Antibiotics Flashcards
(80 cards)
1
Q
What are some of the most common URI pathogens?
A
- Streptococcus pneumoniae (+)
- Haemophilus influenza (-)
- Moraxella catarrhalis (-)
2
Q
What are the fluroquinolones?
A
- regular
- ciprofloxacin
- ofloxacin
- respiratory
- levofloxacin
- moxifloxacin
- gemifloxacin
3
Q
What are the uses of natural PCNs?
A
- Syphillis
- Non-purulent skin infections
- usually strep
- Phyaryngitis
- strep throat
4
Q
What is prophylactic (PPX) therapy?
A
- ABX therapy used to prevent an infxn that has Ø occurred
5
Q
What is the spectrum of activity for the 4th gen Cephalosporin?
A
- Gm +
- MSSA and strep
- Great for Gm- aerobes including:
- P. aeruginosa
- Enterobacter aerogenes and cloacae
6
Q
What is the spectrum of activity for the cyclic lipopeptide?
A
- Gm + aerobes
- MRSA
- vanc-resistant Enterococcus faecium
- Enterococcus faecalis
7
Q
What is ticarcillin and what is the downside to its use?
A
- antipseudomonal PCN
- short (4hr) DoA and high Na+ content
8
Q
What are the clinical uses for 1st gen Cephalosporins?
- Not best choice, but could also work on?
A
- Surgical PPX (not colonic)
- Skin and soft tissue infxns
- Gm+ infxn in PCN-allergic Pts
- Not best choice but can work on:
- URI
- UTI
9
Q
What is unique about macrolide ABX dosing?
A
bacteriostatic at lower doses, bactericidal at higher doses
10
Q
- What are the 3 penicillinase-resistant parenteral PCNs?
A
- methacillin
- d/c d/t nephrotoxic
- oxacillin
- nafcilin
- most active
- best CNS penetration
11
Q
- What class is daptomycin?
- What are the clinical uses for daptomycin?
- When should daptomycin absolutely NOT be used?
A
- Cyclic lipopeptide
- Staph aureus bacteremia and complicated skin/structure infxn
- Ø be used for treatment of pneumonia
- ↑ death rate and serious cardiopulm adverse events vs comparator
12
Q
What do 3rd gen Cephalosporins have:
- moderate activity for?
- less activity for vs. 1st or 2nd gen
A
- moderate vs. pseudomonas
- Gm+ cocci
13
Q
What are fluoroquinolones used for?
A
- Excellent for:
- Gm- aerobes (H. flu, P. aeruginosa, Enterobacter)
- Shigella and Salmonella
- Atypical organisms
- Mycobacterium
- Less used for:
- staph (good, resistance ↑), moderate strep
14
Q
- For what conditions do the risks of using fluoroquinolones outweigh the benefits?
- What is the serious side effect included in this FDA warning?
A
-
conditions:
- acute sinusitis
- acute bronchitis
- uncomplicated UTI
- serious tendonopathies
15
Q
What are the oral formulations of aminopenicillins?
- issues/benefits?
- dosing?
A
- ampicillin
- diarrhea, rash
- QID admin
- amoxicillin
- better absorption, less GI effects
- TID
16
Q
What are aminopenicilins and what makes them unique?
A
- Extended spectrum PCNs
- good as PCN G for Strep and pneumococci
- Also includes some gram (-)
- “NSHEPS”
- N. meningitidis
- Salmonella
- H. influenzae
- E. coli
- P. mirabilis
- Shigela
- “NSHEPS”
17
Q
What are the general guidelines for ABX?
A
- Approved ABX
- Narrowest spectrum
- Proper dose
- Shortest duration
18
Q
What is empiric therapy?
A
- ABX therapy used to treat a known/suspected infxn where organism is not specifically known
19
Q
How is clindamycin used today?
A
- Acne vulgaris
- toxoplasmosis and plasmodium (protozoa)
20
Q
What is the microbiologic activity for macrolide ABX?
