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Pharmacotherapeutics - Midterm > Schoenwald - Antimicrobial Review > Flashcards

Schoenwald - Antimicrobial Review Flashcards

1
Q

what are the classes of penicillins (5)

A

natural
amino
anti-staphylococcal
augmented amino
augmented extended spectrum

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2
Q

what are the 3 natural penicillins

A

Penicillin VK -> PO
Penicillin G -> IV/IM
Benzathine PCN -> IM LA

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3
Q

3 common uses of natural penicllins

A

strep pharyngitis
cellulitis
syphillis

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4
Q

which abx is used for syphillis

A

benzathine penicillin (bicillin LA)

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5
Q

what are the 2 aminopenicillins

A

amoxicillin -> PO
ampicillin -> IV

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6
Q

coverage of aminopenicillins (6)

A

borelia burgdorfi
listeria
enterococci
strep pyogenes
strep agalactaie
strep pneumo

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7
Q

5 clinical uses of aminopenicillins

A

sinusitis
lyme dz < 8 yo
otitis media
pharyngitis
endocarditis prophylaxis

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8
Q

what are the 2 anti-staphylococcal penicillins

A

dicloxacillin -> PO
nafcillin -> IV

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9
Q

clinical use of nafcillin and dicloxacillin

A

staph skin/soft tissue infxns

also work well against strep

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10
Q

what are the 2 augmented penicillins

A

amoxicillin/clauvanate -> Augmentin (PO)
ampicillin/sulbactim -> Unasyn (IV)

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11
Q

coverage of augmented penicillins

A

borella burgdorferi
listeria
strep pyogenes
strep pneumo
strep agalactaie

pasteurella
h.flu
anaerobes
moraxella

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12
Q

4 clinical uses of augmented penicillins

A

sinusitis
acute bronchitis
dental infxns
bites
otitis media
skin/soft tissue infxns

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13
Q

what pathogen is mc responsible for acute bronchitis exacerbations

A

H.flu

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14
Q

what js the augmented extended-spectrum penicillin

A

piperacillin/tazobactam -> zosyn (IV)

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15
Q

clinical usefulness of zosyn

A

broad spectrum, including pseudomonas

think hospitalized pt’s

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16
Q

3 ADR for penicillins

A

hypersensitivity rxn’s
augmentin -> diarrhea, subclinical hepatotoxicity

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17
Q

1st gen cephalosporins have good gram __ coverage and poor gram __ coverage

A

good: positive
poor: negative

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18
Q

as cephalosporin generations increase, gram __ coverage increases, and gram __ coverage decreases

A

increases: negative
decreases: positive

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19
Q

which cephalosporin has broad coverage and MRSA coverage

A

ceftaroline

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20
Q

which cephalosporin is linked with biliary sludging/pseudocholelithiasis

A

ceftriaxone

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21
Q

1st gen cephalosporins (2)

A

cephalexin (Keflex) -> PO
cefazolin (Ancef) -> IV

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22
Q

coverage of 1st gen cephalosporins

A

strep pyogenes
MSSA
limited e.coli, klebsiella, proteus

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23
Q

clinical indications for 1st gen cephalosporins (4)

A

skin/soft tissue infxns
strep pharyngitis
pre op prophylaxis
uncomplicated cystitis

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24
Q

which abx is used for pre op prophylaxis

A

cefazolin (ancef)

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25
Q

2nd gen cephalosporin

A

cefuroxime (ceftin) -> PO

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26
Q

coverage of cefuroxime

A

strep pyogenes
MSSA
some e. coli, klebsiella, proteus
strep pneumo
m. cat
h.flu (respiratory)

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27
Q

4 clinical uses of 2nd cefuroxime (ceftin)

A

otitis media
sinusitis
acute chronic bronchitis
skin and soft tissue infxns

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28
Q

first line drug for acute exacerbations of chronic bronchitis

A

augmentin

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29
Q

3rd gen cephalosporins (2)

