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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

cell wall synthesis inhibitors

A 
PCNs
CEPHALOSPORINS
CARBAPENEMS
VANCOMYCIN
BACITRACIN
POLYMYXIN
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2
Q

PENICILLINS
vk - oral
g - IM/IV

A
  • natural penicillins
  • gram positive, gram-positive anaerobes

Ind:
STREP PARYNGITIS
ORAL/DENTAL INFX
SYPHILIS

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3
Q

NAFCILLIN (IV)
DICLOXACILLIN (PO)
OXACILLIN (IV)

A
  • penicillinase-resistant “anti-stapholococcus”
  • gram positive, designed PRIMARILY VS B-LACTAMASE PRODUCING STAPHYLOCOCCUS

Ind:
STAPHYLOCOCCAL SKIN/SOFT TISSUE INFX
ONLY PCNs EFFECTIVE VS. B-LACTAMASE BACTERIA ON OWN

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4
Q

AMOXICILLIN (PO)

AMPICILLIN (PO, IM, IV)

A
  • amino penicillins
  • gram positive and negative coverage
Ind:
UTI IN PREGNANCY
AOM
ACTIVE VS ENTEROCOCCUS
H.FLU
E.COLI
LISTERIA
GBS
SALMONELLA
PROTEUS
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5
Q

AUGMENTIN (AMOXICILLIN + CLAVULANATE)

UNASYN (AMPICILLIN + SULBACTAM)

A
  • amino-penicillins w/ B-lactamase inhibitor
  • ENHANCED COVERAGE INCLUDING B-LACTAMASE producing m. catarrhalis, h.influ, e.coli, b.fragilis, anaerobes
Augmentin Ind:
AOM
SINUSISITUS
ABECB
DENTAL INFX
BITE WOUNDS

Unasyn Ind:
SKIN/SOFT TISSUE INFX
INTRABDOMINAL/PERIONITIS

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6
Q

ZOSYN (PIPERACILLIN / TAZOBACTAM IV)
TIMENTIN (TICARCILLIN / CLAVULANATE IV)
CARBENICILLIN (PO)

A
  • ANTI-PSEUDOMONAL PCNs

- BROADEST SPECTRUM PCNs

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7
Q

CEFALEXIN (KEFLEX) - PO
CEFAZOLIN (ANCEF) - IV
CEFADROXIL (DURICEF) - PO

A

1ST GEN - SKIN/SOFT TISSUE
-gram-positive cocci (including B-lactamase), anaerobes

Ind:
SKIN/SOFT TISSUE INFX (STAPH/STREP)
SURGICAL PROPHYLAXIS

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8
Q

CEFACLOR (CECLOR)
CEFUROXIME (EFTIN PO or ZINACEF IV, IM)
CEFOXITIN - IV
CEFOTETAN

A

2ND GEN - SKIN, RESPIRATORY/ENT, UTI ANAEROBES
-increasing level of gram-negative activity and loss of gram-positive as you go from 1st to 4th gen

Ind:
AOM
PNEUMONIA
UTI
ABDOMINAL INFX (ANAEROBES)
SKIN/SOFT TISSUE

CEFUROXIME: ACUTE EPIGLOTITIS, EARLY LYMES DZ

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9
Q 
CEFTRIAXONE (ROCEPHIN) - IM/IV
CEFTAZIDIME
CEFIBUTEN
CEFOTAXIME
CEFIXIME
A

3RD GEN - PNA, CNS, GRAM NEGATIVE, BROAD SPECT

Ind:
MENINGITIS (GOOD CNS PENETRATION)
GONORRHEA
CAP (HOSPITALIZED)

-CEFTAZIDIME COVERAGE VS PSEUDOMONAS

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10
Q

IMIPENEM - IV

MEROPENEM - IV

A

CARBAPENEMS

  • BROADEST SPECTRUM OF ALL ABX!
  • cilastatin added to imipenem to reduce renal clearance of imipenem

SE: ASSOC W/ LOWERING OF SEIZURE THRESHOLD

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11
Q

AZTREONAM - IV

A

MONOBACTAM

  • GRAM-NEGATIVE AEROBES ONLY, INC PSEUDOMONAS
  • beta lactam w/ no cross reactivity with other beta lactams

SE: GI UPSET, VERTIGO

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12
Q

VANCOMYCIN

A
  • GRAM POS ONLY
  • inhibits phospholipids/PEPTIDOGLYCANS

Ind:
IV: MRSA, MRSE
PO: C.DIFF (not absorbed)

