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Pharm- Antimicrobials 10/05 Flashcards

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1
Q

Ampicillin, Drug Class

A

Penicillin; Aminopenicillin

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2
Q

Ampicillin, Spectrum

A

extended-spectrum; extends beyond gram-positive to gram-negative (Haemophilus influenzae, Escherichia coli, Proteus mirabilis), Listeria monocytogenes, susceptible meningococci, enterococci
“HEELP”

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3
Q

Ampicillin, MOA

A

Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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4
Q

Ampicillin, ADR

A

Nausea, vomiting, diarrhea
Allergic reactions (0.7-10%)
Anaphylaxis (0.004-0.04%)
Pseudomembranous colitis

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5
Q

Amoxicillin, Drug Class

A

Penicillin; Aminopenicillin

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6
Q

Amoxicillin, Spectrum

A

extended-spectrum; extends beyond gram-positive to gram-negative (Haemophilus influenzae, Escherichia coli, Proteus mirabilis), Listeria monocytogenes, susceptible meningococci, enterococci
“HEELP”

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7
Q

Amoxicillin, MOA

A

Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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8
Q

Amoxicillin, ADR

A

Nausea, vomiting, diarrhea
Allergic reactions (0.7-10%)
Anaphylaxis (0.004-0.04%)
Pseudomembranous colitis

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9
Q

Ceftriaxone, Drug Class

A

3rd generation cephalosporin, b-lactam

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10
Q

Ceftriaxone, Spectrum

A

less active against gram-positive, more active against Enterobacteriaceae (although resistance increasing due to B-lactamase producing strains)
“KEPSH”, don’t “tri” anything crazy –> gonorrhea

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11
Q

Ceftriaxone, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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12
Q

Ceftriaxone, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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13
Q

Ceftazidime, Drug Class

A

3rd generation cephalosporin, b-lactam

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14
Q

Ceftazidime, Spectrum

A

less active against gram-positive, more active against Enterobacteriaceae (although resistance increasing due to B-lactamase producing strains)
“KEPSH”

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15
Q

Ceftazidime, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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16
Q

Ceftazidime, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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17
Q

Cefepime, Drug Class

A

4th generation cephalosporin, penicillin

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18
Q

Cefepime, Spectrum

A

Extends beyond 3rd generation, useful in serious infections in hospitalized patients. Effective against Pseudomonas.

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19
Q

Cefepime, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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20
Q

Cefepime, ADR

A

Risk of cross reactivity with penicillins (1%)

Diarrhea

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21
Q

Meropenem, Drug Class

A

Carbapenem, b-lactam

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22
Q

Meropenem, Spectrum

A

Aerobes and anaeorbes; gram-positive, Enterobacteriaceae, Pseudomonas, Acinetobacter. Stenotrophomonas maltophilia is resistant.
“meroPEAnem” = pseudomonas, enterobacteriaceae, acinetobacter

