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Advanced Pharmacology > Week 10 Antibiotics > Flashcards

Week 10 Antibiotics Flashcards

1
Q

First-generation cephalosporins are active against which organisms?

A

First-generation cephalosporins are active against gram-positive cocci, including
S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most
streptococci.

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2
Q

Why is there often cross-sensitivity and cross-resistance between penicillins and cephalosporins?

A

Due to the fact that both drug classes contain structurally similar side chains and beta lactam ring.

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3
Q

Doxycycline is not used during pregnancy because it may cause which effect in neonates?

A

Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates.

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4
Q

A 33-year-old pregnant female patient has developed community-acquired pneumonia (CAP). Which antibiotic is most appropriate for this patient?

A

erythromycin or azithromycin is the first choice because each is Pregnancy Category B

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5
Q

A 42-year-old pregnant female patient comes to the clinic with an outbreak of herpes simplex to the lips. Which medication would be most appropriate for the patient?

A

Acyclovir is Pregnancy Category B and safe to use in pregnancy.

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6
Q

A 46-year-old patient is newly diagnosed with hepatitis C. The APN understands that hepatitis B serum will need to be drawn prior to starting any hepatitis C virus (HCV) medications for which reason?

A

There is a risk of reactivation of hepatitis B, and this would need to be covered.

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7
Q

Which of these is first-line therapy for a mild case of impetigo, with fewer than five 2-cm lesions on the left leg of a 10-year-old patient?

A

First-line therapy for impetigo is mupirocin unless it is a moderate to severe case.

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8
Q

Mupirocin is bactericidal and has a wide range of coverage against gram-positive bacteria, including methicillin-resistant S. aureus, and a limited coverage against some gram-negative organisms. Mupirocin acts by which mechanism?

A

Mupirocin is bactericidal at concentrations achieved by topical administration of the 2% ointment. Mupirocin acts by binding to bacterial isoleucyl-tRNA synthetase.

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9
Q

What is the difference between facultative & obligate?

A

Obligate truest sense of the term
Obligate aerobe has to have oxygen, If the oxygen drops a little bit the bacteria start to die
Obligate anaerobe: poisoned by oxygen

Facultative: in-between “gray scale”
Facultative anaerobic “prefers no o2” but can still survive

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10
Q

What 2 bugs should come to mind when you think of gram +?

A

Strep & Staph

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11
Q

What bug comes to mind when you think of gram negative?

A

e. coli

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12
Q

Bacterio-static:

A

slows cell from growing a multiplying…drug keeps growth slow so immune system can clean up mess

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13
Q

Bacteri-cidal:

A

KILLS the cells think for immunocompromised patients

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14
Q

What are the bacteriocidal mechanisms of action?

A

Cell wall synthesis inhibitors “open up cell wall guts spill out*
DNA synthesis inhibitors *stop dna from replicating = death”
Metabolic synthesis inhibitors “need metabolism for energy = death”

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15
Q

What are the bacteriostatic MOA?

A

Protein synthesis = usually static, at high doses&raquo_space; cidal

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16
Q

What are the 4 ways bacteria become resistant to abx?

A

Change target: Abx targets bacteria, bacteria can change self so it doesn’t get detected

Influx Pumps: for bacteria to survive it can reduce influx pump (less abx gets into it)

Efflux Pumps: Increase efflux pump to pump abx out faster (less time for abx to work)

Enzymatic inactivation: Enzymes breakdown abx so bacteria survive attack and become resistant. Trait passed down to next generation of bacteria

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17
Q

Pt has positive strep and medical hx of PCN allergy…what do you give?

A
  • What’s first line and can they take? If yes, stop thinking

- If not, 1st gen cephalosporin, Kephlex

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18
Q

What are the cell wall synthesis inhibitors?

A

PCN, cephalosporin (lactam abx) Vanco

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19
Q

Folic acid synthesis inhibitors (Metabolism Synthesis):

A

Sulfonamides & Trimethoprim (put together to form Bactrim)

Macrobid (Nitrofranitoin)

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20
Q

DNA Synthesis inhibitors:

A

Quinolones & Rifampin

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21
Q

Protein Synthesis inhibitors:

A

50S subunit: Macrolides & Clindamycin

30S subunit: Tetracycline

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22
Q

What inhibits the 50S subunit?

