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antibiotics Flashcards

(44 cards)

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1
Q

Inhibitors of cell wall synthesis

A

Beta-Lactams penicillins
Cephalosporins
Glycopeptides: vancomycin
TB medications

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2
Q

Inhibitors of translation and transcription

A 
Tetracyclines
Macrolides
Clindamycin
Oxazolidinones: linezolid
Aminoglycosides and Spectinomycin
TB medications
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3
Q

Inhibition of DNA syntheses and integrity/

Inhibitors of folate synthesis and function

A

Sulfonamides,
Trimethoprim
Quinolones

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4
Q

Bactericidal

A

Mechanism is generally inhibition of cell wall synthesis
Time-dependent killing: serum level above MIC
Beta lactams and vancomycin
Concentration-dependent killing: higher drug concentration determines rate and extent of killing
Aminoglycosides and quinolones

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5
Q

Bacteriostatic

A

Mechanism is generally inhibition of protein synthesis
Weakens so body can kill
Tetracyclines, macrolides, sulfonamides

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6
Q

contraindicated in renal impairment

A

nitrofurantoin, sulfonamides (long-acting),

tetracyclines

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7
Q

adjust dosage if renal impairment

A

, aminoglycosides, carbapenems, cephalosporins

trimethoprim-sulfamethoxazole, vancomycin

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8
Q

adjust dosage in hepatic impairment

A

metronidazole
chloramphenicol, clindamycin, erythromycin
clindamycin, erythromycinine

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9
Q

narrow spectrum PCN

A 
Peniciilinase-susceptible
Penicillin G
Penicillin VK
Penicillinase–resistant
Nafcillin
Oxacillin
PCN for strept pyogenes  aka strept throat
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10
Q

wide spectrum PCN

A 
(+/−) penicillinase inhibitor
Ampicillin
Amoxicillin (for H. influenza PCN doesnt work)
Piperacillin
Ticarcillin
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11
Q

PCN PK ADE

A

PK: rapid renal elimiination
ADE: hypersensitivity (5%) cant breath
maculopapular rash from ampicillin

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12
Q

PCN treats

A 
Narrow spectrum
Streptococcal infections
Staphylococcal infections
Meningococcal infections 
Syphilis

Wider spectrum
Greater activity vs gram-negative bacteria

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13
Q

Cephalosporins

A 
First generation (narrowest)
Cephalexin
Second generation
Cefuroxime
Third generation
Ceftriaxone*
Cefixime
same class as PCN so give if PCN allergy
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14
Q

Cephalosporins PK ADE

A 
PK: Oral use for older drugs
Mostly IV for newer drugs 
 Renal elimination
Third-generation drugs enter CNS
ADEs
Hypersensitivity reactions (~2%)
complete cross-reactivity between cephalosporins 
First generation partial cross-reactivity with penicillins
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15
Q

cephalosporin contraindicated

A

No ceftriaxone to newborns b/v its cleared by billary tract and newborns cannot clear

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16
Q

Cephalosporin activity

A 
First generation: Skin, soft tissue, UTI
Second generation:
More active vs S pneumoniae and H influenza; B fragilis (cefotetan)
Third generation:
Many uses including pneumonia, meningitis, and gonorrhea
Broad activity, beta-lactamase-stable
Fourth generation:
Pseudomonas coverage
Fifth generation:
Skin, soft tissue
CAP community acquired pneumonia
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17
Q

Carbapenems

A

Imipenem-cilastatin (Primaxinbroad spectrum:
some PRSP strains (not MRSA)
gram-negative rods
Pseudomonas sp
ADEs:
CNS effects include confusion and seizures

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18
Q

beta lactams

Study These Flashcards
A

penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems

19
Q

Monobactams

Study These Flashcards
A 
Aztreonam 
only for gram -bacteria: 
Klebsiella
Pseudomonas
Serratia spp
ADEs: CNS
Headache
Vertigo 
No cross-allergenicity with other beta-lactams
20
Q

glycopeptides

Study These Flashcards
A 
vancomycin
covers MRSA and PRSP
Activity Spectrum
Gram-positive activity includes
MRSA and PRSP strains
21
Q

glycopeptides PK/ADE

Study These Flashcards
A 
PK:
Parenteral for systemic infections
ORAL vancomycin for C difficile colitis 
Renal elimination
Toxicities:
Red-neck or red man syndrome
Erythematous rash on face and upper body
Infusion rate cause and not an allergic reaction
Rare nephrotoxicity
22
Q

Daptomycin

Study These Flashcards
A

Daptomycin
Lipopeptide
ADE: myopathy as a unique toxicity: myopathy so monitor CK weekly

23
Q

Daptomycin for:

Study These Flashcards
A 
Activity Spectrum
Gram-positive activity
Endocarditis and sepsis
Off-labeled uses
Osteomyelitis
Prosthetic join infections
MSSA and MRSA coverage
24
Q

