Antimicrobial Review - Schoenwald Flashcards
(174 cards)
1
Q
What are the 4 class of beta lactams?
A
- Penicillins
- Extended spectrum penicillins
- Cephalosporins
- Carbapenems
2
Q
What are examples of natural PCN?
A
Penicillin G or Penicillin VK
Benzathine Penicillin
3
Q
Whats the formulation of penicillin G?
A
IV or IM
4
Q
Whats the formulation for penicillin VK?
A
PO
5
Q
Whats the formulation for Benzathine penicillin?
A
long-acting IM
6
Q
If a patient has strep throat what is the abx?
A
Penicillin G or Penicillin VK
7
Q
If a pt has cellulitis, what is the abx?
A
Penicillin G or Penicillin VK
8
Q
Pt has syphilis, what is the abx you choose?
A
Benzathine Penicillin
9
Q
What are the two abx under Aminopenicillins?
A
Ampicillin or amoxicillin
10
Q
Which aminopenicillins is IV?
A
Ampicillin
11
Q
Which aminopenicillin is PO
A
Amoxicillin
12
Q
What does aminopenicillin cover?
A
Strep pyogenes
Strep agalactaie
Strep pneumonia
Enterococci
Borrelia burgdorferi
Listeria
13
Q
Pt comes with Pharyngitis
A
Ampicillin or amoxicillin
14
Q
Pt comes with sinusitis
A
Ampicillin or amoxicillin
15
Q
Pt comes with OM
A
Ampicillin or amoxicillin
16
Q
Pt comes with endocarditis ppx
A
Ampicillin or amoxicillin
17
Q
Pt with who is younger than 8 y.o for lyme disease
A
Ampicillin or amoxicillin
18
Q
Which two abx are Anti-Staphylococcal Penicillins?
A
- Nafcillin
- Dicloxacilin
19
Q
whats the formulation of nafcillin?
A
IV
20
Q
Whats the formulation for Dicloxacillin?
A
PO
21
Q
What type of infection is Anti-Staphylococcal Penicillins best for?
A
Skin and soft tissue infections with suspected Staph but works against Strep as well
22
Q
What are the Augmented Aminopenicillins?
A
- Ampicillin/sulbactim
- Amoxicillin/clavulanate
23
Q
What’s the formulation for Ampicillin/sulbactim?
A
IV
24
Q
Whats the formulation for Amoxicillin/clavulanate?
A
PO
25
What does augmenting the PCN do?
Protects the drug from beta-lactams
26
What does PCN cover?
Same as aminopenicillins plus
- Pasteurella (dog/cat bites)
- Moraxella
- Haemophilus influenza
27
What are the common augmented PCN treatments?
- Bites
- Otitis media
- Sinusitis
- Acute exacerbation of chronic bronchitis
- Dental infections
- Skin and soft tissue infections
28
What is the augmented extended-spectrum PCN?
Piperacillin/tazobactam (Zosyn)
29
What's the pip/tazo formulation?
IV
30
Whats the coverage for pip/tazo?
Broad spectrum + pseudomonas
31
Whats the MOA of PCN?
Stops cell wall synthesis by binding penicillin binding protein
32
What is the MOR (Mechanism of resistance) for PCN?
Bacteria is developing B lactamases and PBP alterations
33
What kind of ADR do you see with PCN?
Hypersensitivity rxn
34
What's the ADR with clavulanate?
- Diarrhea
- Hepatoxicity
35
Does gram + coverage increase of decrease with cephalosporin generation?
Decreases and gram - increases
36
How many generation of cephalosporins are there?
4 generation and next generation
37
Which cephalosporins has broad coverage and MRSA?
Ceftraoline
38
Whats the MOA for cephalosporins?
Stops cell wall synthesis by binding penicillin binding protein
39
Whats the MOR for cephalosporins?
Beta lactamases
40
What's ADR for ceftriaxone?
biliary sludging/pseudocholelithiasis
41
Name 1st fen cephalosporins
- Cefazolin
- Cephalexin
42
What the coverage for 1st gen cephalosporins?
- Excellent gram +
- NO MRSA
- Low gram - coverage
43
Bacteria coverage for 1st gen cephalosporins?
- Strep pyogenes, MSSA
- Some E coli, Klebsiella, Proteus
44
What are common treatment indication for 1st gen cephalosporins?
