Antimicrobial Review w/ Schoeny Flashcards
(142 cards)
1
Q
List the Beta Lactams
A
Penicillins
Extended spectrum penicillins
Cephalosporins
Carbapenems
2
Q
List the Non Beta Lactams
A
Macrolides Tetracyclines Clindamycin Aminoglycocides Fluoroquinolones Nitrofurantoin Sulfonamides
3
Q
Natural PCNs
A
- Penicillin G(IV or IM) or Penicillin VK (PO)
- Benzathine Penicillin (long-acting IM)
4
Q
Penicillin G or PCN VK is commonly used to treat?
A
-Strep pharyngitis/cellulitis
5
Q
_______ is used to treat Syphilis
A
Benzathine Penicillin (Bicillin LA)
6
Q
Primary Syphilis Sx:
A
sore or sores at the original site of infection. These sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth, sores are firm/round/ painless.
7
Q
Secondary Syphilis Sx:
A
maculopapular skin rash, swollen lymph nodes, and fever. Money spots on palms of hands/feet
8
Q
List the Aminopenicillins
A
Ampicillin(IV) or amoxicillin (po)
9
Q
What do aminopenicillins cover?
A
Coverage: Strep pyogenes (group A strep infections), Strep agalactaie, Strep pneumonia, Enterococci, Borrelia burgdorferi, Listeria
10
Q
Aminopenicillins: commonly used to treat?
A
Pharyngitis, sinusitis, otitis media, endocarditis prophylaxis, Lyme dx (age <8 years)
11
Q
Anti-staph PCNs:
-list two and their formulations
A
Nafcillin (IV) or dicloxacillin (PO)
12
Q
Anti-Staphylococcal Penicillins
are commonly used to treat?
A
Skin and soft tissue infections with suspected Staph but works against Strep as well
13
Q
Child (7 yo) was recently diagnosed with lyme disease. What tx is appropriate?
A
amoxicillin for kids <8 yo
borrelia burgdorferi
14
Q
Where does listeria originate?
-What is Listeria’s WORST complication?
A
contaminated soft cheeses like brie—or cantaloupe in CO! and unpasteurized dairy products. Listeria is a food borne illness that causes diarrhea, severe dehydration, the worst complication is Meningitis!!!!!!! Esp young kids/elderly. It can also cause miscarriages in pregnancy –if someone presents to the ER with meningeal symptoms and there has been a listeria outbreak– MUST give them an aminopenicillin
15
Q
Are Nafcillin (IV) or dicloxacillin (PO) good for MRSA infections?
A
NO, minimal staph coverage
16
Q
List the Augmented Aminopenicillins
A
Ampicillin/sulbactim (Unasyn IV) or amoxicillin/clavulanate (Augmentin PO)
17
Q
Coverage for the Augmented Aminopenicillins:
A
Same as aminopenicillins plus Pasteurella, Moraxella, Haemophilus influenza, anaerobes
18
Q
Augmented Aminopenicillins are MC used to treat:
A
- Bites
- Otitis media, sinusitis, acute exacerbation of chronic bronchitis
- Dental infections
- Skin and soft tissue infections
**Pasteurella from animal bites!!! (cat and dog), respiratory infections like bacterial sinusitis
COPD—acute exacerbations of bronchitis-–H influenzae is BIG player
Skin and soft tissue infections BUT NO MRSA coverage
19
Q
Augmented Extended-Spectrum Penicillins: list
-coverage and typical Pt population this abx is used?
A
- Piperacillin/tazobactam (Zosyn IV)
- *Broad spectrum w/ Pseudomonas coverage–> think hospitalized Pts!
- Zoysn is broad spectrum– gram + and – and good pseudamonas coverage, used in hospital Pts, BUT no MRSA coverage
20
Q
PCNs MOA:
A
stops cell wall synthesis by binding penicillin binding protein
21
Q
PCNs MOR:
A
B lactamases and PBP alterations
22
Q
PCNs Pharmacology
A
- Renal
- Bacteriocidal
23
Q
Bacteriostatic vs bacteriocidal
A
Bacteriostatic: slows growth of the bacteria, but doesn’t kill it all off, relies on working with the Pt’s immune system to also help fight the infection
Vs
Bacteriosidal: KILLS the bacteria, so it cant mutate
24
Q
PCNs
-List ADRs (clavulanate is associated with _____**)
A
- Hypersensitivity Reactions
- Clavulanate assoc. w/ diarrhea and subclinical hepatotoxicity
25
Cephalosporins are classified by:
generations! 1st-5th
26
Cephalosporin generalized rule regarding the generations and coverage:
- 1st generation has excellent gram positive activity and poor gram negative activity.
