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Antibiotics Flashcards

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1
Q

How would you dose a time-dependent killing drug?

A

Dose it often, has a minimal post-antibiotic effect

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2
Q

How would you dose a concentration-dependent killing drug?

A

Increase the dose all at once

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3
Q

Examples of time-dependent drugs

A

All B-lactam agents

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4
Q

Examples of concentration-dependent drugs

A

Aminoglycosides and Fluoroquinolones

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5
Q

What does synergistic drug effects mean?

A

Antibiotics given together that enhance the efficacy of a drug

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6
Q

Example of synergistic drug

A

Sulfamethoxazole/Trimethoprim (Bactrim)

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7
Q

What are the two PCN resistance methods?

A
  1. B-lactamase enzymes inactivate the antibiotic

2. Modification of the target PBP/ low or decreased affinity for Penicillin binding protein

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8
Q

Which organisms typically are effected with beta-lactamase enzymes?

A

Gram - organisms and staph aureus

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9
Q

How do you overcome the b-lactamase enzymes?

A

Co-formulate with b-lactam inhibitors

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10
Q

How do you overcome the extended spectrum beta-lactamase (ESBL)?

A

Give Carbapenems

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11
Q

How to overcome resistance when the PBP site is changed

A

Switch to an agent covering MRSA, or give high dose drugs (amoxicillin as example)

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12
Q

If you have a MRSA or strep pneumoniae resistance what do you do?

A

Change antibiotics

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13
Q

What are the two antibiotics in the NPCN class?

A 
PCN G (IV)
PCN VK (PO)
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14
Q

What do the natural penicillins cover?

A

Strep, VSE, Anaerobe (Peptostreptococcus)

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15
Q

What is a common indication for the NPCNs?

A

Dental infections, throat infections

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16
Q

What are the examples of Penicillinase resistant antibiotics?

A

Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

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17
Q

What do the penicillinase resistants cover?

A

MSSA (GREAT), Strep

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18
Q

What is a common indication for the penicillinase resistants?

A

Skin infections, MSSA infections including endocarditis

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19
Q

What are the examples of AminoPCNs?

A

Ampicillin (IV)

Amoxicillin (PO)

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20
Q

What do the AminoPCNs cover?

A

Strep, VSE, Anaerobes (Peptostreptococcus), +/- GNR, +/- H.flu M.Catarral

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21
Q

What are common indications for the AminoPCNs?

A

Otitis media, UTIs/URIs
Meningitis (Ampicillin)
Listeria (Ampicillin GOLD STANDARD)

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22
Q

What are the example of the Amino+BLIs?

A

Augmentin (Clavulanic acid, PO)

Unasyn (Sulbactam, IV)

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23
Q

What do the Amino+BLIs cover?

A

MSSA, Strep, VSE, Anaerobe (pepto), GNR, H.flu M.catarral, GN Anaerobe (bacteroides)
EVERYTHING EXCEPT PSEUDO MRSA and ATYPICALS

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24
Q

What are common indications for the Amino+BLIs?

A

Human bites, animal bites (Augmentin)

