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Antimicrobials Flashcards

(52 cards)

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1
Q

Which beta lactams have good anaerobic activity against Bacteroides fragilis?

A

Penicillins + penicillinase inhibitor – very effective against anaerobes

Carbapenems – very resistant to all enzymes except carbapenemases

Cefoxitin is acceptable used as antibiotic prophylaxis for colorectal surgery, GYN infxns

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2
Q

Meningitis due to Strep pneumo

A
  • Ceftriaxone and vancomycin until MIC of isolate is known
  • If strep pneumo with very low MIC to both penicillina nd ceftriaxone, can use either high-dose penicillin G every 4h or high dose ceftriaxone every 12h
  • If high MIC to both ceftriaxone and penicillin, vancomycin would have been effective initially but a second antibiotic would be selected by ID specialist bc vanco may decrease in CSF as inflammation decreases with therapy
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3
Q

Enterococcus faecalis endocarditis

A

Ampicillin plus low dose gentamycin most effective
Ampicillin alone also OK if aminoglycoside contraindicated bc of kidney disease
Wrong: vancomycin alone has low potency for E faecalis although adding gentamicin to vancomycin would help

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4
Q

C Diff

A

Metronidazole, PO Vancomycin

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5
Q

Peptidoglycan synthesis inhibitors

A

Vancomycin, Bacitracin

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6
Q

Amoxicillin uses? ADE?

Ampicillin uses?

A

Amoxicillin+clavulanate for trx of common ENT infxns (sinusitis, pharyngitis, otitis media), animal bites (dogmentin)
Give to pt with EBV mono –> RASH

Ampicillin/sulbactam: drug of choice for listeria, “easy” gram negative coverage (H flu, E coli, shigella, salmonella)

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7
Q

Antipseudomonal penicillin? Also does?

A

Only one: piperacillin (+tazobactam)

Also does Gram + (incl e faecalis, streptococci, strep pneumo, MSSA)

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8
Q

Folic acid synthesis inhibitors

A

Sulfonamides (e.g. sulfamethoxazole) (PABA –X–> DHF)

Trimethoprim (DHF –X–> THF)

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9
Q

Carbapenems uses? ADEs?

A

Imipenem (+cilastatin), meropenem, ertapenem

  • Broad spectrum
  • For tough/resistant Gram negatives – covers almost everything EXCEPT MRSA, C diff, e faecium; ertapenem doesn’t cover pseudomonas or e faecalis

ADEs: GI upset, rash, seizures

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10
Q

Dog bite with MSSA

- Elaborate

A

Ampicillin/sulbactam (Augmentin)
- Sulbactam is penicillinase inhibitor that augments spectrum of ampicillin to include penicillinase-producing bacteria, including MSSA, H flu, Moraxella, and anaerobes

Also PO amoxicillin/clavulanate has similar spectrum

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11
Q

Which cephalosporin reliably covers enterococci?

A

None

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12
Q

TMP/SMX

  • MOA
  • Use
  • Toxic
A

MOA: inhibits folate synthesis and thus DNA synthesis: SMX inhibits PABA –> DHF, TMP inhibits DHF—> THF

Use:

  • First line uncomplicated UTI
  • Pneumocystitis jiroveci (PCP) tx and prophylax in AIDS
  • CA- MRSA, esp. osteomyelitis
  • Listeria if penicillin allergy

Toxicities:

  • Bone marrow (neutropenia, anemia)
  • Hypersensitivity (rash, SJS, TEN, sulfa allergies)
  • Hemolysis in G6PD
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13
Q

Community acquired MRSA pneumonia

A
  • Vancomycin (+ clindamycin to decrease toxin production)
  • Linezolid monotherapy OK
  • Daptomycin works but no advantage
  • Wrong: beta-lactam antibiotic other than ceftaroline as they do not bind to PBP2a
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14
Q

MSSA IV catheter related bloodstream infxn

  • Best
  • If penicillin allergy without anaphylaxis
  • If anaphylaxis to penicillin
  • Wrong antibiotic and why
A
  • Best: antistaph penicillin: nafcillin or oxacillin
  • Cefazolin
  • Vancomycin or daptomycin
  • Wrong: linezolid - not bactericidal and inferior for bloodstream infxns and endocarditis
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15
Q

Which cephalosporin reliably covers MRSA?

A

Ceftaroline

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16
Q

Vancomycin resistant Enterococcus faecium acquired in hospital?

  • Best abx until susceptibilities known?
  • Wrong?
A
  • Daptomycin

- Linezolid – lower efficacy for bloodstream infxn and endocarditis

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17
Q

Macrolides

  • MOA/resistance
  • Uses
  • Toxicities
A

MOA: 50S ribosomal subunit/change 23S + efflux pumps
Uses: Atypical walking pneumonia (legionella, mycoplasma, chlamydia), Chlamydia (+ ceftri for gonorrhea), H pylori, whooping cough, alternative for beta-hemolytic strep ENT infxn
Toxicity (MACRO)
- Motilin analogue (peristalsis, diarrhea, vomiting –> noncompliance)
- Acute cholestatic hepatitis (erythromycin)
- Cardiac arrhythmia (long QT –> Torsades de Pointes)
- Rash
- eOsonophilia

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18
Q

Listeria

A

Ampicillin, TMP-SMX

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19
Q

Syphilis?

