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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

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2
Q

MOA of Fluoroquinolones

A

Inhibit DNA synthesis through competitive binding

“unzips the genes”

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3
Q

MOA of Tetracyclines

A

Irreversibly binds to 30s ribosomal unit which inhibits protein synthesis

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4
Q

MOA of Cephalosporins

A

Bind to PCN binding protein. Cell wall synthesis inhibitor

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5
Q

MOA of Macrolides

A

Binds to the 50s ribosomal subunit targeting 23S ribosomal RNA…. inhibits protein synthesis

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6
Q

MOA of Aminoglucosides

A

Irreversibly binds to 30s ribosomal subunit causing misreading of mRNA  cell wall damage

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7
Q

MOA of Carbapenems/Monobactams

A

Bind to PCN binding protein, cell wall synthesis inhibitor

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8
Q

Which class covers Gram positive, but has increasingly more Gram negative coverage with each newer generation?

A

Cephalosporins

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9
Q

Which class covers Gram negative, including pseudomonas?

A

Aminoglucosides

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10
Q

What is the ABX of choice for ESBL’s?

A

carbapenems

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11
Q

T/F: Beta Lactams cover primarily Gram Positive?

A

True

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12
Q

What do carbapenems/monobactams cover?

A

Most aerobic/anaerobic gram pos/neg including pseudomonas

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13
Q

What do macrolides primarily cover?

A

Respiratory organisms

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14
Q

What do tetracyclines cover?

A

A lot of gram pos/neg

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15
Q

T/F: Fluoroquinolones cover primarily Gram Positive?

A

False; gram neg

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16
Q

Which classes are bactericidal?

A
  1. Beta lactams 2. Cephalosporins 3. Carbapenem/Monobactams 4. Fluoroquinolones 5. Aminoglucosides
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17
Q

Which classes are bacteriostatic?

A
  1. Macrolides 2. Tetracyclines
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18
Q

Which classes are safe for renally impaired patients?

A
  1. Macrolides 2. Tetracyclines 3. Aminoglucosides
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19
Q

Examples of Beta lactams?

A
  1. PCN 2. Ampicillin 3. Amoxicillin 4. Piperacillin
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20
Q

What is the most frequently used class of ABX?

A

Cephlapsorins

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21
Q

How do cephlasporins compare to PCN’s?

A

Same MOA as PCN (bacteriocidial), but Less suspectible to beta lactamase than PCN’s

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22
Q

Examples of Cephalosporins?

A

1st gen: cefazolin

2nd gen: cefoxitin

3rd gen: Ceftriaxone and ceftazidime

4th gen: Cefepime

5th gen: Ceftaroline

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23
Q

With cephlasporins, you get better gram ___ with lower gens and better gram ___ with higher gens

A

positive

negative

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24
Q

When should Cefazolin be redosed?

A
  1. Redose Q4hrs (2 half-lives)
  2. If EBL >1.5L
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25
Q

How does 2nd gen cephs compare to 1st gen?

A

Less gram +, more gram -

add in h.influenza, enterobacter, and Neisseria

Good safety profile and hypersensitivy

Used alot for respiratory infections

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26
Q

Which generation cephlasporins are assoc. with CBC abnormalities?

A

1st gen

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27
Q

Which generation cephlasporins are used for respiratory infections/community acquired PNA?

A

2nd gen, specfically Cefuroxime (Ceftin)

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28
Q

Which generation cephalosporins crosses the blood brain barrier?

A

3rd gen: ceftriaxone and ceftazidime

Hence, these are good for meningitis

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29
Q

Which generation cephalosporin covers MRSA?

A

5th gen: Ceftaroline

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30
Q

Which 3rd gen cephlasporin has 50% renal elimination and significant biliary excreiton?

A

Cefotaxime (Claforan)

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31
Q

Which 3rd gen cephlasporin can cause diarrhea, biliary sludging, and precpipiate with calcium?

A

Ceftriaxone (Rocephin)

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32
Q

What electrolyte abnormality is assoc. with 3rd gen PCN’s (timentin and zosyn)?

A

Hypokalemia

ticarcillin is also associated with hypernatremia in the elderly

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33
Q

Which generation cephlasporins increase bleeding time?

A

3rd gen

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34
Q

What are two important points that Emily talked about withn Ceftazidime (Fortaz)?

A

most gram negative with good Pseudomonal coverage; less gram positive and anaerobic than other 3rd gens.

