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Flashcards in Antibiotic Agents Deck (99):
1

Bactericidal Antibiotics

Very Finely Proficient At Cell Murder
Vancomycin
Fluoroquinolones
Penicillins
Aminoglycosides
Cephalosporins
Metronidazole

2

Bacteriostatic Antibiotics

ECSTaTiC
Erythromycin
Clindamycin
Sulfamethoxazole
Trimetoprim
Tetracycline
Chloramphenicol

3

What Bacteriostatic antibiotics become bactericidal when combined?

TMP - SMX

4

Define: Lowest concentration capable of inhibiting growth of an organism

Minimum Inhibitory Concentration

5

MOA of Which Class of Drugs?
Binds to PBP
Inhibits Transpeptidation Reation
Activates Autolytic Enzymes

Beta Lactams

6

Mechanisms for Penicillin Resistance

Beta-lactamases
Structural changes in target PBPs
Changes in porin structures

7

Narrow spectrum Penicillin
Drug of Choice for Syphilis
SE: Hypersensitivity, cross-allergenicity with similar drugs, GI disturbances

Penicillin G

8

Renal Tubular Reabsorption of this drug is inhibited by Probenecid

Penicillin G

9

VERY NARROW spectrum Penicillin
DOC for Staphylococcal infections
SE: Hypersensitivity, cross allergenicity with similar drugs, GI disturbances, INTERSTITIAL NEPHRITIS, NEUTROPENIA
Resistant to beta-lactamase

Methicillin
(Naf/Oxa/Cloxacillin)

Use Naf for Staph.

10

Extended spectrum Penicillin
Drug for Enterococci, Listeria, E. Coli, Proteus, H. Influenzae, MORAXELLA
SE: Pseudomembranous Colitis, Rash
Inactivated by beta-lactamase
Enhanced with beta-lactamase inhibitors
Synergistic effect with aminoglycosides

AMPicillin (AMPed up Penicillin)
(AmOxicillin) (greater Oral bioavailability)

11

Extended spectrum penicillins are effective for the following organisms

Hemophilus influenza
E. Coli
Listeria
Proteus
Salmonella spp.
Enterococci

Amoxicillin HELPS kill Enterococci

12

Anti-pseudomonal Penicillin
Drug for Pseudomonas, Enterobacter, Klebsiella
SE: Hypersensitivity, Cross-allergenicity with similar drugs, GI disturbances
Inactivated by beta-lactamase
Enhanced with beta-lactamase inhibitors
Synergistic effect with aminoglycosides vs. Pseudomonas

Piperacillin
(Ticarcillin, Carbenicillin)

13

Anti-pseudomonal antibiotic with anti-platelet activity

Ticarcillin

14

Drugs for Pseudomonas

Takes Care of Pseudomonas
Ticarcillin
Carbenicillin
Piperacillin

15

First Generation Cephalosporin
Binds to PBP, inhibits transpeptidation
Drug for Surgical Prophylaxis, Bone Infection, E. Coli, Klebsiella, Proteus
SE: Hypersensitivity, partial cross-allergenicity with penicillins
Increases nephrotoxicity of aminoglycosides

CeFAZolin

FADer help me FAZ my PHarmacology boards

16

First Generation Cephalosporins

FADer help me FAZ my PHarmacology boards
CeFADroxil
CeFAZolin
CePHalothin
CePHradine
CePHalexine

17

Second Generation Cephalosporin
Can cross BBB
Drug for Haemophilus, Enterobacter, and Neisseria
SE: Hypersensitivity, Disulfiram reaction with CefaMANdole and CefoTETan
Increases nephrogenicity of aminoglycosides

Cefamandole

FOXy FAMily in FUR, drinking TEa
CeFOXitin, CeFAMandole, CeFURoxime, CefoTEtan
FAC! LORA the PROfessional AZhOLE is on the FONe.
CeFAClor, LORAcarbef, CefPROzil, CefmetaZOLE, CeFONicid

18

Second Generation Cephalosporins

FOXy FAMily in FUR, drinking TEa
CeFOXitin, CeFAMandole, CeFURoxime, CefoTEtan
FAC! LORA the PROfessional AZhOLE is on the FONe.
CeFAClor, LORAcarbef, CefPROzil, CefmetaZOLE, CeFONicid

19

Third Generation Cephalosporin
Drugs for Pseudomonas and Bacteroides
SE: Hypersensitivity, Disulfiram reaction with Cefoperazone
Synergistic with AMINOGLYCOSIDES

