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Antibiotics > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Types of Natural Pencillin

A
  • Penicillin G aqueous
  • Penicillin G procaine and benathine
  • Penicillin V (PenVeek, Vi-CillinK
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2
Q

Types of Amino Penicillin

A
  • amoxixillin (Amoxil)

- ampicillin (Omipen)

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3
Q

Antistaphylococcal Penicillin

A

dicloxacillin (Dynapen)
nafcillin (Nafcil, Unipen)
oxacillin (Prostaphlin)

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4
Q

Antipseudomonal Penicillin

A

pipercillin (Piperacil)

ticarcillin (Ticar)

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5
Q

B-Lacatamase inhibtors

A

Ampicillin/sulbactam (unasyn)
amoxicillin/clavulanate (Augmentin)
piperacillin/tazobactam (Zosyn)
ticarcillin/clavulante (Timentin)

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6
Q

1st Generation Cephalosporins

A

Cefadroxil (druicef) PO
Cefazolin (Ancef, Kefzol) INJ
Cephalexin (Keflex) PO

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7
Q

2nd Generation Cephalosporins

A 
Cefaclor (Ceclor)
cefotetan (Cefotan)
cefoxitin (Mefoxin)
cefprozil (Cefzil)
cefuroxime (Zinacef)
cefuroxime axetil (Ceftin)
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8
Q

3rd Generation Cephalosporins

A 
cefdinir (Omnicef)
cefditoren (Spectracef)
cefixime (Suprax)
cefotaxime (Clarforan)
cefpodoxime (Vantin)
ceftazidime (Fortaz)
cefibuten (Cedax)
ceftriaxone (Rocephine)
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9
Q

Penicillin: Mechanism of action

A

Interfere with bacterial cell wall synthesis

bind to peptidoglycan layer causing bacterial cell lysis and death

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10
Q

Penicillin: Mechanism of Resistance

A

1) B-Lactamase/Penicillinase
2) Modified PBP’s (decreased affinity for PCN)
3) Decreased permeability (Gram negative external surfaces that reduce drug permeability)

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11
Q

Types of Macrolides

A

azithromycin (Z-Pak, Zithromax)
clarithromycin (Biaxin)
erythromycin (multiple brands)

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12
Q

Macrolides: Mechanism of action

A

inhibits bacterial ribosomal protein synthesis

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13
Q

Macrolides: Antibacterial Spectrum

A

Respiratory/genital infections (if pt. allerigic to PCN)
Otitis media
Community acquired pneumonia
Pelvic infections caused by Chlamydia trachomatis
Topical for acne
Whooping Cough

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14
Q

Macrolides: ADR

A 
GI intolerance (most common)
Cholestatic jaundice
Abnormal taste sensations
Prolonged QT interval
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15
Q

Drug responsible for metal taste in mouth

A

Clarithromycin

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16
Q

Antipseudomonal Penicillins: Spectrum Diseases

A

Nosocomial pneumonia, nosocomial UTI, complicated cellulitis, abdominal infections

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17
Q

Drug interactions with erythromycin and clarithromycin

A 
theophylline
warfarin
antifungals
statins
seizure drugs
detrol
digoxin
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18
Q

Caution with macrolides in patients with what?

A

Severe hepatic dysfunction

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19
Q

Macrolides: off label uses

A

erythromycin used to treat diabetic gastroparesis by increasing GI motility and gastric emptying

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20
Q

List of tetracyclines

A

demeclocycline (Declomycin)
doxycycline (Vibramycin)
minocycline (Minocin)
tetracycline (Sumycin)

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21
Q

Natural Penicillin: Spectrum of Bacteria/Pathogens

A

Bacteria-Gram Positive Cocci

Pathogens- Strep Viridans, Strep pyogenes, strep pneumonia

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22
Q

Natural Penicillin: Spectrum Diseases

A

Syphilis, endocarditis, pneumonia, strep throat, group B strep infections

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23
Q

Amino Penicillins: Spectrum of Bacteria/Pathogens

A

Bacteria- Both gram positive and gram negative

Pathogens- haemophilus influenzae, strep pneumonia, E. coli, proteus mirabilis, enterococcus