- Skin and soft tissue infections
- Strep pharyngitis
- Pre op prophylaxis (cefazolin)
- Uncomplicated cystitis
45
What are the 2nd generation cephalosporins?
Cefuroxime
46
What does cefuroxime cover?
Covers same as 1st generation plus
Strep pneumonia
Moraxella catarrhalis
Haemophilus influenza (respiratory)
47
when would you use cefuroxime?
- Otitis media
- Sinusitis
- Acute exacerbations of chronic bronchitis
- Skin and soft tissue infections
48
What are the 3rd generation cephalosporins?
Ceftriaxone and cefdinir
49
What are the coverage for 3rd generation?
Gram - and some gram +
50
T/F Ceftriaxone does not cross the BBB
False, it does cross BBB
51
What are the common indications for 3rd generation?
- Community acquired pneumonia
- Meningitis
- Gonorrhea (with Azithromycin)
- Pyelonephritis
52
What is the 4th generation cephalosporins?
Cefepime
53
What does cefepime cover?
- Gram - rods
- More resistant gram negative than pseudomonas
54
Whats the 5th generation cephalosporins?
Ceftraoline
55
What does ceftaroline cover?
Very gram - and gram +
MRSA COVERAGE
56
Whats are the indication for Ceftraoline?
- Pneumonia
- Skin and soft tissue infxn
57
What are the IV formulation for cephalosporins?
- Cefazolin
- Ceftriaxone (IM too)
- Cefepime
- Ceftaroline
58
What are the different carbapenems?
- Meropenem
- Imipenem
- Ertapenem
- Doripenem
59
Whats the formulation of carbapenems?
IV
60
Whats the coverage of carbapenems?
Excellent gram negative coverage, some gram positive coverage
61
Whats the MOA for doripenem?
Bind to penicillin binding proteins
62
Whats the MOR for Doripenem?
Alteration in PBP protein, efflux pump, and carbapenamase production by bacteria
63
When is carbapenems used for?
More resistant bacteria
- ESBL
- Pseudomonas
64
What is one carbapenem that doesn't cover pseudomonas?
Ertapenem
65
Whats the ADR for carbapenems?
Seizures and nephrotoxicity
66
What are the common treatment indications for carbapenems?
- Ventilator associated pneumonia
- Resistant complicated UTI
- Nosocomial infections
67
What are different tetracyclines?
Tetracycline, minocycline, doxycycline (PO,IV)
68
Whats the MOA for tetracycline?
protein synthsis inhibition at 30 S bacterial ribosome
69
MOR for tetracycline?
Efflux pump
70
Is tetracycline bacterocidal or static?
Bacteriostatic
71
Whats the ADR for tetracyclines?
Photosensitivity
Contraindicated in pregnancy/kids <8 years of age
72
What are the common indications for tetracycline?
- Sinusitis
- Acute Exacerbations of chronic bronchitis
- Community acquired pneumonia
- Non gonococcal urethritis/cervicitis
- TICK BORNE disease (Lyme, Rickettsia)
73
What other meds should you not add tetracycline with and why?
Isotretinoin causes pseudotumor cerebri
74
What supplement should you be careful with when taking tetracycline?
- Calcium bc decreases absorption
- They can have dietary supplements but have to wait for few hours
75
What are the different macrolide?
Azithromycin, clarithromycin and erythromycin
76
What bugs do macrolides cover?
Strep pneumo, Strep pyogenes, Moraxella catarrhalis, H influenza, Chlamydia, Mycoplasma, H pylori, and pertussis
77
Whats the MOA of macrolide?
protein synthesis inhibition at 50S ribosome
78
Whats the MOR for macrolide?
ribosomal changes and efflux pump
79
Whats the pharmacology of macrolides?
Bacteriostatic
80
Whats the safety concerns for macrolide?
- Clarithromycin potent CYPA4 inhibiter-monitor warfarin
- QTC prolongation> azithromycin has new black box warning
81
Which Macrolide causes N/V & Diarrhea
Erythromycin
82
What macrolide causes metallic taste?
Clarithromycin
83
Common indications for Macrolides
Pharyngitis (typically given with another agent bc resistance)
Otitis media
Community acquired pneumonia/atypical pneumonia(Mycoplasma)
Whooping cough-pertussis
Urethritis and cervicitis
H pylori
84
Whats example of lincosamide?
Clindamycin
85
What does clindamycin cover?