A

Macrolides & Clindamycin

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23
Q

Penicillin, Cephalosporins, & Glycopeptides (Vanco)
MOA
cidal or static?

A

Inhibit cell wall synthesis

Bacteriocidal

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24
Q

Penicillin

MOA
1st line
2nd line
How to take
ADR #3
Drug interaction #4
Pregnancy
A

MOA:
- inhibit cell wall synthesis; bactericidal

1st line: Syphilis and strep throat/pharyngitis
2nd line: lyme disease

How to take: empty stomach

Adverse Reactions:
Maculopapular rash w/MONO,
C. Diff,
Seizures,

Drug Interactions:

  • Warfarin,
  • diuretic,
  • tetracycline,
  • probenecid *

VERY SAFE IN PREGNANCY

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25
Q

Pen V

Narrow or Broad?
What bacteria does it cover?
What would you take it for?

A

(Very easy to take = oral) & Pen G (IV form) (natural PCN)

Very Narrow Spectrum = Gram + = strep including GABHS
Only cover strep

*When you have strep throat think natural Pen V

26
Q

What makes PCN resistant unique?

A

Only PCN that covers STAPH AUREUS
(specifically Methicillin sensitive resistant SSA) & staph species

Staph has an enzyme that breaks down PCN EXCEPT penicillinase resistant

27
Q

What inhibits the 30S subunit?

A

Tetracyclines

Protein synthesis inhibitors

28
Q

What is PCN 1st line for? 2nd line?

A

1st:
Syphillis & strep throat/pharyngitis

2nd line:
-Lyme disease

29
Q

What is Amoxicilline 1st line for? #4

2nd line? #2

A

1st line:

  • Sinusitis
  • Acute Otitis Media
  • Endocarditis prophylaxis
  • H. Pylori

2nd line:

  • Lyme (Children <8yrs)
  • CAP
30
Q

What are 2 Augmentin indication?

A

Has beta-lactamase inhibitor that broadens anaerobic coverage…

COPD, CAP, Pregnancy UTI*

31
Q

What type of bacteria have a lot of beta lactamase?

A

Anaerobic

32
Q

What is Augmentin 1st line for?

A

Dog bites because of its anaerobic coverage

33
Q

Which one is a Macrolide?

Clindamycin
Gentamycin,
Azithromycin
Vancomycin

A

Azithromycin and Erythromycin are macrolides

34
Q

What does Macrobid treat?

A

Lower UTI for elderly

super concentrated in bladder

35
Q

What is first line for Lyme disease? 2nd line?

A

Tetracycline (doxycycline)

2nd line: Amoxicillin (children <8yrs)

36
Q

What are people with COPD prescribed?

A

Augmentin because it has anerobic coverage to cover the pus/mucus pockets

37
Q

What are the characteristics of abx that cause c. Diff/

A

narrow spectrum & Gram + coverage

38
Q

What are Cephalosporins MOA?
ADR? #3
Safe in pregnancy?

A

inhibits cell wall synthesis, beta lactam ring breaks down wall
Bacteriocidal

ADR:
C. Diff
Hemolytic anemia (rare)
10% cross sensitivity with PCN
Maculopapular rash
39
Q

Cephalexin (Keflex)

What generation?
1st line for?
Activity
Indication

A

1st gen cephalosporin “cepha”

**Think 1st gen mostly staph & strep”
LEAST TISSUE PENETRATION
Superficial

1st line
-Cellulitis (skin & soft tissue infection)

Activity:
-Gram +
MSSA, Strep, E. coli

Indication:
Cellulitis (99% staph or strep)
Impetigo (type of cellulitis)

40
Q

Cefuroxime, Cefprozil, Cefaclor

What generation?
Activity?
Indication

A

2nd generation cephalosporin

Activity: Gram +

Indication:
-COPD Exacerbation (d/t more gram – coverage)

41
Q

Ceftriaxone

Which generation?
1st line for? #2
Indication? #2
Contraindication
ADR
A

3rd generation cephalosporin

1st line:

