Antimicrobials Flashcards
(75 cards)
1
Q
Penicillin family
A
- MOA: weakens cell wall
- Spectrum: variety of bact.
- Structure: Beta-lactam ring
- ADVERSE: allergy likely - #1 allergy drug, likely allergic to similar drugs
2
Q
Beta-Lactam Family
A
- 4 sided Beta-lactam Ring
- Includes: Penicillin Cephalosporin Aztreonam Imipenem Meropenem Ertapenem
- ***ADD PICTURE
3
Q
Penicillin G (Benzylpenicillin) (&V)
A
- Quintessential**
- Family: Penicillin
- Spectrum: Narrowest
- Sensitivity: Penicillinase (Xed by <—)
4
Q
Nafcillin
A
- Family: Penicillin
- Spectrum: Narrow Spectrum of Penicillin family
- Sensitivity: none? (resistant to penicillinase)
- Target: Staphylococcus Aureus
5
Q
Oxacillin
A
- Family: Penicillin
- Spectrum: Narrow
- Sensitivity: none? (resistant to penicillinase)
- Target: Staphylococcus Aureus
6
Q
Dicloxacillin
A
- Family: Penicillin
- Spectrum: Narrow
- Sensitivity: none? (resistant to penicillinase)
- Target: Staphylococcus Aureus
7
Q
Ampicillin
A
- Family: Penicillin
- Spectrum: Broad-Spectrum (Aminopenicillins)
- Sensitivity: Penicillinase sensitive
- ALT: Unasyn (Ampicillin/sulbactam)
- Target: Gram +, more Gram -
- Example: Haemophilus influenzae, E-coli, Proteus mirabilis, enterococci, Neisseria Gonorrhoeae
- ADVERSE: Rash and Diarrhea
8
Q
Amoxicillin
A
- Family: Penicillin
- Spectrum: Broad-Spectrum (Aminopenicillins)
- Sensitivity: Penicillinase
- ALT: Augmentin (Amoxicillin/clavulanic acid)
- Target: Gram +, more Gram -
- Example: Haemophilus influenzae, E-coli, Proteus mirabilis, enterococci, Neisseria Gonorrhoeae
- ADVERSE: Rash and Diarrhea
9
Q
Ticaracillin
A
- Family: Penicillin
- Spectrum: Extended-Spectrum
- Sensitivity: Penicillinase (X by <—)
10
Q
Pipercillin
A
- Family: Penicillin
- Spectrum: Extended-Spectrum
- Sensitivity: Penicillinase (X by <—)
11
Q
Bacterial Resistance to Penicillins
A
- Inactivation by bacterial enzymes EX: penicillinase or beta-lactamase
- PBP alteration - alter sites of penicillin binding (MRSA)
12
Q
Penicillin Allergy
A
- Immediate - 2-30 mins (most severe)
- Accelerated - 1-72 hours
- Delayed - 1 day - weeks
- Anaphylaxis - Laryngeal edema, Bronchoconstriction, Severe Hypotension
- ***EPINEPHERINE to Treat*****
13
Q
Aminoglycocsides
A
- Therapeutic: Work together with Penicillin
- Penicillin breaks cell wall
- Aminoglycoside sweeps in to block protein synthesis
- ADVERSE: dosing together will inactivate!
