Miscellaneous Antibiotics Flashcards
(35 cards)
1
Q
What class of antibiotics are….
- Gentamicin
- Tobramycin
- Amikacin
- Streptomycin
- Neomycin
A
Aminoglycosides
2
Q
Amnioglycosides
- Extremely good for gram __________
- bind 30S ribosome inhibiting protein _________
- __________ activity
- _________ dependent
- Requires intense _______ monitoring
A
- Extremely good for gram NEGATIVE
- bind 30S ribosome inhibiting protein SYNTHESIS
- BACTERICIDAL activity
- CONCENTRATION dependent
- Requires intense LEVEL monitoring
3
Q
Aminoglycosides — Spectrum
- Benefit = _________ has not developed
- ______, gram negative rods (GNRs)
- _________ = best option in class d/t decreased MICs and lower required doses
- S. aureus (do not use as __________)
- __________ = often reserved for tob/gent resistant bugs (most nephrotoxic)
A
- Benefit = RESISTANCE has not developed
- AEROBIC, gram negative rods (GNRs)
- TOBRAMYCIN = best option in class d/t decreased MICs and lower required doses
- S. aureus (do not use as MONOTHERAPY)
- AMIKACIN = often reserved for tob/gent resistant bugs (most nephrotoxic)
4
Q
Aminoglycosides
- 100% ______ eliminated (requires monitoring)
- Very hydro______ which limits distribution in tissues
- Narrow ________ window, _________ dosing
A
- 100% RENALLY eliminated (requires monitoring)
- Very HYDROPHILIC which limits distribution in tissues
- Narrow THERAPEUTIC window, INDIVIDUALIZED dosing
5
Q
Aminoglycosides — Clinical Uses
- used for ________ infections
- only use monotherapy for ______
- Gram _______ sepsis, HCAP, bactermia
- Not great for skin __________ (hydrophilic)
- Gram _________ used as synergy
A
- used for HOSPITALIZED infections
- only use monotherapy for UTIs
- Gram NEGATIVE sepsis, HCAP, bactermia
- Not great for skin INFECTIONS (hydrophilic)
- Gram POSITIVE used as synergy
6
Q
Aminoglycosides — ADRs
- Primary reason people like to avoid the drug = _________
- occurs ______ days after start of therapy
- Generally mild AKI and ____________ - ____________ (very rare, but often irreversible); associated /c accumulation not excessive dosing
A
- Primary reason people like to avoid the drug = NEPHROTOXICITY
- occurs 5 - 7 days after start of therapy
- Generally mild AKI and REVERSIBLE - OTOTOXICITY (very rare, but often irreversible); associated /c accumulation not excessive dosing
7
Q
Trimethoprim / Sulfamethoxazole (Bactrim)
- ______ antibiotic
- _______, gram _________ organisms
- ________ spectrum
- Used alot in ____/________ and some ________
- Great drug for community acquired _______
- _________ = resistance increasing steadily such that use not recommended when strep is suspected pathogen
- ________, gram __________ organisms
A
- UTI antibiotic
- AEROBIC, gram POSITIVE organisms
- BROAD spectrum
- Used alot in AIDS/HIV and some CANCERS
- Great drug for community acquired MRSA
- STREPTOCOCCI = resistance increasing steadily such that use not recommended when strep is suspected pathogen
- AEROBIC, gram NEGATIVE organisms
8
Q
Trimethoprim / Sulfamethoxazole (Bactrim)
- _________ eliminated
- Significant drug interaction /c ___________
A
- RENALLY eliminated
- Significant drug interaction /c WARFARIN (COUMADIN)
- Bacterium blocks metabolism of warfarin so it stays in the system longer (nose bleeds, gum bleeds, bruising)
9
Q
Trimethoprim / Sulfamethoxazole (Bactrim) — ADRs
- ________/ ________/________ (NVD)
- Anorexia
- Hematologic: _________, _________, ____________ (seen /c larger doses, reversible)
- ____________ (/c high doses)
- more prone to ___________
A
- NAUSEA/ VOMITING/DIAHRREA (NVD)
- Anorexia
- Hematologic: NEUTROPENIA, THROMBOCYTOPENIA, ANEMIA (seen /c larger doses, reversible)
- HYPERKALEMIA (/c high doses)
- more prone to SUNBURNS
