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Infectious Disease and Medical Microbiology > Antibiotic Therapy > Flashcards

Antibiotic Therapy Flashcards

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0
Q

Mechanism of action of glycopeptides

A

Inhibition of bacterial cell wall synthesis. Work at an earlier stage than do beta-lactams.

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1
Q

Vancomycin is a “BLANK”

A

Glycopeptide

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2
Q

Daptomycin is a “BLANK”

A

Lipopeptide

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3
Q

Mechanism of action of Lipopeptides

A

Disruption of cell wall.

  • Calcium dependent
  • Depolarizes cell membrane
  • Disrupts RNA, DNA, protein synthesis –> cell death
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4
Q

In general, Glycopeptides/Lipopeptides are active against:

A

Gram +ve organisms, including beta-lactam resistant organisms (i.e. MRSA)

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5
Q

Are Glycopeptides/Lipopeptides bacteriostatic or bactericidal?

A

Bactericidal

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6
Q

This Glycopeptide is slowly cidal, and when given PO is not systemically absorbed

A

Vancomycin

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7
Q

Lung surfactant inactivates “BLANK”; therefore, this agent should not be used to treat pneumonia!

A

Daptomycin

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8
Q

Spectrum and indications for Vancomycin IV

A

Spectrum: Gram +ve (Enterococci, penicillin resistant Streptococci, MRSA, CNS

Indications: Bacteremia, pneumonia, endocarditis, bone/joint, SSTI, surgical prophylaxis

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9
Q

Spectrum and indications for Vancomycin PO

A

Spectrum: C. difficile

Indications: C. difficile infection

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10
Q

Spectrum and indications for Daptomycin IV

A

Spectrum: Gram +ve (Enterococci, penicillin-resistant Streptococci, MRSA, CNS, and VRE)

Indications: Bacteremia, endocarditis, bone/joint, SSTI

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11
Q

Gentamycin and Tobramycin are both “BLANKS”

A

Aminoglycosides

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12
Q

Mechanism of action for Aminoglycosides

A

Inhibit protein synthesis by binding the 30S ribosomal subunit

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13
Q

Are Aminoglycosides bacteriostatic or bactericidal?

A

Bactericidal

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14
Q

Aminoglycosides are renally excretable and may cause the following toxicities (2)

A
  1. Nephrotoxicity

2. Ototoxicity

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15
Q

Gentamicin and beta-lactams act synergistically against what?

A

Enterococci

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16
Q

Spectrum and indications for Gentamicin IV

A

Spectrum: Gram -ve, Pseudomonas, synergy vs Streptococci and Enterococci with beta-lactam or vancomycin

Indications: Drug resistant UTI, combination therapy for Gram -ve sepsis, synergy for Gram +ve bacteremia and endocarditis

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17
Q

Spectrum and indications for Tobramycin IV

A

Spectrum: Gram -ve, Pseudomonas (better than gentamicin)

Indications: Drug resistant UTI, combo therapy for serious Pseudomonas infections

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18
Q

Azithromycin is a “BLANK”

A

Macrolide

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19
Q

Mechanism of action for Macrolides

A

Inhibit protein synthesis by binding the 23S rRNA in the 50S ribosomal subunit

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20
Q

Macrolides are active against intracellular organisms, true or false?

A

TRUE

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21
Q

Are Macrolides bacteriostatic or bactericidal?

A

Bacteriostatic

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22
Q

Does Azithromycin have a long or short half life?

