Antibiotics Flashcards
(147 cards)
1
Q
Cephalosporin
A
Beta Lactation antibiotics that are derived from acrimonious fungus
2
Q
MOA cephalosporins
A
Inhibit bacteria wall synthesis
Bactericidal
3
Q
Are cephalosporin penicillinase resistant
A
Yup
Not susceptible to penicillinases
4
Q
Each new generation of cephalosporin has greater gram _ properties
A
Negative
5
Q
Side effects cephalosporin
A
Hypersensitivity reactions vitamin k defiency
Disulfiram like reaction with alcohol
Increased nephrotoxicity of aminoglycosides
6
Q
Hypersensitivity cephalosporin
A
Same with penicillin
Careful giving to people with penicillin allergies
Rashes, hives, itchy eyes, swollen tongue
7
Q
Cephalosporin vitamin k
A
Cephalosporin activates vitamin k, causing defiency
8
Q
Alcohol and cephalosporin
A
Disulfiram like reaction-flushing, fast heartbeat, nausea, thirst, chest pain, vertigo, low bp
Occurs as a result of accumulation of acetaldehyde due to inhibition of acetaldehyde dehydrogenase
9
Q
Increased nephrotoxicity of aminoglycosides with cephalosporin
A
Demonstrate synergistic nephrotoxicity interaction when used in combination
10
Q
1st generation cephalosporin
A
Beta Lactation antibiotics that are derived from acrimonious fungus. Inhibit bacterial cell walls ynthesis. Not susceptible to peniciliinases.
Not strong gram -
11
Q
Examples of first generation cephalosporin
A
Cefazolin and cephalexin
12
Q
What are 1st gen cephalosporin effective against
A
Proteus mirabilis, E. coli, klebsiella pneumonia and gram positive cocci
13
Q
Cefazolin
A
Intramuscular
Gram + bacterial infections of the skin but more severe infections involving bon,e lungs, GI and urinary tract. Also pre operative prophylaxis
14
Q
Cephalexin
A
Orally
Gram positive infections int he middle ear, bone, lungs, and skin. Also endocarditis prophylaxis
15
Q
Indications for 1st gen cephalosporin
A
Proteus mirabilis
E. coli
Klebsiella
Gram positive cocci
16
Q
2nd gen cephalosporin
A
Cefoxitin, cofactors and cefuroxime
For proteus mirabilis, E. coli, klebsiella, haemophilus influenza, enterobacter, neisseria, serratia marcescens and gram positive cocci
17
Q
Cefoxitin
A
Gram negatives, gram positive and even anaerobes.
NOT for active against pseudomonas and enterococci
18
Q
Cefaclor
A
For septicemia, pneumonia peritonitis, UTI and biliary tract infections. It is active against both gram positive and gram negative bacteria
19
Q
Cefuroxime
A
Unlike other second generations can cross the BBB and is active against haemophilus influenza, neisseria gonorrhea and Lyme disease
20
Q
Indications for 2nd generation
A
Proteus mirabilis E. coli Klebsiella Gram positive cocci Haemophilus influenza Enterobacter Neisseria Serratia marcescens
21
Q
3rd generation cephalosporin
A
Ceftriaxone, cefotaxime, and ceftazidime
Broad spectrum
Good against gram negative organisms resistant to other beta lactate
22
Q
Cefotaxime
A
Respiratory infections, CT, urinary tract, genita tract, meninges, and blood. Can cross the BBB
Most gram negative bacteria (espicially pseudomonas) also gram positive cocci, except enterococcus
23
Q
Ceftriaxone
A
Community acquired pneumonia, haemophilus influenza infection, and can be used for bacterial meningitis.
GONORRHEA from dingle muscular injection
Can cross the BBB
24
Q
Cefdinir
A
Pneumonia, bronchitis, ear infections, sinusitis, pharyngitis, tonsillitis, skin infections.
