Antibiotics Flashcards
(145 cards)
1
Q
Azithromycin (Zithromax; Z-pak)
A
PO/IV
Macrolide
2
Q
Clarithromycin (Biaxin)
A
PO
Macrolide
SE: GI upset
3
Q
Erythromycin (E-Mycin)
A
PO/IV
Macrolide
little h.flu coverage
SE: GI upset, QT prolongation
4
Q
Erythromycin 0.5% ointment
A
Macrolide - opthalmic
Prophylaxis opthalmia neonatorum
conjunctivitis (q 4-6 hrs)
5
Q
Azithromycin 1.0% solution (AzaSite)
A
Macrolide - opthalmic
conjunctivitis >1 year old
dosing: bid then qd (more convenient than e-mycin)
Store in refrigerator
6
Q
Beta-Lactams MOA
A
- Targets cell membrane
1. Inhibits the enzyme transpeptidase (pcn binding protein), causes lysis of the cell.
2. bacteriocidal
3. time dependent
7
Q
Beta-Lactams - General uses
A
pharyngitis (esp. GABHS), prevention of rheumatic heart disease and syphilis
8
Q
Neurosyphilis DOC
A
Aqueous PCN G
9
Q
Aqueous PCN G
A
Beta Lactam Penicillin
IV/IM
Adult: 0.5-4 MU q 4 hrs
Peds: weight based
10
Q
PCN VK
A
Beta Lactam Penicillin
only PO
11
Q
Benzathine PCN G (Bicillin)
A
Beta Lactam Penicillin
IM
Adult: 2.4 MU x 1
*make sure has tolerated PCN before because the dose lasts a long time
12
Q
Why should you not use PCN in staph cellulitis?
A
because staph produces penicillin-ase that neutralizes the drug (use PCN-ase resistant PCN instead)
13
Q
Beta Lactams - side effects
A
anaphylaxis
rash
nausea
seizure
14
Q
Penicillinase-Resistant PCNs - spectrum
A
NARROWED spectrum to staph (aureus and epidermidis)
mostly for cellulitis and endocarditis
15
Q
Dicloxacillin (Dycill; Pathocil)
A
BL: PCNase resistant
PO (empty stomach)
QID
MSSA only
16
Q
Nafcillin (Unipen)
A
BL: PCNase resisitant
IV (burns)
4-6 times a day
MSSA
17
Q
Oxacillin (Bactocil)
A
BL: PCNase resistant
IV/IM
PCN-ase resistant
Used in Lab to test for resistance (MRSA)
Not used much b/c of SE (renal and liver)
18
Q
Aminopenicillins - coverage
A
expanded gr-
“HELPS” - h.flu, e.coli, listeria, proteus, salmonella/shigella
Good activity against PCN-resistant strep pneumo
*Enterococcus
19
Q
Aminopenicillins - General uses
A
OM, sinusitis, lower UTI, Shigella, Salmonella, h.pylori, listeria
20
Q
Listeria (meningitis) DOC
A
Ampicillin
21
Q
GBS prophylaxis for delivery DOC
A
Ampicillin or PCN
22
Q
Ampicillin
A
Aminopenicillin
PO/IV q6
SE: rash (especially if give for viral/mono infection)
Renal dosing
23
Q
Amoxicillin (Amoxil)
A
Aminopenicillin
PO q8
SE: rash (especially if given for viral/mono)
PO dosing provides better absorption and less frequent administration improves compliance
24
Q
Shigella DOC
A
Ampicillin
25
Salmonella DOC
Amoxicillin
26
Extended Spectrum Penicillins (Beta Lactam) - spectrum
extended to cover pseudomonas and enterobacter
"Treats Pseudomonas"
Ticarcillin, Piperacillin
27
Beta Lactam/Beta Lactamase Inhibitor (BLI)
BLIs inhibit the enzymes that bacteria produce that inactivate the beta-lactam antibiotic. Given with some beta lactams to decrease resistance.
28
What are the 3 BLIs?
SUB - sulbactam
CA - clavulanic acid
TZ - tazobactam
29
Amoxicillin/CA (Augmentin)
Extended spectrum PCN
Only PO option (q 8-12)
renal dosing
*no pseudomonas
30
Ampicillin/SUB (Unasyn)
```
IV/IM q 6-8
Extended spectrum PCN
*no pseudomonas
Covers anaerobes
Best of this group for enterococcus
```
31
What are the extended spectrum penicillins for enterococcus?