A
- Gm +
- Gm - (H. flu)
- genital pathogens
- N. gonorrhoeae, Chlamydia trachomatis, Treponema pallidum
21
Q
What is the 4th gen Cephalosporin?
A
Cefepime (cefazolin [1st] + ceftazidime [3rd])
22
Q
What are some “atypical” URI pathogens and what makes each unique?
A
- Mycoplasma pneumoniae
- no cell wall
- Chlamydophila pneumoniae
- must infect another cell to reproduce
- Legionella pneumophilia
- unique lipopolysaccharide content in outer cell membrane
23
Q
What are the 4 major mechanisms of ABX resistance?
A
- destroy the drug
- enzymatic b/d
- limiting access into cell
- thickened cell wall
- change drug target
- altered binding site
- pump drug out of cell
- efflux pump
24
Q
What is minimum bactericidial concentration (MBC)?
A
- [Lowest] of ABX that kills 99.9% of the initial inoculum
25
What are the common gram negative pathogens?
* Enterobacteriaceae
* PEcK (Klebsiella, E. coli, Proteus)
* Shigella, Salmonella
* SPACE bugs
* Serratia
* Pseudomonas
* Acinetobacter
* Citrobacter
* Enterobacter
26
What is a minimum inhibitory concentration (MIC)?
* [Lowest] of an ABX that inhibits **VISIBLE** growth of an organism
* quantitative measure of Rx activity vs a bacteria
27
What are the 3rd gen Cephalosporins?
* Oral
* cefditoren
* cefdibuten
* cefdinir
* Parenteral
* cefotaxime
* ceftazidime
* ceftriaxone
28
* What is the spectrum of activity for the 5th gen Cephalosporin?
* What's it good for?
* Spectrum:
* Gm+ and MRSA
* less Gm- vs 4th gen
* Good for:
* MSSA and MRSA
* Streptococcus
* GNRs
29
What is fidaxomicin?
Difi cid(e)
* a non-absorbable macrolide-like antibiotic
* so concentrates in the gut
* used exclusively for infxn of C. diff
30
1. What is PCN VK
2. Dosing?
3. Main Uses?
1. An acid stable form of oral natural PCN
2. 125-250 mg q6hr
3. Strep pharyngitis, PPX for rheumatic heart dz
31
How are 3rd gen Cephalosporins generally used?
* Gm- meningitis
* CAP and HAP
* bacteremia
* febrile neutropenia
* complicated UTI
32
1. What is Procaine PCN G?
2. Uses?
3. Dosing?
1. IM only PCN G that has detectable levels for 12-24 hours
2. used to treat gonorrhea
3. doses q8-12 hr
33
What organisms are 3rd gen Cephalosporins generally used for?
* generally used for more Gm- organisms
* enhanced activity against "SHEEP"
* Serratia
* H. influenza
* Enterobacter
* E. coli
* Proteus
34
What are the 4 carbapenems?
* doripenem
* imipenem
* combined 1:1 w/ cilastatin
* meropenem
* ertapenem
35
What are the different CLSI Interpretive Criteria?
* susceptible
* infxn d/t isolate may be treated w/ nml dose of recommended agent
* intermediate
* infxn may be treated at body sites where:
* Rx physiologically concentrated, or
* higher doses can be used
* resistant
* infxn Ø inhibited by usually achievable concentrations w/ nml dosing schedule
36
What is the microbiologic activity of tetracyclines?
* Gm +
* Gm -
37
What is the spectrum of activity for 2nd gen Cephalosporins?
* 1st gen activity, plus...
* H. influenzae
* M. catarrhalis
* N. meningitidis
* N. gonorrhoeae
38
What are two of the major limiting factors for tetracyclines?
* That they are bacteriostatic
* They are good at everything but not great against anything
39
What are the indications for SMX-TMP?