14
Q
Bacteriostatic Antibiotics
A
Reduces rate of bacterial growth ADVERSE: negates effect of bacteriocides (ie Penicillins) - these need high bacteria growth to lyse cell walls and kill
15
Q
Probenecid
A
ADVERSE: delays excretion of penicillin from body = BAD
16
Q
Beta-lactamase inhibitors
A
- Clavulanic Acid, Tazobactam, sulbactam
- MOA: extends antimicrobial spectrum of penicillinase sensitive antibiotics (suppresses activity of -ase enzyme)
17
Q
Unasyn
A
Ampicillin/sulbactam Antibiotic + Penicillinase-suppressor
18
Q
Augmentin
A
Amoxicillin and clavulanic acid Antibiotic + Penicillinase-suppressor
19
Q
Timentin
A
Ticarcillin/clavulanic acid Antibiotic + Penicillinase-suppressor
20
Q
Zosyn
A
Piperacillin/tazobactam Antibiotic + Penicillinase-suppressor
21
Q
Cephalosporin Family
A
- Family: Beta-lactam (similar to penicillin)
- MOA: bacteriocide- bind to penicillin proteins and lyse cell wall - prefer dividing cells
- Route: parenteral usually
- Sensitive: less sensitive to cephalosporinase (B-lactamase) as generations progress, 1+2 especially sensitive
- ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
- D v. D:
- Probenecid - delays renal excretion
- Alcohol - can cause alcohol poisoning Drugs that promote bleeding: Cephalosporins can also promote bleeding
22
Q
Cephalexin
A
- Family: Cephalosporin
- Generation: 1st
- Route: Parenteral usually
- Therapeutic: most active against gram +, Prophylaxis for surgical patients, Rarely used for active infections
- ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
- D v. D:
- Probenecid - delays renal excretion
- Alcohol - can cause alcohol poisoning
- Drugs that promote bleeding: Cephalosporins can also promote bleeding
23
Q
Cefoxitin
A
- Family: Cephalosporin
- Generation: 2nd
- Route: Parenteral usually
- Therapeutic: not many. Oral cefuroxime - otitis, siusitis, URIs
- ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
- D v. D:
- Probenecid - delays renal excretion
- Alcohol - can cause alcohol poisoning
- Drugs that promote bleeding: Cephalosporins can also promote bleeding
24
Q
Cefotaxime
A
- Family: Cephalosporin
- Generation: 3rd
- Route: Parenteral usually
- Therapeutic: preferred for multiple infections, HIGHLY active. For gram -, CSF penetration, used only when necessary
- ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
- D v. D:
- Probenecid - delays renal excretion
- Alcohol - can cause alcohol poisoning
- Drugs that promote bleeding: Cephalosporins can also promote bleeding
25
Cefepime
* Family: Cephalosporin
* Generation: 4th
* Route: Parenteral usually
* Therapeutic: Health care and hospital pneumonias, esp. resistant Pseudomons
* ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
* D v. D:
* Probenecid - delays renal excretion
* Alcohol - can cause alcohol poisoning
* Drugs that promote bleeding: Cephalosporins can also promote bleeding
26
Ceftaroline
* Family: Cephalosporin
* Generation 5th
* Route: Parenteral usually
* Therapeutic: MRSA
* ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
* D v. D:
* Probenecid - delays renal excretion
* Alcohol - can cause alcohol poisoning
* Drugs that promote bleeding: Cephalosporins can also promote bleeding
27
Cefatriaxone
* Family: Cephalosporin
* Gen: Unknown \*\*\*\*FILL. IN\*\*\*\*\*\*\*
* ADVERSE: plus calcium = highly toxic/fatal precipitates
28
Cefuroxime
* Family: Cephalosporin
* Gen: 2nd
* Therapeutic: Oral - otitis, siusitis, URIs
29
Imipenem
* Family: Carbapenems
* AKA: Primaxin
* Therapeutic: most bacteria and resistant bacteria NOT MRSA, HIGH active gram + cocci and many gram - cocci and bacilli
* \*\*Most effective beta-lactam against anaerobic bacteria
30
Vancomycin
* Family: ?
