Schoenwald - Antimicrobial Review Flashcards
1
Q
what are the classes of penicillins (5)
A
natural
amino
anti-staphylococcal
augmented amino
augmented extended spectrum
2
Q
what are the 3 natural penicillins
A
Penicillin VK -> PO
Penicillin G -> IV/IM
Benzathine PCN -> IM LA
3
Q
3 common uses of natural penicllins
A
strep pharyngitis
cellulitis
syphillis
4
Q
which abx is used for syphillis
A
benzathine penicillin (bicillin LA)
5
Q
what are the 2 aminopenicillins
A
amoxicillin -> PO
ampicillin -> IV
6
Q
coverage of aminopenicillins (6)
A
borelia burgdorfi
listeria
enterococci
strep pyogenes
strep agalactaie
strep pneumo
7
Q
5 clinical uses of aminopenicillins
A
sinusitis
lyme dz < 8 yo
otitis media
pharyngitis
endocarditis prophylaxis
8
Q
what are the 2 anti-staphylococcal penicillins
A
dicloxacillin -> PO
nafcillin -> IV
9
Q
clinical use of nafcillin and dicloxacillin
A
staph skin/soft tissue infxns
also work well against strep
10
Q
what are the 2 augmented penicillins
A
amoxicillin/clauvanate -> Augmentin (PO)
ampicillin/sulbactim -> Unasyn (IV)
11
Q
coverage of augmented penicillins
A
borella burgdorferi
listeria
strep pyogenes
strep pneumo
strep agalactaie
pasteurella
h.flu
anaerobes
moraxella
12
Q
4 clinical uses of augmented penicillins
A
sinusitis
acute bronchitis
dental infxns
bites
otitis media
skin/soft tissue infxns
13
Q
what pathogen is mc responsible for acute bronchitis exacerbations
A
H.flu
14
Q
what js the augmented extended-spectrum penicillin
A
piperacillin/tazobactam -> zosyn (IV)
15
Q
clinical usefulness of zosyn
A
broad spectrum, including pseudomonas
think hospitalized pt’s
16
Q
3 ADR for penicillins
A
hypersensitivity rxn’s
augmentin -> diarrhea, subclinical hepatotoxicity
17
Q
1st gen cephalosporins have good gram __ coverage and poor gram __ coverage
A
good: positive
poor: negative
18
Q
as cephalosporin generations increase, gram __ coverage increases, and gram __ coverage decreases
A
increases: negative
decreases: positive
19
Q
which cephalosporin has broad coverage and MRSA coverage
A
ceftaroline
20
Q
which cephalosporin is linked with biliary sludging/pseudocholelithiasis
A
ceftriaxone
21
Q
1st gen cephalosporins (2)
A
cephalexin (Keflex) -> PO
cefazolin (Ancef) -> IV
22
Q
coverage of 1st gen cephalosporins
A
strep pyogenes
MSSA
limited e.coli, klebsiella, proteus
23
Q
clinical indications for 1st gen cephalosporins (4)
A
skin/soft tissue infxns
strep pharyngitis
pre op prophylaxis
uncomplicated cystitis
24
Q
which abx is used for pre op prophylaxis
A
cefazolin (ancef)
25
2nd gen cephalosporin
cefuroxime (ceftin) -> PO
26
coverage of cefuroxime
strep pyogenes
MSSA
some e. coli, klebsiella, proteus
strep pneumo
m. cat
h.flu (respiratory)
27
4 clinical uses of 2nd cefuroxime (ceftin)
otitis media
sinusitis
acute chronic bronchitis
skin and soft tissue infxns
28
first line drug for acute exacerbations of chronic bronchitis
augmentin
29
3rd gen cephalosporins (2)
cefdinir (omnief) -> PO
ceftriaxone (rocephin) -> IM/IV
30
coverage of 3rd gen cephalosporins
gram negative
limited gram positive
31
3rd gen cephalosporins do not cover what 2 gram positive pathogens
enterococcus
MRSA
32
4 clinical indications for 3rd gen cephalosporins
CAP
meningitis
gonorrhea
pyelonephritis
33
which 3rd gen cephalosporin crosses the blood brain barrier
ceftriaxone
34
ceftriaxone is first line tx for (2)
meningitis
gonorrhea
35
4th gen cephalosporin
cefepime -> IV
think hospitalized patients
36
coverage of cefepime
most gram negative rods
resistant gram negatives
37
which cephalosporin covers pseudomonas
cefepime
38
next generation (5th) cephalosporin
ceftaroline (teflaro)
39
coverage of ceftaroline
broad spectrum
including MRSA
40
ceftaroline does not cover what gram negative pathogen
pseudomonas
41
2 clinical indications for ceftaroline
CAP
skin/soft tissue infxns
42
3 carbapenems
meropenem
imipenem
ertapenem (invanz)
43
coverage of carbapenems
excellent gram negative
limited gram positive
44
what 2 bacteria do you think of when you see carbapenems
e.coli
pseudomonas
