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Pharm Final antibiotics/fungals > Anibiotics > Flashcards

Flashcards in Anibiotics Deck (99):
1

what are some of the advantages of oral administration

decreases cost
less resources, IV, pumps etc
patient preferred
reduced phlebitis
increased pt mobility
earlier discharge

2

What is the MOA for Beta-Lactams

Bind to pencillin binding proteins and inhibit cell wall synthesis

3

what makes up the class of beta-lactams

penicillins, Cephalosporins, beta-lactamase inhibitors, aztreonam

4

what are natural penicillins used for

treat pharyngitis, erysipelas and syphillis

5

what is the Jarisch -Herxheimer rxn

with treatment of spirochetal inf.
reaction due to release of large amount of toxin after bacterial killing
Fever, Chills, Myalgia

6

What are the 1st Gen cephalosproins

Cephalexin-oral
Cefazolin-IV

7

What are the 2nd Gen cephalosproins

Cefuroxime-oral
Cefoxitin-IV

8

What are the 3rd Gen cephalosproins

Cefpodoxime
Ceftriaxone

9

What are the 4th Gen cephalosproins

Cefepime
Ceftaroline

10

What makes cephalosporin activity better

they are less susceptible to beta-lactamases giving them broader spectrum of action compared to penicillins

11

what is the spectrum of activity for 1st Gen Cephalosporin

SPEcK
Staph,Strep(+)
Proteus, E. Coli, Klebsiella(-)

12

what is the spectrum of 2nd gen Cephalosproin

HMSPEcK
Staph, Strep(+)

Harmophilus, Morazell Catarrhalis, Proteus, E coli, Kleb (-)

13

What are 1st gen ceph used for

UTI, Pharyngitis, mild skin or soft tissue, and upper and lower respiratory tract

14

What does 2nd gen ceph used for

sinusitis, pharyngitis, otitis media, lower respiratory tract inf,
Cefuroxime- lyme

15

what does 3rd gen cover

Strep pneumo (+)

Enterobacteriacease, H. influenzae, M. cararhalis (-)

16

what are 3rd gen ceph used for

CAP, OM, URI, Meningitis, Neutropenia,

17

what do 4 gen ceph cover

Strep and Staph(+)

Enterobacreriaxease, H. influ, M catarhalis, Psudomonas aerug,
Bacterocides

18

what has the highest incidence of GI effects

cefixime

19

what has the lowest incidence of diarrhea

cefprozil

20

what has the highest incidence of rash

cefaclor

21

what is the benefit of probenicid with cephalosporins

increases concentration

22

what are rates of allergic reactions like with chepalosporin

low about 1%

23

which generation of chepalosporin have higher risk of reaction

1st gen

24

what is a mono bactam an what is their MOA

Aztreonam
bind to penicillin binding protein and inhibit cell wall synthesis which causes cell death

25

what selectivity does Aztreonam have?
what type of infections is it good for?
What does it need dose adjustment for?
what is the cross sensitivity like for it?
what are the adverse effects like?

only monobactam in US
gram (-) coverage including pseudomonas, does not cover anaerobic or gram (+)
Good for resistant infections b/c it is resistant to many beta lactamases produced by gram (-) bacteria
decreased renal function
low incidence of adverse effects-diarrhea

26

What drugs are part of the carbapems

Imipenem/ Cilastatin
Meropenem
Doripenem
Ertapenem

27

what is the MOA for carbapenems

bind to penicillin binding protein and inhibit cell wall synthesis which leads to cell death

28

What bacteria are carbapenems good for

resistant to most beta-lactamases and the drug of choice for infection caused by ESBL

29

What do carbapenems cover

Staph, Strep, Listeria (+)
Gram (-)
anaerobes
Pseudomonas except ertapenem

30

what are clinical uses of carbapenems

UTI, lower respiratory infections, intra-abdominal and gynecological infections, skin, soft tissue, bone, and joint inf

31

what are the adverse effects of carbapenems

N/V, seizures-highest with imipenem with pts that have renal failure

32

what drugs are part of the glycopeptide antibiotics

Vancomycin, Telavancin

33

what is the MOA of glycopeptide antibiotics

prevents cross linking of the cell wall peptidoglycan during cell wall synthesis

34

What does Vancomycin cover

gram (+) only

35

what type of infections does Vancomycin cover

MRSA infection- sepsis, endocarditis, meningitis, skin and soft tissue infections
USED to treat C. Diff only

