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MISC abx Flashcards

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1
Q

Beta lactam- PCN: side chain impacts (4)

A

Spectrum
Stability to stomach acid
Cross-hypersensitivity
Susceptibility to bacterial degradative enzymes

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2
Q

adverse rxns to PCN (6)

A
  • Allergic rxns
  • GI side effects such as nausea, vomiting and diarrhea
  • Nephritis – acute interstitial nephritis (nafcillin)
  • Neurotoxicity – can cause seizures
  • Hematologic – with therapy > 2 weeks -decrease coagulation
  • Secondary infections: ex/ C. diff or vaginal candidiasis from suppressing normal flora
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3
Q

3 classes of PCNs

A

Penicillins AKA natural penicillins
Anti-staphylococcal penicillins
Extended spectrum penicillins

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4
Q

natural PCNs and how you administer

A

Penicillin G is given parenterally
Penicillin Benzathine is given IM
Penicillin V is a potassium salt, is more acid-stable, and able to be given orally

“Natural Voluptuous Girls = Benza-yonce”

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5
Q

what is used for gangrene and syphilis treatment?

A

natural PCN

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6
Q

spectrum of natural PCN?

A

treats: Gram pos. cocci and rods, and anaerobes, Gram neg cocci, and spirochetes
Little activity against gram negative rods because penicillin can’t penetrate their outer membrane
Not effective for S. Aureus

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7
Q

PCN MOA

A

inactivate transpepsidase, disrupt cross-linking (PBPs) –> cell lysis. effect mostly cells that are growing/dividing

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8
Q

Anti-staph PCN MOA + spectrum

A

Same MOA as penicillin G, but are beta-lactamase (penicillinase) resistant penicillins

Spectrum
Staphylococcus aureus (MSSA)
Streptococcus Grp A, B

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9
Q

extended spectrum PCN - subgroups and general spectrum

A

Ampicillin/amox and pipercillin/ticarcillin- greater activity against gram neg. (diff. side chain allows to better penetrate outer wall)

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10
Q

ampicillin/amox spectrum

A

Spectrum: Same as natural penicillins PLUS: gram pos and gram neg.
Not effective for pseudomonas aeruginosa or MSSA or MRSA

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11
Q

pipercillin/ticarcillin spectrum

A

natural PCN spectrum + gram negs (including pseudomonas)

Spectrum: same as ampicillin PLUS
Pseudomonas + other gram pos.
Resistance can develop so save them for when you really need them.

Used in very ill patients often in combination with another antibiotic to prevent resistance & increase killing power

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12
Q

Anti-staph PCN subgroups (4)

A

Naficillin, Oxacillin, Dicloxicillin, Methacillin

drug test for staff? “Nah… Oxy + Meth Dictate (me)”

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13
Q

beta lactamase inhibitor MOA

A

Beta lactamase is an enzyme made by bacteria that breaks apart the beta lactam ring of the ABX.
Beta lactamases are a source of resistance.
If you give an inhibitor of the enzyme that is produced by the bacteria with the Abx, the bacteria will not be as resistant to the Abx

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14
Q

beta lactimase inhibitor subgroups

A

Clavulanic acid
Avibactam (combined with ceftazidime)
Sulbactam
Tazobactam

“CAST” -inhibits from being “betta…” or
“Clara, Avi, Sultan, Taz”

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15
Q

beta lactams: subgroups

A

PCNs, Beta-inhibitors, cephalosporins, carbopenems, monobactams

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16
Q

dosing for combo beta-lactam inhibitors and beta lactam

A

Available in fixed combinations (don’t use inhibitor on its own- only in combo)
The dose is based on the strength of the primary antibiotic – not the beta lactamase inhibitor.

