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MNI pharm > Antibacterials > Flashcards

Antibacterials Flashcards

1
Q

Beta lactamase inhibitors

A

Clavulanic Acid, Sulbactam, Tazobactam, Avibactam

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2
Q

DOC for syphilis and Rheumatic fever prophylaxis

A

benzathine penicillin G
- lasts for 3-4 weeks
- given IM

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3
Q

Drug less active against Gram neg and given orally

A

Penicillin V

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4
Q

Drug of choice for:
• Strep throat

A

Penicillin V

Employed mostly orally for mild-moderate infections eg,
pharyngitis, tonsilitis, skin infections (caused by
Strep)

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5
Q

Restricted to treatment of b-lactamase-producing
staphylococci

A

Nafcillin, Oxacillin, Dicloxacillin

  • b-lactamase resistant
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6
Q

Used for treatment of a number of infections: acute otitis media, streptococcal pharyngitis, pneumonia, skin infections, UTIs etc.
• Widely used to treat upper respiratory infections
Safe in pregnancy and children

A

Amoxicillin

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7
Q

prophylactic treatment for dog, cat, and human bites - immediate

A

Amoxicillin + clavulanic acid

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8
Q

prophylactic treatment for dog, cat, and human bites - a week or more

A

Ampicillin + sulbactam

Ampicillin used for same things as amoxicillin

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9
Q

Commonly used to treat Pseudomonas aeruginosa
Main clinical use = as an injectable treatment of Gram
negatives

A

Ticarcillin, Piperacillin

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10
Q

Which penicillin is safe to give to a patient with kidney failure

A

Nafcillin
- bc excreted in bile

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11
Q

Which penicillin causes maculopapular rash

A

Ampicillin and amoxicillin

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12
Q

Which penicillin causes pseudomembranous colitis

A

Ampicillin

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13
Q

Which penicillin causes interstitial nephritis

A

Methicillin

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14
Q

Which penicillin causes neutropenia

A

Nafcillin

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15
Q

Which penicillin causes hepatitis

A

Oxacillin

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16
Q

Which penicillin causes positive combs test

A

Penicillin G and V

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17
Q

less susceptible to beta-lactamases. Rarely need to combine with a beta-lactamase inhibitor

A

Cephalosporins

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18
Q

All cephalosporins are inactive against ?

A

LAME
listeria, legionella, acinetobacter, mycoplasma, enterocci

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19
Q

Which cephalosporin generation is active against MRSA

A

5th

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20
Q

DOC for surgical prophylaxis

A

1st gen cephalosporins —> cephazolin

*from gen 1-3 gram pos activity decreases
* first gens are Cefazolin, Cephalexin

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21
Q

prophylaxis & therapy of abdominal and pelvic cavity infections

A

Cefotetan & cefoxitin
* second gen cephalosporins are Cefaclor, Cefoxitin, Cefotetan, Cefamandole

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22
Q

DOC for gonorrhea

A

Ceftriaxone
* 3rd gen cephalosporins—> Ceftriaxone, Cefoperazone, Cefotaxime, Ceftazidime,
Cefixime

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23
Q

Prophylaxis of meningitis in exposed individuals

A

Ceftriaxone and vancomycin

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24
Q

Treatment of disseminated Lyme disease (CNS or
joint infection)

A

Ceftriaxone

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25
Q

Cephalosporins that have action against P.aeruginosa

A

Cefoperazone, Ceftazidime

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26
Q

Treatment of complicated UTI’s, complicated intra-abdominal infections, febrile neutropenia

Wide antibacterial spectrum eg, enterobacter,
Haemophilis, Neisseria, E.coli, pneumococci, P.mirabilis & P.aeruginosa

A

Cefipime
*4th gen cephalosporins (broad spectrum)

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27
Q

Treatment for Skin and soft tissue infection due to MRSA, particularly if Gram-negative pathogens are coinfecting