25
Side effects cefdinir
Can bind iron in GI and cause red stool
| Diarrhea, vaginal infections, nausea, head ache, abdominal pain
26
Ceftazimidime
Gram positive and gram negative bacteria. ACTIVE AGAINST PSEUDOMONAS
27
Whic third generation cephalosporin should i use for pseudomonas
Ceftazidime
28
Indications for 3rd gen cephalosporin
Serious gram negative infections, which are typically resistant to other beta Lactation antibiotics
29
4th gen cephalosporins
Cefepime
Broad spectrum of activity and further increased activity against gram negative organisms resistant to other beta lactams
Used for pseudomas a
30
Cefepime
For moderate-severe hospital acquired infections by multi resistant bacteria such as pseudomonas and can cover resistant strep p as well as enterobacteriaceae
31
Indications 4th gen cephalosporin
Increased activity against gram positive infections and pseudomas and gram positive infections like staph a...also gram -
32
5th generation cephalosporin
Broad spectrum
| Specifically created for resistant organisms such as MRSA
33
Indications 5th generation cephalosporin
Resistant bacteria like MRSA
| Broad spectrum against gram positive and gram negative
34
Examples of 5th generation cephalosporin
Ceftobiprole
| Ceftaroline
35
Ceftobiprole
Antipseudomonal (binds strongly to penicillin binding protein 2a)
MRSA, strep p, enterococci, health care associated pneumonia (powerful antipseudomnonal)
MRSA which are less susceptible to daptomycin , vancomycin or linezolid
36
Ceftaroline
Broad spectrum activity against many gram positive organisms, such as MRSA, MRSE, and VRE.
Not great for gram - bacteria like bacteroides
NO PSEUDOMONAS COVERAGE
37
Protein synthesis inhibitors
Slows or stops the growth or proliferation of cells by disrupting the generation of new proteins, usually the ribosome level
38
Protein synthesis inhibitors prok vs euk
Effect only prokaryote 30 50s =70s
39
Protein synthesis inhibitors of 30s ribosome
Aminoglycosides
| Tetracyclines
40
Protein synthesis inhibitors 50s
```
Chloramphenicol
Clindamycin
Erythromycin
Linomycin
Linezolie
```
41
Aminoglycosides
Bactericidal
Inhibit formation of the initiation complex and cause misreading of. MRNA. They require oxygen for uptake and are ineffective against anaerobes and are typically used for severe gram - rod infections
42
Tetracyclines
Bacteriostatic
| Prevent attachment of 30s to aminoacyl-trna
43
Examples of tetracyclines
Doxyclycline
Demeclocycline
Minocycline
44
What are tetracyclines used for
Lyme
H pylori
M pneumoniae
Rickettsia and chlamydia
45
Chloramphenicol
Bacteriostatic inhibits 50s peptidyltransfersase
46
Why is chloramphenicol rarely used in the US and more in developing countries
Severe toxicities-anemia, plastic anemia and gray baby syndrome
But its cheap
47
Clindamycin
Bacteriostatic
| Blocks peptide bond formation at 50s
48
What in clindamycin used for
Bacteroides fragility and clostridium perfringens above the diaphragm
49
Erythromycin
Inhibits protein synthesis by binding to the 23 rRNA and 50s subunit and blocking translocation
50
What in erythromycin used for
Atypical pneumonia caused by mycoplasma, chlamydia and legionella as well as URI and TDS
51
Lincomycin
Binds 50s similar structure to macrolides
52
Why in lincomycin rarely used
Adverse effects and toxicity
Reserved for patients with penicillin allergies and high resistant bacteria
53
Linezolid
Binds 50s for gram positive infections that are resistant to other antibiotics like strep, vancomycin resistant enterococci, mrsa
54
Indication for linezolid
Infections of skin, soft tissue and hospital acquired pneumonia
55
Linezolid (zygote)
Bacteriostatic part of oxazolidinone class inhibit 50s
56
What is linezolid used for
Gram positive causes of pneumonia and skin infections as well as MRSA and WRE
57
Why linezolid not commonly used
Expensive, severe adverse effects, hard to obtain
58
Side effects linezolid
Bone marrow suppression, serotonin syndrome
59
What is linezolid used for
Drug resistant organisms!