  • Gonorrhea,
  • meningitis (greatest tissue penetration)

Indication:

  • Broader infection,
  • URI

Contraindication:
-Neonates r/t hyperbilirubinemia 3rd gen
highly protein bound

ADR:
-pain at injection site

42
Q

Vancomycin, telavancin (Vibativ) & dabavancin (Zeven)

What drug class?
MOA
PO indication?
IV indication?
3 ADR
Pregnancy?
A

Glycopeptide

MOA:
-Inhibits cell wall synthesis by binding to D-A1a-D-A1a portion,

Activity:
Narrow, only gram +

  1. PO cdiff,
  2. IV Vanco MRSA
  3. Watch out for: Red Man syndrome, nephrotoxic, ototoxic
  4. little absorption, safe in Pregnancy Category B
    IV 1st line bacteremia MRSA, Pregnancy Category C
    2nd line outpatient Clindamycin for pregnancy
43
Q

5 Clindamycin fun facts

A 
5 Fun facts:
Very narrow spectrum, only gram +
Great for MRSA
Anaerobic
Dental Infections
Watch for C. Diff
44
Q

Clindamycin

MOA
Activity
1st line for? #3
Indications
Contraindications?
Side Effects #3
BBW #2
A

Lincosamides

Action: Protein Synthesis inhibitor (bacteriostatic) - 50S subunit,

Activity:
very narrow spectrum gram + & select, anaerobic coverage
Staph & strep

1st line: MRSA, PCN-allergic patients, PID

Indications: acne,
no absolute contraindications to clindamycin, well tolerated for everyone even renal

Side Effects:

  • Macularpapular rash,
  • GI,
  • blood dyscrasia

BLACK BOX WARNING: colitis, C. diff infection

45
Q

First line for cellulitis what do you think 1st & 2nd line?

A

1st gen. Cephalosporin (Keflex);

if there’s an anaphylactic allergy…2nd line Clindamycin

46
Q

Bactrim tx which kind of infection?

A

UTI, gram – e. coli

47
Q

How to treat MRSA?

A

CLINDAMYCIN: 1st line if you know it’s MRSA

BACTRIM: (covers e. coli & MRSA) = EMPIRIC

DOXYCYCLINE: MOST BROAD and anaerobic coverage

48
Q

What is clindamycin BBW?

A

C. diff & colitis

49
Q

Azithromycin, Clarithromycin, Erythromycin (ACE)

Drug class?
1st line for? #2
contraindications #2
Drug Interaction 
Side Effect #4
A

Macrolides

Activity:
Broad Spectrum, gram +/-, MSSA,
PERTUSSIS, Mycoplasma,
CHLAMYDIA , H. Pylori

1st line:
respiratory infections community acquired PNA (mycoplasma),
Pertussis,
Chlamydia in lungs,

Indication: Chlamydia, Pertussis, H. Pylori, chronic bronchitis

Contraindicated: AOM or sinusitis

Drug Interaction: All CYP450 inhibitors

Side Effect:

  • watch for explosive, watery diarrhea
  • QT prolongation/Torsade’s (take 2nd line Doxycycline)
  • Watch liver
  • Hypersensitivity (red man syndrome)

Always for pertussis even for less than 6 months even though could cause PYLORIC STENOSIS IN BABIES

50
Q

What is the major indication/unique for Erythromycin

A

Bacterial conjunctivitis & topical acne

51
Q

What are Clarithromycin’s indications #3?

A

COPD exacerbation, H. pylori, Pertussis

52
Q

What 2 drug classes prolong QT?

A

Macrolides & Fluoroquinolones

53
Q

3 most common abx for photosensitivity?