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13
Q

BACITRACIN

A
  • GRAM POS
  • little effect vs. anaerobes or gram neg

NEPHROTOXIC SO PRIMARILY USED AS TOPICAL

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14
Q

POLYMYXIN

A
  • GRAM NEGATIVE
  • disrupt cell membrane and outer membrane permeability of gram negatives

IM/IV PREPARATIONS ARE NEPHROTOXIC AND NEUROTOXIC –> TOPICAL, OPHTHALMIC & OTIC FORMS

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15
Q

protein synthesis inhibitors

A 
MACROLIDES
TETRACYCLINES
CLINDAMYCIN (LINCOSAMIDE)
AMINOGLYCOSIDES
LINEZOLID
CHLORAMPHENICOL
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16
Q

MACROLIDES (GENERAL)

A

-bind to 50S ribosomal unit

  • SE: GI & MANY DRUG-DRUG INTERACTIONS, ESP ERYTHRO (CYP P450 INHIB); caution w/ pt taking warfarin, theophylline, carbamazepine (may increase levels)
  • CAUTION IF PT ON NIACIN OR STATINS (INC MUSCLE TOXICITY)
  • PROLONGED QT INTERVAL
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17
Q

ERYTHROMYCIN (MACROLIDE)

A
  • good gram-negative and gram-positive (strep/staph)
  • atypicals: MYCOPLASMA, LEGIONELLA, CHLAMYDOPHILA
Ind:
STREP THROAT (IF PCN ALLERGIC)
CAP
TOPICAL FOR ACNE
SAFE IN PREGNANCY

SE: POOR GI TOLERANCE

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18
Q

AZITHROMYCIN (MACROLIDE)

A
  • same as erythro, also: H.FLU, MORAXELLA
  • BEST ATYPICAL COVERAGE (MYCOPLASMA, CHLAMYDIA, LEGIONELLA)
Ind:
CAP
ABECB
1ST TIME 1g DOSE CHLAMYDIA
ANTI-INFLAMMATORY IN LUNG
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19
Q

CLARITHROMYCIN (MARCROLIDE)

A

-same as azithro

Ind:
CAP
LEGIONELLA
H.PYLORI
SINUSITIS, BRONCHITIS, ABECB
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20
Q

TETRACYCLINES (GENERAL)

A
  • bind to 30S ribosomal subunit (bactericidal)
  • GOOD VS GRAM-POS AND GRAM-NEG, INTRACELLULAR ORGANISMS
  • SE: GI disturbances, PHOTOSENSITIVITY, DENTAL STAINING
  • NOT USED IN CHILDREN <8y OR IN PREGNANCY, HEPATOTOXIC
  • DON’T GIVE W/ DAIRY PRODUCTS (Ca, Mg, Al, Fe)
  • safe w/ renal failure
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21
Q

DOXYCYCLINE (TETRACYCLINE)

A 
Ind: 
CHLAMYDIA
Q-FEVER
BUBONIC PLAGUE
CAT SCRATCH FEVER
RMSF
LYME DISEASE
PID
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22
Q

TETRACYCLINE ((TETRACYCLINE)

A

Ind: ACNE

23
Q

MINOCYCLINE (TETRACYCLINE)

A

Ind: ACNE

24
Q

CLINDAMYCIN

A
  • covers GRAM-POS
  • MOST ANAEROBES ABOVE DIAPHRAGM (little gram-neg)

SE: MAY CAUSE C. DIFF!!!

25
Q

AMINOGLYCOSIDES (GENERAL)

A
  • bind to 30S ribosomal subunit (bactericidal)
  • GRAM-NEG AEROBES ONLY!
  • not good CNS penetration
  • commonly used w/ PCN for broad empiric coverage (synergism allows for AG gram-pos activity)

SE: OTOTOXIC & NEPHROTOXIC; hearing loss usually irreversible, tinnitus, vertigo, ataxia

26
Q

GENTAMICIN (AMINOGLYCOSIDE)

A

-GRAM NEG INCLUDING PSEUDOMONAS

Ind:
USED W/ AMPICILLIN IN NEONATAL MENINGITIS
SEPTIC SHOCK
PYELO &amp; COMPLICATED UTI
ENDOCARDIDITS (ENTEROCOCCUS)
YERSINIA
TULAREMIA
27
Q

TOBRAMYCIN (AMINOGLYCOSIDE)

A

-slightly inc activity w/ PSEUDOMONAS

Ind:
TOPICAL (ERATITIS)
NOSOCOMIAL PNEUMONIA (GIVEN W/ 3RD GEN CEPH)

28
Q

NEOMYCIN (AMINOGLYCOSIDE)

