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OU Practice Spring 2018 > Antimicrobials > Flashcards

Antimicrobials Flashcards

(94 cards)

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1
Q

time dependent

A

Optimal effect when the antibiotic’s concentration remains above the MIC in any one duration of the dosing interval

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2
Q

concentration dependent

A

Optimal effect when concentrations are appreciably above the MIC for a given organism, up to a specific level

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3
Q

What is AUC?

A

total exposure / time

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4
Q

Bacteriostatic activity

A

refers to the inhibition of bacterial growth

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5
Q

Bactericidal activity

A

refers to killing the bacteria

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6
Q

Gram +

A
  • thicker cell wall (peptidoglycan)

- contains teichoic acid

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7
Q

Gram -

A
  • has periplasmic space
  • thinner cell wall (peptidoglycan)
  • has an outer membrane
  • has endotoxins
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8
Q

Beta-lactam antibiotics

A
  • Inhibit bacterial cell wall synthesis
  • Responsible for antimicrobial action
  • Bactericidal
  • Time-dependent killing
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9
Q

Which medications are in the class Penicillins?

A
  • Penicillin VK
  • Amoxicillin
  • Dicloxacillin
  • Amoxicillin-clavulanate
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10
Q

Penicillin VK

A
  • Veetids®
  • Covers mostly gram-positive organisms: Enterococci and Streptococci
  • Time dependent
  • bactericidal
  • Administer around-the-clock to promote less variation in peak and trough serum levels
  • Take on an empty stomach 1 hour before or 2 hours after meals
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11
Q

Penicillin VK dosages

A
  • Oral (tablet and solution for reconstitution)
  • Children: 25-75 mg/kg/day in divided doses q. 6-8 hours
  • Adults: 125-500 mg PO q. 6-8 hours
  • an IV exists
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12
Q

Penicillin VK uses and indications

A
  • Pharyngitis
  • Otitis media
  • Skin and soft tissue infections
  • Rheumatic fever
  • IV is used for gonorrhea
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13
Q

Penicillin VK adverse effects

A
  • Melanoglossia (blackening of the tongue)
  • Mild GI effects
  • Nausea, vomiting, diarrhea
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14
Q

Amoxicillin

A
  • Amoxil®
  • Gram-positive and some gram-negative coverage
  • Time dependent
  • bactericidal
  • Administer around-the-clock to promote less variation in peak and trough serum levels
  • Suspension: Shake well before use; may be mixed with formula, milk, fruit juice, water, ginger ale, or cold drinks; administer dose immediately after mixing
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15
Q

Amoxicillin dosages

A
  • Oral (capsule and solution for reconstitution)
  • Children: 25-50 mg/kg/day in divided doses q. 8 hours
  • Adults: 250-500 mg PO q. 8-12 hours
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16
Q

Amoxicillin uses and indications

A
  • Pharyngitis
  • Lower respiratory tract infections (and URI’s)
  • Endocarditis prophylaxis
  • ENT/skin and soft tissues infections
  • Animal bite
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17
Q

Amoxicillin adverse effects

A

Nausea, vomiting, and diarrhea

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18
Q

Amoxicillin-clavulanate

A
  • Augmentin®
  • Covers many gram-negative and gram positive organisms; Some anaerobic coverage
  • Dose adjust in renal dysfunction
  • Administer around-the-clock to promote less variation in peak and trough serum levels
  • Administer with food to increase absorption and decrease stomach upset
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19
Q

clavulanate

A

beta lactamase inhibitor

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20
Q

Amoxicillin-clavulanate dosages

A
  • Oral (tablets and solution for reconstitution)
  • Adults: 500 mg q. 8-12 hours or 875 mg q. 12 hours or 2 grams q. 12 hours
  • Children ( < 40 kg): 20-45 mg/kg/day in divided doses two to three times daily
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21
Q

Amoxicillin-clavulanate uses and indications

A
  • Sinusitis
  • Otitis media
  • Lower respiratory tract infections
  • Community acquired pneumonia
  • Urinary tract infection
  • Bite wounds
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22
Q

Amoxicillin-clavulanate adverse effects

A
  • Diarrhea
  • Nausea, vomiting, and abdominal distress
  • Has more GI problems than regular amoxicillin
  • Hepatic dysfunction (rare)
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23
Q

Dicloxacillin

A
  • Only covers staphylococcus epidermis & aureus (MSSE and MSSA)
  • Administer 1 hour before or 2 hours after meals with at least 120 mL of water (to protect the kidneys)
  • Administer around-the-clock to promote less variation in peak and trough serum levels.
  • Should not be administered in the supine position or immediately before going to bed
  • Drug-drug interaction with warfarin (lower effects of warfarin -> lower INR)
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24
Q