60
What is the oxaxolidinone family
Heterocyclic, nitrogen containing, organic 5 members ring compound. Approved by FDA in 2008
61
MOA linezolid
Binds 23 rRNA of 50s to prevent formation of functional 70s
Inhibits protein synthesis
Bacteriostatic
62
Indication linezolid
Gram positive organisms
(Staph and strep)
MRSA
VRE
63
Side effects linzidolin
Bone marrow suppression (decreased palatable count)
Peripheral neuropathy
Lactic acidosis
Serotonin syndrome
64
When on linezolid taken with tyramine containing for
BAD get tyramine excess causing dangerous bp changes and the associated symptoms of chest pain, tachycardia, confusion, headaches, nausea, and vomiting, vision changes epistaxis and anxiety
65
Aminoglycosides
Irreversibly bind 30S interfere proofreading and can inhibit translocation of peptidyl tRNA and can disrupt bacterial cell membrane
66
Indication for aminoglycosides
Gram negative aerobes (pseudomonas, enterobacter, mycobacteria)
Serious septicemia, GI infections, UTI and hospital acquired pneumonia
67
Why do aminoglycosides not work well with anaerobic bacterial infections
Require oxygen uptake by bacteria
68
Side effects aminoglycosides
Nephrotoxicity and ototoxicity
69
Why aminoglycosides cause nephrotoxicity
Inhibits protein synthesis in renal cells and can lead to acute tubular necrosis and renal failure...common when given with cephalosporins
70
Ototoxicity is common when aminoglycosides are given with ___
Loop diuretics
71
Pregnancy and aminoglycosides
No teratogen
72
Resistance to eminoglycosides
Yea due to certain transferase enzymes that inactivate the drug. They alter the structure of aminoglycosides through various chemical reactions such as acetylation, adenylation or phosphorylation
73
Example of aminoglycosides
```
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
```
74
Gentamicin
For gram negative infections such as pseudomonas and proteus, but is not for neisseria of legionella.
75
Gentamicin side effects
Ototoxicity and nephrotoxicity
76
Administration gentamicin
Not orally due to lack of SI absorption
77
Why is gentamicin often used to coat surgical implants and told
Heat stable
78
Neomycin
For bowel surgery prep
Highly ototoxicity and nephrotoxicity
Not absorbed in intestine
Treats hepatic encephalopathy by eliminating ammonia producing bacteria inthe intestine or to reduce the risk of infection during intestinal surgery by eliminating intestinal bacteria
79
Amikacin
Pseudomonas, enterobacter, serratia infections,
Nephrotoxicity
Ototoxicity.
Can’t be given orally and dosing should be carefully monitors with renal failure
80
Tobramycin
Gram negative infections , better than gentamicin with pseudomonas lung infections
Can’t be given orally
In ophthalmic solution (tobrex) for bacterial conjunctivitis.
Ototoxicity and nephrotoxicity
81
Streptomycin
Mycobacterium tb
Endocarditis, yersinia pestis infestation and tb
Ototoxicity and nephrotoxicity
82
MOA aminoglycosides
Bactericidalbind 30s and inhibit formation of the initiation complex required to translate abcteria mRNA cause misreading of RNAand premature termination or protein synthesis
-interferes with proofreading
RequiresO2 uptake
Only aerobes
83
Resistance to amionglycosidases
Transferase enzymes in plastics and transposons
Acetyltransferases, phosphotransferases and adenyltransferases
84
Indications for aminoglycosides
Gram negative rod infections
Synergistic with b lactma antibiotics-can add espicially for endocarditis
(Ampicillin and gentamicin)
85
Side effects eminoglycosides
Nephrotoxicity espicially when used with cephalosporin
Ototoxicity with look diuretics (furosemide)
Teratogen-category D
86
Macrolides
Macrolides lactone ring
Bind 23s rRNA of 50s to block translocation
Bacteriostatic
87
Examples of macrolides
Erythromycin, azithromycin and clarithromycin
88
Indication for macrolides
Gram positive cocci, atypical pneumonia’s, chlamydia
89
Resistance to macrolides
Alteration of 23S RRNA binding side, usually by post transcriptional methylation
90
Macrolides are potent inhibitors of __, espicially ___
Cytochrome p450
| CYP3A4...can elevate other drugs
91
What combination should be voided with macrolides
Statins—-MTOPATHY
92
Side effects macrolides (erythromycin and clarithromycin)
QT prolongation ,which can lead to torsades de pointes
93
Macrolides exhibit enterohepatic recycling. What’s that
Absorbed int he gut and sent to the liver where it is excreted back into the duodenum in bile...can lead to buildup and cause nausea and GI distress (diarrhea)
94
Macrolides and liver
Hepatotoxicity-direct and immunoallergic effect..
