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Antibiotics Flashcards

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1
Q

Pen G and Pen V:

Route of admin
MOA

A

Pen G- IV and IM
Pen V- oral

D-ala D-ala analog.
Binds PBP to block transpeptidase cross-linking of peptidoglycan in cell wall. Activate autolytic enzymes.

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2
Q

Clinical use for PenG/PenV (5)
Bactericidal or Bacteriostatic?
Penicillinase Sensitivity?

A
  1. S. pneumo
  2. S. pyogenes
  3. Actinomyces
  4. N. meningitidis
  5. T.pallidum

Bactericidal
Penicillinase sensitive

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3
Q

PenG/PenV
Adverse (2)
Mech of Resistance

A
  1. Hypersensitivity (Rash/anaphylaxis)–>Type1 Hypersens
  2. direct Coombs hemolytic anemia (Haptan)–>Type2 Hypersens

Resistance: Penicillinase in bacteria (B-lactamase) cleaves B-lactam ring between N and C=O

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4
Q

Name 2 penicillinase sensitive penicillins

A

Aminopenicillins

  1. Amoxicillin
  2. Ampicillin
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5
Q

Aminopenicillins (Amoxicillin/Ampicillin)
MOA
MOResistance
Penicillinase Sensitivity?

A

MOA:
Same as penicillin w/ wider spectrum

Penicilinas (B-lactamase) cleaves B-lactam ring

Penicillinase sensitive–>combine w/ clavulanic acid to protect against destruction by B-lactamase

Typically: Amox w/ sulbactam, Amp w/ clavulanic acid

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6
Q 
Aminopenicillins:
Clinical Use (8*)
A 
Broad Spectrum
"Ampicillin/Amoxicillin HHELPSS kill Enterococci"
H.flu
H.pylori
E.coli
Listeria
Proteus
Salmonella
Shigella
Enterococci
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7
Q

Aminopenicillins (Amoxicillin/Ampicillin):

Adverse (3)

A
  1. Hypersensitivity
  2. Rash–>not a hypersensitivity (not IgE) but specific for amoxicillin with mononucleosis
  3. pseudomemb colitis
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8
Q

What contributes to Penicillin’s clinical use

A

The R group on penicillins determines

  1. Broad vs. Narrow
  2. ability of drug to cross Bacterial membrane
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9
Q

Name Penicillinase-resistant penicillins (4)

Why “resistant”?

A
  1. Dicloxacillin
  2. Nafcillin
  3. Oxacillin
  4. Methicillin

Bulky -R group blocks B-lactamase’s access to B-lactam ring

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10
Q 
Name Penicillinase-resistant penicillins:
Clinical Use(1*)
A

Narrow spectrum
1. S. aureus (Except MRSA-it mutates transpeptidase enzyme gene so drug can’t bind))

“use Naf for Staph”

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11
Q

Name Penicillinase-resistant penicillins:

Adverse (2)

A
  1. Hypersensitivity (Rash/anaphylaxis)

2. Interstitial Nephritis (remember Methicillin was taken off market for beating up too many kidneys)

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12
Q

Name Antipseudomonal penicillins (2)

Penicillinase Sensitivity?

A
  1. Pipercillin
  2. Ticarcillin

Penicillinase sensitivity–>use B-lactamase inhibitors
*classically Tazobactam w/ Pipercillin/Ticarcillin

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13
Q 
Antipseudomonal penicillins: 
Clinical Use (2)
Adverse (1)
A
  1. Pseudo spp.
  2. Gram (-) rods
    * typically with Tazobactam
  3. Hypersensitivity
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14
Q

Why use B-lactamase inhibs?

Name 3* B-lactamase inhibs

A

Added to penicillin abx to protect abx from penicillinase destruction

“CAST a net to protect Penicillins”

  1. Clavulanic Acid (w/ Amox)
  2. Sulbactam (w/ Amp)
  3. Tazobactam (w/ Pip or Ticar)
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15
Q 
Cephalosporins:
MOA
Bactericidal or Bacteriostatic?
Penicillinase Sensitivity?
MOResistance
A
  • B-lactam drugs inhib cell wall synthesis
  • Bactericidal
  • Less susceptible to penicillinase
  • Structural change in PBP (transpeptidase)
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16
Q

Cephalosporins:

Organisms typically not covered by 1st-4th generation

A

“1st-4th Generation cephalosporins are LAME”

  1. Listeria
  2. Atypicals (chlamydia/mycoplasma)
  3. MRSA (covered by ceftaroline-5th gen)
  4. Enterococci
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17
Q