Dicloxacillin dosages

A
  • Oral capsule

- 125-500 mg q. 6 hours

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25
Dicloxacillin uses and indications
- Skin and soft tissue infections - Bite wounds - Impetigo
26
Dicloxacillin adverse effects
- Abdominal pain - Diarrhea - Nausea
27
What do the Penicillins have in common?
- time dependent killing - bactericidal - GI effects: nausea, vomiting, diarrhea
28
Which drugs are in the Cephalosporins class?
- Cephalexin - Cefaclor - Ceftriaxone - Cefepime
29
Cephalosporins
- Classified by generations: 1st - 4th - Some cross-sensitivity in patients with penicillin allergy - NONE OF THEM COVER ENTEROCOCCI (which is a gram +) but more broad spectrum - also beta lactams
30
Cephalexin
- Keflex® - 1st generation cephalosporin - Covers streptococci and staphylococcus aureus; some gram negative - Dose adjust with renal impairment - can take with food if GI distress - Give around-the-clock to promote less variation in peak and trough serum levels - Associated with elevated INR - drug interaction w/ metformin (increases met. levels)
31
Cephalexin dosages
- Oral (capsule and suspension for reconstitution) - Adult: 250 -1,000 mg q. 6 hours or 500 mg q. 12 hours (max: 4 g/ day) - Children: 25-100 mg/kg/day in divided doses q. 6-8 hours (max: 4 g/day)
32
Cephalexin uses and indications
- Impetigo - Skin and soft tissue infections - Pharyngitis - Urinary tract infection - Otitis media
33
Cephalexin adverse effects
- Abdominal pain - Diarrhea - Dyspepsia
34
Cefaclor
- Ceclor® - 2nd generation cephalosporin - Covers streptococci and staphylococcus aureus - Expanded gram negative coverage and Anaerobic coverage - Dose adjust in renal impairment - Administer around-the-clock to promote less variation in peak and trough serum levels. - Administer without regard to meals; shake oral suspension well before using - Extended release tablets: Do not chew, crush, or split; administer with or within 1 hour of food
35
Cefaclor dosages
- Oral (capsule, tablet, and suspension for reconstitution) - Adult: 250-500 mg q. 8 hours (500 mg q. 12 hours for ER) - Children: 20-40 mg/kg/day divided q. 8-12 hours
36
Cefaclor uses and indications
- Bronchitis | - Otitis media
37
Cefaclor adverse effects
- Diarrhea; Use with caution in patients with history of GI diseases - Increase in transaminases; monitor LFT's
38
Ceftriaxone
- Rocephin® - 3rd generation cephalosporin - Covers gram-positive and gram-negative organisms - Contraindicated in hyperbilirubinemic neonates (< 28d old) b/c drug displaces bilirubin off of albumin - contraindicated in use of this w/ IV Ca++ (which is highly bound to albumin)
39
Ceftriaxone dosages
- Given IV or IM - Adults: 1 -2 g q. 12-24 hours - Children: 50-100 mg/kg/day in 1-2 divided doses q. 12-24 hours
40
Ceftriaxone uses and indications
- Endocarditis - Gonorrhea - GI infections - Meningitis
41
Ceftriaxone adverse effects
- Diarrhea - Skin tightness & warm sensation at injection site (IM) - Pancreatitis (rare)
42
Cefepime
- Maxipime® - 4th generation cephalosporin - Covers gram-positive and gram-negative organisms; Expanded coverage of organisms with multiple-drug resistance patterns - Dose adjust in renal impairment
43
Cefepime dosages
- Usually given IV - Adults: 1-2 g q. 8-12 hours - Children: 50 mg/kg/dose q. 8-12 hours
44
Cefepime uses and indications
- Intra-abdominal infections - Pneumonia - Urinary tract infection - Meningitis
45
Cefepime adverse effects
- Positive direct Coombs test (false positive) - Transaminitis (increase in LFT's) - Hypophosphatemia - Neurotoxicity (rare)
46
What are the classes of Protein Synthesis Inhibitors?
- Aminoglycosides - Tetracyclines - Macrolides - Clindamycin
47
Aminoglycosides
- Binds to the 30S ribosomal subunit - Bactericidal - Concentration dependent - poor bioavailability
48
Which drugs are Aminoglycosides ?
- Gentamycin - Tobramycin - Neomycin
49
Gentamicin
- Covers mostly gram-negative organisms - TDM is required - Avoid in pregnant women - Dose adjust in renal impairment
50
Gentamicin dosages
- IV or IM dosing | - 2-5 mg/kg/day in divided doses q. 8 hours
51
Gentamicin uses and indications
