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Flashcards in Antibiotics Deck (51):
1

Gram Positive Aerobes

COCCI
Clusters - staphylococci
Pairs - S. pneumoniae
chains - group and viridans streptococci
pairs and chains - Enterococcus sp.
BACILLI
Bacillus sp.
Corynebacterium sp
Listeria monocytogenes
Nocardia sp

2

Gram-Negative Aerobes

COCCI
Morexella catarrhalis
Neisseria gonorrhoeae
Neisseria meningitidis
Haemophilus influenzae
BACILLI
E. coli, Enterobacter sp
Citrobacter, Klebsiella sp
Proteus sp., Serratia
Salmonella, Shigella
Acinetobacter, Helicobacter
Pseudomonas aerusinosa

3

Above the diaphragm Anaerobes

Peptococcus
Peptostreptococcus
Prevotella
Veillonella
Actinomyces

4

Anaerobes below the diaphragm

Clostridium perfringens, tetani and diff.
Bacteroides fragilis, disastonis, ovatus, thetaiotamicron
Fusobacterium

5

Atypical Bacteria

Legionella pneumophila
Mycoplasma pneumoniae
Chlamydia pneumoniae
Spirochetes - Treponema pallidum (syphilis)

6

Skin/soft tissue infection causing bacteria

S. aureus, S. pyogenes
S. epidermidis
Pasteurella

7

Bone and Joint infection causing bacteria

S. aureus, S. epidermidis
Streptococci
N. gonorrheoeae
Gram-negative rods

8

Abdomen bacteria causing infection

E. coli, proteus
Klebsiella
Enterococcus
Bacteroides sp

9

Bacteria causing Urinary tract infection

E. coli, Proteus
Klebsiella
Enterococcus
Staph saprophyticus

10

Upper respiratory infection causing bacteria

S. pneumoniae
H. influenzae
M. catarrhalis
S. pyogenes

H

11

Lower respiratory Community infection caused by which bacteria

S.pneumoniae
H. influenzae
K pneumoniae
Legionella pneumophila
Mycoplasma, Chlamydia

12

Meningitis

S. pneumoniae
N. meningitidis
H. influenza
Group B Strep
E. coli
Listeria

13

systems commonly adversely effected by anti-infective therapy

neuro/CNS - potential for seizure and neurotoxicity, esp in elderly and CKD, drug accumulates quickly, adjust dose. CIPRO is classic, meripenem and eripenim
nephro - most common
GI (direct toxic effect to cells),
hepatic - some toxic to liver cells, hepatitis or liver failure

14

Broad Spec penicillins
beta-lactamase inhib (PCN)
common combinations of these

amoxicillin (oral) Ampicillin (IV)
Clavulanic acid, Sulbactam
Amox/Clav acid - AUGMENTIN
ampicillin/sulbactam - UNISYN

15

hypersensitivity reaction

rash, pruritus, fever, urticaria
mild allergic reaction
anaphylaxic-5-10%

16

First Gen cephalosporins, examples, used for what?

same gram + as penicillicn
cefazolin (IV, IM) = ANCEF
cephalexin / KEFLEX

17

2nd Gen cephalosporins, examples, used for what?

H. flu, Nesseria, Entreobacter aerogenes
less effective against gran +
cefixitin

18

3rd Gen cephalosporins, example, used for what

gonorrhea, PID, PNA,
weak gram +
potent against gram-
Serratia marcenscens
cefotaxime (neonates, intra ab, diabetic)
cefpodoxime (oral)
CEFTRIAXONE - the best one, once a day dosing

19

4th gen cephalosporins, example, used for what

gram- bacteria,

20

keflex

1st gen,
look this up

21

cefoxitin

2nd gen cephalosporin
look this up

22

cephalosporin CI

allergies to cephalosporins and penicillins
if hypersensitivity rxn to PCN, like rash/pruritis, ok to give cephalosporins

23

cephalosporin AE and drug-drug

GI - n/v/d, abd pain, flatulence, anorexia
CNS - HA, dizzy, lethargy, paresthesias
Renal - nephrotoxicity in indiv with pre-existing renal disease
hypersensitivity
ETOH- disulfiram-like rxn with some
AE can occur up to 72 h after d/c