Anaerobes (above diaphragm (dental, lung infection)), Staph aureus and Strep pyogenes in PCN allergic patients
86
Whats the MOA of lincosamides?
protein synthesis inhibition at 50 S ribosome
87
Whats the MOR of lincosamides?
Ribosomal modification
88
Whats the pharmacology of lincosamides?
Bacteriostatic
89
Whats the ADR for lincosamides?
- Diarrhea/Nausea
- C.diff
90
Whats the common indication treatment for clindamycin?
- Substitute If PCN allergy for soft skin tissue infection and strep pharyngitis
- Anaerobic infxn/abscess
- Dental infxn
91
What are the best FQ for non-respiratory?
Ciprofloxacin
92
T/F FQ do not cover pseudomonas
False, it does and mostly gram - coverage
93
When is FQ treatment indicated for non-respiratory?
- Complicated UTI (pyelonephritis, prostatitis)
- Enteric infections/traveler’s diarrhea
- Diverticulitis (plus metronidazole
94
When is FQ treatment indicated for respiratory?
- CAP
- Pelvic infxn
95
What are the ADRs for FQ
- Arthropathy
- “Contraindicated” in kids < 18
- Tendinopathy (acute Achilles tendon rupture)
- More common in elderly & pts on steroids
- CNS toxicity
- Photosensitivity
- QT prolongation
- Dysglycemia
- Neuropathy
96
What are the sulfonamide abx?
TMP/SMX aka Bactrim
97
What does TMP/SMX cover
- Gram neg and positive
- MRSA
- E coli, Klebsiella, Proteus, MRSA
- Pneumocystis jiroveci
- H influenza, Moraxella catarrhalis
98
Whats the MOA for sulfonamides?
Inhibition of folate synthesis
99
Whats the MOR for sulfonamides?
Alteration in folate synthesis, decreased binding sites
100
Whats the sulfonamides pharmacology?
- Inhibit CYP2C9-INCREASE INR in warfarin therapy
- Retention of potassium
- Renal excretion – Renally dose
- Bacteriostatic
101
Whats the ADR for sulfonamindes?
- Hypersensitivity rxn
- Myelosuppression
- Hemolytic anemia in G6PD deficiency
102
Whats the common treatment indications for sulfonamindes?
- PCP pneumonia and prophylaxis
- UTI – Uncomplicated ones
- MRSA skin and soft tissue infections
103
What are the two nitroimdazoles?
Metronidazole
Tinidazole
104
Which nitroimdazole is IV?
Metronidazole
105
What does nitroimdazole cover?
anaerobes below the diaphragm, protozoa (giardia etc
106
Whats the MOA for nitroimdazoles?
DNA damage
107
Whats the MOR for Nitroimdazole?
Unknown
108
Whats the pharmacology for nitroimdazole?
- Hepatic
- Bacteriocidal
109
What are the ADR for nitroimdazole?
- Metallic taste
- Disulfram rxn (use w/ alcohol)
- Facial flushing
- Tachycardia
- N/V
- Diarrhea
- Fetotoxic in 1st trimester
110
Whats the common indications for nitroimdazoles?
Anaerobes
Bacterial vaginosis, C diff (not rlly), giardia and trichomoniasis, abdominopelvic infections ( plus another abx)
111
What are the two aminoglycosides?
Gentamicin and Tobramycin
112
What formulation does aminoglycosides come in?
Only IV
113
What coverage does aminoglycosides include?
Gram negative and pseudomonas
114
What is aminoglycosides mostly for?
Nosocomial infection
115
Whats the MOA for aminoglycosides?
Inhibit 30 S ribosome
116
MOR for aminoglycosides?
Ribosomal modification and efflux mechanisms
117
Whats the pharmacology for aminoglycosides?
Renal excretion
Narrow Therapeutic window-measure troughs
bacteriocidal
118
Whats the ADR for aminoglycosides?
- Nephrotoxicity
- Ototoxicity
119
Whats example of glycopepties?
Vancomycin
120
Is vancomycin IV or PO?
Both
121
What does vanco cover?
C.diff (PO only)
MRSA infxn and gram + (IV only)
122
whats the MOA for vanco?
Inhibits cell wall synthesis
123
Whats the MOR for vanco?
alterations in binding sites
124
Whats the pharmacology for glycopeptides?
