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USLME > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Antibiotic classes

A

Beta lactams (Penicillin Cephalosporin Monobactams Carbapenems)
Glycopeptides (eg Vancomycin)
Aminoglycosides (eg Gentamicin)
Macrolides (eg Erythromycin )
Tetracyclines (eg Doxycyclin)
Fluoroquinolones (eg Ciprofloxacin)
Others trimethoprim, sulfamethoxasole, metronidazole, clindamycin

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2
Q

cell wall agents

A

Betalatams and glycopeptides

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3
Q

ribosomal agents

A

Macrolides, aminoglycosides, tetracyclines and clindamycin

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4
Q

DNA

A

Fluoroquinolones

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5
Q

Bacteriacidal agents

A 
Betalactam drugs
Vancomycin 
Fluoroquinolones
Metronidazole
Nitrofruantoin

Aminoglycosides (high dose)
Co-trimoxazole

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6
Q

Bacteriostatic agents

A 
Trimethoprim
Sulfamethoxazole
Tetracyclines
Macrolides
Clindamycin
Aminoglycosides (low dose)
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7
Q

4 big categories of bacteria

A

Gram positive
Gram negative
Anaerobes
Atypical

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8
Q

Coagulase positive staph =

A

S. aureus, only one coagulase producing staph in human infection. Coagulase makes them stick in big number

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9
Q

Coagulase negative staph =

A

All other staph, eg staph epidermidis. They are bunched up in 4-8 cocci, unlike the picture.

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10
Q

All staph became resistant to penicillin due to

A

penicilinase production

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11
Q

What can be used as synergic agent?

A

Aminoglycoside for synergic effect

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12
Q

What if pt gets a rash with penicillin?

A

Rash with penicillin -> use first gen cephalosporin like cefazolin. Cephalosporins have some resistance to penicilinase

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13
Q

What if anaphylaxis?

A

If anaphylaxis -> avoid all beta lactam drugs. Use macrolides, clindamycin, vancomycin, fluoroquinolones instead

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14
Q

Anti-staph penicillin

A

Oxacillin, cloxacillin, dicloxacillin and nefcillin
In NZ flucloxacillin
Penicillinase resistant
Don’t work on gram negatives

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15
Q

MRSA is basically resistant to all beta lactam drugs

A

by altering penicillin binding protein. Any antibiotics works in other ways are ok.
Glycopeptide (Vancomycin)
+ Aminoglycosides/clindamycin/fusidic acid for synergic effect

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16
Q

When do we use methicillin?

A

NEVER! It causes allergic (eosinophilic) nephritis -> renal failure
Methicillin is the first penicillin invented with penicilinase resistance

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17
Q

Vancomycin

A

Glycopeptides
Inhibits cell wall synthesis differently
Don’t work as well as penicillin
Steven-Johnson syndrome

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18
Q

Penicillin

A

Cell wall agent
Covers gram positives
Usually the first line agent of choice
They work!

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19
Q

syphillis, Strep pyogenes

A

Penicillin G
Penicillin G dosent have much gram negative activity because it doesn’t get into the cells.
Penicillin G has poor bioavailability whereas amoxi has good oral bioavailablity (one of the reason why its used a lot in primary care setting)

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20
Q

extended gram negative cover penicilin

A

Ampicillin/amoxicillin

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21
Q

Good pseudomonas cover penicillin

A

Piperacillin extended gram negative

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22
Q

Penicillinase resistant penicillin

A

fluclox

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23
Q

Cephalosporins

First gen:

A

G +ve + PEcK (Proteus, E. coli, Klebisiella) eg Cefazolin

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24
Q

Cephalosporins

Second gen:

A

G+ve + HEN (Haemophillus, Enterobacter and Neisseria) + PEcK eg Cefaclor

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25
Q

Cephalosporins
Third gen:
Antipseudomonal

A

more G-ve eg Ceftriaxone
Ceftazidime
Third gen have poor oral bioavailability -> given IV or IM
Third gen crosses BB barrier -> good agent for meningitis

