What you really need to know for ABX Flashcards
1
Q
MOA of Beta Lactams
A
Bind to PCN binding protein, cell wall synthesis inhibitor
2
Q
MOA of Fluoroquinolones
A
Inhibit DNA synthesis through competitive binding
“unzips the genes”
3
Q
MOA of Tetracyclines
A
Irreversibly binds to 30s ribosomal unit which inhibits protein synthesis
4
Q
MOA of Cephalosporins
A
Bind to PCN binding protein. Cell wall synthesis inhibitor
5
Q
MOA of Macrolides
A
Binds to the 50s ribosomal subunit targeting 23S ribosomal RNA…. inhibits protein synthesis
6
Q
MOA of Aminoglucosides
A
Irreversibly binds to 30s ribosomal subunit causing misreading of mRNA cell wall damage
7
Q
MOA of Carbapenems/Monobactams
A
Bind to PCN binding protein, cell wall synthesis inhibitor
8
Q
Which class covers Gram positive, but has increasingly more Gram negative coverage with each newer generation?
A
Cephalosporins
9
Q
Which class covers Gram negative, including pseudomonas?
A
Aminoglucosides
10
Q
What is the ABX of choice for ESBL’s?
A
carbapenems
11
Q
T/F: Beta Lactams cover primarily Gram Positive?
A
True
12
Q
What do carbapenems/monobactams cover?
A
Most aerobic/anaerobic gram pos/neg including pseudomonas
13
Q
What do macrolides primarily cover?
A
Respiratory organisms
14
Q
What do tetracyclines cover?
A
A lot of gram pos/neg
15
Q
T/F: Fluoroquinolones cover primarily Gram Positive?
A
False; gram neg
16
Q
Which classes are bactericidal?
A
- Beta lactams 2. Cephalosporins 3. Carbapenem/Monobactams 4. Fluoroquinolones 5. Aminoglucosides
17
Q
Which classes are bacteriostatic?
A
- Macrolides 2. Tetracyclines
18
Q
Which classes are safe for renally impaired patients?
A
- Macrolides 2. Tetracyclines 3. Aminoglucosides
19
Q
Examples of Beta lactams?
A
- PCN 2. Ampicillin 3. Amoxicillin 4. Piperacillin
20
Q
What is the most frequently used class of ABX?
A
Cephlapsorins
21
Q
How do cephlasporins compare to PCN’s?
A
Same MOA as PCN (bacteriocidial), but Less suspectible to beta lactamase than PCN’s
22
Q
Examples of Cephalosporins?
A
1st gen: cefazolin
2nd gen: cefoxitin
3rd gen: Ceftriaxone and ceftazidime
4th gen: Cefepime
5th gen: Ceftaroline
23
Q
With cephlasporins, you get better gram ___ with lower gens and better gram ___ with higher gens
A
positive
negative
24
Q
When should Cefazolin be redosed?
A
- Redose Q4hrs (2 half-lives)
- If EBL >1.5L
25
How does 2nd gen cephs compare to 1st gen?
Less gram +, more gram -
add in h.influenza, enterobacter, and Neisseria
Good safety profile and hypersensitivy
Used alot for respiratory infections
26
Which generation cephlasporins are assoc. with CBC abnormalities?
1st gen
27
Which generation cephlasporins are used for respiratory infections/community acquired PNA?
2nd gen, specfically Cefuroxime (Ceftin)
28
Which generation cephalosporins crosses the blood brain barrier?
3rd gen: ceftriaxone and ceftazidime
Hence, these are good for meningitis
29
Which generation cephalosporin covers MRSA?
5th gen: Ceftaroline
30
Which 3rd gen cephlasporin has 50% renal elimination and significant biliary excreiton?
Cefotaxime (Claforan)
31
Which 3rd gen cephlasporin can cause diarrhea, biliary sludging, and precpipiate with calcium?
Ceftriaxone (Rocephin)
32
What electrolyte abnormality is assoc. with 3rd gen PCN's (timentin and zosyn)?
Hypokalemia
ticarcillin is also associated with hypernatremia in the elderly
33
Which generation cephlasporins increase bleeding time?
3rd gen
34
What are two important points that Emily talked about withn Ceftazidime (Fortaz)?
most gram negative with good Pseudomonal coverage; less gram positive and anaerobic than other 3rd gens.
