Antibiotics by Class Flashcards
(155 cards)
1
Q
What are common resistant pathogens?
A
Klebsiella
E. Coli
Acinetobacter
Enterococcus
Staphylococcus
Pseudomonas
(Kill Each And Every Strong Pathogen)
2
Q
Which antibiotics have highest risk of C. diff infection?
A
Clindamycin (BBW)
Carbapenems
Quinolones
Broad spectrum PCNs and cephalosporins
3
Q
Which antibiotics are concentration-dependent killing?
A
Aminoglycosides
Quinolones
Daptomycin
Lipoglycopeptides
4
Q
Which antibiotics are exposure-dependent killing?
A
Vancomycin
Macrolides
Tetracyclines
Polymyxin
5
Q
Which antibiotics are time-dependent killing?
A
Beta lactams
(PCNs, cephalosporins, carbapenems)
6
Q
Quinolones MoA
A
inhibit bacterial DNA topoisomerase IV and gyrase
7
Q
Which quinolones are called “respiratory quinolones” and why?
A
Levofloxacin and Moxifloxacin
Provide reliable coverage of S. pneumoniae
8
Q
Which quinolones are called “antipseudomonal quinolones” and why?
A
Levofloxacin and Ciprofloxacin
Provided coverage for Pseudomonas
9
Q
Which quinolones require renal dose adjustment?
A
All, except moxifloxacin
10
Q
Which quinolones can be used for UTIs?
A
All, except moxifloxacin
11
Q
Which quinolones cover anaerobic pathogens?
A
Moxifloxacin, gatifloxacin
12
Q
Which quinolones cover MRSA?
A
Delafloxacin
13
Q
What combination ear drops is Ciprofloxacin available in?
A
+ dexamethasone (Ciprodex)
+ fluocinolone
+ hydrocortisone
14
Q
What BBWs are associated with quinolones?
A
Tendon inflammation/rupture, peripheral neuropathy, seizures
15
Q
Which quinolone has the highest risk of QT prolongation?
A
Moxifloxacin > levo > cipro
16
Q
Warnings and side effects of quinolones
A
QT prolongation, hypoglycemia/hyperglycemia, psychiatric disturbances, photosensitivity, hepatotoxicity, crystalluria
N/D, headache, dizziness, SJS/TEN
17
Q
Which populations should caution/avoid taking quinolones?
A
-Avoid if seizure history or if taking antiseizure drugs
-Avoid in children
-Avoid in pregnancy/breastfeeding
-Caution in CVD, low K or Mg
-Caution if taking other QT prolonging drugs
18
Q
Drug interactions with quinolones
A
-Antacids and polyvalent cations (inhibit quin absorption)
-phosphate binders like sevelamer and lanthanum (dec. quin conc.) - separate administration
-Ciprofloxacin: strong CYP1A2 inhibitor, inc. levels of caffeine, theophylline, and tizanidine
-Inc. warfarin effect
-inc. hypoglycemic effect of sulfonylurea and insulin
19
Q
What are some examples of QT-prolonging drugs?
A
Azole antifungals, antipsychotics, methadone, macrolides
20
Q
Ciprofloxacin formulations
A
Oral suspension - do not put through NG/feeding tube
Tablet, injection, ointment, ophthalmic, otic
21
Q
Ciprofloxacin brand name
A
Cipro (oral)
22
Q
Moxifloxacin brand name
A
Avelox, Vigamox eye drops
23
Q
Ofloxacin brand name
A
Ocuflox eye drops
24
Q
What quinolones have a 1:1 IV to PO ratio?
