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MS 2 - Unit 6 > Pharmacology - Antimicrobial Therapy I - Jeffrey Steele > Flashcards

Pharmacology - Antimicrobial Therapy I - Jeffrey Steele Flashcards

1
Q

Class: Penicillins

A

Beta-lactam

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2
Q

Class: Cephalosporins

A

Beta-lactam

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3
Q

Class: Aztreonam

A

Monobactam

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4
Q

Class: Vancomycin

A

Glycopeptides

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5
Q

Class: Telavancin
Dalbavancin
Oritavancin

A

Lipoglycopeptides

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6
Q

Beta lactams, Monobactams, Glycopeptides and Lipoglycopeptides all act:

A

on the cell wall of bacteria

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7
Q

MOA: Beta-lactams

A

Bind to (acylation of) PBPs (penicillin binding proteins)

  • -PBPs polymeriza the glycan strand (transglycosylation)
  • -PBPs cross-link between glycan chains (transpeptidation)
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8
Q

What are mechanisms of resistance against beta lactams?

A

Enzymatic Destruction - by gram negative bacteria;
Reduced permeability;
Target site alteration

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9
Q

Beta-lactams do not work on:

A

Mycoplasma pneumoniae;
Chlamydophilia pneumoniae
–these bugs lack cell walls

Legionella
MRSA (except for ceteroline = 5th gen cephalosporin)
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10
Q

Side effects: Beta lactams

A 
Drug fever
Acute interstitial nephritis
Seizures at high doses
Diarrhea
Delayed hypersensitivity reaction - rash
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11
Q

What are the natural penicillins?

A

Penicillin G

Penicillin V

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12
Q

Class: Oxacillin
Nafcillin
Dicloxacillin

A

Penicillinase-resistant penicillins aka antistaphylococcal penicillins

Penicillins - Beta-lactams

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13
Q

Class: Ampicillin

Amoxicillin

A

Aminopenicillins

Amino group increases hydrophilicity - improved penetration into gram negative cell membrane

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14
Q

Class: Ticarcillin

Piperacillin

A

Anti-pseudomonal penicillins

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15
Q

Use: Penicillin G, G procaine, G benzthine, V

A

Streps;
Mostly gram pos aerobic organisms;
Spirochetes - Treponema palladium;
Some enterobacteriaciae

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16
Q

Addition of what to Penicillin is recommended for use against odontogenic infections?

A

Metronidazole

recommended for b-lactamase producing aerobes

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17
Q

Use: Anti-staph penicillins ie oxacillin

A

MSSA - skin and soft tissue infections, joint infection, bacteremia, endocarditis;
(Strep)

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18
Q

T/F: Anti-staph penicillins are superior to vancomycin for MSSA infections.

A

True

Oxacillin
Nafcillin
Dicloxacillin

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19
Q

Adverse events: Oxacillin

A

Hepatotoxicity, neutropenia (delayed)

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20
Q

Adverse events: Nafcillin

A

Hepatotoxicity, neutropenia (delayed) and thrombophlebitis

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21
Q

What anti-staph penicillins require frequent dosing due to their short half life?

A

Oxacillin, Nafcillin

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22
Q

What is the drug of choice for enterococci?

A

Ampicillin (Aminopenicillin class)

–also for Listeria

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23
Q

Use: Amoxicillin

A 
Otitis media;
Upper and lower RTI;
Lyme disease;
Streps ie S. Pneumo
**also covers haemophilus which causes upper ear/RTI stuff (for the unvaccinated child)
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24
Q

Use: IV Ampicillin

A

Listeria - meningitis;
Enterococcal infections
Used with gentamycin for endocarditis

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25
Q

Which aminopenicillin has better bioavailability?

A

Amoxicillin > Ampicillin

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26
Q

The antipseudomonal penicillins, piperacillin and ticarcillin, are always used in conjunction with:

A

B-lactamase inhibitors to expand spectrum to include beta-lactamase-producing organisms

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27
Q

Class: Ampicillin/sulbactam (IV) (Unasyn)

A

Extended spectrum penicillin/beta lactamase inhibitor combinations

28
Q

Class: Amoxicillin/clavulanate (PO) (Augmentin)

A

Extended spectrum penicillin/beta lactamase inhibitor combinations

29
Q

Class: Piperacillin/tazobactam (IV) (Zosyn)

A

Extended spectrum penicillin/beta lactamase inhibitor combinations

30
Q

Class: Ticarcillin/clavulanate (IV) (Timentin)

A

Extended spectrum penicillin/beta lactamase inhibitor combinations

31
Q 
Uses: Extended spectrum penicillin/beta lactamase inhibitor combinations
ie Ampicillin/sulbactam
Amoxicillin/clavulanate
Piperacillin/tazobactam
Ticarcillin/clavulanate
A

Gram pos - MSSA;
Gram neg - Enterobacteriaceae;
Anaerobes ie Bacteroides, Fusobacterium, Prevotella

32
Q

What drugs are recommended for Pseudomonas aeruginosa?

