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Pharmacology 2 > Antibiotics I > Flashcards

Antibiotics I Flashcards

1
Q

antibiotics are produced by _____ that kills or inhibits growth of other opportunistic microorganisms

A

microorganisms

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2
Q

what is an indicator of an antibiotic drug’s selectivity?

A

therapeutic index

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3
Q

pathogen specific and has a rapid response for sensitive organisms

A

narrow spectrum

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4
Q

better for mixed infections, has gram + and gram - coverage, but may give up some effectiveness for gram + to gain effectiveness for gram -

A

broad spectrum

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5
Q

since narrow spectrum antibiotics can target one or two bacteria, they will produce ____ _____ _____.

A

less side effects

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6
Q

what are broad spectrum antibiotics good for?

A

empiric coverage

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7
Q

why do broad spectrum antibiotics lead to super-infection?

A

they alter normal gut flora = allow more pathogenic organisms an opportunity to survive

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8
Q

what spectrum antibiotics are preferred if bug is susceptible/sensitive?

A

narrow spectrum

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9
Q

what will gram + stain look like?

A

blue

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10
Q

what are 3 examples of gram + cocci?

A

staph
strep
enterococcus

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11
Q

what will gram - stain look like?

A

pink

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12
Q

what are 2 examples of gram - cocci?

A

neisseria
h. flu

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13
Q

name the bacteria that is highly adaptive to surrounding environment

A

pseudomonas aeruginosa

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14
Q

what are the bacteria-lacking cell wall called?

A

intracellular (atypical)

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15
Q

4 beta lactam antibiotic classes that are cell wall inhibitors

A

Penicillins
Cephalosporins
Monobactam
Carbapenems

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16
Q

3 antibiotics that are cell wall inhibitors, but not beta-lactams

A

Bacitracin
Cycloserine
Vancomycin

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17
Q

medication that inhibits RNA transcription. what is it used for?

A

Rifampin
treats TB

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18
Q

6 drug classes that inhibit protein (ribosome) synthesis that is necessary for bacterial growth

A

MALT-SO

Macrolides
Aminoglycosides
Lincosamides
Tetracyclines
Streptogramins
Oxazolidinones

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19
Q

what kind of antibiotics penetrate the cytoplasmic membrane integrity of the bacteria?

A

peptide antibiotics

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20
Q

what antibiotic medication inhibits nucleotide biosynthesis of bacteria?

A

trimethoprim-sulfamethoxazole

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21
Q

what class of antibiotics inhibit topo-isomerase?

A

fluoroquinolones

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22
Q

which antibiotic inhibits DNA replication of bacteria?

A

metronidazole

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23
Q

when bacteria goes under a change to become resistant

A

vertical mutation/resistance

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24
Q

when bacteria gets a resistant gene from an already-resistant organism

A

horizontal mutation/resistance

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25
Q

DNA and plasmids carrying the resistant gene transferred directly from resistant to susceptible bacteria. which gram bacteria use this?

A

conjugation

gram -

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26
Q

DNA and plasmids transferred via a bacteriophage (virus infects bacterium, replicates, and incorporates resistant gene). which gram bacteria use this?

A

transduction

gram +

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27
Q

DNA and plasmids acquired from environment (released by dead bacteria). which gram bacteria use this?

A

transformation

gram +

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28
Q

what gram bacteria is more worrisome? why?

A

gram -

less work is required for it to become resistant

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29
Q

drugs that act on targets that are essential for bacterial survival

A

bactericidal

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30
Q

what kinds of drugs are considered bactericidal? (2 MOAs and 1 drug class)

A

cell wall synthesis inhibitors

DNA synthesis inhibitors

aminoglycosides

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31
Q

drugs that act on targets that are necessary for bacterial growth, but not survival

A

bacteriostatic

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32
Q

what kinds of drugs are considered bacteriostatic? (3)

A

protein synthesis inhibitors

sulfonamides

trimethoprim

linezolid

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33
Q

linezolid is bacteriostatic against what? (2)

A

staph aureus
enterococcus

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34
Q

linezolid is bactericidal against what? why?

A

strep pneumo
strep is not as resistant (it’s stupid)

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35
Q

between strep and staph, which is more resistant?

A

staph

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36
Q

smallest amount of antibiotic needed to inhibit the growth of bacteria

A

minimal inhibitory concentration

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37
Q

which 2 antibiotic classes are concentration-dependent killing?

A

aminoglycosides
fluoroquinolones

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38
Q

which 4 antibiotic classes are time-dependent killing?

A

“Bedtime Varies, Morning Comes”

Beta-lactams
Vancomycin
Macrolides
Clindamycin

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39
Q

how should a concentration-dependent killing antibiotic be administered?