45
what bacteria do you think of when you see "extended spectrum beta lactamase"
e.coli
46
which carbapenem should never be used for pseudomonas
ertapenem
47
2 ADRs for carbapenems
seizures
nephrotoxicity
48
3 clinical indications for carbapenems
ventilator associated PNA
resistant complicated UTI
nosocomial infxns
49
what are the 4 beta lactam abx classes
PCNs
extended spectrum PCNs
cephalosporins
carbapenems
50
what are the non beta lactam abx classes (7)
macrolides
tetracyclines
clindamycin
aminoglycocides
fluoroquinolones
nitrofurantoin
sufonamides
51
3 tetracyclines
tetracycline
minocycilne
doxycycline
52
route of admin for all 3 tetracyclines (2)
PO
IV
53
3 ADRs for tetracyclines
photosensitivity
teratogenic
teeth staining kids < 8 yo
54
5 clinical indications for tetracyclines
sinusitis
CAP
acute chronic bronchitis
non gonococcal urethritis/cervicitis
tick borne illnesses -> lyme, rickettsia
55
never combine tetracyclines w. __
because __ could result
isotretinoin
pseudotumor cerebri
56
what mineral decreases absorption of tetracyclines
calcium
57
3 macrolides
azithromycin
clarithromycin
erythromycin
58
rout of admin for macrolides (2)
PO
IV
59
what drug must be monitored w. clarithromycin
warfarin
60
what macrolide has a black box warning about QT prolongation
azithromycin
61
s.e of erythromycin
increased GI motility -> n/v/d
62
s.e of clarithromycin
metallic taste
63
7 clinical indications for macrolides
cervicitis/urethritis
h. pylori
otitis media
whooping cough -> pertussis
CAP
atypical PNA -> mycoplasma
pharyngitis
64
coverage of lincosamide (clindamycin)
gram positive:
anaerobes above the diaphragm
s. aureus
strep pyogenes
65
when would you use lincosamide for strep pyogenes
PCN allergic pt
66
2 s.e of clindamycin
diarrhea/nausea
c.diff
67
clinical indications for lincosamide
skin/soft tissue infxn -> sub for b lactam allergic
strep pharyngitis -> sub for b lactam allergic
anaerobic infxns/abscesses
dental infxns
68
route of admin for lincosamide (2)
PO
IV
69
fluoroquinolones
ciprofloxacin
levofloxacin
moxifloxacin
70
non respiratory fluoroquinolone
cipro -> PO/IV/drops
71
respiratory fluroquinolones
levo -> PO < IV
moxi -> PO, IV
72
coverage of cipro
most gram negative
pseudo
73
coverage of levo/moxi
most gram negative
increased strep pneumo
increased atypical respiratory
74
what 2 minerals decrease absorption of fluoroquinolones
Ca
Mg
75
clinical indications for cipro
complicated UTI
pyelo
prostatitis
enteric infxns -> girardia
diverticulitis
76
for diverticulitis, cipro should be combined w.
metronidazole
77
2 clinical indications for levo/moxi
CAP
pelvic infxns
78
ADRs of fluoroquinolones (7)
arthropathy
achilles tendon rupture
CNS toxicity
photosensitivity
QT prolongation
dysglycemia
neuropathy
79
contraindication for fluoroquinolones
kids < 18
80
2 pt's at higher risk for achilles tendon rupture w. fluoroquinolones
elderly
steroids
81
sulfonamides (2)
bactrim
septra
82
route of admin for sulfonamides (2)
PO
IV
83
coverage of sulfonamides
broad - including:
MRSA
e.coli, klebsiella, proteus
pneumocystis jiroveci
h.flu
m.cat
84
sulfonamides interfere w. __ synthesis
folate
85
how do sulfonamides affect warfarin therapy
increase INR
86
3 ADRs of sulfonamides
hypersensitivity rxn -> SJS/TEN
myelosuppression
hemolytic anemia -> G6PD
87
3 clinical indications for sulfonamides
PCP PNA and prophylaxis
UTI
MRSA skin and soft tissue infxns
88
2 nitromidazoles
metronidazole (flagyl) -> IV/PO
tinidazole (tindamax) -> PO
89
coverage of nitromidazoles
anaerobes below the diaphragm ->
protozoa
girardia
90
3 s.e of nitromidazoles
metallic taste
disulfram rxn
fetotoxic in 1st trimester
91
what is a disulfram rxn
antabuse like rxn w. etoh ->
flushing, nausea, vertigo, diaphoresis, palpitations, tachycardia, hypotn
92
5 clinical indications for nitromidazoles
BV
c.diff
girardia
trichomoniasis
abdominopelvic infxns
93
2 aminoglycosides
gentamicin
tobramycin
94
route of admin for aminoglycocides
IV only
95
coverage of aminoglycocides
gram negative
including pseudomonas
