Principles of Antibiotics Flashcards
1
Q
Beta-Lactams
A
- Penicillins
- Cephalosporins
- Carbapenems
2
Q
Natural Penicillins
A
- Penicillin VK
- Penicillin G
3
Q
Aminopenicillins
A
- Ampicillin
- Amoxicillin
- Anti-staph penicillin’s
4
Q
Anti-staph penicillins
A
- Methicillin
- Nafcillin
- Dicloxacillin
5
Q
Penicillin-based antibiotics
A
- Amoxicillin/clavulanate
- Ampicillin/subactam
- Piperacillin/tazobactam
6
Q
Cephalosporins- First generation
A
- Cefazolin
- Cephalexin
7
Q
Cephalosporins-Second generation
A
Cefuroxime, cefoxitin
8
Q
Cephalosporins- Third generation
A
Ceftriaxone, ceftazidime, cepodoxime
9
Q
Cephalosporins-Fourth generation
A
Cefepime
10
Q
Imipenem
A
Carbapenems
11
Q
Meropenem
A
Carbapenems
12
Q
Doripenem
A
Carbapenems
13
Q
Ertapenem
A
Carbapenems
14
Q
Monobactam
A
Aztreonam
15
Q
Lipopeptides
A
Daptomycin
16
Q
streptococcus- aerobic or anaerobic
A
Aerobic
17
Q
staphylococcus-aerobic or anaerobic
A
Aerobic
18
Q
E. Coli- aerobic or anaerobic
A
Aerobic
19
Q
Klebsiella- aerobic or anaerobic
A
Aerobic
20
Q
Enterobacter-aerobic or anaerobic
A
Aerobic
21
Q
Pseudomonas-aerobic or anaerobic
A
Aerobic
22
Q
Most common place to find streptococcus
A
Community pathogen
23
Q
Most common place to find staphylococcus
A
Community or hospital
24
Q
Most common place to find enterococcus
A
Community or hospital
25
Most common place to find Neiserria
Community
26
Most common place to find Escherichia (E. coli_
Community or hospital
27
Most common place to find Klebsiella
Community or hospital
28
Most common place to find Pseudomonas
Hospital
29
Most common place to find Enterobacter
hospital
30
Most common place to find Acinetobacter
Hospital
31
Most common place to find Serratia
Hospital
32
Most common place to find Citrobacter
Hospital
33
Most common place to find Bacgteroides
Community
34
Most common place to find Peptostreptococcus
Community
35
Empiric therapy
- Initial antibiotic regimen that attempts to improve outcomes
- No culture data yet..... educated guess
36
Definitive/Targeted therapy
- Target specific pathogen --> modify regimen
| - Minimize resistance, toxicity, improve cost-effectiveness
37
Prophylaxis
Administration of drug to prevent disease.
38
Epithelial cells on sputum gram stain report
skin cells in mouth. A lot of these means pt just coughed up spit, we need sputum from down in lungs. This usually means culture is not very good.
39
PMNs on sputum gram stain report
Generally means bacterial infections
40
Purple stain
Gram positive
41
Pink stain
Gram negative
42
what is MIC
Minimum inhibitory concentration
| -Lowest concentration of antibiotic to show no growth of bacteria.
43
The higher the breakpoint....
the harder to treat the bug.
44
SIR, S=
Infection likely to respond
| -MIC is less than the breakpoint
45
SIR, I=
Response is indeterminate, may respond
| -MIC is equal to the breakpoint
46
SIR, R=
Therapy is likely to fail
| -MIC is greater than the breakpoint.
47
Common indications:
MSSA Cellulitis, bacteremia, joint infections, prosthetic device infections,
E.coli and Klebsiella uncomplicated urinary tract infections
First generation: Cefazolin, Cephalexin
48
Common indications:
Otitis media or sinus infections
Prophylaxis for intra-abdominal surgery
Second generation: cefuroxime, cefoxitin
49
Common indications:
Hospital-acquired pneumonia
Febrile neutropenia
-not good for gram positive
ceftazidime
50
Common indications for:
Severe community-acquired pneumonia
Intra-abdominal infection (usually in combination with another drug that covers anaerobes)
Complicated urinary tract infections
ceftriaxone and cefuroxime
51
Great coverage for strep:
Ceftriaxone/cefuroxime
| Ceftriaxone: great 1st choice.
52
Common Indications:
Febrile neutropenia
Hospital acquired or health-care associated pneumonia
-Also covers pseudomonas
Cefepime
53
What does cefepime not cover?
Enterococcus faecalis, Bacteroides fragilis, VRE, and MRSA
54
Common indications:
| Intra-abdominal infections, diabetic foot infections
Ertapenem
55
Which drug class may lower the seizure threshold?
Carbapenems
56
Used for gram-negative coverage when beta-lacgam allergy
Aztreonam
Use when you can't use zosyn.