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23
Q

Meropenem, MOA

A

Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis

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24
Q

Meropenem, ADR

A

Nausea/vomiting (1-20%)
Seizures (1.5%)
Hypersensitivity

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25
Ertapenem, Drug Class
Carbapenem, b-lactam
26
Ertapenem, Spectrum
Aerobes and anaeorbes; gram-positive, Enterobacteriaceae, Pseudomonas, Acinetobacter. Stenotrophomonas maltophilia is resistant. "meroPEAnem" = pseudomonas, enterobacteriaceae, acinetobacter
27
Ertapenem, MOA
Same as penicillins. Beta-lactam. structural analogs of D-Ala-D-Ala; Inhibits transpeptidation; covalently binds penicillin binding proteins (PBPs) preventing cross-linking of peptidoglycan; leads to cell autolysis
28
Ertapenem, ADR
Nausea/vomiting (1-20%) Seizures (1.5%) Hypersensitivity
29
B-lactamase inhibitor prototypes
Ampicillin-sulbactam Amoxicillin-clavulanic acid Piperacillin-tazobactam
30
Ampicillin-sulbactam, Drug Class
B-lactamase inhibitor
31
Ampicillin-sulbactam, MOA
prevent destruction of B-lactam antibiotics
32
Amoxicillin-clavulanic acid, Drug Class
B-lactamase inhibitor
33
Aminopenicillin prototypes
Ampicillin | Amoxicillin
34
Cephalosporin prototypes
Cefriaxone, Ceftazidime | Cefepime
35
Carbapenem prototoypes
Meropenem | Ertapenem
36
Glycopeptide prototype
Vancomycin
37
Vancomycin, Drug Class
Glycopeptide
38
Vancomycin, Spectrum
Broad gram-positive coverage [S. aureus (including MRSA), S. epidermidis (including MRSE), Streptococci, Bacillus, Corynebacterium spp, Actinomyces, Clostridium] ABCcDerm'SS = Actinomyces, Bacillus, Clostridium, Corynebacterium, S. epidermidis, S. aureus & Streptococci
39
Vancomycin, MOA
Inhibits cell wall synthesis; binds to D-alanyl-D-alanine of cell wall precursor units
40
Vancomycin, ADR
Macular skin rash, chills, fever, rash Red-man syndrome (histamine release): extreme flushing, tachycardia, hypotension Ototoxicity Nephrotoxicity
41
Respiratory Fluoroquinolone prototoype
Levofloxacin
42
Levofloxacin, Drug Class
Fluoroquinolone (respiratory)
43
Levofloxacin, Spectrum
E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp
44
Levofloxacin, MOA
Concentration-dependent; Targets bacterial DNA gyrase & topoisomerase IV "FLOOR IT" = concentration dependent, give it everything you've got!
45
Levofloxacin, ADR
GI (3-17%): mild nausea, vomiting, abdominal discomfort CNS (0.9-11%): mild headache, dizziness, delirium, rare hallucinations Rash Photosensitivity Achilles tendon rupture Contraindicated: children "FluoroquinoLONES --> be good to your BONES"
46
Aminoglycoside, prototype
Gentamicin
47
Gentamicin, Drug Class
Aminoglycoside
48
Gentamicin, Spectrum
Aerobic gram-negative bacteria, limited action against gram-positive, synergistic bactericidal effects in gram-positive with cell wall active agent
49
Gentamicin, MOA
Concentration-dependent; Binds 30S ribosomal subunit; interferes with initiation of protein synthesis; causes misreading of mRNA
50
Gentamicin, ADR
Ototoxicity (up to 25%) Nephrotoxicity (8-26%) Neuromuscular block and apnea
51
Tetracycline prototype
Doxycycline
52
Doxycycline, Drug Class
Tetracycline
53
Doxycycline, Spectrum
Bacteriostatic; wide range of aerobic & anaerobic gram-positive and gram-negative activity; Rickettsia, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia spp, Legionella, atypical mycobacterium, Plasmodium, Borrelia burgdorferi (Lyme’s disease), Treponema pallidum (syphilis) "My dachshund's name is BART": doxy = Borrelia, Atypicals (Mycoplasma, Legionella, Chlamydia), Rickettsia, Treponema
54
Doxycycline, MOA
Binds 30S ribosomal subunit; prevents access of aminoacyl tRNA to acceptor (A) site on mRNA ribosome complex
55
Doxycycline, ADR
``` GI (epigastric burning, N/V/D) C. difficile superinfections Photosensitivity Teeth discoloration Thrombophlebitis Contraindicated: children ```
56
Macrolide prototype
Azithromycin
57
Azithromycin, Drug Class
Macrolide
58
Azithromycin, Spectrum
Bacteriostatic; respiratory tract infections (spectrum S. pneumoniae, H. influenzae, and atypicals: Mycoplasma, Chalmydophilia, Legionella), alternative for otitis media , sinusitis, bronchitis, and SSTIs. Pertussis, gastroenteritis, H. pylori, Mycobacterial infections "SHHAMP" = Strep, Haemophilus, Helicobacter, Atypicals, Mycobacterial, Pertussis
59
Azithromycin, MOA
Binds reversibly 50S ribosomal subunit; inhibits translocation
60
Azithromycin, ADR
``` GI: epigastric distress Hepatotoxicity Arrhythmia QT prolongation DDI: CYP3A4 inhibition - prolongs effects of digoxin, warfarin… ```
61
Lincosamide prototype
Clindamycin
62
Clindamycin, Drug Class
Lincosamide
63
Clindamycin, Spectrum
Bacteriostatic/-cidal (depends on conc, infection site, organism); Strep pneumoniae, pyogenes, viridans MSSA; anaerobes (B. fragilis)
64
Clindamycin, MOA
Binds 50S ribosomal subunit; inhibits translocation and suppresses protein synthesis
65
Clindamycin, ADR