A

Bactrim, Flouroquinones, Doxycycline

54
Q

Doxycycline, Minocycline, Tetracycline

MOA
1st line: #3
2nd line #1
ADR #2
Interactions
A

Tetracycline
&laquo_space;a lot of resistance

Activity: Protein synthesis inhibitor – 30S, bacteriostatic very broad spectrum, anaerobic & atypical

Indication: MRSA (CBD oil) strep pneumo, mycoplasma, acne, tick borne ill ness
1st line: tick borne illness, acne
2nd line: CAP
ADR: 
photosensitivity, 
GI,

Interactions:

  • Back up birth control
  • Milk & Calcium absorption (Doxy binds to calcium in teeth)

Pregnancy: NO
Peds: >8yrs

55
Q

Ciprofloxacin, Levofloxacin “-floxacin”

ADR #3
BBW
Contraindications #3
Education
preg/lact
1st line for?
A

Fluoroquinolones

MOA: DNA gyrase inhibitor, bactericidal

Activity: very broad spectrum, especially gram – E.Coli, P. aeruginosa

Instruction: Take on empty stomach

ADR: GI,
phototoxic, tendinitis (rare),
tendon rupture (rare), skeletal muscle joint pain,

BLACK BOX WARNING: tendon rupture & tendonitis (cartilage abnormalities)

Contraindicated:
QT prolongation,
G6PD,
Myasthenia Gravis

Education: Report new onset pain, could be delayed by months

Pregnancy/Lactation: NO!
Elderly & Peds: as long as they can talk

1st line: serious/complicated infections = Pyelonephritis
3rd line: simple = CAP, UTI

56
Q

Bactrim

MOA
Activity
Side Effect #5
Contraindication #3
pregnancy
Education #3

1st line?
2nd line?

A

MOA: Folate Synthesis (Metabolism) inhibitor – bacteriocidal, Inhibits dihydrofolate synthetase
(Individually bacteriostatic/ together synergistic)

Activity: Broad Spectrum, E. Coli, MRSA, PCP* (polycystic PNA) &laquo_space;opportunistic HIV infection

Side Effect:

  • Kernicterus (brain damage),
  • Crystalluria,
  • Hypersensitivity,
  • hemolytic anemia,
  • photosensitivity

Contraindication:

  • Pediatrics <2 months (kernicterus (hyperbilirubinemia) r/t undeveloped liver/brain)
  • G6PD
  • Sulfa Allergy

Pregnancy: NO

Education: stay hydrated, Sunscreen, Give folic acid supplement

1st line: UTI
2nd line: MRSA = Empiric Coverage “CBD oil”

57
Q

What 3 abx cannot be taken with G6PD?

A

Bactrim, Nitrofurantoin, & Fluroquinolones

58
Q

When do you have to start an antiviral after an outbreak?

A

within 72 hours

59
Q

Ledipasvir/Sofosbuvir, Sofosbusvir/Velpatasvir

Indication
Monitor
BBW

A

*Always use 2 combo drug 12 weeks

Indication:
Hepatitis C

MOA: Inhibit HSV protein necessary for viral replication

Monitor:
Kidney,
bilirubin,
liver (treating virus in liver)

BLACK BOX WARNING: Hep B reactivation

60
Q

How do you treat Hepatitis C?

A

Always need to know genotype

61
Q

Oseltamivir (Tamiflu), Peramivir (Rapivab), Zanamivir (Relenza)

MOA
Monitor
ADR

A

Neuraminidase inhibitor

MOA: Neuraminidase Inhibitor = prevents virus from leaving the host cell so it can’t spread to other host cells

Monitor:
Renal fx

ADR: 
neuropsychiatric events (Caution in elderly),

Peds: >3months

  • Start within 48 hours
  • Works for influenza A & B

Zanamivir special monitoring? Bronchitis & SOB
Which medication for influenza is safe for lactation? Oseltamivir (Tamiflu)

62
Q

Metronidazole

Indication: #5
ADR #5
Caution #2
Pregnancy
BBW
A

Activity: Gram +/-, antiprotozoan (parasite), antifungal, anaerobes, antibacterial BROADEST OF THE BROAD

Indication: c. diff, bacterial vaginosis, H. Pylori (for PCN reaction), Trichomoniasis, PID

MOA: inhibits protein synthesis

ADR: 
GI, 
blood dyscrasia, 
CNS effects, 
metallic taste, 
dark urine

Caution:
Seizure threshold,
liver fx

Pregnancy: Avoid 1st trimester
Peds: OK

BLACK BOX WARNING: carcinogenic

Advanced Pharmacology (5 decks)

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