Antimicrobials Flashcards
(240 cards)
1
Q
class of abx that wors by weakening the organisms cell wall, causing excessive amount of water to be taken up, and rupturing the cell wall, thus disrupting cell wall synthesis and promoting its discretion
A
Cillins
2
Q
Coverage of ______:
Gm+
A
Cillins
3
Q
\_\_\_\_\_\_ treat: Respiratory GU tract Skin, soft tissue, joints Intra Abdominal infections Prophylactically bacterial endocarditis prevention prior to dental procedure or dental surgery.
A
Cillins
4
Q
SE of \_\_\_\_\_\_: nausea, vomiting, diarrhea, abdominal pain, stomach upset, skin rash, hives, itching
A
Cillins
5
Q
Interactions of ______:
Oral contraceptives: ↓effectiveness (rare)
A
Cillins
6
Q
Interactions of ______:
Methotrexate→ ↑ methotrexate level
Warfarin→ slight ↑ bleed risk
A
Penicillin
7
Q
Interactions of ______:
Atenolol: choose different ABT
Allopurinol: avoid
A
Ampicillin
8
Q
______ causes rash when used to treat strep throat and mono
A
Amoxicillin
9
Q
Contrainidications of ________:
Any person who has a history of type 1 allergic reaction to these drugs
Caution in patients with allergy to cephalosporin
A
Cillins
10
Q
Pregnancy/Lactation Considerations for _______:
- Safe in pregnancy and lactation
- Few studies, use only when clearly indicated
- Lacation: low concentrations in milk, may cause diarrhea, candidiasis, or allergic response in infants
A
Cillins
11
Q
Pediatric Considerations for _________:
Safety for children < 12 yo not established for carbenicillin and piperacillin-tazobactam
PCN dose adjustments may be required for infants
A
Cillins
12
Q
______ are completely safe for use in the elderly.
A
Penicillins
13
Q
Class of Abx?
Cefadroxil
Cefazolin
Cephalexin
A
1st Generation Cephalosporins
14
Q
Class of Abx that Interfere with cell wall synthesis
A
Cephalosporins
15
Q
Coverage of ______:
Gm+ (Strep and Staph but NOT MRSA)
***Enterococcus are resistant
A
1st Generation Cephalosporins
16
Q
Coverage of ______:
- Gr+ (but less than 1st gen) & Gm-
- Anaerobes
A
2nd Generation Cephalosporins
17
Q
Class of Abx? Cefaclor Cefotetan Cefoxitin Cefproil Cefuroxime Loracarbef
A
2nd Generation Cephalosporins
18
Q
Class of Abx? Cefdinir Cefixime Cefotaxime Cefpodoxime Ceftazodine Cefitibuten Ceftriaxone
A
3rd Generation Cephalosporins
19
Q
Class of Abx?
Cefepime
A
4th Generation Cephalosporins
20
Q
Coverage of ______ + _________:
Gr+ & Gm-
Pseudomonas
A
3rd Generation Cephalosporins
4th Generation Cephalosporins
21
Q
SE of _______:
If a patient has a true allergy to PCN, they are more likely to have allergic reaction, particularly 1st generation
A
Cephalosporins
22
Q
Interactions of ______:
Probenecid: ↑ and prolong abx plasma levels
Loop diuretics: ↑ nephrotoxicity
Warfarin: ↑ bleed risk
A
Cephalosporins
23
Q
Interactions of ______:
ETOH: avoid
Antigoagulants: choose different abx class
A
Cefotetan <2nd Generation Cephalosporin>
24
Q
Interaction of ______ (3 drugs):
Antacids: space admin at least 2hr
A
Cefaclor <2nd Generation Cephalosporin>
Cefdinir + Cefpodoxime <3rd Generation Cephalosporins>
25
Interaction of ______ :
| Iron:space admin at least 2hr
Cefdinir <3rd Generation Cephalosporin>
26
Contrainidications of ________:
| Type 1 Allergy to PCN
Cephalosporins
27
Contrainidications of ________:
| Patients w/ renal impairment
1st Generation Cephalosporins
28
Contrainidications of ________:
| Patients w/ hepatic impairment
Ceftriaxone <2nd Generation Cephalosporin>
29
Pregnancy/Lactation Considerations for _______:
Safe during pregnancy
Category B, all cross placenta; low presence in breast milk
1st Generation Cephalosporins
30
Pregnancy/Lactation Considerations for _______:
| Reaches therapeutic levels in cord blood
Cefotetan <2nd Generation Cephalosporin>
31
Pregnancy/Lactation Considerations for _______ (3 drug classes):
Safe
2nd Generation Cephalosporins
3rd Generation Cephalosporins
4th Generation Cephalosporins
32
Pediatric Considerations for _________:
| Not established for infants < 1 month old
Cefazolin <1st Generation Cephalosporin>
Cefaclor <2nd Generation Cephalosporin>
Cefotaxime <3rd Generation Cephalosporin>
33
Pediatric Considerations for _________:
| ***Varies across generations… more than what’s listed here***
Cephalosporins
34
Pediatric Considerations for _________:
| Not established for infants < 2 months old
Cefpodoxime <3rd Generation Cephalosporin>
35
Pediatric Considerations for _________:
| Not established for infants < 3 months old
Cefuroxime <2nd Generation Cephalosporin>
36
```
Class of Abx?
