Antibiotics, Antifungals, & Antivirals

Question 1

What class of antiobiotics will be the most commonly used?

Answer 1

Beta lactams

Question 2

What antibiotics inhibit cell wall synthesis?

Answer 2

Beta lactams (PCN, cephalosporins, carbapenems, aztreo)

Vancomycin

Question 3

What antibiotics inhibit ribosomal protein synthesis?

Answer 3

Aminoglycosides
Clindamycin
Macrolides
Tetracycylines

Question 4

What antibiotics inhibit DNA synthesis?

Answer 4

Fluoroquinolones

Question 5

What antibiotics inhibit folate?

Answer 5

Sulfonamides

Trimethoprim

Question 6

What do the beta lactam meds have in common?

Answer 6

Beta lactam ring

Even a monobactam has this beta lactam ring

Question 7

About how many people will retain a PCN allergy into adulthood?

Answer 7

10%

Question 8

What is the narrowest beta lactam?

Answer 8

Natural PCN

Question 9

What is natural PCN used for?

Answer 9

Strep pharyngitis/Endocarditis

Syphilis

Question 10

Pen G is what formulation?

Answer 10

IV/IM

Question 11

Pen V is what formulation?

Answer 11

PO

Question 12

Natural PCN can also be used for dental surgery prophylaxis?

Answer 12

Because it does cover some oral anaerobes (Peptostreptococcus and Clostridia tentani)

Question 13

What bugs does Natural PCN cover?

Answer 13

Gram pos - strep pyogenes, strep agalactiae, listeria monocytogenes (CNS infections)

Gram neg - Neisseria meningitidis (not often used), Pasteurella multocida (animal bites)

Anaerobes - Peptostreptococcus (mouth flora), Clostridia tetani

Spirochetes - Treponema pallidum (Syphilis)

Question 14

PCN half life

Answer 14

~ 30min

Question 15

What can help to increase PCN concentrations/effects?

Answer 15

Adding Probenecid (antigout med)

Question 16

What is the long-acting PCN? How long does it last?

Answer 16

Benzathine PCN

Effects can be seen up to 1 month

Question 17

What are some ADRs to natural PCN?

Answer 17

Hypersensitivity, AKI

Question 18

What are some anti-staph PCN?

Answer 18

Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

Question 19

What coverage does anti-staph PCNs cover?

Answer 19

strep + syphilis + staph

*Does NOT cover MRSA (but it does cover staph aureus)

Question 20

If a bug is resistent to Nafcillin and Oxacillin, what does that mean?

Answer 20

MRSA

Because methycillin was an old version of these drugs

Question 21

What are anti-staph PCN used for?

Answer 21

SSTI, endocarditis

Question 22

What drugs are aminopenicillins?

Answer 22

Ampicillin

Amoxicillin

Question 23

What do aminopenicillins cover?

Answer 23

Gram pos - Staph, strep, listeria, enterococcus

Gram neg - shigella, E coli (most common), H. flu, proteus mirabilis, pasteurella multocida

Question 24

What diseases are aminopenicillins used for?

Answer 24

URIs (even pneumonia, if it’s caused by H flu), otitis media
Enterococcus
Dental prophylaxis

Question 25

ADR for aminopenicilins?

Answer 25

Maculopapular rash (from mono)

Question 26

How can we increase our coverage for aminopenicillins?

Answer 26

Add a beta lactamase inhibitor

Question 27

Beta lactams combined with beta lactamase inhibitors make what?

Answer 27

Amoxicillina/Clavulanate (Augmentin) Ampicillin/Sulbactram (Unasyn) Piperacillin/Tazobactam (Zosyn)

Question 28

Dose administration used by Augmentin, Unasyn, Zosyn?

Answer 28

Augmentin - PO Unasyn - IV Zosyn - IV

Question 29

What do beta lactam/beta lactamase inhibitors cover?

