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Antimicrobials Flashcards

1
Q

PCNase-Susceptible
Narrow Spectrum
Tx: Gonorrhea, Syphilis
PCN G, PCN V, Benzathine PCN

A

Natural Penicillins

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2
Q

PCNase-Resistant
Narrow Spectrum (minimal to no gram - activity)
MSSA
Methicillin, nafcillin, oxacillin, dicloxacillin
Hepatic excretion: nafcillin, oxacillin

A

Anti/staphylococcal Penicillins

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3
Q 
PCNase-Susceptible
Aminopenicillins
Broad Spectrum
Similar to PCN G, more gram- bacilli coverage 
Amoxicillin, ampicillin
A

Extended Coverage Penicillins

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4
Q 
PCNase-Susceptible
Extended Spectrum
Broad + pseudomonas coverage
Piperacillin, ticarcillin
Parenteral only
A

Anti/pseudomonal Penicillins

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5
Q 
Beta-lactam
Bactericidal
Stronger resistance against B-lactamases
5 generations 
Gen 1→5 = + gram- and anaerobe coverage
Gen 1→5 = + resistance against B-lactamases
A

Cephalosporins

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6
Q

Only commercially available b-lactam of its class that can take on MRSA. Reserved for complicated skin conditions as well as community-acquired pneumonia. Broad spectrum. Advanced generation. Pro-drug.

A

Ceftaroline

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7
Q

Renal dosage adjustments for cephalosporins except for 3rd generation _____, which is hepatically metabolized.

A

Ceftriaxone

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8
Q

Extremely broad coverage (nearly than all other antimicrobials. Pseudomonas coverage. None active against MRSA, though. Renal adjustments. Imipenem, Meropenem, Ertapenem, Doripenem.

A

Carbapenems

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9
Q 
Aztreonam
Relatively B-lactamase resistant
Gram - coverage
Renal adjustment
Not resistant to ESBLs
A

Monobactams

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10
Q 
Non-B-lactam
Gram +
Glycopeptide
Most widely used in US hospitals
Tx: C. difficle, MRSA
Binds precursors for cell wall biosynthesis
MRSE
Nephrotoxic, ototoxic, RED MAN
A

Vancomycin

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11
Q 
Non-B-lactam
Gram +
\$\$$
Tx of skin, skin MRSA, Skin VRE
[dependent]
Cell membrane rapid depolarization
No good for tx of peneumonia due to surfactants 
Can cause rhabdo
Stop Statins
A

Daptomycin

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12
Q 
Non-B-lactam
Vanco/Dapto alternative
for resistant gram+ including MRSA
[dependent]
Vanco synthetic derivative 
fetal risk
QT interval prolongation 
foamy urine
A

Telavancin

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13
Q

Non-B-lactam

treatment UTI due to E. coli/E. faecalis

A

Fosfomycin

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14
Q

Non-B-lactam
“detergent-like” effect
[dependent]
Gram -

A

Polymyxin

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15
Q

Tetracyclines: “Like My Chronic CRAP”

A

Lyme, Mycoplasma Pneumonia, Cholera, Chlamydia, Rocky Mtn Spotted Fever, Acne, Peptic Ulcer

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16
Q

Protein Synthesis Inhibitor
Broad specturm
Bacteriostatic
Gram +/-, others
Crosses placenta
Enters bones and dentition due to calcification
Avoid dairy, antacids, iron while taking
Demeclocycline, doxycycline, minocycline, tetracycline

A

Tetracyclines

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17
Q

___cycline can be taken with/or without food.

A

Minocycline

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18
Q

Absorption of demclocycline, doxycycline and tetracycline are ____ by food.

A

reduced

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19
Q

Only minocycline and doxycycline achieve therapeutic levels in ____.

A

CSF

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20
Q

_____ is a drug of choice in renal impairment.

A

Doxycycline

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21
Q 
Gastric discomfort 
Limit in pediatrics (discolored teeth)
Hepatotoxicity
Phototoxicity (sunburn)
Dizziness, vertigo, tinnitus
Contraindicated for pregnancy, breast-feeding
A

Tetracyclines

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22
Q

Protein Synthesis Inhibitor
Tigecycline (minocycline derivative)
Tx for complicated skin and soft tissue infections
Tx for intra-abd infections
Developed for TCN class resistant organisms**

A

Glycylcyclines (Tigecycline)

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23
Q 
Protein Synthesis Inhibitor 
Broad spectrum 
(MRSA, VRE, b-lactamase gram -, resistant strep)
Penetrates tissues well, low [plasma] 
adverse: n/v, pancreatitis hepatotoxic,
A

