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MOD exam 3 > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

What adverse effects are seen with Streptogramins?

A

Usually they are well tolerated but if adverse rxn occurs it is consistent with infusion site rxns such as pain and arthralgia-myalgia syndrome

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2
Q

Beta lactamase inhibitors are not necessarily antibiotics, so in order to cover certain bacteria, what is done with this medication?

A

Beta lactamase inhibitors are co-formulated with a beta lactam abx to extend the spectrum of coverage

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3
Q

The only abx class to inhibit DNA/RNA synthesis is fluoroquinolones. How does this class do so?

A

Inhibit replication by inhibiting topoisomerase II

Block cell division by inhibiting topoisomerase IV

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4
Q

Examples of 1st generation cephalosporins

A

Cefadroxil

Cephalothin

Cephadrine

Cefazolin

Cephalexin

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5
Q

Examples of benzylpyrimidines

A

Trimethoprim

Bactrim (when trimethoprim is combined with sulfamethoxazole)

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6
Q

If an antibiotic is considered to be a protein synthesis inhibitor, what is likely the MOA?

A

Binding to one of the ribosomal subunits (either the 50S or 30S), disrupting the protein synthesis

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7
Q

What is not covered by first generation cephalosporins?

A

Beta lactamases

MRSA

Enterococci

  • S. epidermidis*
  • P. aeruginosa*
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8
Q

Common adverse effects of the tetracycline class?

A

N/V/D

Possible development of C. diff

Effects on bone and teeth (brown discoloration of the teeth in children)

**Should avoid giving to pregnant women**

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9
Q

Aminopenicillins cover what bacteria types?

A

Gram (+) cocci

expanded coverage against gram (-) cocci to include E. coli and the enterics

*combine with beta lactase inhibitor for broader coverage*

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10
Q

Adverse effects of the carbapenem abx class

A

Most adverse effects occur with imipenem and include rxn at infusion site, skin rashes, N/V/D, renal failure and seizures

Rare anaphylaxis

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11
Q

Adverse effects of the penicillin class?

A

Hypersensitivity rxn to the beta lactam ring: anaphylaxis, N/V/D

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12
Q

Adverse effects of Moxifloxacin

A

High risk for QT prolongation which can induce torsades de pointes arrhythmia

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13
Q

Examples of ketolides

A

Telithromycin

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14
Q

Examples within the antipseudomonal penicillin class

What is this abx always paired with?

A

Piperacillin

Tazobactam

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15
Q

What class of abx functions to inhibit DNA/RNA synthesis?

A

Fluoroquinolones

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16
Q

Examples of streptogramins

How are streptogramins prescribed if they are?

A

Dalfopristin

Quinupristin

Combined at Q30% / D70%

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17
Q

Coverage provided by macrolides

A

Good activity against strep, staph and pneumococci

Erythromycin: C. jejuni, M. pneumoniae, C. trachomatis, C. psittaci, C. pneumonia, H. pylori, Gram (+) bacilli including C. perfringens, C. diphtheriae, L. monocytogenes, Gram (-) including bartonella, quintana, Neisseria, Rickettesia, T. pallidum

Azithromycin: similar to erythro except less coverage against staph and strep with more against H. influenzae, M. catarrhalis, chlamydia (HIGHLY ACTIVE), L. pneumonia, B. burgdorferi, M. pneumoniae, H. pylori

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18
Q

Examples of oxazolidinones

A

Linezolid

Tedizolid

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19
Q

Penicillinase-resistant penicillin class coverage

A

Poor gram (+) coverage

Primary abx for staph once MRSA is ruled out

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20
Q

Adverse effects of 2nd generation cephalosporins

A

Hypersensitivity rxn including maculopapular rash, eosinophilia, fever

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21
Q

Ketolides are often classified with macrolides because of their similar MOA, what additional coverage do ketolides provide that macrolides do not?