FEnge Po ng PERA to FIX my TTTTTv
CeFEtamet
CefPOdoxin
CefoPERAzone
CeFIXime
CefTriaxone
CefTazidime
CefoTaxime
CefTizoxime
CefTibuten

20

Third Generation Cephalosporin

FEnge Po ng PERA to FIX my TTTTTv
CeFEtamet
CefPOdoxin
CefoPERAzone
CeFIXime
CefTriaxone
CefTazidime
CefoTaxime
CefTizoxime
CefTibuten

21

Wide coverage against gram positive and gram negative bacteria
SE: Hypersensitivity
Resistant to Beta-lactamase

CefePime

Porth (4th)

22

Anti-Pseudomonal Cephalosporins

CefTAZidime 3rd
CeFEPime 4th
CefoPERAzone 3rd

23

Carbapenem
Wide coverage against gram positive and gram negative bacteria
SE: Hypersensitivity, CNS Toxicity (Confusion, Enceph, Seizures)
Reserved for serious life threatening conditions

Imipenem-Cilastatin

24

This drug inhibits renal metabolism of Imipenem

Cilastatin

With Imipenem, Kill is LASTIN with CiLAStaTIN

25

Monobactam
Drug for Gram (-) Rods, NO GRAM +/Anaerobe COVERAGE
SE: superinfection
Resistant to Beta-lactamase
No cross allergenicity with penicillins

Aztreonam

26

Beta-lactamase inhibitor
Inhibits inactivation of penicillins by bacterial penicillinase
SE: Hypersensitivity
Usually combined with Amoxicillin, Ampicillin, and Piperacillin

Clavulanic Acid
(Sulbactam, Tazobactam)

27

Glycopeptide
Inhibits D-Ala D-Ala terminus of nascent peptidoglycan
Drug for MRSA, Pseudomembranous colitis
SE: Redman Syndrome, Nephrotoxicity, Ototoxicity
Reserved for serious life threatening infections

Vancomycin

28

First line drug for Pseudomembranous Colitis

Metronidazole

29

Tx for Redman syndrome

Slow down infusion rate

30

Drugs of Last Resort

I AM your Last Shot at Victory
Imipenem
Amikacin
Meropenem
Linezolid
Streptogrammins
Vancomycin

31

Peptide Antibiotic
Interferes with late-stage cel wall synthesis in Gram + bacteria
SE: Nephrotoxicity
Reserved for Topical Use only due to marked nephrotoxicity

Bacitracin

32

Antimetabolite
Blocks incorporation of D-Ala
2nd line drug for Drug-Resistant TB
SE: Neurotoxicity

Cycloserine

33

30s Inhibitors

Aminoglycosides
Tetracyclines

Buy AT 30

34

50s Inhibitors

Chloramphenicol
Erythromycin (Macrolides)
Lincosamides (Clindamycin)
Linezolid
Streptogrammins

CELLS at 50

35

Bactericidal Protein Synthesis Inhibitors

Aminoglycosides
Streptogrammins

36

Broad Spectrum Antibiotic
Bacteriostatic
Inhibits 50s
Drug for Meningitis (esp Neisseria), Backup for Salmonella Rickettsia, Bacteroides
SE: Aplastic Anemia, Gray Baby Syndrome

Chloramphenicol

37

Decreased RBC, Cyanosis and Cardiovascular Collapse
Ashen Gray Skin
Premature neonates with deficient glucuronosyltransferase

Gray Baby Syndrome

38

Binds to 30s subunit, Bacteriostatic
Drug for M. Pneumoniae, Chlamydia, Rickettsiae, Vibrio, PUD, SIADH
SE: Tooth enamel dysplasia/dyscoloration, Photosensitivity
Tigecycline has broadest spectrum

Tetracycline
(Doxycycline, Minocycline, Tigecycline, Demeclocyline)

LAHAT NG MAY -CYCLINE

39

Tetracycline with broadest spectrum

Tigecycline

40

Antibiotic that should NOT be take with Milk

Tetracyclines
(Decreased absorption)

41

Tetracycline for Acne

Doxycycline

42

Drug of Choice for Cholera

Class?