A

cefdinir (omnief) -> PO
ceftriaxone (rocephin) -> IM/IV

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30
Q

coverage of 3rd gen cephalosporins

A

gram negative
limited gram positive

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31
Q

3rd gen cephalosporins do not cover what 2 gram positive pathogens

A

enterococcus
MRSA

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32
Q

4 clinical indications for 3rd gen cephalosporins

A

CAP
meningitis
gonorrhea
pyelonephritis

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33
Q

which 3rd gen cephalosporin crosses the blood brain barrier

A

ceftriaxone

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34
Q

ceftriaxone is first line tx for (2)

A

meningitis
gonorrhea

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35
Q

4th gen cephalosporin

A

cefepime -> IV

think hospitalized patients

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36
Q

coverage of cefepime

A

most gram negative rods
resistant gram negatives

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37
Q

which cephalosporin covers pseudomonas

A

cefepime

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38
Q

next generation (5th) cephalosporin

A

ceftaroline (teflaro)

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39
Q

coverage of ceftaroline

A

broad spectrum
including MRSA

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40
Q

ceftaroline does not cover what gram negative pathogen

A

pseudomonas

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41
Q

2 clinical indications for ceftaroline

A

CAP
skin/soft tissue infxns

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42
Q

3 carbapenems

A

meropenem
imipenem
ertapenem (invanz)

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43
Q

coverage of carbapenems

A

excellent gram negative
limited gram positive

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44
Q

what 2 bacteria do you think of when you see carbapenems

A

e.coli
pseudomonas

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45
Q

what bacteria do you think of when you see “extended spectrum beta lactamase”

A

e.coli

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46
Q

which carbapenem should never be used for pseudomonas

A

ertapenem

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47
Q

2 ADRs for carbapenems

A

seizures
nephrotoxicity

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48
Q

3 clinical indications for carbapenems

A

ventilator associated PNA
resistant complicated UTI
nosocomial infxns

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49
Q

what are the 4 beta lactam abx classes

A

PCNs
extended spectrum PCNs
cephalosporins
carbapenems

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50
Q

what are the non beta lactam abx classes (7)

A

macrolides
tetracyclines
clindamycin
aminoglycocides
fluoroquinolones
nitrofurantoin
sufonamides

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51
Q

3 tetracyclines

A

tetracycline
minocycilne
doxycycline

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52
Q

route of admin for all 3 tetracyclines (2)

A

PO
IV

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53
Q

3 ADRs for tetracyclines

A

photosensitivity
teratogenic
teeth staining kids < 8 yo

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54
Q

5 clinical indications for tetracyclines

A

sinusitis
CAP
acute chronic bronchitis
non gonococcal urethritis/cervicitis
tick borne illnesses -> lyme, rickettsia

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55
Q

never combine tetracyclines w. __
because __ could result

A

isotretinoin
pseudotumor cerebri

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56
Q

what mineral decreases absorption of tetracyclines

A

calcium

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57
Q

3 macrolides

A

azithromycin
clarithromycin
erythromycin

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58
Q

rout of admin for macrolides (2)

A

PO
IV

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59
Q

what drug must be monitored w. clarithromycin

A

warfarin

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60
Q

what macrolide has a black box warning about QT prolongation

A

azithromycin

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61
Q

s.e of erythromycin

A

increased GI motility -> n/v/d

62
Q

s.e of clarithromycin

A

metallic taste

63
Q

7 clinical indications for macrolides

A

cervicitis/urethritis
h. pylori
otitis media
whooping cough -> pertussis
CAP
atypical PNA -> mycoplasma
pharyngitis

64
Q

coverage of lincosamide (clindamycin)

A

gram positive:

anaerobes above the diaphragm
s. aureus
strep pyogenes

65
Q

when would you use lincosamide for strep pyogenes

A

PCN allergic pt

66
Q

2 s.e of clindamycin

A

diarrhea/nausea
c.diff

67
Q

clinical indications for lincosamide

A

skin/soft tissue infxn -> sub for b lactam allergic
strep pharyngitis -> sub for b lactam allergic
anaerobic infxns/abscesses
dental infxns

68
Q

route of admin for lincosamide (2)

