Antibiotics I & II Review Flashcards
(100 cards)
1
Q
- fungal overgrowth
- most common type of superinfection
- continue administration of antibacterial agent
- treat w/ antifungal , ex: oral nystatin for GI
A
intestinal candidiasis
2
Q
- life threatening
- discontinue admin of antibacterial agent
- treat w/ oral vancomycin (not absorbed, treats locally)
A
staphylococcal enterocolitis
3
Q
- life threatening, caused by c/ difficile
- discontinue admin of antibacterial
- treat w/ oral metronidazole (or vancomycin)
- often caused by clindamycin
A
pseudomembranous colitis
4
Q
-aminoglycosides, vancomycin, minocycline cause what organ directed toxicity?
A
ototoxicity
5
Q
chloramphenicol and sulfonamides cause what organ directed toxicity?
A
hematopoietic
6
Q
tetracyclines, macrolides, isoniazid, sulfonamides, and ampho B cause what organ directed toxicity?
A
hepatotoxicity
7
Q
aminoglycosides, vancomycin, ampho B, cephalosporins, and sulfonamides cause what organ directed toxicity?
A
renal
8
Q
primaquine, sulfonamides, and nitrofurantoin cause what idiosyncratic response?
A
hemolytic anemia (in G6PDH deficiency)
9
Q
tetracyclines, sulfonamides, and fluoroquinolones cause what idiosyncratic response?
A
photosensitivity
10
Q
sulfonamides can cause what hypersensitivity reaction?
A
stevens johnson
11
Q
beta lactams and vanocmycin blocks enzymatic steps in the _______ space, and other ICWs (fosfomycin, cycloserine) act at _______ sites
A
periplasmic
intracellular
12
Q
penicillins primarily useful against gram positive microbes?
A
pen G, pen V
13
Q
nafcillin, methcillin, oxacillin, dicloxacillin are __________ penicillincs
A
anti-staph
14
Q
ampicillin, amoxacillin, piperacillin, ticarcillin are extended spectrum penicillins with increased ________ activity
A
gram negative
15
Q
antipseudomonal penicillins effective against proteus and pseudomonas? use in combo with aminoglycoside
A
piperacillin, ticarcillin
16
Q
beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases, bactericidal
A
cephalosporins
17
Q
cefazolin and cephalexin are ____ generation cephalosporins
A
1st
18
Q
- good activity against gram positive and modest gram negative
- treat staph and strep cellulitis
- DOC for surgical prophylaxis
A
cefazolin (1st gen)
19
Q
cefaclor, cefoxitin, cefuroxime, cefotetan are _____ generation cephs
A
2nd (fur ox with two fac tets)
20
Q
- increased activity against gram negative bacteria (Ecoli, Kelbsiella, Proteus, haemophilus, moraxella catarrhalis)
- PID, diverticulitis, surgical prophylaxis for abdominal, bronchitis
A
uses for 2nd gen cephalosporins (cefaclor, cefoxitin, cefuroxime, cefotetan)
21
Q
-ceftriaxone, cefotaxime, ceftazidime, cefpodoxime are ______ generation cephs
A
3rd
22
Q
- decreased gram (+) but increased gram negative (enterobacter, serratia)
- pseudomonas activity
- meningitis
- CAP, lyme disease, osteomyelitis, gonorrhea
- penetrate CNS, so many useful in meningitis
A
3rd gen cephalosporin use
23
Q
cefipime a ____ generation cephalosporin
A
4th
24
Q
- extensive gram positive and gram neg activity
- increased resistance to beta lactamases
- reserve for situations such as neutropenic fever
A
4th gen ceph (cefepime)
25
- MRSA activity, gram negs except pseduomonas
| - approved for cSSSIs and CAP
5th gen cephalosporin (ceftaroline)
26
- monobactam, only gram negative activity
- no anaerobe activity
- for pseudomonas use w/ an aminoglycoside
- beta lactamase resistant
- no cross reactivity to penicillin allergies
aztreonam
27
- broad spectrum: gram (+), (=), and anaerobes
- beta lactamase resistant
- inactivated by renal dipeptidase (co admin cilastatin)
- cross sensitivity w/ penicillin allergies
- pseduomonas resistance rapid, so use w/ aminoglycosides
carbapenems: imipenem, meropenem, doripenem, ertapenem
28
vancomycin inhibits _________ by binding to D-ala D-ala terminus of petidoglycan monomer
transglycosylation
29
vancomycin bactericidal for _______ bacteria
gram positive
30
vancomycin used systemically for ______
MRSA
31
vancomycin enhances oto and nephro toxicity of ________
aminoglycosides
32
- used for infections caused by gram positive, penicillin resistant organisms
- s. aureus, MRSSA, enterococci, C diff alternative treatment
vancomycin
33
- newer ICWS, gram positive and negative activity
- inhibits cytoplasmic step in cell wall precursor synthesis
- actively transported by G6P transporter into bacteria
- approved for single dose therapy of UTI
- actively excreted by kidney
fosfomycin
34
- topical antibiotic only, for gram (+) organisms
| - markedly nephrotoxic
bacitracin
35
-inhibit dihydrofolate synthesis, bacteriostatic (-cidal when combined with trimethoprim)
sulfonamides (sulfamethoxazole, sulfadizaine)
36
- inhibits dihydrofolate reductase, bacteriostatic
| - combo for UTIs, shigella, salmonella, pneumocystis, toxoplasmosis
trimethoprim, pyrimethamine (protozoa), methotrexate (mammalian)
37
-inhibit prokaryotic enzymes topoisomerase II, bactericidal
fluoroquinolones
38
- prototype quinolone
| - oral, rapidly glucoronidated and actively excreted in urine
nalidixic acid
39
all fluoroquinolones have what suffix?