A

Penicillin G!

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20
Q

What are the common gram positives? Gram negatives? Anaerobes?

A

Gram +:Staph, strep, enterococci (faecalis and faecium)
Gram -: Enterics (E. Coli, Klebsiella, Serratia, Enterobacter, Salmonella, Shigella) / Non-enterics (Pseudomonas, Acinobacter)
Anaerobes: Bacteriodes fragilis (G-), Clostridium difficile (G+)

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21
Q

Chlamydia/Mycoplasma

Study These Flashcards
A

Azithromycin, doxycycline

22
Q

Which oral antibiotics cover mild MRSA skin infxns?

Study These Flashcards
A
  • TMP/SMX and doxycycline
  • Clindamycin OK but risk of inducible resistance when isolate is resistant to erythromycin
  • Linezolid effective but expensive and unnecessary
  • Wrong: oral beta lactams
23
Q

Daptomycin uses, MOA, ADE

Study These Flashcards
A
  • Uses: similar to Vanco, good for endocarditis, DON’T use for pneumonia bc binds surfactant
  • Binds and disrupts cell membrane of Gram +s
  • ADE: rhabdo, monitor CPK
24
Q

Cephalosporin uses? ADEs? Do not do?

Study These Flashcards
A

As you go up, increasing gram negative coverage, decreasing gram positive, PCN allergy decreases
1st gen:
- Cefazolin: surgical prophylaxis for MSSA and strep
- Cephalexin: MSSA and soft tissue infxns
- Gram + and Gram - UTI bugs (PEK: Proteus, E Coli, Klebsiella)
2nd gen:
- Cefoxitin: surgical prophylaxis below diaphragm
- Cefuroxime: UTIs, rare
- 1st gen + HeNS (H flu, Neisseriae, Serratia)
3rd gen:
- Ceftriaxone: gonnorrhae, S.pneumo, good CSF penetration for meningitis
- Cetazidime: pseudomonas (decreasing efficacy)
4th gen: pseudomonas, SPACE G-s that make beta-lactamase (staph, pseudomonas, aspergillus, candida, enterobacteriae (klebsiella and serratia))

ADEs: increased nephrotoxicity with aminoglycoside, disulfiram-like rxn with alcohol

Do not do LAME: Listeria, Atypical bacteria (mycoplasma, chlamydiae), MRSA, Enterococci

