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APRN A. Pharm- Test 1 > Week 2- Antibiotics > Flashcards

Week 2- Antibiotics Flashcards

1
Q

What are Beta-Lactams

A

Penicillins and Cephalosporins

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2
Q

What class is Penicillin V and Penicillin G?

A

Beta Lactam, natural penicillin

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3
Q

How is Penicillin V taken?

A

PO

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4
Q

What is Penicillin V used for?

A

pharyngitis, dental abscesses, URI, pneumonia

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5
Q

Is Pencillin V effective against Staph Aureus?

A

No

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6
Q

Mechanism of Action of Pencillin V and Penicillin G?

A

Beta-lactam, inhibits biosynthesis of bacterial cell wall, peptidoglycan… binds to transpeptidase

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7
Q

What are the PharmK and PharmT of Penicillin V and Penicillin G?

A

Negligible metabolism, excreted unchanged in urine, high urinary concentration

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8
Q

Is Penicillin V safe in pregnancy?

A

Yes

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9
Q

Penicillin allergies

A

IgE mediated, less than 1%, cross allergies to cephalosporins and carbapenems

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10
Q

Adverse effects with Penicillin V

A

Rash, GI upset, potential for c. diff infection if inappropriately used

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11
Q

Food/ Med interactions of Pencillin V

A

Food decreases absorption, could decrease potency of contraceptives

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12
Q

How is Penicillin G taken?

A

IM

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13
Q

Uses of Penicillin G?

A

syphillis, meningitis

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14
Q

Major adverse reactions of penicillin G?

A

Allergic reactions, same as pencillin V, neurotoxicity at high doses

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15
Q

Are beta-lactams (penicillins and cephalosporins) bacteriostatic or bacteriocidal?

A

bacteriocidal

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16
Q

What drug class is amoxicillin?

A

Beta Lactam- Penicillin

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17
Q

Mechanism of action of amoxicillin?

A

Inhibits cell wall synthesis

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18
Q

What bacteria does amoxicillin target?

A

broad spectrum: gram + and gram - bacteria

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19
Q

what is amoxicillin used for?

A

otitis media, sinusitis and UTIs

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20
Q

Major adverse reactions to amoxicillin

A

rash, diarrhea, superinfection

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21
Q

what class is amoxicillin/clavulanate?

A

beta lactam- penicillin

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22
Q

mechanism of action amoxicillin/clavulanate

A

inhibits cell wall synthesis

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23
Q

what is amoxicillin/clavulanate used for?

A

respiratory and skin infections

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24
Q

adverse reactions of amoxicillin/clavulanate?

A

diarrhea, potential for hepatotoxicity

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25
Q

difference between amoxicillin and amoxicillin/clavulanate?

A

spectrum is increased to include beta-lactamase-producing strains as well as broadening the coverage to include other bacterial species (overcomes abx resistant strains!)

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26
Q

what is clavulanate acid?

A

mechanism-based β-lactamase inhibitor

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27
Q

what drug class are cephalosporins?

A

beta-lactams

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28
Q

what are cephalosporins often used for?

A

acute otitis media, sinusitis, Group A Strep, pneumonia, chronic bronchitis

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29
Q

what are the first-generation cephalosporins?

A

cephalexin and cefazolin (IM/IV)

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30
Q

what are second generation cephalosporins?

A

cefuroxime

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31
Q

what are third generation cephalosporins?

A

cefdinir, cefpodoxime, ceftriaxone

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32
Q

unique differences for first generation cephalosporins?

A

fairly narrow spectrum, can be used by individuals allergic to penicillin

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33
Q

unique difference for second generation cephalosporins?

A

less active against gram-+ cocci than first generation oral cephalosporinsu

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34
Q

unique differences for third generation cephalosporins

A

more resistance to beta-lactamase

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35
Q

drug class of cephalexin

A

beta lactam- first generation cephalosporin

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36
Q

how does cephalexin work?

A

inhibits cell wall synthesis

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37
Q

what does cephalexin work against?

A

skin infections, UTIs (works against s. aureus)

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38
Q

side effects of cephalexin

A

diarrhea, hypersensitivity reactions

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39
Q

food/drug monitoring considerations with cephalexin

A

well absorbed in GI tract, food delays absorption, renal function impairment significantly impacts the half life

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40
Q

Adverse reaction for all cephalosporins?

A

type 1 reaction/ serum sickness-like reactions: erythema multiforme, skin rashes, arthralgia, fever

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41
Q

route of cefazolin?

A

IM/IV

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42
Q

what class is cefazolin?

A

beta lactam- cephalosporin, first generation

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43
Q

how does cefazolin work?

A

inhibits cell wall synthesis, works against some gram + cocci, some gram negative rods

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44
Q

what do we use cefazolin for?