- Endocarditis - Meningitis - Intra-abdominal infections - Sepsis/septic shock - Synergy
52
Gentamicin adverse effects
- Nephrotoxicity - Neurotoxicity - Ototoxicity - Neuromuscular toxicity
53
Tetracyclines
- Bind to 30S ribosome subunit - Bacteriostatic - Time-dependent
54
Which drugs are in the Tetracycline class?
- Doxycycline (Vibramycin®, Adoxa®) - Minocycline (Minocin®) - Demeclocycline
55
Doxycycline
- Vibramycin®, Adoxa® - Some gram-positive and gram negative organisms; some anaerobes; atypical organisms - Chronic ethanol use may reduce the serum concentrations of doxycycline. - Serum levels may be slightly decreased if taken with high-fat meal or milk. - Administration with iron or calcium may decrease doxycycline absorption. - May cause tissue hyperpigmentation, tooth enamel hypoplasia, or permanent tooth discoloration when used during tooth development in last half of pregnancy, infancy, and childhood ≤8 years of age
56
Doxycycline dosages
- Oral (immediate-release and extended-release formulations) - 100-200 mg/day in one-to-two divided doses
57
Doxycycline uses and indications
- Pneumonia - Rock Mountain spotted fever - Chlamydia - Lyme Disease
58
Doxycycline adverse effects
- GI inflammation/ulceration (esp if taken without water or lying down) - Intracranial hypertension - Photosensitivity - Tissue hyperpigmentation - Hepatotoxicity (rare)
59
Macrolides
- Bind to 50S ribosome subunit - Time-dependent or concentration-dependent - Bacteriostatic
60
Which drug classes are in the Macrolide class?
- Azithromycin (Zithromax®) - Erythromycin (E.E.S. 400®, Ery-Tab®) - Clarithromycin (Biaxin®) - Fidaxomicin (Dificid®)
61
Azithromycin
- concentration dependent - Bacteriostatic - Coverage: Some gram-positive and gram-negative; Atypical organisms - Inhibitor of P-gp -> drug interactions - Avoid in combination with amiodarone
62
Azithromycin dosages
- Oral formulations - 1-2 g as a single dose (Chlamydia) - 500 mg daily - 500 mg on day 1, followed by 250 mg daily on days 2-5
63
Azithromycin uses and indications
- Pneumonia - Sinusitis - Chlamydia - H. pylori infection - Pharyngitis - Pelvic inflammatory disease
64
Azithromycin adverse effects
- GI: loose stools (common), vomiting, nausea, diarrhea (not as common) - QT prolongation
65
Clindamycin
- Cleocin® - Lincosamide - Bind to 50S ribosome subunit - Bacteriostatic - Time-dependent - Coverage: expanded gram-positive and anaerobic organisms - Use with caution in patients with GI disease - Caution in patients with moderate to severe hepatic impairment
66
Clindamycin dosages
- Oral and IV - Adults: 150 – 450 mg PO q. 6 hours; 600-2700 mg/day in 2-4 divided doses - Children: 8-40 mg/kg/day PO in 3-4 divided doses; 20-40 mg/kg/day in 3-4 divided doses
67
Clindamycin uses and indications
- Pneumonia - Otitis media - Bone and joint infections - Intra-abdominal infections - Lower respiratory tract infections - Skin and soft tissue infections
68
Clindamycin adverse effects
- Diarrhea - Metallic taste: IV formulation - Black-box warning: Colitis
69
Metronidazole
- Flagyl® - Nitroimidazole pro-drug - Reduced by organism to active form - Bactericidal - Concentration-dependent - Effects organism’s DNA: Disrupts structure, Inhibits replication - Coverage: Anaerobic organisms, Parasites - IV formulation contains sodium - Taking alcohol with this can lead to: abd cramps, nausea, vomiting, headaches, and flushing - avoid alcoholic beverages or products containing propylene glycol during oral or injectable therapy and for at least 3 days after therapy - Dose adjust with severe hepatic impairment - Contraindicated in first trimester of pregnant patients - Drug-drug interactions: Warfarin, Lopinavir
70
Metronidazole dosages
- Oral and IV formulations | - 250-750 mg q. 8 hours
71
Metronidazole uses and indications
- Amebiasis - Bacterial vaginosis - Intra-abdominal infections - Trichomoniasis - Giardiasis - Clostridium difficile-associated diarrhea (important)
72
Metronidazole adverse effects
- Headache (not as common, can take with food if IR) - Nausea (not as common, can take with food if IR) - Metallic taste - CNS-related effects - Black Box Warning: Metronidazole has been shown to be carcinogenic in mice and rats