Is immunoallergic will get rash and peripheral eosinophils
95
MOA macrolides
Bacteriostatic
96
Erythromycin
GI disturbances be is a motility agonist. Can treat gastroparesis
Prolonged QT
97
Azithromycin (Zithromax or Zmax)
Derived from erythromycin
Prevents bacterial infections, espicially middle ear infections, strep throat , pneumonia, and sinusitis. Also effective against STD (chlamydia)
Cardiovascular effects-qT prolongation
98
Clarithromycin
Treat pharyngitis, tonsillitis, maxillary sinusitis, pneumonia and acut bacterial exacerbation of chronic bronchitis.
99
Why can clarithromycin be taken orally
Acid stable and best bioavailability
100
Indication for macrolides
Gram positive cocci
Atypical pneumonia
Chlamydia
101
Resistance to macrolide
Alterations of the 23s rRNA binding site usually by post transcriptional methylation
102
Macrolides side effects
```
Diarrhea
Prolonged qt interval
P450 inhibitors
Cholestatic hepatitis
Skin rash
Eosinophilia
```
103
Neomycin sulfate
Aminoglycoside that targets aerobic gram negative bacilli
| Not absorbed in GI tract and do not enter CSF
104
Indication for neomycin sulfate
Topical infection
| Prophylaxis for patients scheduled for intestinal surgery
105
Side effects neomycin sulfate
Ototoxicity, nephrotoxicity, rash, blood dyscrasias
Monitor patients for GI superinfection
106
MOA neomycin sulfate
Aminoglycoside disrupts protein synthesis and causes rapid bacterial death. Bactericidal
107
Side effects neomycin sulfate
Ototoxicity, nephrotoxicity, rash, blood dyscrasias
| GI superinfection -minotor
108
Penicillin
From penicillium fungi
Penicillin G, V, benzathine
All are beta lactate antibiotics
Widely used for gram positive organisms and spirochetes
109
MOA penicillin
Binds to penicillin binding protein which is also known as the enzyme transpeptidase, a critical enzyme involved int he peptidoglycan cross linking in the bacterial cell wall...death from osmotic pressure induced cytoplysis
Small size allows it to penetrate deeply into the cell wall
Also activates autolytic enzymes inth e bacteria to cause cell death
110
Penicillin bacteriostatic or bactericidal
Bactericidal
| Causes cell death
111
Side effects penicillin
Hypersensitivity
Immune mediated hemolysis due to a haten mechanism, which is when the antibodies target the combination of penicillin in Association with the rbc and activate complements to induce hemolysis and removal of rbc
112
Indications for penicillin
```
Gram positive (bc inhibit formation of peptidoglycan cross linking in the bacterial cell wall)
Spirochetes-syphilis
```
113
MOA penicillin
Binds PBP(component of bacterial cell wall and involved in cell wall synthesis)
Blocks transpeptidase cross linking of the cell wall
Activates autolytic enzymes
Bactericidal
114
Side effect penicillin
```
Hypersensitivity
Hemolytic anemia(immune mediated hemolysis of rbc via hapten mechanism in which antibodies are targeted against the combination of penicillin attached to rbc-> complement activation and removal of rbc by spleen)
```
Beta lactamse sensitive
115
Beta lactamase
Enzymes produced by some bacteria to cleave beta lactate antibiotics
116
Beta lactamase sensitive bacteria
Susceptible to cleavage by beta lactamase and are likely to be ineffective against beta lactamase producing bacteria
117
Aminopenicillin mechanisms
Beta lactam