Tetracycline

43

Macrolide
Binds 50s, bacteriostatic
Prokinetic agent, stimulates GI motility
SE: Cholestatic hepatitis, QT prolongation, Drug interactions

Erythromycin
(Azithromycin, Clarithromycin, Telithromycin)

LAHAT NG MY -THROMYCIN

44

All Macrolides inhibit CYP450 EXCEPT

Azithromycin

45

Macrolide with highest Vd and slowest elimination

Azithromycin

46

Macrolide used for macrolide resistance

Telithromycin

47

Lincosamide
Binds 50s subunit, bacteriostatic
Drug for Anaerobic infections, PCP Pneumonia
SE: Pseudomembranous colitis (C. difficile overgrowth)
Cross resistance between macrolides is common

Clindamycin
(Lincomycin)

48

DOC for Anaerobic infections ABOVE the diaphragm

Clindamycin

49

DOC for Anaerobic infections BELOW the diaphragm

Metronidazole

50

Streptogramin
Binds 50s subunit, bactericidal
Drug for MRSA, VRSA, VRE
SE: Arthralgia-myalgia syndrome
Inhibits CYP450 enzymes, causing multiple drug interactions

Quinupristin-Dalfopristin

51

Oxazolidinone
Binds 50s subunit, bacteriostatic
Drug for MRSA, VRSA, VRE, Listeria, Corynebacteria

Linezolid

52

Identify Mode of Antibacterial Action:
As the plasma level is above the MIC, an increasing proportion of the bacteria are killed at a more rapid rate

Concentration-Dependent Killing Action

Seen in Aminoglycosides

53

Identify Mode of Antibacterial Action:
Efficacy is directly related to time above the MIC

Time-Dependent Killing Action

54

Greater efficacy when administered as a single large dose
Toxicity depends on a critical plasma concentration

Seen in which drug?

Postantibiotic effect

Seen in aminoglycosides and fluoroquinolones

55

Identify class of Antibiotics:
Not absorbed after oral
Limited Tissue Penetration
Glomerular Filtration is mode of excretion

Aminoglycosides

56

Aminoglycoside with narrowest therapeutic window

Amikacin

57

Antibiotics with this MOA are synergistic with Aminoglycosides

Cell Wall Inhibitors

58

Class of Antibiotics that require oxygen for reuptake
Binds to 30s

Aminoglycosides
Ineffective against anaerobes

59

Drugs with Postantibiotic Effect

Amikacin
Levofloxacin
Aminoglycosides
Fluoroquinolones

60

Resistance to this drug arises from
Group Transferases
Changes to ribosomal binding site

Aminoglycosides

61

Aminoglycosides

mean GNATS canNOT kill anaerobes
Gentamicin: Nephrotoxicity
Neomycin: Ototoxicity
Amikacin: Teratogen
Tobramycin
Streptomycin

62

Aminoglycoside that binds to 30s subunit, bactericidal
Drug for aerobic gram - bacteria, endocarditis, ocular infections
SE: Nephrotoxicity, Ototoxicity

Gentamicin
(Tobramycin)

63

Most vestibulotoxic and nephrotoxic aminoglycosides

Gentamicin
Tobramycin

64

Aminoglycoside
Binds to 30s, bactericidal
Drug for Pseudomonas, Drug Resistant TB (2nd line)
SE: Nephrotoxicity, Ototoxicity

Amikacin

65

Aminoglycoside with the least resistance and narrowest therapeutic window

Amikacin

66

Aminoglycoside
Binds to 30s, bactericidal
Drug for TB, Tularemia, Bubonic Plague, Brucellosis
SE: Nephrotoxic (reversible), Ototoxic (vestibulotoxic, Irreversible) Teratogen (Congenital Deafness)
Administered IM

Streptomycin

67

Aminoglycoside
Binds to 30s, bactericidal
Drug for bowel preparation for elective surgery, hepatic encephalopathy, Visceral Leishmaniasis
SE: Neuromuscular blockade
Limited to topical and oral use

Neomycin
(Kanamycin, Paromomycin)

68

Neuromuscular blockade from Neomycin may be reversed with _____________ and _________

Calcium Gluconate
Neostigmine

69

Most Ototoxic Aminoglycosides

Kanamycin
Amikacin

70

Aminoglycoside
Binds to 30s, bactericidal
Drug for gonorrhea in penicillin-allergic and drugresistant pxs
SE: Nephrotoxicity (reversible), Ototoxicity (irreversible), anemia

Spectinomycin

71

Most Nephrotoxic Aminoglycosides

Tobramycin
Gentamicin

72

Skin reactions are most common in which Aminoglycosides

Neomycin
Streptomycin

73

Short acting Sulfonamide

Sulfisoxazole

74

Intermediate acting Sulfonamide

Sulfamethoxazole

75

Long acting Sulfonamide

Sulfadioxine

76

Weakly acidic
Resembles PABA
Decreased solubility in Acidic Urine

Class?

