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RRCCPA Pharmacotherapeutics > Antimicrobial Review (Schoenwald) (Midterm) > Flashcards

Antimicrobial Review (Schoenwald) (Midterm) Flashcards

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1
Q

“Beta lactams” contain which classes of abx?

A
  • Penicillins
  • Extended spectrum penicillins
  • Cephalosporins
  • Carbapenems
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2
Q

Penicillin G may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

B and C (IV or IM)

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3
Q

Penicillin VK may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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4
Q

What is the preferred abx for syphilis and how is it administered?

A

Benzathine penicillin IM

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5
Q

Which abx are in the “natural penicillins” class?

A
  • Penicillin G
  • Penicillin VK
  • Benzathine Penicillin
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6
Q

Which abx are in the “aminopenicillin” class? What do these abx commonly treat?

A
  • Ampicillin
  • Amoxicillin
  • Common tx:
    • Pharyngitis
    • Sinusitis
    • Otitis media
    • Endocarditis prophylaxis
    • Lyme dz (age <8 y/o)
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7
Q

Which abx are in the “anti-staphylococcal penicillin” class? What do these abx commonly tx?

A
  • Nafcillin
  • Dicloxacillin
  • Common tx:
    • Skin and soft tissue infxn w/ suspected Staph but works great against Strep as well
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8
Q

Ampicillin may be given (choose 1 or more answer):

a) PO
b) IV
c) IM

A

b) IV

*It’s the IV equivalent of amoxicillin

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9
Q

Amoxicillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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10
Q

Nafcillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

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11
Q

Dicloxacillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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12
Q

Which abx are included in the “augmented aminopenicillin” class? What are these abx commonly used to tx?

A
  • Ampicillin/sulbactam (Unasyn)
  • Amoxicillin/clavulanate (Augmentin)
  • Common tx:
    • Bites (dogmentin, duh)
    • Otitis media
    • Sinusitis
    • Acute exacerbation of chronic bronchitis
    • Dental infxns
    • Skin and soft tissue infxns
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13
Q

Ampicillin/sulbactam (Unasyn) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

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14
Q

Amoxicillin/clavulanate (Augmentin) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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15
Q

Which abx are included in the “augmented extended-spectrum penicillins” class? What are these abx commonly used to tx?

A
  • Piperacillin/tazobactam (Zosyn)
  • Common tx:
    • Broad spectrum with Pseudomonas coverage
    • Think hospitalized pts
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16
Q

What is the MOA of penicillins?

A

Stops cell wall synthesis by binding penicillin binding protein.

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17
Q

What is the MOR of Penicillins?

A

Beta lactamases and penicillin binding protein (PBP) alterations

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18
Q

Penicillins are bacteriostatic or bacteriocidal?

A

Bacteriocidal

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19
Q

Clavulanate can be associated with what adverse drug rxn?

A

Diarrhea and subclinical hepatotoxicity

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20
Q

In general, 1st generation cephalosporins have excellent gram (+ or -) activity and poor gram (+ or -) activity.

A

Excellent gram +

Poor gram -

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21
Q

Cephalosporins: Gram positive activity (increases/decreases) as generations increase.

A

Decreases

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22
Q

Cephalosporins: Gram negative activity (increases/decreases) as generations increase.

A

Increases

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23
Q

MOA of cephalosporins?

A

Stops cell wall synthesis by binding penicillin binding protein

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24
Q

MOR of cephalosporins?