25
Which beta lactam antibiotics cover ampicillin susceptible E faecalis?
Ampicillin, amoxicillin, piperacillin, and imipenem
26
Aminoglycosides - MOA - Uses - Toxicity - Other
Gentamycin, Neomycin, Tobramycin, Amikacin, streptomycin - MOA: 30S ribosomal subunit, dose dependent - Uses: Severe Gram Negative AEROBIC rod infxns; Gentamycin good for endocarditis - Toxicity NOT: Nephrotoxic (esp with cephalosporins), Ototoxic (esp with loop diuretics), Teratogen - Other: requires O2 for uptake --> ineffective against anaerobes; not effective in low pH environments like abscesses, synergy with vancomycin or beta-lactam which can attack cell wall allowing entry
27
VRE
Linezolid, tigecyclin
28
Clindamycin - MOA/resistance - Uses - Toxicities
MOA/resistance: 50S; change 23S Uses: anaerobic infxn (clostridia perfringes, bacteriodes) above the diaphgram (metro below the diaphragm) Toxic: C Diff, GI upset
29
Damages DNA
Metronidazole
30
What are the beta-lactam antibiotics?
Penicillins - PCN G (IV) - Penicillinase resistant: nafcillin (IV), oxacillin (IV/IM), dicloxacillin - Aminopenicillins: amoxicillin/clavulanate (PO); ampicillin(IV)/sulbactam Cephalosporins - 1st gen: cefazolin, cephalexin - 2nd gen: cefoxitin, cefuroxime - 3rd gen: ceftriaxone, cefotaxime, cetazidime - 4th gen: cefepime Carbapenems (imipenem(+cilastatin), meropenem) Monobactam (aztreonam)
31
Vancomycin uses, MOA, resistance, form of admin, toxicity
- Uses: Serious, gram positive, multi-drug resistant bugs - MOA: binds D-Ala, D-Ala portion of cell wall, inhibiting glycosyltransferase and block synthesis of peptidoglycan chains - Resistance: bug changes to D-Ala, D-Lac - Must be given IV (PO only for C Diff) - Toxicity (Deaf Red Man can't pee no Bone): Ototoxic, Red Man syndrome, Nephrotoxic, Bone marrow issues)
32
Malaria - Types - Prophylaxis - Trx (normal, severe, P vivax/ovale hypnozoite; ADEs)
- P falciparum, p.ovale, p.vivax most common - Prophylaxis: Doxycycline (QD dosing, pregnancy contraindication), Atovaquone/proguanil (malarone), chloroquinone (but resistance), mefloquine (but lots of cardiac and CNS ADE and resistance in Asia) - Trx: - Oral: atovaquone/proguanil (malarone), artemether/lumefantrine (co-arthrem), chloroquine if not resistant - Severe: IV quinidine + doxycycline (ADE: long QT) - P ovale/vivax hypnozoites: Primaquine (ADE: hemolysis in G6PD deficient pts)
33
E faecium
Vancomycin, daptomycin
34
MSSA
Nafcillin, oxacillin, dicloxacillin
35
Pseudomonas
Cefepime, piperacillin, ceftazidime
36
Metronidazole - MOA - Use - Toxicity
MOA: bactericidal, produce free radicals damaging DNA Use: - GET GAP on the Metro: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, h Pylori) - Anaerobes below the diaphgram (C Diff!!, bacteroides, protozoa) Toxic: - Disulfiram-like rxn with EtOh - Peripheral neuropathy - Headache - Metallic taste
37
Protein synthesis inhibitors - 30S - 50S
buy AT 30, CCEL at 50 30: Aminoglycosides (Gentamycin, Neomycin, Streptomycin, Tobramycin, Amikacin), Tetracyclines (doxycycline) 50: Clindamycin, Chloramphenicol, Erythromycin (= Macrolides: Azithromycin), Linezolid
38
Fluoroquinolones - MOA - Use - Toxicity
Ciprofloxacin, levofloxacin, norfloxacin, moxifloxacin MOA: inhibit DNA gyrase (topoisomerase II), dose-dependent Use: - Gram negative rods of urinary tract - Pseudomonas - Community acquired pneumonia (s pneumo) --> monotherapy with respiratory quinolones (levofloxacin, moxi) works Toxicity: - Cartilage --> contraind in pregnancy and children; tendonitis and tendon rupture in adults - GI upset - CNS hallucinations, seizures - Skin rash - QT prolongation
39
UTI (E Coli)
TMP-SMX, fluoroquinolones
40
MRSA
Vancomycin, daptomycin, clindamycin, TMP/SMX (CA-MRSA)
41
E faecalis
Ampicillin, piperacillin, imipenem, vancomycin
42
Tetracyclines - MOA - Uses - Toxicities
Tetracycline, Doxycycline - MOA: 30S ribosomal subunit - Uses: Chlamydia, walking pneumonia (mycoplasma), Rickettsia (RMSF), Bartonella, acne - Toxicities: Photosensitivity, GI distress, dizziness; contraindicated in pregnancy, don't give to kids (binds to calcium leads to tooth discoloration and inhibits bone growth, increases ICP), don't take with milk/antacids
43
TB therapy - Treatment course - Drugs - MOA - Side effects
RIPE - RIPE for 4 months, then RI for 2 - Rifampin: inhibits DNA-dep RNA pol; hepatitis, orange body fluids, flu-like sx, auto-inducer of CYP450, rapid resistance if used alone - INH: inhibits mycolic acid synthesis; induces neuropathy and hepatotoxicity --> peripheral neuropathy (B6 deficiency, pellagra --> give with pyridoxine supp), hepatitis, lupus-like syndrome - Pyrazinamide: MOA?/hyperuricemia, hepatotoxic - Ethambutol: inhibits cell wall synth; optic neuropathy affect red/green color vision
44
Gonorrhea
Azithromycin, ceftriaxone
45
- Bactericidal? | - Bacteriostatic?
Bactericidal (Very Finely Proficient At Cell Murder) - Vancomycin - Fluoroquinolones - Penicillins - Aminoglycosides - Cephalosporins - Metronidazole Bacteriostatic (ECSTaTiC) - Erythromycin (=Macrolides) - Clindamycin - Sulfamethoxazole - Trimethroprim - Tetracyclines - Chlorampenicol
46
Strep pneumo
Ceftriaxone, vancomycin for resistant strains, fluoroquinolones
47
What non beta-lactam antibiotic is excellent against anaerobes below the diaphragm?
Metronidazole
48
Aztreonam uses? What's special?
Only for AEROBIC gram negative bacteria (e.g. pseudomonas, legionella) Resistant to beta-lactamases; ONLY beta-lactam with no penicillin cross allergy
49
What non beta-lactam antibiotic is excellent against anaerobes above the diaphragm?
Clindamycin, but 25% B fragilis is resistant so not recommended below the diaphragm
50
Neisseria sp
Ceftriaxone
51
DNA Topoisomerases
Fluoroquinolones (cipro, levofloxacin, etc.)
52
Community-acquired pneumonia: single antibiotic that would cover strep penumo, h influenzae, and common "atypical" pneumonia pathogens (which are)?
Moxifloxacin or levofloxacin Wrong: - Ceftriaxone -- does not cover atypical pneumonia pathogens (Legionella pneumo, Chlamydiophila pneumo, Mycoplasma penumo) - Ciprofloxacin -- poor activity on Strep pneumo

Pharmacology (4 decks)

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