Fiser Absite. Ch 06-07. Antibiotics. Medicines And Pharmacology Flashcards by jeremy linson

What is the difference between an antiseptic and a disinfectant?

antiseptic kills and inhibits organisms on body. disinfectant kills and inhibits organisms on inanimate objects

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What is the difference in coverage for iodophors like Betadine and Clorhexidine?

Both cover GPCs, GNRs but Chlorhexidine is better for fungi

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What is the mechanism of action for penicillins, cephalosporins, carbapenems, monobactams and vancomycin?

inhbition of cell wall synthesis

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What is the mechanism of action of tetracycline, aminoglycosides and linezolid?

inhibitors of the 30s ribosome and protein synthesis

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What is the mechanism of action of erythromycin, clindamycin, chloramphenicol, Synercid?

inhibitors of the 50s ribosome and protein synthesis

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What is the mechanism of quinolones?

inhibitor of DNA helicase (DNA gyrase)

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What is the mechanism of rifampin?

inhibitor of RNA polymerase

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What is the mechanism of metronidazole?

Produces oxygen radicals that breakup DNA

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Whast is the mechanism of sulfonamides?

PABA analogue, inhibit purine synthesis

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What is the mechanism of trimethoprim?

inhibits dihydrofolate reductase, inhibits purine synthesis

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____ have irreversible binding to ribosome and are considered bactericidal

aminoglycosides

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What is the most common method of antibiotic resistance?

transfer of plasmids

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How is the mechanism of resistance to methiclllin or vancomycin developed?

mutation in cell wall binding protein

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How is the mechanism of resistance to gentamicin developed?

resistance due to modifying enzymes leading to decrease in active transport

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What do you do if abx peak is too high?

decrease amount of each dose

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trough too high?

decrease frequency

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Which antibiotic’s coverage can be described as: Not effective against Staphylococcus or Enterococcus. But effective against GPCs, streptococci, syphilis, Neisseria meningitides (GPR), Clostridium perfringens (GPR), beta-hemolytic Streptococcus, anthrax

Penicillin

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Anti-staph penicillins

Oxacillin/nafcillin

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Same coverage as penicillin but also picks up enterococci

Ampicillin/amoxicillin

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Name the two abx that are broad-spectrum - pick up GPCs (staph and strep), GNRs, +/- anaerobic coverage. Effective for enterococci but not effective for pseudomonas, acinetobacter or serratia.

Unasyn (ampicillin/sulbactam) and Augmentin (amoxicillin/clavulanic acid)

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Name the two antipseudomonal abx that are broad spectrum – pick up GPCs (staph and strep), GNRs, anaerobes. Effective for enterococci; effective for Pseudomonas, Acinetobacter, and Serratia.

Timentin (ticarcillin/clavulanic acid) and Zosyn (piperacillin/sulbactam)

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What are the side effects of ticarcillin/piperacillin?

inhibit platelets; high salt load

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Name two first generation cephalosporins

Ancef (cefazolin), Keflex (cephalexin)

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What does the first generation cephalosporins cover?

GPCs staph and strep

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limitations of ancef / keflex

Not effective for enterococcus; does not penetrate CNS

Which first generation cephalosporin is best for phrophylaxis?

cefazolin (Ancef) has the longest half-life

What are the side effects of the first generation cephalosporins?

can produce positive coombs test

Name three 2nd-generation cephalosporins

cefoxitin, cefotetan, cefuroxime

Main side effect of 2nd-generation cephalosporins.

Prolonged PT

Third generation cephalosporins cover ___ mostly, +/- anaerobic coverage.

GNRs

What major side effect of ceftriaxone?

cholestatic jaundice, sludging in the gallbladder

Monobactam (aztreonam) covers GNRs and picks up what 3 others?

Pseudomonas, Acinetobacter, Serratia

Carbapenems (meropenem/imipenem) are broad spectrum covering GPCs, GNRs and anaerobes. Not effective for what 3 (with mnemonic)?

