ABx Flashcards
(185 cards)
1
Q
G+ cocci to know
A
staph, strep, entero
2
Q
G+ bacilli
A
bacilus anthracis, clostridium diptheria
3
Q
G- cocci
A
neiseria gonnorhoeoa, meningitides
4
Q
gram- bacilli
A
e coli, proteus, enterobacter, salmonema
5
Q
sprichetes
A
treponema pallidum
6
Q
acid fast bacteria
A
mycobacterium tuberculosis, bovis, leprae
7
Q
antibiotic strategies
A
employ a substances that attacks a non-mammalian part of the growth process
slow growth so the immune system gains the upper hand
employ agents to kill log order growth in immune compromised patients
8
Q
what is the risk of introducing substances that act against non-mammalian metabolism
A
there will be an allergic event
9
Q
three factors to fight ABx resistance
A
long enough treatment
only use Abx when necessary
use a combination of Abx when needed
10
Q
how can the same drug be bacteriocidal and bacteriostatic
A
at a low dose it might just kill enough microbes to keep the net colony growth to zero
a higher dose might kill all the colonies faster than they can be replaced
11
Q
what is the goal of a bacteriocidal drug
A
to allow the immune system to catch up
12
Q
how do you decide to use bacteriostatic vs cidal
A
healthy patients can use either, but immunocompromised patients bacteriocidal agents should be used
13
Q
cell wall active drugs are generally _____
protein synthesis inhibitors are usually _____
A
bacteriocidal
bacteriostatic
14
Q
four targets of ABx action
A
cell wall synthesis
protein synthesis
nucleic acid synthesis
inhibitor of folate biosynthesis (inhibitors of metabolism)
15
Q
why is inhibition of folate a good method to kill bacteria
A
folate is needed to make DNA
humans are able to take in folate but bacteria need to convert it from other substances
if we can block conversion the bacteria will die and spare our cells
16
Q
two groups of cell wall inhibitors
A
beta lactams
others
17
Q
four beta lactam ABx
A
´Penicillins
´Cephalosporins
´Carbapenems
´Monobactams
18
Q
non beta lactam ABx that target cell walls
A
´Vancomycin
´Daptomycin
´Bacitracin
19
Q
four penicillin types
A
natural
anti staphyolococcal
extended spectrum
anti pseudomona;
20
Q
natural penicillin is used against what
A
Gram + except staph
syphilis
21
Q
antistaph penicillin
what are they used against
A
methicilin
cloxacin
nafcillin
oxacillin
staph infections except MRSA
22
Q
what is the goal of extended spectrum penicillins
A
improve gram negative coverage
23
Q
two common extended spectrum penicillins
common probelms
A
ampicilin (oral and parenteral)
amoxicilin (oral only)
rash
24
Q
aminopenicillins (ampicillin, amoxicilin) are used on what
A
Otitis media
strep
UTI (where ther isk of resistant e coli is low
25
anti pseudomonal penicllin
´Carbenicillin (Geocillin)
´Mezocillin (Mezlin)
´Piperacillin (Pipracil)
´Ticarcillin (Ticar)
26
what is the most powerful antipseudomonal penicillin
piperacillin
used in intrabdominal infections but is susceptible to beta lactamase
27
toxicicty to penicilin
hypersensitivity (rash, angioedema, anaphylaxsis)
diarrhea
nephritis (exp mthicillin)
28
synergistic drugs with penicillins
aminoglycosides, but can be mixed in the same vial
29
antagonistic drugs with penicillin