* MOA: lyses cell wall, no B-lactam ring
* Route: IV - (GI absorbtion poor)
* AKA: Vancocin, Vancoled
* Therapeutic: severe infections only
* Example: MRSA, Staph-epidermidis, Cdiff
* ADVERSE:
* Ototoxicity (sometimes permanent)
* Red man syndrome
* Thrombophlebitis (common)
* Thrombocytopenia (rare)
* Allergy Renal failure
31
Red man syndrome
Flushing, rash, pruritus (itching), uticaria (hives), tachycardia, hypotension
32
Tetracyclines
* MOA: Bacteriostatic inhibitor of Protein Synthesis (slows down)
* Spectrum: Broad
* Types: Tetracycline, Demeclocycline, Doxycycline, Minocycline (pharmkin. Differences)
* Route: Oral, absorbtion reduced by food (Chelation = insoluble chelates formed with Ca2+) (no milk, iron, magnesium lax, antacid)
* Bact. Resistance: Has started to occur
* Therapeutic: Acne, peptic ulcer disease, periodontal disease, rheumatoid arthritis, mycoplasma pneumoniae, lyme, anthrax, H. Pylori
* ADVERSE:
* GI irritant
* Discolor teeth esp children
* superinfections
* hepatotoxicity(esp high dose IV)
* renal toxicity (excreted in urine)
* photosensitivity
33
Tetracycline and Demeclocycline
Accumulated in patients with kidney disease
34
Erythromycin
* Family: Macrolide
* MOA: Inhibition of protein synthesis - slows down (sometimes bactericidal)
* Spectrum: Broad
* Therapeutic use: Allergic to Penicillin, Most gram + some gram -
* Specific Use: Whooping cough, acute diphtheria, Corynebacterium diphtheriae, chlamydial infections, M. Pneumoniae, Group A strep. Pyogenes
* D v. D: Hepatic enzyme inhibitor \*ex. Theophylline, carbamazepine, warfarin
* ADVERSE:
* GI
* QT elongation + sudden cardiac death
* superinfections
* thrombophlebitis
* hearing loss (transient)
35
Clyndamicin
* Family: ????\*\*\*\*
* MOA: Bacterial Static Inhibitor of Protein Synthesis
* Therapeutic: Anaerobic Bacteria (gram + and gram -)
* Use Example: Anaerobic infections outside of CNS, alternative to penicillin
* ADVERSE:
* C. Diff cause
* hepatic toxicity
* Blood dyscrasias (blood cell disorder)
* Diarrhea
* Hypersensitivity Rxn (allergy)
36
Linezolid
1. Class: Oxazolidinones (new)
2. MOA: Bacteriostatic inhibitor of Prot. Syn.
3. Use: MDR-gram +, aerobic and facultative gram +
4. EX: VRE, MRSA
5. Resistance: Unlikely
6. ADVERSE: Diarrhea, N/V, Headache, myelosuppression
7. DvD: Inhibitor of MAO so with Monoamine oxidase inhibitors (MAOI) = Hypertensive crisis
37
Telithromycin
1. Class: Ketolide (Prototypic) (like erythromycin and other macrolides)
2. Use: Streptococcus pneumoniae
3. ADVERSE:
1. Severe liver injury
2. GI effects
3. Visual disturbances
4. Prolonged QT interval
38
Aminoglycosides
1. Class: Aminoglycosides
2. Spectrum: Narrow
3. Type: Gentamicin, tobramycin, amikacin
4. MOA: BacteriCIDal Inhibitor of Prot. Synthesis
5. Use: Aerobic, gram- bacilli
6. ADVERSE:
1. ototoxic
2. nephrotoxic
3. Hyper sensitivity
4. Blood dyscrasias
7. DvD GOOD: Penicillin, Cephalo, Vacomycin
8. DvD BAD:
1. Neuromuscular blocker/skeletal muscle relaxants - do not interact well with neuromuscular blockers, general anesthetics and in myasthenia gravis
2. Ototoxic drugs
3. nephrotoxic drugs
9. Route: Parenteral - no oral
10. Treatment of choice: Reversal with IV Infusion of a calcium salt
11. SERUM LEVELS: Diff. Plasma levels in diff. Patients - watch out for trough creep (test peak 30 mins after, test trough immediately before next dose or 1 hour before if only 1x per day)
39
Gentamicin
1. Class: Aminoglycoside
2. Use: aerobic gram- bacilli
3. EX: Pseudomonas aeruginosa, E. Coli, Klebsiella, Serratia, Proteus mirabilis
4. ADVERSE: Nephrotoxicity, Ototoxicity
40
Sulfonamides
1. Spectrum: broad
2. Similar to: Trimethoprim
3. MOA: Suppress bacterial growth by inhibiting tetrahydrofolic acid (folic acid cycle)
1. \*mammals intake folic acid, bacteria synthesize it
4. USE: UTI, Nocardiosis, Chlamydia trachomatis, toxo/malaria, ulcerative colitis
5. ADVERSE:
1. Hypersensitivity - Stevens-Johnson syndrome
2. Hemolytic anemia
3. Kernicterus
4. Renal damage from crystalluria
6. DvD:
1. intensifies - warfarin, phenytoin, sulfonylureas.