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35
Q

When would you use 4th gen ceph ABX like Cefepime (Maxipime)?

A

ESBL’s, Pseudomonas and Enterobacteriaceae that are resistant to 3rd gen cephs

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36
Q

Which generation cephalosporin covers pseudomonas?

A

3rd gen: Ceftriaxone and ceftazadime

ceftazadime = “taz”manian devil which kills everything

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37
Q

What med when added to a 3rd gen ceph gives you significant gram negative coverage and would be good for ESBL’s?

A

avibactam (Avycaz)

Avycaz is ceftazidime/avibactam added together.

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38
Q

Which drug has the second highest chance of causing C Diff?

A

Cefazolin

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39
Q

T/F: Cefazolin covers MRSA

A

False

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40
Q

Examples of Carbapenems?

A

“penems” 1. Imipenem (cilastatin) 2. Meropenem 3. Erapenem

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41
Q

What patients are carbapenems contraindicated in?

A

Pts with seizure disorder or head injury at increased risk of seizure

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42
Q

Which carbapenem has the lowest risk of seizures? Which has the highest?

A

lowest = Ertapenem (Invanz)

highest = Imipenem/Cilastatin (Primaxin)

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43
Q

What two non-ABX meds greatly increase the risk of seizures in combo with Imipenem/Cilastatin (Primaxin)?

A

Ultram and Wellbutrin

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44
Q

How is monobactam different from carbapenems?

A

Same MOA as carbapenems, but no seizure risk

Ex.Aztreonam (Azactam)

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45
Q

Examples of Monobactam?

A

Aztreonam

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46
Q

MOA of Vanco

A

Inhibits peptidoglycan formation; disrupts cell wall synthesis; bactericidal

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47
Q

Is Vanco concentration or time dependent?

A

Concentration

dose to trough levels

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48
Q

Does Vanco cover gram negative?

A

No, gram postive only.

So you wont get E.Coli coverage

Do get MRSA coverage

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49
Q

Vanco is ____ eliminated

A

Renally

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50
Q

What are the 4 major adverse effects of Vanco?

A

Red man syndrome

Nephrotoxocicty

Ototoxicity

TTP

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51
Q

With vanco, is red-man syndrome a true allergic reaction?

A

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

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52
Q

What is a good alternative to vancomycin?

A

Linezolid

Esp for VRE and MRSA, covers “blind spots” that vanco has

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53
Q

MOA of Linezolid (Zyvox)

A

Bacteriostatic

Per Emily, know that it slows down/inhibits ribosomal formation of 50S subunit and that it is NOT a cell wall synthase inhibitor

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54
Q

What are the adverse effects with Linezolid (Zyvox)?

A

Myelosuppression (anemia, leukopenia, pancytopenia, thrombocytopenia (very often))

Will see drops in CBC values

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55
Q

Linezolid (Zyvox) has potential drug interaction with ___, so hold ____ meds because of the risk of _____ syndrome

A

MAO’s inhibitors

Antidepressant

serotonin syndrome (looks like MH)

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56
Q

What is drug of choice for legionnaires?

A

Erythromycin

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57
Q

Which macrolide has the most GI toxicity side effects?

A

Erthromycin

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58
Q

Examples of Macrolides?

A

“Mycins”

  1. Azithromycin 2. Biaxin 3. Erthromycin
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59
Q

What is drug of choice for bacterial GI infections?

A

Ciprofloxacin

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60
Q

Examples of fluorquinolones?

A
  1. Ciprofloxacin 2. Levofloxacin 3. Ofloxacin 4. Moxifloxacin 5. Delafloxacin
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61
Q

Which fluoroquinolone can treat MRSA?

A

Delafloxacin

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62
Q

Which fluorquinolone does not have risk of QT prolongation or photosensitivity?

A

Delafloxacin

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63
Q

Examples of Tetracyclines?

A
  1. Doxycycline 2. Tigecycline
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64
Q

Examples of Aminoglucosides?

A
  1. Amikacin 2. Gentamicin
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65
Q

Can Gentamicin be used for gram positive organisms?

A

Yes; but must be used with cell wall destructive agent as well.

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66
Q

Adverse effects of Beta lactams?

A
  1. N/V/D for all of them. Newest gen (ticaricillin and piperacillin) 1. prolong bleeding time 2. hypokalemia
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67
Q

Adverse effects of cephalosporins?

A

N/V/D

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68
Q

Which cephalosporin produces biliary sludging?