Cefotaxime excreted primarily in urine
Ceftriaxone excreted primarily by liver

26
Q

Cephalosporins

Fourth gen:

A

Good G +ve and –ve + anti pseudomonal eg Cefepine

27
Q

Carbapenems

A

Broadest spectrum betalactam drug
G +ve and –ve + anaerobes
Covers pseudomonas
No intracellular coverage e.g. Chlamydia
Betalactamase resistant
Good empiric therapy for invasive disease eg sepsis
Emerging resistance. E. Coli, enterococcus

28
Q

Gram positive bacilli

Claustridia –

A

difficile, botulinum, tetani (GI tract)

Metronidazole because anaerobes

29
Q 
Gram positive bacilli
Listeria monocytogenes (pneumonia)
A

Resistant to all cephalosporines

Amoxi to treat

30
Q

Gram positive bacilli

Corynebacterium – diptheria

A

Penicillins, macrolides, fluoroquinolones

31
Q

Enterococcus faecalis
Gram positive bacilli
Multi-drug resistant

A

Amoxi if sensitive. Vancomycin, linezolid, daptomycin

32
Q

Gram negative cocci
3 medically relevant species
All diplococci
Moraxella is common cause of respiratory tract infection and occasinally UTI

A 
Moraxella catarrhalis
Neisseria gonorrhoeae
Neisseria meningitidis 
IV Ceftriaxone if meningitis
Rifampicin for prophylaxis
33
Q

Gram negative cocci

Moraxella catarrhalis

A

Amoxi is ok but high betalactamase prevalence

34
Q

Gram negative cocci

Neisseria gonorrhoeae

A

IM Ceftriaxone 250mg single dose

35
Q

Gram negative cocci

Neisseria meningitidis

A

IV Ceftriaxone if meningitis

Rifampicin for prophylaxis

36
Q

Gram negative bacilli

GI + UTI

A 
E. coli
Salmonella
Shigella
Vibrio
Yersinia
Proteus
Campylobacter
Pseudomonas
37
Q

Gram negative bacilli
Don’t need Abx for diarrhoea unless invasive
Invasive diarrhoea means

A

blood and fever

38
Q

the most common cause of UTI

A

E. Coli

BPAC recommends trimethoprim as first line

39
Q

The term Urosepsis is used because of high likelihood of …

Another organism to keep in mind in urosepsis is

A

gram –ve organism involvement, especially E coli.
Enterococcus faecalis, G +ve bacilli because E. coli and E. faecalis have high prevalence of resistance + multidrug resistance.

40
Q

Gram negative bacilli

Invasive pathogens

A

Salmonella
Shigella
Yersinia
Chamylobacter

41
Q

Ascending cholangitis, cholecystitis, peritonitis

usually caused by

A 
Gram negative bacilli
Invasive pathogens
Salmonella
Shigella 
Yersinia 
Chamylobacter
42
Q

Gram negative bacilli drug of choice

A 
Aminoglycosides
Carbapenems
Fluoroquinolones
3rd and 4th cephalosporines
Monobactams
43
Q

Psudomonas
G –ve bacilli, aerobic
Difficult to treat!! Why?

A 
Multiple mechanisms of Abx resistance
biofilm
Thick wall 
Active pump
Extended spectrum betalactamase

CFS, intubated, wound

44
Q

Psudomonas G-ve vacilli, aerobic

antibiotics

A

Aminoglycosides, tazocin, carbapenem, ceftazedime, fluoroquinolone
Tazocin contains piperacillin and tazobactam – tazobactam must be used due to betalactamase

45
Q

Atypicals

Cannot gram stain

A 
Spirochetes 
Syphilis – Penicillin G
Borrelia (lyme’s disease) -Doxy
Mycoplasma - Macrolide
Chlamydia - Macrolide
Mycobacterium – 4 Tb meds 
Rikettisia - Doxy
46
Q

4 Tb meds RIPE, and side effects

A

Rifampin R for red, it stains all ur body fluid red/orange colour.
Isoniazid isoNiazid, N for neuropathy
Pyrazinamide P for Pain in the joint
Ethambutol E for eye, causes retionopathy