bacteriostatic agents will decrease the effective ness of bacteriocidals, so macrolides and tetracyclines dont work with penicillin
30
how can penicillins be used to fight beta lactam producing bacteria
add a beta lactamase inhibitor (clavulanic acid)
31
amoxicillin with clavulanic acid = \_\_\_\_\_
ticarcillin + clavulanic acid = \_\_\_\_
augmentin
timentin
32
two important 1st gen cephalosporins
cefazolin, cephalexin
33
3rd genetation cephalosporin to remember
rocephin
34
what are cephalosporins used for
treating mainly gram + with some gram - coverage depending on generation
35
4th genetation cephalosporin to know
cefepime (esp against pseudomonas)
36
5th geneation cephalosporin to know
ceftaroline
only beta lactam useful against MRSA
37
adverse effects associated with cephalosporin
allergic cross reactive with penicillin (3-5%)
1-2% allergic reaction with no pen allergy
can also cause bleeding due to anti vitamine K action
38
advantage of monobactum
what is it used for
relatively beta lactamase resistant, low allergic reaction potential with penicillin allergy
usually against enterobacter and other G-. not G +
39
monobactum to know
azetronam
40
T/F carbapenems are not cross reactive with penicillin/ceph allergies
false, they can be
41
advantages of carbapenems
adverse effects
broad spectrum
expensive, nausea, diarrhea, can cause sz
42
nonbeta lactams
´Vancomycin (Vancocin)
´Bacitracin (ointment, Neosporin, Polysporin)
´Fosfomycin (Monurol): UTI treatment
´Cycloserine (Seromycin)
43
why is vancomysin important
because it works for most bacteria and is controlled to prevent resistance
44
vancomycin toxicity
´Nephrotoxicity
´Ototoxicity
´Flushing due to histamine release
´“Red Man Syndrome”
45
red man syndrome
flushing diue to histamine release realted to vancomycin
46
when is vancomycin used
MRSA
enterococcus
clostridium (oral)
47
uses for daptomycin
disadvantages
G+ coverave for resistant staph, strep, enterococcus
parenteral only, not useful in pneumonia, must stop statins
48
what is telavancin used for
similar to daptomycin
reserved for mrsa
can prolong QT interval
interferes with some blood tests
49
types of protein inhibiting ABx to know
tetracyclines
aminoglycosides
macrolides
50
tetracyclines are most often used in what setting
outpatient
51
are tetracylcines bacteriostatic or cida
static, but not against gram negative UTIs
52
tetracycline is especially useful against what
chlamydia
mycoplasma
rickettsia
cholera
anthrax
acne
53
three tetracylcines to know
tetracycline
doxycycline
minocyclin
54
what inhibits absorption of tetracylcline
dairy
55
T/F tetracycline has anti-inflammatory effect
true, which makes it useful in acne treatment
56
T/F doxycycline is not affected by renal disease
true it is almost entirely metabolized in the liver
57
special contraindications for tetracycline
pregnancy and children under 9 due to dental enamal dysplasia and discoloration, growth inhibition, bone deformities
photosensitive, so wear sin screen
58
most common tetracycline complaint
gastric distress, but that can be combated by taking it with food
59
tetracycline derivative that can be used against resistant staph and strep in IV formuation
adverse effects?