1st Gen Cephalosporins:
Names (2)
coverage (5)
Any special uses

A
  1. Cefazolin-used pre surgery to prevent S.aureus infection
  2. cephalexin

“PEcK-g”

  1. gram + cocci
  2. Proteus
  3. E.coli
  4. Klebsiella
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18
Q

2nd Gen Cephalosporins:
Names (3)
Coverage (8)

A

“FAke FOX FUR”

  1. CeFOXitin
  2. CeFAclor
  3. CeFURoxime

“PEcK-g HENS”

  1. gram + cocci
  2. Proteus
  3. E.coli
  4. Klebsiella
  5. H. flu
  6. Enterobacter aerogenes
  7. Neisseria
  8. Serratia marcescens
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19
Q

3rd Gen Cephalosporins:
Names (3)
Coverage (3,1)

A

Serious gram (-) infections resistant to other B-lactams

  1. Ceftriaxone- 1. N.meningitids 2. N.gonorrhea 3. Lyme
  2. Cefotaxime
  3. Ceftazidine- 1. Pseudo
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20
Q

4th Gen Cephalosporins:
Names (1)
Coverage (3)

A

Cefepime

  1. Gram (+)
  2. Gram (-)
  3. Pseudo
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21
Q

5th Gen Cephalosporins:
Names (1)
Coverage (3)

A

Ceftaroline

  1. Gram (+)
  2. Gram (-)
  3. MRSA
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22
Q

Name 2 Cephalosporins that cover Psuedomonas

A
  1. Ceftaz (3rd gen)

2. Cefepime (4th gen)

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23
Q

Cephasporins:

Adverse (6)

A
  1. Hypersensitivity
  2. Autoimmune Hemolytic anemia
  3. Disulfuram-like Rxn
  4. Vit K def (from killing off enteric bacteria)
  5. Cross-react w/ penicillins
  6. Nephrotox w/ Aminoglycosides
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24
Q

Name Carbapenems (4)

