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Bloc G - Infection > Apr26 M1-Antimicrobial antibiotics > Flashcards

Apr26 M1-Antimicrobial antibiotics Flashcards

(58 cards)

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1
Q

aminoglycosides coverage (3) + do they cross the BBB

A 
-gram negative only. (including pseudomonas)
EXCEPT Salmonella spp and Neisseria spp
-TB and TB mycobacteria for some
-giardia (protozoa) for paromomycin
*DON'T CROSS THE BBB*
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2
Q

other activities of aminoglycosides (2)

A
  • some have TB and non TB-mycobacteria activity

- paromomycin = anti-parasitic activity against giardia lamblia

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3
Q

paromomycin is what and does what

A
  • aminoglycosides Abx

- anti-parasitic activity against giardia lamblia

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4
Q

good and bad situations to use aminoglycosides

A

good for: UTIs and complicated infections

bad for: bacteremia (too slow acting)

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5
Q

aminoglycoside nephrotoxicity: why and charact

A
  • high trough (accumulated) levels, tubule toxicity
  • reversible
  • more toxic if with other nephrotoxic drugs
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6
Q

important irreversible SE of aminoglycosides and how to prevent it

A

hearing loss. prevent by stopping the Abx when have tinnitus (ringing in the ear), tinnitus is reversible

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7
Q

aminoglycosides how to determine the next dose given

A

measure the trough rate and adjust the next dose

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8
Q

other side effect of aminoglycosides than nephrotoxicity and vestibular, cochlear toxicity

A

muscular blockade. avoid them in pts with neuromuscular diseases:

  • botulism
  • DMD (Duschenne)
  • myasthenia gravis
  • etc
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9
Q

how to make sure tinnitus (and hearing loss) and nephrotoxicity are avoided while using aminoglycosides

A

monitor for a therapeutic drug level

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10
Q

how to recognize aminoglycosides by their name

A

end with cin (gentamicin, amikacin) or mycin (tobramycin, streptomycin, paromomycin) (but azythromycin and clarithromycin are macrolides, ketolides)

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11
Q

how to recognize fluoroquinolones by name

A

end with floxacin (gatifloxacin, grepafloxacin)

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12
Q

most important fluoroquinolones

A
  • Ciprofloxacin (po or IV) = Cipro
  • Levofloxacin (po or IV) = Levaquin
  • Moxifloxacin po (Avelox)
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13
Q

2 fluoroquinolones considered to be the respiratory ones

A
  • Levofloxacin (Levaquin)

- Moxifloxacin (Avelox)

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14
Q

fluoroquinolones how many generations and what they cover

A
  1. are BROAD SPECTRUM
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15
Q

FQs activity against S pneumoniae

A

gen 2,3,4 increasing. 4 is best

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16
Q

FQs activity against MSSA (and which one specifically)

A

moxifloxacin (gen 4) ONLY

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17
Q

moxifloxacin good and bad situations to use it

A

good for: community acquired pneumonia
bad for: UTIs
are broad spectrum so associated with c.diff

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18
Q

FQs enteric gram negative rods coverage

A

gen 2,3,4 are good. gen 1 is weak

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19
Q

FQs pseudomonas spp coverage

A

gen2,3,4 decreasing. gen 2 is the best

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20
Q

FQs atypical bacteria coverage

A

gen2,3,4 are good.

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21
Q

FQs anaerobes coverage

A

gen4 only

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22
Q

FQs: which cover enterococcus faecalis

A

gen4 only

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23
Q

fluoroquinolones: how much more bioavailability if give IV instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