MEPP: MRSA, Enterococcus, Proteus, Pseudomonas

What can be added to carbapenems to prevent renal hydrolysis of the drug and increase half-life.

cilastin

What is the major side effect of carbapenems?

can cause seizures

What is the coverage of Bactrim?

GNRs, +/- GPCs. Not effective Enteroccoccus, Pseudomonas, Acinetobacter, and Serratia

Bactrim side effects?

teratogenic, allergic reactions, renal damage, Steven-Johnson syndrome (erythema multiforme, hemolysis in G6PD-deficient patients

What is the coverage of quinolones?

GPCs, mostly GNRs. Not effective for Enterococcus; picks up Pseudomonas, Acinetobacter and Serratia. 40% of MRSA sensitive

What is the coverage of aminoglycosides?

GNRs. Good for pseudomonas, Acinetobacter and Serratia. Not effective for anerobes (need O2).

Aminoglycosides are synergistic with ___ for Enterococcus

ampicillin

What is the coverage for macrolides?

GPCs; best for CAP and atypical pneumonias

The main side effects of macrolides are ___ (PO) and ___ (IV). Also binds ___ receptor.

nausea, cholestasis, motilin receptor (prokinetic for bowel)

Name side effects of vancomycin

HTN, redman syndrome (histamine release), nephrotoxicity, ototoxicity

Main side effect of tetracycline?

tooth discoloration in children

Coverage of clindamycin

anaerobes, some GPCs, good for aspiration pneumonia. Can be used to treat C. perfringens

Main side effect of clindamycin?

pseudomembranous colitis

Metronidazole covers ____

anaerobes

2 main side effects of metronidazole

disulfiram-like reaction, peripheral neuropathy

Prolonged broad-spectrum antibiotics +/- fever -> add ____

fluconazole

Possible fungal sepsis -> add ___

amphotericin

2 side effects of Isoniazid?

hepatotoxicity, B6 deficiency

2 side effects of Rifampin?

hepatotoxicity, GI sx

Side effect of Pyrazinamide?

hepatotoxicity

Side effect of Ethambutol?

retrobulbar neuritis

Name 4 TB drugs?

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Inhibits DNA polymerase, usually used for HV infections; can be used for EBV.

Acyclovir

Used for CMV infections. Side effects decreased bone marrow, CNS toxicity.

Ganciclovir

Name 4 drugs effective for enterococcus.

vancomycin, Timentin/Zosyn, ampicillin/amoxicillin, or gentamicin with ampicillin.

Name drugs effective for Pseudomonas, Acinetobacter and Serratia

ticarcillin/piperacillin, Timentin/Zosyn, third-generation cephalosporins, aminoglycosides, meropenam/imipenam (resistance can develope in Pseudomonas), or fluoroquinolones

Significance of sublingual and rectal drugs?

do not pass through liver first

skin absorption based on ____ through the epidermis

lipid-solubility

CSF absorption is restricted to ____, ____ drugs

nonionized, lipid-soluble

Albumin - largely responsible for binding drugs (____ and ____ 90% bound)

PCN, warfarin

____ will displace unconjugated bilirubin in newborns

sulfonamides

___ and heavy metals stored in bone

tetracycline

In what type of kinetics constant amount of drug is eliminated regardless of dose?

0 order kinetics

In what type of kinetics is drug eliminated proportional to dose?

1st order kinetics

How many half-lives for a drug to reach steady state?

Amount of drug in the body divided by amount of drug in plasma or blood

Volume of distrobution

Drugs with a high volume of distrobution have higher concentrations in the ___ compartment compared with the ___ compartment.

extravascular (ie fat tissue), intravascular

Fraction of unchanged drugs reaching the systemic circulation. Assumed to be 100% for IV drugs, less for other routes.

bioavailability

Drug level at which desired effect occurs in 50% of pts.

ED50

Drug level at which death occurs in 50% of pts.