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24
Q

Amnio Penicillins: Spectrum Diseases

A

Sinusitis, throat infections, otitis media, UTI’s

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25
Q

Antipseudomonal Penicillins: Spectrum of Bacteria/Pathogens

A

Bacteria- gram negative bacilli/rods

Pathogens- pseudomonas aeruginosa, serratia, klebsiella

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26
Q

Antipseudomonal Penicillins: Diseases

A

Nosocomial pneumonia, nosocomial UTI, complicated cellulitis, abdominal infections

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27
Q

Tetracyclines: Mechanism of Action

A

inhibits bacterial ribosomal protein synthesis

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28
Q

Tetracyclines: Spectrum

A 
Community acquired pneumonia
lyme's disease, rocky mountain spotted fever, tularemia, anthrax treatement
pelvic infections
acne
MRSA
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29
Q

Best drug to treat CAP

A

Docycycline

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30
Q

Pelvic infection caused by

A

Chlamydia trachomatis

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31
Q

Tetracyclines :pharmacokinetics

A

high concentrations achieved in body organs, skin, bone and teeth

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32
Q

Tetracyclines: pharmacokinetics

A

Metabolized in liver first, then excreted by kidneys

Crosses placenta and excretes into breast milk

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33
Q

Tetracyclines: drug interactions

A

Chelate with 2+ and 3+ cations (Ca2+, Fe3+)
antacids, multivitamins
milk, cheese

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34
Q

Tetracyclines: ADR

A

GI intolerance
Photosensitivity
Teeth discoloration
Hypersensitivity reactions
Fatal hepatic toxicity at high doses (rare)
inhibit skeletal growth in developing fetus during pregnancy

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35
Q

Clindamycin: Mechanism of Action

A

inhibits bacterial ribosomal protein synthesis

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36
Q

Clindamycin: ADR:

A

hypersensitivity reactions
high incidence of causing Clostridium difficile
Cause non-Clostridium difficile diarrhea, N/V

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37
Q

Clindamycins: Spectrum

A

excellent anaerobic and gram+ coverage
almost no gram - coverage
alternative to PCN and cephalosporins where gram+ coverage is needed

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38
Q

Clindamycins: commonly used

A

Diabetic foot cellulitis where gram- not suspected
skin and soft tissue infections w/ PCN allergy
Mild aspiration pneumonias where anaerobe may be present
acne
Staphylococcus aureus (CA-MRSA)

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39
Q

B-Lactamase Inhibitor Combinations: Spectrum of Bacteria/Pathogens

A

Bacteria- gram positive, enhanced gram negative and anaerobic coverage
Pathogens- “anything that’s stinky”

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40
Q

B-Lactamase Inhibitor Combinations: Spectrum Diseases

A

diabetic foot ulcers, abscesses, animal bites, abdominal infections, anaerobic infections, polymicrobial infections

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41
Q

Antistaphylococcal Penicillins: Spectrum of Bacteria/Pathogens

A

Bacteria- gram positive

Pathogens- staph aureus, other staph strains

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42
Q

Antistaphylococcal Penicillins: Spectrum Diseases

A

Soft tissue and bone infections, endocarditis

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43
Q

Antifolate Drugs: Sulfa Drugs/Sulfonamides

A 
Mafenide
Silver sulfadiazine (Silvadene)
Sulfacetamide (Cetamide)
Sulfadiazine (Microsulfon)
Sulfamethoxazole (Bactrim component)
Sulfisoxazole (Gantrisin)
Triple sulfa vaginal cream (Sultrin)
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44
Q

Antifolate Drugs: Sulfa Drugs: Mechanism of Action

A

Sulfonamides use up much of the enzyme needed to convert PABA to folic acid, thus decreasing folic acid production.