2. Cross hypersensitivity - thiazide, diuretics, loop diuretics and sulfonylureas
7. Fun facts: first drug available for systemic bact. Infection (better drugs now available)
41
Trimethoprim
1. MOA: inhibits dihydrofolate reductase (key enzyme in conv. B/t dihydrofolic acid to active tetrahydrofolic acid = suppress DNA/RNA/Protein in bacteria)
2. USE: Acute, uncomplicated UTI, EColi, Proteus Mirabilis, Klebsiella pneum., Enterobacter, coagulase-negative staph.
3. ADVERSE:
1. Megoblastic anemia
2. thrombocytopenia
3. neutropenia
4. Hyperkalemia
5. teratogenic (folate deficiency)
42
TMP/SMZ
1. Combo: Trimethoprim/Sulfamethoxazole
2. MOA: Inhibits several sequential steps in folic acid synth. - more powerful
3. Route: Plasma levels should be 1:20 ratio
4. USE: UTI, otitis media, bronchitis, shigellosis, pneumonia from Pneumocystis jiroveci, “”pneumonia and GI
5. ADVERSE: GI-N/V, Rash, Hyperkalemia, Hypersensitivity (Stevens-Johnson) = blood dyscrasias, kernicterus, Crystallura (renal damage)
43
Fluoroquinolones
1. Spectrum: Broad/many applications
2. MOA: Disrupt DNA replication and cell division
3. Route: oral or IV
4. ADVERSE: tendon rupture (achilles heel)
1. Population = under 18, over 60, with Kidney, Heart or Lung Transplant
5. DvD: Glucocorticoids (Tendon rupture)
44
Ciprofloxacin
1. Class: Fluoroquinolone
2. Spectrum: Broad
3. MOA: inhibits DNA gyrase and topoisomerase II
4. Use: Gram - and some gram +
5. EX: multiple system infections, Respiratory, UTI, GI, bones, joints, skin and soft tissue
6. DRUG OF CHOICE: Anthrax
7. ADVERSE: Mild - GI (N/V, diarrh., abdom. Pain) CNS - dizziness, headache, restless ness, confusion, seizures (rare), Tendon rupture, Phototoxicity, Candida, Risk of CDAD
8. Pop affected: Older - confusion, somnolence, psychosis, visual dist. Myasthenia gravis
9. DvD/DvF:
1. Absorb reduced: Alum and Mag. Antacids, Iron and Zinc Salts, Sucralfate, Milk and Dairy Elevation of Tehopylline (asthma), Warfarin (anticoag), Tinidazole (antifungal)
45
Ofloxacin
Class: Fluoroquinolones
46
Moxifloxacin
Class: Fluoroquinolones
47
Norfloxacin
Class: Fluoroquinolones
48
Levofloxacin
Class: Fluoroquinolones
49
Gemifloxacin
Class: Fluoroquinolones
50
Metronidazole
1. MOA: Bactericidal
2. AKA: Flagyl
3. USEE: Protozoal infections, obligate anaerobes, H.pylori, CDI (CDAD)
4. ADVERSE: Neurotoxic, Allergy, Superinfections
51
Daptomycin
1. Class: Cyclic Lipopeptide (new)
2. AKA: Cubicin
3. MOA: Bactericidal
4. USE: all Gram +, MRSA
5. EX: Blood infection with S.aureus, complicated skin/skin related infections by gram +
6. DvD: none
7. ADVERSE: muscle injury
8. Route: IV 1x daily
52
Rifampin
1. Spectrum: Broad
2. USE: TB, also meningitis (not monotherapy), proph. Of meningitis from Haemophilus influenzae
3. Can turn urine orange
53
Rifaximin
1. Non absorbable PO form of Rifampin
2. USE: traveler’s diarrhea OR prevent encephalopath in older patients with chronic liver disease