Ciprofloxacin
Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
Gemifloxacin
```
Fluoroquinolones
37
Class of abx that interfere w/ synthesis and repair enzymes of bacterial DNA so that bacteria can’t reproduce
Fluoroquinolones
38
class of abx that, when taken PO, are not absorbed well, aren’t highly protein bound, minimally metabolized in the liver, and excreted primarily in urine
Fluoroquinolones
39
Coverage of _________:
~Narrow spectrum~
Mostly Gm-
Some Gr+
Newer drugs have ↑ activity against Staph, Enterococcus, Strep, DRSP
Atypical organisms: Chlamydia, Legionella, Mycoplasma
Fluoroquinolones
40
Coverage of ________ :
| Anaerobic bacteria
Moxifloxacin (Fluoroquinolone)
41
```
SE of _________:
*Tendon Rupture
*Tendonitis
Dizziness
N/V/D
Abdominal pain
Altered taste
Fever
Chills
Blurred vision
Tinnitus
Phototoxicity: ranging from mild erythema to severe bullous eruptions in sun- exposed areas
Bacterial/fungal overgrowth
Severe: diarrhea w/ blood, pus, mucus
Rare: CV- Angina, Atrial Flutter, Cardiopulmonary Arrest, Cerebral Thrombosis, MI, Ventricular Ectopy
Rare: Acute Renal Failure, Seizures
```
Fluoroquinolones
42
Most common SE of _________:
| GI symptoms including altered taste
Fluoroquinolones
43
```
SE of __________:
Acidosis
Polyuria
Urine retention
Calculi
```
Cipro (Fluoroquinolone)
44
Interactions of ___________:
Antacids: ↓ GI absorption, ↓ serum levels
Antidiabetics: blood sugar changes
Some antiarrhythmics: risk of serious CV effects, fatal arrhythmias
Glucocorticoids: tendon rupture
Warfarin: ↑ anticoagulant effect
Fluoroquinolones
45
```
Interactions of ___________:
Caffeine
Phenytoin
Probenecid
Theophylline
```
Cipro (Fluoroquinolone)
46
Interactions of ___________:
| NSAIDS
Levofloxacin (Fluoroquinolone)
47
Interactions of ___________:
| Rifampin
Moxifloxacin (Fluoroquinolone)
48
Interactions of ___________:
Caffeine
Cyclosporine
Nitrofurantoin
Norfloxacin (Fluoroquinolone)
49
Contraindications for __________:
Patients w/ myasthenia gravis: avoid (tendonitis, tendon rupture)
Patients w/ renal impairment, known or suspected CNS disorders, or predisposed to seizures
First sign of jaundice: Discontinue
Fluoroquinolones
50
Pregnancy/Lactation Considerations for ___________:
Category C: NOT recommended
No adequate, well-controlled studies
Only use if there is clear benefit that justifies risk to fetus
Lactation: Lower doses (only if no safer alternative)
Fluoroquinolones
51
Geriatric Considerations for ___________:
High risk for tendonitis and tendon rupture
Increased risk for adverse CNS reactions
Fluoroquinolones
52
Pediatric Considerations for _________:
Not recommended for children < 18 years old
Only use for complicated UTIs, Pyelonephritis, Post-Anthrax Exposure
Restricted to when there is no safe and effective alternative
Fluoroquinolones
53
```
class of abx that inhibit RNA- dependent protein synthesis by acting on small portion of ribosome.
They reversibly bind to P site of 50s ribosome.
They are distributed to most tissues and body fluids except CSF when meninges are inflamed
```
Macrolides
54
______ are acid sensitive so they must be buffered or have enteric coating for PO to prevent destruction by gastric acid
Macrolides
55
________ are absorbed in the duodenum.
Macrolides
56
Coverage of _______:
Broad spectrum against Gr(+) and some Gm(-)
PO: Gm(-)
Atypical and intracellular orgs commonly resistant to beta-lactams
Macrolides
57
_______ is the greatest coverage of the ______ class against Gm(-) and anaerobes
Azythromycin; Macrolides
58
```
SE of _________:
***Overall fewer
Epigastric distress
N/V/D, diarrhea esp w/ large doses
rash
fever
eosinophilia
anaphylaxis
reversible hearing loss
Fatal hepatotoxicity
Potentially fatal exacerbations of myasthenia gravis
Visual disturbances
```
Macrolides
59
SE of _______:
hepatitis
liver abnormalities
Erythromycin
Azithromycin
Telithromycin
(Macrolides)
60
SE of _______:
SJ syndrome
skin changes
Erythromycin (Macrolide)
61
```
Class of Abx?
