Q1 Abx Flashcards
HNPEK stands for?
They are Gram ____ organizms
Hemophilis
Nysteria
Proteus
E-coli
Klebsiela
Gram NEGATIVE
VRE stands for?
Gram _____ organisms
Vanc resistant Enterococus
Gram POSITIVE
Antibiotic selection is made based on what 4 categories?
Infection site (and therefore likely organism)
Antibiotic characteristics
Patient characteristics
Treatment guidelines
What type of organisms are usually found in the oral site?
Gram-POS bacteria (usually streptococcus) and candida
What type of organisms are usually found on the skin and introduced through vascular access?
GPos and Gneg usually staphylococcus and candida
what type of organism is typically found in the intra-abdominal site
Gram NEG (usuallly Enterobacteriacae
And Gram POS usually Enterococcus
Candida
What type of bacteria is found in the urinary site typically introduced through catheters?
Gram Neg Psuedomonas and Enterobacteriacase
Gram POS E-coli
Candida
What organisms are found in respiratory tract (ventilator associated)
Gram neg pseudomonas, acinetobacter, enterobacteriacae
Gram pos staphylococcus
Fungi - candida and aspergillus.
2 main categories of abx based on excretion
Hydrophilic (Beta-lactate, aminoglycosides, Vanc, Daptomycin, Polymyxins)
Lipophilic (Quinolones, Macrolides, Rifampin, Linezolid, Tetracycline)
Characteristics of hydrophilic abx
Small Vd -> less tissue penetration
Most renally eliminated
Not active against atypical pathogens because of low intracellular concentration
Poor-moderate bioavailability
Characteristics of lipophilic abx
Large Vd -> better tissue penetration
Hepatically metabolized
Many DDIs
High Intracellular concentration so effective against atypical pathogens
Excellent bioavailability (IV:PO ratio is or close to 1:1)
Even though quinolones are lipophilic, they still require ______
Renal dose adjustments
If the term CYP (“sip”) is used in relation with a medication, what does this mean?
It is an enzyme in the liver that helps to clear/eliminate medications.
5 main classes of antibiotics based on __________
How they affect the target cell.
Cell-Wall Inhibitors
Folic Acid Synthesis Inhibitors
DNA/RNA inhibitors
Cell Membrane Inhibitors
Protein Synthesis Inhibitors
Beta-Lactams, Monobactams and Vanc are _______ kind of abx
Cell wall inhibitors
Aminoglycosides, Macrolides, Tetracyclines, Clindamycin, Linezolid are all _______
Protein Synthesis Inhibitors
Polymixins, Daptomycin, Telvancin and Oritavancin are all _______
Cell Membrane inhibitors
Quinolones (-floxacin), Metronidazole, Tinidazole and Rifampin are all ______
DNA/RNA inhibitors
Sulfonamides, Trimethoprim and dapsone are all _________
Folic Acid Synthesis inhibitors.
Penicillins, cephalosporins and carbapenems are ________ abx
Beta-Lactam Antibiotics
How do BLs work?
Inhibit bacterial cell wall synthesis by binding to Penicillin binding Proteins (PBPs)
GPos aerobe organisms
MRSA, MSSA, S Pneumoniae, Streptococcus viridans group, Enterococcus (not VRE)
MMSSE
GNeg aerobe organisms
HNPEK, CAPES, pseudomonas
Anaerobic organisms
Gram pos (mouth flora)
Gram negative (bactericides fragilis)
Atypical organisms
Chlamydia, legionella, mycoplasma
What abx are preferred for SSTI, bone and joint, endocarditis and bloodstream infections caused by MSSA?
Antistaphylococcal PCNs
Dicloxacillin, Nafcillin, Oxacillin
What does CAPES stand for?
Citrobacter, Acinetobacter, Provedencia, Enterobacter cloacae, Serratia spp
What is the most broad PCN and what does it cover?
Pip/Tazo (Zosyn)
HNPEK/CAPES and Psuedomonas
What do PCNs NOT cover?
MRSA and atypicals
DOC for otitis media?
Amoxicillin or augmentin
DOC for Bacterial sinusitis
Augmentin
DOC for Infective endocarditis PROPHY
Amoxicillin
DOC for dental procedure prophy?
Amox
DOC for Pseudomonas
Zosyn
DOC for syphilis
PCN G Benzathine (Bicillin L-A)
Box warnings and contraindications for PCNs
Bicillin L-A - not for IV use.