A

Ceftriaxone

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69
Q

What medication can ceftriaxone not be administered with?

A

Calcium- causes precipitate

70
Q

Adverse effects of Carbapenems?

A
  1. N/V/D 2. Seizures
71
Q

Patient is taking an MAO-I and/or SSRI, what ABX is contraindicated?

72
Q

What class of ABX had the best respiratory bug coverage?

A

Macrolides (“mycins”)

73
Q

Is the half life of azithromycin long or short?

A

super long (68hrs)

74
Q

What meds can cause drug interactions with azithromycin?

A

theophylline, cyclosporin, phenytoin, HIV meds (AZT and CZT)

75
Q

What EKG abnormality is assoc. with azithromycin?

A

prolonged QT interval

76
Q

What is Clarithromycin (Biaxin) good for ?

A

Peptic ulcer disease

77
Q

Which macrolide is the least active of against H.influenzae?

A

Clarithromyicn (Biaxin)

78
Q

Which macrolide is the most potent inhibitor of CYP3A4?

A

Clarithromycin (Biaxin)

79
Q

Which macrolide has the highest risk of PONV?

A

Erythromycin, has ALOT of GI toxicity

Be cautious bc of lot of pts take this for long term gastroparesis

80
Q

Adverse effects of Macrolides?

A
  1. N/V/D
  2. Prolonged QT
  3. Many drug reactions
  4. Significant GI toxicity with erythromycin
81
Q

What ABX is “macrolide lite”?

A

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
Q

What can be used for Macrolide resistant organisms?

83
Q

Adverse effects of fluoroquinolones?

A
  1. N/V/D, PONV
  2. QT prolongation (except delafloxacin)
  3. Many drug interactions (NSAID, Warfarin, Antacids, Amiodarone, probenicid)
  4. Arthalgias, muscle pains
  5. Tendonitis
  6. Neurologic issues: SZs, agitation, CNS excitement, post-op delirium
  7. Hypoglycemia, esp if NPO
  8. Morbidity/mortality in elderly
84
Q

Which patients should fluoroquinolones be avoided in?

85
Q

What is the drug of choice for traveller’s diarrhea?

86
Q

Which FQ has the best strep coverage? Which FQ has the least?

A

best = Moxifloxacin (Avelox), hence best for resp out of the FQ’s

least = ????

87
Q

What are the three biggest reasons ciprofloxacin is prescribed?

A
  1. UTIs
  2. Pneumonia
  3. Travelers diarrhea
88
Q

T/F

Tetracycline binds reversibly to 30S ribosomal unit

A

FALSE

binds irreversibly

89
Q

Adverse effects of tetracyclines?

A
  1. N/V/D
  2. Photosensitivity
  3. Inhibition of bone growth (2nd/3rd trimester up to 8yrs old)
  4. Hepatotoxicity
  5. Tooth discoloration
  6. Enamel hypoplasia
90
Q

T/F

Tetracycline has a narrow volume of distribution

A

FALSE

has wide VOD. Gets down into the bones and into the CNS

91
Q

What age patients should not take tetracyclines?

A

Birth to 8yo (including 2nd/3rd trimester fetuses)

92
Q

What are potential drug interactions with doxy?

A

Oral contraceptives

Warfarin

PHT

CBZ

93
Q

When would you use Tigecycline (Tygacil)?

A

TCN-resistant bacterias

3rd line for MRSA

increasing use for Acinetobacter

94
Q

Which TCN has a high risk of PONV?

A

Tigecycline (Tygacil)

95
Q

(per emily) Pretty much all MRSA is treated with _____ in the community?

A

Bactrim (trimethoprim/sulfamethoxazole)

96
Q

Can sulfa allergic patients take Bactrim?

97
Q

Rank the aminoglycosides from highest to lowest risk of drug interactions for NMB prolongation

A

Neomycin > kanamycin > amikacin > gentamycin > tobramycin > streptomycin

just know which one is highest and lowest

98
Q

Are aminoglycside concentation or time dependent?

A

Concentration (want high peaks and low troughs)

Has a long PAE

99
Q

Adverse effects of Aminoglucosides?

A
  1. N/V/D
  2. Ototoxicity
  3. Nephrotoxicity (significant)
  4. NMB
100
Q

How do aminoglycosides cause/prolong NMB?

A

Interefe with Ca+ and Mg+, which inhibits ACh release from the endplate

101
Q

When will you mostly see neomycin used?