Erythromycin
Azithromycin
Fidaxomicin
Telithromycin
Clarithromycin
```
Macrolides
62
SE of _______:
| Taste changes
Clarithromycin (Macrolide)
63
```
Interactions of _________:
strong CYP450 inhibitors
cyclosporine
most statins
rivaroxaban
theophylline
carbamazepine
select benzos
```
Increased effect of:
colchicine
digoxin
warfarin
Causes dysrhythmia:
pimozide
tourette tx
Slows absorption:
Antacids with aluminum or magnesium
Macrolides
64
3 drugs in Macrolide class that have more drug interactions than the others
Erythromycin
Telithromycin
Clarithromycin
65
Contraindications of ________:
Patients at risk for torsades de pointes
Meds that prolong QT interval
Macrolides
66
Contraindications of ________:
| Not appropriate for treatment of minor upper respiratory infections
Azithromycin
67
Contraindications of ________:
Pre-existing liver disease
Myasthenia gravis
Erythromycin
68
Pregnancy Considerations for Macrolides:
| _______ + ________ are safe, Category B
Erythromycin
| Azithromycin
69
Lactation Considerations for Macrolides:
(3) drugs are compatible with breastfeeding
Caution w/ other meds in class due to few studies
Erythromycin
Azithromycin
Clarithromycin
70
Pregnancy Considerations for Macrolides:
| (2) drugs have adverse effects on fetal development, Category C
Telithromycin
| Clarithromycin
71
Macrolide that is safe for infants and children
Erythromycin
72
Macrolide that is safe for children as young as 6 mos for otitis media, sinusitis, CA
and children > 2 yo for pharyngitis and tonsillitis
Azithromycin
73
Macrolide that is safe for children > 6 mo
Clarithromycin
74
Macrolide that safety is not established for children < 12 yo
Dirithromycin
75
Macrolide that safety is not established for children
Telithromycin
76
Geriatric Considerations for ________:
No specific dosage adjustments or precautions recommended w/ normal renal and hepatic function
*WIth impairment, treat as you would other patients w/ no additional precautions
Macrolides
77
```
Class of Abx?
Minocycline
Tetracycline
Doxycycline
Tigecycline
Demeclocycline
```
Tetracyclines
78
Class of abx that inhibit growth or multiplication of bacteria by penetrating bacterial cell
(Bacteriostatic) Tetracyclines
79
Class of abx that work on highly susceptible organisms and high concentrations by binding primarily to subunit of the ribosome causing protein synthesis inhibition
Reversibly to 30S
(Bactericidal) Tetracyclines
80
```
Coverage of ________:
Broad Gr+ and Gm-
Also...
aerobic
anaerobic
spirochetes
mycoplasmas
rickettsiae
chlamydiae
gonorrhea
some protozoa
MRSA
```
Tetracyclines
81
```
SE of _______:
N/V/D
photosensitivity
abdominal distress/distention
Teeth: discoloration, enamel hypoplasia
Severe: hepatic and renal toxivity
Decreased oral contraceptive effectiveness
```
Tetracyclines
82
```
SE of ______ (Tetracycline):
lightheadedness
dizziness
vertigo
vestibular reactions
```
Minocycline
83
SE of ______ (Tetracycline):
| fatty infiltration of the liver
Tetracyclines
84
Interactions of _________:
| Best to avoid calcium/iron or take >2 hours apart: Milk products- space 1-2 hrs after meals
Tetracyclines EXCEPT Minocycline and Doxycycline
85
Interactions of __________:
aluminum, magnesium, calcium (↓ PO absorption)
Oral contraceptives
Tetracyclines
86
```
Interactions of __________:
iron salts
bismuth
zinc sulfate (space dosing)
(All of these decrease absorption of 2 drugs in this class)
```
Tetracycline
| Doxycycline
87
```
Interactions of __________:
barbiturates
carbamezepine
phenytoin
ETOH
(All of these increase metabolism and decrease effect of 1 drug in this class)
```
Doxycycline (Tetracycline)
88
Contraindications of __________:
Pregnancy
Children up to 8 yo: binds to calcium in bones and teeth → yellow or brown discoloration and hypoplasia of tooth enamel
Premies: suppresses long bone growth
Caution in patients w/ renal and hepatic impairment
Tetracyclines
89
Pregnancy Considerations for ________:
!!Contraindicated!!
Cat X, should not be used in pregnancy
*Cross placenta w/concentration up to 60%
Tetracyclines
90
Lactation Considerations for __________:
Excreted in breastmilk
AAP consideres it compatible b/c serum concentrations below detectable level
Tetracyclines
91
Tetracycline that may affect breast milk production or composition
Minocycline
92
Only Tetracycline that is Cat D, not Cat X
Doxycycline
93
Pediatric Considerations for ___________:
Do not give to children < 8 yo
Do not give to premies (suppresses long bone growth)
Tetracyclines
94
In pediatric patients, the tetracycline less likely to harm but risks outweigh benefits for most indications
Doxycycline
95
Geriatric Considerations for _________:
| None, safe to Rx
Tetracyclines
96
```
Class of Abx?
