Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Antibiotic Review > Flashcards

Antibiotic Review Flashcards

(110 cards)

Start Studying
1
Q

How to select an antibiotic?

A
  1. What bacteria are you trying to target?
  2. What is the antibiotic spectrum of coverage?
  3. Are there any contraindications or side effects to consider?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Characteristics of gram positive bacteria?

A

Thick cell wall
2-layer envelope
NO porin channel
NO endotoxin
Vulnerable to lysozyme and PCN

*Lyzozyme: small enzyme that attacks cell walls of bacteria, part of natural immune system
**Gram positive bacteria stain purple on gram stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Characteristics of gram negative bacteria?

A

Thin cell wall
3-layer cell envelope
Porin channel
Resistant to lysozyme and PCN

**stains pink/red on gram stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gram + vs. gram - cell wall picture (flip for reference)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of aerobic gram positive organisms

A

Streptococcus
Staphylococcus
Enterococcus
Corynebacterium
Listeria

Aerobbic gram positive organisms have enzymes to break down O2 (unlike anaerobes), therefore, blood cultures are taken in 2 tubes (1 w/ oxygen and 1 w/o)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Types of anaerobic gram positive organisms

A

Peptococcus
Peptostreptococcus
Clostridia (C. diff)
Propionibacterium acnes

Anaerobic gram positive organisms are associated with acne, above diaphragm, tooth abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Types of aerobic gram negative organisms

A

Enterobacteriaceae (E coli, Klebsiella, Proteus, Enterobacter, Serratia, Providencia, Salmonella, Shigella, Morganella, Citrobacter)
Moraxella
Haemophilus
Neisseria
Pseudomonas
Helicobacter
Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of anaerobic gram negative organisms

A

Bacteroides
Fusobacterium

Of note: anaerobics generally below diaphragm (diabetic foot ulcers, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Types of atypical organisms (neither gram + or gram -)

A

Chlamydia
Chlamydophila
Rickettsia
Mycoplasma (no cell wall)
Spirochetes (Syphilis, Lyme Disease)
Mycobacterium (TB, mycobacterium avium intracellulare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 main MOAs for most antibiotics?

A

Inhibit cell wall production, inhibit protein synthesis (30s or 50s ribosome), inhibit DNA synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Examples of antibiotics that inhibit cell wall synthesis

A

Beta-Lactams
(Penicillins, Cephalosporins, Carbapenems)

Vancomycin

Glycopeptides

Fosfomycin

Bacitracin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Examples of antibiotics that inhibit protein synthesis

A

Macrolides (50s)

Ketolides (50s)

Oxazolidinones (50s)

Clindamycin (50s)

Aminoglycosides (30s)

Tetracyclines (30s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of antibiotics that inhibit DNA synthesis

A

Fluoroquinolones (topoisomerase)

Sulfamethoxazole/Trimethoprim (folic acid antagonist)

Rifampin (RNA polymerase)

Metronidazole “alters” DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some bactericidal antibiotics (“kills the bacteria”)?

A

Beta Lactams

Fluoroquinolones

Glycopeptides

Aminoglycosides

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some bacteriostatic antibiotics (“prevents the growth of bacteria”)?

A

Tetracyclines

Macrolides

Lincosamides

Sulfonamides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Spectrum of penicillins?

A

Gram-positive (S. pneumo and Staph resistance), gram-negative, anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

AEs of penicillin?

A

Hypersensitivity, GI, hematological, seizures

Mostly renal elimination (adjust if CKD) EXCEPT nafcillin (hepatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe examples, spectrum, and use of natural penicillins

A

Pen G, Pen VK, Procaine, Benzathine

Spectrum: T. pallidum, streptococcus,
enterococcus,
Neisseria meningitidis,
Borrelia burgdorferi (all gram +)

Use: Syphilis, Strep pyogenes, Lymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe examples, spectrum, and use of anti stapholococcal penicillins

A

Dicloxacillin, Nafcillin, Oxacillin, Methicillin

Spectrum: Staphylococcal and streptococcal infections (all gram +)

Use: MSSA, skin infections (mastitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe examples, spectrum, and use of amino penicillins

A

(IV Ampicillin, PO Amoxicillin)

Spectrum: GAS, GBS, enterococci, listeria, Borrelia burgdorferi, H. pylori (all gram +)

Use: Respiratory tract infections, Lymes, GI ulcers, UTI, endocarditis prophylaxis*

Amox + Mono = maculopapular rash*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe examples, spectrum, and use of extended spectrum penicillins

A

Piperacillin, Ticarcillin

Spectrum: Gram positives and negatives including pseudomonas

Use: IV only, serious infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Examples agents of beta-lactamase inhibitors

A

Oral = amoxicillin/clavulanate (Augmentin)
IV = ampicillin/sulbactam (Unasyn), piperacillin/tazobactam (Zosyn), ticarcillin/clavulanate (Timentin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Spectrum, use, and AEs of beta-lactamase inhibitors?