A
Levofloxacin and moxifloxacin
25
Common uses of quinolones
Pneumonia, UTIs, intra-abdominal infections, traveler's diarrhea
26
Counseling points for quinolones
Avoid sun exposure
Separate from polyvalent cations
Monitor blood glucose if diabetic
27
Macrolide MoA
bind to 50S ribosomal subunit to inhibit protein synthesis
28
Common uses of all macrolides
community-acquired upper/lower respiratory tract infections
Certain STIs (chlamydia)
Alternative to beta-lactam for pharyngitis (strep-throat)
29
Common uses of azithromycin
COPD exacerbations
Pertussis
Chlamydia (pregnant patients)
Prophylaxis for Mycobacterium avium complex
Severe traveler's diarrhea (including dysentery)
30
Common uses of clarithromycin
H. pylori treatment regimens
31
Common uses of erythromycin
gastroparesis (increases gastric motility)
32
Macrolide coverage
Atypicals (Legionella, Chlamydia, Mycoplasma, Mycobacterium avium complex)
S. pneumoniae, Haemophilus, Moraxella (these three have increasing resistance to macrolides)
33
Azithromycin brand name
Zithromax, Z-Pak, Zithromax Tri-Pak
34
What is the difference in dosing schedule of Z-Pak and Tri-Pak?
Z-Pak: 500 mg on day 1, then 250 mg on days 2-5
Tri-Pak: 500 mg daily for 3 days
35
Erythromycin brand name
E.E.S. (erythromycin ethylsuccinate)
Ery-Tab
Erythrocin
36
Which macrolides require renal dose adjustment?
Clarithromycin (CrCl < 30 mL/min)
37
Contraindications of macrolides
-Hx cholestatic jaundice/hepatic dysfunction
-Clarithromycin and erythromycin: do not use with lovastatin or simvastatin, pimozide, ergotamine, dihydroergotamine
-Clarithromycin: use with colchicine in renal/hepatic impairment
38
Warnings of macrolides
QT prolongation (erythromycin > azithromycin > clarithromycin),
hepatotoxicity, exacerbation of myasthenia gravis
Caution in CVD, decreased K/Mg
39
Side effects of macrolides
GI upset (diarrhea, ab pain, cramping), altered taste, ototoxicity, SJS/TEN/DRESS
40
What should be cautioned with Clarithromycin specifically?
-Patients with CAD (inc. mortality after 1 year of D/C)
-avoid with colchicine in patients with renal/hepatic impairment
-avoid with lovastatin or simvastatin (CYP3A4 metabolized)
-caution with warfarin
41
What should be cautioned with both clarithromycin and erythromycin?
-avoid with lovastatin or simvastatin, pimozide, ergotamine, dihydroergotamine
-caution with warfarin, apixaban, colchicine, dabigatran, rivaroxaban, theophylline
42
Which macrolide has fewer clinically significant drug interactions than others?
azithromycin
43
Tetracycline MoA
bind to 30S ribosomal subunit and inhibit bactrial protein synthesis
44
Tetracycline coverage
Gram-pos: staphylococci, streptococci, enterococci
Gram-neg: atypicals, Haemophilus, Moraxella
45
Doxycycline uses
CAP, tickborne/rickettsial diseases, chlamydia, CA-MRSA skin infections, VRE UTIs
46
Which tetracyclines DO NOT require renal dose adjustments?
doxycycline, minocycline
47
doxycycline brand name
Vibramycin
48
Minocycline brand name
Minocin, Solodyn
49
Tetracycline warnings
-Children < 8 yrs, pregnancy, breastfeeding - myelosuppression
-Photosensitivity, SJS/TEN/DRESS
-GI inflammation
50
Drug-induced lupus erythematosus (DILE) is a major warning for which tetracycline?
Minocycline
51
What are specific administration points for patients when taking doxycycline?