Glycylcyclines (Tigecycline)

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24
Q 
Protein Synthesis Inhibitor
Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin
Parenteral, EXCEPT neomycin (top/oral)
Often combined with B-lactams
Nephro/ototoxic 
Neomycin: contact derm
A

Aminoglycosides

25
``` Protein Synthesis Inhibitor Azithromycin, Clarithromycin, Erythromycin, Telithromycin Broad spectrum Bacteriostatic Bactericidal at higher does 50s binding Hepatic metabolism CP450, EXCEPT azithromycin Can lead to drug toxicities ```
Macrolides
26
Azithromycin and erythromycin should be taken ____ food.
without
27
Clarithromycin should be taken ____ food.
with
28
Protein Synthesis Inhibitor Hepatic Metabolism CP450 Strong inhibitors: medication hx/reconciliation is important. Clarithromycin is eliminated by the kidneys and the liver Can prolong QT (ketolides also can do this) Ototoxic, Gastric distress, jaundice Hepatic contraindications
Macrolides
29
Telithromycin: box warning for pts with ____ ____.
myasthenia gravis
30
Corynebacterium diphtheriae, Bordatella pertussis
Erythromycin
31
Good choice for those patients with B-lactam PCN allergy
Erythromycin
32
Chlamydial infection, legionnaires, mycoplasma pneumonia
Azithromycin
33
Z-pack loading dose on day one, then four more; commonly prescribed; long half-life
Azithromycin
34
Mycobacterium Avium Complex (MAC)
Azithromycin
35
``` Protein Synthesis Inhibitor Macrocyclic Narrow Spectrum (gram +/anaerobes) Costly RNA polymerase inhibitor C.diff tx Adverse: n/v, abd pain, hyper. rxns Not recommended for pts w/ macrolide allergies ```
Fidaxomycin (Dificid)
36
``` Protein Synthesis Inhibitor Broad spectrum Reserved for life threatening infections, IV Intensive care 50s, peptidyl transferase inhibitor ```
Chloramphenicol
37
Protein Synthesis Inhibitor Bacteriostatic, with +dose could become ~cidal CSRA (Chlamydia, Spirochetes, Ricketessiae, anaerobes) Hepatically metabolized Adverse: Anemias, GRAY BABY Weak inhibition of CYP2C9
Chloramphenicol
38
``` Protein Synthesis Inhibitor Lincosamide IV/oral GI intolerance Cross-resistance with erythromycin Bacteriostatic gram + (MRSA, anaerobes) ```
Clindamycin
39
Protein Synthesis Inhibitor Distributes well, poor CSF Adverse: diarrhea, causes C. diff Accumulation in renal/hepatic impairment
Clindamycin
40
What beta-lactamase inhibitor was known to cause diarrhea?
Clavulanic acid
41
Protein Synthesis Inhibitor Developed to combat resistant gram + organisms (MRSA, VRE, PCN resistant strep) Binds to the "23s Ribosomal RNA" of the 50s subunit, which inhibits 70s action Mycobacterium tuberculosis tx Dapto alternative for tx of VRE
Linezolid
42
``` Protein Synthesis Inhibitor no required renal adjustments Oral/IV Bacteriostatic Bacteriocidal against Streptocooci Gram + main clinical use adverse: n/v/d/headache; rash; thrombocytopenia MAO activity ```
Linezolid
43
Glycopeptide
Vancomycin
44
Tigecycline
Glycylcycline
45
Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin
Aminoglycosides
46
Azithromycin, Clarithromycin, Erythromycin, Telithromycin
Macrolides
47
____ derived from erythromycin.
Ketolide
48
50s subunit (ex: erythromycin)
Macrolides
49
costly Macrocyclic (similar macrolide structure)
Fidaxomycin (dificid)
50
50s; peptidyl transferase inhibitor
Chloramphenicol
51
tx: CSRA
Chloramphenicol
52
Lincosamide
Clindamycin
53
"23s of rRNA" of the 50s→70s formation inhibition
Linezolid
54
Main clinical use = tx for drug resistant gram +
Linezolid
55
MAO activity
Linezolid
56
Used only against PCNase producing strands of S. aureus; MSSA
Anti/staphylococcal penicillins
57
Amoxicillin/clavulanate (augmentin)
PCN Combo with B-lactamase inhibitor
58
Cephalosporin eliminated by the liver; 3rd gen
Ceftriaxone

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