36

What is the dosing regimen for Vancomycin

dosing is variable based on body weight and renal function

37

what level should vancomycin be above to prevent resistance

10-20mcg/ml

38

what are the adverse Rxn of vancomycin

ototoxicity, nephrotoxicit, and injection site rxn

39

what increases the risk of nephrotoxicity

when administered with other nephrotoxic drugs

40

What drug causes red man syndrome

Vancomycin
infusion related reaction that is caused by the release of histamine.
may cause erythematous or urticarial reactions, flushing tachycardia, hypotension

41

how do you manage red man syndrome?

stop infusion, wait for it to subside, then slow the infusion rate down no faster than 1gm/hr can also administer benadryl prior to infusion

42

what is the black box warning with Telavancin

warning in pre pregnancy which may cause abnormal fetal development. Perform pregnancy test in women of child bearing age

43

what type of infections are Telavacin used for

complicated skin and soft tissue infections.
investigated for nosocomial pneumonia
needs to be dose adjust for renal function

44

what are the ADRS for Telavacin

Red man syndrome, infuse over 60min, nephrotoxicity, GI upset, metallic taste

45

What spectrum of activity does Daptomycin have

similar to vancomycin but it also covers vancomycin resistant enterococci vancomycin resistant s. aureus (VRSA)

46

What conditions is daptomycin used to treat

skin/soft tissue, bacteremia, endocarditis

47

what are adverse effects of daptomycin

injection site reaction, fever, chills, diarrhea, N/V
muscle cramps/ weakness
must monitor CPK and discontinue drug if muscle pain and elevation of CPK>5x ULN

48

What is Fosfomycin used to treat

oral formulation
covers Gam (+),(-)
used for UTI in women

49

what is bacitracin used for

used topically only very nephrotoxic

50

what is cycloserin used for
what are its ADR?

covers gram (+), (-)
mainly used to treat TB
H/A, Tremors, acute psychosis

51

what is the MOA for tetracyclines

binds to the 30s ribosomal subunit which prevents binding of the tRNA to the mRNA ribosome complex which interferes with protein synthesis

52

what is the spectrum of activity for tetracycline?

S. pnemo, S. pyogenes, community acquired Staph (CA-MRSA)
gram (-) ecoli, klebsiella, H influenzae
Atypical: C. pneumonae, M. neumoniae, legionella, C trachmatic, lyme

53

what are the clinical uses for tetracyclines

Respiratory infections, MRSA, CA-MRSA
anthrax, chlamydia, lyme

54

what are adverse effects of tetracycline

GI intolerance
Photosensitivity
Tooth discoloration and abnormal bone growth (do not use in second half of pregnancy or kids younger than 8
Vestibular tox.

55

What are the special considerations of tetracyclines

administration must be separated from food containing aluminum, magnesium, Calcium, and iron by 12 hours
Food: Minocycline: with or without food
Tetracycline: empty stomach
Doxycycline: with food due to GI intolerance

56

What does tigecycline cover

gram (+),(-) and anaerobes

57

what is the clinical uses of Tigecycline

used in complicated skin and skin structure inf. and complicated abdominal inf.
CAP
MRSA
MRSE
VRE
penicillin resistant strep pneumo

58

what is the MOA for macrolides

bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis

59

what drugs belong to macrolide class

Fidaxomicin
Azithromycin
Clarithromycin
Erythromycin

60

What is the spectrum of activity of
Azithro, Clarithromycin, Erythromycin

Strep (+)

H. inf, N gonnorrhoeae (-)
Atypical: Myco, Legionella, Chlamydia

61

what is the spectrum of activity of Fidaxomicin

C. Diff

62

What are the common uses for Erythromycin, Calthromycin, Azithromycin

alternate for PCN allergy
CAP
Pahryngitis
OM
Azithro- Urethritis

63

what are the ADR for macrolies
Erythromycin, Azithro, Clarithromycin

N/V
Abdominal pain
diarrhea
renal failure
QT prolongation

64

what are the ADR for fidaxomicin

GI hemorrhage
N/V
abdominal pain
Anemia neutropenia

65

What are the food interactions

Azithro and Erythro take one hour before or 2 hour after a meal

66

What are the drug interactions for Eryhtromycin and clarithromycin

inhibit CYP 450 enzyme

67

what are the drug interactions for azithro

may increase cyclosproine and digoxin levels

68

what is the MOA for clindaymycin

binds to 50s ribosome subunit and inhibits protein synthesis

69

what is the spectrum of activity for clindamycin

Stap. aureus, MSSA, CA-MRSA, Strep. ssp, peptostreptococus
ananerobes, C diff, prevotella, fusobacterium

