Antibiotics Flashcards
(101 cards)
1
Q
Antibiotics that are time dependent?
A
Beta Lactams:
Penicillins
Cephalosporins
Carbapenems
2
Q
Antibiotics that are concentration dependent?
A
Fluoroquinilones
Aminoglycosides
Daptomycin
Macrolide
3
Q
What does “cidal” mean?
A
- Defined as having a 2 log drop in your bacteria over a 24 hr period
- Beta lactams are categorized as these
4
Q
4 categories of Beta Lactams
A
- Cephalosporins
- Penicillins
- Carbapenems
- Aztreonam
5
Q
Penicillins
A
- Categories include natural, amino, anti-staph and extended spectrum with combo beta lactamase inhibitors
- Kill gram positives (MSSA)
- Work at the PBP on the peptidoglycan bacterial wall to cause apoptosis
- Primarily cidal drugs
- Generally have poor BA
6
Q
3 major side effects of Penicillins
A
Hypersensitivities
Blood dyscrasias
Lower seizure threshold
7
Q
T/F: When beta lactams can be given with continuous infusion they should be.
A
TRUE
8
Q
T/F: GAS is completely susceptible to amoxicillin, ampicillin and penicillin
A
TRUE
9
Q
Best way to administer penicillin?
A
Less drug and slow infusion allows you to reach better targets to treat your patients
10
Q
What drug in combo with Penicillin will drastically increase Penicillin’s concentration in the body?
A
Probenecid
11
Q
Ceftriaxone
A
- DOC for Strep pneumo
- IV only
- Treats diseases of the biliary tract because it is primarily biliary eliminated
- BAD drug to give in neonates can –> hyperbilirubinemia –> developmental delay
- May see calcium precipitation with this drug
- Normally given once daily unless meningitis (twice)
12
Q
Third generation cephalosporins target?
A
Gram - bacteria
13
Q
Fourth generation cephalosporins target?
A
Gram + and - bacteria (cefepime)
14
Q
Fifth generation cephalosporins are important for?
A
Binding to the mutated site of the PBP site created by MRSA
15
Q
Which drugs fit this description?
- Lumped under second generation cephalosporins but they also cover anaerobes
- Cephamycins
A
Cefotetan and Cefoxitin
16
Q
Cephalosporin PEARLS
A
- Cephamycin’s have enhanced gram-negative anaerobic activity
- Third and fourth generation have enhanced CSF penetration (e.g. ceftriaxone, ceftaz, cefepime)
- Poor BA
17
Q
Cephalosporins do NOT have activity against _______?
A
Enterococcus
18
Q
Cephalosporins that can treat meningitis?
A
3rd and 4th generation
19
Q
What 3 cephalosporins can be administered during dialysis?
A
Cefazolin, cefepime and perhaps ceftazidime
20
Q
Ceftaroline
A
- 5th generation cephalosporin
- Activity vs. MRSA and gram-negatives
21
Q
Two cephalosporins that should only be used with patients who have significant drug resistant infections.
Sometimes seen with CF and LVADS
A
Ceftazidime/Avibactam & Ceftolozane/Tazobactam
22
Q
Mainly developed to treat gram negative bacterial infections
INCLUDE:
Imipenem/Cilastatin
Meropenem
Ertapenem
Doripenem
A
Carbapenems
23
Q
PEARLS of Carbapenems
A
- IV only
- Worst offender of lowering the seizure threshold
- Lower the valproic acid level in your body drastically (DDI)
- Ertapenem has no pseudomonal activity
- Imipenem/Cilastatin duo may have better activity against gram positive bacterium
- Should be renally adjusted
24
Q
How does Imipenem/Cilastin combo work?
A
Gives Imipenem a longer half life by inhibiting kidney enzymes!
25
Which carbapenem does not cover Pseudemonas?
Ertapenem
26
The beta lactamase inhibitors include:
* Clavulanic acid
* Tazobactam
* Sulbactam
* Avibactam
* Vaborbactam
27
Lone monobactam
Does not work AT ALL against gram + bacterium
Can give the drug inhaled for isolated pneumonia
Aztreonam
28
Aztreonam only treats which type of bacteria?
Gram -
29
Potential side effect for Azetreonam?
Transaminitis
30
There might be cross reactivity between aztreonam and ______ but otherwise, there is no cross-reactivity between aztreonam and beta lactams
Ceftazidime
31
First generation cephalosporin that is the "go to" oral Abx
Cephalexin
32
First generation cephalosporin that is the "go to" IV Abx
Cefadroxil
33
ABx that binds directly to the amino acid (Alanine) present on the bacterial cell wall of all gram positive bacteria, not the PBP
Does not have good activity to gram negative bugs
Acts against MRSA, strep and enterococcus
Cidal
Drug of choice against C diff and MRSA
AUC/MIC \>400
Very high serum concentrations
Vancomycin
34
Targets of Vancomycin?