35
When would you use 4th gen ceph ABX like Cefepime (Maxipime)?
ESBL's, Pseudomonas and Enterobacteriaceae that are resistant to 3rd gen cephs
36
Which generation cephalosporin covers pseudomonas?
3rd gen: Ceftriaxone and ceftazadime
ceftazadime = "taz"manian devil which kills everything
37
What med when added to a 3rd gen ceph gives you significant gram negative coverage and would be good for ESBL's?
avibactam (Avycaz)
Avycaz is ceftazidime/avibactam added together.
38
Which drug has the second highest chance of causing C Diff?
Cefazolin
39
T/F: Cefazolin covers MRSA
False
40
Examples of Carbapenems?
"penems" 1. Imipenem (cilastatin) 2. Meropenem 3. Erapenem
41
What patients are carbapenems contraindicated in?
Pts with seizure disorder or head injury at increased risk of seizure
42
Which carbapenem has the lowest risk of seizures? Which has the highest?
lowest = Ertapenem (Invanz)
highest = Imipenem/Cilastatin (Primaxin)
43
What two non-ABX meds greatly increase the risk of seizures in combo with Imipenem/Cilastatin (Primaxin)?
Ultram and Wellbutrin
44
How is monobactam different from carbapenems?
Same MOA as carbapenems, but no seizure risk
Ex.Aztreonam (Azactam)
45
Examples of Monobactam?
Aztreonam
46
MOA of Vanco
Inhibits peptidoglycan formation; disrupts cell wall synthesis; bactericidal
47
Is Vanco concentration or time dependent?
Concentration
dose to trough levels
48
Does Vanco cover gram negative?
No, gram postive only.
So you wont get E.Coli coverage
Do get MRSA coverage
49
Vanco is ____ eliminated
Renally
50
What are the 4 major adverse effects of Vanco?
Red man syndrome
Nephrotoxocicty
Ototoxicity
TTP
51
With vanco, is red-man syndrome a true allergic reaction?
No, its infusion rate related. Once you slow down the infusion rate (no more than 1g/hr), it should decrease
can treat with anti-histamines if really bothering the pts
52
What is a good alternative to vancomycin?
Linezolid
Esp for VRE and MRSA, covers "blind spots" that vanco has
53
MOA of Linezolid (Zyvox)
Bacteriostatic
Per Emily, know that it slows down/inhibits ribosomal formation of 50S subunit and that it is NOT a cell wall synthase inhibitor
54
What are the adverse effects with Linezolid (Zyvox)?
Myelosuppression (anemia, leukopenia, pancytopenia, thrombocytopenia (very often))
Will see drops in CBC values
55
Linezolid (Zyvox) has potential drug interaction with \_\_\_, so hold ____ meds because of the risk of _____ syndrome
MAO's inhibitors
Antidepressant
serotonin syndrome (looks like MH)
56
What is drug of choice for legionnaires?
Erythromycin
57
Which macrolide has the most GI toxicity side effects?
Erthromycin
58
Examples of Macrolides?
"Mycins"
1. Azithromycin 2. Biaxin 3. Erthromycin
59
What is drug of choice for bacterial GI infections?
Ciprofloxacin
60
Examples of fluorquinolones?
1. Ciprofloxacin 2. Levofloxacin 3. Ofloxacin 4. Moxifloxacin 5. Delafloxacin
61
Which fluoroquinolone can treat MRSA?
Delafloxacin
62
Which fluorquinolone does not have risk of QT prolongation or photosensitivity?
Delafloxacin
63
Examples of Tetracyclines?
1. Doxycycline 2. Tigecycline
64
Examples of Aminoglucosides?
1. Amikacin 2. Gentamicin
65
Can Gentamicin be used for gram positive organisms?
Yes; but must be used with cell wall destructive agent as well.
66
Adverse effects of Beta lactams?
1. N/V/D for all of them. Newest gen (ticaricillin and piperacillin) 1. prolong bleeding time 2. hypokalemia
67
Adverse effects of cephalosporins?
N/V/D
68
Which cephalosporin produces biliary sludging?
Ceftriaxone
69
What medication can ceftriaxone not be administered with?
Calcium- causes precipitate
70
Adverse effects of Carbapenems?