3. ADVERSE: N, fart, defecation urgency
54
Bacitracin
Route: topical Systemic - could be toxic
55
Polymyxin B
Topical - ears, eyes, skin USE: in combo Risk of systemic infection b/c of toxicity
56
Acute Pharyngitis/tonsillitis/Scarlet fever (Sterpococcus pyogenes, supected or proven)
1st Choice: Penicillin V or G 2nd Choice: Erythromycin, Clindamycin, Vancomycin, Azithhromycin, daptomycin, linezolid, any cephalosporin \*\*\*Most sore throats are viral\*\*\*
57
Diptheria (corynebacterium diptheriae)
1st choice: Erythromycin 2nd choice: Penicillin G \*\*\*\*Antitoxin and supportive treatment are very important (antibiotic 2ndary). Give antibiotic to close contacts and immunize.\*\*\*\*
58
Acute Otitis Media and acute sinusitis (Strep pneumoniae, Haemophilus influenzae and Moraxella catarrhalis)
1st Choice - Ampicillin, Penicillin G/V or Amox. - Strep Pneumonia, Trimethorprim/Sulfamethoxazole - Haeemophilus influenze 2nd Choice - Strep Pneumonia - cephal., erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin Haemophilus Influenza - Cefurxime, amox/clavulanic acid, flouroquinolone \*\*\*\*S. Pneumoniae and H. influenzae in Malaysia = sensitive to ampicillin BUT M.Cattarhalis = resistant to ampicillin\*\*\*
59
Acutee Epiglottitis (Haemophilus influenzae)
1st choice: chloramephenicol 2nd choice: Ampicillin OR 3rd gen. Cephalosporin \*\*\*\*Acute epiglottitis is a medical emergency and requires hospitalization\*\*\*\*\*
60
Pertusssis (Bordetella pertussis)
1st Choice: Erythromycin, Azithromycin, Clarithromycinee 2nd Choice: Trimethorprim/sulfamethoxazole \*\*\*\*\*Antibiotics don’t do much, but may erradicate oropharyngeal organisms and disrupt transmission\*\*\*\*\*
61
Acute bronchitis (2ndary bact. Infecition from S.Pneumoniae and Haemophiluss influenzae)
1st Choice: Ampicillin S. Pneumonia - Penicillin G/V or Amox. H. influenza - Trimethorprim/sulfamethoxazole 2nd Choice: S. Pneumonia - Cephal., erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin H. Influenza - cefurxime, amox/clavulanic, a flouroquinolone \*\*\*\*usually viral = antibiotics not indicated!!! 2ndary BACT. infection may occur in severe cases. IF mycoplasma THEN Erythromycin\*\*\*\*\*\*
62
Acute Exacerbations of chronic bronchitis (Steptococcus Pneumoniae, H. Influenzae, M. Catarrhalis)
1st choice: Ampicillin S. Pneumonia - Peni. G/V or Amox. H. Influenza - Trimethorprim/sulfamethoxazole 2nd choice: S. Pneumonia - Cephalo., Erythro, azithro, levofloxacin, imipenem, tetracycline, vancomycin H. Influenza - Cefurxime, Amox/Clavulanic, a flouroquinolone
63
Pneumonia (Community Acquired mild to moderate) Streptococcus Pneumonaie, Haemophilus Influenzae, Mycoplasm
1st Line: Ampicillin OR Strep. Pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole Mycoplasm - erythromycin, clarithromycin 2nd Line: Strep. Pneumonia: cephalosporin, erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin Haemophilus influenza - Cefurxime, amoxicillin/clav. \*\*\*\*When Staph Aureus USE cloxacillin and gentamicin\*\*\*\*\*\*