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17
Q

cephalosporins: general features

A
  • beta lactam ring like penicillins, w/ diff base compound attached
  • Generally more stable in face of beta lactamases so overall broader spectrum than PCNs
  • Work similar (on bacterial cell wall) as PCN- similar resistance problems
  • Potential option for PCN-allergic patient
  • Bactericidal
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18
Q

cephalosporin: categorizing for generations

A

Five generations

  • Generations are based on when they are made & what they kill.
  • significant modification made to the group that really changed the spectrum = a new generation.
  • First generation the oldest
  • higher generations for deadlier bacteria species (more coverage of bacteria overall)
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19
Q

PK of cephalosporins: admin. distribution. elimination

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A

Administration
-Many IV, fewer oral due to poor oral absorption
Distribution:
-Good, but CSF penetration limited to Ceftriazone, cefotaxime. All cross placenta
Elimination
-Tubular secretion and or glomerular filtration
Exception: ceftriaxone – eliminated in bile/feces

20
Q

4 combos of Beta lactamase inhibitor w/ Abx

Study These Flashcards
A

Amoxicillin + clavulanic acid = Augmentin
Ampicillin + sulbactam = Unasyn
Ticarcillin + clavulanic acid = Timentin
Piperacillin + tazobactam = Zosyn

21
Q

adverse rxns to cephalosporins: hypersensitivity rxns most significant between what two types of Abx?

Study These Flashcards
A

PCN and 1st gen cephalorsporins
*Allergy to cephalosporin = 10 % chance of allergy to PCN
Allergy to PCN = 5% change of allergy to cephalosporin

22
Q

adverse rxns to cephalosporins

Study These Flashcards
A

Hypersensitivity reactions:
GI
Superinfections: (C. difficile and vaginal candidiasis, thrush
Hypoprothrombinemia (low prothrombin level) with some cephalosporins)

Give vitamin K twice a week to prevent bleeding if giving antibiotic long term

Disulfiram-like reaction with cefotetan- (induced vomitting)
Increase nephrotoxicity of aminoglycosides

23
Q

1st gen cephalosporins

Study These Flashcards
A

Cef-azolin, Ceph-alexin

” Cefa’s PEcK” - all 1st gen only use Cefa- (except 2nd gen cefaclor)

gram + cocci: Streptococci, staphylococci
PEcK: Proteus mirabilis, E. coli, Klebsiella
Doesn’t cover: MRSA, Pseudomonas

24
Q

2nd gen cephalosporins

Study These Flashcards
A 
Ce-foxtin
Ce-furoxime
Ce-fote-tan
Cefacl-or
Cef-prozil

“Fox Fur For Tan Or Prozac”