1. N/V/D 2. Seizures
71
Patient is taking an MAO-I and/or SSRI, what ABX is contraindicated?
Linezolid
72
What class of ABX had the best respiratory bug coverage?
Macrolides ("mycins")
73
Is the half life of azithromycin long or short?
super long (68hrs)
74
What meds can cause drug interactions with azithromycin?
theophylline, cyclosporin, phenytoin, HIV meds (AZT and CZT)
75
What EKG abnormality is assoc. with azithromycin?
prolonged QT interval
76
What is Clarithromycin (Biaxin) good for ?
Peptic ulcer disease
77
Which macrolide is the least active of against H.influenzae?
Clarithromyicn (Biaxin)
78
Which macrolide is the most potent inhibitor of CYP3A4?
Clarithromycin (Biaxin)
79
Which macrolide has the highest risk of PONV?
Erythromycin, has ALOT of GI toxicity
Be cautious bc of lot of pts take this for long term gastroparesis
80
Adverse effects of Macrolides?
1. N/V/D
2. Prolonged QT
3. Many drug reactions
4. Significant GI toxicity with erythromycin
81
What ABX is "macrolide lite"?
Ketolides, same MOA just more SE's
useful for macrolide-resistant organisms like h.influenza
Ex.Telithromycin (Ketek)
Emily says its a "dumb med"
82
What can be used for Macrolide resistant organisms?
Ketolides
83
Adverse effects of fluoroquinolones?
1. N/V/D, PONV
2. QT prolongation (except delafloxacin)
3. Many drug interactions (NSAID, Warfarin, Antacids, Amiodarone, probenicid)
4. Arthalgias, muscle pains
4. Tendonitis
5. Neurologic issues: SZs, agitation, CNS excitement, post-op delirium
6. Hypoglycemia, esp if NPO
7. Morbidity/mortality in elderly
84
Which patients should fluoroquinolones be avoided in?
Elderly
85
What is the drug of choice for traveller's diarrhea?
Cipro
86
Which FQ has the best strep coverage? Which FQ has the least?
best = Moxifloxacin (Avelox), hence best for resp out of the FQ's
least = ????
87
What are the three biggest reasons ciprofloxacin is prescribed?
1. UTIs
2. Pneumonia
3. Travelers diarrhea
88
T/F
Tetracycline binds reversibly to 30S ribosomal unit
FALSE
binds irreversibly
89
Adverse effects of tetracyclines?
1. N/V/D
2. Photosensitivity
3. Inhibition of bone growth (2nd/3rd trimester up to 8yrs old)
4. Hepatotoxicity
4. Tooth discoloration
5. Enamel hypoplasia
90
T/F
Tetracycline has a narrow volume of distribution
FALSE
has wide VOD. Gets down into the bones and into the CNS
91
What age patients should not take tetracyclines?
Birth to 8yo (including 2nd/3rd trimester fetuses)
92
What are potential drug interactions with doxy?
Oral contraceptives
Warfarin
PHT
CBZ
93
When would you use Tigecycline (Tygacil)?
TCN-resistant bacterias
3rd line for MRSA
increasing use for Acinetobacter
94
Which TCN has a high risk of PONV?
Tigecycline (Tygacil)
95
(per emily) Pretty much all MRSA is treated with _____ in the community?
Bactrim (trimethoprim/sulfamethoxazole)
96
Can sulfa allergic patients take Bactrim?
No
97
Rank the aminoglycosides from highest to lowest risk of drug interactions for NMB prolongation
Neomycin \> kanamycin \> amikacin \> gentamycin \> tobramycin \> streptomycin
just know which one is highest and lowest
98
Are aminoglycside concentation or time dependent?
Concentration (want high peaks and low troughs)
Has a long PAE
99
Adverse effects of Aminoglucosides?
1. N/V/D
2. Ototoxicity
3. Nephrotoxicity (significant)
4. NMB
100
How do aminoglycosides cause/prolong NMB?
Interefe with Ca+ and Mg+, which inhibits ACh release from the endplate
101
When will you mostly see neomycin used?
High ammonia levels with liver toxicity, portal HTN, cirrhosis
Binds up and breaks down ammonia. Good for people who cant tolerate lactulose. Not really used as an antibiotic anymore, mainly now for hyperammonia
102
Aminoglycosides are used for gram negative coverage, but what is the one that has some gram postive?