A

Ceftaroline
*5th gen

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28
Q

Cephalosporins are eliminated via kidney except

A

ceftriaxone & cefoperazone excreted in bile

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29
Q

Which drug AE is kernicterus

A

Ceftriaxone

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30
Q

Cefamandole, cefoperazone & cefotetan contain
methyl-thiotetrazole group, all can cause

A

hypoprothrombinemia and disulfiram- like reactions
Prevent by k1 admin and avoiding alcohol

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31
Q

Which carbapenem is less broad and not active against P.aeruginosa

A

Ertapenem
* DIME: Doripenem, Imipenem, meropenem, Ertapenem
- generally broad spectrum

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32
Q

Imipenem forms potentially nephrotoxic metabolite. Combine with what to prevent toxicity ?

A

Cilastatin

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33
Q

Active against Aerobic Gram-negative rods ONLY (including pseudomonas)

A

Aztreonam - monobactam
- resistant to beta lactamases

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34
Q

Useful for treatment of Gram-negative infections in
patients allergic to penicillin

A

Aztreonam

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35
Q

Bacterial glycoprotein
Active against Gram-positive bacteria only
Effective against multi-drug resistant organisms (eg,
MRSA, enterococci, PRSP)

A

Vancomycin
- can give if patient allergic to penicillin

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36
Q

Binds to the D-Ala-D-Ala terminus of nascent
peptidoglycan pentapeptide

A

Vancomycin

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37
Q

Given orally (and Drug of Choice) for the treatment of
staphylococcal enterocolitis or antibiotic-associated
pseudomembranous colitis (C.difficile)

A

Vancomycin

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38
Q

Which drug causes red man or red neck syndrome ?

A

Vancomycin
- infusion-related flushing over face and upper torso

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39
Q

AE of vancomycin

A

Ototoxicity (drug accumulation)
• Nephrotoxicity (drug accumulation)
• DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome

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40
Q

Effective against resistant Gram-positive organisms
(eg, MRSA, enterococci, VRE & VRSA)

Treatment of complicated skin/structure infections
caused by susceptible S.aureus

A

Daptomycin

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41
Q

This drug AE is Elevated creatine phosphokinases (recommended to discontinue coadmin. of statins)

A

Daptomycin

42
Q

Marked nephrotoxicity → mainly topical use

A

Bacitracin

43
Q

Bind reversibly to 30S subunit of ribosome, preventing attachment of aminoacyl tRNA

A

Tetracyclines

44
Q

Drugs of choice for:
• Chlamydia
• Mycoplasma pneumoniae
• Lyme disease
• Cholera
• Anthrax prophylaxis
• Rickettsia (Rocky Mountain Spotted Fever,
typhus)

A

Tetracyclines

45
Q

Tetracyclines are excrete in urine except

A

doxycycline
- through bile

46
Q

Discoloration & hypoplasia of teeth, stunting of
growth (generally avoided in pregnancy & not given in
children under 8y)
TERATOGENIC – all cross placenta & are excreted into
breast milk (FDA category D)
Photosensitization

A

Tetracyclines

47
Q

Generally used to treat complicated skin, soft tissue and intraabdominal infections. Increased risk of mortality has been observed compared with other antibiotics when used to treat serious infections

A

Tigecycline- glycylcyclines

48
Q

Glycylcycline Contraindications

A

Pregnancy & children <8y

49
Q

This drug only requires once daily dosing

A

Aminoglycosides
** Amikacin, Gentamicin, Tobramycin, Streptomycin,
Neomycin

50
Q

Concentration-dependent killing

A

aminoglycosides

51
Q

Time-dependent killing

A

penicillins, cephalosporins

52
Q

Covalently bind to 30S ribosomal subunit prior to
ribosome formation leading to irreversible inhibition of initiation complex :
• misreading of mRNA, &
• blockade of translocation