Answer 29

Broad spectrum gram pos/neg Anaerobes

Question 30

In addition to other beta lactam/beta lactamase inhibitors, what does Zosyn also cover?

Answer 30

Pseudomonas aeruginosa

Question 31

What are beta lactam/beta lactamase inhibitors used for?

Answer 31

Intra-abdominal infections, pneumonia, mixed infections, bite wounds, gynecologic infections, DM foot infections

Question 32

Unasyn is basically the IV version of what?

Answer 32

Augmentin

Question 33

What do beta lactamase inhibitors do?

Answer 33

Prevent the beta lactam ring from being broken down by bacteria They don't do anything in terms of killing the bacteria, but allows coverage expansion

Question 34

PCN ADRs

Answer 34

``` Hypersensitiviy GI - N/V/D Thrombocytopenia/neutropenia (rare) Nephrotoxicity/Hepatotoxicity Electrolyte abnormalities (because PCN has Na/K salt) ```

Question 35

PCNs are eliminated how?

Answer 35

renally eliminated

Question 36

T or F: if someone has a PCN allergy, you should never use PCN to treat them.

Answer 36

F - if absolutely needed, you can desensitize the pt to PCN

Question 37

Cross sensitivity risk of PCN with other beta lactams?

Answer 37

Studies show as high as 11%, but really it's probably 3-5%

Question 38

What are first generation cephalosporins?

Answer 38

Cephalexin (Keflex) Cefazolin (Ancef) Cefadroxil (Duricef)

Question 39

What are some second generation cephalosporins?

Answer 39

Cefoxitin (Mefoxin) Cefuroxime (Zinacef) Cefotetran (Cefotan)

Question 40

What are 3rd generation cephalosporins?

Answer 40

Cefotaxime (Claforan) Ceftazidime (Fortaz) Cefdinir (Omnicef) Ceftriaxone (Rocephin)

Question 41

What are fourth generation cephalosporins?

Answer 41

Cefepime (Maxipime)

Question 42

5th generation Cephalosporins?

Answer 42

Ceftaroline (Teflaro)

Question 43

As you increase your cephalosporin generation, what happens?

Answer 43

You gain more gram neg coverage

Question 44

What does Cefepime (Maxipime) (4th gen cephalosporin) also cover?

Answer 44

Pseudomonas

Question 45

What does Ceftaroline (Teflaro) additionally cover?

Answer 45

MRSA

Question 46

Are cephalosporins bactericidal or bacteriostatic?

Answer 46

Bactericidal

Question 47

Which cephalosporin has the broadest coverage?

Answer 47

Cefepime (4th gen)

Question 48

Cefazolin (Ancef) is basically the IV version of what?

Answer 48

Cephalexin (Keflex)

Question 49

Which generation of cephalosporins has the highest risk of cross-sensitivity in PCN allergies?

Answer 49

1st gen

Question 50

What are 1st gen cephalosporins mostly used for?

Answer 50

SSTIs, UTIs, surgical prophylaxis

Question 51

Which 1st gen cephalosporin will be seen a lot for surgical prophylaxis?

Answer 51

Cefazolin

Question 52

What do second gen cephalosporins cover?

Answer 52

H flu, Neisseria, Moraxella, E coli, Kelbsiella, proteus

Question 53

What are second gen cephalosporins used for?

Answer 53

otitis media, URIs, PNA Bowel surgery prophylaxis

Question 54

Which second gen cephalosporins have anaerobic activity?

Answer 54

Cefoxitin (Mefoxin) | Cefotetan (Cefotan)

Question 55

What do 1st gen cephalosporins cover?

Answer 55

Gram pos - staph and strep | Gram neg - E coli, Klebsiella, proteus

Question 56

What do 3rd gen cephalosporins cover?

Answer 56

Increased gram neg coverage, but decreased gram pos coverage Covers strep well, but we may loose a little bit of staph coverage

Question 57

What 3rd gen cephalosporins cover pseudomas?

Answer 57

Ceftazidime (Fortaz)