Antibiotics/Antivirals/Antifungals

Question 0

B-Lactams (class)

Answer 0

Inhibit cell wall synthesis
BACTERICIDAL
Synergist with aminoglycosides

Ex. Penicillins, cephalosporins, carbapenems, monobactams

Question 1

Categories of Antibiotics (5)

Answer 1

B-Lactams (inhibit cell wall synthesis) BACTERICIDAL

Aminoglycosides (Inhibit RNA translation/destabilize cell wall) BACTERICIDAL

Tertracyclines (Inhibit RNA attachment to acceptor site) BACTERIOSTATIC

Macrolides (Dissociation of RNA from ribosome during elongation) BACTERIOSTATIC

Quinolones (Inhibit DNA synthesis)
BACTERICIDAL

Question 2

Penicillins (B-Lactam)

Answer 2

End in “cillin”
Commonly used against P. aeruginosa, enterobacteriaceae, S. aureus

Hypersensitivity most common side effect

Question 3

Cephalosporins (B-Lactam)

Answer 3

First generation- gram positive
Second generation- gram positive and some negative
Third generation- most gram negative
Fourth generation- extended negative and positive coverage (clinical)
NO ALCOHOL

Ex. Cefotetan, cefoperazone

Question 4

Carbapenems (B-Lactam)

Answer 4

Broad spectrum antibiotic for gram negative and positive AND anaerobic bacterias like P. aeruginosa, MRSA, community and nosocomial pneumonias

Can cause seizures in patients with renal dysfunction

Ex. Imipenem-cilastatin (Primaxin), Meropenem, Entrapenem, Doripenem)

Question 5

Monobactams (L-Bactam)
aka Aztreonam (aerosolized)

Answer 5

Gram negative aerobic bacilli like Enterobacteriacae and P. aeruginosa
Rare rash as side effect

Aerosolized to treat pulmonary infections in CF, improves symptoms in CF patients with colonized P. aeruginosa, NOT indicated for children under 7.

2ml(75mg) vial mixed with 1mL sterile diluent
Pretreat w/ bronchodilator, TID 28days on/off, refrigerate
Side effects include bronchospasm and decrease in FEV1

Question 6

Aminoglycosides (class)

Answer 6

BACTERICIDAL
Inhibit RNA translation, cell wall destabilization
Used clinically for gram negative nosocomial infections like Vent. associated pneumonia

Ototoxicity, nephrotoxicity

Ex. Gentamicin, Tobramycin (aerosolized), Netilmicin, amikacin

Question 7

Tobramycin (aerosolized aminoglycoside)

Answer 7

Pulmonary infections in CF, to treat or prevent colonization with P. aeruginosa and to maintain current lung function or reduce rate of deterioration.

Dose; 300mgBID, 28days on/off
Administered with PARI LC Plus

(IV route) Ototoxicity, nephrotoxicity, NM blockade
Tinnitus and voice alteration (SVN)

Question 8

Tetracyclines (class)

Answer 8

BACTERIOSTATIC
Inhibit attachment of RNA to acceptor site

Broad spectrum gram positive and negative
Used against rickettsiae, chlamydiae, mycoplasmas, spirochetes, PROTOZOA (first line), mycobacteria.

Contraindicated in pregnancy and breastfeeding mothers, and children under 8. Rare nausea, vomiting, diarrhea.

Question 9

Tigecycline (Tetracycline)

Answer 9

BACTERIOSTATIC
Inhibits protein synthesis, even against tetracycline resistant organisms, bactericidal against S. pneumoniae

Used for complicated skin and intraabdominal infections

Question 10

Macrolides (class)

Answer 10

BACTERIOSTATIC
Induce dissociation of RNA from ribosome during elongation
Clinical uses include rickettsiae, chlamydia (in pregnant women), mycoplasmas, LEGIONELLA

May increase concentration of drugs like Theophylline, Warfarin, Triazolam

Ex. Erythromycin, clarithromycin, azithromycin

Question 11

Telithromycin (Macrolide)

Answer 11

Inhibits bacterial protein synthesis
Used for sinusitis and community acquired pneumonia

Adverse rxns; nausea, diarrhea, visual disturbances, prolonged Q-T interval

Question 12

Quinolones (class)

aka Fluoroquinolones

Answer 12

BACTERICIDAL
Inhibit DNA synthesis
Used for upper/lower respiratory infections, GI infections, skin infections
Side effects, one of the safest, maybe GI issues, prolonged Q-T

Ex. Levofloxacin, Moxifloxacin (-xacin)…

Question 13

TMP-SMX (specific)

Answer 13

BACTERIOSTATIC
blocks enzymes needed by bacteria
First-line drug for PCP

Question 14

Clindamycin (specific)

Answer 14

BACTERIOSTATIC
Inhibits protein synthesis
Used against gram positive and anaerobic bacteria, MRSA

Question 15

Metronidazole (specific)

Answer 15

BACTERICIDAL
Unknown mechanism
Used for anaerobic infections (C. difficile)
side effects include metallic taste, vomiting, peripheral neuropathy (long-term)

Question 16

Vancomycin (specific)

