
Rash
Photosensitivity
Achilles tendon rupture
Contraindicated: children
“FluoroquinoLONES –> be good to your BONES”

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46
Q

Aminoglycoside, prototype

A

Gentamicin

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47
Q

Gentamicin, Drug Class

A

Aminoglycoside

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48
Q

Gentamicin, Spectrum

A

Aerobic gram-negative bacteria, limited action against gram-positive, synergistic bactericidal effects in gram-positive with cell wall active agent

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49
Q

Gentamicin, MOA

A

Concentration-dependent; Binds 30S ribosomal subunit; interferes with initiation of protein synthesis; causes misreading of mRNA

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50
Q

Gentamicin, ADR

A

Ototoxicity (up to 25%)
Nephrotoxicity (8-26%)
Neuromuscular block and apnea

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51
Q

Tetracycline prototype

A

Doxycycline

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52
Q

Doxycycline, Drug Class

A

Tetracycline

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53
Q

Doxycycline, Spectrum

A

Bacteriostatic; wide range of aerobic & anaerobic gram-positive and gram-negative activity; Rickettsia, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia spp, Legionella, atypical mycobacterium, Plasmodium, Borrelia burgdorferi (Lyme’s disease), Treponema pallidum (syphilis)
“My dachshund’s name is BART”: doxy = Borrelia, Atypicals (Mycoplasma, Legionella, Chlamydia), Rickettsia, Treponema

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54
Q

Doxycycline, MOA

A

Binds 30S ribosomal subunit; prevents access of aminoacyl tRNA to acceptor (A) site on mRNA ribosome complex

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55
Q

Doxycycline, ADR

A 
GI (epigastric burning, N/V/D) 
C. difficile superinfections
Photosensitivity
Teeth discoloration
Thrombophlebitis 
Contraindicated: children
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56
Q

Macrolide prototype

A

Azithromycin

57
Q

Azithromycin, Drug Class

58
Q

Azithromycin, Spectrum

A

Bacteriostatic; respiratory tract infections (spectrum S. pneumoniae, H. influenzae, and atypicals: Mycoplasma, Chalmydophilia, Legionella), alternative for otitis media , sinusitis, bronchitis, and SSTIs. Pertussis, gastroenteritis, H. pylori, Mycobacterial infections
“SHHAMP” = Strep, Haemophilus, Helicobacter, Atypicals, Mycobacterial, Pertussis

59
Q

Azithromycin, MOA

A

Binds reversibly 50S ribosomal subunit; inhibits translocation

60
Q

Azithromycin, ADR

A 
GI: epigastric distress
Hepatotoxicity
Arrhythmia
QT prolongation
DDI: CYP3A4 inhibition - prolongs effects of digoxin, warfarin…
61
Q

Lincosamide prototype

A

Clindamycin

62
Q

Clindamycin, Drug Class

A

Lincosamide

63
Q

Clindamycin, Spectrum

A

Bacteriostatic/-cidal (depends on conc, infection site, organism); Strep pneumoniae, pyogenes, viridans MSSA; anaerobes (B. fragilis)

64
Q

Clindamycin, MOA

A

Binds 50S ribosomal subunit; inhibits translocation and suppresses protein synthesis

65
Q

Clindamycin, ADR

A 
GI: diarrhea (2-20%)
Pseudomembranous colitis (0.01-10%)
	d/t C. difficile 
Skin rash (10%)
Reversible increase in aminotransferase activity 
May potentiate neuromuscular blockade
66
Q

50S ribosomal subunit inhibitors

A

Macrolides (Azithromycin)
Lincosamides (Clindamycin)
Linezolid
“buy AT 30, CEL at 50”

67
Q

30S ribosomal subunit inhibitors

A

Aminoglycosides (Gentamicin)
Tetracyclines (Doxycycline)
“buy AT 30, CEL at 50”

68
Q

Oxazolidinone prototype

69
Q

Linezolid, Drug Class

A

Oxazolidinone

70
Q

Linezolid, Spectrum

A

Gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (penicillin resistant S. pneumoniae), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods (Corynebacterium, L. monocytogenes)

71
Q

Linezolid, ADR

A

Myelosuppression [thrombocytopenia (2.4%), anemia, leukopenia]
Headache
Rash
DDI: weak, nonspecific inhibitor of monoamine oxidase (antidepressants)