A

PO
IV

69
Q

fluoroquinolones

A

ciprofloxacin
levofloxacin
moxifloxacin

70
Q

non respiratory fluoroquinolone

A

cipro -> PO/IV/drops

71
Q

respiratory fluroquinolones

A

levo -> PO < IV
moxi -> PO, IV

72
Q

coverage of cipro

A

most gram negative
pseudo

73
Q

coverage of levo/moxi

A

most gram negative
increased strep pneumo
increased atypical respiratory

74
Q

what 2 minerals decrease absorption of fluoroquinolones

A

Ca
Mg

75
Q

clinical indications for cipro

A

complicated UTI
pyelo
prostatitis
enteric infxns -> girardia
diverticulitis

76
Q

for diverticulitis, cipro should be combined w.

A

metronidazole

77
Q

2 clinical indications for levo/moxi

A

CAP
pelvic infxns

78
Q

ADRs of fluoroquinolones (7)

A

arthropathy
achilles tendon rupture
CNS toxicity
photosensitivity
QT prolongation
dysglycemia
neuropathy

79
Q

contraindication for fluoroquinolones

A

kids < 18

80
Q

2 pt’s at higher risk for achilles tendon rupture w. fluoroquinolones

A

elderly
steroids

81
Q

sulfonamides (2)

A

bactrim
septra

82
Q

route of admin for sulfonamides (2)

A

PO
IV

83
Q

coverage of sulfonamides

A

broad - including:
MRSA
e.coli, klebsiella, proteus
pneumocystis jiroveci
h.flu
m.cat

84
Q

sulfonamides interfere w. __ synthesis

A

folate

85
Q

how do sulfonamides affect warfarin therapy

A

increase INR

86
Q

3 ADRs of sulfonamides

A

hypersensitivity rxn -> SJS/TEN
myelosuppression
hemolytic anemia -> G6PD

87
Q

3 clinical indications for sulfonamides

A

PCP PNA and prophylaxis
UTI
MRSA skin and soft tissue infxns

88
Q

2 nitromidazoles

A

metronidazole (flagyl) -> IV/PO
tinidazole (tindamax) -> PO

89
Q

coverage of nitromidazoles

A

anaerobes below the diaphragm ->
protozoa
girardia

90
Q

3 s.e of nitromidazoles

A

metallic taste
disulfram rxn
fetotoxic in 1st trimester

91
Q

what is a disulfram rxn

A

antabuse like rxn w. etoh ->
flushing, nausea, vertigo, diaphoresis, palpitations, tachycardia, hypotn

92
Q

5 clinical indications for nitromidazoles

A

BV
c.diff
girardia
trichomoniasis
abdominopelvic infxns

93
Q

2 aminoglycosides

A

gentamicin
tobramycin

94
Q

route of admin for aminoglycocides

A

IV only

95
Q

coverage of aminoglycocides

A

gram negative
including pseudomonas

96
Q

clinical indication for aminoglycocides

A

nosocomial infxns

97
Q

2 ADR of aminoglycosides

A

nephrotoxic
ototoxic

98
Q

clinical indication for oral vanco

A

c. diff

although still no oral absorption

99
Q

coverage of vanco

A

serious gram positive
including MRSA

100
Q

infuse vanco over 1 hr to avoid __

A

red man syndrome

101
Q

3 ADRs of vanco

A

red man
ototoxic
nephrotoxic

102
Q

2 abx that only work in the bladder and has no systemic absorption

A

nitrofurantoin (macrobid)
fosfomycin (monurol)

103
Q

clinical indication for nitrofurantoin and fosfomycin

A

uncomplicated UTI

104
Q

coverage of nitrofurantoin

A

broad

105
Q

what bacteria do you think of when you see nitrofurantoin

A

ESBL - e.coli

106
Q

contraindication for notrofurantoin (macrobid)

A

G6PD -> hemolytic anemia

107
Q

what abx comes in a powdered form and is used for ESBL UTI

A

fosfomycin (monourol)