LD50

Tachyphylaxis

tolerance after only a few doses

Dose required for effect.

Potency

Ability to achieve result without untoward effect

efficacy

Microsomal drug metabolism takes place in ____

hepatic cell endoplasmic reticulum, P-450 system

Which phase of microsomal drug metabolism has demethylation, oxidation, reduction, hydrolysis reactions (mixed function oxidases, requires NADPH/oxygen)

Phase I

Which phase of microsomal drug metabolism has glucuronic acid and sulfates attache (forms water-soluble metabolite); often inactive and ready for excretion.

Phase II

P-450 Inducers with mnemonic

Queen Barb Steals Phen-phen and Refuses Greasy Carbs Chronically; Qunidine, Barbituates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic etoh

P-450 inhibitors with mnemonic

SIC KEG A Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erthyromycin, Grapefruit juice, Acute etoh

P-450 system transforms aromatic hydrocarbons into ___

carcinogens

What is the most important organ for eliminating most drugs?

kidney (glomerular filtration and tubular secretion)

What type of druges are more water soluble and more likely to be eliminated in unaltered form.

Polar drugs (ionized)

What type of drugs are more fat soluble and more likely to metabolized before excretion?

Nonpolar drugs (nonionized)

Gout is caused by uric acid buildup; end product of ___ metabolism

purine

Used in the tx of gout, anti-inflammatory; binds tubulin and inhibits migration.

Colchicine

Used in the tx of gout, anti-inflammatory.

Inomethacin

Used in the tx of gout, xanthine oxidase inhibitor, blocks uric acid formation from xanthine.

Allopruinol

Used in the tx of gout, increases renal secretion of uric acid.

Probenecid

Lipid lowering agent that can bind vitamin K and cause bleeding tendancy.

cholestyramine (Questran)

What antiemetic causes tardive dyskinesia (inhibits dopamine receptors)? what is the tx?

Promethazine (Phenergan), diphenhydramine (Benadryl)

Prokinetic drug that is a dopamine receptor blocker that can be used to increase gastric motility and gut motility in general.

Metoclopramide (Reglan)

Antiemetic; serotonin receptor inhibitor.

Ondansetron (Zofran)

Somatostatin analog used to treat acromegaly and diarrhea associated with carcinoid syndrome and VIPomas.

Octreotide

Digoxin MOA?

inhibits Na/K ATPas and increases myocardial calcium

Digoxin major side effect

decreased blood flow to intestine has been implicated in mesenteric ischemia

What does hypokalemia do to Digoxin?

increased sensitivity of heart, can precipitate arrhythmia or AV block

Is digoxin cleared with dialysis?

3 major side effects of Procainamide

lupus-like syndrome, pulmonary fibrosis, torsades

treatment for Torsades?

Magnesium

QT interval that is concerning with Procainamide

>400

Medication that causes transient interruption of the AV node?

adenosine

Best single agent shown to reduce mortality in pts with CHF. Can also prevent CHF post-MI.

ACEi (captopril)

MOA of atropine

acetylcholine antagonist

Name 2 drugs used to inhibit adrenal steroid synthesis. Used in patients with adrenocortical CA.

Metyrapone and aminoglutethimide

Analogue of GnRH and LHRH. Inhibits release of LH and FSH from pituitary when given continuously (paradoxic effect)

Leuprolide

Can be used in pts with GI bleeding by reducing intestinal blood flow.

Vasopressin (ADH)

Used in gout and to close PDA

indomethacin (inhibits prostaglandin production)

PGE1 derivative; a protective prostaglandin used to prevent peptic ulcer disease. Consider use in pts on chronic NSAIDs

Misoprostol

What is the 1st and 2nd acid/base disturbances seen in ASA poisoning.

1st respiratory alkalosis; 2nd metabolic acidosis

Side effect of Gadolinium?

nausea

Fiser Absite. Ch 06-07. Antibiotics. Medicines And Pharmacology Flashcards

(112 cards)