A

Spectrum: extends spectrum to beta-lactamase producing organisms (Staph aureus, Moraxella Haemophilus, Neisseria, Bacteroides, Enterobacteriaceae)

Use: Amox-clav = respiratory tract infections, dental infections, animal bites, skin infections

AE: diarrhea (clavulanate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Example agents of first generation cephalosporins?

A

Oral: cephalexin (Keflex)
Parenteral: cefazolin (Ancef)

All have ph except Cefazolin, but don’t let that faze you

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Spectrum and use of first generation cephalosporins?
Spectrum: **Gram positives** (staph/strep), MSSA, limited gram negatives (E. coli, Klebsiella), oral anaerobes Use: Skin infections, streptococcal infections, pre-op prophylaxis
26
Example agents of second generation cephalosporins?
Oral: cefuroxime (Ceftin) Parenteral: cefuroxime, cefoxitin, cefotetan The **fam**ily is gathered, some wearing **fur** coats, and your **fox**y cousin is drinking **te**a
27
Spectrum and use of second generation cephalosporins?
Spectrum: **Less gram positive, more gram negative than first generation.** H influenzae, Moraxella, Neisseria, Enterobacter, Borrelia burgdorferi. Use: Respiratory tract infections, UTI, Lyme, skin infections
28
Example agents of third generation cephalosporins?
PO: cefpodoxime, cefixime, cefdinir (Omnicef), ceftibuten IV: ceftriaxone (Rocephin) Most end in the suffix -**me**. **Din**e **A**l**one** (Ce**din**ir and Ceftri**a**x**one**)
29
Spectrum and use of third generation cephalosporins?
Spectrum: **Less gram +, more gram -** **(including pseudomonas) ** Use: Respiratory, skin (not great), UTI, gonorrhea, meningitis
30
Example agents of fourth generation cephalosporins?
IV: cefepime (Maxipime)
31
Spectrum and use of fourth generation cephalosporins?
Spectrum: **Gram + and - coverage (including Pseudomonas) ** Use: Unknown cause of infection pending blood cultures
32
Example agents of fifth generation cephalosporins?
IV: ceftaroline
33
Spectrum and use of fifth generation cephalosporins?
Spectrum: **Gram + and - coverage (*NOT* including Pseudomonas) ** Use: MRSA and resistant S. pneumoniae “Think Ceftriaxone + MRSA coverage”
34
MOA of carbapenems?
Inhibits cell synthesis
35
Carbapenem agents?
Imipenem, meropenem, ertapenem **(ALL IV)**
36
Spectrum and AEs of carbapenems?
Spectrum: VERY BROAD (includes ESBL organisms) "Heavy hitters" **Ertapenem is the only carbapenem with NO pseudomonas coverage (narrower spectrum) ESBL: extended-spectrum beta-lactamases
37
AEs of carbapenems?
Hypersensitivity (penicillins), GI, seizures, hypotension
38
MOA of monobactams?
Inhibit cell wall synthesis
39
Monobactam agents?
IV only aztreonam
40
Spectrum of monobactams?
Spectrum: aerobic gram negative only (including Pseudomonas) "Heavy hitters"
41
AEs of monobactams?
GI
42
Aztreonam pearls
Similar to aminoglycosides Little cross reactivity with PCN allergies Note renal dosing Is not often used unless allergic to something else
43
Fluoroquinolone MOA?
Inhibits DNA synthesis (topoisomerase - inhibit twisting of DNA)
44
FQ agents?
Ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin
45
FQ spectrum?
Gram + (moxifloxacin) Gram - (cipro and levo) Pseudomonas, atypicals (Chlamydia, Mycoplasma)
46
FQ use?
Good tissue penetration (bone and prostate), respiratory tract infections, UTIs (not first line), pyelonephritis, GI (Salmonella, Shigella, traveler’s diarrhea), PID, urethritis, cervicitis
47
FQ AEs?
AEs: QT prolongation, cartilage toxicity in pediatrics (avoid < 18 yo), avoid during pregnancy, photosensitivity, increased LFTs, hypo/hyperglycemia **BBW**: tendinitis/tendon rupture, peripheral neuropathy, exacerbation of myasthenia gravis, CNS (hallucinations, depression and anxiety)
48