Sulfadiazine
Sulfamethoxazole
Sulfamethoxazole/trimethoprim (Bactrim)
Sulfisoxazole
Sulfasalazine
```
Sulfanomides
97
Class of abx that acts by interfering with folic acid synthesis by preventing addition of para-aminobenzoic acid (PABA) into the folic acid molecule through competing for the enzyme dihydropteroate synthetase.
These drgus are antimetabolites that substitute for PABA, resulting in blockade of enzymes needed for biogenesis of purine bases, etc, needed for formation of RNA. The effect is bacteriostatic; bactericidal action is evident at the high concentrations found in urine.
Sulfanomides
98
```
Coverage of _________:
Gr+ and Gr-
Nocardia
Actinomyces spp
some protozoa such as coccidia and Toxoplasma spp
```
```
More active drugs in this class may include several species of:
Streptococcus
Staphylococcus
Salmonella
Pasteurella
E. coli
```
Sulfanomides
99
```
Resistant to __________:
Strains of Pseudomonas
Klebsiella
Proteus
Clostridium
Leptospira spp
Rickettsiae
Mycoplasmas
Chlamydia.
```
Sulfanomides
100
```
SE of ___________:
**Severe hypoglycemia
Weight gain
**Dermatological reactions
GI disturbances
SIADH
**Excessive water retention
Hemolytic anemia
**Agranulocytosis
Leukopenia
**Thrombocytopenia
```
Sulfanomides
101
```
Interactions for _________:
Alcohol
Androgens
Anticoagulants
Chloramphenicol
Fluconazole
Gemfibrozil
Histamine 2 blockers
Magnesium salts
Methyldopa
MAOIs
NSAIDs (except diclofenac)
Phenylbutazone
Probenecid
Salicylates
Tricyclic antidepressants
Urinary acidifiers
Beta-adrenergic blockers
Cholestyramine
Diazoxide, hydantoins, rifampin, thiazide diuretics, urinary alkalinizers, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, nicotinic acid, sympathomimetics, and isoniazid
```
Sulfanomides
102
```
Contraindications for __________:
Allergy to ANY drugs in this class or thiazide diuretics.
Nursing or pregnant.
Type 1 diabetes, DKA, diabetic coma.
Liver or kidney disease.
Uncontrolled infection.
Burns and trauma.
CHF
```
Sulfanomides
103
Pregnancy/Lactation Considerations for ________:
Do not Rx!
Class C: Teratogenic in animal studies - no human studies on pregnant women conducted
Several drugs penetrate breastmilk at dangerous levels
Sulfanomides
104
Pediatric Considerations for ________:
Potential for studies, but no data currently.
May cause severe hypoglycemia.
Sulfanomides
105
Geriatric Consideration for ___________:
May cause severe hypoglycemia.
Poor hepatic or renal function may cause complications.
Caution should be used in prescribing
Sulfanomides
106
Abx that inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome. It is bacteriostatic
CLINDAMYCIN (ANTIANAEROBIC AGENT)
107
Coverage of __________:
Active/effective against roughly ⅔ of B. fragilis and roughly 80% of isolates of Clostridium, Peptostreptococcus, and Fusobacterium
Spectrum includes BOTH aerobic & anaerobic bacteria, Pneumonocystis, malaria, and Toxoplasma
Clindamycin
108
```
SE of _________:
Positive:
inhibits synthesis of toxic shock syndrome toxins
Negative:
Allergic reactions
Minor reversible elevation in AST/ALT
Potential liver injury
C.diff.
Local phlebitis
Serum sickness
N/V
headache
dysrhythmias
Reversible neutropenia
thrombocytopenia
eosinophilia
```
Clindamycin
109
Interactions of __________:
Kaolin
Muscle relaxants
St. John’s Wort
ANTIANAEROBIC AGENTS
| Clindamycin and Metronidazole
110
Contraindications for __________:
History of hypersensitivity
Concomitant use: Erythromycin is not recommended.
Gastrointestinal: Use with caution in patients with a history of gastrointestinal disease, particularly colitis .
Hepatic disease
Allergic-type risk may be higher in patients with aspirin sensitivity
Caution in atopic individuals
ANTIANAEROBIC AGENTS
| Clindamycin and Metronidazole
111
Pregnancy/Lactation Considerations for _________:
Pregnancy:
Class C - teratogenic.
Fetal risk cannot be ruled out.
Breastfeeding:
WHO: Avoid breastfeeding if possible. Monitor infant for side effects.
Micromedex: Infant risk cannot be ruled out.