10
Q
Tetracyclines — Spectrum
- ________ spectrum
- __________ = inhibits further growth
- _________ is high
- Gram ____________ coverage
- used for ________ (treats pneumonia in adults and children)
- Good for ______ borne disease and ______ disease
- some gram ________ coverage
A
- BROAD spectrum
- BACTERIOSTATIC = inhibits further growth
- RESISTANCE is high
- Gram POSITIVE coverage
- used for ATYPICALS (treats pneumonia in adults and children)
- Good for TICK borne disease and LYME disease
- some gram NEGATIVE coverage
11
Q
Tetracycline — ADRs
- _______/_______/________ (NVD)
- Binds to __________ cations
- ___________ (i.e. sunburns)
- Decreased ___________ activity
- ____________ of teeth and bone (permanent)
- Retardation of ________ development
A
- NAUSEA/VOMITING/DIAHRREA (NVD)
- Binds to DIVALENT cations
- PHOTOSENSITIVITY (i.e. sunburns)
- Decreased ORAL CONTRACEPTIVE activity
- DISCOLORATION of teeth and bone (permanent)
- Retardation of BONE development
12
Q
Tetracyclines — Clinical Uses
- Community acquired __________, ______ infections
- _______ disease
- Acne
- _________ infections (i.e. COPD, pneumonia)
- ______ related infections
- Downside = _________ is an issue
A
- Community acquired MRSA, SKIN infections
- LYME disease
- Acne
- ATYPICAL infections (i.e. COPD, pneumonia)
- TICK related infections
- Downside = RESISTANCE is an issue
13
Q
Metronidazole (Flagyl)
- Use: _______ & ________ antibiotic
- MOA: binds to and disrupts _____ and _________ synthesis
- ________ (kills bacteria)
- ________ dependent
- only __________ coverage (under the diaphragm)
- Gram ________
A
- Use: GUT & URINARY antibiotic
- MOA: binds to and disrupts DNA and NUCLEIC ACID synthesis
- BACTERICIDAL (kills bacteria)
- CONCENTRATION dependent
- only ANAEROBIC coverage (under the diaphragm)
- Gram NEGATIVE
14
Q
Metronidazole (Flagyl) — ADRs
- _______/_________/__________
- Pancreatitis
- ______ complications
- Disulfiram reaction (violent nausea) — avoid /c _________
A
- NAUSEA/VOMITING/DIAHRREA
- Pancreatitis
- CNS complications
- Disulfiram reaction (violent nausea) — avoid /c ALCOHOL (EtOH)
15
Q
Metronidazole (Flagyl)
- F:1 = good ___________
- Well distributed in tissues (including _______)
- First line option for _______ colitis
- Add on therapy for ________ infections (below the diaphragm anaerobic coverage)
- Bacterial __________
A
- F:1 = good BIOAVAILABILITY
- Well distributed in tissues (including C. DIFF)
- First line option for ABDOMINAL colitis
- Add on therapy for ANAEROBIC infections (below the diaphragm anaerobic coverage)
- Bacterial VAGINOSIS
16
Q
Clindamycin (Cleocin)
- for ________ above the diaphragm
- Gram ________ only
- ________ (oxygen requiring)
A
- for ANAEROBES above the diaphragm
- Gram POSITIVES only
- AEROBES (oxygen requiring)
17
Q
Clindamycin (Cleocin)
- Resistance /c _______ use
- Great __________
- ADR: _____ intolerance, antibiotic associated ______ (diarrhea)
A
- Resistance /c SUSTAINED use
- Great ABSORPTION
- ADR: GI intolerance, antibiotic associated COLITIS (diarrhea)
18
Q
Clindamycin (Cleocin) — Clinical Uses
- Community acquired _______, ______
- _________ outside of the CNS
- Ance
- Encephalitis
- ___________ in AIDS patients /c bactrim allergy
- Bacterial __________
- “above the diaphragm” __________
A
- Community acquired MRSA, SSTI
- ANAEROBES outside of the CNS
- Ance
- Encephalitis
- PNEUMONIA in AIDS patients /c bactrim allergy
- Bacterial VAGINOSIS
- “above the diaphragm” ANAEROBES
19
Q
Fosfomycin (Monurol)
- Some use for ______
- Concentrates well in _______ and maintains adequate ______
A
- Some use for UTI’s
- Concentrates well in URINE and maintains adequate URINE
20
Q
Fosfomycin (Monurol) — ADR’s
- ______ tolerated
