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Pharm COMLEX 1 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Penicillins

A

Time-dependent killing

Eliminated by kidney, inhibited by probenecid

Generally safe

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2
Q

Natural Penicillins

A

Penicillin G (IV)
-Strep A, B, viridans
-Staph
-Neisseria meningitidis
-Treponema pallidum
-Leptospira sp
-Clostridia sp
-Enterococcus sp
-Peptococcus
-Actinomyces
-Peptostreptococcus

BenzaTHINE PCN
-DOC for Treponema pallidum (Syphillis)
-Longest acting

ProCAINE PCN (IV)

Penicillin V (PO)
-Acid stable

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3
Q

Penicillinase Resistant Penicillins (Anti-Strep Penicillins)

A

Requires double loading dose due to HIGH protein binding

NAFcillin (IV)
-DOC for beta-lactamase+ bacteria

CLOXacillin (PO)

OXacillin (PO)

DiCLOXacillin (PO)

Methicillin
-Use for testing only
-Side effect: Interstitial nephritis

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4
Q

Extended Spectrum Penicillins (PO)

A

AMPicillin

AMOXicillin
-DOC for B. burgdoferi, H. pylori, Listeria

BACAMPicillin

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5
Q

Antipseudomonal Penicillins (IV)

A

CARBenicillin

MEZLOcillin

PIPERacillin
-Most active
-Combine with aminoglycoside to tx P. aeruginosa

TiCARcillin

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6
Q

Cephalosporins

A

Time dependent killing

Probenecid slows elimination

Side Effects:
-Pseudomembranous colitis
-Disulfram-like reaction
-Renal tubular necrosis (dose-dependent)
-Candidiasis
-Super-infections

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7
Q

1ST GEN Cephalosporins

A

Good for gram+
Moderate for gram-

DOC for Proteus, E. coli, Klebsiella (PEK)

CefaZOLIN (IM, IV)
-DOC for surgery prophylaxis

CephaLEXIN (PO)

CephRADINE (PO, IM, IV)

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8
Q

2ND GEN Cephalosporins

A

Good for gram-

DOC for PEK + HENS H. influenzae, Enterobacter aerogenes, Neisseria meningitidis, Serratia

CefOXITIN

CefaMANdole

CefaCLOR
-Side effect: Serum sickness

CefoTETAN
-Side effect: Disulfram-like reaction

CefuROXIME

CefPROZIL

LoraCARBef

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9
Q

3RD GEN Cephalosporins

A

Good for Enterobacteriaceae > P. aeroginosa > Salmonella & Moraxella

Less so for gram+

CefoTAXIME sodium
-CNS penetration

CefoPERAZONE
-CNS penetration
-Liver metabolism
-Good for P. aeroginosa

CeftiZOXIME

CeftaZIDIME

CefaTRIAXONE
-CNS penetration
-Liver metabolism
-DOC for N. gonorrhea

CefiXIME

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10
Q

4TH GEN Cephalosporins

A

More resistant to some beta-lactamases

CefePIME
-Increased ability to penetrate bacteria’s outer membrane
-Kidney elimination
-Tx. Pseudomonas

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11
Q

Other Cephalosporins

A

CetaROLINE fosamil
-Good for MRSA, VRSA
-Not good for P. aeroginosa

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12
Q

Sulfonamides

A

PABA antagonist

Bacteriostatic
Broad spectrum
Cross placenta & BBB

DOC of UTIs
+Toxoplasmosis
+Pneumocystis carinii

Side effects:
-Crystalluria
-Kernicterus in nursing infants
-Blood abnormalities
-Kidney & liver damage
-Neuropathy
-Stevens-Johnson Syndrome (SJS)
-Photosensitivity

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13
Q

Sulfa Abx

A

Sulfamethoxazole-Trimethoprim (SMX-TMP)
= Inhibits dihydrofolate reductase

-DOC for uncomplicated UTIs, Pneumocystis carinii
-Xanthomonas, Moraxella, Enterobacteriaceae, Nocardia (Nosocomial infections)
-Otitis media

SulfaSALAZINE (Pro-drug to Mesalamine)
-Tx: Ulcerative colitis

SulfaDIAZINE (+ Pyrimethamine)
-DOC for Toxoplasmosis, Nocardia
-Side effects: Crystalluria

Silver SulfaDIAZINE
-Topical for burns
-Also effective against yeast

Sulfacetamide/Sulfur
-Topical for dry skin

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14
Q

Macrolides

A

Erythromycin
-Reversibly binds 50S, blocking translocation
-Alternative for PCN allergy, similar to PCN-G
-DOC for Legionella pneumophilia
+Erysipelas due to GAS
+Pneumonia due to M. pneumoniae
+Chlamydia

Side Effects: Diarrhea because stimulates motilin (Erythro is worst > Azithro > Clarithro)
+Ototoxicity
+Prolong QT (Azithro’s the worst)
+Phlebitis

Clarithromycin
-Similar MOA, penetrates lungs & macrophages
-Tx Mycobacterium avium complex (MAC)
+H. pylori associated duodenal ulcers
+Community-acquired pneumonia