A

Coverage over S. pneumoniae and S. aureus

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22
Q

First generation cephalosporin coverage

A

most gram (+) cocci including S. aureus

Gram (-) cocci including Moraxella catarrhalis, Klebsiella pneumoniae, E. coli, Proteus mirabilis

anaerobic cocci except for B. fragilis

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23
Q

Examples of beta lactamase inhibitors

A

Clavulanic acid

Sulbactam

Tazobactam

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24
Q

What abx within the aminoglycoside class have the adverse effect of auditory damage?

A

Amikacin

Kanamycin

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25
Examples of carbapenems
impinem Meropenem Doripenem Ertapenem
26
What abx within the aminoglycoside class have the adverse effect of vestibular damage?
Streptomycin Gentamycin
27
Most common adverse effect of 5th generation cephalosporins
Hypersensitivity rxn including maculopapular rash, eosinophilia, fever
28
Examples of aminoglycosides
Streptomycin Gentamycin Tobramycin Amikacin Neomycin Paromomycin Kanamycin Netilmicin
29
What class of abx functions by disrupting membrane integrity?
Polymyxins
30
Examples of 4th generation cephalosporins
Cefepime
31
Examples of glycylcylines
Tigecycline
32
Examples of sulfonamides
Sulfamethoxazole
33
Coverage provided by 4th generation cephalosporins
Enterobacter sp. Pseudomonas sp. Expands coverage of gram (-) bacteria to include P. aeruginosa Poor activity against *B. fragilis*
34
Examples of 3rd generation cephalosporins
Ceftriaxone Cefotaxime Cefixime Cefdinir Ceftibuten Ceftazidime Cefpodoxime-proxetil Cefditoren-pivoxil
35
Examples of 2nd generation cephalosporins
Cefuroxime, cefaclor, cefprozil (these arent used in the US anymore)
36
Adverse effects of antipseudomonal penicillin class
Hypersensitivity rxn
37
What classes of abx are inhibitors of folate synthesis?
Sulfonamides Benzylpyrimidines
38
Examples of monobactams and what is the structure?
Aztreonam, a monolytic beta lactam ring
39
Adverse effects of macrolides
N/V/D Anorexia rarely arrhythmias Hepatotoxicity 2/2 prolonged erythromycin use Hypersensitivity rxn including skin eruptions, eosinophilia, fever
40
What classes of abx are inhibitors of protein synthesis?
Oxazolidinones Macrolides Ketolides Streptogramins Tetracyclines Glycylcyclines Aminoglycosides
41
Adverse effects of the fluoroquinolone class as a whole?
Rare abd discomfort N/V Sometimes can lead to C. diff CNS effects including HA or dizziness Rare achilles tendon rupture, but men \> 60 y/o more at risk of this
42
Cephamycins, which are classified with 2nd generation cephalosporins, provide coverage against what bacteria?
*B. fragilis* Some Serratia sp. Less active against *H. influenzae*
43
What abx classes are considered to be bacteriostatic, as they inhibit growth of the bacteria rather than kill it?
Oxazolidinones Macrolides Tetracyclines Sulfonamides (monotherapy)
44
First generation cephalosporins can have what adverse effects?
Hypersensitivity rxn including maculopapular rash, eosinophilia, fever
45
Most common adverse effect of 4th generation cephalosporins
Hypersensitivity rxn including maculopapular rash, eosinophilia, fever
46
Examples of lipoglycopeptides
Telavancin Dalbavancin Oritavancin
47
The fluoroquinolones provide what bacterial coverage?
Cover against borth gram (+) and gram (-) including campylobacter, enterobacter, shigella, salmonella, proteus, klebsiella and E. coli Also cover intracellular organisms including legionella and chlamydia The newer fluoroquinolones including cipro and levo have increased activity against gram (+) like *S. pneumoniae* and some gram (-) like *P. aeruginosa* Even newer fluorquinolones including moxifloxacin, gatifloxacin and gemifloxacin are more active against gram (+) like *S. pneumoniae* and some staph as well as some anaerobes