A

surgical prophylaxis and infections

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45
Q

adverse reactions for cefazolin?

A

hypersensitivity, potential for nephrotoxicity

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46
Q

what class is cefuroxime

A

beta lactam- second generation cephalosporin

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47
Q

how does cefuroxime work?

A

it inhibits cell-wall synthesis

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48
Q

what does cefuroxime work against?

A

it is broad spectrum, includes anarobes– used for bronchitis and lyme disease (h. influenzae)

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49
Q

common side effects of cefuroxime?

A

diarrhea, rash, cns effects

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50
Q

what class is cefdinir

A

third generation cephalosporin/beta lactam

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51
Q

how does cefdinir work?

A

it inhibits cell wall synthesis

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52
Q

what does cefdinir work against?

A

otitis media, sinusitis, respiratory infections (broad spectrum), MSSA, gonorrhea and h. influenzae

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53
Q

common side effect of cefdinir

A

diarrhea, allergic reactions

54
Q

what class is ceftriaxone?

A

beta lactam- 3rd generation cephalosporin

55
Q

how is ceftriaxone delivered?

A

IV/IM

56
Q

what does ceftriaxone fight against?

A

severe bacterial infections, meningitis, gonorrhea

57
Q

how does ceftriaxone work?

A

it inhibits cell wall synthesis

58
Q

side effects of ceftriaxone?

A

biliary sludging, pseudolithiasis

59
Q

what drugs are in the fluoroquinolone class?

A

ciprofloxacin and levofloxacin

60
Q

are fluoroquinolones (cipro and levofloxacin) bacteriostatic or bacteriocidal?

A

bacteriocidal

61
Q

how do fluoroquinolones work?

A

inhibits DNA gyrase… interferes with enzymes required for the synthesis and repair of bacterial DNA

62
Q

what is the different between ciprofloxacin and levofloxacin?

A

levofloxacin is the newer generation, cipro is older

63
Q

what does ciprofloxacin fight against?

A

broad spectrum including gram negative bacteria, UTIs and gastrointestinal infections

64
Q

what does levofloxacin fight against?

A

broad spectrum including gram negative bacteria AND atypical pathogens- respiratory infections, UTIs

65
Q

BLACK box warning with fluoroquinolones

A

cipro and levofloxacin may cause tendon rupture/tendonitis– higher likelihood with older patients, steroid use, h/o transplant

66
Q

what impacts fluoroquinolone (cipro and levofloxacin) absorption?

A

dairy products and antacids

67
Q

adverse effects of fluoroquinolones?

A

may exacerbate muscle weakness w/ myasthesnia gravis, prolonged QT, photosensitivity, neurologic adverse effects

68
Q

what people should stay away from fluoroquinolones?

A

pregnant people, under 18, renal function impairment

69
Q

drug interactions of fluoroquinolones?

A

*** inhibits CYP3A4 and CYP1A2

70
Q

what drug class is clindamycin?

A

lincosamide

71
Q

how does clindamycin work?

A

Binds to 50S subunit of bacterial ribosome; Suppresses protein synthesis

72
Q

what is clindamycin used for?

A

good for penicillin ax alternative- bacterial endocarditis, pnuemococcal pneumonia, skin and tissue infections, drug resistant pneumococcal, BV?

73
Q

is clindamycin bacteriocidal or static?

A

bacteriostatic

74
Q

adverse effects of clindamycin

A

highest risk of c. diff and severe diarrhea!!!!! also: n/v, dizziness, cardiac arrhythmias, hypotension, dizziness, metallic taste *

75
Q

what drugs are in the macrolide/ azalide class?

A

macrolide: erythromycin and clarithromycin
azalide: azithromycin * preferred medication

76
Q

are macrolides/azalides bacteriostatic or bacteriocidal

A

the MYCINs are bacteriostatic

77
Q

How do macrolides work?

A

reversibly binds to P site of the 50S ribosomal subunit of the susceptible organism and inhibit RNA dependent protein synthesis

78
Q

what is erythromycin best used for?

A

atypical bacteria, gram positive cocci

79
Q

what are azithromycin and clarthromycin best used for?

A

broad spectrum- atypical pathogens

80
Q

side effects of macrolides?

A

GI upset, hepatotoxicity, QT prolongation, abnormal taste w/ clarithomycin

81
Q

what is erythromycin best used for?

A

respiratory infections/skin infections (community acquired pneumonia)

82
Q

what is azithromycin best used for?

A

respiratory infections like CAPI, STIs (chlamydia)

83
Q

what is clarithomycin best used for?

A

resp infections (CAP), h. pylori

84
Q

which macrolides have the bost drug interactions?

A

erythromycin and clarithromycin-b/c strong inhibitors of CYP enzymes

85
Q

what drug should be stopped with clarithromycin?