Ampicillin/SUB (Unasyn)
32
Ticarcillin/CA (Timentin)
Extended spectrum PCN
IV/IM q 4-8
Pseudomonas
renal dosing
33
Piperacillin/TZ (Zosyn)
Extended spectrum PCN
IV/IM q 4-6
pseudomonas
renal dosing
34
What are the extended spectrum penicillins for pseudomonas?
Ticarcillin/CA and Piperacillin/TZ
35
Cephalosporin (Beta Lactam) - general info
bacteriocidal
| 5 generations - each generation sees greater gr- coverage and CNS penetration
36
What 3rd generation cephalosporin common causes brick red or maroon stool?
Cefdinir (Omnicef)
37
What 3rd generation cephalosporin covers pseudomonas?
Ceftazidime (Fortaz)
38
Monobactams (Beta Lactam) - spectrum
"MONObactams only cover 1 type of bacteria which can be 'negative'" (gram negative only)
39
Monobactams - general uses
UTIs, skin infections, pneumonia, intrabdominal infections, septicemia, gyn infections
40
Aztreonam (Azactam)
Monobactam
IV 1-2 g q 8-12 hrs
SE: phlebitis, rash, elevated liver enzymes
41
Carbapenems (Beta Lactam) - spectrum
multi-drug resistant pathogens and pseudomonas (except ertapenem)
Similar to 4th gen cephlasporins in coverage
42
Which carbapenem does NOT cover pseudomonas?
ertapenem
43
Carbapenems - general uses
UTIs, febrile neutropenia, soft tissue infections, bacterial meningitis (>3 mos old)
44
Carbapenems
imipenem (primaxin) IV
ertapenem (Invanz) IM/IV (no pseudomonas)
doripenem (doribax) IV
meropenem (merrem) IV/IM
SE: up to 50% of pts allergic to PCN are allergic to carbapenems
renal dosing
45
Vancomycin - IV or PO?
PO for c.diff only (doesn't absorb - too big!)
| IV for MRSA
46
Vancomycin - C.diff treatment
```
wash hands with soap/water, alcohol does not kill
#1 Metronidazole 500mg po tid x 10-14 days (for 1st/2nd mild-moderate infections)
#2 Vancomycin 125 mp PO qid x 10-14 days (severe infection)
#3 vancomycin 500 mg po qid for servere +/_ metronidazole IV (if inflaned colon or complete ileus)
```
47
Telavancin (Vibativ)
IV
Lipoglycopeptide
complicated skin and skin structure infections (cSSSI) caused by: MRSA, strep pyogenes, strep agalactiae, enterococcus faecalis)
renal dosing
SE: taste disturbances (soap/metal), nephrotoxic, QT prolongation
Preg C but there is concern
Expensive
48
Macrolides and Ketolide MOA
inhibit protein synthesis by binding to domain II and V on the ribosomal subunit
49
Telithromycin (Ketek)
PO
Ketolide
s.pneumoniae, CAP, bronchitis, sinusitis, s.aureus, h.flu, atypicals
CYP3A4 inhibitor
renal adjust
hepatotoxic
*Lots of issues: FDA, renal dosing, side effects --> not used much anymore
50
Tetracyclines - MOA
bind to the 30S ribosomal subunit and interfere with translocation reaction
51
Tetracyclines - general uses
Anthrax, CAP, acne, tick born diseases
52
Tetracycline (Sumycin)
PO
SE: yellowing teeth/decreased bone growth in peds, phototoxicity, GI, esophageal ulcerations
di and trivalent cations decrease absorption
53
Minocycline (Dynacin; Minocin; Solodyn)
```
PO (empty stomach)/IV
Tetracycline
ADE: blue gray staining of teeth
CA-MRSA
renal adjust
di and trivalent cations reduce absorption
```
54
What is the Preg category for all tetracyclines?
D
55
Doxycycline (Vibramycin)
```
PO/IV
Tetracycline
MRSA
*no renal adjustment
phototoxicity
```
56
What is the only tetracycline that does not require renal adjustment?
Doxycycline
57
What class of drugs is used to treat tick borne illnesses like Lyme and RMSF?
Tetracyclines
58
Which antibiotics (general) cover gr+?
All except tetracyclines and metronidazole
59
Which antibiotics (general) cover gr-?
All except daptomycin, clindamycin and metronidazole.
60
Which antibiotics cover atypicals?