Renal dosage in CrCl <30
PCN drug interactions
Warfarin - PCNs inhibits the anti coagulation effects - may need increased warfarin dosing while on abx.
Methotrexate - serum concentration increased while PCNs.
What do cephalosporins NOT cover?
Enterococus and atypicals
DOC for MRSA?
Ceftaroline
DOC for surgical prophy?
Cefazolin (1st gen)
GI surgery - cefotetan and cefoxitin (2nd gen)
DOC for CAP
Cefuroxime (2nd gen)
DOC for meningitis, pyelo?
Ceftriaxone, cefotaxime (3rd gen)
DOC for PseudoMonas?
CefatazidiMe + CefepiMe
What patient pop are cephalosporins contraindicated in?
Neonates.
Box warnings and SEs of Cephalosporins
Do not use with IV Ca products.
Cross-reactivity with PCN allergies
Renally dose as appropriate
Separate from antacids by 2 hrs.
What is a side effect of Cefotetan use?
Alcohol can cause a disulfiram-like reaction.
What do carbapenems NOT cover?
MRSA, VRE, atypical pathogens or C-Diff.
What does ErtAPenem NOT cover?
EAP
Enterococcus
Acinetobacter
Pseudomonas.
Carbapenems are reserved for
MDR gram NEG infections and polymicrobial infections
Box warning for carbapenem DIs
Any drugs used to prevent seizure (esp Valporic acid) - carbepenems may lower seizure threshold by lowering medication concentration.
Monobactam (Aztreonam) cover all _________
Gram Neg including pseudomonas and CAPES (and HNPEK)
Aztreonam is typically used when _______ is present
Beta-lactate allergy.
What does Vanc cover? What type of abx is it?
Gram POS
NOT VRE
Cell-wall inhibitor
Warnings for Vanc?
Can be nephrotoxic/ototoxic.
What type of abx is SMX/TMP? DOC for?
Folic Acid Synthesis inhibitor
MRSA (2nd line), recurrent UTI
SMX/TMP DIs?
Warfarin, methotrexate, ACE, ARB, NSAIDS, K-sparing diruetics.
What are the 2 examples of DNA/RNA inhibitors?
Flouroquinolones and Metronidazole
DOC for respiratory gram pos bacteria and atypical pathogens?
Levofloxacin and moxifloxacin (s. Pneumoniae)
What flouroquinolone does not require renal adjustment?
Moxifloxacin
What is a boxed warning for flouroquinolones?
DIs?
Tendon inflammation or rupture.
QT prolongations, warfarin, Glucose control agents
1st line for MRSA?
VANC
Could Moxifloxacin be used to treat UTIs?
No - it’s not renally cleared.
Why is Daptomycin not used for pneumonia?
Inhibited by lung surfactant
Daptomycin used to treat
MRSA, VRE, SSTI and S. Aureus blood stream infections, R -sided endocarditis
Boxed warnings with Daptomycin
Muscle toxicity and increased risk for rhabdo especially with concurrent statin use.
Can falsely elevate PT/INR.
Aminoglycosides are typically used ________
In conjunction with another therapy (not as a mono therapy)
What are some examples of Aminoglycosides
Gentamicin Tobramycin and Amikacin, streptomycin.
What are some examples of Macrolides?
Azithromycin, clarithromycin, erythromycin.
Macrolides spectrum covers:
Atypicals (legionella, chlamydia, mycoplasma Dan mycobacterium and harmonious.
Macrolides are used to treat
CAP, COPD exacerbations, chlamydia, h. Pylori and gastropareiss
What abx is a good option for patients with renal impairment that need a Macrolides?
Azithromycin - not renally cleared.
Box warning for Macrolides
Hepatotoxic, QT prolongation, increased risk for rhabdo with statins.
Abx used for rickettsia, anthracite, treponema paliduum (syphilis), tickbourne illnesses.
Doxycycline/mini cycling (tetracyclines)
Why are tetracyclines contraindicated in children <8yrs old and pregnancy/breastfeeding?
Suppresses bone and MSK growth/development.
Linezolid is a type of ________ abx.
DI with ______
Protein synthesis Inhibitors.
MAOIs and oral hypoglycemics
Metronidazole is a type of ________ abx and covers________
Protein synthesis inhibitor
Anaerobes.
Drug of choice in uncomplicated UTIs
Nitrofurantoin.