73
Sulfamethoxazole & Trimethoprim components
- Sulfamethoxazole • Sulfonamide with structural similarity to PABA • Inhibits the conversion of PABA to dihydropteroic acid by inhibiting the enzyme dihydropteroate synthase - Trimethoprim • Prevents reduction of dihydrofolic acid to tetrahydrofolic acid by inhibition of dihydrofolate reductase
74
Sulfamethoxazole & Trimethoprim
- bactericidal - Concentration-dependent - Coverage: Staphylococci, Gram-negative organisms - many drug interactions; can cause increased INR - Avoid in first trimester of pregnancy - Dose adjust in renal impairment - Avoid in patients with G6PD deficiency -> could cause hemolysis - Avoid in sulfa hypersensitivity
75
Sulfamethoxazole & Trimethoprim dosages
- Dosing (PO and IV) - Bactrim DS® (PO) 160 mg TMP/800 mg SMX tablets -> 1 tablet PO q. 12 hours - Bactrim SS® (PO) 80 mg TMP/400 mg SMX tablets -> 2 tablets PO q. 12 hours - IV: 80 mg TMP/400 mg SMX
76
Sulfamethoxazole & Trimethoprim uses and indications
- Urinary tract infections - Pneuomcystis carinii jirovecii (PJP) - Nosocomial infections - Otitis media
77
Sulfamethoxazole & Trimethoprim adverse effects
- GI: nausea, vomiting (take with food to decrease) - Rise in serum creatinine (has nothing to do with renal function; this is due to renal tubular secretion) - Hyponatremia - Crystaluria (drink plenty of fluid to avoid this) - Hyperkalemia (Trimethoprim component, it looks like amiloride)
78
Nitrofurantoin
- Activated by enzymatic reduction - Damage bacterial DNA - Bactericidal - Concentration-dependent - Coverage: Gram-positive and Gram-negative organisms - Take with food - Avoid in patients with a history G6PD deficiency - Contraindications: Pregnant patients at term (38-42 wks), CrCl < 60 mL/min, History of cholestatic jaundice or hepatic dysfunction - interacts with magnesium; lowers the effect of the drug
79
Nitrofurantoin dosages
- Oral dosing - Macrodantin®: 50-100 mg q. 6 hours - Macrobid®: 100 mg PO BID
80
Nitrofurantoin uses and indications
Urinary tract infection
81
Nitrofurantoin adverse effects
- Colors urine brown - Optic neuritis & peripheral neuropathy (rare); associated with long term use - Pulmonary toxicity - Hepatic reactions (rare)
82
Fluoroquinolones
- Inhibition of DNA gyrase and topoisomerase IV - Bactericidal - Concentration-dependent - Coverage: broad spectrum; minimal gram + but many gram - - Atypical organisms - Varying anaerobic organisms coverage - Avoid concomitant administration of antacids, certain iron salts, and certain zinc salts - Black box warning: due to high ADE's, this should be reserved for pts that have no alternative treatment options for the following indications: acute exacerbation of chronic bronchitis, acute sinusitis, and acute uncomplicated cystitis (UTI)
83
Which drugs are in the Fluoroquinolone class?
- Ciprofloxacin (Cipro®) - Levofloxacin (Levaquin®) - Moxifloxacin (Avelox®)
84
Compare and contract Fluoroquinolone agents with respect to coverage
- Levofloxacin and moxifloxacin are better respiratory-covering agents - Moxifloxacin has expanded coverage
85
Fluoroquinolone uses and indications
- UTI - Endocarditis - Prostatitis - Pneumonia - STIs - GI and abdominal infections - Respiratory tract infections - Bone, joint, and soft tissue infections
86
Fluoroquinolones adverse effects
- GI upset - CNS effects - QT prolongation - Hepatotoxicity - Tendon rupture - Hypoglycemia - Crystaluria - Photosensitivity
87
Ciprofloxacin
- PO: 500-750 mg q. 12 hours - IV: 400 mg q. 12 hours - Dose adjust in renal impairment - Drug-drug interactions
88
Levofloxacin
- PO or IV: 250-750 mg q. 24 hours - Dose adjust in renal impairment - Minimal hepatic metabolism
89
Moxifloxacin
- PO or IV: 400 mg q. 24 hours - PO or IV: 400 mg q. 24 hours - Not metabolized via CYP450 isoenzymes - Highest risk of QT prologation - not to be used for UTIs
90
Minocycline brand name
Minocin®
91
Erythromycin brand name
- E.E.S. 400® | - Ery-Tab®
92
Clarithromycin brand name
Biaxin®
93
Fidaxomicin brand name
Dificid®
94
Moxifloxacin brand name
Avelox®

OU Practice Spring 2018 (9 decks)

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