A

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
Q

Aminoglycosides are used for gram negative coverage, but what is the one that has some gram postive?

A

Gentamycin

103
Q

Which ABX can contribute to neuromuscular blockade?

A

Aminoglycosides

104
Q

What is drug of choice for infections that have produced a bio film?

A

Rifampin and Rifabutin

105
Q

What ABX is an alternative for cleocin and covers “ALL ANAEROBES both bacterial and protozoa”?

A

Metronidazole

106
Q

MOA of bactrim

A

MOA: 2 bacteriostatic molecules = bacteriocidal

Starves the bacteria of folic acid

DO NOT NEED TO SUPPLEMENT PT WITH FOLIC ACID

107
Q

4 AE’s of bactrim

A

pancytopenia, neutropenia, TTP, Stevens Johnson

108
Q

Four big things on Bactrim?

A
  1. Broad spectrum
  2. Renally eliminated
  3. Oral coverage for MRSA
  4. Avoid in Sulfa allergic pt
109
Q

Two big things on Macrobid?

A
  1. Urinary pathogen specific medication

2 Will cause neuropathies

110
Q

What is macrobid mainly used for?

A

UTI’s

its narrow spectrum

111
Q

AE’s of nitrofurantoin (Macrobid)?

A

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
Q

What drug is reserved for multiple drug resistant organisms (MDROs) when other meds have failed?

A

Daptomycin

113
Q

Does Cleocin cover anerobes?

A

YES! hence its 1st line agent for abd surgeries, perforated bowels

114
Q

Can Cleocin cause NMB?

115
Q

What medication has the highest risk of developing C Diff?

A

Clindamycin (cleocin)

116
Q

2 things to know on Acyclovir and Valacyclovir?

A
  1. Renally eliminated
  2. CNS side effects
117
Q

4 Adverse effect of amphoteracin B?

A
  1. Nephrotoxic
  2. K and Mg wasting
  3. Anemia
  4. Infusion reactions
118
Q

What is the most commonly used anti-fungal?

A

Fluconazole (Diflucan)

ton of drug interactions bc its a potent CYP3A4 inhibitor

119
Q

Three Adverse effects to watch for in all the “azole” anti-fungal agents?

A
  1. Drug interactions
  2. Hepatoxicity (rare)
  3. Renal Failure
120
Q

Which class of drugs has the most significant amount of FDA safety concerns? and why?

A

Fluoroquinolones: High risk of tendonitis, neurologic issues, hypoglycemia, morbidity/mortality= avoid in elderly

121
Q

Which drug class “unzips the genes”?

A

Fluoroquinolones ( binds DNA gyrase and prevents supercoiling)

122
Q

5 Things to know on Macrolides?

A
  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
Q

Which drug causes thrombocytopenia “kind of often” (per emily)?

A

Linezolid (Zyvox)

124
Q

Out of vancomycin and linezolid, which changes the way proteins synthesize in the organism?

A

Linezolid; whereas, vanco is a cell wall synthesis inhibitor

125
Q

For SSI, when should vancomycin be re-doses?

A

Not typically re-dosed unless surgery is longer than 16hours

126
Q

Desired vanco trough for UTI?

A

5-10mcg/ml

127
Q

Desired vanco trough for CNS infection, pneumonia, severe osteomyelitis?

A

15-20mg/ml

128
Q

Desired vanco trough for endocarditis?

A

10-15mg/ml

129
Q

What are ESBLs?

A

Extended Spectrum Beta Lactams that have evolved into a further resistant bacteria

130
Q

How do ESBLs become resistant?

A

By producing Beta LActamase

131
Q

What does beta lactamase do?

A

Breaks bonds in the beta lactam ring to disable the molecule and therefore decrease its ability to work

132
Q

What can be done to combat the effects of beta lactamase producing bacteria?

A

Administered ABX with Beta Lactamase Inhibitors

133
Q

What are the three Beta Lactamase Inhibitors?

A
  1. Sulbactam 2. Tazobactam 3. Clavulanic Acid
134
Q

Why is it important to know PCN kills strep veridans?

A

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
Q

Can people with PCN allergy take keflex or ancef?

A

Yes; 95% of people who report a PCN allergy can safely take keflex or ancef

136
Q

What is the risk of having a PCN allergy?

A

MRSA and C Diff rates are high in patients with reported PCN allergies d/t use of broader spectrum ABX

137
Q

How is augmentin different than amoxil?