A

Piperacillin/tazobactam;

Ticarcillin/clavulanate

33
Q

What unique strength does sulbactam have?

A

Activity against nosocomial bug Acinetobacter baumanni

34
Q

What cephalosporins have activity against Pseudomonas aeruginosa?

A

Ceftazidime;

Cefepime

35
Q

Class: Ceftaroline

A

5th gen cephalosporin

36
Q

Ceftriaxone should be avoided in neonates because:

A

AE - biliary sludging

37
Q

What cephalosporins are responsible for causing a disulfiram-like reaction w/ ethanol?

A

Cefamandole;
Cefotetan;
Cefoperazone

38
Q

Class: Cefazolin (IV)

A

1st gen cephalosporin

39
Q

Class: Cephalexin (PO)

A

1st gen cephalosporin

40
Q

Class: Cephadroxil (PO)

A

1st gen cephalosporin

41
Q

Use: 1st gen cephalosporin
Cefazolin
Cephalexin
Cephadroxil

A

MSSA - joint, SSTI (skin and soft tissue infections), bacteremia
Streptococci
Some enteric GNRs

42
Q

Side effects: 1st gen cephalosporin
Cefazolin
Cephalexin
Cephadroxil

A

Hypersensitivity rxns

Better tolerated than anti-staph penicillins (oxacillin, nafcillin)

43
Q

Do 1st gen cephalosporins, is Cefazolin, Cephalexin, Cephadroxil cross the BBB?

A

No. can’t use for CNS infections

44
Q 
Class: 
Cefuroxime (IV/PO)
Cefaclor (PO) 
Loracarbef (PO) 
Cephamycins (Cefoxitin, Cefotetan)
A

2nd gen cephalosporins

45
Q

Use: 2nd gen cephalosporins

A

Most commonly post colon surgery
Some staph, strep but less active than 1st gen cephalosporins;
Gram neg: some enterobacteriaceae, h. influenzae, m. catarrhalis, N. gonorrheae

46
Q

Class: Cefotaxime (IV)

A

3rd gen cephalosporin

47
Q

Class: Ceftriaxone (IV)

A

3rd gen cephalosporin

48
Q

Class: Ceftazidime (IV)

A

3rd gen cephalosporin

49
Q

Class: Cefdinir (PO)

A

3rd gen cephalosporin

50
Q

Class: Cefpodoxime (PO)

A

3rd gen cephalosporin

51
Q

Class: Ceftibutin (PO)

A

3rd gen cephalosporin

52
Q

Class: Cefixime (PO)

A

3rd gen cephalosporin

53
Q

Use: Ceftazidime

A

Pseudomonas
less active against Staph and Strep

3rd gen cephalosporin

54
Q

Which generation of cephalosporins is more active against staphylococci?

A

1st gen better than 3rd gen

55
Q

Uses: Ceftriaxone (3rd gen)

A

Community-acquired pneumonia - use w/ azithromycin;
Meningitis;
Complicated UTI;
Intra-abdominal infection w/ metronidazole;
CSF Lyme disease;
Strep endocarditis;
Gonococcal infection and PID

56
Q

Side effects: 3rd gen cephalosporins

A

Greater correlation w/ C. diff infection than other drugs;

Development of resistant organisms (ESBLs)

57
Q

Side effects: Ceftriaxone (3rd gen)

A

Concerns in neonates - biliary sludging, kernicterus, interaction with calcium-containing solutions causing precipitation

58
Q

What drug should be used instead of Ceftriaxone in neonates?

A

Cefotaxime

59
Q

T/F: Ceftriazone, Cefotaxime, Ceftazidime have effective penetration across the BBB.

60
Q

Is dose-adjustment necessary for patients with renal dysfunction who are administered Ceftriaxone?

61
Q

Class: Cefepime

A

4th gen cephalosporin

62
Q

MOA: Cefepime (4th gen)

A

Zwitterion - neutral molecule with pos and neg Q

Permits rapid entry into outer membrane of gram neg bacteria

63
Q

Cephalosporins have notably no effect on what class of bacteria?

A

Enterococcus

64
Q

Use: Cefepime (4th gen)

A

Geared toward nosocomial infections

Enterobacteriaceae;
Pseudomonas
Meningitis
MSSA
Strep pneumo, including all strains resistant to penicillin
65
Q

Side effects: Cefepime (4th gen)

A

Akinetic seizures

66
Q

MOA: Ceftaroline (5th gen)

A

Has a side chain that mimics a portion of the cell wall structure and acts as a trojan horse allowing access to the PBP2a

MS 2 - Unit 6 (34 decks)

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