ANTIANAEROBIC AGENTS
| Clindamycin and Metronidazole
112
Pediatric Considerations for ________:
Do not administer the oral capsules to children who cannot swallow them whole
Capsules do not provide exact mg/kg doses
Consider using palmitate oral solution
ANTIANAEROBIC AGENTS
| Clindamycin and Metronidazole
113
Geriatric Consideration for ___________:
| no specific dosage adjustments appear to be necessary
ANTIANAEROBIC AGENTS
| Clindamycin and Metronidazole
114
Abx that works by passive diffusion into cytoplasm of anaerobic bacteria, messing with cellular transport. It interacts with intracellular DNA resulting in the inhibition of DNA synthesis and degradation and ultimately bacterial death . Topical application exerts an antiinflammatory effect in the treatment of rosacea.
Metronidazole (ANTIANAEROBIC AGENT)
115
Coverage of __________:
Limited spectrum of activity that encompasses various protozoans
most Gm- and Gr+ anaerobic bacteria
Metronidazole
116
```
SE of _________:
>Common:
Gastrointestinal: Abdominal discomfort
Abnormal taste
Diarrhea
Nausea
Jarisch Herxheimer reaction
Dizziness
Headache
Candidiasis
>Serious:
Dermatologic: Stevens-Johnson syndrome
Epidermal necrolysis
CNS damage,
Liver damage,
Kidney damage,
Eye & ear damage.
```
Metronidazole
117
Abx that inhibits bacterial wall synthesis causing ↑ susceptibility to lysis; also damages cell membrane
Glycopeptides (Vancomycin and Telavancin)
118
Coverage of __________:
Gr+
Vanco: staph (slow), strep, pneumococci
Telav: S.aureus, MRSA, enterococcus, strep
Glycopeptides (Vancomycin and Telavancin)
119
SE of ________:
Nephrotoxicity
High IV rate: red man syndrome (slower push ↓ risk)
Glycopeptides
120
```
SE of _________:
ototoxic(rare)
reversible neutropenia
eosinophilia
thrombocytopenia
Oral: rash
```
Vancomycin
121
SE of __________:
QT prolongation
GI disturbance
hypersensitivity
Telavancin
122
Interactions of __________:
| drugs with nephro or ototoxic effects (aminoglycosides)
Vancomycin
123
Interactions of __________:
| drugs affecting renal function (ACE inhibitors, loop diuretics, NSAIDS)
Telavancin
124
Contraindications for ____________:
PO not appropriate for systemic infect
Also avoid IM admin
Inflammatory GI mucosa disorders
Glycopeptides (Vancomycin and Telavancin)
125
Contraindications for ____________:
| Impaired renal fxn
Vancomycin
126
Pregnancy Considerations for _________:
PO: Category B
IV: Category C
Vancomycin
127
Pregnancy Considerations for _________:
| Category C- no data so avoid use
Telavancin
128
Lactation Considerations for _________:
| Caution with nursing mothers- little data
Glycopeptides (Vancomycin and Telavancin)
129
Pediatric Considerations for ________:
| confined to serious infections usually only used when hospitalized
Vancomycin
130
Pediatric Considerations for ________:
| not studied or approved for <18yo
Telavancin
131
Geriatric Consideration for ___________:
| Use Caution
Vancomycin
132
Abx used in combination therapy both to achieve additive or synergistic antibacterial efficacy and to reduce the risk of development of resistance. Also used as a prophylaxis for close contacts of people suspected with infection.
Rifampin
133
1st line drug for Tuberculosis; interferes with lipid & nucleic acid biosynthesis
Isoniazid (INH)
134
Abx used for UTI’s which works by inhibiting rotein synthesis, aerobic energy metabolism, DNA/RNA synthesis, and cell wall synthesis
Bacteriostatic in low concentrations
Bacteriocidal in high concentrations
Nitrofurantoin
135
Coverage of ___________:
| activity with Mycobacterium
Rifampin
136
Coverage of ___________:
| Bactericidal against susceptible mycobacteria. Bactericidal to both extracellular and intracellular organisms
Isoniazid (INH)
137
Coverage of ___________:
Gr+ cocci
Gm- bacilli
Nitrofurantoin
138
```
SE of ________:
anorexia
N/V/D
flatulence
abdominal pain
Transient elevation of liver enzymes
```
Rifampin
139
```
SE of ________:
Hepatitis
peripheral neuropathy
photosensitivity
convulsions
allergic skin rashes
toxic encephalopathy
```
Isoniazid (INH)
140
SE ________:
Acute/Chronic pulmonary reactions:
pulmonary fibrosis
sudden onset of chest pain, dyspnea, fever, cough
Dark colored urine
Peripheral neuropathy that can be irreversible
Nitrofurantoin
141
Interactions of ________:
Antacids: decreases abx levels
Warfarin: Suboptimal anticoagulation
Rifampin
142
Interactions of ________:
ETOH/Rifampin: increased risk of hepatic injury
PO hypoglycemics: decreased levels of hypoglycemics
Isoniazid (INH)
143
```
Interactions of ________:
Anticholinergics
Magnesium salt
Probenecid
High doses decrases renal clearance
```
Nitrofurantoin
144
Contraindications for _________:
| Do not use as monotherapy
Rifampin
145
```
Contraindications for _________:
Hemodialysis: on dialysis days administer the dose after dialysis
Precautions:
HIV patients
pregnant
patients with hepatic impairment
>35 years old
severe renal dysfunction
```
Isoniazid (INH)
146
Contraindications for _________:
| Cannot use in patients with CCr < 60 mL/min.