96
clinical indication for aminoglycocides
nosocomial infxns
97
2 ADR of aminoglycosides
nephrotoxic
ototoxic
98
clinical indication for oral vanco
c. diff
although still no oral absorption
99
coverage of vanco
serious gram positive
including MRSA
100
infuse vanco over 1 hr to avoid __
red man syndrome
101
3 ADRs of vanco
red man
ototoxic
nephrotoxic
102
2 abx that only work in the bladder and has no systemic absorption
nitrofurantoin (macrobid)
fosfomycin (monurol)
103
clinical indication for nitrofurantoin and fosfomycin
uncomplicated UTI
104
coverage of nitrofurantoin
broad
105
what bacteria do you think of when you see nitrofurantoin
ESBL - e.coli
106
contraindication for notrofurantoin (macrobid)
G6PD -> hemolytic anemia
107
what abx comes in a powdered form and is used for ESBL UTI
fosfomycin (monourol)
108
4 antimycobacterial drugs
rifampin
isoniazid
pyrazinamide
ethambutol
109
historic drug of choice for latent TB
isoniazid
changed in 2020
110
tx guidelines for isoniazid for latent TB
5 mg/kg daily x 5 mo
OR
15 mg/kg twice weekly x 6 mo
111
2 ADR for isoniazid
increased liver enzymes
peripheral neuropathy
112
newer drug of choice for latent TB
rifampin
113
which antimycobacterial is a CYP inducer
rifampin
114
avoid rifampin with what drugs
HIV
115
2 ADR for rifampin
red lobster syndrome
elevated liver enzymes
116
tx guidelines for adults for rifampin for latent TB
10 mg/kg qd x 4 months
117
s.e of pyrazinamide
polyarthralgias
118
s.e of ethambutol
color blindness
119
what drug do you think of when you see ishihara testing
ethambutol
120
3 antifungal classes
polyenes
azoles
allylamines
121
polyenes
amphotericin b
nystatin
122
clinical indication for amphotericin b
resistant or deep fungal infxns
123
ADR of amphotericin b
nephrotoxic!!!
124
route of admin for nystatin (2)
topical powder
mouthwash
125
2 clinical indications for nystatin
thrush
intertrigo
126
2 topical skin azoles
clotrimazole (lotrimin)
miconazole
127
3 topical vaginal azoles
terconazole
miconazole (monistat)
tioconazole
128
2 topical oral azoles
clotrimazole (mycelex)
miconazole
129
5 systemic azoles
ketoconazole
itraconazole
fluconazole
voriconazole
posaconazole
130
2 clinical indications for azoles
candidal infxns ->
vulvovaginitis
esophagitis
131
only azole that gets into the bladder
tx for fungal UTI
fluconazole
132
allyamine
terbinafine (lamisil) -> PO, topical
133
2 clinical indications for terbinafine
onychomycosis
cutaneous dermatophyte infxns
134
ADR of terbinafine
hepatotoxic
135
2 abx associated w. nephrotoxicity
aminoglycosides
vanco
136
which abx do you think of when you see ATN
gentamicin
137
4 abx associated w. pigmentation changes
vanco -> red man
rifampin -> lobster
tetracyclines -> teeth
sulfonamides -> yellow babies
138
Cat B pregnancy abx (4)
beta lactams
clindamycin
azithromycin
metronidazole -> EXCEPT 1st trimester
139
Cat C pregnancy abx (3)
fluoroquinolones
clarithromycin
bactrim
140
cat D pregnancy abx (2)
aminoglycosides
tetracyclines
141
what is the FAST mnemonic used for in abx
abx associated w. pregnancy complications:
fluoroquinolones -> arthropathy
aminoglycosides -> CN8 toxicity
sulfonamides -> newborn kernicterus
tetracyclines -> tooth/bone issues
142
hypersensitivity rxn overview
type I: IgE -> anaphylaxis/uticaria
type II: IgG -> complement mediated -> bone marrow suppression
type III: abs/ag -> serum sickness, PSGN
type IV: t cell -> delayed hypersensitivity -> SJS/TEN, organ rejection
143
3 good oral options for skin infxns
think MRSA ->
cephalexin
doxycycline
augmentin
clindamycin
144
4 good oral options for MRSA infxns
bactrim
tetracyclines
clindamycin
linezolid
145
3 good IV options for MRSA infxns
vanco
cefteroline
daptomycin
146
what IV abx can not be used for PNA bc it reacts w. surfactant
daptomycin
147
3 good oral options for gram negative infxns
cipro
augmentin
bactrim
148
only oral option for pseudomonas coverage
fluoroquinolones
149
2 IV options for pseudomonas infxns
aminoglycosides
cefepime
150
main oral option w. pseudo coverage
cipro