Gram + bacteria
MRSA
C. diff
35
Why does Vanco not have good activity against gram - bacterium?
The drug cannot fit through the channels of the double layered membrane
36
How is Vanco administered for C Diff?
Orally
37
2 ideal treatments for MSSA?
1. anti Staph penicillins
2. Cefazolin
38
ADEs of Vancomycin?
* Red Mans syndrome
* Thrombocytopenia
* Neutropenia
* Ototoxicity
* Nephrotoxicity
39
Vancomycin may have DDI with?
Aminoglycosides and Nephrotoxic Agents
40
Risk factors for nephrotoxicity while on Vancomycin include...
High doses
Obesity
Hypotension
Concurrent nephrotoxins
Concurrent beta lactams (piperacillin)
41
When dosing and monitoring Vancomycin you must take into account _______ dose and _______ dose
Loading and maintenance dose
you must ALSO take into account weight and renal function
42
* Used for efficacy, not so much toxicity
* 30 mins prior to 4th does
* Make sure patient is in steady state before ordering
* Done every week to two weeks after the initial monitoring is done because the patient maintains relatively stable concentrations
Trough concentrations
43
* Lipoglycopeptide
* IV
* Predominately gram positive
* Inhibits cross-linking and peptidoglycan formation (D-Ala-D-Ala) and causes membrane depolarization
* Highly protein bound
* Patient's with bad kidneys did not have good results with this drug
* Chalky taste and foamy urine
* Decreases blood clotting
* Can be used for MRSA but not used over Vanc
* AUC/MIC
Telavancin
44
* 2nd generation lipoglycopeptides
* Treat staph and strep (MRSA)
* Long acting IV injections because of their very large half lives
* Used to treat osteomyelitis
Dalbavancin and Oritavancin
45
Has cidal activity except with enterococcus
Concentration dependent
Causes a membrane depolarization leading to an inhibition of DNA, RNA and protein synthesis
May cause musculoskeletal atrophy (statins may also increase CPK levels)
Weight based dosing
Do not use to treat any sort of pulm infection
Daptomycin
46
Route of administration for Daptomycin?
IV
47
What does Daptomycin treat?
Predominately gram positive including MRSA and VRE
**NOT enterococcus**
48
Daptomycin ADE?
May cause muscle toxicity with an increase in CPK
49
Daptomycin DDI?
Statins (might also increase CPK)
50
Work predominantly on gram negative bacterium because there are no holes on the gram positive membrane
Concentration dependent
Nephrotoxicity and ototoxicity
Very high PAE
Need to be cautious with this drug; therapeutic drug monitoring
Gram positive synergy (e.g. vanc)
Aminoglycosides
51
Aminoglycosides MOA?
Irreversible 30s subunit binding
52
Aminoglycosides- Why can we use/Why do we use?
Peak/MIC ration predictive of cidal activity
High peaks do not equal toxicity
Less nephrotoxicity
PAE
Less monitoring (once daily dosing)
53
Atypical pathogens?
Mycoplasma, Chlamydia, Legionella
54
Abx that work on atypcials?
Tetracyclines, Microlides and Fluoroquinilones
55
* Works against atypical pathogens (mycoplasma, chlamydia and legionella)
* Works against some gram negatives
* Limited with anaerobes
* STIs
* Strep pneumonia and staph areus
* Activity against C diff
Tetracyclines
56
Tetracycline MOA?
Works on the 30s ribosomal subunit; static
57
Tetracyclines used for treating S. aureus activity?
Doxycycline and Minocycline
58
Tetracycline ADE?
* GI dyspepsia
* Binding with multivalent cations
* Tooth discoloration
* Sun sensitivity
**Minocycline:** vertigo, discoloration, hepatitis, lupus, leukopenia, pericardial effusion
59
T/F: tetracyclines have really good tissue penetration but really poor serum concentrations
(Aka would not use to treat blood stream infections)
TRUE
60
Vancomycin-Resistant Enterococcal UTI's
Doxy \> Tetra \> Mino
61
Tetracycline that treats SIADH (syndrome of inappropriate ADH secretion)
Demeclocycline
62
Tigecycline
* Tetracycline that binds to two sites on the ribosome
* Enhanced minocycline
* Broad spectrum but doesn't work well in pts because it rapidly leaves blood stream and penetrates tissues greatly
* Rarely ever used
* Biliary excretion is the primary route of elim
* Been to work well with mycobacterium infections and severe C diff
63
The Tetracyclines include?