-floxacin
40
- actively excreted in urine, blocked by probenicid
| - treat gram (-) rods of urinary and GI tracts, some gram (+), otitis externa
fluoroquinolones
41
-excellent activity against many gram (-) bacteria (gonococcus, psuudomonas, mycobacteria, chlamydia)
2nd gen fluoroquinolones (cipro, ofloxacin)
42
- 3rd gen fluoroquinolone, given 2X daily
| - greater gram (+) activity (strp pneumo, enterococci, MRSA), resp infections)
levofloxacin
43
-broadest spectrum fluoroquinolones, respiratory
4th gen (moxifloxacin, gemifloxacin)
44
- chronic infections with long dormant periods separating intermittent active periods
- intracellular pathogens
- requires constant prolonged treatment with multiple drugs
tuberculosis and leprosy
45
_______ favored over rifampin for HIV patients on HAART cocktails b/c of less DDIs
rifabutin
46
- may involve oxidative stress, urinary tract antiseptic
- excreted in urine 50% as active drug
- treats UTI, gram positive or negative, most effective at acidic urine pH
- adverse: headaches, anorexia, GI, hemolytic anemia if G6PDH deficient
- pseudomonas and proteus resistant
nitrofurantoin
47
- alter permeability and damage bacterial cytoplasmic membrane, leakage
- gram (-) only
- topically
- systemically as last resort for pseudomonas
- nephrotoxic
polymixins (colistin, polymixin E, polymixin B)
48
- binds cell membrane of susceptible organisms, causes rapid depolarization
- gram (+) only
- IV
- treats complicated skin infections
- used for vancomycin resistant bacteria
daptomycin
49
- binds bacterial isoleucyl transferase RNA synthetase, inhibits protein synthesis
- topical: for impetigo caused by s aureus and s. pyogenes
- intranasal for MRSA
mupirocin
50
abx of choice for:
| H pylori
amoxicillin, clarithromycin, omerprazole
51
abx of choice for: listeria
ampicillin
52
abx of choice for: neisseria gonorrhea
ceftriaxone, cefexime
53
abx of choice for: H. influenza, klebsiella
3rd gen cephalosporins
54
abx of choice for: borrelia burgdorferi, Rickettsiae?
doxycycline
55
abx of choice for: legionella
erythromycin
56
abx of choice for: candida
fluconazole, miconazole, nystatin
57
abx of choice for: mycobacterium tuberculosis
isoniazid, rifampin, ethambutol, pyrazinamide
58
abx of choice for: mycoplasma pneumonia, legionella, corynebacterium diptheria, chlamydia
macrolides
59
abx of choice for: trichomonas, c diff
metronidazole
60
abx of choice for: treponema pallidum, bacillus anthracis, clostridium, bacteroides
penicillin G
61
abx of choice for: campylobacter, shigella
fluoroquinolones
62
abx of choice for: vibrio cholera
tetracycline
63
abx of choice for: salmonella, shigella
TMP-SMX
64
abx of choice for: C diff
metronidazole, vancomycin
65
prophylaxis for surgical procedures?
cefazolin
66
prophylaxis for surgery where anaerobe present?
cefoxitin, cefotetan
67
prophylaxis for GBS?
ampicillin, penicillin
68
prophylaxis for pneumocytsis, UTIs?