Special considerations per drug

A
  1. Imipenem
  2. Meropenem- less Seizure Risk, stable to Dehydropeptidase I
  3. Ertapenem-new, limited Pseudomonas coverage
  4. Doripenem-new
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25
Carbapenems: MOA Special administration*? Broad or Narrow
MOA: B-lactamase resistant - Always admin w/ CILASTATIN (inhib Renal Dehydropeptidase I) to decrease inactivation of drug in Renal tubules - Broad spectrum "With imipenem, the kill is LASTIN' with CILASTATIN"
26
Carbapenems: Coverage(3) When used?
1. Gram + cocci 2. Gram - rods 3. anaerobes * Wide spectrum but limited use to life-threatening infections or after other drugs fail b/c of significant Adverse
27
Carbapenems: | Adverse (3)
1. Seizures/ CNS tox @ high plasma levels 2. GI distress 3. Skin rash
28
Aztreonam (a Monobactam): MOA Penicillinase sensitivity Adverse
Prevents Peptidoglycan cross-linking by binding to PBP-3 - Less susceptible to B-lactamases - usually non-toxic, occasional GI upset
29
Aztreonam: Coverage (1) 3 special uses
Gram - rods 1. Penicillin-allergic patients safe 2. well-tolerated in renal insuff pt (who can't use Aminoglycosides) 3. Synergistic activity w/ amino glycosides
30
Vancomycin: MOA Penicillinase Sensitivity Bactericidal or Bacteriostatic
- binds Dala Dala portion of cell wall precursors to prevent peptidoglycan formation - Not sensitive to penicillinase - Bactericidal against most (Bacteriostatic for C.Diff) - bacterial A.A. mutation to Dala Dlac "Pay back 2Dala's (dollars) for VANdalizing"
31
Vancomycin: | Adverse(4)
"Vancomycin is generally well tolerated but NOT trouble free" 1. Nephrotox 2. Ototox 3. Thrombophlebitis 4. Red Man Syndrome- pretreat w/ histamines & slow infusion
32
Bacterial Ribosome subunits
70S (30S, 50S)
33
Which Abx bind 30S and which bind 50S? | Bactericidal or Bacteriostatic
" Buy AT 30, CCEL (sell) at 50" 30S: 1. Aminoglycosides- bactericidal 2. Tetracyclines-bacteriostatic 50S: 1. Chloramphenicol-bacteriostatic 2. Clindamycin-bacteriostatic 3. Erythromycin (macrolides)-bacteriostatic 4. Linezolid-variable
34
Name Aminoglycosides (5)*
"MEAN (a-min-oglycoside) GNATS caNNOT kill ANAEROBES." 1. Gentamicin 2. Neomycin 3. Amikacin 4. Tobramycin 5. Streptomycin
35
Aminoglycosides: MOA(2)* Special consideration about MOA*
"'A' starts the alphabet, 'A'minoglycosides inhib INITIATION" 1. Irreversible inhib initiation-->mRNA misread 2. inhib translocation Require O2 for uptake making them ineffective against anaerobes "'Mean' GNATS caNNOT kill ANAEROBES"
36
``` Aminoglycosides: Clinical use (4) ```
1 . Severe Gram - rod (like Pseudo/E.coli) 2. Synergistic w/ B-lactams--> increase response 3. Bowel surgery (Neomycin) 4. Neonate suspected infections (Gentamycin & Ampicillin)
37
Aminoglycosides: | Adverse*
"'Mean' GNATS caNNOT kill ANAEROBES" 1. Nephrotox (worse w/ cephalosporines) 2. Neuromuscular blockade 3. Ototox (worse w/ Loops) 4. Teratogen
38
Aminoglycosides: | MOResistance
Bacterial transferase enzymes inactivate drug by: 1. acetylation 2. phosphorylation 3. adenylation
39
Abx's ending in -mycin (4 groups)
1. Aminoglycosides ('GNAT') 2. Clindamycin 3. Macrolides (Azithromycin, Clarithromycin, Erythromycin) 4. Daptomycin
40
Tetracyclines: Tetracycline, Doxycycline, Minocycline MOA Bactericidal or Bacteriostatic MOResistance
Binds 30S -->prevent aminoacyl-tRNA attachment Bacteriostatic Plasmid-encoded transport pumps decrease uptake/increase efflux
41
Tetracyclines: Tetracycline, Doxycycline, Minocycline CNS penetration D-D(3)
- limited CNS penetration | - Milk(Ca+2), antacids (Ca/Mg), Fe+-containing preparations: Divalent cations inhib gut drug absorption
42
Tetracyclines: Tetracycline, Doxycycline, Minocycline Coverage (5) Special population use
Atypicals/Intracellular: 1. Lyme (borrelia burgdorferi) 2. M. pneumo 3. RMSF (Rickettsia) 4. Clamydia 5. Acne Fecally excreted-->Good for pt w/ Renal Failure VACUUM THe BedRoom: Vibreo, acne, chlamydia, ureaplasma, urealyticum, mycoplasma, Tuleremia, H pylori, Borrelia burgdorferi, rickettsia
43
Tetracyclines: Tetracycline, Doxycycline, Minocycline Adverse(4) Contra(2)
1. GI distress (fecally excreted) 2. Discoloration of Teeth 3. Inhib bone growth children (not