Azithromycin
-Similar MOA, dosed once a day
-DOC for Campylobacter, Legionella, Chlamydia, Pregnant patients
+Chlamydia & gonorrhea
+Pedi otitis media
+Pharyngitis
+MAC prophylaxis

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15
Q

Ketolides

A

Telithromycin
-Binds 50S, broad spectrum
-Tx respiratory pathogens, intracellular & atypical bacteria

Side Effects: Hepatotoxicity (BLACK BOX)

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16
Q

Clindamycin

A

Binds 50S

DOC for Strep pyogenes, Clostridia, Actinomyces
Toxoplasmic encephalitis in AIDS (+Pyrimethamine)
Osteomyelitis

Side Effect: Pseudomembrane colitis

17
Q

Streptogramins

A

DalfoPRISTIN, QuinuPRISTIN
-Irreversibly blocks 50S
-Tx. Vancomycin-resistant enterococci (VRE)
-MRSA
-Inhibits CYP34A***

18
Q

Oxazolidinones

A

Linezolid
-Reversible, non-selective MAOI & binds 50S
-Oral bioavailability 100%
-Tx Aerobic G+
-VRE
-MRSA

Side Effects: Superinfection

19
Q

Aminoglycosides

A

Concentration-dependent killing
No oral or CSF penetration
Inhibit aerobic G-
Irreversibly bind 30S
Good for P. aeruginosa, or sepsis

Side Effects: Ototoxicity, Nephrotoxicity, Neuromuscular weakness

STREPTOmycin
-Tularemia
-Bubonic plague (+Doxy)
-Brucella
-TB (2nd line)
-Endocarditis

GENTAmycin (of AmiKACIN if resistant)
-DOC tularemia
-Burns & wounds
-Bactericidal against 95% S. aureus
-P. aeruginosa (+PCN)

TOBRAmycin
-Severe infections

SPECTINOmycin
-Single shot for gonorrhea (not in USA)

NEOmycin (Topical)
-Hepatic encephalopathy
-Prep for colon surgery

PAROMOmycin
-Intestinal amebiasis
-Cryptosporidium parvum

20
Q

Chloramphenicol

A

Reversibly binds 50S in anaerobes
Bacteriostatic
Oral bioavailability 100%
CNS penetration
Resistance due to bacterial acetyltransferase

Typhoid fever (2nd line, after Bactrim)
Meningitis
Rickettsia
Eye infections (Topical)

Interactions: Increase effect of warfarin, Decrease effect of PCN

Side Effects: Grey baby syndrome, deadly aplastic anemia

21
Q

Tetracyclines

A

Bind 30S
Bacteriostatic
Wide distribution, except CNS & joints
Resistance via plasmids
Teratogenic, & do not use in kids <6

Brucella (w/ aminoglycoside)
Bubonic plague (w/ streptomycin)
Chlamydia
Cholera
H. pylori (w/ metronidazole & bismuth)
M. pneumonia
Lyme disease

Side Effects: Photosensitivity, Fanconi syndrome, Liver damage, Deposits in teeth & bones, RTA

Interactions: Chelation with Al, Ca, Fe, Cl

Tetracycline, Short-acting
DeMECLOcycline, Intermediate-acting (Inh. ADH)
Doxycycline, Long-acting, Good for Syphillis
Minocycline, Long-acting, but ototoxicity

22
Q

Glycyclines

A

TIGEcycline (Derivative of minocycline)
-Binds 30S
-Bacteriostatic
-Tx MRSA
+Methicillin-resistant Staph epidermidis (MRSE)
+Penicillin-resistant Strep pneumoniae (PRSP)
+Vancomycin-resistant Enterococci (VRE)

23
Q

Treating UTIs

A

NitroFURANtoin
->Effect in acidic urine
-Sfx: Methemoglobinemia, hemolysis & brown urine, interstitial pulm fibrosis, severe neuropathy

METHenamine Mandelate (Acidifies the urine)
-Converts to formaldehyde in urine, binds amino groups
-BacterioCIDAL, No resistance, NON-toxic
-Tx. E. coli

SMX/TMP, Cephalosporins GENTAmycin/ AmiKACIN, TOBRAmycin, Ampicillin, Amoxicillin, Augmentin, Trimentin, Fosfomycin tromethamine

24
Q

Treating UTIs With Fluoroquinolones

A

Inhibit DNA gyrase

Norfloxacin
-UTI & prostatitis

Ciprofloxacin
-DOC prophylaxis for anthrax inhalation
-For Pseudomonas & MRSA & Shigella
-Good skin, bone, joints, tissue penetration
-Sfx: Transient increase LFTs, tendon rupture

OFLOXacin

MoxiFLOXacin, GemiFLOXacin
-Good respiratory tissue penetration
-Good for Strep pneumo
+Acute sinusitis
+Chronic bronchitis
+Pneumonia

GatiFLOXacin
-Topical for eye infection
-OFF MARKET SINCE 2006

Pharm COMLEX 1 (1 decks)

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