Tetracyclines

Study These Flashcards
A 
Doxycycline
bind to 30S ribosomal subunit inhibits transcription/translation
for: Acne
CAP, bronchitis
Cellulitis (purulent) due to CA-MRSA
Off-label use
Lyme disease
Periodontitis
Acute bacterial rhinosinusitis (off-label use)
25
Tetracyclines ADE
ADEs GI upset (take with cola not milk) repeat if puke <1hr Interaction with di and trivalent ions (that milk has) Deposition in developing bones and teeth Photosensitivity (wont looked burned but act burned) CONTRAINDICATED: in pregnant and <8
26
Tetracyclines activity
``` Anthrax Chlamydial Mycoplasma Rickettsiae RMSF Typhus Spirochetes Lyme disease, relapsing fever Syphilis H pylori regimens ```
27
Macrolides
``` Azithromycin (zpack) bind to 50S ribosomal subunit inhibits transcription/translation for:CAP Pertussis, Corynebacteria Diphtheria Chlamydial Prokinetic affect: increase GI motility  diarrhea ```
28
Macrolides
``` GI upset Hepatic dysfunction QT elongation CYP450 inhibition not azithromycin ```
29
Lincosamides
``` Clindamycin bind to 50S ribosomal subunit inhibits transcription/translation for: Skin, soft tissue infections Anaerobic infections (diaphragm up) ADE: Can cause C difficile colitis (highest incidence) ```
30
Chloramphenicol
``` Chloramphenicol bind to 50S ribosomal subunit inhibits transcription/translation serious infections due to organisms resistant to less toxic antibiotics Bacteroides H. influenza Neisseria meningitides Salmonella Rickettsia Active against many vancomycin-resistant enterococci ```
31
Chloramphenicol
``` Dose-related anemia Frequent monitoring of CBC Gray baby syndrome so contraindicated in babies Symptoms: Circulatory collapse Cyanosis Acidosis Abdominal distention Myocardial depression Coma Death Risks Serum levels > 50mcg/ml Patients with impaired hepatic or renal function ```
32
Oxazolidinone
``` Linezolid bind to 23S ribosomal subunit inhibits transcription/translation for: MRSA PRSP VRE strains (vanco resistant enterococci) ```
33
Oxazolidinone ADE
Dose-related anemia Neuropathy Optic neuritis Serotonin syndrome with SSRIs
34
Aminoglycosides
gentamicin and tobramycin inhibit protein synthesis via binding to 30S ribosomal subunit For: Aerobic gram-negative bacteria H, influenza M. catarrhalis Shigella species Often used in combinations with beta-lactams (empiric)
35
Aminoglycosides: ADE
Nephrotoxicity (reversible), Ototoxicity (irreversible), Neuromuscular blockade (used in surgery so dont mix with surgery blockers)
36
Inhibition of DNA syntheses and integrity and Inhibitors of folate synthesis and function
Sulfonamides, Trimethoprim, Quinolones
37
antifolate antibiotics
sulfonamide and trimethoprim: block folic acid synthesis fluoroquinolones: interfere with bacterial DNA synthesis by inhibiting DNA gyrase
38
Trimethoprim-sulfamethoxazole
``` synergistic inhibition of folic acid synthesis dose is based on trimethoprim UTI Respiratory infections (bronchitis) Ear infections MSSA or MRSA-skin/soft tissue infections ```
39
Trimethoprim-sulfamethoxazole ADE
Bone marrow suppression Hyperkalemia rash, fever high incidence of adverse effects in AIDs patients neutropenia, Stevens-Johnson syndrome and toxic epidermal necrolysis. contraindicated in first trimester of pregnancy
40
Quinolones
Ciprofloxacin Levofloxacin inhibits DNA replication via binding to DNA gyrase (gram-negative organisms) and topoisomerase IV (gram-positive organisms) Urogenital and GI tract infections Ciprofloxacin and ofloxacin for urinary tract infections Levofloxacin, gemfloxacin, and moxifloxacin are respiratory
41
Quinolones ADE
CNS effects (dizziness, headache) Tendinitis due to effects on cartilage (tendon rupture) Try to avoid in young children and pregnancy Peripheral neuropathy Neuromuscular-blocking activity QTc prolongation Oral absorption impaired by cations-Calcium, magnesium, aluminum (milk) not with class 1a/3 antiA
42
Synergism
Inhibitory/killing effects of combos significantly greater than expected from their effects when used individually
43
check before prescribe
``` ✓ Allergy or history of adverse drug reactions ✓ Age of patient ✓ Pregnancy ✓ Metabolic or genetic variation ✓ Renal and hepatic function: ✓ Concomitant drug therapy: ✓ Concomitant disease states ```
44
Antibiogram
report of resistance/susceptibility local resistance patterns for determining empiric treatment

pharmacology (9 decks)

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