tigecycline
similar to tetracycline with more nausea and vomitting
60
are aminocylcosides bacteriostatic or cidal
cidal
61
T/F aminoglycosides are usualyl used alone and are effect against G+ infections
false, they are almost always used with a specific G+ agent (cilin or cephalosporin) and work well against G-
62
T/F aminoglycosides are absorbed well in oral form
false, they are for parenteral use only
63
three notable aminoglycosides
amikacin, gentamicin, tobramycin
64
aminoglycocide toxicity (2+1)
ototoxic
nephrotoxic
exacerbated by loop diurectics (furosimide/lasix or bumetanide/bumex)
65
what type of bacteria are macrolides useful against
good against G+, useful against "Others" like chlamydia
weak against G-
66
T/F erythromycin are safe for kids and pregnancy
true
67
what is the treatment for syphilis in the penicillin allergic patient
erythromycin
68
macrolides to know
erythromycin
azithromycin
clarithromycin
thelthromycin
69
what is the advantage of ketolides over macrolides
one example of a ketolide
broader spectrum of action with less antibacterial resistance
telithromycin
70
typical dosage of azithromycin
500mg on day one, 250mg on days 2-5
71
macrolide toxicity
GI distress
drug interactions fomr CYP3A4 inhibitors
72
why do macrolides cause GI distress
macrolides mimic the structure of a natural chemical called motilin that triggers peristalsis
73
macrolides are CYP3A4 inhibitors
why is that relevant
it stops many drugs from being broken down and can cause the circulating blood levels of some othe rmedications to increase to dangerous leveslk
74
drugs that can have a dangerous interaction with erythromycin due to CYP inhibition
astemizole
carbamazepine
warfarin
75
macrolide derivative used against C diff
what is its mode of action
fidaxomicin
acts gainst bacterial DNA transcriptions
76
notable drug in lincomycin class
clindamyvcin
77
what clindamycin used best against
anaerobes except C diff
78
risks of clindamycin
C diff
liver impairment
neutropenia
79
what will a superfincetion of C diff cause
pseudomembranous colitis
80
risk factors for pseudomembranous colitis
ABx use
hospitialization
PPI
81
ABx most likely to produce a C diff superinfection
Clindamycin
amoxicillin, ampicillin
cephalosporin
fluoroquinolines
82
pros and cons of chloramphenicol
excellent G+/G- coverage
causes bone marrow supression, neonatal toxicity (Gray baby syndrome), drug interaction
83
drugs that will have a dangerous interaction with chloramphenocol
chlorpropamide
phenytoin
tolbutamide
warfarin
84
what is the coverage of oxazolidinones
common type and what it is used for
works well against G+, G-, anaerobes, aerobes
linezolid, used against vancomsycin resistant bugs
85
toxicity with oxazolindnones
hematologic toxicity from thrombocytopenia
inhibit monoamine oxidase (parkinsons treatment)
86
sterptogramin use
two types, with use
bacteriocideal against most organsisms
quinupristin and dalfopristin (synercid), vancomycin resistance
87
toxicity associated with streptogramins
arthralgia and myalgia
hyperbilirubinema
88
fwhat is the action of fluoroquinolones
inhibits DNA synthesis
89
notable 1st generation quniolines
nalidixic acid, used for UTIs
90
what are 2nd generation quinolines used for
examples
* Expanded gram negative coverage
* Atypical coverage (chlamydia, mycoplasma)
* Some gram + coverage
norfloxicin, ciprofloxicin
91
what are 3rd generation quinolines used for
examples
* Expanded gram negative coverage
* Atypical coverage (chlamydia, mycoplasma)
* better G+ coverage than 2nd gen
levofloxacin
92
wqhat are 4th generation quinolones used for
examples
* gram + and anaerobic coverage
* Less useful against atypicals
moxifloxacin
93
other uses of quinolones
* Gonorrhea (ciprofloxacin, ofloxacin)
* Mycoplasma, ureaplasma, chlamydia
* Legionella
* Some mycobacteria (TB, avium)
* Anaerobes (Avelox, Trovan)
* Anthrax prophylaxis
94
fluoroquinoline toxicity
GI distress
CNS symptoms
liver toxicity
photosensitivity
generally well tolerated
95
when might fluoroquinolones be contraindicated due to risk factors
when a person is at risk for tendon rupture due to age \>60 or steroids
96
are fluoroquinolines safe for pregnancy
no, they are Grade C but they should be avoided because they can damage growing cartilage
97
inhibitors of folate metabolism
sulfonamide
trimethoprim
co-trimoxazole
98
sulfonamides is a generic term for what
PABA analogs
99
sulfonamide choices for systemic disease
IBD
sulfamethoxazole
sulfisoxazole
sulfadizaine
sulfasalazine
100
what is the most common use of sulfonamidea
UTIs (co-trimoxazole)
101
common brand name of co-trimoxazole (combination fo trimethoprim and sulfamethazone)
used for
bactrim
UTI
Prostatitis
adjunct to H flu, listeria, legionella
102
adverse drug reactions from cotrimoxazole
allergry (5%)
hemolytic anemia with G6PD deficienct
can cause aplastic anemia
103
contrinducations for sulfonamides
new borns (cause kernicterus)
late pregnancy (dtto)
antagonistic with methaminde
104
three types of urinary antiseptics
methenamine
nitrofuratoin
nitrofurantoin monohydrate
105
action of methenamine
can it be used against proteus?