A

-GRAM NEG INCLUDING PSEUDOMONAS

Ind:
BOWEL PREP
PART OF NEOSPORIN & CORTISPORIN
OTITIS EXTERNA (but not if TM isn’t visualized/rupture)

29
Q

AMIKACIN (AMINOGLYCOSIDE)

A

-PSEUDOMONAS, ACINETOBACTER, SERRATIA

RESTRICTED USE BY CDC (RESERVED FOR BAD INFX)

30
Q

STREPTOMYCIN (AMINOGLYCOSIDE)

A

Ind:
TUBERCULOSIS
TULAREMIA
YERSINIA PESTIS

31
Q

LINEZOLID

A

moa: inhibits protein synthesis (50S ribosomal unit)
- GRAM-POS ONLY: MRSA, VRE, ENTEROCOCCUS FAECIUM AND FAECALIS
* BEST PO COVERAGE AGAINST MRSA
- also covers atypicals: mycoplasma, chlamydophila, legionella

SE: N/V/D, headache thrombocytopenia, MAO inhibition

32
Q

CHLORAMPHENICOL

A
  • moa: inhibits protein synthesis (50S ribosomal unit)
  • BROAD SPECTRUM
  • usually indicated w/ severe anaerobic infx or unresponsive life-threatening infx
  • GOOD CSF PENETRATION

SE: BONE MARROW SUPPRESSION (reversible anemia, hemolytic anemia, aplastic anemia)
-GRAY BABY SYNDROME!!

33
Q

DNA or RNA synthesis inhibitors

A

FLUOROQUINOLONES
METRONIDAZOLE
DAPTOMYCIN

34
Q

FLUOROQUINOLONES (GENERAL)

A

-moa: inhibits DNA gyrase (bactericidal)

C/I: PREGNANT FEMALES, <18yo (INTERFERES W/ CARTILAGE)

35
Q

CIPROFLOXACIN (CIPRO)

A
  • BEST GRAM-NEG COVERAGE OF ALL FQ (ENTERIC ORGANISMS, H.flu, Neisseria, Campylobacter)
  • EXCELLENT FOR PSEUDOMONAS
  • NOT ACTIVE VS S.PNEUMO
Ind:
UTI, PYELONEPHRITIS
GASTROENTERITIS
PID
malignant OE, sinusitis
gonococcal arthritis
36
Q

NORFLOXACIN (NORFLOX)

LEVOFLOXACIN (LEVAQUIN)

A
  • better activity vs. gram-positive
  • RESPIRATORY FQ - USED FOR CAP

Ind:
CAP
uti, pyelonephritis
gonococcal, gastroenteritis

37
Q

MOXIFLOXACIN (AVELOX)

A

-BEST GRAM-POSITIVE, ANAEROBIC & ATYPICAL OF FQs

Ind:
respiratory: CAP, bronchitis, sinusitis
intrabdominal infx
ophthalmic
skin infx
38
Q

OFLOXACIN (FLOXIN)
Gatifloxacin (Tequin)
Lomefloxacin (Maxaquin)

A

-newer fq, advanced coverage of staph aureus, epidermis, saprophyticus + strep pneumo

Ind: similar to moxi
CAP
ABECB

39
Q

METRONIDAZOLE (FLAGYL)

A

moa: inhibits DNA synthesis
EFFECTIVE ONLY VS:
-ANAEROBES: B. FRAGILIS, C.DIFF
-PROTOZOA: ENTAMOEBA HISTOLYTIA, GIARDIA LAMBLIA, TRICHOMONADS

Ind:
INTRAABDOMINAL
VAGINITIS
PSEUDOMEMBRANOUS COLITIS
AMOEBIC LIVER ABSCESS
  • DISULFIRAM-LIKE RX IF USED W/ ETOH, NEUROTOXIC
  • approved for 1st trimester pregnancy
40
Q

DAPTOMYCIN

A

-moa: binds + depolarizes bacterial membranes, causing inhibition of protein, DNA and RNA synthesis

  • GRAM-POSITIVE ONLY: MRSA, VRE, ENTEROCOCCUS FAECIUM + FAECALIS
  • inactivated by surfactant so not used in pneumonia

Ind:
COMPLICATED SKIN INFX

SE: MUSCLE TOXICITY, GI, arthralgias

41
Q

inhibitors of essential metabolites

A

TRIMETHOPRIM / SULFAMETHOXAZOLE (BACTRIM)

NITROFURANTOIN

42
Q

TRIMETHOPRIM / SULFAMETHOXAZOLE (BACTRIM)