70

what are the clinical uses for clindamycin

skin and soft tissue inf, CA-MRSA, anaerobes, aspiration PNA, dental prophylaxis in PCN pts

71

what are the adverse effects of Clindamycine

GI: diarrhea, nausea, dyspnea
rash
High incidence of C diff
heptao tox
back pain

72

how should clindamycin be administered

with food to decrease GI upset and water to decrease esophageal ulceration

73

what is the spectrum of activity for linezolid

gram (+) only
works on staph
(methacillin susceptible and resistant)
works on staph
(vancomycin intermed and resistant)
Enterococcus faecium

74

what are the common uses for linezolid

MRSA, Vancomycin resistant E. faecium
skin inf and soft tissue
bone/ joint inf
bacteremia

75

what are some of the special considerations of linezolid

good pulm penetration
exhibits weak reversible inhibition of monoamine oxidase
oral form is 100% bioavailable
preferable in PVL and CA-MRSA

76

what drugs are part of the aminoglycosides

Gentamicin
Tobreamycin
Amikacin
Streptomycin
neomycin
kenamycin

77

what is the MOA of aminoglycosides

inhibits 30s ribosomal subunit

78

what is the spectrum of activity of Gentamicin, tobramycin, amikacin

staph aureus, strep, enterocc
mostly aerobic gram (-) bacilli

79

what is the clinical uses of gentamicin, tobramycin, amikacin

rarely used alone with gram (+) organisms,
PNA, meningitis
Used with vancomycin or PCN for endocarditis

80

what are the ADR for aminoglycosides

ototoxicity, nephrotoxocity only occur when used longer than 5 days

81

what are the benefits of extended interval dosing

probable reduced nephrotoxicity
decreased lab monitoring
no risk of sub-therapeutic peak level
decreased pharmacy time for prep
easier for home care

82

what is the MOA of sulfonamides

competitive antagonist of para-aminobenzoic acid which prevents formation of folic acid

83

what is the spectrum of activity for sulfonamides

staph, s. pneumo, bacillus anthrasis, clostridium tetani
ecoli, proteus mirabillis, H. influenza
chlamydia trachomatis

84

what are the common uses of sulfonamides

UTI, toxoplasmosis
1st line for MRSA
URI
HIV PNA
CA-MRSA

85

what are adverse reactions with sulfonamides

photosensitiviy
rash
SJS
blood dyscrasias
sulfa allergies

86

what drugs make up the fluroquinolones

Ciprofloxacin
Olfoxacin
Norfloaxin
Levofloxacin
Moxifloxacin

87

what is the MOA of fluroquinolones

inhibit bacterial topoisomerase II

88

what is the spectrum of activity of cipro, ofloxacin, norfloxacin

enterobacteriacase, H. influ, M. catarrhalis, Neisseria,

89

what are the common uses of norfloxacin

uncomplicated UTI

90

what is cipro and ofloxacin

complicated UTI, gasteroenteritis, prostatits, STD, skin inf
Cipro for anthrax prep

91

what is the spec of coverage with
levo, moxifloxacin, gatifloxacin

strep pneumo,
enterobacteriacase
H.influenzae
M. catarrhalis
Neisseria,

92

what is the clinical use of levofloxacin, moxifloxacin

CAP,
URI infections

93

what are the adverse reactions of fluroquinolones

N/V
Diarrhea,
constipation
tendon rupture
photosensitivity
prolonged QT

94

what does metronidazole cover

protoza
anaerobes
bacteroides
Fusobacterium
Veillonella
C. Diff
peptococcus
peptostreptococcus

95

what are the uses of metronidazole

intra abdominal infection
Gyn inf
pseudomembraneous colitis
C. diff
H pylori

96

what are the adverse effects of metronidazole

dry mouth, metallic taste
anorexia abdominal pain
CNS

97

what is nitrofurantoin used to treat

UTI

98

what is nitrofurantoin spectrum of activity

e coli klebsiella
staph
strep
Viridians
enterococcus

99

what are some special considerations with nitrofurantoin

CrCl lass than 60ml
Hepatotoxicity and pulmonary toxicity
probenecid may increase serum concentration