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45
Q

Antifolate Drugs: Sulfa Drugs: Pharmacokinetics

A 
Well absorbed orally.
Distributes throughout body water.
Highly protein bound. 
Metabolized in the liver.
Excreted renally.
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46
Q

Antifolate Drugs: Sulfa Drugs: Drug Interactions

A

With other highly protein bound drugs e.g. warfarin and phenytoin (Dilantin)

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47
Q

Antifolate Drugs: Sulfa Drugs: ADR

A

Hypersensitivity Reactions
Nephrotoxicity
GI upset, diarrhea
Kernicterus: sulfonamides displace bilirubin from protein binding sites
Rare: aplastic anemia, pancreatitis, thrombocytopenia

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48
Q

Persons allergic to sulfonamides may have cross sensitivity with these medications

A 
Celecoxib (Celebrex)
Furosemide (Lasix)
Hydrochlorothiazide 
sulfasalazine (Azulfidine)
Zonisamide (Zonegram)
Glyburide & Glipizide sulfonylureas
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49
Q

If you are allergic to sulfonamide Rx, then which 3 drugs will the pharmacist call you on (to tell you, you cannot administer these drugs)?

A

Celecoxib (Celebrex)
Sulfasalazine (Azulfidine)
Zonisamide (Zonegram)

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50
Q

Antifolate Drug: Trimethoprim: Mechanism of Action

A

Dihydrofolate reductase inhibitor. Dihydrofolate reductase converts folic acid to its active form, tetrahydrofolic acid

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51
Q

Antifolate Drug: Trimethoprim: Pharmacokinetics

A 
Similar to sulfonamides: 
Well absorbed orally.
Distributes throughout body water.
Highly protein bound. 
Metabolized in the liver.
Excreted renally.
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52
Q

Antifolate Drug: Trimethoprim: ADR

A

can produce effects of folate deficiency if given in very high doses

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53
Q

Co-Trimoxazole (Bactrim, Septra): Mechanism of Action

A

Synergy: shows greater antimicrobial activity than equivalent quantities of either drug used alone
Inhibits 2 sequential steps in the synthesis of active folic acid

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54
Q

Co-Trimoxazole (Bactrim, Septra): ADR

A

Hypersensitivity Reactions
Nephrotoxicity
GI upset, diarrhea
Kernicterus: sulfonamides displace bilirubin from protein binding sites
Rare: aplastic anemia, pancreatitis, thrombocytopenia
Can produce effects of folate deficiency if given in very high doses

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55
Q

Co-Trimoxazole (Bactrim, Septra): Drug Interactions

A

With other highly protein bound drugs e.g. warfarin & phenytoin (Dilantin)

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56
Q

Co-Trimoxazole (Bactrim, Septra): Therapeutic Indications

A

UTI
Prostate Infections
Otitis media, sinusitis, & other resp. infections
Tx & prophylaxis Pneumocystis jiroveci pneumonia
CA-MRSA

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57
Q

What are the main pathogens that Bactrim & Septra target?

A 
Serratia
M. catarrhalis
H. influenza 
L. monocytogenes 
P. mirabilis
E. coli
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58
Q

What pathogen is most common in a UTI?

A

E. coli

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59
Q

ketoconazole: Mechanism of action

A

alters permeability of fungal cell wall & inhibits several fungal enzymes that causes toxin build up in fungal cell

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60
Q

ketoconazole: Therapeutic uses

A

OTC dandruff shampoo

orally for systemic fungal infections of lung, bone, skin, ect.

61
Q

ketoconazole: systemic fungal infections are caused by what?

A

Blastomyces dermatitidis, Candida albicans, Coccidioides immitis, Histoplasma capsulatum

62
Q

ketoconazole: pharmacokinetics

A

1) requires an acidic environment for adequate absorption 2) food, antacids, H2-blockers and proton pump inhibitors impair oral absorption

63
Q

ketoconazole: drug interactions

A

significant cytochrome p450 interactions

64
Q

Ketoconazole: adverse drug reactions

A

GI upset, N/V, diarrhea, rash
endocrine effects - can inhibit sex steroid synthesis
black box warning: fatal hepatic toxicity can occur

65
Q

fluconazole: mechanism of action

A

same as itraconazole: decreases ergosterol synthesis and inhibits cell membrane formation

66
Q

fluconazole: therapeutic uses

A

IV & oral: oral and esophageal candidiasis (thrush)
oral: single oral dose effectively treats vulvovaginal candidiasis (yeast infection)
IV & oral: systemic fungal infections of lung, bone, skin

