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Therapeutics III > Study > Flashcards

Study Flashcards

1
Q

Macrolides

A

Erythromycin, clarithromycin, azithromycin

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2
Q

Macrolides MOA

A

Blocks peptide formation at the 50s ribosomal subunit to inhibit protein synthesis

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3
Q

Macrolides C vs S

A

Static

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4
Q

Macrolides PD

A

Time-dependent

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5
Q

Macrolides pathogens

A

Broad spectrum
Gram +, Neisseria, Treponema
DOF for atypicals (mycoplasma, legionella, chlamydia)

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6
Q

Macrolides main uses

A

Used in pregnancy and for penicillin allergies
STI (chlamydia, gonorrhea)
RTI (pharyngitis, otitis, CAP)
Gastroparesis

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7
Q

Do macrolides have MRSA or pseudomonas coverage?

A

No

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8
Q

Macrolides AE

A

GI

Increased QTc interval

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9
Q

Macrolides DDI

A

CYP3A4 inhibitor- increases levels of: warfarin, statins, theophylline, triazolam, carbamazepine, cyclosporine, sildenafil, etc.
Less interactions with azithromycin

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10
Q

Macrolides resistance

A

Low level resistance is associated with the mef gene (efflux pump)
High levels are associated with target-site modification, Domain 5 is methylated, coded by erm gene, and macrolides cant bind

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11
Q

Oxazolidinones

A

Linezolid, Tedizolid

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12
Q

Linezolid MOA

A

Inhibits early protein synthesis at 70s initiation complex

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13
Q

Linezolid S vs C

A

Static

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14
Q

Linezolid PD

A

Time-dependent

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15
Q

Linezolid pathogens

A

Narrow spectrum

Gram (+), MRSA, VRE

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16
Q

Linezolid main uses

A

Alternative to vanc in MRSA, VRE

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17
Q

Linezolid MRSA or pseudomonas coverage?

A

MRSA

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18
Q

Linezolid AE

A

GI, rashes, neuropathy

Warnings: serotonin syndrome, hematologic (weekly CBC)

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19
Q

Lincosamide

A

Clindamycin

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20
Q

Lincosamide MOA

A

Binds to 50s, inhibiting protein synthesis

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21
Q

Lincosamide C vs S

A

Static

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22
Q

Lincosamide PD

A

Time-dependent

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23
Q

Lincosamide pathogens

A

Broad spectrum

Gram +, anaerobes, pneumocystis, toxoplasma

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24
Q

Lincosamide main uses

A 
Skin, soft tissue, bone infections
Used for its anti-toxin properties
IA anaerobes infections
Acne, rosacea
Toxoplasma, pneumocystis
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25
Q

Lincosamide MRSA/pseudomonas?

A

No

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26
Q

Lincosamide resistance

A

Altered target, decreased binding, efflux

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27
Q

Streptogramin

A

Quinupristin-dalfopristin (Synercid)

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28
Q

Streptogramin MOA

A

Dalfopristin alters conformation of the 50s ribosome such that affinity for quinuprostin is increased.

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29
Q

Streptogramin s vs c

A

Synergistically cidal

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30
Q

Streptogramin PD

A

Concentration-dependent

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31
Q

Streptogramin spectrum

A

Gram +, MRSA, VRE

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32
Q

Streptogramin MRSA/pseudomonas coverage?

A

MRSA

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33
Q

Streptogramin AE

A

Local vein reactions

Arthralgia

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34
Q

Streptogramin DDI

A

Inhibits 3A4 metabolism

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35
Q

Streptogramin resistance

A

Increased binding to target, enzymatic inactivation, efflux

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36
Q

Lefamulin MOA

A

Inhibits protein synthesis through interactions with A and P sites of Domain 5 of 50s subunit

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37
Q

Lefamulin C vs S

A

both

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38
Q

Lefamulin PD

A

Time-dependent

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39
Q

Lefamulin pathogens

A

Strep, staph (MRSA), atypicals

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40
Q

Lefamulin main uses

A

CAP

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41
Q

Lefamulin MRSA/ pseudomonas?