24

monobactams

Aztreonam
Used for gram neg aerobes, not active against Gram + or anaerobes
ONLY one that can be used if PCN or cephalosporin allergies
Gram -
E. coli, H, influ, M catarrhalis, Enterobacter, Salmonella, Shigella
seudomonas aeruginosa

25

Aminoglycosides

bacteriocidal, very potent, little resistance
severe SE
all IV or nebulized
Gentamycin, Tobramycin
SE OTOTOXICITY, RENAL TOXICITY, can progress to renal failure, elderly more susceptible, dose and duraiton related
CNS - irreversible deafness, confusion, depression, numbness, tingling, weakness, paralysis
HEMA - bone marrow suppression,, immune suppression, super-infection
WEAR SUNSCREEN, photosensitivity, rash/urticaria, exfoliative dermatitis
Cardiac - palpitations, hypotension or HTN
drug-drug- Diuretics
Synergistic, with PCN

26

Examples of macrolides, and use

Azythromycin (bronchitis, COPD)
Clarithromycin (H. pylori protocol only, cheap)
Erythromycin (OB prefer this)
Streptococcal infection
Mycoplasma infection
Listeria
GROUP A BETA HEMOLYTI strep infection

27

macrolide CI, caution, AE

caution with hepatic dysfunction, lactating women/pregnancy
CI - allergy to any macrolide
AE - GI, abd cramping, diarrhea, vomitting, anorexia, pseudomembranous colitis
HEPATOTOXICITY - if taken with other hepatotoxic drugs
CNS - confusion, abnormal thinking, uncontrollable emotions

28

Lincosamine, one drug

more toxic than macrolides, but similar
CLINDAMYCIN - most commonly assoc with C.diff, lots of GI SE

29

Tetracyclines, examples, CI, precautions

long acting-
DOXYCYCLINE - good for MRSA, bronchitis, URI
MINOCYCLINE - Derm likes, antiinflammatory
Not recommended in preg/lactation
Avoid in kids < 8
AE - Photosensitivitiy and rash, GI-N/V/D, abd pain, glossitis, dysphagia. FETAL hepatotoxicity.
SKELETON - weakening of bone/teeth, staining, pitting
DRUG-DRUG; PCN (dec. PCN)
decreased effectiveness of OCPs
DIGOXIN toxicity
dairy binds to it, unabsorbable
take on empty stomach, 1h before food or 2-3 h after meal or meds

30

fluoroquinolones

Broad spectrum of activity
good bioavailability
tissue penetration,
prolonged half-lives
RESISTENCE is a major issue
CIPROFLOXACIN (older) PO, IV, complicated UTI, second line or sulfa allergy, abd infection, below diaphragm
LEVOFLOXACIN - (newer) PO, IV, excellent for resp, $$
AE- GI, n/v/d/dyspepsia, CNS- HA, agitation, insomnia, dizzy, seizures (elderly), rare hallucinations
Hepatotoxicty - LFT elevation
Variable QTc complex

31

Fluoroquinolones drug-drug interactions

zinc, iron, ca, aluminum, mag,
antacids, sucralfate, ENTERAL FEEDINGS will impair oral absorption, CLINICAL failure, 2 to 4 h interval
Theophylline and cyclosporine, inhib metabolism, inc levels, inc toxicity
WARFARIN - idiosyncratic

32

Macrolides

Erythromycin, narrow spectrum, short 1/2 life, poor GI SE,
Clarithromycin and azithromycin - broader spectrum, longer half-life, availability, more toleratework d

33

what good macrolides for? SE?

anaerobes (upper airway)
atypical bacteria - legionella, Chlamydia, Mycoplasma, campylobacter, borrelia, bordetella, pasteurella
SE - GI, most common with erythro, QTc prolongation

34

Clindamycin, uses, AE

gram +, C. diff, GI SE
gram + aerobes, MSSA, Strep pneumoniae- resistence is starting
Group and viridans streptococci
most freq caused c diff colitis (treat with metrondazole), N/v/d/d
rare hepatotoxicity and allergy

35

Metronidazole, uses, AE

used for anaerobes
GI-n/v, stomatitis, metallic tast
CNS- MOST SERIOUS, peripheral neuro (if used long term), encephalopathy, seixures. caution with preexisting CNS d/o
Mutagenicity, carcinogenicity, avoid preg, commonly used with BF