Nitrofurantoin
147
Pregnancy/Lactation Considerations for _________:
| Category C- Probably safe, monitor infant for toxicity
Rifampin
148
Pregnancy/Lactation Considerations for _________:
Category B, safe but should not be used near term, in labor, or when lactating
Infants with G6PD (glucose-6-phosphate-dehydrogenase deficiency) should not nurse while mother is receiving drug
Nitrofurantoin
149
Pregnancy/Lactation Considerations for _________:
| Category C- add pyridoxine for pregnant women
Isoniazid (INH)
150
Pediatric Considerations for __________:
Children: Should not wear contact lenses/risk of being stained
Teenage girls: should not use oral contraceptives they have ↓ effect when on this drug and menstruation might become irregular
Rifampin
151
Pediatric Considerations for __________:
| can be used on children but need to watch liver
Isoniazid (INH)
152
Pediatric Considerations for __________:
Should not be given to infant <1 month old
Can cause hemolytic anemia in the newborn
Nitrofurantoin
153
Geriatric Considerations for __________:
Caution for patients w/ underlying renal dysfunction
Neurotoxicity
Rifampin
154
Geriatric Considerations for ___________:
Educate to look for s/s of clinical hepatitis(dark urine, yellow eyes or skin)
> 65 yrs old give pyridoxine 25 mg/day
Isoniazid (INH)
155
Geriatric Considerations for ___________:
| Watch for acute pneumonitis and peripheral neuropathy
Nitrofurantoin
156
Abx that inhibits bacterial ribosomal protein synthesis by binding to 50s ribosomal subunit preventing the formation of a 70s initiation complex
Oxazolidinones
157
Coverage of ____________:
Bacteriostatic in Gr+
Most effective against Staphylococci & Enterococci
Bactericidal against other bacteria
In Vitro spectrum of activity includes scant amount of Gm- bacteria.
Oxazolidinones
158
```
SE of _________:
Most common: diarrhea and nausea
Myelosuppression can result and resolves with discontinuance
Watch out for Serotonin Syndrome!
IncreasedBP
```
Oxazolidinones
159
Interactions of __________:
Tyramine-rich food & beverages: balance and don’t eat in large quantities
Dopaminergics, vasopressors, & sympathomimetics can have increased effects when given w/ Lenezolid
Oxazolidinones
160
Contraindications of __________:
Use for >28 days can cause peripheral and optic neuropathy
MAOI’s- Concomitant use or within 2 weeks is contraindicated
Oxazolidinones
161
Pregnancy/Lactation Considerations for __________:
Category C,
No clear studies, so only prescribe for pregnancy if the potential benefit to the mom outweighs the risk to the fetus.
Excreted in breast milk or consider benefit in mom choosing to continue drug/or discontinue breastfeeding.
Oxazolidinones
162
Pediatric Considerations for _________:
Can use from birth on up,
Preterm infants and neonates require reduced dosing
Oxazolidinones
163
Geriatric Considerations for __________:
| Increased risk for toxic neuropathies and excessive CNS stimulation
Oxazolidinones
164
4 atom ring within Penicillins, Cephalosporin, Carbapenems, & Monobactams.
Beta-Lactam
165
drug that has minimal antibacterial activity but irreversibly inactivates beta-lactamase enzymes produced by bacteria by binding to their active site & protecting the antibiotic from inactivation.
Beta-Lactamase Inhibitors
166
Coverage of ________:
Broad spectrum
Gr+ and Gm-
Beta-Lactam/Beta-Lactamase Inhibitors
167
These 3 bacterias are Gram +
| All others are Gram -
Staph, Strep, or Enterococci
168
drugs that treat viral syndromes in immunocompromised like herpes simplex and cytomegalovirus
○ including: Acyclovir, cidofovir, famciclovir, ganciclovir, valacyclovir, valganciclovir, ribavarin
Nucleoside analogues
169
Clavulanate, Sulbactam, & Tazobactam are all in the class of ...
Beta-Lactamase Inhibitors
170
Antiviral used to treat Hep C and RSV
Ribaviran
171
Antiviral drug that works by interfering with DNA synthesis and inhibiting viral replication (each type has a specific pathway to this)
● Most need to be metabolized to be effective (prodrug?)