* UTI
* URI - in areas where resistance low
* Salmonella, Shigella
* Travelers diarrhea
* PCP infxns - terminal HIV
* Pneumocystis jiroveci
40
What is the spectrum of activity for natural PCNs?
* non-β lactamase producing gram + cocci
* streptococci
* Enterococcus faecalis
* gram + anaerobes, except C. diff
* spirochetes
* Treponema pallidum
41
What are the 1st gen Cephalosporins?
* Oral
* cephalexin Keflex
* cephradine Duracef
* cefadroxil Velocef
* Parenteral
* cefazolin Ancef
42
1. What are penicillinase-resistance PCNs used for?
* Also works on?
* Doesn't work on?
1. Choice Rx for penicillinase-producing Staph aureus
* Strep (no better than PCN G)
* Ø against enterococci or gram (-) infxns
43
What 4 major groups of ABX are β-Lactams?
1. PCNs
2. Cephalosporins
3. Carbapenems
4. Monobactams
44
What are some of the ABX selection criteria used?
* Effectiveness against pathogen
* Site of Infxn
* Host Defenses
* cidal vs static
* Allergy
* Pt Variables
* Age, pregnancy, genetics
45
What are glycopeptides used for?
* Gm + aerobes
* Staph, including MRSA
* Enterococcus
* Strep, including PCN resistant
* Gm + anaerobes
* Clostridium, including C. diff
* Gram + ONLY
46
What are the 4 major MoA for ABX?
* Cell wall synthesis inhibitors
* PCN and Cephalosporins
* RNA or DNA synthesis inhibitors
* Rifampin and Fluoroquinolones
* Protein synthesis inhibitors
* TCN and Macrolides
* Antimetabolites
* Sulfonamides
47
What are the macrolide ABX?
* erythromycin
* clarithromycin
* azithromycin
48
What are the two oral penicillinase-resistant PCNs?
* dicloxacillin
* good oral absorb
* 125-250 mg q 6 hours
* cloxacillin
* best oral absorb
* 250-500 mg q 6 hours
49
What is one important point that MIC's do not take into account?
the site of infxn
50
What is a Clostridium difficule infxn and how is it treated?
* An ABX-induced overgrowth of C. diff that → severe diarrhea and serious bowel inflammation
* Normally treated w/ oral vancomycin (cheaper)
* Or they put it up your butt if you can't swallow
51
1. What are aminoglycosides used for?
2. What are the ADRs for these drugs?
1. powerful Gm- activity
2. ADRs:
* nephrotoxicity
* ototoxicity
52
What are the vancomycin ADRs?
* nephrotoxicity
* ototoxicity
* tinnitis, vertigo, hearing loss
* neutropenia
* phlebitis
* _more common in the past_:
* red man syndrome
* purified formulation has ↑ safety profile
53
What S/Sx differentiate Type I rxns from other Type rxns?
* bronchconstriction
* laryngeal edema
* urticaria (hives)
* hypotension
* anaphylaxsis
54
What are the detection methods used?
* Serology (antibodies)
* Direct Detection
* special stains
* antigen
* toxin
* molecular assays
* Culture
* biochem rxn
* antimicrobial susceptibility
55
How is the 4th gen Cephalosporin primarily used?
* Empiric therapy drug
* try and kill everything drug
56
What are the names of the short-acting and long-acting tetracyclines?
* SA = tetracycline
* LA = doxycycline and minocycline
57
What is sulbactam and how is it used?
* a β-lactamase inhibitor combined with the amino PCN ampicillin
* makes a parenteral formulation called Unasyn
58
1. What is piperacillin?
2. What is it mixed with to prevent β-lactamase b/d?
1. A low Na+ content potent antipseudomonal PCN
2. tazobactam
59
What are 1st gen Cephalosporins ineffective against?
* ineffective against other:
* Enterobacter
* H. influenza
* Proteus and Pseudomonas
* Serratia and Salmonella
60
What is SMX-TMP and what is its microbiologic activity?