67
Q

fluconazole: drug interactions

A

Significant cytochrome p450 interactions

68
Q

fluconazole: adverse drug reactions

A

GI upset, N/V, headache, diarrhea, rash

fatal hepatic toxicity can occur

69
Q

itraconazole: mechanism of action

A

same as fluconazole: decreases ergosterol synthesis and inhibits cell membrane formation

70
Q

itraconazole: oral therapeutic use

A

onychomycosis of the fingernail and toenails

71
Q

itraconazole: pharmacokinetics

A

1) capsules and oral solution are not bioequivalent
2) requires acidic environment for absorption
3) food, antacids, H2-blockers and proton pump inhibitors impair oral absorption

72
Q

itraconazole: drug interactions

A

significant cytochrome p450 interactions

73
Q

itraconazole: adverse drug reactions

A

GI upset, N/V, diarrhea, rash
fatal hepatic toxicity can occur
black box warning: rase cases of serious CV adverse events have occurred. Cation with pts with left ventricular dysfunction or CHF

74
Q

posaconazole: therapeutic uses

A

oral: treats thrush in patients refractory to other “azoles”

Prophylaxis of invasive Candida and Aspergillus infections in immunocompromised patients

75
Q

List the quinolones

A

ciprofloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, sparfloxacin

76
Q

Quinolone mechanism of action

A

inhibit the replication of the bacteria by interfering with 2 bacterial enzymes, DNA gyrase and topoisomerase

77
Q

First line quinolones for community-acquired pneumonias

A

Levofloxacin and moxifloxicin

78
Q

most common pathogens for community-acquired pneumonia

A 
Streptococcus pneumonia
Haemophilus influenzae
Chlamydia pneumoniae
Mycopolasma pneumoniae
Legionella pneumoniae
79
Q

Quinolone coverage of bacteria (in general)

A

excellent gram negative coverage
some gram positive coverage
almost no anaerobic coverage

80
Q

Quinolone of choice for pseudomonas coverage

A

Ciprofloxacin

81
Q

Quinolone spectrum

A

UTI, prostate infections, CAP, pseudomonas infections, pelvic infections caused by chlamydia trachomatis, anthrax, some skin and soft tissue infections

82
Q

Quinolone pharmacokinetics

A

excellent oral absorption, distributes into bone and prostate, high levels in lungs and urine

83
Q

Quinolone ADRs

A

GI upset, diarrhea, nausea, hypersensitivity reactions, CNS side effects, prolonged QT interval (torsades), tendon ruptures, bone development abnormalities,

84
Q

Quinolones are contraindicated in which patients?

A

pregnancy, breast-feeding, and children under age 18 b/c of bone development abnormalities

85
Q

griseofulvin: mechanism of action

A

inhibits fungal cell mitosis at metaphase

86
Q

griseofulvin: therapeutic uses

A

treatment of susceptible tinea infections of skin, hair and nails

87
Q

Vulvovaginal Candidiasis (uncomplicated): choosing which pharmacologic treatment

A

Therapy is personal preference - cure rates are similar among products. Immediate relief is better achieved with topical products rather than oral.

88
Q

Metronidazole therapeutic uses

A

DOC for clostridium difficile, good anerobic coverage (abdominal infections, aspiration pnneumonia), protozoal infections

89
Q

Metronidazole ADR

A

N/V, headache, metallic taste, anorexia, vertigo, insomnia, seizure

90
Q

Metronidazole Drug Interactions

A

Disulfuram reaction with alcohol–severe N/V and abdominal cramps, avoid alcohol during therapy and up to 24 hours after last dose

91
Q

Nitrofurantoin mechanism of action

A

inhibits various bacterial enzymes

92
Q

Oropharyngeal Candidiasis (OPC): treatment for low risk patients

A

topical antifungals are first-line therapy for OPC

93
Q

Nitrofurantoin ADR

A

Discoloration of urine, GI disturbances, hypersensitivity reactions, pulmonary toxicity

94
Q

Which “big-gun” antifungal is a member of the azole family and often reserved for azole-resistant infections?

A

voriconazole

95
Q

Which “big-gun” antifungal is almost always used with other antifungals?

A

flucytosine

96
Q

Tinea infections: pathophysiology

A

1) Infection does not involve living tissue but the superficial layers of skin only

97
Q

What is Butenafine cream (Lotrimin Ultra) used for?

