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antibiotics 2 Flashcards

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1
Q

importance of D-alanine

A

amino acid that combines with other amino acids to create a polypeptide that helps the peptidoglycan unit attach to other PG units, leading to PG later of cell wall

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2
Q

vancomycin

A

glycopeptide

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3
Q

telavancin

A

glycopeptide

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4
Q

what abx inhibits cell wall synthesis by binding to D-ala D-ala and prevents the formation of peptidoglycan and phospholipids

A

glycopeptides
bactericidal

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5
Q

how are we seeing resistance against glycopeptides

A

alternation of binding site to D-ala-D-Lac
seen in VRE

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6
Q

what type of bacteria does vancomycin kill?

A

g+
NO G-

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7
Q

Main indications of vancomycin

A

S. aureus (MRSA)
Clostridium (C. diff)

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8
Q

what is the main tx of MRSA for inpatient therapy

A

vancomycin

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9
Q

you must adjust vancomycin for…

A

renal impairment

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10
Q

vancomycin dosing is based upon…

A

CrCL and TBW
impaired renal function = less frequent dosing intervals

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11
Q

how do you monitor vancomycin for severe MRSA infections

A

area under the curve (AUC) calculations

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12
Q

using vancomycin for other infection (not severe) you base the dosing based upon…

A

trough levels

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13
Q

when is vancomycin monitoring not needed?

A

uncomplicated skin/soft tissue infections in non-obese pts who have normal renal function

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14
Q

trough level adjustments of vancomycin is measured ____ prior to next infusion after steady state is reached

A

30 mins
normal renal function - after 4th dose
impaired - assess “spot” serum conc until renal function stabilizes

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15
Q

for AUC level adjustments for vancomycin, trough levels are obtained _____, peak levels are obtained ______

A

30 mins before dose
1-2hrs after dose

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16
Q

adverse effects of vancomycin

A
  1. hyperemia (Red man syndrome)
  2. nephrotoxicity/ototoxicity
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17
Q

how do you avoid hyperemia when using vancomycin

A

do slow infusions (1-2h)

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18
Q

what can you give to preteat hyperemia when prescribed vancomycin

A

antihistamines

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19
Q

nephrotoxicity/ototoxicity is more likely with vancomycin when it’s combined with ?

A

aminoglycosides

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20
Q

what alternatives of vancomycin can be used for MRSA infections

A
  1. televancin - no VRE
  2. dalbavancin - no VRE
  3. oritavancin
  4. daptomycin
  5. linezolid
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21
Q