44
Chloramphenicol: MOA Bactericidal or Bacteriostatic MOResistance
Blocks peptidyltransferase of 50S Bacteriostatic Plasmid-encoded acetyltransferase inactivates drug
45
``` Chloramphenicol: Clinical use(2) ```
1. Meningitis (H.flu/Neisseria/S.pneumo) | 2. RMSF (Rickettsia)
46
Chloramphenicol: Adverse (3) (special note)
1. Microcytic Anemia (dose dependent)-->*know picture 2. Aplastic Anemia (dose independent) 3. Gray-Baby syndrome (premature babies lack UDP-glucuronyl transferase-->decrease renal excretion) *Limited use in USA b/c adverse but still used in developing countries($cheap)
47
Clindamycin: MOA Bactericidal or Bacteriostatic
Block peptide transfer at 50S | Bacteriostatic
48
``` Clindamycin: Clinical Use (4) ```
Treats anaerobic infections above diaphragm 1. aspiration pneumo 2. lung abscesses 3. oral infections 4. invasive GAStrep
49
Aspiration pneumo patients (3)
1. alcoholics 2. seizures 3. Altered mental status
50
Gray Baby symptoms(4) | Which drug causes this?
1. Gray ash-colored skin 2. V 3. Limp Muscles 4. CV collapse Cloramphenicol- premies lack UDP glucuronyl transferase
51
Clindamycin: | Adverse (2)
1. C.diff-pseudomembranous colitis | 2. F/D
52
Abx to treat Lyme disease (2) | Vector
1. Doxycycline 2. Ceftriaxone Ixodes tick
53
Use of Demeclocycline | MOA
treat SIADH | block V2-R in collecting duct (and bind 30s to prevent attachment of aminoacyl-tRNA)
54
C.diff causing Abx: (2)
potentially all Abx but the 2 big ones are: 1. Clindamycin 2. Ampicillin (aminopenicillin)
55
Linezolid (a Oxazolidinone): MOA Bactericidal or Bacteriostatic MOResistance
Bind 50S and prevent initiation complex formation Bacteriostatic rRNA point mutations
56
Linezolid (a Oxazolidinone): | Clinical Use
Gram + esp. MRSA & VRE
57
Linezolid (a Oxazolidinone): | Adverse (3)
1. BM suppression (esp. thrombocytopenia) 2. peripheral neuropathy 3. serotonin syndrome
58
treatment of pt w/ MRSA and kidney disease?
Linezolid (not Vancomycin- Nephrotox)
59
Macrolides: | Names (3)
1. Azithromycin 2. Clarithromycin 3. Erythromycin
60
Macrolides: MOA* Bactericidal or Bacteriostatic MOResistance
``` Bind 23S (of 50S) to block translocation ("macroSLIDES") Bacteriostatic Methylation of 23S ```
61
``` Macrolides: Clinical Use (4) ```
1. Atypical pneumonia (Mycoplasma/Chlamydia/Legionella) 2. STI (Chlamydia) 3. Gram + Cocci (Strep in penicillin-allergic) 4. B. pertussis
62
Macrolides: Adverse (5)* D-D(2)
"MACRO" 1. Motility issues (GI) 2. Arrhythmia (prolonged QT-->torsades de pointe) 3. Cholestatic hepatitis (bile produced in liver/stored in gallbladder) 4. Rash 5. eOsinophilia Clarithromycin & Erythromycin INHIB P450-->^serum concentration 1. Theophylline 2. oral anticoag
63
``` Serotonin Syndrome Symp (6) Causative ABx Treatment serotonin precursor molecule ```
Life threatening!! 1. HA 2. Aggitation 3. Sweating 4. muscle twitch 5. clonus 6. Hallucinations Abx cause: Linezolid Tx: stop med Tryptophan-->serotonin
64
Sulfonamides: | Name (3)
1. Sulfamethoxazole (SMX) 2. Sulfisoxazole 3. sulfadiazine
65
Sulfonamides: MOA Bactericidal or Bacteriostatic MOResistance(3)
Competitive Inhib DihyDROPteroate synthase-->inhib folate synthesis "Don't DROP the 'S'oap" Bacteriostatic (bactericidal w/ Trimethoprim) 1. alter dihyDROPteroate synthase 2. decrease uptake 3. increase PABA (substrate for RXN)
66
``` Sulfonamides: Clinical Use(5) ```
1. Gram + 2. Gram - 3. Nocardia 4. Clamydia 5. Simple UTI "SNAP" Sulphonamides=Nocardia Actinomyces = Penicillin
67
Sulfonamides: | Adverse(6)
1. Hypersensitivity 2. Hemolysis of G6PD def 3. Nephrotox (Tubulointerstitial Nephritis) 4. Photosensitivity 5. Kernicterus (infants) 6. Displace drugs from Albumin (esp. warfarin-->must decrease dose)
68
Drugs causing Photosensitivity(4)
"SAT For PHOTO" 1. Sulfonamides 2. Amidarone 3. Tetracyclines 4. 5-FU
69
Drugs causing Hemolysis in G6PD def (7) | Characteristic cells found on G6PD blood smear?
"Hemolysis IS D PAIN" 1. isoniazid 2. sulfonamides 3. dapsone 4. primaquine 5. aspirin 6. ibuprofen 7. nitrofurantoin Bite cells & Heinz bodies(Hb precipitation)
70
What is Kernicterus? Cause in infants? Why do sulfonamides cause kernicterus?