48
Sulfonamides are usually not given alone as they have a prevalence of resistance; however, if given, what are the possible adverse effects?
N/V Photosensitivity Fever Hives and rashes RARE: Stevens-johnson syndrome
49
Adverse effects of monobactam abx class
Rare elevations of aminotransferases Skin rashes
50
Adverse effects of the penicillin-resistant penicillin class
Hypersensitivity rxn: anaphylaxis, N/V/D
51
The glycopeptide abx Vancomycin covers what bacteria?
Gram (+) including ampicillin-resistant enterococci, penicillin-resistant strep and MRSA ## Footnote **does not cover gram (-) bacteria**
52
Coverage provided by the monobatam abx Aztreonam
Broad spectrum covering most gram (-) bacteria including P. aeruginosa and H. influenzae **does not cover** gram (+) bacteria OR anaerobes
53
Adverse effects of polymyxins
No adverse effects of the topical administration Systemic administration can cause dose-dependent nephrotoxicity, slurred speech, vertigo, paresthesias, apnea, and muscle weakness
54
Examples within the penicillin class
Penicillin G
55
The polymyxin class of abx provides coverage over what bacteria
Gram (-) Aerobes Enterobacteriaceae, pseudomonas, acinetobacter (resistance to these is on the rise)
56
Examples within the penicillin-resistant penicillin class
Methicilin ## Footnote **Nafcillin** **Oxacillin** **Dicloxacillin**
57
When vancomycin is given intravenously, what are the possible adverse effects?
Infusion related nephrotoxicity "Red man syndrome" comprised of HoTN, tachycardia, skin flushing 2/2 histamine release *should give with antihistimines to avoid*
58
Examples of 5th generation cephalosporins
Ceftaroline fosamil (pro drug, active metabolite is ceftaroline) Ceftolozane (coupled with tazobactam)
59
Adverse effects of 3rd generation cephalosporins
Ceftriaxone displaces bilirubin which leads to jaundice in neonates so cefotaxime should be used instead Ceftriaxone can also lead to gallstones Hypersensitivity rxn including maculopapular rash, eosinophilia, fever
60
Coverage of oxazolidinones includes
Primarily gram (+) bacteria **_Bacteriocidal_** against Strep
61
Examples of polymyxins
Polymyxin B Polymyxin E (Colistin) when in topical form Colistimethate when in IV form
62
Second generation cephalosporin coverage
Most gram (+) cocci including S. aureus Gram (-) cocci including M. catarrhalis, K. pneumoniae, E. coli, P. mirabilis active against H. influenzae, N. meningititis, S. pneumoniae
63
The antipseudomonal penicillins cover what bacteria spectra
More gram (-) coverage, the broadest spectrum of all penicillin classes Targets *Pseudomonas aeruginosa, Klebsiella pneumoniae, E. coli, H. influenzae, B. fragilis*
64
Carbapenem abx class coverage
**Imipenem:** gram (+), anaerobes, gram (-) including P. aeruginosa, Acinetobacter sp, B. fragilis; requires renal dipeptidase inhibitor- celastatin **Meropenem/Doripenem:** less coverage against gram (+) but more coverage against gram (-); does **not** require renal dipeptidase inhibitor- celastatin **Ertapenem:** Same as others but does not cover *P. aeruginosa* or Acinetobacter sp.
65
Glycylcyclines are a similar class to tetracyclines because of their similar MOA, though the glycylcyclines provide coverage over what bacteria that the tetracycline class does not?
Greater coverage over enterococci, enterobacteriaceae, Acinetobacter and *B. fragilis*
66
Examples of macrolides Bold which one covers *C. diff*
Erythromycin Clarithromycin Azithromycin **Fidaxomicin**
67
5th generation cephalosporins cover what bacteria
Ceftaroline covers against MRSA and pseudomonas sp. Most gram (-) except for B. fragilis More gram (+) coverage including MRSA and *S. pneumoniae* Use ceftolozane for gram (-)
68
Adverse effects of the benzylpyrimidine class?
Anemia Leukopenia Granulocytopenia
69
What are the adverse effects of cephamycins?