A

superficial dermatological fungal infections

98
Q

What are the OTC antifungals for superficial mycoses?

A

Butenafine, Butoconazole, Clotrimazole, Miconazole, Nystatin, Terbinafine, Terconazole, Ticonazole, Tolnaftate

99
Q

Vulvovaginal Candidiasis: pathogens

A

primarily Candida albicans (90%)

100
Q

Recurrent Vulvovaginal Candidiasis is more common in what groups of people? (3)

A

immunocompromised
uncontrolled diabetes
pregnancy

101
Q

What kinds of alterations in the vaginal environment can increase risk of Vulvovaginal Candidiasis?

A

pH changes, stress, hormone changes, sexual activity, pregnancy, contraceptive use, douches, antibiotics

102
Q

Vulvovaginal Candidiasis: non-pharmacologial treatment

A

1) keep genital area clean and dry, avoid hot tubs
2) avoid constrictive clothing, wear cotton
3) avoid soaps and perfumes in genital area

103
Q

Community-Acquired Pneumonia (CAP): treatment of adult outpatient co-morbidities

A

levofloxacin alone, moxifloxacin alone, or a combination of azithromycin, clarithromycin, or doxycycline PLUS either high dose amoxicillin or high dose amox/clavulanate

104
Q

Pharmacologic Treatment of Recurrent VVC

A

14 days of an intravaginal product or 2 doses of fluconazole 3 days apart may be used followed by 6 months long-term suppressive therapy

105
Q

Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: pathogens

A

Candida albicans causes 80% of OPC and esophageal candidiasis

106
Q

Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: epidemiology

A

1) often occurs in infants, elderly, & immunocompromised

2) 1/3 to 1/2 of older adults develop OPC

107
Q

Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: etiology

A

1) Most commonly reported ADR of inhaled corticosteroids (37% occurrence)
2) Most common opportunistic infection of HIV patients (80-90% will develop at some time) and is
an extremely common initial manifestation of the disease

108
Q

Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: treatment for low risk patients

A

topical antifungals are first-line therapy for OPC

109
Q

Oropharyngeal Candidiasis (OPC): treatment for severe or unresponsive cases

A

systemic antifungals

110
Q

Esophageal Candidiasis: treatment

A

aggressive systemic antifungal therapy

111
Q

Tinea infections: epidemiology & etiology

A

1) Tinea infections are second only to acne in frequency of reported skin disease
2) Of all the forms of tinea, tinea pedis is the most common

112
Q

Tinea infections: pathophysiology

A

1) Infection does not involve living tissue but the superficial layers of skin only

113
Q

What are the specific non-pharmacological treatment for Tinea pedis

A

Change socks two to three times daily and wear protective footwear in public showers & pool areas

114
Q

Tinea infections: What do you tell pts about topical antifungal treatment?

A

Apply topically at least 1 inch beyond affected area. Continue tx at least 1 to 2 weeks after clearing

115
Q

Onychomycosis: treatment

A

Oral antifungals are required x at least 3 months for toenails and at least 2 months for fingernails.

116
Q

five classifications of pneumonia

A

1) Community-acquired pneumonia, 2) Aspiration

pneumonia, 3) Hospital-acquired pneumonia, 4) Ventilator-associated pneumonia, and 5) Healthcare-associated pneumonia

117
Q

Community-Acquired Pneumonia (CAP): most common pathogen (25-70%)

A

steptococcus pneumoniae

118
Q

Community-Acquired Pneumonia (CAP): treatment of adult outpatient otherwise healthy

A

azithromycin, clarithromycin, erythromycin, or

doxycycline; alternatives include levofloxacin or moxifloxacin

119
Q

Community-Acquired Pneumonia (CAP): treatment of adult outpatient co-morbidities

A

levofloxacin alone, moxifloxacin alone, or a combination of azithromycin, clarithromycin, or doxycycline PLUS either high dose amoxicillin or high dose amox/clavulanate

120
Q

Community-Acquired Pneumonia (CAP): treatment of Pediatric outpatient:

A

azithromycin or clarithromycin; alternatives include high dose amoxicillin, high dose amoxicillin/clavulanate, or IM ceftriaxone

121
Q

Community-Acquired Pneumonia (CAP): duration of treatment

A

Azithromycin - 5 days
Levofloxacin when dosed at 750mg daily - 5 days
all other antibiotics - 7 to 10 days

122
Q

Gonorrhea: pathogen

A

Neisseria gonorrhoeae (gram-negative diplococci)

123
Q

A pt who tests positive for gonorrhea should also be tested for which other STIs?