- H_________
- ______/_________/________
A
- WELL tolerated
- HEADACE
- NAUSEA/VOMITING/DIAHRREA
21
Q
Nitrofurantonin (Macrobid)
- use for ________
- requires good ______ function
A
- use for UTI
- requires good RENAL function
22
Q
Nitrofurantoin (Macrobid)
- requires functioning _________ for efficacy
- Uses: ______, ______ prophylaxis, acute _______
A
- requires functioning KIDNEYS for efficacy
- Uses: UTI, UTI prophylaxis, acute CYSTITS
23
Q
Fluoroquinolones — MOA
- For gram ________ & ________ bacteria
- _________ dependent
- ________ (rapid)
A
- For gram POSITIVE & NEGATIVE bacteria
- CONCENTRATION dependent
- BACTERICIDAL (rapid)
24
Q
Fluoroquinolones — Spectrum
- Very ________ spectrum: good to use out of the gate
- Good gram ________ coverage
- _______ gram ________ coverage
- __________ (moderate activity)
- _________ (very active)
- does NOT cover ________ well
A
- Very BROAD spectrum: good to use out of the gate
- Good gram NEGATIVE coverage
- AEROBIC gram POSITIVE coverage
- MYCOBACTERIA (moderate activity)
- ATYPICALS (very active)
- does NOT cover ANAEROBES well
25
Fluoroquinolones
- Use for _______ infection, not for _______ infection
- What are 3 drug interactions?
- Use for LUNG infection, not for UTI infection
| - (1) ANTIACIDS, (2) WARFARIN, (3) FOOD
26
Fluoroquinoloes — ADRs
| - What are 4 ADRs of Fluoroquinolones?
(1) Nausea/vomiting/diahrrea
(2) Rash
(3) QTc prolongation
(4) Achiles tendon reupture
27
What population should Fluoroquinolones be avoided in?
Children < 18 y.o. d/t arthropathies notes in animal studies
28
Fluoroquinolones — Clinical uses
- Cover everything except __________
- for nasty ________ infections (upper and lower)
- _______ tract infection
- _________ infections
- S_____
- O_________
- overuse leads to _________
- Cover everything except ANAEROBES
- for nasty RESPIRATORY infections (upper and lower)
- URINARY tract infection
- ABDOMINAL infections
- SKIN
- OSTEO
- overuse leads to RESISTANCE
29
What class of antibiotics are...
- Azithromycin (Zithromax)
- Erthromycin
- Clarithromycin (Biasing)
- Fidaxomicin (Dificid)
Macrolides
30
Macrolides — MOA
- bind to _____ ribosome to inhibit _______ — dependent protein syntehsis
- _________ dependent
- Slowly _________ or ________
- bind to 50S ribosome to inhibit RNA — dependent protein syntehsis
- TIME dependent
- Slowly BACTERICIDAL or BACTERIOSTATIC
31
Macrolides — Spectrum
- _______ spectrum
- Really good for _________ (walking pneumonia)
- _________ pathologies
- Strep and __________
- BROAD spectrum
- Really good for ATYPICALS (walking pneumonia)
- GENITAL pathologies
- Strep and STAPH
32
Macrolides — Kinetics
- Less absorbed/effective at ______ pH
- Very large, extensive tissue _________ and _______ intracellular concentrations
- Azithromycin = ______ half life
- allows for popular ____ pack or ____ pack --> leads to drug being below MIC after this so ________ is developed
- Less absorbed/effective at ACIDIC pH
- Very large, extensive tissue PENETRATION and HIGH intracellular concentrations
- Azithromycin = 66 half life
- allows for popular Z pack or TRI pack --> leads to drug being below MIC after this so RESISTANCE is developed
33
Macrolides — ADRs
| - What are 3 ADRs?
(1) Nausea/vomiting/Diarrhea
(2) Taste disturbances --> Clarithromycin (drug)
(3) QTc prolongation
34
Macrolides
| - _________ is most used b/c it has the fewest drug interactions
- AZITHROMYCIN is most used b/c it has the fewest drug interactions
35
Macrolides — Clinical Uses
- upper and lower ________ infections
- ______ bacteria infections
- _________ (chlamydia trachomatis)
- H. _______
- upper and lower RESPIRATORY infections
- ATYPICAL bacteria infections
- STDs (chlamydia trachomatis)
- H. PYLORI