A

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
Q

Amoxil and what other drug are so similar that they are basically used interchangeably?

A

Ampicillin

139
Q

What is ampicillin and sulbactam combined called?

140
Q

When MSSA has been specifically identified, what ABX is preferred?

A

Oxacillin (prostaphlin)

141
Q

What two drugs can be used for MSSA, but do not need to be renally adjusted like Oxacillin?

A

Nafcillin and Dicloxacillin

142
Q

Which ABX’s affect DNA?

A

Metronidazole (DNA synthesis)

Fluoroquinilones (DNA gyrase)

143
Q

Which ABX affects RNA during transcription?

144
Q

Which ABX affects the phospholipid membrane?

A

Polymixins

145
Q

Does beta lactamase affect cell wall synthesis or cell wall integrity?

A

Cell wall intergrity

146
Q

What classes of ABX affect cell wall snythesis?

A

beta lactams

Vanco

Bacitracin

Cehplasporins

Cephlamycin

D-cyclosporins

147
Q

Which ABX’s affect 30S protnei synthesis?

A

Tetracycline

Streptomycin

Kanamycin

Spectinomycin

148
Q

Which ABX’s affect 50S protein synthesis?

A

E-mycin

Clindamycin

Linomycin

Choramphenicol

149
Q

T/F

50S and 30S protein synthesis ABX’s affect DNA transcription

A

FALSE

affect translation

150
Q

All the beta-lactams share a ____

A

beta-lactam ring (double bonded O2 and 4-sided nitrogen)

151
Q

What class is consider the “suicide inhibitors”?

A

Beta lactamase inhibitors

152
Q

Examples of beta-lactamase inhibitors?

A

Sulbactam

Tazobactam

Clavulanic Acid

153
Q

T/F

Beta lactamase inhibitors have no antibiotic effect

A

True

They just help to combat beta-lactamase and are always combined with a ABX (ex. unasyn = amplicillin/sulbactam)

154
Q

What is the only FQ that is effective against MRSA and has no QT prolognation or photosensitvity?

A

Delafloxacin (Baxdela)

155
Q

T/F

Patients with a PCN allergy have a 50% increase chance of SSI

A

True

d/t receiving 2nd line prohylactic ABX like vanco

156
Q

SE’s of Flagyl

A

Pancreatitis

Peripehral neuropahty

Will vomit it used in combo with ETOH

encephalopathy/confusion

Ataxia/tremors

157
Q

What is a major drug interaction to be concerned about if a patient is taking Flagyl?

158
Q

What are some major concerns with Quinupristin/Dalfopristin (Synercid) ?

A

Post op pain and arthralgias

159
Q

How should Quinupristin/Dalfopristin (Synercid) be adminsitered?

A

Central line due to risk of phlebitis

160
Q

What is a concern with Daptomycin and its SE’s?

A

Post-op ambulation complications

causes limb/muscle pain

161
Q

Why is rifamptin and rifabutin never given alone?

A

Monotherapy results in rapid resistance

162
Q

Rifampin and Rifabutin are mainly used for ____ and ___

A

TB and prostehtic infections

163
Q

Rifampin and Rifabutin are potent CYP450 ____

A

inducers

get significant drug interactions by speeding up metabolism of other meds

164
Q

With Rifampin and Rifabutin, you can see drug interactions up to _ months after d/c’ing med

165
Q

SE’s of Rifampin and Rifabutin

A

Orange-red body fluids (tears, sweat, urine)

rare heptotoxicity

166
Q

Which antiviral is a good option for those unresponsive to previous agents and those treated with acyclovir and failed?

167
Q

Why would foscarnet be a better option than tamiflu for the flu?

A

Doesnt cause hallucinations, agitations, or tremors

168
Q

What is the major SE’s of tamiflu?

A

hallucinations, confusion, falls in the elderly

169
Q

What is the most broad-spectrum azole?

A

Itraconazole (Sporanox)

has a risk of hypokalemia

170
Q

What are the adverse effects of PCN?

A

Hypersensitivity

GI upset, diarrhea

*Jarish-Herxheimer reaction* - will see this esp if treating a tic-borne illness. Produce flu-like symptoms

171
Q

T/F

Linezolid is bacteriostatic against enterococci and staph, and bacteriocidal against most strep

172
Q

Is vanco bacteriostatic or bacteriocidal?

A

bacteriocidal

Pharm 2 (19 decks)

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