A

Chlamydia trachomatis, syphillis, and HIV

124
Q

Antibiotic tx for gonorrhea should also include coverage against what? With which 2 drugs?

A

Coverage against Chlamydia trachomatis with Azithromycin or Doxycycline

125
Q

Gonorrhea: Which class of drugs should you not use in individuals w/ a hx of recent travel to foreign countries w/ known resistance or in men who have sex w/ men?

A

Fluoroquinolones

126
Q

Gonorrhea: uncomplicated tx of infx of the cervix, urethra, rectum, or pharynx

A

ceftriaxone IM plus azithromycin or doxycycline (dual gonococcal coverage + chlamydial coverage)

127
Q

Gonorrhea: tx in pregnant women

A

ceftriaxone IM plus azithromycin

128
Q

Gonorrhea: tx ophthalmic neonatorum prophylaxis

A

either erythromycin or tetracycline ophthalmic ointment single application

129
Q

Gonorrhea: tx for cases of severe cephalosporin allergy

A

azithromycin orally

130
Q

Chlamydia: pathogen

A

Chlamydia trachomatis

131
Q

Chlamydia: best tx options

A

azithromycin 1g single dose

doxycycline 100mg q12h x 7 days

132
Q

Chlamydia: other tx alternatives

A

erythromycin x 7 days

levofloxacin x 7 days

133
Q

Chlamydia: tx in pregnancy

A

AVOID fluoroquinolones and tetracyclines!

Macrolides are preferred and Amoxicillin can be an alternative.

134
Q

Chlamydia: tx of ophthalmic or lung infx in neonates

A

erythromycin oral x 14 days

135
Q

Syphillis: pathogen

A

Treponema pallidum (a spirochete/gram-negative bacteria)

136
Q

Syphillis: prominence

A

black men and men who have sex w/ men

137
Q

Syphillis: primary symptoms

A

solitary, painless cancre at the site of the infx about 3 wks after exposure

138
Q

Syphillis: secondary symptoms

A

systemic symptoms: fatigue, diffuse rash, fever, lymphadenopathy, and genital condyloma latum (flat, wart-like growths)

139
Q

Syphillis: infx rates in infants to infected mothers

A

nearly 100%

140
Q

Syphillis: preferred tx

A

Benzathine penicillin G IM. Dose & duration vary depending upon stage and HIV status.

141
Q

Syphillis: alternatives in PCN allergy

A

ceftriaxone IM, doxycycline, minocycline, tetracycline, erythromycin, or azithromycin

142
Q

Trichomoniasis: pathogen

A

Trichomonas vaginalis

143
Q

Trichomoniasis: tx

A

Metronidazole or tinidazole

144
Q

Bacterial Vaginosis: pathogen

A

Gardenella vaginalis, Prevotella sp., Mycoplasma hominis, and Mobiluncus sp.

145
Q

Bacterial Vaginosis: tx

A

oral or intravaginal metronidazole or clindamycin

146
Q

Pelvic Inflammatory Disease (PID): pathogens

A

Chlamydia trachomatis
Neisseria gonorrheoeae
Possible anaerobes (Bacteroides, Peptostreptococci)
Possible gran-negative rods (Haemophilus, E. coli)

147
Q

PID: outpatient tx

A

ceftriaxone IMx1 + doxycycline x 14 days +or- metronidazole x 14 days

148
Q

PID: alternative outpatient tx

A

ceftriaxone can be replaced w/ cefotetan IMx1 + probenecid x 1

149
Q

PID: inpatient tx

A

cefotetan IV or cefoxitin IV + doxycycline po or IV

clindamycin IV + gentamicin IV + doxy +or- metronidzole

Antibiotics (3 decks)

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