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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
Which aminopenicillin has better bioavailability?
Amoxicillin > Ampicillin
26
The antipseudomonal penicillins, piperacillin and ticarcillin, are always used in conjunction with:
B-lactamase inhibitors to expand spectrum to include beta-lactamase-producing organisms
27
Class: Ampicillin/sulbactam (IV) (Unasyn)
Extended spectrum penicillin/beta lactamase inhibitor combinations
28
Class: Amoxicillin/clavulanate (PO) (Augmentin)
Extended spectrum penicillin/beta lactamase inhibitor combinations
29
Class: Piperacillin/tazobactam (IV) (Zosyn)
Extended spectrum penicillin/beta lactamase inhibitor combinations
30
Class: Ticarcillin/clavulanate (IV) (Timentin)
Extended spectrum penicillin/beta lactamase inhibitor combinations
31
``` Uses: Extended spectrum penicillin/beta lactamase inhibitor combinations ie Ampicillin/sulbactam Amoxicillin/clavulanate Piperacillin/tazobactam Ticarcillin/clavulanate ```
Gram pos - MSSA; Gram neg - Enterobacteriaceae; Anaerobes ie Bacteroides, Fusobacterium, Prevotella
32
What drugs are recommended for Pseudomonas aeruginosa?
Piperacillin/tazobactam; | Ticarcillin/clavulanate
33
What unique strength does sulbactam have?
Activity against nosocomial bug Acinetobacter baumanni
34
What cephalosporins have activity against Pseudomonas aeruginosa?
Ceftazidime; | Cefepime
35
Class: Ceftaroline
5th gen cephalosporin
36
Ceftriaxone should be avoided in neonates because:
AE - biliary sludging
37
What cephalosporins are responsible for causing a disulfiram-like reaction w/ ethanol?
Cefamandole; Cefotetan; Cefoperazone
38
Class: Cefazolin (IV)
1st gen cephalosporin
39
Class: Cephalexin (PO)
1st gen cephalosporin
40
Class: Cephadroxil (PO)
1st gen cephalosporin
41
Use: 1st gen cephalosporin Cefazolin Cephalexin Cephadroxil
MSSA - joint, SSTI (skin and soft tissue infections), bacteremia Streptococci Some enteric GNRs
42
Side effects: 1st gen cephalosporin Cefazolin Cephalexin Cephadroxil
Hypersensitivity rxns Better tolerated than anti-staph penicillins (oxacillin, nafcillin)
43
Do 1st gen cephalosporins, is Cefazolin, Cephalexin, Cephadroxil cross the BBB?
No. can't use for CNS infections
44
``` Class: Cefuroxime (IV/PO) Cefaclor (PO) Loracarbef (PO) Cephamycins (Cefoxitin, Cefotetan) ```
2nd gen cephalosporins
45
Use: 2nd gen cephalosporins
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
Class: Cefotaxime (IV)
3rd gen cephalosporin
47
Class: Ceftriaxone (IV)
3rd gen cephalosporin
48
Class: Ceftazidime (IV)
3rd gen cephalosporin
49
Class: Cefdinir (PO)
3rd gen cephalosporin
50
Class: Cefpodoxime (PO)
3rd gen cephalosporin
51
Class: Ceftibutin (PO)
3rd gen cephalosporin
52
Class: Cefixime (PO)
3rd gen cephalosporin
53
Use: Ceftazidime
Pseudomonas less active against Staph and Strep 3rd gen cephalosporin
54
Which generation of cephalosporins is more active against staphylococci?
1st gen better than 3rd gen
55
Uses: Ceftriaxone (3rd gen)
Community-acquired pneumonia - use w/ azithromycin; Meningitis; Complicated UTI; Intra-abdominal infection w/ metronidazole; CSF Lyme disease; Strep endocarditis; Gonococcal infection and PID
56
Side effects: 3rd gen cephalosporins
Greater correlation w/ C. diff infection than other drugs; | Development of resistant organisms (ESBLs)
57
Side effects: Ceftriaxone (3rd gen)
Concerns in neonates - biliary sludging, kernicterus, interaction with calcium-containing solutions causing precipitation
58
What drug should be used instead of Ceftriaxone in neonates?
Cefotaxime
59
T/F: Ceftriazone, Cefotaxime, Ceftazidime have effective penetration across the BBB.
True
60
Is dose-adjustment necessary for patients with renal dysfunction who are administered Ceftriaxone?
No
61
Class: Cefepime
4th gen cephalosporin
62
MOA: Cefepime (4th gen)
Zwitterion - neutral molecule with pos and neg Q | Permits rapid entry into outer membrane of gram neg bacteria
63
Cephalosporins have notably no effect on what class of bacteria?
Enterococcus
64
Use: Cefepime (4th gen)
Geared toward nosocomial infections ``` Enterobacteriaceae; Pseudomonas Meningitis MSSA Strep pneumo, including all strains resistant to penicillin ```
65
Side effects: Cefepime (4th gen)
Akinetic seizures
66
MOA: Ceftaroline (5th gen)
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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