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Flashcards in DD Antimicrobials Brainscape Deck (58):
1

Penicillins- MOA, E, Adverse Rxns

c.w. synthesis inhibition (III) bactericidal), renal, anaphylaxis (Type I, rare) and rash (more common)

2

Penicillin G- A, Spectrum and Uses, Adverse Reactions

IM/IV (poor oral), Narrow spectrum: Cocci gram + (Staph, Strep, and Entero), Cocci gram - (Neisseria), Anaerobes (most, but NOT bacterides), convulsions at very high doses

3

Penicillin V- A, Spectrum and Uses, Adverse Reactions

good oral, Narrow spectrum- Cocci gram + (Staph, Strep, and Entero), Cocci gram - (Neisseria), Anaerobes (most, but NOT bacterides), cinvulsions at high doses

4

Oxacillin, Dicloxacillin, Methicillin, Nafcillin- A, Spectrum and Uses

good oral (except meth and naf), penicillinase resistant: penicillinase producing S. aureus (MSSA) and skin infections (NOT MRSA)

5

Other PCN penicilinase susceptible or resistant?

Susceptible; unless combined w/ B lactamase inhibitor such as amoxicillin-clavulanate.

6

Amoxicillin and Ampicillin- A, Spectrum and Uses, Adverse Rxns

good oral, Extended Spectrum: Rods gram - (E.coli, H. flu, Proteus), Cocci gram + (less than Pen G/V), diarrhea (less w/ amoxiciilin) and superinfection possible

7

Pipercillin + B lactamase inhibitor- A, Spectrum and Uses

IV only, Antipseudomonal: Pseudomonas and Bacteriodes (+other anaerobes) (Amox/Clav also Bacteriodes)

8

Cephalosporins- MOA, E, Spectrum and Uses, Adverse Reactions

c.w. synthesis inhibition (III) bactericidal, renal excretion (almost all), Extended spectrum: NOT susceptible to pencillinases (NSBL) and some gram neg, allergy, less severe than penicillins (some cross sensitivity ~1.5%)

9

Cephalexin and Cefazolin (1st Gen)- A, Spectrum and Uses, Adverse Rxns

Good oral (cefalexin) and IV/IM only (cefazolin), cocci gram +, rods gram- (Proteus, E.coli, Kleibsiella) (similar to amoxicillin), diarrhea

10

Cefaclor/ Cefuroxime, Cefoxitin (2nd gen)- A, Spectrum/Uses, Adverse Rxns

good oral (cefaclor/ceuroxime), IM/IV (cefoxitin), Rods: gram - (H.flu, Enterobacter), Bacteriodes (+ other anerobes), DDI: enhancement of warfarin, superinfection possible

11

Cefdinir and Ceftriaxone (3rd gen) and Cefepime (4th)- A, Spectrum/Uses, Adverse Rxns

good oral (cefdinir), IV/ IM (cetriaxone), both with good CNS penetration, Rods: expanded gram-, good gram + cocci for cetriaxone, moderate antipseudomonal activity, superinfection possible

12

What are the 1st, 2nd, and 3rd generation of Cephalosporins?

1st: cephalexIN and cephazolIN, 2nd: Cefaclor/ Cefuroxime, and Cefoxitin, 3rd: Cefdinir and Ceftriaxone

13

Vancomycin- MOA, A, E, Spectrum/Uses, Adverse Rxns

c.w. synthesis inhibition (Stage II) bactericidal, IV only (poor absorption), renal excretion, narrow spectrum: cocci gram+, active against MRSA and enterococci, anaerobes: C. difficile, Terrible at gram - rods, Infusion related problems (chills, fever, rash), ototoxicity, renal toxicity (need routine monitoring of Cp levels)

14

Carbapenems (Imi-, mero-, dori-, and ertapenum) - MOA, A, E, Spectrum/Uses, Adverse Rxns

c.w. synthesis inhibition (Stage III) bactericidal, IV only, renal excretion, once daily for Ertapenum, wide spectrum (reserved for multidrug resistant organisms) Imi, mero, dori tx pseudomonas), nausea, vomiting, diarrhea, seizures possible at highest doses

15

Macrolides-MOA, A, D, E, Spectrum/Uses, Adverse Rxns

protein synthesis inhibtion (50S), bacteriostatic, good oral (also IV), concentrates in lungs, extended spectrum: cocci/rods: gram + anerobes (alternative if PCN allergy), Atypical (Mycoplasma, chlamydia) GI disturbances (n/v, diarrhea, ERY > CLA-AZI), DDI due to inhibition of CYP450 (not AZI)

16

What are three types of macrolides?

