Pharm Abx

Question 1

-penicillin G

Answer 1

beta lactam ring, safest MO drug, narrow spectrum, gram+ some gram-
N/V/D, BM suppression, hepatic renal tox, superinfection
Skin rash if allergy, possible anaphylaxis w allergy
Ampicillin, amoxicillin are wide spectrum
empty stomach

Question 2

-dicloxacillin

Answer 2

gram+ only, new betalactamase resistant, tx staph MRSA

same sxs penicillin, empty stomach

Question 3

-cephalosporins

Answer 3

beta lactam, but more immune to BLM, expensive, 60min pre-op
penetrate CNS at 3rd generation, gram+/- starting at 2nd gen, broader spectrum/BLM resistance w generations, later = IM IV no PO
N/V/D c-diff superinfection, renal, hypersensitivity/anaphylaxis, hemolytic anemia
CI aminoglycosides and vanco = nephrotoxic, careful Ca combination in infants

Question 4

-vancomycin

Answer 4

↓ RNA synthesis/cell wall, gram- and some gram+, narrow spectrum
very strong to tx resistants MRSA staph strep, endocarditis, osteomyelitis, c-diff
give IV unless GI target
ototoxic avoid ASA and furosemide mx trough plasma levels, nephrotoxic, anaphylaxis, potentiates NM blockers, rapid IV = histamine red man syndrome, thrombophlebitis

Question 5

-aminoglycosides

Answer 5

aerobic gram- UTI TB, outside CNS, narrow spectrum match to MO
poorly absorbed in GI
ototoxic excessive trough = HA NV dizziness, Qday ↑ intervals; nephrotoxic some hepatic, NM block numbness tingling weakness, GI NV stomatitis, BM and immune depression
CI pancuronium, inactivated by penicillin, corticosteroids

Question 6

-tetracyclines

Answer 6

wide spectrum, cost effective, great resistance, bacteriostatic tx acne H pylori peridontal
GI upset, photosensitivity, teeth stain, vestibular dizziness, good renal function, hepatic, c-diff superinfections
CI chelates w Ca, Al, Mg, Fe, zinc; empty stomach 1hr ac 2hr pc

Question 7

-erythromycin

Answer 7

safest abx, alternative to penicillin narrow spectrum
significant GI take w food, dysrhythmic forming
CI carbamazepine, warfarin = ↑ mac levels

Question 8

-clindamycin

Answer 8

gram+/-, outside CNS, tx respiratory and soft tissue, sepsis

significant risk c-diff tx vanco or metronidazole

Question 9

-linezolid

Answer 9

aerobic gram+ tx multi-drug resistant VRE MRSA
CI MAOI SSRI adrenergics; immunosuppressed, HTN, CV px
N/V/D, c-diff, HA, CV HTN, neuropathy, BM suppression

Question 10

-chloramphenicol

Answer 10

last resort and for life threatening infections
may ↓ host protein can = aplastic anemia and death, gray syndrome mx CBC
peripheral and optic neuritis, ↓ metabolizing enzymes of others drugs = tox

Question 11

-quinolones

Answer 11

wide spectrum gram+/-, ↓ DNA
CNS HA dizziness insomnia confusion, GI weight loss, BM depression, photosensitive rash, tendon rupture, hypokalemia, potentiates warfarin
CI dysrhythmic drugs, NSAIDs (CNS), iron or mineral supplements, tetracycline (impaired

Question 12

-metronidazole

Answer 12

gram- some gram+, CNS, anaerobic bacterial, protozoa eg trichomonias
1st for c diff and GI overgrowth, H. pylori
GI NVD, stomatitis, metallic taste, dry mouth, CNS insomnia dizziness, dark urine
disulfiram like sxs avoid etoh, potentiates warfarin

Question 13

-sulfonamides/trimethoprim

Answer 13

↓ bacterial folic acid, broad spectrum, 1st for UTIs
Stevens Johnson Syndrome rare w 25% mortality rate; drug induced fever, hemolytic anemia; renal damage from crystal formation, superinfection photosensitivity
hyperK from trimeth
potentiates warf, phenytoin, and sulfas

Question 14

-isoniazid

Answer 14

B6 neuropathy can supplement pyridoxine, hepatotoxic
CI BM and alcohol
potentiates phenytoin
empty stomach

Question 15

-rifampin

Answer 15

wide spectrum
↑ drug metabolizing enzymes eg warf, oral BC, NNRTIs, protease inhibitors; hepatotoxic mx @ baseline and 2-4wks, red secretions
take w food

Question 16

-pyrazinamide

Answer 16

↑ uric acid secretion gout, nongouty polyarthralgia, hepatotoxic
INH, RIF, PZA, EMB standard regimen initial phase 2mo, continuation phase 4 or 7mos

Question 17

-ethambutol

Answer 17

for very specific active TB
optic neuritis blurred vision and color, allergic rash, GI upset, gout
take w food

Question 18

-amphotericin B

Answer 18

broad spectrum for systemic mycoses
last resort highly toxic, nephro and ototoxicity, BM suppression, hypoK–gradual infusion
infusion reaction, may provide antihistamine or acetaminophen prior to admin

Question 19

-ketoconazole

Answer 19

safe topical, stinging, burning on site

if taken for direct GI NVD

Question 20

-acyclovir

Answer 20

↓ viral DNA, only when in active stage; HSV, VZV, CMV
nephrotoxicity from crystallization, GI NV anorexia abd pain, CNS vertigo HA confusion depression, tingling sensation is topical
metabolizes anti-epileptics (Dilantin and valproic acid) ↑ seizure risk

Question 21

-ganciclovir

Answer 21

CMV in immunocompromised pts (HIV or transplant)
give w food, intravitreal over 5-8months SE retinal detachment hemorrhage cataracts visual impairment
CNS depression confusion HA, GI NVD, BM suppression granulocytopenia, neutropenia, thrombocytopenia, ↓ sperm, renal fx