* bacteriocidal combo of sulfamethoxazole-trimethoprim
* activity against:
* Gm + and Gm - aerobic activity
* Chlamydia
* Protozoa
61
What are the 3 big categories of gram positive pathogens?
* Staphylococcus
* Streptococcus
* Enterococcus
62
1. What is aztreonam?
2. What is its spectrum of activity?
3. For what condition is it given as an alternative?
1. a monobactam that's cetazidime's cousin
2. Gm- ONLY
3. Given if type-I PCN allergy present d/t no cross-reactivity with other β-lactams
* way to replace 3rd gen Cephalosporins when allergy present
63
What is the 5th gen Cephalosporin?
Ceftaroline
64
What are the main aminoglycoside agents?
* gentamicin
* tobramycin
* neomycin
65
What is the cyclic lipopeptide drug?
daptomycin
66
1. Approach if PCN allergy w/ drug fever or maculopapular rash occurs?
2. Approach if PCN allergy w/ hives or anaphylaxis occurs?
1. Cross sensitivity w/ β-lactam (3-5%) low so may safely give other β-lactams
2. Do NOT give β-lactams w/ potential cross-reactivity (Type I)
* give aztreoman instead (β-lactam ABX that can be used)
67
What are the components of ABX Stewardship?
* Appropriate Dx
* indication for ABX?
* Appropriate antimicrobial therapy
* ABX choice
* Dose: adjustment for renal fxn or Wt
* Duration
68
What are 1st gen Cephalosporins active against?
* Gm+ cocci (Staph and Strep)
* except MRSA
* Most Gm+ anaerobes
* except B. fragilis
* Okay-ish GNR like Klebsiella and E. coli
69
When does desensitization therapy work?
Only for Type I Hypersensitivity reactions
70
What are the only 4 PCNs Ø destroyed by β-lactamases?
* oxacillin
* nafcillin
* dicloxacillin
* cloxacillin
71
What is definitive/directed therapy?
* ABX therapy used after C/S is known
72
1. What is Augmentin and what SE issues does it have?
2. What can you now kill with Augmentin?
1. oral amoxicillin combined w/ clavulanic acid (β-lactamase inhib)
* more GI SE
2. Gram (+) streptococci, "NSHEPS", and any of these that NOW produce β-lactamases
73
1. What is Benzathine PCN G
2. Uses?
3. Dosing?
1. IM only PCN G that has detectable levels for 15-30 days
2. treats syphilis, pharyngitis
3. q weekly
74
1. What is another formulation of natural PCN?
2. What can it penetrate?
3. How is it eliminated?
4. What is the T1/2 and what does this mean for dosing?
5. What are its clinical uses?
1. Aqueous PCN G (parenteral)
2. BBB
3. 90% renally
4. VERY Short T1/2 (30 mins) + Time-dpdt killing = q4-6 hr admin
5. neurosyphilis, endocarditis
75
What are the carbapenems used for?
* Wide range of bacterial infxns
* LRI
* CNS infxn
* skin/soft tissue
* bone and joint
* intra-ABD
* Empiric therapy for severe systemic infxn and/or mixed infxns
76
What are the Gm - Neisseria pathogens?
* N. meningiditis
* N. gonorrhoeae
77
What are the glycopeptides?
* vancomycin
* telavancin
78
1. How do all β-Lactams work?
2. How are most eliminated?
3. When do they not typically work?
1. All have bacteriocidal action by inhibiting cell wall synthesis in time-dependent manner
2. Most are renally eliminated
3. Ø coverage for atypicals
79
What are the 2nd gen Cephalosporins?
* Oral
* cefaclor
* cefprozil
* cefuroxime axetil
* loracarbef
* Parenteral
* cefuroxime
* cefoxitin
* cefotetan
80
What is metronidazole primarily used for?
* bacteriocidal action against:
* Gm + and Gm - anaerobes
* Trichomonas vaginalis
* Giardia lamblia
* C. diff