108
Q

4 antimycobacterial drugs

A

rifampin
isoniazid
pyrazinamide
ethambutol

109
Q

historic drug of choice for latent TB

A

isoniazid

changed in 2020

110
Q

tx guidelines for isoniazid for latent TB

A

5 mg/kg daily x 5 mo
OR
15 mg/kg twice weekly x 6 mo

111
Q

2 ADR for isoniazid

A

increased liver enzymes
peripheral neuropathy

112
Q

newer drug of choice for latent TB

A

rifampin

113
Q

which antimycobacterial is a CYP inducer

A

rifampin

114
Q

avoid rifampin with what drugs

A

HIV

115
Q

2 ADR for rifampin

A

red lobster syndrome
elevated liver enzymes

116
Q

tx guidelines for adults for rifampin for latent TB

A

10 mg/kg qd x 4 months

117
Q

s.e of pyrazinamide

A

polyarthralgias

118
Q

s.e of ethambutol

A

color blindness

119
Q

what drug do you think of when you see ishihara testing

A

ethambutol

120
Q

3 antifungal classes

A

polyenes
azoles
allylamines

121
Q

polyenes

A

amphotericin b
nystatin

122
Q

clinical indication for amphotericin b

A

resistant or deep fungal infxns

123
Q

ADR of amphotericin b

A

nephrotoxic!!!

124
Q

route of admin for nystatin (2)

A

topical powder
mouthwash

125
Q

2 clinical indications for nystatin

A

thrush
intertrigo

126
Q

2 topical skin azoles

A

clotrimazole (lotrimin)
miconazole

127
Q

3 topical vaginal azoles

A

terconazole
miconazole (monistat)
tioconazole

128
Q

2 topical oral azoles

A

clotrimazole (mycelex)
miconazole

129
Q

5 systemic azoles

A

ketoconazole
itraconazole
fluconazole
voriconazole
posaconazole

130
Q

2 clinical indications for azoles

A

candidal infxns ->
vulvovaginitis
esophagitis

131
Q

only azole that gets into the bladder
tx for fungal UTI

A

fluconazole

132
Q

allyamine

A

terbinafine (lamisil) -> PO, topical

133
Q

2 clinical indications for terbinafine

A

onychomycosis
cutaneous dermatophyte infxns

134
Q

ADR of terbinafine

A

hepatotoxic

135
Q

2 abx associated w. nephrotoxicity

A

aminoglycosides
vanco

136
Q

which abx do you think of when you see ATN

A

gentamicin

137
Q

4 abx associated w. pigmentation changes

A

vanco -> red man
rifampin -> lobster
tetracyclines -> teeth
sulfonamides -> yellow babies

138
Q

Cat B pregnancy abx (4)

A

beta lactams
clindamycin
azithromycin
metronidazole -> EXCEPT 1st trimester

139
Q

Cat C pregnancy abx (3)

A

fluoroquinolones
clarithromycin
bactrim

140
Q

cat D pregnancy abx (2)

A

aminoglycosides
tetracyclines

141
Q

what is the FAST mnemonic used for in abx

A

abx associated w. pregnancy complications:

fluoroquinolones -> arthropathy
aminoglycosides -> CN8 toxicity
sulfonamides -> newborn kernicterus
tetracyclines -> tooth/bone issues

142
Q

hypersensitivity rxn overview

A

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
Q

3 good oral options for skin infxns

A

think MRSA ->

cephalexin
doxycycline
augmentin
clindamycin

144
Q

4 good oral options for MRSA infxns

A

bactrim
tetracyclines
clindamycin
linezolid

145
Q

3 good IV options for MRSA infxns

A

vanco
cefteroline
daptomycin

146
Q

what IV abx can not be used for PNA bc it reacts w. surfactant

A

daptomycin

147
Q

3 good oral options for gram negative infxns

A

cipro
augmentin
bactrim

148
Q

only oral option for pseudomonas coverage

A

fluoroquinolones

149
Q

2 IV options for pseudomonas infxns

A

aminoglycosides
cefepime

150
Q

main oral option w. pseudo coverage

A

cipro

Pharmacotherapeutics - Midterm (11 decks)

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