what is their main use
converts formaldehyde to acid in urine
proteus can split urea and neutralize the acid
only against uncomplication LUTIs
106
contraindications for methenamine
hepatic insufficiency
renal insufficiency
sulfa drugs
Upper UTI
107
limitation of nitrofurantoin
common issue
rare complications
only useful against UTI caused by non-resistant E Coli
brown urine
pneumonitis/fibrosis, peripheral nephtitis
108
analgesics for cystitis
useed for
side effection
pryridium
pain relief for the first 1-2 days of UTI
orange urine, 10% incidence of GI upset
109
new ABx class
what is it useful against
teixobactin
all G+, mycoplasma, mycobacterium
110
main mycobacterium pathogens
tuberculosis, mycobacterium bovis, mycobacterium leprae
111
treatment for leprosy
dapsone, colfazamine, rifampin
112
dapsone is useful against leprosy and what
adverse effects
pneumocystis
hemolysis
peripheral nephropathy
113
what do we refer to as "latent TB"
TB in 90-95% of peole that is kept in check by the immune system
114
factors that will trigger conversion from latent to active TB
HIV
corticosteroid therapy
chemo
immunosuppresive therapy
115
what is the prognosis of avtive TB
100% cure rate if the patient is compliant and the strain isnt resistant
without treatment only 35% of patients will live beyond 5 years
116
6 month regimen for TB treatment
first 2 months: isoniazid, rifampin, pyrazinamide, ethambutol
3-6 months: isoniazid, rifampin
117
importnt 1st line TB drugs
isoniazid
rifamycins
118
isoniaizd is bacteriostatic or cidal
both
119
T/F genetic backgroun of isoniazid can lead to slow of fast clearance
treu
120
isoniazid toxicity
peripheral neuritis
heptatis (linked to age and ETOH)
drug interactions
121
adverse drug ractions with rifampin
generally well tolerated
commonly causes nausea and rash
CYP induction will interact with oral contraception, warfarin
122
rifampin + pyrazinamide will result in what adverse effect
liver toxicity
123
other than isoniazide and rifampin, what types of drugs are used against TB
fluoroquinolones, typically moxifloxacin and gatifloxacin
124
what percent of TB is resistant to all 1st line drugs
10-15%
125
four types of fungal pathology
superifical infection
pulmonary infections
CNS infections
systemic
126
what will increase risk of fungal disase
large exposure to pathogen
reduction in normal bacterial flora
immunosuppression (HIV, chemo, malnutrition)
127
common systemic fungal pathogens
* Candida albicans
* Histoplasma capsulatum
* Coccidioides immitis
* Blastomyces dermatitidis
* Cryptococcus neoformans
* Pneumocystis jirovecii (formerly: P. carninii)
128
typical superficial fungal infections
* Tinea pedis (athlete’s foot)
* Tinea cruris (jock itch)
* Tinea corporis (ringworm)
* Onychomycosis (nail bed infection)
* Vaginal infections (yeast infection)
* Oral cavity infections (thrush)
129
main superficial fungal pathogens
* Trichphyton
* Microsporum
* Epidermophyton
130
typical superficial antifungal agents
* Clotrimazole (Lotrimin)
* Miconazole (Monistat)
* Econazole (Spectazole)
* Nystatin (Mycostatin)
* Grieseofulvin (Grifulvin)
131
two primary systemic antifungal drugs
* Amphotericin B (Amphotec, AmBisome)
* Fluconazole (Diflucan)
132
systemic antifungals new to market, only IV use, inhibits fungal cell walls
echinocandins
133
amphotericin B is significantly effective against what bugs
Candida,
Histoplasma,
Cryptococcus,
Coccidioides,
Blastomyces
134
what is the risk of treatment with amphotericin B
they are toxic, cause fever, chills, hypotension, anemia, thrombophlebitis
135
three amphotericin B formulations
most important
Cholesteryl sulfate complex, Lipid complex, Lipsomal
liposomal
•Reduces toxicity, particularly renal
136
benefits of the azole drugs
fungistatics effective for superficial and systemic infections
teratogenic when given systemically in high doses
CYP3A4-5 inhibition leading to ADR
137
what type of azole has the least impact one CYP
other benefits
fluconazole
good CNS penetration for fungal menigitis
Oral or IV
single dose treatment for vaginitis
low risk for hepatotoaxicity
138
facts about ketoconazole
* Broad spectrum antifungal
* Best use: Histoplasmosis
* Food impairs absorption, Coca-cola improves!