Broad empiric coverage, H-A infections, B-lactamase producing organisms

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25
What is the antipseudomonal?
Piperacillin-Tazobactam (Zosyn) IV
26
What does Zosyn cover?
Everything except MRSA and ATYPICALS
27
What is the gold standard for PCN sensitive enterococcus?
Ampicillin
28
What else can Unasyn cover?
Acinetobacter
29
What can you do for a Strep pneumoniae resistance for Otitis media?
Can give high dose Amoxicillin, then change class if still not working
30
Which drugs are in the 1st generation cephalosporins?
Cefazolin (IV) Cephalexin (PO) Cephadroxil (PO)
31
What do the 1st generation cephalosporins cover?
MSSA, Strep, GP Anaerobe (pepto), +/-GNR
32
What are some common indications for the 1st gen cephalosporins?
2nd line for MSSA, SSTIs, UTI, Pre-op Abx
33
Which drugs are in the 2nd generation cephalosporins?
Cefoxitin (IV considered abd) Cefotetan Cefuroxime (IV considered resp) Cefprozil
34
What do the 2nd gen cephalosporins cover?
MSSA, Strep, GP Anaerobe (pepto), GNR, +/-HNM
35
What does Cefoxitin cover that Cefuroxime does not? (2nd gens)
+/- coverage for GN Anaerobe Bacteroides Fragilis
36
What are the common indications for 2nd gen cephalosporins?
Respiratory tract infections, abdominal infections, GYN infections
37
Which drugs are in the 3rd gen cephalosporins?
Ceftriaxone IV Cepodoime PO | Ceftazadime (IV)
38
What is the coverage for 3rd gen cephalosporins?
MSSA, Strep, GP Anaerobe (pepto), GNR, HNM
39
What else does Ceftazadime cover that Ceftriaxone does not (3rd gen)?
+/- MSSA, also covers pseudomonas
40
What is the 4th gen cephalosporin?
Cefepime (IV)
41
What does Cefepime (IV) cover?
MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, Pseudomonas
42
What is a common indication for 3rd gen cephalosporin?
CAP, meningitis, lyme *Gonorrhea: Ceftriaxone* Hospital acquired pneumonia: Ceftazadime
43
What is a common indication for Cefepime (IV)?
Hospital-acquired infections, neutropenic fever
44
What is the 5th gen cephalosporin?
Ceftaroline (IV)
45
What does Ceftaroline (Iv) cover?
MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, MRSA
46
What is a common indication for Ceftaroline (IV)?
Skin and sin structure infections, MRSA and VSA infections
47
Do cephalosporins cover enterococcus (VSE) infections?
NO
48
Which 2nd gens are used for respiratory infections?
Cefuroxime, Cefaclor, Cefprozil
49
Which 2nd gens are used for abdominal/GYN infections?
Cefoxitin, Cefotetan
50
What are the 4 fluoroquinolones?
Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin
51
What is the spectrum for fluoroquinolones?
Excellent atypical coverage (chlamydia, legionella, mycoplasma)
52
What are the common indications for fluoroquinolones?
Respiratory tract infections (except cipro) UTIs (except moxi) Intra-abdominal infections, osteomyelitis
53
What does Ciprofloxacin cover?
+/-MSSA and Strep, GNR, HNM, Pseudomonas, ATYPICALS
54
What does Levofloxacin cover?
MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, Pseudomonas, ATYPICALS
55
What does Moxifloxacin cover?
MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, +/- Bacteroides, ATYPICALS
56
What are carbapenems also called?
Gorilla-cillins
57
What are carbapenems the DOC for?
Ceftriaxone-resistant E.coli, Klebsiella, P.mirabilis (ESBL), complicated UTI, intra-abdominal infections
58
What are the 4 carbapenems? (IV only)
Impenem/cilastatin (Primaxin) Meropenem (Merrem) Doripenem (Doribax) Ertapenem (Invanz)
59
What is the coverage for carbapenems?
MSSA, Strep, GP Anaerobe (pepto), GNR (entero), HNM, Pseudomonas (except Ertapenem), GN Anaerobe (B.fragilis)
60
What is an important ADR about carbapenems?
Higher risk of seizures with imipenem at high doses
61
What does Monobactam cover? (Aztreonam IV)
GNR and respiratory organisms and pseudomonas
62
What do you do if pt has anaphylaxis to beta-lactams?
Switch to a different class of antibiotics
63
What do you do if pt has a rash to a PCN?
Can consider a cephalosporin w/decreasing levels of cross reactivity or carbapenem
64
Can you use aztreonam if pt has a rash to PCN?
Yes, unless Ceftazidime allergy
65
What are important ADRs associated with fluoroquinolones?
Cant give to pregnant or children, FDA BBW for tendonopathies especially in elderly and children, prolongs Cumadin levels
66
What are the Macrolides?
Erythromycin, Clarithromycin, Azithromycin
67
What is the coverage for macrolides?
+/- MSSA Strep and GP Anaerobes, HNM, Atypicals | Cover for respiratory Gram -s
68
What are the common indications for macrolides?
Respiratory tract infections, alternative for PCN-allery (otitis media, pharyngitis), Chlamydia, Travelers diarrhea
69
What is important to note about macrolides?
NOT used for sepsis, urine or soft tissue infections!! Cause QTc prolongation
70
What are the tetracyclines?
Doxycycline, Tetracycline, Minocycline, Tigecycline
71
What are the common indications for tetracyclines?
Respiratory tract infections, MRSA skin and soft tissue infections, Tick-borne infections
72
What are some ADRs with tetracyclines?
Not indicated for children less than 8 or pregnancy. Cause tooth discoloration, GI esophagitis, photosensitivity
73
What is the coverage for tetracyclines?
MSSA, MRSA, +/- Strep, GP Anaerobes, HNM, Atypicals
74
What else does Tigecycline (IV) cover that other tetracyclines do not?
GNR, B.fragilis

Clinical Therapeutics (8 decks)

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