- Gram positive activity decreases as generations increase
- Gram negative activity increases as generations increase
- 4 generations + next generation
27
EXCEPTION to the cephalosporin rule
** Next generation(ceftaroline) has broad coverage AND MRSA coverage
28
Cephalosporins: MOA
stops cell wall synthesis by binding penicillin binding protein
29
Cephalosporins: MOR
beta-lactamases
30
Cephalosporins: ADR
Ceftriaxone (3rd gen) linked with biliary sludging /pseudocholelithiasis
31
List the 1st gen cephalosporins and formulations
Cefazolin (Ancef IV) or cephalexin (Keflex po)
32
1st gen cephalosporins: coverage?
* *Coverage: gram positives excellent EXCEPT MRSA, minimal gram negative coverage
- Strep pyogenes, MSSA
- Some E coli, Klebsiella, Proteus
33
1st gen cephalosporins:
| Common tx indications?
- Skin and soft tissue infections
- Strep pharyngitis
- Pre op prophylaxis (cefazolin)
- Uncomplicated cystitis
34
2nd Generation cephalosporins: list
Cefuroxime (Ceftin po)
35
Cefuroxime (ceftin) coverage ?
Covers same as 1st generation (gram positives excellent EXCEPT MRSA, minimal gram negative coverage) plus Strep pneumonia, Moraxella catarrhalis, Haemophilus influenza (respiratory)
36
2nd Generation cephalosporins: Common tx indications?
```
(Cefuroxime)
Otitis media
Sinusitis
-Acute exacerbations of chronic bronchitis
-Skin and soft tissue infections
```
37
3rd generation cephalosporins: list
Ceftriaxone (Rocephin IM or IV), cefdinir (Omnicef PO)
38
3rd generation cephalosporins: coverage?
gram negative with some gram positive- NOT enterococcus or MRSA
**Ceftriaxone crossed blood brain barrier--> can be used for empiric meningitis tx (BUT not for listeria meningitis) . Also good for CAP and gonorrhea
39
3rd generation cephalosporins: common tx indications
CAP
Meningitis
Gonorrhea (with Azithromycin)
Pyelonephritis
40
New tx regimen for chlamydia and gonorrhea
New tx for gonorrhea– ceftriaxone 500 mg IM by itself NO azithromycin
Same with chlamydia– now doxycycline 100 mg PO BID x 7 days is TOC for chlamydia. *Azithromycin is now alternative
41
4th generation Cephalosporins: list
Cefepime (IV)
42
4th generation Cephalosporins: coverage
most gram negative rods, more resistant gram negatives>Pseudomonas
**4th gen MC used in hospital setting (cefepime IV)
43
5th gen cephalosporin: list
Ceftaroline(Teflaro IV)
44
5th gen cephalosporin: coverage?
- very broad gram negative and gram positive coverage
- **MRSA coverage
-Pneumonia and skin and soft tissue infections
BUT NO pseudomonas
45
Tetracyclines: list
Tetracycline, minocycline, doxycycline (PO,IV)
46
Tetracyclines: coverage
Step pneumo, Moraxella catarrhalis, H influenza, Chlamydia, Legionella, Mycoplasma, Rickettsia, Ehrlichia, Borellia, Staph aureus including MRSA
47
Tetracyclines: MOA**
protein synthesis inhibition at **30 S bacterial ribosome
| MOR:efflux pump
48
Tetracyclines: MOR
-pharmacology?
