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Pharmacology > Antimicrobial Review (extensive) > Flashcards

Antimicrobial Review (extensive) Flashcards

lmk if there are any errors

1
Q

What are the two main subdivisions of beta-lactam antibiotics

A

penicillins and cephalosporins

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2
Q

Name a benzylpenicillin

A

penicillin G

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3
Q

Name an aminopenicillin

A

ampicillin and amoxicillin

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4
Q

What is the spectrum of penicillin G

A

strep, anaerobes

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5
Q

What is the spectrum of aminopenicillins

A

gram neg aerobes in urine, strep, anaerobes

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6
Q

What is the spectrum of aminopenicillins with a beta-lactamase inhibitor

A

same as aminopenicillins (gram neg aerobes in urine, strep, anaerobes) plus methicillin susceptible staph and bacteroides

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7
Q

How is clavamox different from amoxicillin

A

it has a beta-lactamase inhibitor added (clavulonic acid)

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8
Q

How is unasyn different from ampicillin

A

it has a beta-lactamase inhibitor added (sulbactam)

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9
Q

Describe the pattern for the spectrum of cephalosporins

A

gram negative spectrum increases as generation number increases
gram positive spectrum may decrease as generation number increases (but 3rd just as good as 1st for gram +)
anaerobic spectrum variable

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10
Q

Name the first generation cephalosporins

A

cefazolin and cephalexin
(remember b/c a is 1st in the alphabet)

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11
Q

What is the spectrum of 1st generation cephalosporins

A

strep, methicillin susceptible staphs
cefazolin may get gram positive anaerobes and some gram negatives

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12
Q

Describe the use of 2nd generation cephalosporins

A

cefoxitin has very limited use in vetmed
may be used as surgical prophylaxis for severe dental/gingival dz (anaerobes)

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13
Q

What is the spectrum of 3rd generation cephalosporins

A

strep, methicillin susceptible staph (not ceftiofur), gram negative anaerobes (not ceftiofur), gram negatives at higher doses (cefpodoxime most active)

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14
Q

Name the third generation cephalosporins

A

ceftiofur, cefpodoxime proxetil, cefovecin

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15
Q

Summarize the spectrum of beta-lactam antibiotics

A

excellent for strep
cephalosporins better for staph (penicillins need BLI)
aminopenicillins (for UTI) and 3rd gen cephalosporins have best gram neg spectrum
penicillins and aminopenicillins have best anaerobic spectrum

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16
Q

What drugs are aminoglycosides

A

amikacin and gentamicin

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17
Q

What is the spectrum of aminoglycosides

A

gram neg, staph (use limited to MRS b/c of side effects), mainly used for severe gram neg aerobes
NO anaerobes and NO strep

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18
Q

In what environments do aminoglycosides become inactivated

A

purulent environments

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19
Q

What drugs are fluoroquinolones

A

enrofloxacin, marbofloxacin, orbifloxacin, pradofloxacin, ciprofloxacin

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20
Q

What is the risk with pradofloxacin use in dogs

A

bone marrow suppression, best to use a diff drug in the class

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21
Q

What is the risk with ciprofloxacin in horses

A

fatal colitis! do not use for horses!!

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22
Q

What is the spectrum of fluoroquinolones

A

gram neg, staph (save use for MRS), rarely gets strep, rickettsia, mycoplasma
NO anaerobes
very similar to aminoglycosides, but more active in purulent environments

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23
Q

What organ is at risk with aminoglycoside use

A

kidney toxicity

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24
Q

What tissue is at risk with fluoroquinolone use

A

cartilage

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25
Q

What drugs are tetracyclines

A

oxytetracycline, docycycline, minocycline

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26
Q

What is the spectrum of tetracyclines

A

gram positives, gram negatives, anaerobes, rickettsia
“jack of all trades…master of rickettsia”
lots of resistance out there. main use is for rickettsia

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27
Q

List the tetracyclines in order from most to least active

A

minocycline, doxycycline, oxytetracycline

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28
Q

What does it mean if a bacteria is susceptible to oxytetracycline

A

it is susceptible to all 3 tetracyclines

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29
Q

What does it mean if a bacteria is resistant to oxytetracycline

A

resistant to oxytet, but may be susceptible to the other 2 (minocycline and doxycycline)