A

dose once a day

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40
Q

how should a time-dependent killing antibiotic be administered?

A

dose more frequently so concentration is always above the MIC

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41
Q

since gram + bacteria has a huge cell wall that covers the penicillin binding protein, what kinds of antibiotics are important to use?

A

cell wall inhibitors

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42
Q

why don’t gram - bacteria respond well to beta lactams?

A

because gram - bacteria contain a beta-lactamase that destroys beta lactam rings

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43
Q

which 2 drug classes bind to penicillin-binding proteins on the cell membrane to inhibit the last step of cell wall synthesis and weakens the cell wall?

A

penicillins
cephalosporins

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44
Q

narrow spectrum PCN used to treat staph and strep

A

penicillin-v

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45
Q

broad spectrum PCNs used to treat gram +, gram -, and gram - anaerobes (2)

A

amoxicillin
ampicillin

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46
Q

what do all bacterial cell wall inhibitors in beta lactam category contain?

A

beta lactam ring structure

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47
Q

what is a beta lactam ring structure essential for?

A

bactericidal activity

48
Q

how does staph produce beta-lactamases (penicillinase); AKA enzymes for resistance?

A

via altered penicillin-binding-proteins

49
Q

where are penicillins distributed to?

A

most body fluids (bile, serum, synovial fluid)

50
Q

where do penicillins have poor penetration? (2)

A

bone
cerebrospinal fluid (unless inflamed meninges)

51
Q

how are penicillins elminated?

A

renal elimination

52
Q

since penicillins have a high TI, which patients can actually receive it? (2)

A

pregnancy
lactating

53
Q

what are the 4 main ADR of penicillins?

A

Neurotoxic
Abdominal pain
Skin rash/Seizure
Throat closure
Yacking (vomitting)
Diarrhea (C. difficile)

54
Q

what kind of penicillins cause concern for C. difficile (super-infection)?

A

broad spectrum penicillins

55
Q

when does neurotoxicity occur in penicillins? (2)

A

high dose
intrathecal administration (CSF)

56
Q

which penicillin has a high risk of interstitial nephritis?

A

methicillin

57
Q

what should be avoided in patients with history of severe allergies to PCNs? why?

A

all beta-lactam antibiotics with a R-side chain

body forms IgE to penicillic acid (reactive metabolite)

58
Q

which PCN has poor oral absorption because it is acid-labile?

A

PCN G

59
Q

which PCN has good oral absorption because it is stable in gastric acid?

A

PCN V

60
Q

what characteristics make PCN a broad spectrum? (2)

A

increased water solubility
increased membrane penetration

61
Q

which amino-penicillin has a better bioavailability?

A

amoxicillin

62
Q

what is the amoxicillin used as first line treatment for?

A

sub-acute bacterial endocarditis prophylaxis

63
Q

what PCN is the only one still used for pseudomonas aeruginosa? what is the administration route?

A

piperacillin

IV

64
Q

what is the main characteristic of anti-staph penicillins?

A

stable against beta-lactamase

65
Q

what are the 3 PCNs that are combined with a beta-lactamase inhibitor?

A

amoxicillin/clavulanic acid (augmentin)
ampicillin/sulbactam (unasyn)
piperacillin/tazobactam (zosyn)

66
Q

which PCN + beta-lactamse inhibitor combo has better bone penetration?

A

piperacillin/tazobactam (zosyn)

67
Q

what is the use for PCN combined with B-lactamase inhibitor? (3)

A

severe intra-abdominal infections
severe soft tissue infections
anaerobes

68
Q

what are the 1st generation Cephalosporins?
what do they treat?

A

cephalexin
cefazolin

MSSA (staph)
strep

69
Q

which cephalosporin is a good alternative in questionable or mild PCN allergies (rash)?

A

1st gen cefazolin

70
Q

which generation cephalosporins are used for anaerobes and gram -?

A

2nd generation (cefotetan + cefoxitin)

71
Q

2nd generation Cephalosporins (cefotetan + cefoxitin) are first line prophylactic treatment for …..

A

intra-abdominal surgery prophylaxis

72
Q

which is the only approved “anti-MRSA” cephalosporin in the US?

A

ceftaroline

73
Q

what specific organisms is ceftaroline used for?

A

MRSA
PRSP (penicillin-resistant staph pneumo)

74
Q

which cephalosporine generation/drug has good gram + and gram - coverage?

A

4th generation
cefepime

75
Q

what are the 2 uses of 4th gen cephalosporin cefepime?

A

anti-pseudomonal
critically ill patients

76
Q

which organism cannot be covered with any cephalosporin?