Gentamycin
103
Which ABX can contribute to neuromuscular blockade?
Aminoglycosides
104
What is drug of choice for infections that have produced a bio film?
Rifampin and Rifabutin
105
What ABX is an alternative for cleocin and covers "ALL ANAEROBES both bacterial and protozoa"?
Metronidazole
106
MOA of bactrim
MOA: 2 bacteriostatic molecules = bacteriocidal
Starves the bacteria of folic acid
DO NOT NEED TO SUPPLEMENT PT WITH FOLIC ACID
107
4 AE's of bactrim
pancytopenia, neutropenia, TTP, Stevens Johnson
108
Four big things on Bactrim?
1. Broad spectrum
2. Renally eliminated
3. Oral coverage for MRSA
4. Avoid in Sulfa allergic pt
109
Two big things on Macrobid?
1. Urinary pathogen specific medication
2 Will cause neuropathies
110
What is macrobid mainly used for?
UTI's
its narrow spectrum
111
AE's of nitrofurantoin (Macrobid)?
Ton's of SE's,
Big ones Emily harped on:
pulmonary fibrosis/complicatoins (eps if kidney function is bad)
increasing pain
peripheral neuritis
post-op agitation/confusion
112
What drug is reserved for multiple drug resistant organisms (MDROs) when other meds have failed?
Daptomycin
113
Does Cleocin cover anerobes?
YES! hence its 1st line agent for abd surgeries, perforated bowels
114
Can Cleocin cause NMB?
yes
115
What medication has the highest risk of developing C Diff?
Clindamycin (cleocin)
116
2 things to know on Acyclovir and Valacyclovir?
1. Renally eliminated
2. CNS side effects
117
4 Adverse effect of amphoteracin B?
1. Nephrotoxic
2. K and Mg wasting
3. Anemia
4. Infusion reactions
118
What is the most commonly used anti-fungal?
Fluconazole (Diflucan)
ton of drug interactions bc its a potent CYP3A4 inhibitor
119
Three Adverse effects to watch for in all the "azole" anti-fungal agents?
1. Drug interactions
2. Hepatoxicity (rare)
3. Renal Failure
120
Which class of drugs has the most significant amount of FDA safety concerns? and why?
Fluoroquinolones: High risk of tendonitis, neurologic issues, hypoglycemia, morbidity/mortality= avoid in elderly
121
Which drug class "unzips the genes"?
Fluoroquinolones ( binds DNA gyrase and prevents supercoiling)
122
5 Things to know on Macrolides?
1. Good Respiratory coverage 2. Super long half life 3. Prolong QT 4. Lots of drug interactions 5. Highest risk of GI upset/PONV with E-mycin
123
Which drug causes thrombocytopenia "kind of often" (per emily)?
Linezolid (Zyvox)
124
Out of vancomycin and linezolid, which changes the way proteins synthesize in the organism?
Linezolid; whereas, vanco is a cell wall synthesis inhibitor
125
For SSI, when should vancomycin be re-doses?
Not typically re-dosed unless surgery is longer than 16hours
126
Desired vanco trough for UTI?
5-10mcg/ml
127
Desired vanco trough for CNS infection, pneumonia, severe osteomyelitis?
15-20mg/ml
128
Desired vanco trough for endocarditis?
10-15mg/ml
129
What are ESBLs?
Extended Spectrum Beta Lactams that have evolved into a further resistant bacteria
130
How do ESBLs become resistant?
By producing Beta LActamase
131
What does beta lactamase do?
Breaks bonds in the beta lactam ring to disable the molecule and therefore decrease its ability to work
132
What can be done to combat the effects of beta lactamase producing bacteria?
Administered ABX with Beta Lactamase Inhibitors
133
What are the three Beta Lactamase Inhibitors?
1. Sulbactam 2. Tazobactam 3. Clavulanic Acid
134
Why is it important to know PCN kills strep veridans?
It is found mostly in the mouth and is used to decrease drainage of this bacteria to heart valves from the mouth
Its why PCN is good for heart valve infections
135
Can people with PCN allergy take keflex or ancef?
Yes; 95% of people who report a PCN allergy can safely take keflex or ancef
136
What is the risk of having a PCN allergy?
MRSA and C Diff rates are high in patients with reported PCN allergies d/t use of broader spectrum ABX
137
How is augmentin different than amoxil?