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30
Q

What is the spectrum of potentiated sulfonamides

A

gram positives, gram negatives, and protozoa
“jack of all trades, master of none”
there is a lot of resistance so it doesn’t treat anything very well

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31
Q

What environments do potentiated sulfonamides not work well in

A

purulent

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32
Q

What do you need to keep in mind with susceptibility tests for sulfas

A

in vitro tests overestimate anaerobic activity, so don’t believe susceptibility tests on them

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33
Q

What drugs are macrolides

A

erythromycin, clarithromycin, azithromycin

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34
Q

What drugs are lincosamides

A

clindamycin

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35
Q

What species cannot have clindamycin and why?

A

horses and rabbits b/c lethal diarrhea

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36
Q

What is the spectrum of macrolides and lincosamides?

A

good for abscesses and intracellular bacteria
gram positive aerobes, anaerobes (clindamycin and sort of azithromycin, but macrolides rarely used for anaerobes)

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37
Q

What are macrolides commonly used for?

A

R.equi
azithromycin for small animal upper resp infections

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38
Q

What is the spectrum of phenicols

A

gram positive aerobes, anaerobes, some gram negatives, mycoplasma, rickettsia
good for abscesses and intracellular bacteria

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39
Q

Which drug classes are good for abscesses and intracellular bacteria

A

macrolides, lincosamides, phenicols

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40
Q

What drugs are nitroimidazoles

A

metronidazole

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41
Q

What is the spectrum of nitroimidazoles

A

anaerobes!!!
protozoa
do not work in the presence of oxygen

42
Q

What is the MOA of beta-lactams

A

cell wall inhibitors

43
Q

What is the MOA of fluoroquinolones

A

DNA gyrase inhibitors

44
Q

What is the MOA of potentiated sulfonamides

A

folic acid inhibitors

45
Q

What is the MOA of nitroimidazoles

A

DNA inhibitors via production of toxic metabolites

46
Q

What is the MOA of aminoglycosides

A

protein synthesis inhibitors 30S

47
Q

What is the MOA of tetracyclines

A

protein synthesis inhibitors 30S

48
Q

What is the MOA of macrolides

A

protein synthesis inhibitors 50S

49
Q

What is the MOA of lincosamides

A

protein synthesis inhibitors 50S

50
Q

What is the MOA of phenicols

A

protein synthesis inhibitors 50S

51
Q

Why do you have to be careful with procaine penicillin

A

it can cause seizures if any goes IV in horses

52
Q

Which benzylpenicillin can go IV

A

potassium penicillin, but slowly b/c K can affect the heart

53
Q

Which of the following penicillins are absorbed orally?
a. benzylpenicillins
b. clavamox
c. ampicillin

A

b and c in dogs and cats
(amoxicillin has better oral absorption than ampicillin)

54
Q

Describe the distribution, metabolism, and elimination of penicillins

A

hydrophilic, minimal metabolism, renal elimination

55
Q

Why are penicillins good for UTI

A

they are actively pumped into the urine, so there is a greater urine concentration than plasma concentration

56
Q

What does it mean if a drug has extensive metabolism

A

liver disease causes the drug to stick around longer and risks toxicity

57
Q

What does it mean if a drug is hydrophilic

A

it is confined to the plasma and extracellular fluid

58
Q

What does it mean if a drug has active metabolites

A

liver disease means the liver doesn’t make the metabolite well and the drug doesn’t work

59
Q

Which of the following cephalosporins are absorbed orally?
a. cefazolin
b. cephalexin
c. ceftiofur
d. cefovecin
e. cefpodoxime proxetil

A

b and e ( both in dogs and cats, but not horses)
cefpodoxime proxetil is absorbed orally in foals

60
Q

Describe the distribution, metabolism, and elimination of cephalosporins

A

hydrophilic, minimal metabolism (except ceftiofur is highly), renal elimination

61
Q

*Are beta-lactams time- or concentration-dependent? What does this mean for dosing?