Erythromycin, Azithromycin, Clarithromycin

17

Erythromycin- A, E

QID (4x/day), liver metabolism

18

Azithromycin- A, E

QD, biliary

19

Clarithromycin

BID (2x/day) meatbolism to active metabolite

20

Tetracyclines- MOA, Spectrum and Uses, Adverse Reactions

protein synthesis inhibition (30S), static, broad spectrum BUT many gram +/- organisms now resistant, choice in CA-MRSA, Atypical: chlamydia and mycoplasma. , abnormal bone and tooth development (avoid in preg and <8y/o) n/v/diarrhea, fungal superinfection, DDI w/ metal cations (Antacids/ dairy/ iron) in stomach.

21

Doxycyline- A, E

po, biliary

22

Clindamycin- MOA, A, D, E, Spectrum/Uses, Adverse Rxns

Protein synthesis inhibition (50S), bacteriostatic, good po (also IV), penetrates into bone, hepatobiliary elimination, narrow spectrum: gram + cocci (PCN Alternative), anaerobes (NOT C diff, acne, choice in CA-MRSA), severe diarrhea, pseudomembranous colitis

23

Aminoglycosides (Tobra-, genta-, neo-, streptomycin)- MOA, A, D, E, Spectrum/Uses, Adverse Rxns

protein synthesis (30S), bactericidal, poor oral absorption (IV/IM), distrubuted in extracellular fluid, accumulates in kidney and ear, renal excretion, narrow spectrum: gram- aerobes (E.coli, Pseudomonas), bowel sterilization presurgery (Neo), Tuberculosis (Strepto), vestibular and auditory toxicity, nephrotoxicity (routine monitioring of Cp levels)

24

Fluoroquinolones- MOA, A, Spectrum/Uses, Adverse Rxns

Inhibition of DNA gyrase, bactericidal, good oral (also IV), extended spectrum, well tolerated, some GI upset, superinfections, possible DDI w/ theophylline (decrease metabolism) and antacids (decrease absorption), rare: CNS disorders, NOT 1st choice in children)

25

What are the 2nd, 3rd, and 4th generations of Fluoroquinolone?

Ciprofloxaxin, Levofloxacin, Moxifloxacin

26

Ciprofloxacin (2nd gen FQ)- E, Spectrum and Uses

primarily renal excretion --> excellent G- (Pseudomonas, UTIs)

27

Levofloxaxin (3rd gen FQ)- E, Spectrum and Uses

primarily renal excretion, Excellent gram +/- (respiratory, UTIs)

28

Moxifloxaxin (4th gen FQ)- E, Spectrum and Uses

primarily hepatic (20% renal), excellent gram +/- (respiratory plus some anaerobes/ atypical)

29

Nitrofurantoin- MOA, A, E, Spectrum/Uses, Adverse Rxns

reduced in cell to intermediates that damage DNA, cidal, rapid, complete GI absorption, but rapid complete excretion via kidneys, thus acts as urinary antiseptic, 1st line agent in UTIs if TMP-SMX resistant E.coli, GI side effects, macrocrystalline forms better tolerated. (gram- rods

30

Metronidazole- MOA, A, E, Spectrum/Uses, Adverse Rxns

reduced intracellularly to active form; interference with DNA fxn bactericidal, good oral bioavailability,hepatic metabolism, anerobicbacteria (Cdifficile), protozoa, nausea, headache, GI distress, antaabuse-like reaction, occasional candidal superinfection

31

Antibiotics Sensitive/ Resistant to Streptococcus pyogenes

Sensitive: Macrolides and Clindamycin

32

Antibiotics Sensitive/ Resistant to Viridans strep

Sensitive: Clindamycin

33

Antibiotics Sensitive/ Resistant to MSSA (S. aureus)

Sensitive: Dicloxacillin, Amox/Clav, Pip/Tazo, all Cephasporins (+/- with Ceftazidime 3rd gen), all carbapenems, +/- with Clindamycin

34

Antibiotics Sensitive/ Resistant to MRSA (S. aureus)

Sensitive: Vancomycin, and +/- Clindamycin, Resistant: all penicillins, all cephalosporin, all carbapenems