A
  • EFFECTIVE VS GRAM-NEG, STAPH
  • 2ND BEST PO AGAINST MRSA

Ind:
UTI
AOM
ABECB

-AVOID IN PREGNANCY + INFANTS - INHIBITS FOLIC ACID SYNTHESIS
SE: GI upset, hepatitis, leukopenia, thrombocytopenia, SJS, hemolysis if G6PD deficiency

43
Q

NITROFURANTOIN

A
  • moa: excreted in urine, where active metabolites attack multiple bacterial sites
  • gram-positives, gram-negatives, enterococcus

Ind:
CYSTITIS (not pyelo)
SE: HYPERSENSITIVITY PNEUMONITIS, CHRONIC PULMONARY FIBROSIS

SAFE IN PREGNANCY (except at term)

44
Q

QUINUPRISTIN / DALFOPRISTIN (SYNERCID)

A
  • MOA: STREPTOGRAMIN CLASS - binds 50S subunit to inhibit protein synthesis; bacteriostatic (cidal to some)
  • GRAM POSITIVE; MRSA, VRSA
  • covers vanc-resistant enterococcus faecium only
  • atypicals: mycoplasma + legionella

SE: THROMBOPHLEBITIS (so only given through central line)

45
Q

AMPHOTERICIN B

A

POLYENE ANTIFUNGALS
-moa: bind to cell membrane sterols (inc permeability/fragility of cell membrane)

Ind:
ANTIFUNGAL OF CHOICE FOR MOST INVASIVE OR LIFE-THREATENING FUNGAL INFX

SE: FEVER/CHILLS DURING INFUSION, HYPOK + MG, NEPHROTOCICITY, hematoxicity, inc BUN/Cr, arrhythmia

*Lipid-based Ampho B: higher tissue concentrations, dec infusion rx, DECREASED NEPHROTOXIC BUT $$$

46
Q

NYSTATIN

A

POLYENE ANTIFUNGALS

  • moa: bind to cell membrane sterols (inc permeability/fragility of cell membrane)
  • poor bioavailability

Ind:
ORAL CANDIDIASIS - TOPICAL
topically for vaginal candida

47
Q

“azoles” general

A

moa: INHIBITIS ERGOSTEROL SYNTHESIS (essential for fungal cell memb stability)

Indications: CANDIDIASIS, CRYPTOCOCCUS, HISTOPLASMOSIS, COCCIDIOIDOMYCOSIS, TINEA

Imidazoles: 
Clotrimazole (Lotrimin)
Ketoconazole (Nizoral)
Econazole
Miconazole
Triazoles:
Fluconazole (Diflucan)
Itraconazole
Voriconazole
Posaconazole
48
Q

FLUCONAZOLE

A

DOC:
NONINVASIVE CANDIDA
CRYPTOCOCCAL INFX
-GOOD FOR URINE & CSF INFX (water soluble)

SE: HEPATITIS, nausea, rash, alopecia, headache

49
Q

VORICONAZOLE

A

-extended-spectrum –> covers ASPERGILLUS

DOC:
ASPERGILLUS

50
Q

ITRACONAZOLE

A
  • extended-spectrum –> covers ASPERGILLUS
  • lipid-soluble, poor CSF penetration, inhibits CP450

DOC:
NONINVASIVE HISTOPLASMOSIS, BLASTOMYCOSIS, COCCIDIODOMYCOSIS

SE: may cause CHF

51
Q

KETOCONAZOLE

A

-lipid-soluble, poor CSF penetration, inhibits CP450

SE: SUPPRESSION OF TT & CORTISOL (used to tx refractory Cushing’s), inc LFTs

52
Q

TERBINAFINE (LAMISIL)

BUTENAFINE (MENTAX)

A

ALLYLAMINES
-moa: inhibits ergosterol synthesis (by inhibiting squalene epoxidase)

Ind:
DERMATOPHYTE INFX
-ONYCHOMYCOSIS –> Terbinafine PO
-TINEA (corporis, pedis, cruris)–> Terbinafine or Butenafine topical

53
Q

GRISEOFULVIN

A
  • moa: inhibits fungal cell mitosis preventing proliferation and function
  • GIVE W/ FATTY MEALS to increase absorption

Ind:
TINEA (CAPITUS, cruris, pedis, unguium

SE: HEPATITIS, TERATOGENIC (males too - avoid conceiving for 6mo after tx)

54
Q

CASPOFUNGIN
ANIDULAFUNGIN
MICAFUNGIN

A

-moa: inhibits cell wall glucan synthesis
ONLY IV –> $$$

Ind:
AZOLE- + AMPHO B-RESISTANT ASPERGILLUS + CANDIDIASIS

SE: fever, thrombophlebitis, headache, inc LFTs, rash, flushing

Pharmacology (4 decks)

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