- Renal excretion
- Trough target 10-20
- NO ORAL absorption of PO formulation
- Bacteriocidal gram positive organism only
- Infuse over 1 hour/slowly to avoid “Red Man Syndrome”
125
Whats the ADR for glycopeptides?
Ototoxicity, nephrotoxicity, Red Man Syndrome
126
Whats formulation for Nitrofurantoin?
PO only
127
When is nitrofurantoin indicated?
Uncomplicated UTI ONLY. Not for kidney infxn
128
What does nitrofurantoin cover?
Gram negative and gram positive coverage
Used for ESBL resistance mechanism for UTI
129
Whats ADR for nitrofurantoin?
Hemolytic anemia potential in G6PD deficiency
130
Whats the trade name for fosfomycin?
Monourol
131
When is it indicated?
UTI PO, ESBL + UTI
132
How do you take fosfomycin?
Comes in powder packet to be missed with water (3 grams orally x 1 dose)
Generally well tolerated
133
Can you take fosfomycin for kidney infection?
NO, only for uncomplicated UTI
134
What are all the antimycobacterials?
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
135
What's the ADR for Isoniazid?
- Increased liver enzymes
- Peripheral neuropathy
136
Whats the first line meds for latent TB?
Rifampin
137
What should you avoid rifampin with?
Avoid with HIV meds
138
Whats the ADR with rifampin?
- Red Lobster syndrome
- Elevated liver enzymes can occur
139
Review slide 38
-
140
Whats the ADR with pyrazinamide?
Polyarthralgia
141
Is Pyrazinamide part of active or latent TB?
Part of multidrug regimen for treatment of active TB
142
Whats the ADR for ethambutol?
Color blindness
143
Is Ethambutol part of active or latent TB?
Active
144
What is amphotericin B used for?
Resistant/deep fungal infections
145
Whats the formulation for Nystatin?
Topical powder or mouthwash
146
Whats the indication for nystatin?
thrush or intertrigo
147
What do you use on the skin for fungal infxn?
Clotrimazole
Miconazole
148
What do you use for vaginal fungal infxn?
terconazole, miconazole (monistat), tioconazole
149
What do you use for topical oral antifungal?
clotrimazole (Mycelex) , miconazole
150
What are the systemic antifungals
Ketoconazole
Itraconazole
Fluconazole
Voriconazole
Posaconazole
151
Whats the pharmacology for azoles?
Inhibits CYP2C9 (warfarin)
Renal excretion
Qt prolongation
152
When are azoles indicated?
Candidal infections-vulvovaginitis, esophagitis
153
What is the only antifungal that gets into the bladder for fungal tx?
Fluconazole
154
Whats the formulation for terbinafine?
- PO
- Topical
155
Whats the ADR for terbinafine?
Hepatotoxic
156
Whats the indication for Terbinafine?
Used for onychomycosis and cutaneous dermatophyte infections
157
What are the ABX associated with nephrotoxicity?
Aminoglycosides>ATN usually gentamicin
Vancomycin
158
Which abx causes red man syndrome?
vancomycin
159
What abx causes red lobster syndrome?
Rifampin
160
What abx causes discolored teeth?
tetracyclines
161
What abx causes yellow babies?
Sulfonamides
162
Whats the cat B for preg?
Beta lactams
Clindamycin
Azithromycin
Metronidazole-EXCEPT in first trimester maybe fetotoxic
163
Is metronidazole ok in the 1st trimester?
No, fetotoxic
164
What is cat C in pregnancy?
Fluoroquinolones
Clarithromycin
Tmp/smx
165
Whats Cat D in pregnancy?
Aminoglycosides
Tetracyclines
166
Whats the acronym for abx that causes complication in pregnancy?
F
A
S
T
167
What is the F in Fast complication?
FQ - Arthrhopathy
168
Whats the complication of aminoglycosides?
Possible CN8 toxicity in fetus
169
Which abx causes newborn kernicterus?
Sulfonamides
170
Which abx causes tooth/bone problems?
Tetracycline
171
What is type I hypersensitivity rxns?
IgE mediated>anaphylaxis/urticaria
172
What is type II hypersensitivity rxns?
IgG and complement mediated>bone marrow suppression
173
What is type III hypersensitivity rxns?
Antibody /antigen complexes>serum sickness/post streptococcal glomerulonephritis
174
What is type IV hypersensitivity rxns?
T cell>delayed hypersensitivity rxn>stevens Johnson/toxic epidermal necrolysis/organ rejection