A

Beta lactamases

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25
What is a possible adverse drug reaction of cephalosporins?
Ceftriaxone linked with biliary sludging/pseudocholelithiasis
26
Which abx are 1st gen cephalosporins?
* Cefazolin (Ancef) * Cephalexin (Keflex)
27
Cefazolin (Ancef) may be given (choose 1 or more answers): a) PO b) IV c) IM
b) IV
28
Cephalexin (Keflex) may be given (choose 1 or more answers): a) PO b) IV c) IM
a) PO
29
What are some examples of bacteria and conditions you can treat with 1st gen cephalosporins?
* Coverage: gram-positives excellent EXCEPT MRSA * Strep pyogenes * MSSA * Some E coli, klebsiella, proteus * Common tx indications: * Skin and soft tissue infections * Strep pharyngitis * Pre-op prophylaxis (cefazolin) * Uncomplicated cystitis
30
What's the one 2nd gen cephalosporin Schoeny wants us to know? How is it given (PO/IV/IM)?
Cefuroximine (Ceftin) PO
31
2nd gen cephalosporins are good at covering what bugs?
Same as 1st gen, plus Strep pneumo, M cat, and H flu (respiratory)
32
Which abx are included in 3rd gen cephalosporin class?
* Ceftriaxone (Rocephin) * Cefdinir (Omnicef)
33
Ceftriaxone (Rocephin) may be given (choose 1 or more answers): a) PO b) IV c) IM
b and c) IV or IM
34
Cefdinir (Omnicef) may be given (choose 1 or more answers): a) PO b) IV c) IM
a) PO
35
T/F: Ceftriaxone crosses the blood brain barrier
True
36
T/F: 3rd gen cephalosporins have good MRSA coverage
False. Only next gen cephalosporins have MRSA coverage.
37
Common tx indications for 3rd gen cephalosporins?
* Coverage: gram negative with some gram positive * Common tx indications: * CAP * Meningitis * Gonorrhea * Pyelonephritis
38
Which abx is 4th gen cephalosporin?
Cefipime (Maxipime)
39
Cefepime (Maxipime) may be given (choose 1 or more answers): a) PO b) IV c) IM
b) IV
40
4th gen cephalosporins can be used for coverage of....
Most gram negative rods, more resistant gram negatives
41
Which cephalosporin generation is the only generation to have any pseudomonas coverage?
4th gen (cefepime)
42
Which abx is next (5th) gen cephalosporin?
Ceftaroline (Teflaro)
43
Ceftaroline (Teflaro) may be given (choose 1 or more answers): a) PO b) IV c) IM
b) IV
44
Which generation of cephalosporins is the only gen to have MRSA coverage?
Next/5th generation
45
Which 3 abx are classified as tetracyclines?
* Tetracycline * Minocycline * Doxycycline
46
Tetracyclines may be given (choose 1 or more answers): a) PO b) IV c) IM
a and b) PO or IV
47
T/F: Tetracyclines cover MRSA
True
48
MOA of tetracyclines?
Protein synthesis inhibition at 30S bacterial ribosome
49
MOR of tetracyclines?
Efflux pump
50
Tetracyclines are bacteriostatic or bacteriocidal?
Bacteriostatic
51
Examples of adverse drug reactions with tetracyclines?
* Photosensitivity * Contraindicated in pregnancy or kids \<8 y/o
52
Which meds should you not combine with tetracyclines? Why?
* DO NOT combine with isotretinoin → pseudotumor cerebri * Calcium decreases absorption
53
Tick borne disease (lyme, rickettsia) should be tx with which abx?
Tetracyclines
54
Name the 3 macrolides
* Azithromycin * Clarithromycin * Erythromycin
55
Macrolides may be given (choose 1 or more answers): a) PO b) IV c) IM
a and b) PO or IV
56
Which abx do you use to tx chlamydia?
* 100 mg Doxycycline BID x7 days (preferred) * May use Azithromycin as an alternative (i.e. pregnancy)
57
Abx of choice for pertussis?
Macrolides (Azithromycin or clarithromycin)
58
MOA of macrolides?
Protein synthesis inhibition at 50S ribosome
59
MOR of macrolides?
Ribosomal changes and efflux pump
60
Macrolides are bacteriostatic or bacteriocidal?
Bacteriostatic
61
Clarithromycin is a potent CYP3A4 inhibitor, which means you need to closely monitor/adjust which of the other patient's medication?
Warfarin
62
What should you look out for on EKG with macrolides?
QTc prolongation. Azithromycin has new black box warning.
63
Adverse drug rxn of macrolides?
* Erythromycin is a promotility agent → n/v/d * Clarithromycin = metallic taste
64
Which abx is included in the lincosamide class?
Clindamycin
65
Clindamycin may be given (choose 1 or more answers): a) PO b) IV c) IM
a and b) PO or IV
66
If someone has a serious B-lactam/PCN allergy, you can use _______________ instead for skin and soft tissue infections and strep pharyngitis.
Clindamycin
67
Clindamycin is good for (_Anaerobic or aerobic)_ infections above the diaphragm.
Anaerobic
68
MOA of clindamycin?
Protein synthesis inhibition at 50S ribosome
69
MOR of clindamycin?
Ribosomal modification
70
Clindamycin is bacteriostatic or bacteriocidal?
Bacteriostatic
71
ADR of clindamycin?
* Nausea * Diarrhea * C diff
72
T/F: Fluoroquinolones do not cover pseudomonas
False
73
Which fluoroquinolones are respiratory vs non-respiratory?
* Respiratory: Levofloxacin and Moxifloxacin * Non-respiratory: Ciprofloxacin
74
MOA of fluoroquinolones?
Inhibit bacterial DNA topoisomerase
75
MOR of fluoroquinolones?
Alteration in DNA topoisomerase
76
Fluoroquinolones are bacteriostatic or bacteriocidal?
Bacteriocidal
77
\_\_\_\_ and ____ decrease absorption of fluoroquinolones
Ca and Mg
78
What EKG change should you look out for when someone is taking a fluoroquinolone?
QTc prolongation
79
What are common non-respiratory indications for fluoroquinolones?
* Complicated UTI (pyelonephritis, prostatitis) * Enteric infections/traveler's diarrhea * Diverticulitis (plus metronidazole) * Pelvic infections
80
What is a common respiratory indications for fluoroquinolones?
CAP
81
ADRs associated with fluoroquinolones?
* Arthropathy ("contraindicated" in kids \<18) * Tendinopathy (Achilles rupture) * CNS toxicity * Photosensitivity * QT prolongation * Dysglycemia * Neuropathy
82
Which abx is/are in the Sulfonamides class and are they given PO/IV/IM?
Trimethoprim/sulfamethoxazole (Bactrim or Septra) * PO or IV
83
MOA of sulfonamides?
Inhibition of folate synthesis
84
MOR of sulfonamides?
Alteration in folate synthesis, decreased binding sites
85
Which bugs do suolfonamides cover?
* Gram negative and positive * MRSA * E coli, klebsiella, proteus * Pneumocystis jiroveci * H flu, M cat
86
Sulfonamides can increase the effects of what other medication?
Sulfonamides inhibit CYP2C9, which can lead to an increased INR in warfarin therapy
87
Which lab value on BMP should you watch out for with sulfonamides?
Hyperkalemia
88
T/F: Sulfonamides are cleared via the liver
False. Kidneys.
89
Sulfonamides are bacteriocidal or bacteriostatic?
Bacteriostatic
90
ADRs of sulfonamides?
* Hypersensitivity rxn * Myelosuppression * Hemolytic anemia in G6PD deficiency
91
Common tx indications for sulfonamides?
* PCP PNA (ayyyy jiroveci \*Italian accent\*) and prophylaxis * UTI * MRSA skin and soft tissue infections
92
Which abx are in the nitromidazole class and how are they given (PO/IV/IM)?
* Metronidazole (Flagyl) * PO or IV * Tinidazole (Tindamax) * PO
93
MOA of nitromidazoles?
DNA damage
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RRCCPA Pharmacotherapeutics (11 decks)

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