*macrolides
Newer fluoroquinolones,tetracyclines
61
Dental prophylaxis - DOC
AMX
If PCN allergy: macrolide
62
If someone is PCN allergic, what is usually the next option?
Macrolide (azithromycin, clindamycin, clarithromycin, etc.)
63
What is the concern the PCN Benzathine?
IM - want to make sure pt has had PCN before and tolerated well. Lasts a long time!
64
Doxycycline DDI
Di and trivalent cations...ca, mg, al, fe. Separate by 2-4 hrs
65
Tetracycline - dental effects
Not used in utero or <8 yrs
Causes permanent staining - yellow or gray to brown
Tetracycline binds to calcium during mineralization. When exposed to light, starts as Fluorescent yellow to brown over months-yrs.
66
Minocycline - dental effects
All ages
Blue gray, does not fluoresce
Why? Drugs binds to collagen and drug etches enamel (from saliva)
<100mg/day can decrease risk
67
What are the drugs in the PCN group?
PCN G
PCN VK
Benzathine
68
What are the drugs in the Penicillinase resistant group?
Dicloxacillin
Nafcillin
Oxacillin
69
What are the aminopenicillins?
Ampicillin
| Amoxicillin
70
2nd gen cephalosporins - Coverage
Better gram negative
HEN PECKS
H.influenza, E. coli, n. Meningitis and gonorrhea, proteus, klebsiella, serratia marascens
71
Ceftriaxone - DDI
Contraindicated with calcium in neonates
72
5th generation cephalosporins - coverage
Improved gram + esp. PCN resistant strep and MRSA
73
Monobactam if PCN allergic?
Yes, OK
74
Carbapenems if PCN allergic?
Caution! Up to 50% are also allergic
75
Carbapenems - biggest ADE?
Seizure - esp. with imipenem
76
Vancomycin - ADE
Ototoxic
Nephrotoxic
Thrombophlebitis
77
Vancomycin - monitoring of levels
Troughs most important (time dependent killer)
| 10-20 (15-20 if MRSA)
78
Vancomycin - 2 uses
MRSA
| C.diff
79
Telavancin - use
Complicated skin infection - MRSA, strep pyogenes,enterococcus, strep agalactiae
80
Telavancin - ADE
Taste disturbances (metal soapy)
Nephrotoxic
Ototoxic
C.diff
81
Why don't beta lactams work for mycoplasma Pneumonia?
Because it works on the cell wall and m. Pneumo has no cell wall
82
Tetracyclines - what drugs?
Tetracycline
Minocycline
Doxycycline
83
What drug class can treat anthrax?
Tetracyclines
84
Anaerobic agent
Clindamycin (cleocin)
85
Clindamycin - unique property
Especially good for pneumo with abcess and anaerobes
86
Which abx has clinical properties similar to macrolides?
Clindamycin
87
Which abx, besides macrolides, is a good alternative to PCN?
Clindamycin
88
Dietary restriction: Linezolid
No aged cheeses
89
DDI Linezolid
MAO inhibitor properties
90
Which abx are considered ototoxic?
Aminoglycosides
Telavancin
Vancomycin
91
What can be done to decrease potential of ototoxicity with certain drugs?
Try to limit to one
| Don't give too much or for too long
92
Which carbapenem requires co-administration of cisplatin in order to remain active?
Imipenem
93
Which macrolide is used for h.pylori and uncomplicated skin, URI and LRI?
Clarithromycin
94
What is the most common side effect of erythromycin?
GI toxicity
95
Ciprofloxacin DDI
Calcium
Teaching - separate by 2 hours
Why? Ca increases gastric ph, causes ciprofloxacin to become negatively charged, absorption is reduced.
96
Which fluoroquinolones are not used for UTIs?
Moxifloxacin and gemifloxacin - don't get into bladder in high enough concentrations
97
FQs - ADE
NSAIDs - increase seizure risk
Should avoid FQs if seizure risk (epilepsy, etc.) or lower seizure threshold (certain meds, renal dysfunction, etc.)
98
Linezolid - ADE
Anemia (up to 94% platelet reduction in some cases!)
99
Itraconazole (capsules) -DDI
Proton pump inhibitors - needs acid environment
100
FQs - di and trivalent cations
Avoid +/- 2 hours
101
What is the only FQ that is used in Peds?
Ciprofloxacin for CF
102
Can Vitamin C decrease tooth staining with Tetracycline and Minocycline?
No. May actually increase with Minocycline.