Nucleoside analogues
172
Coverage of _________:
| Active against HSV-1 and 2, varicella zoster (VZV); somewhat against epstein barr (EBV), CMV and HSV-6
Acyclovir
173
__________ is converted to acyclovir after PO admin is active against same viruses as acyclovir
Valcyclovir
174
Coverage of _________:
| Active against, HSV-1 and 2, VZV, EBV, hep B
Famciclovir
175
```
SE of ____________:
hypersensitivity skin rash
thrombotic thrombocytopenic pupera
hemolytic uremic syndrome (TTP/HUS)
IV route: reversible kidney impairment
PO: headache, N/V/D
```
Acyclovir and Valacyclovir
176
this drug has a higher incidence of side effects compared to PO acyclovir (especially TTP/HUS)
Valacyclovir
177
SE of ________:
| nephrotoxicity in more than half of patients
Cidofovir
178
SE of _______:
| granulocytopenia and thrombocytopenia
Ganciclovir
179
SE of _______(2):
| headache, nausea, neuro effects, paresthesias
Famciclovir and Valcyclovir
180
SE of _______:
| seizures, retinal detachment, neutropenia, bone marrow suppression
Valganciclovir
181
SE of _______:
| Neuro: ataxia, dizziness, confusion, encephalopathy, tremor, and seizures
Nucleoside Analogues
182
Interactions of ________:
Very few...
Acyclovir + Famciclovir =Probenicid: ↑ serum, ↓ renal clearance, avoid concurrent use; nephrotoxic-monitor closely
Famciclovir= Cimetidine and Theophylline: not clinically significant
Digoxin: little significance, monitor dig levels closely
Nucleoside Analogues
183
Contraindications for ____________:
| renal impairment: consider dose adjustment (dehydration)
Nucleoside Analogues
184
Pediatric Considerations for ___________:
Acyclovir: safest of these for children, oral approved >2yo
Famciclovir: no established safety and efficacy for <18yo
Valacyclovir: no safety/efficacy established for any age child
Nucleoside Analogues
185
Geriatric Considerations for _________:
| Patients with renal impairment more likely to experience neuro side effects
Nucleoside Analogues
186
Pregnancy Considerations for _______:
Category B
Little info for famciclovir, so acyclovir or valacyclovir are preferred
Nucleoside Analogues
187
Lactations Considerations for _________:
Acyclovir: excreted in milk, concentrations are low, considered minimal risk
Others have little research available
Nucleoside Analogues
188
Antiviral that works by inhibition of neuraminidase (enzyme responsible for cleaving viral attachment to the host cell surface→ viral cirulation) which prevents release of the virus and halts infection
● Oseltamivir is a prodrug
Influenza Antivirals
189
Coverage for __________:
Amantadine and Rimantadine: approved for prevention and tx of resp infection caused by influenza A (CDC recommends against due to high resistance to influenza A)
Zanamivir (inhaled), Oseltamivir (Tamiflu), Peramivir: active against influenza A and B
Influenza Antivirals
190
SE of _______:
| bronchitis, cough, shortness of breath
Zanamivir
191
SE of ________:
| nause and vomiting
Oseltamivir (Tamiflu)
192
Rare SE of all _______:
| severe skin reaction, neuropsychiatric events
Influenza Antivirals
193
Interactions of __________:
None reported
Some research suggests they may impair immune system if coadministered with live attenuated influenza vaccine (should space 2 weeks before or 48 hours after)
Influenza Antivirals
194
Pediatric Considerations for ________:
| children < 12 yo: higher clearance → decreased drug exposure
Oseltamivir (Tamiflu)
195
Pregnancy Considerations for _________:
Category C- Limited research
Zanamivir crosses placenta in low levels
Influenza Antivirals
196
Lactation Considerations for ____________:
Olseltamivir: poorly excreted in milk, adverse effects not expected for infants
Zanamivir is inhaled and unlikely to pass to infant, but unknown by current research
Influenza Antivirals
197
Drugs that work by inhibiting Fungal CYP450
○ These systemic agents are different than topicals
○ This also is the source of the many drug interactions
● Terbinafine for onychomycosis: used off label for tinea apitus
● Hepatotoxicity- important to monitor liver funciton especially in those already impaired
● **QT prolongation Risk**
● Diabetics have increased risk for fungal infections
● Pregnancy/lactation: Diflucan is considered safe, but caution with higher doses which can cause congenital abnormalities
Antifungals
198
Drug to Drug Interactions of __________:
* **Caution in use with other QT prolongation drugs
* **Statins often contraindicated
Antifungals
199
cells that produce antibodies and mediate humoral immunity
B lymphocytes
200
cells that produce cell mediated immunity (particularly active against viruses)
T lymphocytes
201
live attenuated (best and longest immune response)
live vaccine
202
inactivated whole killed pathogen
whole killed vaccine
203
vaccines that work against toxins and require sufficient standing antibody titer and needs boosting
toxoid vaccine
204
vaccine that contains only part of the microorganism (less effective than whole, also less side effects)
recombinant vaccine
205
type of vaccine that is revaccination with same vaccine to replenish the immune response
booster
206
Tdap is recommended in pregnancy is between _______ weeks- but may safely be given at any time if needed due to wound management, pertussis outbreak or other extenuating circumstances.