A

LONG

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23
Q

Spectrum and indications for Azithromycin IV/PO

A

Spectrum: Mycoplasma, Chlamydophila, Legionella, M. catarrhalis, Chlamydia trachomatis, N. gonorrheae, MAC

Indications: Combo therapy for MAC Tx, MAC prophylaxis in HIV pt’s, 2nd line for STI’s, combo with beta-lactam for CAP

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24
Why is Azithromycin the preferred macrolide over erythromycin and clarithromycin? (5)
1. Broader spectrum 2. Fewer drug interactions 3. Once daily dosing 4. Tolerability 5. IV option
25
Clindamycin is a "BLANK"
Lincosamide
26
What is the mechanism of action of Clindamycin?
Inhibits proteins synthesis by binding to the 50S ribosomal subunit
27
What is the bioavailability of Clindamycin?
Excellent
28
Is Clindamycin bacteriostatic or bactericidal?
Bacteriostatic
29
Clindamycin inhibits toxin production from what?
Group A Streptococcus
30
Clindamycin is used in combination with what other antibiotic to treat necrotizing faciitis?
Penicillin
31
Clindamycin is high risk for what?
C. difficile
32
Spectrum and indications for Clindamycin PO/IV
Spectrum: Streptococci, S. aureus, MRSA (if susceptible), anaerobes Indications: SSTI, bone/joint, abscesses, alternative for dental infections, polymicrobial infections in combo with Gram -ve agent, combo vs necrotizing faciitis
33
Doxycycline and Tigecycline fall under what family of antibiotics?
Tetracyclines/Glycylcyclines
34
What is the mechanism of action of Tetracyclines/Glycylcyclines?
Inhibits protein synthesis by binding the 30S and 50S ribosomal subunits
35
Tetracyclines/Glycylcyclines are bacteriostatic, true or false?
TRUE
36
Tetracyclines and Glycylcyclines are active against intracellular pathogens, true or false?
TRUE
37
Spectrum and indications for Doxycycline PO
Spectrum: Mycoplasma, Chlamydophila, Legionella, Chlamydia trachomatis, S. pneumoniae, Haemophilus, Moraxella, S. aureus (including MRSA) Indications: COPD, CAP, Chlamydial STIs, purulent cellulitis (suspected MRSA)
38
Spectrum and indications for Tigecycline IV
Spectrum: Broad spectrum, Gram +ve (E. faecalis, MRSA), Gram -ve, anaerobes Indications: Last line option of polymicrobial, multidrug resistant organisms if susceptibility confirmed
39
3 problems with Tetracycline PO
1. Requires QID dosing on an empty stomach 2. Poorly tolerated 3. Narrower spectrum than Doxycycline
40
Ciprofloxacin and Levofloxacin are both "BLANKS"
Fluoroquinolones
41
What is the mechanism of action of Fluoroquinolones?
Inhibition of DNA gyrase and topoisomerase
42
Bioavailability of Fluoroquinolones
EXCELLENT
43
Are Fluoroquinolones bacteriostatic or bactericidal?
Bactericidal
44
What 2 Fluoroquinolones are active against intracellular pathogens?
1. Levofloxacin | 2. Moxifloxacin
45
Fluoroquinolones are high risk for C. difficile, true or false?
TRUE
46
Widespread use of Fluoroquinolones is leading to the development of resistance by which type of bacteria?
Gram -ve
47
Spectrum and indications for Ciprofloxacin IV/PO
Spectrum: Gram -ve, Pseudomonas Indications: Not usually 1st line due to increasing Gram -ve resistance, UTI, in combo with metronidazole or clindamycin for polymicrobial infections
48
Spectrum and indications for Levofloxacin IV/PO
Spectrum: Streptococci, Mycoplasma, Chlamydophila, Legionella, Gram -ve Indications: Not 1st line, reserve for suspected drug-resistant respiratory infections or allergy to 1st line agents.
49
Moxifloxacin is a respiratory fluoroquinolone, what is the risk of C. difficile with this drug?
High
50
Which Fluoroquinolone is active against multidrug resistant TB?