64
Acute Urinary Tract infection (E.coli, staphylococcus saprophyticus)
1st Line: E. Coli - Cefataxime, ceftazidime, cefepime, ceftriaxone Staphylococcus saprophyticus - Ampicillin, Amoxicillin 2nd Choice: Ecoli - Ampicillin w/or w/o gentamycin, ticarcillin/clav., trimepthroprim/sulfamethoxazole, imipenem, meropenem Staphylococcus Saprophyticus - Nitrfuratoin, a fluoroquinolone, fosfomycin \*\*\*\*\*Many now resistant to ampicillin. Uncomplicated cystitis in adults = 4 tabs cotrimoxazole in one dose. Pregnant - ampicillin given for 10 days\*\*\*\*\*\*\*
65
Pyelonephritis and complicated UTI (E Coli, other Enterobacteriaceae)
1st Line: 2nd Gen. Cephalosporin and Gentamicin, A quinolone
66
Catheter associated infections (Enterbacteriaceae, Pseudomonas and Enterococcus)
Treat after culture and sensitivity report Enterobacteriaceae - Imipenem, meropenem, cefepime Pseudomonas - Ciprofloxacin Enterococcus - Ampicillin, Amoxicillin 2nd Line: Enterobacteriaceae - Trimethorprim/sulfamethoxazole, gentamicin, ciprofloxacin, cefotaxime, turcarcillin/clavulanic acid Psuedomonas- Levofloxacin, ceftazidime, cefepime, imipenem, gentamiicin Enterococcus - nitrofurantoin, a fluoroquinolone, fosfomycin
67
Impetigo (Strep pyogenes, Staph aureus)
1st Choice: Penicillin G/V 2nd Choice: Clindamycin, vancomycin, erythromycin, daptomycin, linezolid, a cephalosporin
68
Cellulitis (Strep pyogens)
1st Line: Penicillin G/V 2nd Choice: Clindamycin, vancomycin, erythromycin, dapto mycin, linezolid, a cephalo.
69
Diabetic Foot Infection (Polymicrobial infection, Enterobacteriaceae, Staph aureus, Strepttococci, Anaerobic bacteria)
1st Line: 2nd or 3rd Generation Cephalo and Metronidazole OR Betalactam-Betalactamase inhibitor combination 2nd Choice: Cloxacillin AND Gentamicin AND Metronidazole \*\*\*\*\*could involve extensive tissue and bone necrosis. Surgical debridement is often needed. Duration of treatement depends on response\*\*\*\*\*
70
Gingivitis (Spirochaetal, streptococci and oral anaerobes)
1st Line: Penicillin V AND metronidazole 2nd Choice: Doxycycline, ceftriaxone
71
Periodontal infections (Strepttococci and oral anaerobes)
1st Line: Penicillin G/V 2nd Choice: Erythromycin
72
Anitbiotic Associated Colitis (Clostridium difficile)
1st Line: Vancomycin (oral) OR metronidazole
73
MRSA
1st Line: Vancomycin w/ or w/o Gentamicin w or w/o Rifampin 2nd Choice: Linezolid, daptomycin, trimethorprim/sulfamethoxazole, a fluoroquinolone
74
Neisseria meningitides (Meningitis)
1st Line: Penicillin G 2nd Choice: Cefotaxime, ceftriaxone, chloramphenicol, sulfonamide, a fluoroquinolone
75
Borrelia burgdorferi (Lyme Disease)
1st Line: Doxycycline, amoxicillin, cefuroxime 2nd: Ceftriaxone, cefotaxime, penicillin G, azythromycin, clarithromycin