72
Q

Linezolid, MOA

A

Inhibits protein synthesis binding P site of 50S ribosomal subunit, prevents formation of initiation complexes

73
Q

Causes QT prolongation

A

Macrolides (Azithromycin)

74
Q

Achilles Tendon Rupture

A

Fluoroquinolones (Levofloxacin)

75
Q

DDI: CYP3A4 inhibition

A

Macrolides (Azithromycin)

76
Q

Ototoxicity

A

Aminoglycosides (Gentamicin)

Glycopeptides (Vancomycin)

77
Q

Nephrotoxicity

A

Aminoglycosides (Gentamicin)

Glycopeptides (Vancomycin)

78
Q

Red-mann Syndrome

A

Glycopeptides (Vancomycin)

79
Q

B-lactams

A

Penicillins, Cephalosporins, Carbapenems

80
Q

Causes seizures

A

Carbapenems

81
Q

MRSA

A

Vancomycin, Linezolid

82
Q

Pseudomonas

A

Ceftzidime, Cefepime, Meropenem, Ertapenem, Levofloxacin, B-lactamase inhibitors

83
Q

Anaerobes

A

Meropenem, Ertapenem, B-lactamase inhibitors, Doxycycline, Clindamycin, Linezolid (gram + anaerobic cocci)

84
Q

Anaerobic coverage

A

Meropenem, Ertapenem, Doxycycline, Clindamycin, Linezolid

85
Q

Piperacillin, Spectrum

A

extends spectrum to Pseudomonas aeruginosa, Enterobacter, and Proteus spp.

86
Q

CURB 65 Criteria

A 
Confusion
Uremia BUN > 20 
Respiratory rate >30bpm 
Low BP, SBP <90, DBP = 60
Age >/=65
0-1 = outpatient
2 = admit 
3+ = often require ICU care
87
Q

CURB 65 Minor Criteria

A 
Multilobar infiltrates
WBC < 4000
PLT <100,000
Core temp < 36C 
Hypotension requiring agggressive fluid resuscitation
88
Q

absolute indications for ICU admission

A 
mechanical ventilation 
septic shock (+ vasopressors)
89
Q

CAP- Infecting Organisms for Underlying Bronchopulmonary disease

A

H. influenzae
Moraxella catarrhalis
+S. aureus during influenza outbreak

90
Q

CAP- Infecting Organisms with chronic oral steroid use, severe underlying bronchopulmonary disease, alcoholism, or frequent antibiotic use

A

enterobacteriaceae

pseudomonas

91
Q

CAP- Infecting Organisms with classic aspiration pleuropulmonary syndrome in alcohol/drug overdose or in seizures with gingival disease or esophageal motility disorders

92
Q

CAP- Common viruses

A

influenza
RSV
adenovirus
parainfluenza virus

93
Q

DOC for Non-resistant S. pneumoniae

A

PCN

Amoxicillin

94
Q

DOC for Resistant S. pneumoniae

A

Cefotaxime, ceftriaxone, levofloxacin, vancomycin, linezolid (based on susceptibility)

95
Q

DOC for non-beta lactase producing H. influenzae

A

amoxicillin

96
Q

DOC for beta lactase producing H. influenzae

A

2nd or 3rd generation cephalosporin, amoxicillin/clavulanate

97
Q

DOC for Mycoplasma pneumoniae

A

Macrolide, tetracycline

98
Q

DOC for Chlamydophila pneumoniae

A

Macrolide, tetracycline

99
Q

DOC for Chlamydophila psittaci

A

doxycycline

100
Q

DOC for Legionella spp

A

FQ, azithromycin, doxycycline

101
Q

DOC for Enterobacteriaceae (Klebsiella, E coli, Proteus)

A

3rd or 4th generation cephalosporin, carbapenem (if ESBL producer)

102
Q

DOC for Pseudomonas

A

antipseudomonal b-lactam w/ ciprofloxacin, levofloxacin, or aminoglycoside

103
Q

DOC for anaerobe (bacteroides, fusobacterium, peptostreptococcus)

A

b-lactam/b-lactamase inhibitor, clindamycin

104
Q

DOC for MSSA

A

anti-staphylococcal PCN (nafcillin)