Answer 16

Prevents formation of cell wall
BACTERICIDAL against gram positive
BACTERIOSTATIC against enterococci
Used against MRSA, oral for C. difficile
Side effects include ototoxicity, nephrotoxicity

Question 17

Quinupristin and Dalfopristin (specific)

Answer 17

Usually last treatment option because of side-effects
Inhibit protein synthesis
BACTERICIDAL against MRSA
BACTERIOSTATIC against VREF

Question 18

Linezolid (specific)

Answer 18

Prevents RNA translation

Used against VREF (last choice for treatment)

Question 19

Antimycobacterials

Answer 19

Used against mycobacterium tuberculosis (TB)
multiple antibiotic regiments for 6-12 months

4 drugs used in combination and a fifth added if need

First 4; Isonazid, Rifampin and Rifabutin, Pyrazinamide (first three BACTERICIDAL), Ethambutal (BACTERIOSTATIC)

Question 20

Isoniazid (antimycobacterial, TB)

Answer 20

Inhibits cell wall synthesis, BACTERICIDAL

Hepatotoxicity, neurotoxicity

Question 21

Rifampin and Rifabutin (antimycobaterial, TB)

Answer 21

Inhibit ENA polymerase, BACTERICIDAL

Hepatotoxicity, Fever, chills, nausea, vomiting

Question 22

Pyrazinamide (antimycobacterial, TB)

Answer 22

Unknown mechanism, BACTERICIDAL

Hapatotoxicity, nausea vomiting

Question 23

Ethambutol (antimycobacterial, TB)

Answer 23

BACTERIOSTATIC, decreases cell wall polysaccharides

Optic-neuropathy side effect

Question 24

Streptomycin (antimycobacterial, TB)

Answer 24

Added fifth drug if needed, similar to aminoglycosides | Nephrotoxicity, ototoxicity

Question 25

Antifungal Agents

Answer 25

Polyenes, Azoles, Echinocandins, "OTHER"

Question 26

Polyenes (amphotericin B and nystatin) (antifungal)

Answer 26

Fungicidal Used against Aspergillosis (can digest lung tissue) Severe adverse reactions may include flushing, fever, chills, renal impairment Least safe of antifungals

Question 27

Azoles (antifungal)

Answer 27

Fungistatic against Candidiasis | Safest of the antifungals

Question 28

Echinocandins

Answer 28

Fungicidal or fungistatic depending on isolate Used against Candida and Aspergillus Reactions include fever, rash, flushing, thrombophlebitis 2nd safest antifungal 1st choice in patients with kidney dysfunction

Question 29

Flucytosine ("other" antifungal)

Answer 29

Inhibits fungal RNA formation Fungistatic against Candida, Cryptococcus (only drug for treating this), Aspergillus Adverse rxns, bone marrow supression

Question 30

Griseofluvin and Terbinafine ("other" antifungal)

Answer 30

Used for fungal infections of skin, hair, nails

Question 31

Antiviral agents

Answer 31

Acyclovir (HSV, HZV, VZV) and Valacyclovir Gangciclovir (CMV) and Valganciclovir Oseltamivir

Question 32

Acyclovir and Valacyclovir (Antiviral)

Answer 32

Terminate viral replication | Used for HSV, EBV, Cytomegalovirus (CMV), VZV

Question 33

Ganciclovir and valgangciclovir (antiviral)

Answer 33

Terminates viral DNA synthesis/replication Used for HSV, VZV, CMV Bone marrow supression

Question 34

Oseltamivir (antiviral)

Answer 34

Inhibits Influenza A and B, prevents virus from leaving host cell Used to treat Influenza A and B Nausea and vomiting may occur in first days of therapy.

Question 35

Aerosolized Antiinfective agents

Answer 35

Pentamidine, Ribavirin, Tobramycin, Aztreonam, Zanamivir

Question 36

Pentamidine (antiinfective)

Answer 36

Prevention of PCP and immunodeficient patients Second line treatment for patients who could not tolerate oral TMP-SMX (1st line) Brand name NebuPent, given 300mg inhalation once every 4 weeks, reconstituted in 6ml sterile water NOT SALINE. Administered only with Respirgard II (5-7 L/min, 1-2MMAD) Blocks RNA and DNA synthesis, inhibits oxidative phosphorylation

Question 37

Ribavirin (antiinfective)

Answer 37

Treatment of infants with severe lower respiratory tract infection caused by respiratory syncytial virus (RSV) NOT recommended for routine RSV infection 20mg/mL delivered 12-18hrs/day for 3-7 days only with a SPAG-2 (1.3MMAD)

Question 38

Tobramycin (antiinfective)

Answer 38

Management of chronic P. aeruginosa in CF 300mgBID, 28days on/off Given with PARI LC Plus

Question 39

Aztreonam (antiinfective)

Answer 39

Used for pulmonary infections in CF patients to improve symptoms in P. aeruginosa. Delivered with Altera Nebulizer system TID for 28 days off/on

Question 40

Zanamivir (antiinfective)

Answer 40

Treatment of uncomplicated influenza in adults/children over 5. Off label treatment of H1N1 influenza A DPI (Diskhaler) 2 blisters, 2x's a day for 5 days.