Tablets/capsules should be taken with 8 oz of water (all tetracyclines)
Doxycycline: sit upright for at least 30 minutes after dose to avoid esophageal irritation
52
Tetracycline drug interactions
-Antacids and polyvalent cations (inhibit quin absorption)
-sucralfate, bismuth subsalicylate, bile acids (chelate and inhibit absorption of tetracyclines)
-avoid dairy products 1 hour before or 2 hours after tetracyclines
53
Sulfonamide MoA
inhibits folic acid pathway
54
Sulfonamide (SMX/TMP) coverage
MRSA
Broad gram-neg, including Shigella, Salmonella, Stenotrophomonas
Some opportunistic pathogens: Pneumocystis, Toxoplasmosis
NO activity against Pseudomonas, enterococci, atypicals, or anaerobes
55
Sulfamethoxazole/Trimethoprim brand name
Bactrim, Bacrim DS
56
Single Strength Bactrim dosing
400 mg SMX / 80 mg TMP
57
Double Strength Bactrim dosing
800 mg SMX / 160 mg TMP
58
Bactrim dosing for uncomplicated UTI
1 DS tablet PO BID x 3 days
59
All Bactrim products are formulated with a SMX:TMP ratio of ____
5:1
60
Bactrim dosing for Pneumosystis pneumonia (PCP) prophylaxis
1 DS or SS tablet daily
61
Contraindications of Bactrim
Sulfa allergy
Anemia (due to folate deficiency)
Renal or hepatic disease
Infants < 2 months
62
Which indication requires Bactrim to be renally dose adjusted?
PCP treatment
CrCl 15-30 mL/min
If < 15 mL/min, Bactrim is not recommended
63
Bactrim warnings
Skin reactions: SJS/TEN, thrombotic thrombocytopenic purpura (TTP)
Hemolytic anemia: immune-mediated (pos. Coombs) or caused by G6PD deficiency
Hypoglycemia, thrombocytopenia
64
Can Bactrim be used in pregnancy?
Yes, but only if the benefit outweighs the risk
Bactrim will block folic acid metabolism, leading to congenital defects
65
Common side effects of Bactrim
photosensitivity, increased K, crystalluria (pls hydrate), N/V/D, anorexia, decreased folate, false SCr elevations
66
Bactrim drug interactions
-mod-strong CYP2C8 and CYP2C9 inhibitor, can increase INR if used with warfarin
-risk for hyperkalemia increases in renal dysfunction or in combo with ACEi/ARBs, aliskiren, aldosterone receptor antagonists, K-sparing diuretics, cyclosporine, tacro, NSAIDs
67
Vancomycin MoA
inhibits bacterial cell wall synthesis
68
Vancomycin coverage
gram-positive only, including MRSA, streptococci, enterococci (NOT VRE), and C. diff (PO only)
69
Vancomycin brand name
Vancocin
70
Vancomycin is first-line for what indication?
mod-severe systemic MRSA infections
71
When should you consider an alternative drug to vancomycin in terms of MRSA MIC?
MRSA MIC is at least 2 mcg/mL
72
Vancomycin IV dosing (standard)
15-20 mg/kg q8-12h (dose based on TOTAL body weight)
73
How are the dosing frequencies of vancomycin (IV) different in renal impairment?
CrCl 20-49 mL/min: q24h
CrCl < 20 mL/min: give one dose, then dose per levels
74
Peripheral IV vancomycin infusions should not exceed ____ mg/mL
5 mg/mL
75
Vancomycin PO dosing
125 QID for 10 days
No renal adjustment required
76
What formulations of vancomycin can be used if treating C. diff infections?
PO only
77
What formulations of vancomycin can be used if treating systemic infections?
IV only
78
Vancomycin warnings
Ototoxicity and nephrotoxicity
Infusion reaction
79
Vancomycin infusions should not be infused faster than ___ gram per hour
1 gram per hour
80
Vancomycin side effects
ab pain, nausea (PO), phlebitis, myelosuppression, SJS/TEN
81
What should be monitored when on vancomycin?
Renal function
Drug levels (AUC/MIC ratio or steady state trough)
82
What is the recommended AUC/MIC ratio for vancomycin in serious MRSA infections?
AUC/MIC ratio of 400-600
83
When should you draw the steady state trough for vancomycin?
30 minutes before the 4th or 5th dose
84
What is the recommended goal trough for vancomycin in serious MRSA infections?
15-20 mcg/mL
85
Vancomycin drug interactions
-Risk of nephrotoxicity increases with other nephrotoxic drugs
-Risk of ototoxicity increases with other ototoxic drugs
86
What are common nephrotoxic drugs?
Aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, contrast dye
87
What are common ototoxic drugs?
Aminoglycosides, cisplatin, loop diuretics
88
What drugs are lipoglycopeptides?
end in -vancin
Telavancin, Oritavancin, Dalbavancin
89
Which lipoglycopeptides follow a single-dose IV regimen?
Oritavancin and dalbavancin
90
Lipoglycopeptide MoA
inhibit bacterial cell wall synthesis
91
Which lipoglycopeptides have a black box warning? What does it caution?
Telavancin - fetal risk and nephrotoxicity
-need to obtain pregnancy risk before initiating therapy
92
Lipoglycopeptide contraindications
Telavancin: concurrent use of IV unfractionated heparin (UFH)
Oritavancin: do not use IV UFH for 120 hours (5 days) after oritavancin (interference with aPTT lab results)
93
Lipoglycopeptide warnings
Infusion reaction, false increase in aPT/PT/INR
QT prolong (telavancin)
94
Which lipoglycopeptides require renal dose adjustments?
telavancin and dalbavancin
95
Daptomycin coverage
most gram-pos, including MRSA, enterococci (VRE)
NO gram-neg activity
96
Daptomycin brand name
Cubicin (brand d/c'd but name still used)
97
Which antibiotic cannot be used to treat pneumonia? Why not?
Daptomycin: drug is inactivated in the lungs by surfactant
98
Daptomycin warnings
Myopathy, rhabdomyolysis
False increase in PT/INR
99
Daptomycin side effects
Increased creatine phosphokinase
Ab Pain, pruritus, chest pain, edema, HTN, AKI
100
What IV fluids are compatible with daptomycin?
NS and Lactated Ringer (no dextrose)
101
Linezolid/Tedizolid MoA
oxazolidinone that binds to 50S subunit
102
Linezolid/Tedizolid coverage
similar to vanco but also covers VRE
gram-positive only, including MRSA, streptococci, enterococci and C. diff
103
Linezolid brand name
Zyvox
104
Which antibiotics have IV to PO ratios of 1:1?
Doxycycline, Minocycline
Levofloxacin, Moxifloxacin
Linezolid
Metronidazole
105
Oxazolidinone contraindications
Do not use with or within 2 weeks of MAO inhibitors
Avoid tyramine-containing foods and serotonergic drugs
106
Oxazolidinone Warnings
Duration-related myelosuppression (thrombocytopenia)
Optic Neuropathy
Serotonin Syndrome
Hypoglycemia
107
Oxazolidinone Side effects
decreased platelets, Hgb, WBC (monitor weekly CBC)
Headache, N/D
108
Counseling point for linezolid suspensions
do not shake
109
Tigecycline coverage
broad-spectrum gram-positive activity including MRSA and enterococci (VRE)
gram-neg, anaerobes, atypicals
NO activity against the "3 P's": Pseudomonas, Proteus, Providencia
110
Tigecycline brand name
Tygacil
111
Tigecycline warning
BBW: increased risk of death (last resort drug)
Anaphylactic reactions (avoid in tetracycline-class allergy due to similar structure)
112
When should tigecycline be used? When should it not be used?
Clinical use is limited, and is only used when alternative treatments not suitable
Do not use for bloodstream infections (does not achieve adequate conc. in blood since it is lipophilic)
113
When reconstituted, what color should tigecycline be?
Solution should be yellow-orange
If not, discard
114
Polymyxin class consists of what drugs?
Polymyxin B and Colistimethate
115
Colistimethate is a ____ prodrug that is converted to ___
Inactive prodrug that is converted to colistin
116
When are polymyxins primarily used?
for MDR gram-neg pathogens in combo with other antibiotics
117
Which polymyxin can be used by inhalation?