A

MRSA

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42
Q

Lefamulin AE

A

Injection site reactions, insomnia, embryo-fetal toxicity, GI, increased LFTs, QTc prolongation

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43
Q

Lefamulin DDI

A

Inhibits 3A4

Avoid quinidine, amiodarone, sotalol, procainamide

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44
Q

Lefamulin and food

A

Food decreases absorption

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45
Q

Aminoglycosides

A

Gentamicin, Tobramycin, streptomycin, amikacin

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46
Q

Aminoglycosides MOA

A

Irreversibly binds to the 30s ribosome

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47
Q

Aminoglycosides C vs S

A

Cidal

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48
Q

Aminoglycosides PD

A

Concentration dependent

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49
Q

Aminoglycosides pathogens

A 
Primarily gram (-). pseudomonas
Gram (+) if synergistic with cell wall agents
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50
Q

Aminoglycosides uses

A 
Severe gram (-) infections (in combo)
Gram (+) of synergistic with cell wall inhibitors (endocarditis)
Tuberculosis (streptomycin)
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51
Q

Aminoglycosides MRSA/pseudomonas coverage?

A

Pseudomonas

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52
Q

Aminoglycosides AE

A

Nephrotoxicity, ototoxicity, neuromuscular blockade

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53
Q

Aminoglycosides resistance

A

Enzyme modification, altered 30s, efflux

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54
Q

Aminoglycosides PAE

A

LONG PAE, requires serum concentration monitoring

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55
Q

Tetracyclines

A

Tetracyclines, doxycyclines, tigecycline

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56
Q

Tetracyclines MOA

A

Binds to the 30s ribosome, blocking the formation of initiation complex

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57
Q

Tetracyclines C vs S

A

Static

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58
Q

Tetracyclines PD

A

Time-dependent

59
Q

Tetracyclines pathogens

A

Broad spectrum
Gram (+), (-), atypicals, anaerobes
Tigecycline- MDR, VRE, MRSA

60
Q

Tetracyclines uses

A 
GI infections
RTI
STI
Alternative for syphilis in penicillin allergy
DOC for tickborne diseases (doxy)
61
Q

Tetracyclines MRSA/ pseudomonas?

A

Tigecycline- MRSA

62
Q

Tetracyclines AE

A

Tooth discoloration, enamel hyperplasia in childern, photosensitivity, GI, hepatotoxicity, AKI
Minocycline- dizziness, vertigo, tinnutis

63
Q

Tetracyclines DDI

A

Antacids and dairy products intefere with absorption
May potentiate the effects of oral anticoagulants
Decreased effficacy of BC

64
Q

Tetracyclines BBW

A

Tigecycline- increased risk of death

65
Q

Fluoroquinolones

A

Ciprofloxacin, levofloxacin, moxifloxacin

66
Q

Fluoroquinolones MOA

A

Inhibits DNA gyrase blocking DNA replication and leading to cell death

67
Q

Fluoroquinolones C vs S

A

Cidal

68
Q

Fluoroquinolones PD

A

Concentration dependent

69
Q

Fluoroquinolones Pathogens

A 
Broad spectrum
Cipro- best form gram (-)
Others- Gram (+)
All- atypicals, M. Tuberculosis
Moxi, Gemi- anaerobes
70
Q

Fluoroquinolones main uses

A 
RTI (not cipro)
UTIs/prostatitis (not moxi)
GI
Osteomyelitis
Anthrax
Tuberculosis
71
Q

Fluoroquinolones MRSA/Pseudomonas?

A

Delafloxacin- MRSA

Ciprofloxacin, levofloxacin- pseudomonas

72
Q

Fluoroquinolones AE

A

GI, CNS, rash, photosensitivity, hematuria, QTc prolongation, tendonitis, peripheral neuropathy, hypoglycemia, mental health
Do not use in pregnancy or <18 yo

73
Q

Fluoroquinolones DDI

A

antacids impair absorption

74
Q

Fluoroquinolones resistance

A

Chromosomal mutation leading to altered target site, efflux mechanisms

75
Q

Fluoroquinolones BBW

A

Reserve for no other options

76
Q

Sulfonamides

A

Bactrim
Sulfadiaxine + pyrumethamine
Sulfadoxine + pyrimethamine

77
Q

Sulfonamides MOA

A

Folate inhibitor, blocks purine production and nucleic acid synthesis

78
Q

Sulfonamides C vs S

A

Synergistically cidal

79
Q

Sulfonamides PD

A

Time-dependent

80
Q

Sulfonamides pathogens

A

Broad spectrum
Gram (+), Gram (-)
Pneumocystis (PJP)
Atypicals

81
Q

Sulfonamides uses

A

Uncomplicated UTIs
PJP (Pneumocystis)
Prostatitis, skin infections, infectious diarrhea, toxoplasmosis, malaria

82
Q

Sulfonamides MRSA/pseudomonas?