103
DDI - fluoroquinolones and tetracyclines
Dinand trivalent cations (Al, Ca, Mg)
104
Which BLs are 3A4 inhibitors?
Erythromycin and clarithromycin
105
What is the only infection telithromycin is used for?
MDR strep pneumo
106
Which abx classes are contraindicated in pregnancy?
Tetracyclines and fluoroquinolones
107
Which abx classes are contraindicated in peds?
FQ (tendon rupture) and tetracyclines (dental)
108
Why are FQs contraindicated in peds?
Binds with tendons...rupture possible
109
DDI Metronidazole
Coumadin (2C9)
110
DDI Bactrim
Coumadin (2C9)
111
What is the only BL for h.pylori?
Clarithromycin
112
Are BLs bactericidal or bacteriostatic?
bacteriocidal
113
Are BLs time dependent or concentration dependent killers?
time dependent
114
Which 2 abx effect cell wall but are NOT BLs?
Vancomycin and Telavancin
115
Conjunctivitis DOC
Azithromycin > 1 yr old (bid then qd - easier dosing)
| alt. - Erythromycin (q 4-6 hrs)
116
Penicillins - genearl uses
gr + (strep)
gr- aerobes (n.meningitis and pasteurella)
anaerobes (clostridium and some bactericides)
syphillis
117
Penicillins - type of elimination
renal
118
BL - Pregnancy considerations
all ok
119
Extended spectrum PCN - renal consideration
all need renal dosing except Amp/SUB (Unasyn)
120
Aminopenicillins - renal consideration
renal dosing
121
What abx class is a good choice for URI?
Aminopenicillins - Amp, Amx
122
h.pylori treatment
PPI + Clarithromycin + Amx
123
Which aminopenicillin is used to treat h.pylori?
Amx
124
What 4th generation cephalosporin covers pseudomonas?
Cefipime
125
Which aminopenicillin gets better absorption and therefore can be administered less frequently (improved compliance)?
Amx
126
Are BLIs antimicrobial?
No. They protect the antibiotic. The BLI takes the hit from the bug so the abx is safe and can do it's job.
127
If you are using Piperacillin or Ticarcillin for pseudomonas, can you switch to Augmention for po at home?
No. Augmentin does not cover pseudo. Must switch class…FQ, Cephalo, etc.
128
1st generation cephalosporins
PO - Cephalexin (Keflex)
| IV - Cefazolin (Ancef)
129
1st generation cephalosporins - coverage
MSSA, some PCN-susceptible anaerobes, little gr -
130
2nd generation cephalosporins
PO: Cefuroxime axetil (Ceftin), Cefprozil (Cefzil), Loracarbef (Lorabid)
IV: Cefoxitin (Mefoxin) and Cefotetan (Cefotan)
131
3rd generation cephalosporins (+ pseudomonas)
PO: cefidinir (omnicef)
IV: ceftazidime (fortaz) *pseudomonas
132
4th generation cephalosporin - one drug
IV: Cefepime (Maxipime)
*pseudomonas
reserved for severe infections
133
5th generation cephalosporins - one drug (+ MRSA)
IV: Ceftaroline fosamil (Teflaro)
| no pseudo
134
Vancomycin - MOA
inhibits the linking of transpepsidase - blocks the enzyme
| *effects cell wall but by different action
135
Macrolides - Bacteriostatic or Bacteriocidal?
bacteriostatic
136
Which ABX group is effective ONLY against gram- ?
Monobactam
137
Which ABX groups are effective against gr+ only?
PCNase, Ceph 1st gen, Vanc, Telavancin
138
Which ABX groups are effective against anaerobes?
PCN, Extended-spectrum, BL/BLI, Ceph 2nd, Carbapenems, Vanc
139
Which ABX groups are effective against pseudomonas?
Extended-spectrum, BL/BLI, Ceph 3rd/4th, Monobactam, Carbapenem (not erta)
140
Which ABX groups are effective against MRSA?
Vanc, Telavancin, Ceph 5th,
141
Which ABX groups are effective against enterococcus?
PCN, Aminopenicillins, BL/BLI, Vanc, Telavancin
142
Which receptor do some FQs modulate which may increase risk for seizures?
GABA
143
Linezolid ADE
thrombocytopenia
| Why? because binds with platelet glycoprotein receptors and makes the complex antigenic
144
Which FQ has increased seizure risk?
Cipro
145
Levoquine DDI
Fe
| binds and can cause therapeutic failure