Colistimethate, solution must be mixed immediately prior to administration
118
Polymyxin warnings
Dose-dependent nephrotoxicity
Neurotoxicity
Polymyxin B: respiratory paralysis from neuromuscular blockade
119
Polymyxin drug interactions
Nephrotoxicity risk increases with other nephrotoxic drugs (aminoglycosides, amphotericin B, cisplatin, loop diuretics, cyclosporine, NSAIDs, radiocontrast dye, tacrolimus, vancomycin)
120
Why is chloramphenicol rarely used?
due to its adverse effects - fatal blood dyscrasias, Gray syndrome
121
Clindamycin MoA
binds to 50S subunit
122
Clindamycin coverage
most gram-positive, including CA-MRSA and anaerobes
NO coverage for Enterococcus or gram-neg pathogens
123
Clindamycin brand name
Cleocin
Topical: Cleocin-T, Clindagel
124
Clindamycin renal adjustment
none
125
Clindamycin Warnings
BBW: colitis (C. diff)
SJS/TEN/DRESS
126
Clindamycin side effects
N/V/D, urticaria
127
A ___ test should be performed on ____ (pathogen) that is susceptible to clindamycin, but resistant to erythromycin. A flattened zone between the disks indicates _____
-Induction test (D-test)
-S. aureus
-Clindamycin resistance
128
Metronidazole coverage
anaerobes and protozoal organisms
129
Metronidazole is effective for?
bacterial vaginosis, trichomoniasis, giardiasis, C. diff (not preferred), and intra-abdominal infections (in combo regimens)
130
Metronidazole brand name
Flagyl
131
Metronidazole formulations
Tablet, capsule, injection, suspension, topical, vaginalWE
132
What drugs are related to metronidazole?
Tinidazole and Secnidazole
133
Secnidazole dosing
2 gram SINGLE DOSE
134
Metronidazole contraindications
pregnancy (1st trimester)
use of alcohol or propylene glycol-containing products during treatment or within 3 days of D/C (disulfiram reaction)
135
Metronidazole side effects
metallic taste, headache, nausea, furry tongue, SJS/TEN
136
Secnidazole warnings
vulvovaginal candidiasis
137
Metronidazole drug interactions
do not use with alcohol during and for 3 days after D/C due to disulfiram-like reaction (ab cramping, headaches, N/V, flushing)
weak inhibitor of CYP2C9 and can cause increased INR in warfarin
138
Lefamulin (Xenleta) is an antibiotic that has what warnings and side effects?
Avoid use with CYP3A4 substrates that prolong QT interval
Teratogenic (avoid in pregnancy)
QT prolongation
N/D, injection site reactions
139
Fidaxomicin brand name
Dificid
140
Fidaxomicin is used for what indication?
C. diff infections
141
Fidaxomicin is not effective for ____.
systemic infections
142
Rifaximin brand name
Xifaxan
143
Rifaximin uses
Traveler's diarrhea
Hepatic encephalopathy
IBS w/ diarrhea
C. diff (off-label, third or more recurrence)
144
Rifaximin is not effective for ___
systemic infections
145
What antibiotics are not suitable for systemic infections?
PO vancomycin
Rifaximin
Fidaxomicin
146
Fosfomycin (Monurol) indication
urinary agent used for uncomplicated UTI
147
Fosfomycin formulation and dosing frequency
packet granules (3 g per packet)
single-dose
148
Nitrofurantoin brand name
Macrobid, Macrodantin
149
Nitrofurantoin MoA
inhibit bacterial cell wall
150
Nitrofurantoin uses
uncomplicated UTI
151
Nitrofurantoin brand dosing differences
Macrobid: 100 mg PO BID x 5 days
Macrodantin: 50-100 mg PO QID x 3-7 days
MacroBID is BID
Macrodantin is QID
152
Nitrofurantoin contraindications
Renal impairment (CrCl < 60 mL/min)
G6PD deficiency (can can cause hemolytic anemia)
153
Nitrofurantoin side effects
GI upset (take with food!!!), brown urine discoloration
154
Mupirocin uses
Topical nasal ointment (decolonization) used to eliminate staphylococci (MRSA) colonization
155
Mupirocin dosing
500 mg in EACH NOSTRIL BID for 5 days