47
Q

Anaerobes

A 
C. difficile, botulinum, tetani 
Bacteroids - gut
Actinomyces – mouth -> lungs
Disruption of normal flora, poor blood supply and necrosis -> Abscess
Mixed organisms in abscess
Debridement/surgical drainage
48
Q

Anaerobes antibiotics

A

Metronidazole, clindamycin, a penicillin + betalactamase inhibitor, carbapenem, fluoroquinolone
Clindamycin for above diaphragm. ie dental and lung
Bacteroids, Claustridia, actinomyces

49
Q

Aminoglycosides

A

Gentamicin and tobramycin
Good gram –ve cover including pseudomonas
Renal and ototoxic
Don’t cross blood brain barrier
Prolonged exposure > 10mcg/ml should be avoided.
Use ideal body weight for calculating the dose
Check the trough level, should be < 2mcg/ml
Dosing interval 8 hours

50
Q

Tetracyclines

A 
Only doxycycline
G +ve and –ve + anaerobe
Good for intracellular organisms
Malaria 
Chlamydia 
Gonorrhoea
Rickettisia 
Low dose therapy for acne 
Stains bone and teeth, avoid in pregnancy
Oesophagitis
Photosensitivity
51
Q

Macrolides

A

Erythro, azithro, roxithro and clarithromycin
Similar spectrum to amoxicillin
Atypical pneumonia – Chlamydia, mycoplasma and legionella
Good for Campylobacter
Long half life
GI upset + disulfiram like action
Potent CYP3A4 inhibitor except azithromycin
Bad if pt is on statin

52
Q

Fluoroquinolones

A 
Old – Ciprofloxacin 
New – Levo, gemi and moxifloxacin
Good G +ve and –ve coverage 
Good tissue penetration
Cipro – best gram negative potency
Fist line for pyelonephritis 
Moxi has good anaerobic cover

GI upset
Elevate BSL especially with gati
Neuropathy – central and peripheral

53
Q

Trimethoprim

A

First line agent for uncomplicated UTI
Doesn’t cover proteus (Don’t use it if pH is high!!)
Bad in pregnancy
Sulfamethoxazole increases the potency
Covers proteus
Used in uncomplicated paediatric UTI
Prophylaxis for PCP and toxo infection in HIV +ve pt with CD4 cell < 200 cell/microL or 200 x 10^6/L

54
Q

Nitrofurantoin

A

UTI
Safe in pregnancy unless close to term 36-42 weeks
Possible haemolytic anaemia in neonate

55
Q

Gram positive

A

Penicillin
Staph – Anti-staph penicillin
MRSA – Vancomycin

56
Q

Gram negative

A 
Aminoglycosides
Fluoroquinolones
Carbapenems
Monobactam
Penicillin and cephalosporines
57
Q

Atypicals

A

Macrolides or fluoroquinolones for pneumonia

Otherwise depends

58
Q

Anaerobes

A

Metronidazole

Clindamycin (above diaphragm)

59
Q

For 5th year exam

A

Nitrofurantoin for UTI during pregnancy if the bug is resistant to amoxicillin
Penicillin G for syphilis
Amoxicillin for Listeriosis
Macrolides for atypical pneumonia
Azithromycin 1g PO stat for chlamydia
Metronidazole for C. difficile, bacterial vaginosis and Giardia
Ceftriaxone for meningitis unless in neonates and pregnancy
Co-trimoxazole for PCP and Toxo prophylaxis
Quadruple therapy for tuberculosis + their side effects
No antibiotics for non bloody diarrhoea
Gentamicin pharmacokinetics

60
Q

Ceftriaxone is not used for meningitis in babies or pregnant women

A

because of possible listeria infection. Listeria is resistant to all cephalosporins

61
Q

Cotrimoxazole =

A

bactramrim = trimethoprim + sulfamethoxasol

62
Q

Nitrofurantoin is not recommended in pregnancy 37-42 weeks due to

A

possible haemolytic anaemia in neonate

USLME (41 decks)

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