Inhibit PBP
Bactericidal
Broader spectrum of activity than penicillin and are not degraded by acid hydrolysis and can be given orally
118
Are aminopenicillin beta lactamase sensitive
Yup
119
What are aminopenicillin given with to prevent beta lactamase isssues
Clavulanic acid-beta lactamase inhibitor
120
Indication for aminopenicillin
Most gram positive infections and some gram negative(e coli and H influenza)
121
Common aminopenicillin
Ampicillin and amoxicillin
122
Adverse reactions to aminopenicillin
```
Hypersensitivity
Ampicillin rash (when given for mono)
Pseudomembranous colitis
```
123
Indications for aminopenicillin
Some gram _(e coli and H influenza
| Gram +
124
Ampicillin
Gram + and limited gram negative
Rash with mononucleosis
125
Amoxicillin
For otitis media, skin infections, and strep throat
Susceptible to beta lactamse producing bacteria so is combined with clavulanic acid
126
MOAaminopenicillin
Beta lactamase sensitive
| Given with beta lactamase inhibits like clavulanic acid
127
Clavulanic acid
Beta lactamase inhibitor tha tis commonly combined with penicillin to overcome resistance
Suicide inhibitor-covalently binds to the active site of beta lactamase, thus inactivating it.
Commonly combined with amoxicillin and is called augmentin
128
Side effects aminopenicillin
Hypersensitivity
Ampicillin rash
Psudomembranous (with mono/EBV and ampicillin)
colitis(colon infection with foul smelling diarrhea, fever, and abdominal paid cause by c diff)
129
Ampicillin and amoxicillin
Broad spectrum penicillin antibiotics that work by inhibiting enzymes that are key in bacterial cell wall synthesis, eventually leading to cell lysis or rupture
130
What are ampicillin and amoxicillin effective against
Gram + and some gram -
| NOT staph a, unless given with beta lactamase inhibitor
131
Indications for amoxicillin and ampicillin
Gram + (strep p, clostridium tetani) and some gram - (haemophilus influenza, E. coli, salmonella, and shigella)
132
Side effects ampicillin amoxicillin
Rash diarrhea (more in ampicillin than amoxicillin)
Take probiotics
133
Are amoxicillin and ampicillin good for staph a
No bc it has a beta lactamase
134
What are clavulanic acid and amoxicillin called together
Augmentin
135
What are ampicillin and sulbactam called together
Unasyn
136
Allergic reaction to ampicillin and amoxicillin
Rash to anaphylaxis(immediate or 30 min)
If have allergy history don’t give
137
When get ampicillin rash
If accidentally soused for patients with MONO
138
Amoxilccin indication
Otitis media, skin infections, strep throat.
139
Indications for aminopenicillin
```
Shigella
Haemophilus influenza
Salmonella
Listeria
Enterococci
Proteus mirabilis
E. coli
```
140
Antipseudomonal penicillins/carboxypenicillins
Have extra carboxylic acid group
Beta lactam
Bind PBP
Bactericidal
141
What do antipseudomonal penicillins work against
Gram negative organisms like pseudomonas a and proteus mirabalis
142
Antipseudomonal penicillins sensitive to beta lacatamase
Yup give with clavulanic acid
143
Common antipseudomonal penicillin
Ticarcillin
Carbenicillin
Piperacillin
144
Ticarcillin
Injectable used for pseudomonas infections
145
Carbenicillin
Limited coverage against gram +
146
Piperacilin
For pseudomonal infections
Given with tazobactam
IV or IM NOT ORAL
147
Side effects antipseudomonal penicillin
Hypersensitivity