Great for gram - bacteria and life threatening allergies.
57
MOA: binds to D-Ala-D-Ala residue of peptidoglycan precursor at surface of cytoplasmic membrane (inhibits cell wall synthesis)
Vancomycin
58
Spectrum: aerobic and anaerobic G(+) bacteria only
Vancomycin
59
Clinical uses:
| meningitis, endocarditis, cellulitis, bacteremia, HAP, osteomyelitis
IV vanco
PO Vance- C. diff.
60
Red man syndrome may be seen with?
Vanco
61
MOA: Binds to bacterial membrane causing rapid depolarization of membrane potential
Inhibits protein, DNA and RNA synthesis
Daptomycin
62
Spectrum: aerobic and anaerobic G(+) bacteria only
| - MRSA, VRE
Daptomycin
63
binds to 50S ribosomal subunit, prevents protein synthesis
Macrolides (erythromycin, clarithromycin, azithromycin)
64
Spectrum: G(+), selective G(-), atypicals
Macrolides (erythromycin, clarithromycin, azithromycin)
65
MOA: inhibition of protein synthesis by binding to 30s ribosome subunit
Tetracyclines
66
Spectrum: G(+), G(-), anaerobes, atypicals
Tetracyclines
67
Great for ESBL organisms
Tigecycline
68
MOA: Inhibit DNA-gyrase in bacteria, promote breakage of double-stranded DNA
Quinolones
69
Spectrum:
G(-): Enterobacteriaceae, enteric pathogens
G(+): MSSA, some Strep
Atypicals: Legionella, Mycoplasma, Chlamydia
Quinolones
70
Which quinolone is good for anti-pseudomonal bacteria?
Ciprofloxacin and levofloxacin
71
Which quinolone is good for Respiratory organisms?
Moxifloxacin and levofloxacin
72
Which quinolone is good for anaerobes?
Moxifloxacin
73
Clinical uses: CAP, UTI (except moxifloxacin), ocular infections, intra-abdominal, prostatitis, prophylaxis in chemo-induced neutropenia
Quinolones
74
MOA: Inhibits protein synthesis by binding to a site on the ribosomal RNA 50S subunit
Linezolid
75
Spectrum: G(+) only
| MRSA, VRE
Linezolid.
76
MOA: binds to the 50S subunit preventing peptide-bond formation and inhibiting protein synthesis
Clindamycin
77
Spectrum:
G(+): MSSA, MRSA, Strep spp
Anaerobes, protozoa (Plasmodium, Toxoplasma), incr resistance to B. fragilis
Not used: Enterococcus, Group D strep, G(-)
Clindamycin
78
One of the worst drugs for the GI tract
Clindamycin
79
Clinical uses: adjunct therapy in infections with toxin production (ex. Necrotizing fascitis), aspiration pneumonia
Clindamycin
80
MOA: interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolate formation from PABA
Sulfamethoxazole
81
MOA: inhibits dihydrofolate reduction to tetrahydrofolate, resulting in sequential inhibition of the folic acid pathway.
Timethroprim
82
Spectrum
G(+): MSSA, MRSA, Strep spp, Listeria
G(-): Enterobacteriaceae, E. coli, H. influenzae, Stenotrophomonas
Does not cover: Pseudomonas
Sulfamethoxazole-Trimethoprim
83
MOA: interacts with DNA causing a loss of helical DNA structure and strand breakage, resulting in inhibition of protein synthesis
Metronidazole
84
Spectrum:
All anaerobes, except Actinomyces, Propionibacterium acnes, and Lactobacillus spp.
Antiprotozoal, amebicide
Inactive against aerobic bacteria
Metronidazole
85
Spectrum of Activity:
No gram-positive or anaerobic activity
Active against all gram-negatives
Aminoglycosides: Gentamicin, Tobramycin, Amikacin
86
Common Indications:
Rarely used as monotherapy
Often combined with beta-lactams for moderate-severe gram-negative infections in critically ill patients
Aminoglycosides.
87
27yo pregnant female presents with UTI. Which antibiotics would you avoid?
Tetracyclines, bactrim, quinolones, flagyl in first trimester.
88
Cephalosporins spectrum of activity is similar to:
Antistaph penicillin.....MSSA!
89
Which drug is preferred for life-threatening MSSA infections
Nafcillin
90
Common indications for 1st gen cephalosporins
MSSA cellulitis, bacteremia, joint infections, prosthetic device infections.
-E.coli and klebsiella uncomplicated UTI
91
Common indications for 2nd gen cephalosporins
Otitis media or sinus infections.
| Ceftoxitin= prophylaxis for intra-abdominal surgery
92
What drugs are superior to vancomycin against MSSA?
Beta-lactams
93
Deptomycin does not penetrate the ________
Lungs
