Exam 1 - ABX (classes, groups, dynamics, etc) Flashcards by Brad Stone

All Beta-Lactams are ______ and dependent on what?

Bacteriocidal, time dependent

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Which two classes of abx are concentration dependent?

Aminoglycosides, Fluoroquinolones

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Which class of abx are AUC:MUC?

Vancomycin

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What are the four classes of Beta-Lactam antibiotics?

PCN
Cephalosporins
Carbapenems
Monobactam
M.C.C.P (mass college college pharmacy)

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Beta-Lactam MOA?

Inhibits Penicillin Binding Proteins. Breaks peptides cross-linkages and prevention peptidoglycan structures.

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Beta-Lactam abx are bacteriocidal against all except for which one?

Enterococcus

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Beta-Lactams are excreted how? Which three are not?

Excreted renally.

Except for Ceftriaxone, Oxacillin, Naficillin (C.O.N.)

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4 methods of resistance to Beta-Lactams abx?

Inactivated
Modification of PBP
Low or decreased affinity for PBP
Efflux channel pumps

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Which gram bacteria typically resist Beta-Lactams by inactivation?

Gram Negative bacteria. Makes Beta-Lactamase enzyme.

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What is the most common type of resistance of Gram Negative bacteria?

Beta-Lactamase enzyme to inactivate Beta-Lactam abx

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How to overcome inactivation resistance to Beta-Lactams?

Add Beta-Lactam Inhibitors (BLI) to bind do Beta-Lactamase enzyme.

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Three ways to overcome resistance to Low or Decreased Affinity to PBPs with Beta-Lactams?

High dose Amoxicillin, switch to Cephalosporins, or Carbapenems

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Low or Decreased Affinity to PBPs with Beta-Lactams occurs with which bacteria?

Streptococcus Pneumoniae

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Which two bacteria modify their PBPs to resist Beta-Lactam abx?

MRSA, Penicillin-resistant strep pneumoniae

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What happens to Vancomycin and gram negative bacteria?

Too large to transport through the outer envelope. Can’t reach target site.

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What do Efflux Channels do to bacteria resistant to Beta-Lactams?

Pump out the abx across the membrane

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Beta-Lactamase Inhibitor MOA?

Inhibits some but not all Beta-Lactmases. Binds to Beta-Lactamse which prevents breakdown of parent drug.

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What is and does Beta-Lactmase?

Bacterial enzyme which inactivates Beta-Lactam abx

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What does Beta-Lactamase Inhibitor bind to?

Binds to Beta-Lactamase enzymes and prevents destruction of parent drug.

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Three common formulations of Beta-Lactam abx + BLI?

Amoxicillin + Clavulanic Acid (Augmentin)
Ampicillin + Sublactam (Unasyn)
Pipericillin + Tazobactam (Zosyn)

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What are the 4 Penicillin classes?

Natural PCN
Antistaphylococcal (Penicillinase Resistant)
Amino Penicillin (+/- Beta-Lactamase-Inhibitors)
Antipseudomonal agents (3rd and 4th Cephalosporins, + Beta-lactamase Inhibitor)

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Spectrum of the 4 Penicillin classes?

NARROW SPECTRUM
1. Natural PCN 
2. Antistaphylococcal
3. Amino Penicillin
4. Antipseudomonal agents (3rd and 4th Cephalosporins, + Beta-lactamase Inhibitor)
BROAD SPECTRUM

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Which Penicillin class is the most narrow? Most broad?

Narrow=Natural PCN

Broad=Antipseudomonal agents (3rd and 4th generation Cephalosporins)

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What is the spectrum coverage for Natural PCN?

Gram + Aerobes Staph and Strep A, B, C, D, E, F, G

Gram + Anaerobes

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What two common sites of infection is Natural PCN used for?

Dental infections | Throat infections

What are the two drugs in the Natural PCN class?

PenG, PenV

What are the three drugs in the Antistaphylcoccal PCN class?

Nafacillin, Oxacillin, Dicloxacillin

What are Antistaphylcoccal PCNs great at covering?

MSSA

What body side are Antistaphylcoccal PCNs good at treatment?

Skin infections

What are the two drugs in the Amino PCN class?

Amoxicillin, Ampicillin

What is the gold standard for Listeria?

Ampicillin

What are the three drugs in the Antipseudomonal PCN class?

Amoxicillin + Clavulanate (Augmentin) Ampicillin + Sublactam (Unasyn) Piperacillin + Tazobactam (Zosyn)

What two drug groups make up the Antipseudomonal class of PCNs?

Amino PCN + Beta-Lactamase-Inhibitor (BLI)

Beta-Lactam + BLI treats bacteria doing what?