FQ drug interations?
Drugs affecting QT interval and/or blood glucose, theophylline, warfarin (increases INR)
49
FQ pearls
Renal and hepatic elimination Try to use something else before jumping to FQ Hold vitamins (such as Iron or Zinc) - binds to FQs and are not absorbed as well
50
Macrolide MOA?
Inhibit protein synthesis
51
Macrolide agents?
Erythromycin, clarithromycin, azithromycin
52
Macrolide spectrum?
Gram positive Gram negative (no Pseudomonas/Enterobacteriaceae) Atypicals (Mycoplasma, Chlamydia, Rickettsia, Legionella)
53
Macrolide use?
Respiratory tract infections, Lyme, H pylori, chlamydia, gonorrhea
54
Macrolide AEs?
GI (stimulates motility), ototoxicity, prolongs QT interval Inhibits cytochrome P450 = many drug interactions (ex. warfarin, statins) Hepatic elimination
55
Macrolide pearl
Good if PCN allergies Azithromycin longer half life. That's why only dose for 5 days (half life 2-4 days). Erythromycin = more narrow spectrum
56
Tetracycline MOA?
Protein synthesis inhibitors
57
Tetracycline agents?
Tetracycline, doxycycline, minocycline
58
Tetracycline spectrum?
P. acne, H. pylori, Rickettsia, Chlamydia, Mycoplasma, B. burgdorferi, T. pallidum, MRSA **Good for atypicals**
59
Tetracycline uses?
Acne, respiratory tract infections, community-acquired pneumonia, Lyme disease, GI ulcers, Rocky Mountain Spotted Fever, chlamydia, community-acquired MRSA
60
Tetracycline AEs?
Photosensitivity, deposition in teeth/bone (AVOID in pregnancy, OK in children < 8 yo for < 21 days), hepatotoxicity, transient vestibular dysfunction (minocycline) Chelation of Mg and Zinc, warfarin AVOID with isotretinoin, risk of pseudotumor cerebri
61
Aminoglycoside MOA?
Protein synthesis inhibitors
62
Aminoglycoside agents?
**IV ONLY**: gentamicin, tobramycin, amikacin
63
Aminoglycoside spectrum?
Aerobic gram-positives and negatives (including Pseudomonas aeruginosa) "Heavy hitters"
64
Aminoglycoside use?
Generally gram negative infections in hospital Used for empiric therapy of serious infection
65
Aminoglycoside AEs?
Nephrotoxicity (acute tubular necrosis), ototoxicity (SN hearing loss), neuromuscular blockade
66
Aminoglycoside monioring?
Yes Monitor serum concentrations (renally excreted)
67
Aminoglcoside pearls
Streptomycin = highly toxic, rarely used AVOID for patients on loop diuretics as both increase risk of ototoxicity Aminoglycosides: decrease release of ACh in synapse and act as a neuromuscular blocker, this is why it can enhance effects of muscle relaxants Most often used in combination, syndergistic effect with agents that affect cell wall integrity Dose is concentration dependent
68
Sulfonamide MOA?
Inhibit folic acid synthesis
69
Sulfonamide agents?
Bactrim (TMP/SMX AKA Trimethoprim/Sulfamethoxazole)
70
Sulfonamide spectrum?
Gram positive and gram negatives (**NO Pseudomonas**), increasing resistance
71
Sulfonamide uses?
Respiratory tract infections, UTI, PCP, community-acquired MRSA
72
Sulfonamide AEs?
GI, hypersensitivity, photosensitivity, maculopapular rash, QT prolongation, “yellow babies” (AKA newborn kenicterus, avoid use in pregnancy near term), myelosuppression, hemolytic anemia (avoid if G6PD)
73
Sulfonamide drug-drug interactions?
Warfarin, sulfonylureas, caution with ACEi and ARBS (hyperkalemia)
74
General antibiotic classes to be cautious with QT prolongation?
FQs, macrolides, and sulfas
75
Metronidazole (Flagyl) MOA?
Inhibits protein synthesis by interacting with DNA
76
Metronidazole ROA?
PO and IV
77
Metronidazole spectrum?
**Anaerobes** (Bacteroides, C diff - best below diaphragm, parasites, H pylori)
78
Metronidazole use?
Trichomonas, C difficile, H pylori **Good atypical coverage**
79
Metronidazole AEs?
EtOH intolerance (flushing, tachycardia, n/v, hypotension, dyspnea) Interactions with warfarin
80
Lincosamide MOA?