A

Aminoglycosides

53
Q

Aminoglycosides resistance

A

Inactivated by acetylation, phosphorylation and adenylation

54
Q

Drugs of choice for:
• Empiric therapy of infective endocarditis

A

Gentomycin and vancomycin

55
Q

AE OF AMINOGLYCOSIDES

A

Ototoxicity
• Nephrotoxicity
• Neuromuscular blockade (myasthenia gravis =
contraindicated)
• Pregnancy (contraindicated unless benefits outweigh risks – FDA Category D)

56
Q

Used as adjunct in treatment for hepatic
encephalopathy

A

Oral neomycin
- reduces gut flora to reduce the nitrogen containing compounds that can cross the BBB

Other alternatives
• Lactulose
• Oral vancomycin
• Oral metronidazole
• Rifaximin

57
Q

Who traps NH4 in colon effectively reducing
plasma ammonia concentrations

A

Lactulose

58
Q

Reversibly bind to the 23S rRNA of the 50S subunit
blocking translocation

A

Macrolides
- Erythromycin, Clarithromycin, Azithromycin
- mainly treats gram pos infections
- bacteriostatic

59
Q

DOC for whooping cough (B.pertussis)

A

Erythromycin

60
Q

These macrolides inhibit CYP450

A

Erythromycin & clarithromycin

61
Q

inhibit protein synthesis in mitochondrial ribosomes
→ bone marrow toxicity

Very broad spectrum

A

Chloramphenicol

62
Q

Inhibits hepatic oxidases (3A4 & 2C9)

A

Chloramphenicol

63
Q

Drug causes bone marrow depression and Gray baby syndrome (cyanosis)

A

Chloramphenicol

64
Q

Number 1 drug for Potentially fatal pseudomembranous colitis (superinfection of C.difficile)

A

Clindamycin
- ampicillin also causes this problem

65
Q

treatment of infections caused by drugresistant Staphylococci or VRE

A

Streptogramins
Quinupristin, Dalfopristin

66
Q

Inhibitors of CYP 3A4

A

Streptogramin

67
Q

Oral bioavailability 100%

A

Linezolid

68
Q

Cannot combine linezolid with

A

antidepressants
- non selective inhibitor of MAO
- like SSRIs bc it is a weak reversible inhibitor of MAO
- can lead to serotonin syndrome

69
Q

Only treats C. difficile

A

Fidaxomicin

70
Q

Antibiotic belonging to monoxycarbolic acid class
• Activity against most Gram-positive cocci, including
MRSA and most streptococci (but not enterococci)

A

Mupirocin

71
Q

How is mupirocin given

A

Intranasal:
• Eradication of nasal colonization with MRSA in
adult patients and healthcare workers
• Topically:
• Treatment of impetigo or secondary infected
traumatic skin lesions

72
Q

Fluoroquinolones

A

Second generation
Ciprofloxacin
Third generation
Levofloxacin
Fourth generation
Gemifloxacin, Moxifloxacin

73
Q

Inhibit bacterial DNA replication via interference with
topoisomerase II (DNA gyrase) & IV

A

Fluoroquinolones

74
Q

Gram -ve activity with some activity against Gram +ve and atypical organisms.
Synergistic with b-lactams

A

Ciprofloxacin

75
Q

Expanded Gram -ve activity
Improved activity against Gram +ve and atypical organisms. Excellent activity against S.pneumoniae

A

Levofloxacin

76
Q

Improved Gram +ve activity and anaerobic activity

A

Moxifloxacin and Gemifloxacin

77
Q

Travelers diarrhea
P.aeruginosa (CF patients)
Prophylaxis against meningitis
(alternative to ceftriaxone & rifampin)

A

Ciprofloxacin
2nd gen

78
Q

Prostatitis
STD’s (not syphilis)
Skin infections
Acute sinusitis, bronchitis, TB
Community acquired pneumonia

A

Levofloxacin
3rd gen

79
Q

Community acquired pneumonia

A

Moxifloxacin and gemifloxacin

80
Q

Fluoroquinolones AE

A

Connective tissue problems (avoid in pregnancy,
nursing mother, under 18’s) – Black Box Warning!
• Peripheral neuropathy (FDA warning)
• QT prolongation (moxifloxacin, gemifloxacin,
levofloxacin)
• High risk of causing superinfections (C.difficile, C
albicans, streptococci)