efflux pump
Pharmacology:
Split excretion
bacteriostatic
49
Tetracyclines: ADRs
- Photosensitivity
| - **Contraindicated in pregnancy/kids <8 years of age
50
Tetracyclines: common tx indications
```
Sinusitis
Acute Exacerbations of chronic bronchitis
CAP
Non gonococcal urethritis/cervicitis
TICK BORNE disease (Lyme, Rickettsia)
```
51
Tetracyclines SHOULD NOT be combined with ______
**isotretinoin-->can cause pseudotumor cerebri
52
______ decreases tetracyclines absorption
calcium
| **do not let pts take calcium supplements
53
Macrolides: list
Azithromycin, clarithromycin, erythromycin ( po or IV)
54
Macrolides: coverage
Strep pneumo, Strep pyogenes, Moraxella catarrhalis, H influenza, **Chlamydia, Mycoplasma, H pylori, and **pertussis
pertussis= azithromycin
55
Macrolides: MOA
protein synthesis inhibition at **50S ribosome
56
Macrolides: MOR
ribosomal changes and efflux pump
57
Macrolides: pharm
note: clarithromycin is a potent ______ inhibitor
* Bacteriostatic
- Safety concerns: Clarithromycin potent CYPA4 inhibitor--> monitor warfarin
-QTC prolongation---> azithromycin has new black box warning
58
Macrolides:: ADRs
- erythromycin?
- clarithromycin?
- Erythromycin-->promotility agent--> causes nausea/vomiting/diarrhea
- Clarithromycin=metallic taste
59
Macrolides: common tx indications
```
Pharyngitis
Otitis media
Community acquired pneumonia/atypical pneumonia(Mycoplasma)
Whooping cough-pertussis
Urethritis and cervicitis
H pylori
```
60
Lincosamides: list
Clindamycin (IV or PO)
61
Lincosamides: coverage
anaerobes (above diaphragm), Staph aureus and Strep pyogenes in PCN allergic patients
62
Lincosamides: MOA
protein synthesis inhibition at 50 S ribosome
63
Lincosamides:MOA
ribosomal modification
64
Lincosamides: Pharmacology
Bacteriostatic
65
Lincosamides: ADRs
Diarrhea/Nausea
| C diff
66
Which abx is known to cause C diff?
**clindamycin
67
lincosamides: Common tx indications?
- Substitute for serious b lactam allergy in skin and soft tissue infections and strep pharyngitis
- Anaerobic infections/abscesses
- Dental infections (clinda)
68
Fluoroquinolones:
| non-respiratory (list)
**Ciprofloxacin (PO,IV, drops)
69
Ciprofloxacin covers __________
most gram negative rods including Pseudomonas
70
Fluoroquinolones: respiratory
Levofloxacin (PO
71
Respiratory fluoroquinolones coverage
Coverage: same as Cipro plus increased activity for Strep pneumo and atypical respiratory pathogens
72
Fluoroquinolones: MOA
inhibit bacterial DNA topoisomerases
73
Fluoroquinolones: MOR
alteration in DNA topoisomerase
74
Fluoroquinolones: Pharm
- Cidal or static?
- ____ and ____ decrease absorption
- EKG findings associated with fluoroquinolones?
- Split excretion
- Bacteriocidal
- Ca and Mg decrease absorption
- ***QTC prolongation*** KNOW
75
Fluoroquinolones: common tx indications
| non-respiratory-->
- Complicated UTI (pyelonephritis, prostatitis)
- Enteric infections/traveler’s diarrhea
- Diverticulitis (plus metronidazole)
76
Fluoroquinolones: common tx indications
| Respiratory-->
- Community acquired pneumonia
| - Pelvic infections
77
Fluoroquinolones: ADRs (hint: there are LOTs)
-Arthropathy
“Contraindicated” in kids < 18
- Tendinopathy (acute Achilles tendon rupture)-->More common in elderly & pts on steroids
- CNS toxicity
- Photosensitivity
- QT prolongation
- Dysglycemia
- Neuropathy
78
Sulfonamides: list ex's and formulations
Trimethoprim/sulfamethoxazole (Bactrim or Septra IV or PO)
79
Sulfonamides: coverage?
- gram negative and gram positive coverage including MRSA
- E coli, Klebsiella, Proteus, MRSA
- Pneumocystis jiroveci
- H influenza, Moraxella catarrhalis
80
Sulfonamides: MOA
inhibition of folate synthesis
81
Sulfonamides: MOR
alteration in folate synthesis, decreased binding sites
82
Sulfonamides: Pharm?