A

statins- risk of severe myopathy or rhabdomyolysis

86
Q

what drug is in the oxazolidinones class?

A

linezolid

87
Q

what is linezolid used for?

A

MRSA, VRE, severe skin infections/pneumonia- reserve ABX

88
Q

what to watch out for with linezolid

A

serotonin syndrome w/ MAOIs, monitor CBCs weekly

89
Q

What drug is in the nitrofuran class?

A

Nitrofurantoin

90
Q

how does nitrofurantoin work?

A

it is bactericidal- it damages bacterial DNA

91
Q

what does nitrofurantoin work against?

A

UTIs- e.coli and other UTI pathogens

92
Q

Adverse reactions with nitrofurantoin?

A

pulmonary reactions and hepatotoxicitym, neuropathy

93
Q

what class of drug is sulfamethoxazole/trimethoprim?

A

sulfonamide

94
Q

how does sulfamethoxazole/trimethoprim work?

A

inhibits folic acid synthesis

95
Q

is sulfamethoxazole/trimethoprim bacteriostatic or bacteriocidal?

A

cidal

96
Q

what does sulfamethoxazole/trimethoprim work against?

A

UTIs and resp infections,never really given as monotherapy (otitis media, PIP, cholera, VAP too)

97
Q

black box warning with sulfamethoxazole/trimethoprim

A

Can cause stevens-johnson syndrome, instant death in patients with blood dyscrasias, epidermal necrolysis

98
Q

adverse reactions with sulfamethoxazole/trimethoprim

A

hypersensitivity reactions, hematologic changes

99
Q

what class of drug is fosfomycin?

A

phosphonic acid

100
Q

how does fosfomycin work?

A

inhibits cell wall synthesis

101
Q

what does fosfomycin work against?

A

gram - UTIs, only is for UTIs

102
Q

possible side effects with fosfomycin?

A

diarrhea, headache

103
Q

what drugs are in the tetracycline class?

A

doxycycline and tetracycline

104
Q

how does the tetracycline class work?

A

inhibits protein synthesis

105
Q

is the tetracycline class bacteriostatic or bacteriocidal?

A

bacteriostatic

106
Q

what is doxycycline used for?

A

respiratory infections, acne and lyme disease

107
Q

what is tetracycline used for?

A

acne, respiratory infections

108
Q

what are some drug interactions/considerations with tetracyclines?

A

caution with children younger than 8, renal/hepatic impaired patients, pregnant women

109
Q

what drugs do tetracyclines interact with?

A

antacids, salts, magnesium, zinc, increases effect of warfarin

110
Q

risks of using tetracyclines

A

phototoxicity and superinfection, can stain teeth

111
Q

what drug class is vancomycin in?

A

glycopeptide

112
Q

how is oral vancomycin used?

A

only for c. dif treatment!

113
Q

how does vancomycin work?

A

inhibits cell wall synthesis

114
Q

caution with vancomycin (PO)

A

nephrotoxic, skin rash, ototoxicity

115
Q

why is vancomycin used PO for c. dif

A

poor GI absorption

116
Q

what drugs are used for tuberculosis

A

rifampin, isoniazid, pyrazinamide and ethambutol (RIPE!)

117
Q

how does rifampin work?

A

inhibits RNA synthesis

118
Q

is rifampin static or cidal

A

cidal

119
Q

adverse effects of rifampin?

A

hepatitis, orange-red discoloration of body fluids (can stain)

120
Q

how does isoniazid work?

A

inhibits mycolic acid synthesis

121
Q

risk factors with isoniazid?

A

hepatotoxicity, peripheral neuropathy

122
Q

how does pyrazinamide work?

A

it disrupts mycobacterial cell membrane metabolism

123
Q

is pyrazinamide bacteriostatic/cidal?

A

cidal

124
Q

adverse effects of pyrazinamide

A

hepatotoxicity, hyperuricemia

125
Q

how does ethambutol work?

A

inhibits arabinosyl transferase

126
Q

is ethambutol bacteriostatic/cidal

A

static

127
Q

adverse effects of ethambutol

A

optic neuritis (risk of being blind), peripheral neuropathy

128
Q

factors that contribute to antibiotic resistance

A

increase populations of immunocompromised patients, increased # and complexity of medical procedures, inappropriate use of antimicrobials, increased survival of patients with chronic disease

129
Q

what is bacteriostatic

A

inhibits an increase in bacterial growth (clindamycin, tetracylcines, linezolid, macrolides)- relies on good immune system

130
Q

what is bacteriocidal

A

kills bacteria (99.9% dead w/i 24 hrs)- vancomycin, fluoroquinolones, beta-lactams

APRN A. Pharm- Test 1 (5 decks)

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