Moxifloxacin
51
Which Fluoroquinolone has no Pseudomonas activity and does not get to therapeutic concentration in the urinary tract?
Moxifloxacin
52
TMP-SMX and Nitrofurantoin are considered to be part of what family of antibiotics?
Anti-folates
53
Mechanism of action of Trimethoprim-sulfamethoxazole
Together they inhibit purine synthesis, preventing DNA synthesis
54
What is the mechanism of action of nitrofurantoin?
It is reduced inside the cell to produce reactive intermediates that cause cellular damage. There is minimal resistance due to complex mechanism.
55
TMP/SMX acts as a "BLANK" agent
Bacteriostatic
56
The bioavailability of TMP/SMX is...
EXCELLENT (PO)
57
Nitrofurantoin is (bacteriostatic/bactericidal), and only achieves therapeutic concentrations in (urine/blood)
Bactericidal, Urine
58
Nitrofurantoin is effective for cystitis, but not "BLANK"
Pyelonephritis
59
Spectrum and indications for Trimethoprim/Sulfamethoxazole IV/PO
Spectrum: Gram -ve, S. aureus (MRSA), S. pneumoniae, Nocardia, Pneumocystis jiroveci Indications: UTI (not first line), purulent cellulitis (MRSA), Nocardia infections, PCP Tx and prophylaxis
60
Spectrum and indications for Nitrofurantoin PO
Spectrum: E. coli, Klebsiella, E. faecalis Indications: 1st line for cystitis
61
Metronidazole is in which family of antibiotics?
Nitroimidazoles
62
What is the mechanism of action for Metronidazole?
It inhibits DNA synthesis
63
What is the bioavailability of Metronidazole?
EXCELLENT - also has excellent penetration of the CNS
64
What should you avoid when taking Metronidazole?
Alcohol (disulfiram reaction)
65
Spectrum and indications for Metronidazole PO/IV
Spectrum: Anaerobes (including C. difficile), Protozoa (i.e. Giardia) Indications: C. difficile, used in combo for polymicrobial infections/abscesses, trichomoniasis
66
Linezolid belong to this class of antibiotics...
Oxazolidinones
67
Mechanism of action for Linezolid
Inhibits protein synthesis by binding to 23S rRNA in 50S ribosomal subunit - prevents the formation of 70S ribosome.
68
Bioavailability of Linezolid...
EXCELLENT
69
Linezolid is bacteriostatic/bactericidal...
Bacteriostatic
70
What is there a risk of with prolonged use (> 2 weeks) of Linezolid?
Cytopenias
71
Linezolid has activity against beta-lactam and vancomycin resistant organisms, true or false?
TRUE
72
Spectrum and indications for Linezolid PO/IV
Spectrum: Streptococci, Enterococci, Staphylococci, anaerobes Indications: Resistance, allergy or failure with vancomycin therapy
73
Which 4 drugs were presented as anti-tuberculosis drugs?
1. Rifampin 2. Isoniazid 3. Pyrazinamide 4. Ethambutol
74
The 4 drug combo used for TB is bacteriostatic/bactericidal?
Bactericidal
75
Anti-tuberculosis drugs are poorly absorbed, true or false?
FALSE
76
Rifampin is a potent inhibitor/inducer of CYP 3A4?
Inducer
77
What type of toxicity should you monitor for when giving someone the empirical 4 drug combo for TB?
Hepatotoxicity
78
Indications for Rifampin
Penetrates Staph biofilms, TB, MAC, latent TB Tx
79
Indications for Isoniazid
TB and latent TB Tx
80
Indications for Pyrazinamide
TB
81
Indications for Ethambutol
TB, MAC
82
How much can you save by switching to Geico?
15% or more
83
Which antibiotics are effective against MRSA?
1. Vancomycin IV (PO is not systemically absorbed) 2. Daptomycin IV 3. Clindamycin PO/IV (if susceptible..) - High risk of C. difficile! 4. Doxycycline PO 5. Tigecycline IV (last line option) 6. TMP/SMX IV/PO 7. Linezolid PO/IV (expensive, cytopenias with prolonged Tx)

Infectious Disease and Medical Microbiology (23 decks)

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