A

enterococcus

77
Q

how are cephalosporins excreted?

A

kidney

78
Q

what are 3 ADR of cephalosporins?

A

GI
hypersensitivity
super-infection

79
Q

which cephalosporin generations have a cross-reactivity with penicillins?

A

1st gen
2nd gen

80
Q

a patient taking a cephalosporin begins to experience N/V, flushing, tachycardia, headache, and sweating. what is this reaction called and what likely caused it?

A

disulfiram-like reaction
alcohol use

81
Q

a patient taking a cephalosporin presents with bleeding. what caused this? what generation cephalosporin could they be taking?

A

inhibited vitamin K carboxylase = low clotting factors
2nd/3rd generation

82
Q

which medication interacts with some 2nd and 3rd generation cephalosporins? what can the use of both together lead to?

A

warfarin
bleeding

83
Q

a patient is taking a penicillin and presents with hypoprothrombinemia. what could they be taking?

A

piperacillin + CPH

84
Q

which cell wall inhibitor is promoted as “non-nephrotoxic replacement for AMG”?

A

aztreonam

85
Q

what does Aztreonam cover? (2)

A

gram -
pseudomonas

86
Q

a patient presents with a severe gram - infection but is allergic to PCN, CPH, and carbapenems. what can they receive as treatment?

A

aztreonam (cell wall inhibitor)

87
Q

how is aztreonam excreted?

A

renal tubules (kidney)

88
Q

which class does aztreonam have cross resistance with?
especially with which drug?

A

3rd + 4th gen cephalosporins
ceftazidime

89
Q

-penem

A

carbapenems (cell wall inhibitors)

90
Q

how are carbapenems excreted?

A

kidney

91
Q

why does imipenem need to be combined with cilastatin?

A

cilostatin inhibits dehydropeptidase that causes nephrotoxicity

92
Q

what is an ADR of imipenem?

A

seizure

93
Q

which medication do carbapenems decrease, specifically imipenem?

A

valproic acid for seizures

94
Q

which carbapenem has the narrowest spectrum and long half life?

A

ertapenem

95
Q

why are carbapenems considered the atomic bomb of antibiotics?

A

they have the broadest spectrum of all beta-lactams

96
Q

how do carbapenems work against carbapenemase?

A

add a beta-lactamase inhibitor

97
Q

which gram + bacteria is not covered by Carbapenems?

A

enterococcus

98
Q

which beta-lactams are good for serious gram - infections and meningitis? (3)

A

broader spectrum PCN
3rd gen CPH
4th gen CPH

99
Q

what do many use cefazolin for? and why?

A

surgical prophylaxis

least irritating for IM + good bone penetration

100
Q

what are carbapenemas restricted for?

A

severe infections in hospital

101
Q

name the 2 glycopeptides and their MOA

A

vancomycin
telavancin

inhibits late step of cell wall synthesis

102
Q

what are the uses for vancomycin (glycopeptide)? (2)

A

gram +
c. difficile

103
Q

how is vancomycin excreted?

A

kidney

104
Q

what are 5 ADR to remember for vancomycin?

A

Nepthrotoxicity
Ototoxicity
Red man syndrome
Tissue necrosis if IM
corn protein allergy

105
Q

when can vancomycin cause nephrotoxicity and ototoxicity?

A

when used with AMG

106
Q

how does vancomycin cause red man syndrome?

A

releases histamine based on infusion rate

107
Q

a glycopeptide that has large nephrotoxicity, interferes with coag test, not recommending in pregnancy, increased QT interval, and interacts with fluoroquinolones, macrolides, and antipsychotics

A

telavancin

108
Q

polypeptides that inhibit cell wall synthesis (2)

A

fosfomycin
bacitracin

109
Q

which polypeptide works for gram + and gram -, and is used for UTI?

A

fosfomycin

110
Q

what is the dosing for fosfomycin? why?

A

once daily

high TI

111
Q

what are the ADR of fosfomycin?

A

GI
headache

112
Q

which polypeptide works for gram + only and is used for eye and skin infections via topical?

A

bacitracin

113
Q

why isn’t bacitracin used systemically?

A

causes renal necrosis

114
Q

cell membrane destabilizer that is bactericidal and narrow for gram + only

A

daptomycin

115
Q

what is the use for daptomycin?

A

vancomycin-resistant organisms

116
Q

what are 3 ADR of daptomycin?

A

myopathy
rhabdo
eosinophilic pneumonia

117
Q

if a patient is taking a statin, which antibiotic could cause myopathy and rhabdo?

A

daptomycin

Pharmacology 2 (22 decks)

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