25
2nd gen cephalosporins Spectrum
First generation spectrum gram + cocci: Streptococci, staphylococci HENS PEcK ``` PEcK Proteus mirabilis E. coli Klebsiella PLUS: H. Influenzae Enterobacter aerogenes Neisseria spp. Serratia marcescens ``` Don’t get: enterococcus, Pseudomonas, or MRSA
26
what is cephalexin used for?
UTIs (b/c kills some gm-rods) Skin infections (abscess and cellulitis b/c kills staph) Otitis media, pharyngitis (b/c kill strep).
27
clinical uses for 2nd gen cephalosporins
``` Sinusitis & otitis if mildly allergic to PCN ( but Extended spectrum PCN preferred) Lower respiratory tract infections Pneumonia H. flu Moraxella catarrhalis ``` Cefuroxime is special for community acquired pneumonia (CAP) b/c kills resistant H flu, strep pneumonia well
28
special characteristics of 3rd gen Cephalosporins
increased gram neg. coverage and only ceph. that crosses blood brain barrier (BBB) “Ceftaz as tazmanian devil- potent and only one that gets pseudamonas)
29
3rd generation cephalosporins
``` Cef-dinir Ceftri-axone Cef-tazidime ----(Ceftazidime/azobactam) Cefo-taxime Cef-podoxime ``` cephalosporins in 3rd gen all w/ suffix "-ime" PLUS "Dine Alone" -CefDinir CeftriAzone "
30
3rd gen ceph spectrum
Spectrum:Great gram neg. coverage Ceftriaxone: Meningitis Gonorrhea Lyme disease Ceftazidime Pseudomonas coverage Do NOT use for MRSA
31
clinical uses for 3rd gen cephalosporin
Clinical Uses: Multidrug resistant gram negative organisms HAP – Ceftazidime only CAP (hospital and community acquired pneumonias) Gonorrhea
32
4th generation cephalosporins
Cefepime "Pi me" Like 3rd generation more resistant to more beta lactamases Spectrum: Combines gram + (Streptococci & staphylococci) activity of 1st generation with wider gram – (Enterobacter, E. coli, Klebsiella) spectrum of 3rd generation Increased activity against pseudomonas Use: Similar to 3rd generation
33
5th generation Cephalosporin
Ceftaroline Broad Spectrum:Gram positive and negative ``` PLUS LAME (1st-4th generation don’t cover) Listeria Atypical (Chlamydia, Mycoplasma) MRSA Enterococcus faecalis ``` NO Pseudomonas
34
monobactams: name, spectrum, adverse effects
Aztreonam Less susceptible to beta-lactamases Spectrum: No gm + or anaerobe coverage Great Gram – aerobic rods & Pseudomonas aeruginosa Hospital drug for serious gm – infections that are resistant to other drugs or if PCN allergic and can’t use other drugs Renally cleared – prolonged t1/2 in renal failure
35
Carbapenems: names,
"DIME" Doripenem, Imipenem, Meropenem, Ertapenem Bactericidal “DIME” for life-threatening infections takeaway: great broad spectrum, one of the agents (imipenem) needs to be given with cilastin to inhibit other enzyme so you can keep imipenem around . others are resistant to that enzyme
36
Cell Wall Antibiotics- Target PBPs
No beta lactam ring, but work on the cell wall: These work on cell wall but DONT have Beta Lactam Ring - target proteins - polypeptides Glycopeptides -Vancomycin- most important one Cell membrane active agents - Daptomycin - Polymyxin B & Polymyxin E (Colistin) -Fosfomycin
37
Vancomycin MOA
MOA: Inhibits cell wall synthesis by binding to D-Ala-D-Ala portion of the growing peptide during cell wall synthesis --> inhibition of transpeptidase preventing further elongation and cross-linking Same result as beta-lactams, but targets a different site Bactericidal Time-dependent killing Spectrum: Great gm + coverage MRSA, S. epidermidis, sensitive enterococcus, C. diff. NO gm- anaerobes or gm- There is now VRE (vancomycin resistant enterococcus), a bad resistant bug
38
Vancomycin PK: absorbtion, admin, excretion
Not absorbed from GI tract, given IV If given orally it is not being absorbed and giving it to act topically in the GI tract (C. diff) Slow administration – 1 hour Renal excretion - dosage adjust in renal failure Increased nephrotoxicity when given with other nephrotoxic drugs Follow hospital protocol for drug dosing
39
vancomycin Adverse Rxns
“Well tolerated but NOT trouble free” Nephrotoxicity – especially if given with other nephrotoxic drugs (aminoglycosides) Ototoxicity - especially if given with other ototoxic drugs (aminoglycosides) Thrombophlebitis- Irritates tissue at site of injection And-redman’s syndrome skin flushing low BP from histamine release when give IV too fast
40
Clinical Uses for Vancomycin
Serious MRSA infections if MSSA, methicillin sensitive staph aureus, use antistaph penicillins Pseudomembranous enterocolitis due to C. diff. Endocarditis Patients allergic to beta-lactams
41
Daptomycin MOA
MOA: Binds to cell membrane of organism leading to rapid depolarization, potassium efflux and cell death Inhibits DNA, RNA, & protein synthesis Bactericidal Concentration-dependent killing
42
Daptomycin Spectrum + adverse effect
Spectrum Staphylococcus (MRSA), Enterococcus (including VRE) NO gram negative activity use: sepsis Toxicity: skeletal muscle myalgia & weakness
43
Polymixin B and E: MOA
MOA: Bind to phospholipid of gram neg and act like a detergent (Disrupts membrane integrity) Leads to leakage of cellular components and cell death Bactericidal – time-dependent killing
44
Polymixcin B and E uses
Used for salvage therapy for multi-drug resistant gram negative Pseudomonas, E. coli, Klebsiella Nephrotoxic and Neurotoxic (weakness, slurred speech)
45
Fosfomycin MOA + excretion
MOA: Inhibits early cell wall synthesis in gm + and gm- in urine only Bactericidal Excreted unchanged by kidneys Uncomplicated lower UTI only only for UTIs , if infection has moved further up, this drug wont be effective

pharmacology (24 decks)

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