TMP-SMX
69
prophylaxis for h influenza, meningococcal infxn?
rifampin
70
prophylaxis for malaria?
chloroquine
71
prophylaxis for M. avium in AIDS?
azithromycin
72
prophylaxis for dental procedures?
amoxicillin, azithromycin, clindamycin
73
-aminoglycosides, tetracyclines, tigecycline and spectinomycin target the ______ ribosomal subunit
30S
74
chloramphenicol, macrolides, tilethromycin, linezolid, and quinupristin-dalfopristin target the _______ ribosomal subunit
50S
75
________ irreversibly inhibit the 30S subunit, making them bactericidal
aminoglycosides
76
- reversible binding to 30S subunit
- bacterostatic
- chelate metal ions, not absorbed so don't admin with food/milk/antacids
- concentrates in teeth, bone, liver, bile, kidney
- cross placenta and excreted in milk
tetracyclines
77
- mycoplasma, chlamydia, rickettsiae, H pylori
- prophylaxis for plasmodiium falciparum
- helpful for lyme disease
- ability to accumulate intracellulary
tetracyclines
78
- tetracycline analog
- used for CAP, skin and suture infections, intra abdominal infxn (MRSA, E. faecalis)
- FDA black box warning for mortality
tigecycline
79
- cause superinfections
- impaired liver functions
- photosensitization
- calcium chelation
adverse effects of tetracyclines
80
- impaired influx/increased efflux by active transport protein pump
- overuse has fostered emergence of resistance
tetracyclines
81
- reversible inhibitor of protein synthesis (50S subunit) , bacteriostatic
- CNS levels = serum levels
- glucoronidation in liver is rate limiting step for clearance
chloramphenicol
82
- adverse:
- anemia due to bone marrow depression, usually reversible
- aplastic anemia: irreversible and fatal
- gray baby syndrome: newborns are poor glucoronidators
- DDIs, inhibits enzymes
chloramphenicol
83
- powerful antibacterial limited by toxicity
- typhoid fever, RMSF
- alternate for bacterial meningitis, topical for eye infexns
chloramphenicol
84
- bacteriostatic or -cidal depending on dose
- 50S IPS
- acid labile - use enteric coat or ester
- CNS, crosses placenta
- excreted in bile, half life 2-5 hours except one drug
macrolides (erythryomycin, clarithromycin, azithromycin)
85
- GI distress
- cholestatic jaundice
- microsomal enzyme inhibition
- used for atypical pneumonia (mycoplasma, legionnaire's, chlamydia), back for penicillin sensitive patients
macrolides
86
-plasmid mediated resistance to staph, strep, pneumococci
macrolides
87
newer macrolide with less GI effects, given with ethambutal for m avium
clarithromycin
88
-macrolide with minimal P450 inteactions, tissue levels 100X plasma levels (half life 2-4 days), active against m. avium, shorter dosing period
azithromycin
89
- ketolide
- treatment of CAP
- may prolong QT interval
- hepatic failure, respiratory failure in myasthenia gravis
- DDIs CYP3A4
telithromycin
90
- lincosamide
- 50S IPS
- good for bacteroides fragilis
- with primaquine treats pneumocystis in AIDS
- with pyrimethamine for toxoplasmosis
- adverse: clostridium superinfections, hepatotoxicity
clindamycin
91
- significant CYP3A4 inhibitor
- complete cross resistance b/w two components
- no cross resistance with other IPS
- bacteriostatic against E faecium, cidal against others
- e. faecalis is resistant
- approved for vanco and MDR e. facium and MRSA
streptogramins (quinupristin, dalfopristin)
92
- binds 23S rRNA of 50S subunit
- no cross resistance with other IPS
- IV or oral
- for vanco resistant e faecium, MRSA
- adverse: bone marrow suppression, inhibits MAO
- serotonin syndrome
linezolid
93
gentamicin, streptomycin, tobramycin, amikacin, neomycin (topical)
aminoglycosides
94
- bactericidal, inactivate 30S subunit irreversibly
| - interfere w/ initiation, misread mRNA, break up polysomes
aminoglycosides
95
- IV, no significant host metabolism
- glomerular filtration, high concentrations in proximal tubules
- rapid resistance alone
- anaerobes resistant (oxygen dependent uptake)
aminoglycosides
96
- once daily dosing, removes factor of time maintaining concentration
- nephrotoxic: exacerbated in vanco, cephs, ampho B, cisplatin and other nephrotoxics
- ototoxicity
- neuromuscular blockade in MG, common during surgery
aminoglycosides
97
- use for infections with aerobic gram negatives
- ecoli, proteus, klebsiella, serratia, enterobacter
- cell wall inhibitors are synergistic
- treats pseduomonas in combo with penicillins
- tuberculosis
aminoglycoside uses
98
- postantibiotic effect
- useful for non resistant gram (-) infections
- use older first
aminoglycosides
99
order of use of aminoglycosides for pseudomonas?
gentamycin > tobramycin > amikacin
100
- related to aminoglycosides and tetracyclines (30S IPS)
| - useful against drug resistant gonococci and patients allergic to cephalosporins
spectinomycin