A

time-dependent, so need concentrations greater than MIC for only a percentage of dosing interval
50% for immunocompetent patients with gram positive infections
redose more frequently with gram negatives or immunocompromised

62
Q

Which of the following aminoglycosides can be absorbed orally?
a. amikacin
b. gentamicin

A

no oral absorption! sometimes used for “local” tx of GIT

63
Q

Describe the distribution, metabolism, and elimination of aminoglycosides

A

hydrophilic, minimal metabolism, renal elimination
reabsorbed by kidneys, so if worried about an overdose, put on fluids to reduce the time the drug is able to be reabsorbed

64
Q

*Are aminoglycosides concentration dependent or time dependent? What effect does this have on dosing?

A

concentration dependent
dose once per day to prevent nephrotoxicity associated with trough concentrations greater than 2 micrograms/mL

65
Q

Which of the following drug classes are bactericidal and which are static?
a. aminoglycosides
b. beta-lactams
c. sulfonamides alone
d. potentiated sulfonamides
e. tetracyclines
f. fluoroquinolones
g. macrolides
h. lincosamides
i. nitroimidazoles
j. phenicols

A

cidal - a, b, d, f, i
static - c, e, g, h, j

66
Q

What is the rule for MOA related to static vs cidal

A

all protein synthesis inhibitors (except for aminoglycosides) are static
all cell wall synthesis inhibitors and nucleic acid inhibitors are cidal

67
Q

Which of the following fluoroquinolones are absorbed orally?
a. ciprofloxacin
b. enrofloxacin
c. pradofloxacin

A

a (dogs only), b, and c (decreased by food)

68
Q

Describe the distribution, metabolism, and elimination of fluoroquinolones

A

lipophilic (esp enro) so suitable for CNS/prostate and gets intracellular, enro is metabolized to cipro, mostly renal elimination, enro has partial biliary elmination, *exception is prado has mostly hepatic elimination and only partially renal

69
Q

How do renal/hepatic disease affect elimination of fluoroquinolones

A

with renal dz, liver elimination increases
with liver dz, renal elimination increases
therefore you do not need to alter the dose

70
Q

*Are fluoroquinolones time or concentration dependent? What does this mean for dosing

A

concentration dependent, but dose based on AUC (which looks at concentration over time)
typically increase dose to improve efficacy but can decrease dose interval
*some people do 1/2 dose BID. don’t do that

71
Q

Which of the following tetracyclines are absorbed orally?
a. doxycycline
b. minocycline
c. oxytetracycline

A

a and b (both good in dogs and cats, ok in horses)

72
Q

Describe the distribution, metabolism, and elimination of tetracyclines

A

well distributed, intracellular, doxy is most lipophilic but highest protein binding so limited access to protected sites, minocycline best for protected sites, no active metabolites, minocycline mostly hepatic elimination, doxycycline renal and hepatic elimination, oxytet mostly renal elimination

73
Q

Describe the distribution, metabolism, and elimination of potentiated sulfonamides

A

moderately lipophilic, highly metabolized by liver, mainly renal but some hepatic elimination

74
Q

Are potentiated sulfonamides absorbed orally?

A

yes

75
Q

Describe the distribution, metabolism, and elimination of macrolides

A

WIDE distribution, INTRACELLULAR, gets to protected sites but pumped out of cerebrospinal fluid, enter abscesses, extensive hepatic metabolism, mainly hepatic elimination

76
Q

Are macrolides absorbed orally?

A

yes

77
Q

Are lincosamides absorbed orally?

A

good for dogs and cats, but not horses (fatal diarrhea)

78
Q

Describe the distribution, metabolism, and elimination of lincosamides

A

WIDE distribution, intracellular, not cerebrospinal fluid, extensive hepatic metabolism (so not for UTI)

79
Q

Describe the distribution, metabolism, and elimination of chloramphenicol

A

WIDELY distributed, intracellular, readily enters protected sites, extensive hepatic metabolism, inhibits hepatic metabolism of other drugs, eliminated by metabolism but parent drug leftover excreted renally