Cefotetan can cause hypoprothrombinemia and bleeding d/t the methylthiotetrazole group Can also elicit disulfram-like reactions so one should avoid alcohol while taking this abx
70
The oxazolidinone abx class has 3 different adverse effects, what are they?
**Myelosuppression**: thrombocytopenia 7-10 days after start, which can be reversed by stopping medication **Mitochondrial toxicity:** lactic acidosis, optic neuritis, peripheral neuropathy 6 weeks on; inhibits mitochondrial protein synthesis **Drug-drug interactions:** Linezolid is a MAO inhibitor which sets the stage for drug-drug interactions (adrenergic agents and SSRIs) leading to serotonin syndrome -- HA, palpitation, hypertensive crisis
71
If an antibiotic is considered to be a cell wall synthesis inhibitor, what is its likely MOA?
Competitive inhibition of transpeptidase, preventing the cross-linking of peptidoglycans
72
What antibiotics within the aminoglycoside class have the adverse effect of nephrotoxicity?
Gentamycin Tobramycin Neomycin
73
Adverse effects of ketolides
Hypersensitivity rxn including maculopapular rash, eosinophilia, fever N/V/D anorexia
74
Examples of glycopeptides
Vancomycin
75
Streptogramin coverage
Gram (+) cocci including resistant strep, penicillin-resistant S. pneumoniae, *M. pneumoniae, C. pneumoniae, Legionella* **Bactericidal** to Strep/Staph **Bacteriostatic** to *E. faecium*
76
Examples of fluoroquinolones
Moxifloxacin **Ciprofloxacin** **Levofloxacin** Ofloxacin Enoxacin Gatifloxacin Gemifloxacin Pefloxacin
77
Adverse effects of the aminopenicillin class
hypersensitivity rxn: anaphylaxis, N/V/D
78
Examples of cephamycins (which are classified with 2nd generation cephalosporins)
Cefotetan Cefoxitin
79
Adverse effects of Gatifloxacin
This abx is toxic when administered systemically and is only available in the US as a topical ophthalmic solution
80
The benzylpyrimidine class, which is comprised of trimethoprim, is usually combined with a sulfonamide which produces the antibiotic Bactrim. Bactrim covers what bacteria?
*S. epidermidis*, *S. aureus,* MRSA, *S. pyogenes* Viridians group strep Penicillin-resistant strep Serratia, Shigella, Salmonella Enterobacter *Proteus mirabilis* Nocardia Stenotrophomonas maltophilia *Pneumocystis jiroveci* Haemophilus, *M. catarrhalis, K. pneumoniae* Listeria if cannot take penicillin *S. pneumoniae* and *E. coli* but resistance is rising
81
Bacterial coverage by aminoglycosides
Used alone against gram (-) bacteria Combine with a beta lactam abx to expand coverage to include gram (+) listeria, viridians group strep, enterococci and strep
82
Examples of tetracyclines
Doxycycline Minocycline Tetracycline Demeclocycline
83
Examples within the aminopenicillin class
Ampicillin Amoxicillin
84
Spectrum of coverage provided by tetracyclines
Broad!! Gram (+) \>\> Gram (-) Anaerobes, chlamydiae, mycoplasmas, rickettsiae, MRSA, *S. pyogenes, S. pneumoniae, B. anthracis, L. monocytogenes, H. influenze, H. pylori, V. cholera, M. pneumonia,* legionella, plasmodium and the spirochete *T. pallidum*
85
What classes of abx are cell wall synthesis inhibitors?
Penicillin Aminopenicillin Penicillinase-resistant penicillins Antispeudomonal penicillin 1st-5th generation cephalosporins Carbapenems Monobactams Glycopeptides Beta lactamase inhibitors Lipoglycopeptides
86
Penicllin coverage
Gram (+) cocci including *S. pneumoniae, S. pyrogenes* and Viridians group strep Gram (-) cocci including *N. meningiditis* Spriochetes including *T. pallidum* Non-beta lactamase producing anaerobes (clostridium perfringens)
87
Coverage provided by 3rd generation cephalosporins
Almost the same as first and second gen, but more gram (-) coverage This menas less gram (+) coverage, especially against stap and strep Ceftazidime is the only 3rd gen that covers *P. aeruginosa*

MOD exam 3 (1 decks)

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