105
Q

DOC for MRSA

A

vancomycin or linezolid

106
Q

DOC for influenza virus

A

Oseltamivir, zanamivir

107
Q

DOC for Pneuomcystic jiroveci

A

trimethoprim/sulfamethoxazole

108
Q

DOC for Bordatella pertussis

A

azithromycin, clarithromycin

109
Q

DOC for coccidioides spp

A

itraconazole, fluconazole (but no tx necessary if normal host)

110
Q

DOC for Histoplasmosis

A

itraconazole

111
Q

DOC for Blastomycosis

A

itraconazole

112
Q

Oseltamivir, Drug Class

A

neuraminidase inhibitor

113
Q

Oseltamivir, MOA

A

analogs of sialic acid, interferes with release of progeny influenza virus from infected host cell

114
Q

Oseltamivir, ADR

A

N/V, abdominal pain (5-10%), headache, fever, diarrhea, neuropsychiatric effects (approved for children >/= 1 year)

115
Q

neuraminidase inhibitor prototype

A

Oseltamivir

116
Q

Azole prototypes

A

fluconazole, voriconazole

117
Q

Azole, MOA

A

inhibits fungal cytochrome P450, reducing production of ergosterol

118
Q

Azoles, ADRs

A

minor GI upset, abnormalities in liver enzymes, DDIs!!! i.e. prophylactically decrease warfarin

119
Q

Voriconazole ADRs

A

visual changes, photosensitivity

120
Q

Amphotericin B, MOA

A

binds ergosterol, changes permeability of cell, forms pores in membrane

121
Q

Isoniazid, MOA

A

inhibits synthesis of mycelia acids. Prodrug, activated by KatG. Active form binds AcpM and KasA –> inhibits mycolic acid synthesis

122
Q

Isoniazid, Resistance

A

mutation or deletion of katG gene
overexertion of inca and aphid
mutation in kasA

123
Q

Isoniazid, ADRs

A

hepatotoxicity (minor elevation in LFTs 10-20%), clinical hepatitis (1%)
peripheral neuropathy
CNS toxicity (memory loss, psychosis, seizures)
Fever, skin rashes, drug-induced SLE

124
Q

Rifampin, MOA

A

inhibits RNA synthesis (binds B-subunit of DNA-dependent RNA polymerase rpoB)

125
Q

Rifampin, resistance

A

reduced binding affinity to RNA polymerase –> point mutations within rpoB gene

126
Q

Rifampin, ADRs

A 
Harmless red/orange color to secretions
N/V (1.5%) 
rash 
fever 
hepatotoxicity 
flu-like syndrome (20%) in those tied <2x/week
DDI: induces CYPs
127
Q

Pyrazinamide, MOA

A

disrupts mycobacterial cell membrane synthesis and transport functions (exact mechanism unknown)

128
Q

Pyrazinamide, Resistance

A

impaired biotransformation, mutation in pncA

129
Q

Pyrazinamide, ADRs

A

hepatotoxicity (1-5%)!!
Gi upset
hyperuricemia (gouty arthritis)

130
Q

Ethambutol, MOA

A

disrupts synthesis or arabinoglycan. inhibits mycobacterial arabinosyl transferase (encoded by embCAB operon)

131
Q

Ethambutol, resistance

A

overexpression fo emb gene products

mutation in embB gene

132
Q

Ethambutol, ADRs

A

retrobulbar neuritis (loss of visual acuity, red-green color blindness)
rash
drug fever

133
Q

Streptomycin, Drug class=]

A

Aminoglycoside

134
Q

Streptomycin, MOA

A

irreversible inhibitor of protein synthesis. binds S12 ribosomal protein of 30S subunit

135
Q

Streptomycin, resistance

A

mutations in rpsL or rrs gene which alter binding site

136
Q

Streptomycin, ADRs

A

ototoxicity (vertigo and hearing loss)
nephrotoxicity
relatively C/I in pregnancy (newborn deafness)

137
Q

Latent TB infection treatment options

A

Isoniazid x9 mths QD or bi-weekly
Isoniazid & Rifapentine QW x12 by DOT (for pt’s 12+ y/o and HIV pt’s not on ART)
Rifampin QD x4 mths (pt’s intolerant or resistant to INH) or x6 mths in peds

138
Q

Active TB initial therapy

A 
x2 months 
INH
rifampin
pyrazinamide 
ethambutol

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