139
four facts about ketoconazole toxicity
* Hepatic toxicity is possible
* Strong inhibitor of gonadal and adrenal steroids:
* Can not be given with Amphotericin B
* Rarely used systemically in USA
140
facts about voriconazole
* Newer azole (trazole) antifungal agent
* Indications:Candida septicemia, Invasive aspergillosis
* Side effects:
Visual changes (blurred vision, increased light sensitivity
141
differentiate between azole and prazole
azoles are antifungal
prazoles are PPIs
142
classes of antiviral drugs
* Anti-Human Herpes Virus
* Anti-hepatitis
* Anti-influenza
* Anti-retrovirus
143
types of human herpes viruses
* HHV 1 & 2: herpes simplex (HSV) types 1 & 2
* HHV 3: Varicella-zoster virus (VZV)
* HHV 4: Epstein-Barr virus (EBV)
* HHV 5: Cytomegalovirus (CMV)
* HHV 6 & 7: Roseolovirus
* HHV 8: Kaposi Sarcoma associated HV (KSHV)
144
facts about herpes simplex
teratogenic in early pregnancy
potentially fatal in new borns
severe infection possible with immunocompromised patients
145
goals of HSV 1 and 2 treatment
* Shorten length and severity of primary infection
* Prevent or abort recurrences
* Life-saving in immunocompromised patients
146
two common anti herpes drugs
acyclovir
valacyclovir
147
are anti herpes drugs commonly toxic
usually very well tolerated
acyclovir has been used constantly for 10 years with minimal ADR, can have transient renal function
famciclovir linked to cancer and testicle toxicity
148
what is the major complication of CMV
can infect fetus
causes retinitis and encephalitis in immunocompromised pateints
149
anti CMV agents
* Ganciclovir (Cytovene)
* Cidofovir (Vistide)
* Foscarnet (Foscavir)
150
anti cmv toxicity
ganciclovir causes myelosuppression additive with HIV drugs
cidofovir causes renal toxicity
151
types of hep viruses
A B C D E
152
conditons related to Hep B and C
chronic infection
liver failure
hepatoma
153
anti hepatitis drugs
interferon alfa-2a
ribvirin
ledipasvir + sofosbuvir
154
describe interferons
Immune cell produced cytokines which Are anti-viral and anti-neoplastic because They activate key immune system components:
## Footnote
* Macrophages
* Natural killer cells
* Assist with antigen presentation to T cells
155
anti hep interereon toxicity
* Neuropsychiatric: Contraindicated in psychosis, depression
* Flu-like syndromes
* Marrow suppression
* Hepatic toxicity
156
anti hep toxicity ribavirin
* Hemolytic anemia (10-20%)
* Teratogenic in animals
157
anti hep toxicity lamivudine
adefovir
entecavir
usually wel tolerated
renal toxic at high dose
renal toxic at usualy doses
158
new standard of care for chronic hep C
ledipasivr + sofosbuvir
previously was interferon + ribavirin
159
T/F ledipasvir + sofosbuvir are well tolerated and cheap
false, they are well tolerated but wildly expensive
160
common respiratory viruses
FLu A and B
RSV
161
flu treatment
vaccination
anti flu drugs
supportive care
162
anti flu drugs
amantidine and rimantidine prophylaxis against flu A