Doxycycline, Tetracycline, Minocycline, Tigecycline
64
Tigecycline can be given in what situation?
ICU patients with severe drug resistance
65
Tigecycline ADE?
Profuse projectile vomiting
66
Tigecycline route of administration?
IV only
67
* Binding at the 23S and 50S ribosomal subunit
* Static activity and time dependent
* Oral and IV BA 100% (1:1)
* Good to use for vancomycin resistant bugs
* No renal adjustment
* Very high tissue penetration so it has never been clinically proven to be better than Vanco
Linezolid
68
Linezolid works against?
Gram positive, MRSA, VRE, Mycobacterium, C. Diff
69
Linezolid ADE?
* Hematologic (RBC,WBC and platelets)
* Peripheral neuropathies (weakness, numbness, pain in hands and feet)
* Arthralgia in hands and knees
* Optic neuritis
* May see drug drug interactions with SSRI's because it is a MAO inhibitor; reduce SSRI to lowest effective dose
* Caution with tyramine containing foods; increase in BP
70
* Inhibits DNA gyrase and topoisomerase at the site of DNA replication
* 40% resistance of E coli
* Avoid use in "simple uncomplicated infections"
Fluoroquinilones
71
What do fluoroquinilones work against?
Gram +, gram -, pseudo, anaerobes, atypicals
72
ADE for fluoroquinilones?
Sun sensitivity, tendon rupture, Cipro Psychosis, dysglycemia, PN, QT prolong
73
* Not renally adjusted
* Activity against anaerobes
* Activity against atypical organisms
Moxifloxacin
74
* Does not have 1:1 BA like the other fluoroquinolones
* Has MRSA activity
Delafloxacin
75
The fluoroquinilones include?
Ciprofloxacin, Levofloxacin, Moxifloxacin, Delafloxacin
76
What 3 fluoroquinolones have pseudemomas activity?
Ciprofloxacin, Levofloxacin, and Delafloxacin
77
DNA gyrase is more common in which bugs?
Gram +
78
Topoisomerase is more common in which bugs?
Gram -
79
* Fluoroquinolone with higher topoisomerase activity in comparison to DNA gyrase
* Higher affinity for gram negative organisms
* DOES get into the lungs, it just doesn't treat gram positive strep pneumo
Ciprofloxacin
80
The Macrolides include?
Azithromycin, Erythromycin, Clarithromycin
81
What is the MOA of macrolides?
Binding at 50s ribosomal subunit (dissociation of tRNA from ribosome)
82
What do macrolides cover?
Broad spectrum:
Atypical, strep, MSSA, STI, mycobacterium, Helicobacter Pylori
83
Because of their action on the ribosome, macrolides have a long half life, but....
This may breed resistance
84
ADE of macrolides?
* GI
* Dysgeusia
* Cardiotoxicity
85
Which macrolide does not have GI effects and why?
Azithromycin- does not bind to gastrin
86
Clarithromycin and Erythromycin both....
Inhibit 3A4
Therefore you see large increases in statin!
87
All Macrolides also have ________ properties
Anti inflammatory
88
Clindamycin is antagonistic with \_\_\_\_\_\_\_\_?
Macrolides
89
Clindamycin predominately treats?
Strep and Staph- including MRSA
90
Clindamycin BA?
Really good! Penetrates well into most body tissues except CSF
Time dependent killing
91
Biggest ADE for Clindamycin?
Severe diarrhea, high risk for C. Diff\*
92
Clindamycin clinical uses with really bad staph and strep infections?
Clindamycin binds toxins and reduce toxin production of staph and strep
Recommended with limb or life threatening staph or GAS
93
Drug that interferes with human follic acid metabolism?
SMX/TMP
94
SMX and TMP treats?
MRSA, Gram +
95
SMX and TMP are the DOC for?
Nocardia and PJ
96
SMX/TMP ADE?
Bone marrow suppression (anemia)
Hyperkalemia
High serum Creatine
97
2 treatments for UTIs?
Fosfomycin
Nitrofurantoin
98
Side effects of Fosfomycin?
NONE works directly at the bladder and is exreted in the urine
99
DOC for invasive MSSA?
Nafcillin (or Oxacillin) and Cefazolin
100
Beta lactam that works against MRSA and why?
Ceftaroline- affinity for mutated site PBP 2a
101
DOC for MRSA?
Vancomycin