27-36
207
type of abx that disrupt bacteria cell membranes
polymixins and polyenes
208
type of abx that inhibit bacteria cell wall synthesis
SO MANY (Ex: Penicillins and Cephalosporins)
209
type of abx that inhibit DNA and RNA synthesis
Quinolenes and Nalidixic Acids, Rifamycin
210
type of abx that inhibit protein synthesis (ribosomes)...meaning it is BACTERIOSTATIC
erythromycin, tetracyclines, streptomycin, gentamycin, chloraphenicol
211
type of abx that prevent folic acid metabolism (turning PABA to folate)
sulfanomides and trimetoprim
212
Enzymes that provide antibiotic resistance by breaking part of the molecular structure.
Beta Lactamase
213
Abx that are safe during pregnancy?
Penicillins
Macrolides
1st and 2nd Generation Cephalosporins
214
Abx that are UNsafe during pregnancy?
Tetracyclines
| Fluoroquinolones
215
If you think that the microbe might be Beta-Lactamase resistant, you should Rx...
Extended Spectrum Penicillin (like Augmentin)
| 3rd Generation Cephalosporin
216
Which antimicrobials interact with Warfarin and increase INR?
```
Trimethoprim-sulfamethoxazole (TMP-SMX Bactrim)
Erythromycin
Fluconazole
Ketoconazole
Itraconazole
Metronidazole
```
217
Trimethoprim-sulfamethoxazole (TMP-SMX Bactrim) is
associated with the serious adverse effect of __________... especially when with concurrent use of TMP-SMX with angiotensin converting inhibitors or angiotensin receptor blockers (increased risk of cardiac death)
hyperkalemia
218
TMP-SMX is more likely to increase hyperkalemia in ________ patients and in patients with __________
elderly; kidney disease
219
__________ increases risk of aortic aneurysm, decreased blood sugar and certain mental health side effects... especially in artherosclerotic vascular disease, HTN, Marfan's syndrome and the elderly.
Levaquin (levofloxacin)
220
____________ has increased risk of tendon rupture in patients > 60 yo
Levaquin (levofloxacin)
221
absorption of tetracycline is reduced by consumption of ______
food
222
tetracyclines form _____ _______ with calcium, iron, magnesium, aluminum and zinc resulting in decreased absorption
insoluble chelates
223
```
Abx most likely to cause _________:
Imipenem
Ceftazidime
Clindamycin
Moxifloxacin
```
C.Diff
224
Treatment for 1st episode of ________:
Vancomycin 125mg QID x 10 days OR
Fidaxomicin 200mg BID x 10 days
C.Diff
225
It is recommended that abstinence from alcohol occurs during treatment with Flagyl (metrodianozole) and up to 48 hours after treatment ends due to risk of _______ reaction
Disulfiram
226
In the third trimester, the compounds in __________ compete for bilirubin-binding sites on fetal and neonatal albumin resulting in hyperbilirubinemia and kernicterus
This drug should be avoided in 1st and 3rd trimesters due to risk of cardiovascular defects and cleft palate
Sulfanomides
227
__________ should be avoided in pregnancy, UNLESS NO OTHER REASONABLE ALTERNATIVE IS AVAILABLE
Sulfanomides
228
___________has been one of the most commonly used sulfonamides for urinary tract infections but there is significant resistance due to its frequent use.
Trimethoprim/Sulfamethoxazole (Bactrim)
229
________ is recommended for *only symptomatic* BV in any trimester in pregnancy
Flagyl (Metronidazole)
230
________ and_____________ are considered safe while breastfeeding although they may cause GI disturbances or Candidiasis (thrush/diaper rash) in infant
Penicillins and Cephalosporins
231
Some sources consider ________ safe due to the low levels found in breast milk. However, other sources associate exposure with hypertrophic pyloric stenosis
macrolides
232
If a macrolide is indicated while breastfeeding, the safest choice is ___________.
Azythromycin
233
_________ are contraindicated in infants who have either hyperbilirubinemia or G6PD deficiency due to risk of hyperbilirubinemia and kernicterus
Sulfanomides
234
Use of ___________ is controversial during lactation, although Ciprofloxacin--one of the most commonly prescribed drugs in this class--is approved for use by the American Academy of Pediatrics.
fluoroquinolones
235
Drugs that have SE of __________:
Antibiotics-Azithromycin, Ciprofloxacin, Clarithromycin, Erythromycin, Levofloxacin, and Moxifloxacin
Antimalarial - Chloroquine
Antifungal -Fluconazole, Pentamidine
QT interval prolongation
236
HIV patients often have interactions with _______.
Sulfanomides
237
Patients with risk for low B6 (HIV, diabetes, pregnant and lactating) should take supplemental vitamin B6 when taking _______ because it competes with vitamin B6 in certain enzymatic reactions; if untreated, the client can develop symptoms of vitamin B6 deficiency.
Isoniazid (INH)
238
The most commonly seen protozoans are ________ and _________
trichomonads and giardia
239
__________ is used to treat protozoan infections and also used to treat other amoebas and anaerobic bacteria
Metronidazole (Flagyl)
240
a collection of data usually in the form of a table summarizing the percent of individual bacterial pathogens susceptible to different antimicrobial agents
antibiogram