- -inhibit ______ and increase _____
- Retention of _______
**Inhibit CYP2C9-INCREASE INR in warfarin therapy
**Retention of potassium
(MUST check K+ and INR if pt is on bactrim)
-Renal excretion
-bacteriostatic
83
Sulfonamides: ADRs
- Hypersensitivity rxn
- Myelosuppression
- Hemolytic anemia in G6PD deficiency
84
Sulfonamides: common tx indications?
- PCP pneumonia and prophylaxis
- UTI
- MRSA skin and soft tissue infections
85
nitromidazoles: list ex's and formulations
Metronidazole (Flagyl IV or PO) , Tinidazole (Tindamax PO)
86
nitromidazoles: Coverage?
anaerobes below the diaphragm, protozoa (giardia etc
87
nitromidazoles: MOA? MOR?
MOA:DNA damage
MOR: not known
88
nitromidazoles: Pharm
Hepatic
| bacteriocidal
89
nitromidazoles: ADRS
- Metallic taste
- Disulfram rxn
- ****Fetotoxic in 1st trimester
90
nitromidazoles: common tx indications
Bacterial vaginosis, C diff, giardia, and trichomoniasis, abdominopelvic infections ( plus another abx
91
Aminoglycosides: list ex's and forms
Gentamicin, tobramycin (IV)
92
Aminoglycosides: coverage?
- gram negative including Pseudomonas
| - Mostly for nosocomial infections
93
Aminoglycosides: MOA
inhibit 30 S ribosome
94
Aminoglycosides: MOR
ribosomal modification and efflux mechanisms
95
Aminoglycosides: Pharm
- How is it excreted?
- _____Therapeutic window
- Renal excretion
* *Narrow Therapeutic window-measure troughs
- bacteriocidal
96
Aminoglycosides: ADR
- Nephrotoxicity (reversible)
| - ototoxicity (hearing loss is urually irreversible!! watch out w/ gentamycin)
97
Glycopeptides: list ex's and formulations
Vancomycin (IV and PO)
98
Glycopeptides: Coverage?
**oral-C diff
-IV –MRSA infections and other serious gram positive infections
99
Glycopeptides:
- Excretion route?
- Trough target _____
- cidal or static?
Renal excretion
- Trough target 10-20
- Bacteriocidal gram positive organism only
100
Glycopeptides: MOA and MOR?
MOA:inhibits cell wall synthesis
MOR:alterations in binding sites
101
Glycopeptides:
Infuse over _____ hours in order to avoid "Red man syndrome"
-other ADRs?
Vanco=red man syndrome**
*1 hour
-ototoxicity, nephrotoxicity, Red Man Syndrome
102
Glycopeptides:
| describe the oral absorption of PO formulation
NO oral absorption
KNOW– PO vanco is used almost exclusively for c diff infections
103
Carbapenems: list ex's and forms
Imipenem,meropenem,ertapenem (IV)
104
Carbapenems: Coverage?
broad spectrum with Pseudomonas coverage **EXCEPT ertapenem
105
Carbapenems: MOA and MOR
MOA: stops cell wall synthesis
MOR:carbapenamases
106
Carbapenems: ADRs
Seizures
| nephrotoxicity
107
Carbapenems: common tx indications
Ventilator associated pneumonia
Resistant complicated UTI
Nosocomial infections
108
Antimycobacterials:
| Isoniazid is the DOC for tx of ______
* *latent TB-now changed due to treatment guideline update Feb 2020 but still may be on PANCE
- 9 months of therapy for latent TB
- 1 of meds for treatment of active TB
109
Antimycobacterials:
| Isoniazid- ADRs?
- Increased liver enzymes
| - **Peripheral neuropathy
110
antimycobacterials:
| Rifampin is used to tx _____
Latent TB-part of first line regimen in Feb 2020 updates
-Part of multidrug regimen for active TB treatment
111
antimycobacterials: Rifampin should be avoided with ____ meds
Inducer of CYP enzymes- **avoid with HIV meds
112
antimycobacterials: Rifampin
| - ADRs?
Red Lobster syndrome and elevated liver enzymes can occur
113
List 2 ex tx regimens for latent TB
- Isoniazid & Rifapentine for 3 months, dose once weekly
- Rifampin for 4 months, take daily
- Isoniazid and Rifampin for 3 months, take daily
Alt: Isoniazid for 6 months, take daily
114
Antimycobacterials:
| Pyrazinamide- ADRs?