neuraminase inhibitors (Inhaled Zanamivir, oral.parenteral oseltamivir)
ribavirin
163
what is the best use for amantidine/rimantidine
symptomatic treatment in the first 24-48 hrs
prevention
164
Amantadine/Rimantadine
Minor ADRs
Major ADRs
caution
insomnia, dizziness, ataxia
hallucination, seizures
renal failure, sz
165
what is the best use for neuraminase inhibitors
how long will zanamavir and oseltamivir reduce symptoms
reduce symptoms when started \<48hrs after onset
zanamavir 1-2 days
oseltamivir 0.5-4 days
166
ADRs with NI
zanamivir: air way irritation, dangersous with people with asthma or COPD
oseltamivir: GI upset, cramps, nausea, fixed taken with food
167
what is the important clinical challenge for HIV
how do we lengthen the HIV latent phase
168
HIV treatment strategies
* Inhibit Reverse Transcriptase (RT)
* Inhibit Viral Protein Production
* Prevent viral entry into cell
* Prevent integration of HIV into host DNA
* Prevent/Treat Opportunistic Infections
169
five classes of HIV drugs
* I. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
* II. Nonnucleoside RT Inhibitors (“NNRTIs”)
* III. Protease Inhibitors
* IV. Fusion inhibitors
* V. Integrase inhibitor
170
primary Nucleoside/Nucleotide Reverse Transcriptase Inhibitors “NRTIs” drugs
* Zidovudine (Retrovir, AZT)
* Zalcitabine (Hivid, ddC)
* Stavudine (Zerit, d4T)
171
NRTI toxicity
* Pancreatitis
* Renal Impairment
* Peripheral neuropathy
* Bone marrow toxicity (esp. AZT)
* Drug Interactions (esp. AZT)
172
drug interactions with AZT
•Cimetidine, indomethacin, lorazepam, acetoaminophen
173
Nonnucleoside RT Inhibitors
* Nevirapine (Viramune)
* Delavirdine (Rescriptor)
* **Efavirenz (Sustiva)**
174
Nonnucleoside RT Inhibitors toxicity
* Rash
* Fever
* Headache
* Elevated Liver Enzymes
* Epidermal Reactions
175
epidermal reactions assocaited with NNRTIs
* Toxic Epidermal Necrolysis
* Stevens-Johnson Syndrome
176
Protease Inhibitors
* Saquinavir (Invirase)
* Ritonavir (Norvir)
* Ritonavir/lopinavir (Kaletra)
177
Protease Toxicity
* Common:
* Diarrhea, Nausea, fatigue, headache
178
Major Protease Drug Interactions
* Quinidine
* Ergots
* Rifampin
* Some benzodiazepines
* Inhaled steroids
* St. John’s wort
* Many statins
* Fentanyl
179
descrive fusion or entry inhibitors
* Enfuvirtide (Fuzeon); Maraviroc (Selzentry)
* Part of multi-drug strategy
* Problems:
* Rash, injection reaction, hypersensitivity
* Eosinophilia
* Hepatotoxicity (maraviroc)
180
integrase inhibitors
* Raltegravir (Isentress)
* No interference by CYP450 inhibitors or inducers
* Generally well tolerated
* Headache, nausea, diarrhea
181
new standard for when to initiate HIV treatment
at first diagnosis
182
new approach to HIV treatment
* Extract CD4 cells
* Disable CCR5 by in vitro gene editing
* Return the CD4 cells back to the patient
183
parasite drug to know
metronidazole
184
what is the major risk of metronidazole
* Disulfiram (Antabuse)-like reaction possible
* Avoid ethanol
185