- Kernicterus is buildup of bilirubin in CNS - Babies have immature BBB -Sulfonamides outcompete bilirubin for binding albumin-->increase free bilirubin crosses the immature BBB
71
Dapsone: MOA Clinical Use(2) Adverse
-inhib DihyDROPteroate synthase(like sulfonamides, differ structure) 1. Leprosy(lepromatous/tuberculoid) 2. px Pneumocystis jirovecii (PCP) Hemolysis in G6PD def
72
Trimethoprim (TMP): MOA Bactericidal or Bacteriostatic
Inhib bacterial Dihydrofolate reductase | Bacteriostatic (bactericidal w/ Sulfamethoxazole)
73
``` Trimethoprim (TMP): Clinical Use(4 tx, 2 px in immunocompromised) ```
Combo with Sulfamethoxazole 1. UTIs 2. Shigella 3. Salmonella 4. PCP 1. PCP 2. Toxo
74
Fluroquinolones: | Names(7)
" -oxacin" 1. Ciprofloxacin 2. Norfloxacin 3. Levofloxacin 4. Ofloxacin 5. Moxifloxacin 6. Gemifloxacin 7. Enoxacin
75
Fluroquinolones: MOA Bactericidal or Bacteriostatic MOResistance(3)
Inhib prokaryotic topoisomerase-II(DNA gyrase) & topo-IV (topoisomerases break DNA to undo supercoils) Bactericidal 1. Chromosome-encoded mutation in DNA gyrase 2. plasmid-mediated resistance 3. Efflux pumps
76
Fluroquinolones: Clinical Use(3) Which fluroquinolone loves the Lung?
1. Gram - rods UTI & GI (including pseudomonas) 2. Neisseria 3. some gram + Levofloxacin "Levo loves the lungs" -S.pneumo/ H.flu/ Leigenella/ Mycoplasma/ Chlamydia Pneumonia
77
Fluroquinolones: Adverse(6) Contra (2, why)
1. GI upset 2. Superinfections 3. Skin rashes 4. HA/dizzy 5. leg cramps/myalgias (less common) 6. prolong QT interval (some) Contra: 1. Pregnant/Nursing Moms/ Cartilage Damage 2. >60yo/ pt on prednisone-->Tendonitis or Tendon Rupture "FluroquinoLONES hurt attachments to your BONES"
78
Daptomycin: MOA Clinical Use (4)
Lipopeptide disrupts cell membrane of Gram + cocci Severe infections 1. S.aureus skin infections (esp MRSA) 2. Bacteremia 3. Endocarditis 4. VRE
79
Mnemonic for Endocarditis
``` "FROM JANE" Fever Roth spots Osler nodules Murmur Janeway lesions Anemia Nailbed hemorrhages Emboli ```
80
Daptomycin: Adverse(2) What can daptomycin not be used for?
1. Myopathy 2. Rhabdomyolysis ("Dapto causes Rhabdo") "Dapto = SurfactNO" can't be used for pneumonia b/c avidly binds to and is inactivated by surfactant
81
Metronidazole: MOA Bactericidal or Bacteriostatic Other organisms Metronidazole can treat?
Forms Toxic Free Radical metabolites in the bacterial cell that damages DNA Bactericidal anti-protazoal
82
``` Metronidazole: Clinical Use (6- targeting 3 systems) ```
"GET GAP on the METRO with METRONIDAZOLE" 1. GI (Giardia/Enteromoeba) 2. Vaginitis (Trichomonas/ Gardnerella vaginalis) 3. Entero (Anaerobes (Bacteroides, C. Diff)/h. Pylori (part of triple therapy)
83
What drug treats anaerobes above the diaphragm? | Below the diaphragm?
``` Above= Clindamycin Below= Metronidazole ```
84
What is the triple therapy for H.pylori?
1. PPi 2. Metronidazole / amoxicillin 3. Clarithromycin
85
Metronidazole: | Adverse (3)
1. Disulfiram-like Rxn 2. HA 3. Metallic taste ('METro causes METallic taste")
86
Drugs causing Disulfiram-like Rxn (5) | Symptoms
1. Metronidazole 2. Certain cephalosporins 3. Griseofulvin 4. Procarbazine 5. 1st gen sulfonylureas Symps: Flushing, Tachycardia, Hypotension
87
Compare Trichomonas vs. Gardnerella: - smell - discharge - Micro view - cervix appearance - Does the partner need treated too?
Trich: Foul smell, green discharge, trich species/WBC, strawberry cervix, YES YOU TREAT PARTNER Gardnerella:Fish smell, white discharge, Clue cells, NO NEED TO TREAT PARTNER
88
Compare Giardia vs. Entamoeba:
Giardia: bloating/Gas, Foul smelling fatty diarrhea, typically in campers/hikers (be able to identify species with face) Entamoeba: BLOODY diarrhea, liver abscess, "anchovy paste exudate", RUQ pain, flask shaped ulcer
89
How to treat MRSA?
"Very Dangerous Cocci Loathe Treatment" 1. vancomycin (not for renal failure) 2. daptomycin 3. Ceftaroline 4. Linezolid 5. Tigecycline
90
How to treat VRE? | How does resistance develop?
"VRE Doesn't Quite Like Vancomycin" 1. Dalfopristin 2. Quinupristin 3. Linezolid Vancomycin resistance: Dala Dala-->Dala Dlac

Drugs- Basic High Yield Stuff for Boards (20 decks)

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