35

Antibiotics Sensitive/ Resistant to Enterococcus

Sensitive: Penicillin, Amoxicillin/Ampicillin, Vancomycin

36

Antibiotics Sensitive/ Resistant to VRE

Resistant: Vancomycin

37

Antibiotics Sensitive/ Resistant to Neisseria gonorrhoeae

Sensitive: Ceftriaxone (3rd), +/- macrolides and tetracyclines

38

Antibiotics Sensitive/ Resistant to E.coli

Sensitive: Amoxicillin/Ampicillin, AmoxClav, Pip/Tazo, Aminoglycosides, Nitrofurantoin

39

Antibiotics Sensitive/ Resistant to E. coli (TEM-1)

Sensitive: Amox/Clac, Pip/Tazo, Aminoglycosides, and Nitrofurantoin. Resistant: Amoxicillin/Ampicillin

40

Antibiotics Sensitive/ Resistant to E. coli (ESBL, extended specrum B-lactamase)

Sensitive: Aminoglycosides. Resistant: all cephalosporins

41

Antibiotics Sensitive/ Resistant to Klebsiella (SHV-1)

Sensitive: Amox/Clav, Pip/Tazo, and Aminoglycosides. Resistant: Amoxicillin/Ampicillin

42

Antibiotics Sensitive/ Resistant to Klebsiella (KPC)

Sensitive: +/- to Aminoglycosides. Resistant: all Carbapenems

43

Antibiotics Sensitive/ Resistant to Pseudomonas

Sensitive: Pip/Tazo, Ceftazidime (3rd gen), Cefepime (4th gen), Imi/Dori, Meropenem, Ags, Ciprofloxacin and Levofloxacin. Resistant: Ertapenem, Moxifloxacin

44

Antibiotics Sensitive/ Resistant to Clostridium difficile

Sensitive:Vancomycin (oral) and Metronidazole

45

Antibiotics Sensitive/ Resistant to Bacteroides fragilis

Sensitive: Amox/Clav, Pip/Tazo, Carbapenems, Metronidazole, +/- Clindamycin

46

Antibiotics Sensitive/ Resistant to Chlamydia

Sensitive: Macrolides, Tetracycline, all FQs.

47

Antibiotics Sensitive/ Resistant to Mycoplasma

Sensitive: Macrolides, Tetracycline, all FQs.

48

Drug Classes Eliminated by Renal Excretion

Penicillins, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones; all require dosage adjusments if renal impairment.

49

Drug Classes Eliminated by Non-Renal Mechanisms

DQ CRIME- Doxycycline: non-renally eliminated tetracycline, Quinolones: ciprofloxacin is renally eliminated butis a non-substrate inhibitor of P450 (caffeine and theophylline), Clindamycin: non-renally elim, Rifampin: inducer of P450 and hepatotoxicity, Isoniazid: hepatotoxicity, Metronidazole: DDI w/ alcohol due to inhibition of aldehyde metabolism (Anta-abuse reaction), Erythromycin-like: DDI due to inhibition of P450 (Ery-Clae, not Azi), Sulfonamides: renal crystalluria

50

Cocci Gram + Bacterial Classification and Associated Diseases

S. pneumoniae (pneumonia, otitis media, sinusitis), S. pyogenes (pharyngitis), Viridans Streptococci (endocarditis), S. aureus (cutaneous infection, pneumonia, bacteremia, device associated infections), Enterococcus faecium-faecalis (bacteremia, intraabdominal infections, UTIs)

51

Cocci Gram - Bacterial Classification and Associated Diseases

Neisseria gonorrheae

52

Rods Gram - Bacterial Classification and Associated Diseases

E.coli (UTIs, intrabdominal infections, lower respiratory infections, bacteremia, traveler's diarrhea), H. influenza, Klebsiella (UTIs, intraabdominal infections, lower respiratory infections, bacteremia), Pseudomonas aeruginosa (nosocomial infections at any site (UTIs and pneumonia)

53

Anaerobe Gram + Rod Bacterial Classification and Associated Diseases

Clostridium difficile (pseudomembranous colitis), all other Clostridium

54

Anaerobe Gram - Rod Bacterial Classification and Associated Diseases

Bacteroides fragilis (intraabdominal and brain abscess)

55

Atypical Bacterial Classification and Associated Diseases

Chlamydia (trachoma, community-acquired pneumonia, urethitis), Mycoplasma pneumoniae (community-acquired pneumonia)

56

Narrow Antibacterial

AGs, penicillinase-resistant penicillins, clindamycin, vancomycin, metronidazole, penicillin G/V.

57

Extended Antimicrobial

Aminopenicillin (Amox-Amp), Cephalosporins, Fluoroquinolones (cip,levo), carbapenems.

58

Broad Spectrum

Macrolides, FQ (Moxi, Gemi), Tetracycline,.