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24
Q

sulfonamides coverage

Study These Flashcards
A
  • broad spectrum (all bacteria requiring endogenous folic acid synthesis. bc sulfonamides block that)
  • anti-parasitic coverage (toxoplasma)
  • covers pneumocystis jeroveci
25
sulfonamides exceptions: bacteria that are not covered
- GAS (can't give sulfonamides for skin infection) | - enterococcus spp
26
do FQs cross the BB
no
27
sulfonamides: how much more bioavailability if give IV instead of po + preferred mode of administration
bioavailability is same for po and IV. | *so give orally if possible*
28
sulfonamides: do they cross the BBB?
no (can't treat meningitis with Septra)
29
sulfonamides: one common one
trimethoprim-sulfametoxazole (Septra) (TMP-SMX)
30
best Abx for toxoplasma and pneumocystis jeroveci (can see jeroveci more in HIV)
sulfonamides (Septra)
31
tetracyclines Abx spectrum
- gram negative ENTERIC RODS - anaerobes - atypical bacteria
32
tigecycline Abx spectrum
- gram negative ENTERIC RODS (includes tetracycline resistant + multiresistant enterobacteriaceae) - gram posities (MRSA, VRE, penicillin-R strep pneumoniae) - anaerobes - atypicals
33
cyclines (tetra and tige): how much more bioavailability if give IV instead of po + preferred mode of administration
bioavailability is same for po and IV. | *so give orally if possible*
34
how clindamycin (in the lincosamides category) works and type of activity (conc or time dependent)
- inhibits protein synthesis | - time dependent bacteriostatic activity
35
how resistance to clindamycin develops
similar to resistance to macrolides - modification of target site (target mutation) - efflux pump (pump)
36
clindamycin coverage
gram positives and anaerobes
37
clindamycin: how much more bioavailability if give IV or IM instead of po + preferred mode of administration
bioavailability is same for po and IV or IM. | *so give orally if possible*
38
cyclines (tetra and tige): is it used for meningitis (does it cross the BBB)
no
39
clindamycin does it cross the BBB
no
40
main adverse reactions with clindamycin
- moderate diarrhea, possibly (bc kills gut anaerobes) | - C.diff association (pseudomembranous colitis)
41
metronidazole coverage
- anaerobes (gram+ and gram-) - C.diff - parasites (giardia lamblia, entamoeba histolytica)
42
metronidazole: how much more bioavailability if give IV or IM instead of po + preferred mode of administration
bioavailability is same for po and IV. | *so give orally if possible*
43
important limit to using rifamycins
- induce RAPID resistance if used on their own | - always use with other Abx to buffer the resistance
44
when can you use rifamycins alone
- as prophylaxis for meningitis from N meningitidis and H influenzae (if someone was in contact, saliva) - to people known to be carriers (prophylaxis, reduce risk for others): will have yellow secretions, orange urine and tears
45
when would you use rifamycins (rifampin or rifabutin)
- TB and non-TB mycobacteria tx | - post exposure prophylaxis for meningitis from N meningitidis or H influenzae
46
pharmaco key point with rifamycins
MAJOR drug interactions | -rifampin and rifabutin both metabolized by CYP-450 enzymes in liver
47
adverse reactions of all rifamycins
- *mainly* GI (nausea, increase in liver enzymes) | - skin rashes
48
adverse reactions related to rifampin
orange-red colouration of body fluids (urine, tears). stains contact lenses *reversible*
49
rifabutin specific adverse reactions
- bronze discolouration of skin | - violet-red colouration of urine
50
specific things to follow in patient using rifamycins
- monitor liver enzymes | - avoid alcohol and drugs to avoid liver toxicity
51
nitrofurantoin when to use
- ONLY for 1. non-complicated cystitis TREATMENT and 2. UTI PROPHYLAXIS - you only achieve therapeutic concentrations in the urine
52
specific conditions where you would give an Abx like nitrofurantoin for UTI prophylaxis
- babies with vesicoureteral reflux with urine splashing up ureters and kidneys (risk UTI) - honeymoon cystitis (used to UTIs after intercourse)
53
Abx designed specifically for multiresistant gram positive cocci (MRSA, VRE, VISA, VRSA)
- oxazolidinones (Linezolid) - streptogramins (Quinipristin, Dalfopristin) (Synercid) - daptomycin - Ceftaroline (5th generation ceph) (this one only for MRSA)
54
Abx designed specifically for multiresistant gram negative rods
- carbapenems - carbapenem + beta-lactamase inhibitors - tigecycline
55
oxazolidinones (Linezolid): how much more bioavailability if give IV or IM instead of po + preferred mode of administration
bioavailability is same for po and IV. | *so give orally if possible*
56
do oxazolidinones penetrate the BBB
yes. are very good for meningitis
57
(important) adverse reactions with prolonged use of oxazolidinones (Linezolid)
- thrombocytopenia (if >2 weeks of tx, is reversible) | - inhibition of monoamine oxidase (get serotonin syndrome).
58
(important) how to avoid serotonin syndrome with use of oxazolidinones (Linezolid)
- avoid SSRIs | - avoid or limit tyramine containing foods (cheeses, smoked and processed meats)

Bloc G - Infection (39 decks)

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