Bacteria making Beta-Lactamase | MSSA, H. Flu, E. Coli, M. Catt, P. Mira

What are the six classes of Cephalosporins?

1st gen, 2nd gen, 3rd gen, 4th gen, 5th gen, Cephalosporin+BLI

What happens to the spectrum of Cephalosporins as it goes up?

Spectrum goes from narrow to broad Ex: 1st gen is very narrow in coverage, Cephalosporins + BLI is broad.

What gram of bacteria do early generation Cephalosporins cover?

Cover Gram + broadly, cover Gram - narrowly

Which Cephalosporin generation and drug covers Pseudomonas?

3rd gen. Ceftaz.

Which cephalosporin generation and drug covers MSSA and MRSA?

5th gen. Ceftaroline.

What do the Carbapenems class of antibiotics end in?

"-penem"

What are the Carbapenems the drug of choice for?

For Ceftriaxone-resistant E. Coli, Klebsiella, and P. Mirabillis

What is the spectrum of the Carbapenems?

Gram Positive staph, strep, and E. Faecelis Gram Negative including P. Aeruginosa Anaerobes

What two bacteria does Enterapenem not cover?

E. Faecelis (gram +) | P. Auerginosa (gram -)

What can Imipenem cause at high doses?

Seizures

Carbapenems are useful for organisms that are what? Drug of choice for what?

Very resistant organisms. | Drug of choice for ESBL (Extended Spectrum Beta-Lactamase)

What is the only drug and route in the Monobactam class?

Aztreonam IV

What is the coverage of Monobactam (Azetreonam IV)?

Gram Negative Aerobic

Which drug is limited to Gram Negative Aerobic coverage?

Azetreonam IV (the one and one Monobactam)

What is the claim to fame of the Monobactam class (Azetreonam)?

Pseudomonas coverage for the PCN-allergic person

What class is Azetreonam in?

Monobactam

What route for CSF penetration?

What two abx for cystitis?

Nitrofurantoin, Fosfomycin

What are three "problematic agents" for the lungs?

1. Aminoglycosides 2. Daptomycin 3. Vancomycin (VAD...these are "vad" for the lungs")

What is compromising about abscesses?

Compromises abx drug levels

What are the three possible routes for abx excretion? (Hint: one is a combo)

Renal, hepatic, or both.

What will happen to Nitrofurantoin if CrCl is less than 50?

Will lack efficacy

Which four abx don't require dose adjustment in the present of end-organ damage?

1. Ceftriaxone 2. Naficillin 3. Oxacillin 4. Linezolid (C.N.O.L)

Most abx are in which two possible pregnancy categories?

B or C B=animal studies show safe to fetus C=animal studies show some danger to fetus

What three categories of abx to often avoid in pregger women?

1. Fluoroquinolones 2. Sulfamethoxazole-Trimethoprim 3. Tetracyclines (F.S.T....don't get preggers too fast)

Which abx to avoid in kids under 8? Why?

Tetracycline. Effect on bones and teeth.

Which class of abx should be avoided in young children due to poor formation of cartilage?

Fluoroquinolones

What is the general rule for kids and abx?

Use older agents due to more clinical experience with them.

Three bad effects from Fluoroquinolones?

1. QTc prolongation 2. Tendon rupture 3. Mental status change

Big risks with Macrolides?

1. QTc prolongation | 2. Risk of sudden cardiac death

Risk of what with Beta-Lactams and kids? Due to what?

Seizures. Due to improper renal adjustment dosing

What is the cross-reactivity percent between PCN and Cephalosporins?

Historically 10-15%, closer to 5% now

What is the cross-reactivity percent between PCN and Carbapenems?

9.5-50% in skin test and retrospective reviews.

What percent of patients with PCN-positive skin test will react to therapeutic Carbepenem?

In a patient with a less severe reaction to PCN such as a mild rash what are two available options?

1. Cephalosporins | 2. Carbapenems

What is Aztreonam not an option for a PCN allergic patient?

When allergic to Ceftazidime

What is a major factor in C. Diff Infection (CDI)?

Antibiotic use. More than 3 abx increases risk.

Risk of C Diff Infection (CDI) doubles after how long?

After 3 days of antibiotic therapy

Which abx have the same PO and IV bioavailability?

``` Azithromycin Bactrim Clindamycin Doxycycline Fluoroquinolones Linezolid Metronidazole (A.B.C.D.F.L.M) ```

Pseudomonas in the eyes usually due to what?

Contact lenses not being cleaned/changed

Exam 1 - ABX (classes, groups, dynamics, etc) Flashcards

(74 cards)