81
Q

Inhibit bacterial folic acid synthesis
• Synthetic analogs of PABA (p-amino-benzoic acid)
• Competitive inhibitors (& substrate) of dihydropteroate synthase

A

Sulfonamides
Sulfamethoxazole, Sulfadiazine, Sulfisoxazole

82
Q

Sulfonamides AE

A

Crystalluria (nephrotoxicity)
• Hypersensitivity reactions
• Hematopoietic disturbances (esp. patients with G6PD deficiency)
• Kernicterus (in newborns and infants <2 months)

** Ceftriaxone (2nd gen cephalosporins also causes kernicterus)

83
Q

inhibitor of bacterial dihydrofolate reductase

A

Trimethoprim

84
Q

Drug used for
- UTI’s
- Bacterial prostatitis
- Bacterial vaginitis

Antifolate effects (contraindicated in pregnancy)

A

Trimethoprim

85
Q

Combination of trimethoprim & sulfamethoxazole

A

Cotrimoxazole

Synergistic: inhibition of sequential steps in
tetrahydrofolic acid synthesis

86
Q

Uncomplicated UTI’s (drug of choice)

A

Cotrimoxazole

87
Q

PCP (drug of choice)
Nocardiosis (drug of choice)
Toxoplasmosis (alternative drug)

A

Cotrimoxazole

88
Q

Contraindicated in pregnancy (esp. 1st trimester)

A

Cotrimoxazole

89
Q

Anaerobic conditions are vital for optimal activity
• Undergoes reductive bioactivation of its nitro group by ferredoxin
• Forms cytotoxic products that interfere with nucleic acid synthesis → damage DNA

A

Metronidazole

90
Q

Metronidazole AE

A

Disulfiram-like effect (avoid alcohol)
Headache, dark coloration of urine, metallic taste
Not advised in 1st trimester

91
Q

Blocks transcription by binding to b subunit of bacterial DNA-dependent RNA polymerase
→ leading to inhibition of RNA synthesis

A

Rifampin

92
Q

Patient not responding to vancomycin to treat mycobacteri. What to use ?

A

Rifampin

93
Q

Rifampin resistance

A

Point mutations in rpoB, the gene for the b subunit of RNA polymerase
→ decreased affinity of bacterial DNA-dependent RNA polymerase for drug
• Decreased permeability

94
Q

Treatment for

  • TB
    • Prophylaxis for individuals exposed to meningitis
    • Prophylaxis in contacts of children with H.influenzae
    type B
    • MRSA (with vancomycin)
A

Rifampin

95
Q

Imparts harmless orange/red color to bodily fluids
• Strongly induces most CYP P450 isoforms
• SAFE IN PREGNANCY

A

Rifampin AE

96
Q

Attach to and disrupt bacterial cell membranes
Also, bind to and inactivate endotoxin
Gram-positive bacteria are resistant
Extremely nephrotoxic

A

Polymyxin B

97
Q

This drug is contraindicated in patients with

  • Significant renal insufficiency
    • Pregnancy at term (38-42 weeks)
    • Infants <1 month (risk of hemolytic anemia)
A

Nitrofurantoin
- may cause hemolytic anemia (G6PD deficient patients)

98
Q

What is the empiric antibacterial treatment for infective endocarditis?

A

Vancomycin and gentamicin (due to emergence of
MRSA and penicillin-resistant streptococci)

99
Q

When can Rifampin be added to empiric antibacterial treatment for infective endocarditis?

A

In the presence of a prosthetic heart valve.

Linezolid or daptomycin are options for patients with
intolerance to vancomycin of resistant organisms.

100
Q

What is the antibacterial treatment for infective
endocarditis caused by a-hemolytic streptococci?

A

Penicillins (penicillin G and ampicillin) often in
combination with gentamicin.

MNI pharm (7 decks)

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