80
Q

Is chloramphenicol absorbed orally

A

moderate oral absorption

81
Q

Describe the distribution, metabolism, and elimination of nitroimidazoles

A

WIDELY distributed, enters protected sites, extensive hepatic metabolism, mainly hepatic elimination (so not for UTI)

82
Q

are nitroimidazoles absorbed orally

A

yes

83
Q

which drugs classes DO NOT have oral absorption in dogs, cats, and horses

A

benzylpenicillins and aminoglycosides for all 3 species
horses - aminopenicillins, cephalosporins, macrolides (except foals), lincosamides

84
Q

*which drug classes are hydrophilic and what does this mean clinically

A

penicillins, cephalosporins, aminoglycosides
cannot be used for protected sites

85
Q

what adverse drug reactions are seen with penicillins

A

rare ADRs; hypersensitivity, neurologic at high doses, procaine reaction in horses, GI signs

86
Q

what adverse drug reactions are seen with cephalosporins

A

rare ADRs; hypersensitivity, GI signs, reversible anemia and thrombocytopenia, bleeding disorders

87
Q

what is the most important adverse drug reactions are seen with aminoglycosides? how can the risk be decreased

A

dose dependent nephrotoxicity.
risk greatly decreased with q24hr dosing, administration of calcium is protective, and fluid administration will decrease absorption

88
Q

what are all the adverse drug reactions are seen with aminoglycosides

A

renal toxicity, ototoxicity (avoid topical use if eardrum ruptured), deafness in horses, vestibular toxicity, neuromuscular blockade with botulism

89
Q

what adverse drug reactions are seen with fluoroquinolones

A

cartilage toxicity (puppies and foals most susceptible), ocular toxicity in cats (enro esp), pradofloxacin causes bone marrow suppression/maybe arrhythmias in dogs

90
Q

what increases risk of cartilage toxicity with fluoroquinolones

A

more risk when younger, but at risk until bones are mature
more risk when heavier, more active, and more doses received

91
Q

*how can risk of ocular toxicity with enrofloxacin be minimized in cats

A

stay below the maximum 5 mg/kg dose and keep the lights off

92
Q

what adverse drug reactions are seen with tetracyclines

A

nephrotoxicity (oxytet only), idiosyncratic hepatotoxicity, esophageal ulcer/stricture in cats (doxy), rapid IV admin causes hypotension and collapse, skeletal effects, hypersensitivity and fevers in cats, photosensitization

93
Q

what tetracycline cannot be given IV in horses

A

doxycycline IV in horses is fatal!

94
Q

what species is most susceptible to ADRs from potentiated sulfonamides and why

A

dogs b/c they are deficient in acetylation and instead make a toxic metabolite

95
Q

what adverse drug reactions are seen with potentiated sulfonamides

A

hypersensitivity esp in rotties and dobermans, idiosyncratic allergic/immune reactions in other breeds, hepatopathy and thrombocytopenia, rare dermatological emergencies, KCS w/ prolonged admin, “hypothyroid”, rare bone marrow suppression

96
Q

what adverse drug reactions are seen with macrolides

A

GI in small animals, fatal diarrhea in adult horses, may decrease metabolism of some drugs (erythromycin), potentially fatal anhidrosis in foals (esp erythromycin)

97
Q

what adverse drug reactions are seen with lincosamides

A

fatal diarrhea in horses and rabbits (DO NOT USE IN THEM), C. diff colitis, anorexia, vomiting, pain at inj site, esophageal ulcers in cats

98
Q

what adverse drug reactions are seen with chloramphenicol

A

dose-dependent reversible anemia/neutropenia in cats with >60mg/kg/day, rare aplastic anemia/neutropenia in dogs, idiosyncratic aplastic anemia in people

99
Q

what adverse drug reactions are seen with florfenicol

A

dry eye with long-acting otic preparations (not used systemically in dog, cat, or horse)

100
Q

what adverse drug reactions are seen with nitroimidazoles

A

reversible neurotoxicity

101
Q

which drug classes have a large volume of distribution

A

macrolides, phenicols, fluoroquinolones (esp enro), lincosamides (esp clinda), metronidazole
*macrolides and lincosamides not great for CNS b/c pumped out

Pharmacology (5 decks)

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