Inhibits protein synthesis
81
Lincosamide agent?
Clindamycin
82
Clindamycin spectrum?
Gram positive and anaerobes (above diaphragm)
83
Clindamycin use?
MRSA, PCN allergic patients, acne, hidradenitis (topical)
84
Clindamycin AEs?
Bad taste (kids hate), esophageal irritation, hepatotoxicity, pseudomonas colitis (C.diff)
85
Nitrofurans agents?
PO nitrofurantoin (Macrobid)
86
Nitrofurantoin spectrum?
Covers gram positive and gram negative Most urinary pathogens (enterococci, gram negative bacilli)
87
Nitrofurantoin AEs?
Pulmonary fibrosis with long term use, hemolytic anemia, kidney stones Renal excretion
88
Lipo/glycopeptide MOA?
Inhibits cell wall synthesis
89
Lipo/glycopeptide agents?
**Vancomycin**, daptomycin, telacancin, oritavancin, dalbacancin "Heavy hitter"
90
Vancomycin spectrum?
MRSA coverage PO: C diff IV: endocarditis, staph inf, empiric therapy when MRSA suspected
91
Vancomycin use?
**Therapy of choice for serious gram positive staphylococcal infections** when the penicillins and cephalosporins cannot be used Also covers other gram-positive cocci and bacteria and gram-negative cocci
92
Vancomycin AEs?
Infusion reactions, **red man syndrome**, nephrotoxocity, drug induced immune thrombocytopenia, neutropenia, pancytopenia, ototoxicity
93
Oxazolinone MOA?
Inhibits protein synthisis, suppress bacterial production of toxins
94
Oxazolinone agents?
Linezolid, Tedizolid
95
Oxazolinone spectrum?
Gram positive organisms "Heavy hitters"
96
Oxazolinone use?
Linezolid: PNA, skin and soft tissue infections, vancomycin-resistant enterococcus; MRSA coverage
97
Oxazolinone AEs?
Myelosuppression (duration dependent), peripheral/optic neruopathy (duration and dose dependent), hypoglycemia, hepatotoxicity, lactic acidosis, **serotonin syndrome with linezolid**
98
Linezolid monitoring?
Yes: weekly CBC, BMP, LFT if taking > 7 days; neuro and ophtho assessment if taking > 28 days
99
MRSA treatments?
PO: Linezolid and tedizolid IV: Vancomycin Community Acquired: SMX-TMP, clindamycin, tetracyclines Hospital Acquired: Vancomycin (Drug of choice), linezolid, daptomycin, Synercid
100
Vancomycin pearls?
IV best for MRSA PO best for C. diff AEs: Red man’s syndrome (increased histamine), ototoxicity, nephrotoxicity Pretreat with diphenhydramine and slower infusion rate to prevent Red Man’s Syndrome (not a true allergy)
101
What antibiotics have MRSA coverage?
Doxycycline, ceftaroline (5th gen), clindamycin (only some coverage), delafloxacin, bactrim, vancomycin, linezolid and tedizolid
102
What antibiotics have Pseudomonas coverage?
Cefepime (4th gen) , cefiderocol (5th gen), FQs, ceftazidime, pip-tazo, **tobramycin (best for pseudomonas)**, gentamycin, aztreonam, imipenem (must use with cilstatin), metropenem Also: polymyxin B (eye drops); 5th gen cephalosporins are antipseudomonal
103
What antibiotics are renally excreted?
Beta lactams (mostly) Glycopeptides (Vancomycin) Aminoglycosides Nitrofurans
104
What antibiotics have a mixed renal/hepatic excretion?
Fluoroquinolones Tetracyclines
105
What antibiotics are hepatically excreted?
Ceftriaxone Macrolides Metronidazole Nafcillin (only PCN not renally excreted)
106
What antibiotics INCREASE INR?
Macrolides (clarithromycin) FQs (ciprofloxacin) Metronidazole (2-4x increase, esp. older adults) TMP/SMX (2-4x increase, esp. older adults)
107
What antibiotics DECREASE INR?
Rifampin
108
Category B antibiotics?
Most Beta Lactams Clindamycin Azithromycin, Erythromycin Metronidazole (avoid in 1st trimester) PO Vancomycin Nitrofurantoin (avoid at term)
109
Category C antibiotics?
Clarithromycin Fluoroquinolones TMP/SMX (avoid 1st and 3rd trimesters) IV Vancomycin
110
Category D antibiotics?
Aminoglycosides Tetracyclines

Pharmacology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions