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Antibiotics Flashcards

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1
Q

Antibiotics that TREAT Gram -

A

FQs (CIPRO)

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2
Q

Antibiotics that TREAT Gram +

A

Macrolides
Clindamycin

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3
Q

Antibiotics that TREAT BOTH Gram -/+

A

PCN
Cephalosporins
Sulfa
Beta-lactam inhibitors
FQs
Tetracycline

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4
Q

LOCATION: Heart

A

strep (GM +)
s.epi (GM +)

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5
Q

LOCATION: Abdominal

A

e coli (GM-)
enterococcus (GM +)
anaerobes
GM -

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6
Q

LOCATION: Brain

A

strep (GM +)
staph (GM +)
N. meningitides
e coli (GM -)

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7
Q

LOCATION: Respiratory

A

strep (GM +)
moraxella
H. flu
mycoplasma

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8
Q

LOCATION: Skin

A

staph (GM +)
strep (GM +)

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9
Q

LOCATION: GU

A

e coli (GM -)
enterococcus (GM +)

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10
Q

PCN MOA (-cillins)

A

inhibit CELL WALL SYNTHESIS

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11
Q

PCN Pharmacokinetic Profile

A

SE: Allergic RXN, Diarrhea, GI upset, Bacterial overgrowth w/ prolonged repeated treatment

Interactions: BIRTH CONTROL

Med Admin: RENAL function, 10-14 days treatment

Education: SAFE PREGNANCY, EMPTY STOMACH

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12
Q

Beta-Lactam/Beta-Lactam Inhibitors MOA

A

Inhibit CELL WALL synthesis

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13
Q

Beta-Lactam inhibitor Pharmacokinetic profile

A

SE: GI EFFECTS N/V/D

Contraindications: PCN allergy

Education: EXPENSIVE

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14
Q

Cephalosporins MOA

A

inhibit CELL WALL SYNTHESIS

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15
Q

Cephalosporins Pharmacokinetic profile

A

SE: GI (Diarrhea, C diff); Allergy (skin rash)

RISK of pseudomembranous colitis

Hypersensitivity = PCN allergy

Med administration: RENAL function w/ high doses; watch RBC, BUN, UA w/ prolonged treatment

Education: mostly PO, IM dose painful; well absorbed in GI; SAFE PREGNANCY; take w/ food

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16
Q

Fluoroquinolones MOA (-oxacins)

A

Ciprofloxacin, Gatifloxacin, Levofloxacin

inhibit NUCLEIC ACID synthesis

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17
Q

Fluoroquinolones Pharmacokinetic profile (-oxacins)

A

SE: QT prolongation, dizziness

Contraindications: NO PREGNANCY; AVOID peds/older adults = tendon rupture; AVOID Peds = interfere w/ growth plates

Interactions: NO milk, antacids, calcium, magnesium, iron, zinc

Med admin: DEC RENAL function will influence half life

Education: EMPTY STOMACH

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18
Q

Tetracyclines MOA (-cyclines)

A

inhibit PROTEIN SYNTHESIS

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19
Q

Tetracyclines Pharmacokinetic profile

A

Bacteriostatic = severe acne, Lyme disease, Rocky Mtn spotted fever

Contraindications: NO PREGNANCY; Caution w/ RENAL impairment

Interactions: NO antacids, dairy, calcium, iron, anticoagulants, digoxin, insulin, lithium, birth control, PCN

Education: Binds w/ calcium & developing teeth

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20
Q

Sulfonamides MOA (sulfa) (TMP-SMX)

A

Bactrim, Septra

Inhibit METABOLIC PATHWAYS

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21
Q

Sulfonamides Pharmacokinetic profile

A

SE: GI UPSET/Allergic Rxn = 1st degree sx; SJS; photosensitivity

NO PREGNANCY

Interactions: warfarin INC INR, phenytoin, sulfa drugs

Education: DRINK 1L daily (avoid crystallization), AVOID SUN

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22
Q

Clindamycin Class

A

Lincosamides

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23
Q

Clindamycin MOA

A

Inhibit PROTEIN SYNTHESIS

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24
Q

Clindamycin Pharmacokinetic Profile

A

Alternative agent for MRSA

TX: Mouth, Skin, Vagina

SE: GI upset, metallic taste; DIARRHEA

Med admin: MONITOR LIVER & KIDNEY

SAFE PREGNANCY

Education: LARGE glass of water, good for skin/bone

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25
Metronidazole MOA
Flagyl Disrupts DNA & PROTEIN SYNTHESIS
26
Metronidazole Pharmacokinetic Profile
SE: GI, HA, Dizziness, dry mouth, fatigue, metallic bitter taste Contraindications: NO blood dycrasias, seizure d/o, neurological issues NO ETOH Interactions: cimetidine, phenobarbital, phenytoin Med admin: topical form (local irritation) SAFE PREGNANCY TAKE W/ FOOD
27
Nitrofurantoin DOC
Macrodantin
28
Nitrofurantoin MOA
protein synthesis, aerobic energy metabolism, DNA synthesis, RNA synthesis, and cell wall synthesis are inhibited
29
Nitrofurantoin Efficacy
BacterioCIDAL = HIGH con BacterioSTATIC = LOW con
30
Nitrofurantoin Pharmacokinetic profile
SE: GI, SJS, HA, dizziness, may change urine color NO ANTACIDS DOC in PREGNANCY Must complete 7 days of treatment
31
Antimycobacterials MOA
inhibition of the cell wall synthesis
32
Antimycobacterials Pharmacokinetic profile
Used to tx TB
33
Antivirals classes
Nucleoside analogues Influenza
34
Antivirals (nucleoside analogues) MOA
Acyclovir, famciclovir, valacyclovir Inhibit VIRAL CELL DNA SYNTHESIS
35
Antivirals (nucleoside analogues) Pharmacokinetic profile
SE: HA, N/V/D, skin rash INC risk of serious adverse effects in IMMUNOCOMPROMISED individuals Interactions: FEW (probenecid, cimetidine, theophylline, digoxin) Med admin: RENAL impairment = dosage change, START at earliest sign infection; PATIENT SELF INITIATE TX SAFE PREGNANCY; SAFE CHILDREN OVER AGE 2 TAKEN W/FULL GLASS WATER
36
Antivirals (influenza) MOA
Inhibit VIRAL CELL DNA SYNTHESIS
37
Antivirals (influenza) Pharmacokinetic profile
Amantadine/Rimantadine (DEATH OVERDOSE) vs Zanamivir/Oseltamivir (MORE FREQUENT) TX influenza med admin: must be taken within 2 days of exposure or onset of sx
38
Systemic Antifungals (-azoles) MOA
inhibit biosynthesis of ergosterol by interfering w/ the cytochrome P450
39
Systemic Antifungals Pharmacokinetic profile
AZOLES long term therapy = pulse dosing many drug interactions
40
Anti-fungal KETOCONAZOLE
Brand: Nizoral Systemic - candidiasis, blastomycosis, histoplasmosis, dermatophytoses BOX WARNING: hepatotoxicity, NEED LFTs before and during tx DEC oral contraceptive effectiveness monitor drug interactions ADEs = pruritis and GI for oral, take with food Pruritis, burning, drying, rash, hair loss with topical separate oral from antacids
41
Anti-fungal FLUCONAZOLE
Brand: Diflucan (PO, IV) NO PREGNANCY Candidiasis- vaginal, oropharyngeal, esophageal, urinary, systemic **CAUTION renal/hepatic impairment multiple drug interactions - CYP450 Drugs that INC gastric pH will DEC absorption Rifampin, histamine 2 blockers, warfarin Terbinafine, ETOH = liver toxicity ADEs = GI
42
Anti-fungal ITRACONAZOLE
Brand: Sporanox (capsules) dermatophytoses, fungal keratitis, onchomycosis oral and esophageal candidiasis NO PREGNANCY BOX WARNING: cardiovascular effects, no patients w/ LVD and HF NO active liver disease CHECK LFTs ADEs = GI, edema, HA, HTN, abnormal LFT NO grapefruit juice
43
Anti-fungal TERBINAFINE
Brand: Lamisil NO PREGNANCY onychomycosis of nails tineas - pedis, cruris, corporis, versicolor RARE = SJS, liver failure, SLE exacerbation PO NOT for liver/renal impairment oral ADEs = HA, fever, rash, GI Topical - burning, dryness, exfoliation, irritation HYGIENE IMPORTANT
44
Blepharitis TREATMENT
warm compresses for 5-10 minutes 3-4x day apply ERYTHROMYCIN OPHTHALMIC OINTMENT until sx clear + 7 more days Ointment is preferred treatment d/t increased contact w/ ocular tissue Azithromycin 1% solution for 4 wks may be used
45
Conjunctivitis TREATMENT (bacterial, viral, allergic)
BACTERIAL - erythromycin ointment, fluoroquinolones VIRAL - simple (sulfacetamide 10% solution, or broad spectrum); herpes keratitis (antiviral agents - ganciclovir, trifluridine, vidarabine) ALLERGIC -
46
Chronic Bronchitis TREATMENT
sulfonamides amoxicillin
47
Community Acquired Pneumonia CAUSES
strep pneumoniae
48
Community Acquired Pneumonia MICROORGANISMS
STREP PNEUMONIAE (PNEUMOCOCCUS) Common = haemaphilus influenzae, moraxella catarrhalis viruses **most cases causative organism is never identified >> EMPIRIC COVERAGE
49
Community Acquired Pneumonia TREATMENT
Healthy outpatient = MACROLIDE (AZITHROMYCIN) or doxycycline Outpatient w/ comorbidity = RESP FQ (2nd gen or higher) or BETA-LACTAM (amoxicillin or augmentin) + MACROLIDE FQ: NO CIPRO (1st gen) Pregnancy = tx as healthy outpatient. ERYTHROMYCIN or AZITHROMYCIN 1ST CHOICE
50
STI: SYPHILIS
DOC: BENZATHINE PCN (bicillin-LA) Pregnancy DOC: BENZATHINE PCN PCN allergy: desensitize and give BENZATHINE PCN DOSES: Primary/Secondary syphilis: Adults: 2.4 million units IM single dose infants/children: 50,000 units/kg IM single dose LATE LATENT: same dose, but given 3 times, 1 wk apart (ADULT total 7.2 million units, CHILDREN total 150,000 units/kg)
51
STI: GONORRHEA
develops resistance to antimicrobials easily DOC: CEPHALOSPORINS RECOMMENDED TX: cephalosporins + azithromycin or doxycycline DOSAGE: Ceftriaxone 250mg IM single dose + Azithromycin 1g orally single dose
52
STI: CHLAMYDIA
DOSAGE: AZITHROMYCIN 1mg orally single dose OR DOXYCYCLINE 100mg BID x7 days PREGNANCY: AZITHROMYCIN 1g orally single dose INFANTS/CHILDREN: weight >45kg and age <8 yrs: azithromycin 1g PO single dose Age >8 yrs: azithromycin 1g PO single dose OR doxycycline 100mg PO BID x7 days
53
STI: HERPES
USE ANTIVIRALS FIRST EPISODE: ACYCLOVIR 400mg PO TID x7-10 days OR VALACYCLOVIR 1g PO BID x7-10 days RECURRENT HERPES: ACYCLOVIR 400mg PO TID x5 days PREGNANCY: start at 36 wks; ACYCLOVIR 400mg PO TID OR VALACYCLOVIR 500mg PO BID
54
Vaginitis: BACTERIAL VAGINOSIS
fried egg cells w/ pepper DOC: METRONIDAZOLE 500mg PO BID x7 days; Clindamycin cream 2% 5g vaginally x7 days; Metronidazole gel 0.75% one applicator vaginally x5 days PREGNANCY: METRONIDAZOLE 500mg BID x7 days pregnancy ONLY PO MEDS
55
Vaginitis: TRICHOMONIASIS
protozoan infection DOC: METRONIDAZOLE 2g PO single dose OR tinidazole 2g PO single dose OR metronidazole 500mg BID x7 days TREAT PARTNERS PREGNANCY: use METRONIDAZOLE (risk of preterm labor, PROM, LBW)
56
Vaginitis: VULVOVAGINAL CANDIDIASIS
recent hx antibiotic use chronic infections: screen for DM DOC: FLUCONAZOLE 150mg PO single dose PREGNANCY: ONLY TOPICAL CREAM CAUTION: AZOLE DRUG INTERACTIONS
57
Otitis TYPES
Serous Otitis - chronic, viral Otitis Media - bacterial Otitis externa
58
Otitis CAUSES
Bacteria: GM + STREP GM - HAEMOPHILIUS INFLUENZA, MORAXELLA CATARAHALIS
59
Otitis PATHO
Viral URTI >> microbes refluxed into middle ear >> dark warn moist place >> bacteria enters (squatter) >> bacterial infection (AOM)
60
AOM Observational therapy
LOW RISK CASES: watchful waiting, pain management, no longer than 48-72 hrs
61
AOM TREATMENT
Based on severity FIRST LINE: AMOXICILLIN OR ERYTHROMYCIN (IF PCN ALLERGY) If resistance suspected = broad spectrum beta-lactam resistant CEPHALOSPORIN or combo (amoxicillin/clavulanate, TMP-SMX) No response within 48 hrs = change antibiotic therapy
62
Rhinosinusitis TREATMENT
first line = amoxicillin/clavulanate treat 5-7 days in adults, 10-14 days in children other therapy: RECOMMEND saline irrigation (Nettie pots) INTRANASAL CORTICOSTEROIDS
63
First vs Second line therapy RHINOSINUSITIS
FIRST LINE = AMOXICILLIN/CLAVULANATE; PCN allergy: doxycycline or resp FQ SECOND LINE = RESP FQ (NOT CIPRO = 1st gen) use 2nd gen or higher
64
Complicated UTI
recurrent UTI pregnancy pediatric patient to age 18 co-morbidities post-menopausal recent hospital discharge or resident of LTC Men s/sx of pyelonephritis
65
Uncomplicated UTI
healthy woman, NOT pregnant
66
UTI DOC
UNCOMPLICATED UTI: DOC: NITROFURANTOIN 100mg BID x5 days TMP-SMX DS 1 BID x3 days (increasing resistance) Other: FQs 3 day regimen COMPLICATED UTI: SAME AS ABOVE, tx 7-14 days DOC: NITROFURATOIN 100mg BID x7 days NO SULFA/FQs test for cure: urine culture/sensitivity 1 wk after tx
67
URINARY ANALGESIC DRUGS
primary ingredient in these products is phenazopyridine Brands: Azo-standard, Prodium, Pyridium, Uricalm, Urogesic patient can take phenazopyridine 200mg x3 day for 2 days as a urinary analgesic added to treatment regimen
68
Pharmacokinetics vs pharmacodynamics in PEDs
PHARMACOKINETICS -- PHARMACODYNAMICS --
69
Developmental aspects of PED med administration
BREASTFED INFANTS -- drug excretion in breastmilk INFANTS-- teaching parents how to administer meds; discuss reason for med, dose, how to draw up med, length of tx, potential adverse effects; dosing meds for parental convenience INC compliance TODDLERS/PRESCHOOLERS -- discuss med admin w/ parent before prescribing; chewable formulation if possible; prescribe a once or twice daily med if possible SCHOOL-AGE -- include child in decision making process; let child choose formulation; be sure child can swallow pills; teaching should be aimed at both child and parent ADOLESCENTS -- administer own meds; compliance rates vary
70
Factors that influence + outcomes in medication adherence in PED patients
SPECIFIC FACTORS -- long-term med regimens, number of meds prescribed, med interval, palatability, cost, family issues IMPROVE COMPLIANCE -- med concentration (liquid form), written vs oral instructions, self-monitoring calendars, telephone/email reminders, mobile phone med adherence apps, med admin at school, contracts/reinforcement programs CHILDHOOD OBESITY -- no guidelines; monitor patient closely for adverse effect if dosed by weight, efficacy if dosed by age

Pharmacology (12 decks)

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