what alternative use of vancomycin is also the best choice for VRE infection

A

daptomycin

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22
Q

gentamicin

A

aminoglycoside

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23
Q

tobramycin

A

aminoglycoside

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24
Q

amikacin

A

aminoglycoside

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25
streptomycin
aminoglycoside
26
MOA of aminoglycosides
inhibits bacterial protein synthesis - binds to the 30S subunit bactericidal
27
4 modes of resistance of aminoglycosides
1. chromosomal mutation 2. enzymatic destruction of drug 3. lack of permeability through cell wall 4. efflux pump
28
spectrum of aminoglycosides
g- mycobacterium tuberculosis NO G+
29
Aminoglycosides are most frequently used in combo with ?
aminoPCN (ampicillin + gentamicin)
30
how do you monitor aminoglycosides?
1. monitor peak and troughs 2. BUN/Cr 3. audiometry *same precautions as vancomycin*
31
doxycycline
tetracycline
32
minocycline
tetracycline
33
MOA of tetracyclines
inhibits bacterial protein synthesis - binds to 30S ribosomal subunit, blocks tRNA bacteriostatic
34
2 modes of resistances of tetracyclines
1. active efflux 2. enzymatic deactivation
35
spectrum of tetracyclines
1. g+ 2. g- 3. atypicals - mycoplasma, rickettsiae, chlamydiae, spirochetes *includes MRSA*
36
first line and additional treatments of tetracyclines
1. lyme disease 2. rocky mountain spotted fever 3. cholera 4. acne additional - chlamydia, CAP (empiric)
37
contraindications for tetracyclines
1. children <8-9 y/o (<13 not as bad) - tooth discoloration 2. pregnancy/nursing - hepatotoxicity - tooth discoloration (baby) - fetal long bone growth impairment
38
what should you avoid while taking tetracyclines
1. antacids 2. dairy products limits absorption
39
adverse effects of tetracyclines
1. GI distress 2. hepatotoxicity 3. photosensitivity 4. vertigo - especially minocycline 5. C. diff
40
erythromycin
macrolide
41
azithromycin
macrolide
42
clarithromycin
macrolide
43
MOA of macrolides
inhibits protein synthesis and translocation via 50s subunit bacteriostatic
44
3 methods of resistance of macrolides
1. 50s subunit target modification 2. efflux pumps 3. degradation enzymes
45
spectrum of macrolides
- very broad 1. g+ - including s. pneumoniae 2. g- 3. atypicals
46
first line treatments of macrolides
1. CAP - atypicals: mycoplasma, chlamydia 2. chlamydia 3. legionella 4. diphtheria 5. COPD
47
what is the preferred treatment for sinusitis
augmentin
48
which macrolide is not as strong of a CYP450 inhibitor
azithromycin
49
adverse SE of macrolides
1. GI 2. hepatotoxicity 3. prolonged QT interval 3. ototoxicity
50
what other medications should be used with caution when taking macrolides?
antihistamines antidepressants antifungals all also prolong QT interval
51
MOA of clindamycin
inhibits protein synthesis via 50S
52
spectrum of clindamycin
1. g+ (including MRSA) 2. anaerobes
53
common indications for clindamycin (3)
oral abscesses BV MRSA skin infections
54
SE of clindamycin
N/D, rashes
55
BBW of clindamycin
C diff colitis take probiotic
56
ciprofloxacin
quinolones
57
levofloxacin
quinolone
58
moxifloxacin
quinolone
59
which abx inhibits DNA synthesis by interfering with DNA gyrase and topoisomerase IV
quinolones bactericidal
60
3 methods of resistance of quinolones
1. mutation in chromosomal genes 2. efflux pumps 3. decreased cell wall permeability
61
spectrum of quinolones
broad: - better g- > g+ - moxi and levo have better g+ - g+: streptococcus, MSSA - anaerobes = moxi
62
what quinolones have better g+ coverage
levofloxacin, moxifloxacin
63
what quinolone has anaerobic coverage
moxifloxacin
64
first line treatments of quinolones?
1. otitis externa, ophthalmic infections (topical cipro/levo only) 2. URI/pneumonia with comorbidities (levo, moxi) 3. diarrhea (cipro) 4. pyelonephritis (cipro) 5. prostatitis (cipro) 6. anthrax (cipro)
65
PK of quinolones
strong CYP450 inhibitor
66
contraindications for quinolones
1. prolonged QT/arrhythmias 2. myasthenia gravis
67
what abx has a BBW of tendinitis/tendon rupture?
quinolones
68
SE of quinolones
- nephrotoxicity - lower seizure threshold - C. diff - hepatotoxicity - photosensitivity
69
what abx works as a folate reductase inhibitor
trimethoprim bacteriostatic
70
what abx works as a folate synthesis inhibitor
sulfamethoxazole bacteriostatic
71
spectrum of trimethoprim/sulfamethoxazole
Mostly g- some g+ includes MRSA
72
first line treatments for trimethoprim/sulfamethoxazole
1. outpatient for MRSA 2. UTI 3. prophylaxis and prevention of P.jiroveci additional - legionella and certain pneumonias
73
SE of trimethoprim/sulfamethoxazole
1. megablastic anemia (folic acid deficiency ) 2. photosensitivity 3. heptatoxicity
74
what abx only functions as a urinary antiseptic
nitrofurantoin (macrobid/macrodantin)
75
MOA of nitrofurantoin (macrobid/macrodantin)
inhibits bacterial enzymes and damages DNA
76
coverage of nitrofurantoin (macrobid/macrodantin)
E. coli/e. faecalis
77
first line for nitrofurantoin (macrobid/macrodantin)
UTI
78
caution with nitrofurantoin (macrobid/macrodantin)
1. pregnancy - neonatal jaundice - tetratogenicity - first trimester, up to 14 weeks gestation 2. severe renal impairment
79
most common SE of nitrofurantoin (macrobid/macrodantin)
N/V
80
metronidazole
nitroimidazole
81
tinidazole
nitroimidazole
82
MOA of nitroimidazole
disrupts microbial DNA - Causes loss of DNA helical structure and strand breakage
83
first line tx of metronidazole (flagyl)
1. trichomonas 2. BV 3. C. diff
84
PK of metronidazole
minor inhibitor CYP450 does not cause many drug reactions
85
SE of metronidazole
1. metallic taste 2. disulfiram-like reaction
86
what do you need to avoid when taking matronidazole
alcohol
87
what abx has a BBW of carcinogenic in mice and rats
metronidazole
88
what abx is a folate synthesis inhibitor, used as a topical for burns
silver sulfadiazine (silvadene)
89
what abx is a folate synthesis inhibitor used as a tx for opthalmic infections
sulfacetamide
90
what folate reduction inhibitor is used for antiparasite/antimalarial
pyrimethamine
91
what abx is limited to topical application only due to nephrotoxicity
bacitracin active against g+
92
what abx is mainly used for pseudomonas in the eye/mainly ophthalmic drops
polymyxin B g- coverage, ophthalmologic uses due to toxicity
93
what is the main abx for impetigo
mupirocin used combo with chlorhexidine to decolonize MRSA carriers
94
what DNA/protein synthesis abx have pseudomonas coverage
cipro levo aminoglycosides polymyxin B
95
what DNA/protein synthesis abx have MRSA coverage
1. vancomycin 2. tetracycline 3. clindamycin 4. trimethoprim/sulfamethoxazole 5. mupirocin
96
what DNA/protein synthesis abx have anaerobic coverage
1. clinda 2. moxifloxacin 3. nitroimidazoles 4. chloramphenicol
97
what DNA/protein synthesis abx have atypical coverage
1. tetracyclines 2. macrolides
98
what DNA/protein synthesis abx have VRE coverage
1. vancomycin 2. daptomycin 3. oritavancin 4. linezolid
99
what DNA/protein synthesis abx have VRE coverage
1. vancomycin 2. daptomycin 3. oritavancin 4. linezolid
100
all protein synthesis abx are bacteriostatic EXCEPT
aminoglycosides

Infectious disease (15 decks)

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