Augmentin has a beta lactamase inhibitor (clavulanate) included in the formulary. This allows for broader coverage (Like MSSA, e coli, shigella, salmonella, catarrhalis, and gonorrhoeae
138
Amoxil and what other drug are so similar that they are basically used interchangeably?
Ampicillin
139
What is ampicillin and sulbactam combined called?
Unasyn
140
When MSSA has been specifically identified, what ABX is preferred?
Oxacillin (prostaphlin)
141
What two drugs can be used for MSSA, but do not need to be renally adjusted like Oxacillin?
Nafcillin and Dicloxacillin
142
Which ABX's affect DNA?
Metronidazole (DNA synthesis)
Fluoroquinilones (DNA gyrase)
143
Which ABX affects RNA during transcription?
Rifampin
144
Which ABX affects the phospholipid membrane?
Polymixins
145
Does beta lactamase affect cell wall synthesis or cell wall integrity?
Cell wall intergrity
146
What classes of ABX affect cell wall snythesis?
beta lactams
Vanco
Bacitracin
Cehplasporins
Cephlamycin
D-cyclosporins
147
Which ABX's affect 30S protnei synthesis?
Tetracycline
Streptomycin
Kanamycin
Spectinomycin
148
Which ABX's affect 50S protein synthesis?
E-mycin
Clindamycin
Linomycin
Choramphenicol
149
T/F
50S and 30S protein synthesis ABX's affect DNA transcription
FALSE
affect translation
150
All the beta-lactams share a \_\_\_\_
beta-lactam ring (double bonded O2 and 4-sided nitrogen)
151
What class is consider the "suicide inhibitors"?
Beta lactamase inhibitors
152
Examples of beta-lactamase inhibitors?
Sulbactam
Tazobactam
Clavulanic Acid
153
T/F
Beta lactamase inhibitors have no antibiotic effect
True
They just help to combat beta-lactamase and are always combined with a ABX (ex. unasyn = amplicillin/sulbactam)
154
What is the only FQ that is effective against MRSA and has no QT prolognation or photosensitvity?
Delafloxacin (Baxdela)
155
T/F
Patients with a PCN allergy have a 50% increase chance of SSI
True
d/t receiving 2nd line prohylactic ABX like vanco
156
SE's of Flagyl
Pancreatitis
Peripehral neuropahty
Will vomit it used in combo with ETOH
encephalopathy/confusion
Ataxia/tremors
157
What is a major drug interaction to be concerned about if a patient is taking Flagyl?
Coumadin
158
What are some major concerns with Quinupristin/Dalfopristin (Synercid) ?
Post op pain and arthralgias
159
How should Quinupristin/Dalfopristin (Synercid) be adminsitered?
Central line due to risk of phlebitis
160
What is a concern with Daptomycin and its SE's?
Post-op ambulation complications
causes limb/muscle pain
161
Why is rifamptin and rifabutin never given alone?
Monotherapy results in rapid resistance
162
Rifampin and Rifabutin are mainly used for ____ and \_\_\_
TB and prostehtic infections
163
Rifampin and Rifabutin are potent CYP450 \_\_\_\_
inducers
get significant drug interactions by speeding up metabolism of other meds
164
With Rifampin and Rifabutin, you can see drug interactions up to _ months after d/c'ing med
3
165
SE's of Rifampin and Rifabutin
Orange-red body fluids (tears, sweat, urine)
rare heptotoxicity
166
Which antiviral is a good option for those unresponsive to previous agents and those treated with acyclovir and failed?
Foscarnet
167
Why would foscarnet be a better option than tamiflu for the flu?
Doesnt cause hallucinations, agitations, or tremors
168
What is the major SE's of tamiflu?
hallucinations, confusion, falls in the elderly
169
What is the most broad-spectrum azole?
Itraconazole (Sporanox)
has a risk of hypokalemia
170
What are the adverse effects of PCN?
Hypersensitivity
GI upset, diarrhea
\*Jarish-Herxheimer reaction\* - will see this esp if treating a tic-borne illness. Produce flu-like symptoms
171
T/F
Linezolid is bacteriostatic against enterococci and staph, and bacteriocidal against most strep
True
172
Is vanco bacteriostatic or bacteriocidal?
bacteriocidal