A

Community acquired MRSA

83
Q

Sulfonamides AE

A

GI, rash, urticaria, photosensitivty, B.M suppression, hyperkalemia, AKI, hypersensitivity
Do NOT use in newborns or 3rd trimester

84
Q

Sulfonamides DDI

A

CYP2C9 inhibitor- increases effects of sulfonyureas, warfarin, anticoagulants, cyclosporine, methotrexate

85
Q

Nitrofurantoin MOA

A

Inhibits several enzyme systems, including acetyl coA, inhibiting metabolism

86
Q

Nitrofurantoin C vs S

A

Cidal

87
Q

Nitrofurantoin PD

A

Time-dependent

88
Q

Nitrofurantoin pathogens

A

Primarily gram (-)
E. coli
Also covers E. faecalis, MSSA

89
Q

Nitrofurantoin uses

A

UTI (cystitis only)

90
Q

Nitrofurantoin MRSA/Pseudomonas?

A

no

91
Q

Nitrofurantoin AE

A

N/V/D, rash, pulmonary toxicity, increased LFTs, peripheral neuropathy, anemia

92
Q

Nitrofurantoin DDI

A

Antacids (Mg) decrease abs.
Probenecid decreases renal excretion
Ethanol increases CNS depression

93
Q

Nitrofurantoin CrCl cutoff

A

<40ml/min

94
Q

Penicillins

A

Natural- pen vk, pen g
Anti-staphylococcal- nafcillin, oxacillin, dicloxacillin
Amino- amoxicillin, ampicillin
Ureido-piperacillin

95
Q

Beta lactam MOA

A

Cleaves the beta lactam bond of PBP inhibiting the 3rd step of cell wall synthesis

96
Q

Penicillin pathogens

A

Natural- Gram +, strep, syphilis
Anti-staphylococcal- narrow spectrum, Gram +, MSSA
Amino- Gram +, some Gram -
Ureido- Gram +, Gram -, pseudomonas

97
Q

Penicillin uses

A

Pen G- syphilis, meningitis
Pen VK- strep throat
Anti-staphylococcal- serious MSSA infections
Amino- IA, pelvic, skin, pulmonary, bite wounds, STIs
Ureido- pneumonia, bacteremia, IA, diabetic foot, neutropenia

98
Q

Penicillin MRSA/pseudomonas?

A

Ureido- pseudomonas

99
Q

Beta lactam AE

A

GI/rash/allergy

100
Q

Beta lactam resistance

A

Beta lactamases break a bond in the beta lactam nucleus, disabling it. Beta lactamase inhibitors extend spectrum

101
Q

Cephalosporins

A 
1st- cefazolin, cephalexin
2nd- cefoxitin, cefuroxime
3rd- ceftriaxone, ceftazidime, cefdinir
4th- Cefepime, ceftolozane
5th- Ceftaroline
102
Q

Beta lactam S vs C

A

Cidal

103
Q

Beta lactam PD

A

Time dependent

104
Q

Cephalosporin pathogens

A

Spectrum increases from 1st to 4th generation due to enhanced beta lactamase activity.
All cover Gram +
3/4th- penetrate CNS for meningitis and pseudomonas
5th- MRSA

105
Q

Cephalosporin uses

A

1st- surgical prophylaxis, UTI, RTI
2nd- mixed infections, Cefuroxime- meningitis
3rd- Broader- meningitis, gonorrhea, serious hospital infections
4th- serious hospital infections, very broad
5th- MRSA

106
Q

Cephalosporin MRSA/pseudomonas?