36

Metronidazole drug-drug interactions

warfarin, inc aticoag effect
etoh - disulfiram rxn
Phenytoing - inc phenytoin conc
Lithium, inc lithium conc
Phenobarbital, dec. metro conc
Rifampin - dec, metro conc

37

Sulfonamides, moities, ci

Different moeities
Sulfazalazine, sulfamethoxazole, sulfadiazine, sulfixoxazole
prevents the synthesis of folic acid
CI, thiazide diuretic allergy
CI in pregnancy, lactation

38

sulfonamide SE

GI, n/v/d/abd pain, anorexia, stomatitis, hepatic injury d/t direct irritation of GIT
RENAL - crystalluria / proteinuria, hematuria --> can cause nephrotic syndrome (drink tons of water), dizzy, vertigo, ataxia, convulsions, depression (effects nerves)
HEMA-bone marrow depression
DERM - photosensitivity and rash and hypersensitivity
Take with food, no etoh

39

specific anti-tubercular drugs

isoniazid (liver tox, rx with B6, or else peripheral neuritis)
rifampicin (lots of drug-drug, stain contacts, hepatitis, red-orange discoloration of secretions)
pyrazinamide (uric acid goes up, gout/preg prec)
ethambutol (optic neuritis, eye exam, not kids < 6 yo)
worry about liver impairment with all of these, check LFT periodically
multiple drugs to prevent resistence

40

Abx in pregnancy relatively safe

PCN, cephalosporing, erythromycin base

41

ABX in pregnancy, CI and caution

CAUTION
Bactrim (dong give 1st and 3rd), Metronidazole,
Aminoglycosides (could probably give), chloramphenicol (no, no)
CI
tetracyclines, erythromycin estolate, fluoroquinolones

42

Amantadine and Rimantadine

antiviral - inhibs strains of Influenza A
also used for parkinsons
must adjust for renal
can cause confusion, not commonly used
high conc in renal secretions

43

interferons

host species specific
lmw proteins made my mammals in response to viral infections
produced by recombinant genetic techniques

44

Interferon-alpha

renders cells resistant to many viruses
used for Hep B and C
Hairy cell leukemia
Karpsoi's sarcoma
IV
AE; flu-like sx, depression, (responds to SSRI, should have MH care, caution if SI), hypotension
Hep C tx, combined with ribavirin, depends on virus genotype
long-acting; pegylated, once weekly

45

Acyclovir, action, doses for diff. diseases

HSV>VZV>CMV>EBV, herpes viruses differ in their degree of sensitivity to ACV
inhibits DNA polymerase and blocks replication
200-400 mg HSV (very sensitive, suppression tx if >6/year)
VZV needs high dose 800 mg 4x/day
encephalitis IV only 700-800 mg (low absorption, IV to get to CNS)
drug resistence in immunocompromised hosts
drug resistent strains less virulent
topical doesn't work
toxicity - well-tolerated, safe in pregnancy,
hydration imp if taking high doses, LOTS of WATER, could crystalize in high doses

46

Amphotericin B

dont' rx this, get ID consult,
nephrotoxicity - dec GFR, renal tubular acidosis, dec renal conc ability, hypoK, hypoMAG
infusion-related rxns - chills/rigors, fever, n/v, cardiorespiratory rxn, phlebitis
drug of choice for systemic fungal infection.

47

Ketoconazole

tons of drug-drug, P450 very active

48

injuries that decrease fungal defenses

cutaneous injury - catheters, burns, surgery
mucosal injury - mucositis, GI surgery, GI perf
FUNGAL factors - proteinases, phospholipases, lipases

49

Fluconazole, use for what, clearance, AE,

C. albicans, C. tropicalis, NO C. krusei/Aspergillus
Renal clearance (80%)
Clearance - renal (80%)
AE N&V, hepatic

50

Voriconazole

used to treat Aspergillus
AE: N/V, visual dist, hepatic, rash, QTC prolongation

51

Echinocandin Antifungals

very safe, lon inc of hepatotoxicity, only IV
small drug-drug
micafungin more commonly used
used mostly in transplant or renal patient
anidulafungin - lots of etoh in each dose