Polyarthralgias can occur
| -Part of multidrug regimen for treatment of active TB
115
Antimycobacterials: Ethambutol ADRs
**Color blindness common adverse drug effect (Ethambutol –E for eye– monitor them periodically with ishehara color blind test, make sure they aren’t going color blind)
-Part of multidrug regimen for tx of active TB
116
Antifungals:
Polyenes: list
Amphotericin B
&
Nystatin
117
Antifungals:
Amphotericin B is used to tx ______
-ADR??
resistant or deep fungal infections
**NEPHROTOXIC-- high rate of nephrotoxicity
118
Antifungals: Nystatin is used to tx______
Topical powder or mouthwash
| Use for thrush or intertrigo
119
Antifungals: azoles
| -topical skin?
clotrimazole (lotrimin) ,miconazole
120
Antifungals: azoles
| topical vaginal?
terconazole, miconazole (monistat), tioconazole
121
Antifungals: azoles
| -topical oral?
clotrimazole (Mycelex) , miconazole
122
Antifungals: azoles
| -systemic?
```
Ketoconazole
Itraconazole
***Fluconazole
Voriconazole
Posaconazole
```
123
Azoles:
- inhibits _____
- excretion?
- EKG finding?
- Inhibits CYP2C9 (warfarin)
- Renal excretion
- Qt prolongation
124
Azoles: common tx indications
-Candidal infections-vulvovaginitis, esophagitis
| -**Fluconazole is only azole antifungal that gets into bladder --> fungal UTI treatment
monitor INR levels***
125
Allylamines: Terbinafine
- ADR?
- Used to tx______
Terbinafine (Lamisil po or topical)
- Hepatotoxic
- Used for onychomycosis and cutaneous dermatophyte infections
126
What abx are assoc. with nephrotoxicity?
Aminoglycosides-->usually gentamicin,
| Vancomycin
127
Antibiotics associated with color findings:
- red man syndrome?
- Red lobster syndrome?
- Discolored teeth?
- Yellow babies?
- Red man syndrome=vancomycin
- Red lobster syndrome=rifampin
-Discolored teeth-tetracyclines
Yellow babies-sulfonamides
128
Which categories are safe in pregnancy?
A and B
129
Cat B meds:
Beta lactams
Clindamycin
Azithromycin
**Metronidazole-EXCEPT in first trimester maybe fetotoxic
130
Cat C meds:
Fluoroquinolones
Clarithromycin
Tmp/smx
131
Cat D meds:
Aminoglycosides
Tetracyclines
WE SHOULD NOT USE IN pregnancy
132
Potential ABX complications in Pregnancy:
| FAST (aka abx you dont use in pregnancy)
Fluoroquinolones--> artrhopathy
Aminoglycosides--> Possible CN8 toxicity in fetus
Sulfonamides--> Newborn kernicterus
Tetracyclines--> Tooth/bone problems for infant
133
Type 1 hypersens rxn:
IgE mediated>anaphylaxis/urticaria
134
Type 2 hypersensitivity rxn:
IgG and complement mediated->can cause bone marrow suppression
135
Type 3
Antibody /antigen complexes--> assoc. with serum sickness/post streptococcal glomerulonephritis
136
Type 4
T cell>delayed hypersensitivity rxn--> Ex’s: stevens Johnson/toxic epidermal necrolysis/organ rejection
137
What are good oral options for skin infections?
Cephalexin and Bactrim main ones. Other good oral options: dicloxacillin (but no mrsa coverage)
138
What are good oral options for MRSA infections? IV?
Bactrim, Ceftaroline (Teflaro) IV, linezolid (expensive PO option), doxycycline (oral), Vanco (IV-ONLY), Clindamycin
139
When would you use IV vs oral?
IV formulations for more serious type infections, or infections that haven’t responded to PO therapy, often times hospitalized Pts. PO abx are often in outpatient settings.
140
What are good oral options for gram negative infections?
Cefdinir (PO)-3rd gen, fluoroquinolones-cipro,
| -Cephalexin might work for E coli infection,
141
What are good oral options for Pseudomonas infections?
**Fluoroquin– cipro or levo only, moxi not good
142
What are good IV options for Pseudomonas infections?
Carbapenems except ertapenem, pip-taz, aminoglycosides- genta, tobramycin, amacasin, cefepime (4th gen)