A

5th- MRSA

3rd and 4th- pseudomonas

107
Q

Glycopeptides

A

Vancomycin

108
Q

Glycopeptides MOA

A

Complexes to D-Ala-D-Ala precursor of cell wall pentapeptide interfering with elongation of the peptidoglycan backbone

109
Q

Glycopeptides C vs S

A

Cidal

110
Q

Glycopeptides PD

A

Time-dependent killing

111
Q

Glycopeptides pathogens

A

Gram + ONLY, MRSA

Oral-C.diff

112
Q

Glycopeptides uses

A

MRSA

113
Q

Glycopeptides AE

A

Nephrotoxicity, ototoxicity, phlebitis, Red Man Syndrome

114
Q

Vanc trough

A

Little to no PAE

Trough concentration: 10-20ug/mL

115
Q

Daptomycin MOA

A

Binds to gram + via Ca dependent interaction with membrane disruption and loss of K

116
Q

Daptomycin C vs S

A

Cidal

117
Q

Daptomycin PD

A

concentration-dependent

118
Q

Daptomycin pathogens

A

Gram +, MRSA

119
Q

Daptomycin uses

A

Alternative to vanc for MRSA (non-pneumonia)

120
Q

Daptomycin AE

A

myopathy (monitor CPK levels)

121
Q

Polymyxins MOA

A

Binds with anionic LPS molecules by displacing Ca and Mg from the outer membrane of gram negative bacteria, leading to permeability changes, leakage, and cell death

122
Q

Polymyxins S vc C

A

Cidal

123
Q

Polymyxins PD

A

Concentration-dependent

124
Q

Polymyxins pathogens

A

Gram -

125
Q

Polymyxins uses

A

Last resort for MDR

126
Q

Polymyxins MRSA/ pseudomonas?

A

no

127
Q

Polymyxins AE

A

nephrotoxicity, neurotoxicity

128
Q

Atypical microorganisms

A

Legionella, chlamydia, mycoplasma

129
Q

Treatment of atpicals

A

Fluoroquinolones
Macrolides
Tetracyclines

130
Q

Anaerobic coverage

A 
Metronidazole
B-lactam/B-lactamase inihbitors
Cefoxitin, Cefotetan
Carbapenems
Clindamycin
Moxifloxacin
Tigecycline
Chloramphenicol
131
Q

Pseudomonas coverage

A 
Pip/Tazo
Cefepime
Ceftazidime
Ceftolozane
Carbapenems
Ciprofloxacin, Levofloxacin
Aminoglycosides
Aztreonam
Polymyxin B, Colistin
132
Q

Gram negative coverage

A 
PCNs (Ureido>Amino)
2nd, 3rd, 4th gen cephalosporins
Carbapenems
Aztreonam
Aminoglycosides
Fluoroquinolones
TMP/SMZ
Tigecycline
Polymyxin B, Colistin
133
Q

MDR Gram (-) pathogens

A 
Serratia
Pseudomonas
Acinetobacter
Citrobacter
Enterobacter

-Requires broad spectrum coverage with cefepime, pip/tazo, or carbapenems

134
Q

ESBL producers

A 
Klebsiella
E. coli
Enterobacter
Proteus
Serratia

Requires carbapenems

135
Q

Agents with CA-MRSA coverage

A

TMP/SMZ
Doxycycline
Clindamycin

136
Q

Agents with skin MRSA coverage

A

Dalbavacin, oritavancin, delafloxacin

137
Q

Agents with MRSA coverage

A

Vanc, Dapto, linezolid, ceftaroline, telavancin, tigecycline, synercid

138
Q

MSSA treatment and alternatives

A

1st line- nafcillin, oxacillin

Alt- cefazolin

139
Q

MRSA treatment and alternatives

A

Treatment- Vanc

Alt- linezolid, dapto, ceftaroline, tigecycline, dalbavancin, oritavancin

140
Q

MRSE treatment and alt

A

Treatment- Vanc

Alt- linezolid, dapto

141
Q

S. pneumonia treatment and alt

A

T- cefazolin, ceftriaxone

Alt- penicillin, erythromycin

142
Q

E. faecalis treatment and alt

A

T- ampicillin

alt- Vanc

143
Q

VRE treatment and alt

A

T- Linezolid

Alt- dapto, tigecycline

Therapeutics III (7 decks)

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