Sulfonamides

77

Similar to Folic acid
Weak base
High concentrations in prostatic and vaginal fluids

Class?

Trimethoprim

78

Identify Drug Class:
MOA: competitive inhibitor of dihydropteroate synthesis

Sulfonamides

79

Identify Drug:
MOA: selective inhibitor of dihydrofolate reductase

Trimethoprim

80

Building block of DNA

Purines

81

Resistance to Antifolate drugs

decreased drugs
increased substrate
increased tolerance

82

Sulfonamide
Bacteriostatic
Drug for Burns
SE: Acute hemolysis in G6PD deficiency, hypersensitivity, kernicterus
Displaces protein binding of other drugs/bilirubin

Silver Sulfadiazine

83

Sequential blockade of dihydropteroate synthase and dihydrofolate reductase, bactericidal
Drug for urinary tract, P. Jirovecci pneumonia
SE: Acute hemolysis in G6PD deficiency, hypersensitivity, kernicterus
Displaces protein binding of other drugs/bilirubin

Co-Trimoxazole

84

Toxicity of Sulfonamides

Hypersensitivity
GI Distress
Hematotoxicity
Nephrotoxicity
Drug Interactions

85

Increased levels of unconjugated bilirubin
Due to immature BBB
Bilirubin deposits in basal ganglia and subcortical nuclei
Leading to hypo/hypertonia, lethargy, high-pitched cry, opisthotonos

Identify Disease

Kernicterus

86

MOA of which class of antibiotics:
Inhibits Topoisomerase II (DNA Gyrase) in Gram (-) organisms, Topoisomerase IV in Gram (+) organism
Usually bactericidal
Exhibits postantibiotic effect

Fluoroquinolones

87

Resistance of which class of antibiotics
Efflux pumps
changes in porin structure
changes in the sensitivity

Fluoroquinolones

88

Fluroroquinolones

Nalidixic Acid
Ciprofloxacin, Ofloxacin, Norfloxacin
Levofloxacin
Moxifloxacin, Gatifloxacin

89

Trend of Fluoroquinolone coverage
_________ generation, ________ Gram + activity

Increasing generation, increasing gram positive activity

90

Inhibits DNA gyrase and Topisomerase IV, bactericidal
Drug for UTI, Atypical Pneumonia, 2nd line for TB
SE: GI distress, Tendinitis and tendon rupture
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)

Ciprofloxacin
(Ofloxacin, Norfloxacin)

FLUOROquinoBONES!

91

3rd Generation
Inhibits DNA gyrase and topoisomerase IV, bactericidal
Drug for atypical pneumonia and lung infections
SE: GI distress, tendinitis, QTc prolongation (predispose to torsades)
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)

Levofloxacin
(Sparfloxacin, Grepafloxacin)

92

Aminoglycoside that was withdrawn due to severe cardiotoxicity (arrhythmia)

Grepafloxacin

93

4th Generation
Inhibits DNA gyrase, Topoisomerase IV, Bactericidal
Drug with broad spectrum activity and enhanced activity versus ANAEROBES
SE: GI distress, tendinitis, QTc prolongation, diabetes, hepatotoxicity
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)
Widest spectrum of activity

Moxifloxacin

94

Disrupts ETC by forming free radicals, Bactericidal
Drug for Anaerobic or mixed intra abdominal infections, Vaginitis, Pseudomembranous colitis
SE: GI Irritation, Metallic taste, Disulfiram Reaction

Metronidazole

95

Most common drug that causes Pseudomembranous colitis

Clindamycin

96

2nd line drug for Pseudomembranous colitis

Vancomycin

97

Dose of Metronidazole for Trichomonas infection

2grams

98

Bactericidal
Drug used for UTI (except Proteus and Pseudomonas) only uncomplicated
SE: Skin rashes, Pulmonary infiltrates

Nitrofurantoin

99

Pulmonary FIbrosis can be caused by the following drugs

BBBAN Me
Bleomycin
Busulfan
Bromocriptine
Amiodarone
Nitrofurantoin
Methotrexate