``` GI: diarrhea (2-20%) Pseudomembranous colitis (0.01-10%) d/t C. difficile Skin rash (10%) Reversible increase in aminotransferase activity May potentiate neuromuscular blockade ```
66
50S ribosomal subunit inhibitors
Macrolides (Azithromycin) Lincosamides (Clindamycin) Linezolid "buy AT 30, CEL at 50"
67
30S ribosomal subunit inhibitors
Aminoglycosides (Gentamicin) Tetracyclines (Doxycycline) "buy AT 30, CEL at 50"
68
Oxazolidinone prototype
Linezolid
69
Linezolid, Drug Class
Oxazolidinone
70
Linezolid, Spectrum
Gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (penicillin resistant S. pneumoniae), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods (Corynebacterium, L. monocytogenes)
71
Linezolid, ADR
Myelosuppression [thrombocytopenia (2.4%), anemia, leukopenia] Headache Rash DDI: weak, nonspecific inhibitor of monoamine oxidase (antidepressants)
72
Linezolid, MOA
Inhibits protein synthesis binding P site of 50S ribosomal subunit, prevents formation of initiation complexes
73
Causes QT prolongation
Macrolides (Azithromycin)
74
Achilles Tendon Rupture
Fluoroquinolones (Levofloxacin)
75
DDI: CYP3A4 inhibition
Macrolides (Azithromycin)
76
Ototoxicity
Aminoglycosides (Gentamicin) | Glycopeptides (Vancomycin)
77
Nephrotoxicity
Aminoglycosides (Gentamicin) | Glycopeptides (Vancomycin)
78
Red-mann Syndrome
Glycopeptides (Vancomycin)
79
B-lactams
Penicillins, Cephalosporins, Carbapenems
80
Causes seizures
Carbapenems
81
MRSA
Vancomycin, Linezolid
82
Pseudomonas
Ceftzidime, Cefepime, Meropenem, Ertapenem, Levofloxacin, B-lactamase inhibitors
83
Anaerobes
Meropenem, Ertapenem, B-lactamase inhibitors, Doxycycline, Clindamycin, Linezolid (gram + anaerobic cocci)
84
Anaerobic coverage
Meropenem, Ertapenem, Doxycycline, Clindamycin, Linezolid
85
Piperacillin, Spectrum
extends spectrum to Pseudomonas aeruginosa, Enterobacter, and Proteus spp.
86
CURB 65 Criteria
``` Confusion Uremia BUN > 20 Respiratory rate >30bpm Low BP, SBP <90, DBP = 60 Age >/=65 0-1 = outpatient 2 = admit 3+ = often require ICU care ```
87
CURB 65 Minor Criteria
``` Multilobar infiltrates WBC < 4000 PLT <100,000 Core temp < 36C Hypotension requiring agggressive fluid resuscitation ```
88
absolute indications for ICU admission
``` mechanical ventilation septic shock (+ vasopressors) ```
89
CAP- Infecting Organisms for Underlying Bronchopulmonary disease
H. influenzae Moraxella catarrhalis +S. aureus during influenza outbreak
90
CAP- Infecting Organisms with chronic oral steroid use, severe underlying bronchopulmonary disease, alcoholism, or frequent antibiotic use
enterobacteriaceae | pseudomonas
91
CAP- Infecting Organisms with classic aspiration pleuropulmonary syndrome in alcohol/drug overdose or in seizures with gingival disease or esophageal motility disorders
anaerobes
92
CAP- Common viruses
influenza RSV adenovirus parainfluenza virus
93
DOC for Non-resistant S. pneumoniae
PCN | Amoxicillin
94
DOC for Resistant S. pneumoniae
Cefotaxime, ceftriaxone, levofloxacin, vancomycin, linezolid (based on susceptibility)
95
DOC for non-beta lactase producing H. influenzae
amoxicillin
96
DOC for beta lactase producing H. influenzae
2nd or 3rd generation cephalosporin, amoxicillin/clavulanate
97
DOC for Mycoplasma pneumoniae
Macrolide, tetracycline
98
DOC for Chlamydophila pneumoniae
Macrolide, tetracycline
99
DOC for Chlamydophila psittaci
doxycycline
100
DOC for Legionella spp
FQ, azithromycin, doxycycline
101
DOC for Enterobacteriaceae (Klebsiella, E coli, Proteus)
3rd or 4th generation cephalosporin, carbapenem (if ESBL producer)
102
DOC for Pseudomonas
antipseudomonal b-lactam w/ ciprofloxacin, levofloxacin, or aminoglycoside
103
DOC for anaerobe (bacteroides, fusobacterium, peptostreptococcus)
b-lactam/b-lactamase inhibitor, clindamycin
104
DOC for MSSA
anti-staphylococcal PCN (nafcillin)
105
DOC for MRSA
vancomycin or linezolid
106
DOC for influenza virus
Oseltamivir, zanamivir
107
DOC for Pneuomcystic jiroveci
trimethoprim/sulfamethoxazole
108
DOC for Bordatella pertussis
azithromycin, clarithromycin
109
DOC for coccidioides spp
itraconazole, fluconazole (but no tx necessary if normal host)
110
DOC for Histoplasmosis
itraconazole
111
DOC for Blastomycosis
itraconazole
112
Oseltamivir, Drug Class
neuraminidase inhibitor
113
Oseltamivir, MOA
analogs of sialic acid, interferes with release of progeny influenza virus from infected host cell
114
Oseltamivir, ADR
N/V, abdominal pain (5-10%), headache, fever, diarrhea, neuropsychiatric effects (approved for children >/= 1 year)
115
neuraminidase inhibitor prototype
Oseltamivir
116
Azole prototypes
fluconazole, voriconazole
117
Azole, MOA
inhibits fungal cytochrome P450, reducing production of ergosterol
118
Azoles, ADRs
minor GI upset, abnormalities in liver enzymes, DDIs!!! i.e. prophylactically decrease warfarin
119
Voriconazole ADRs
visual changes, photosensitivity
120
Amphotericin B, MOA
binds ergosterol, changes permeability of cell, forms pores in membrane
121
Isoniazid, MOA
inhibits synthesis of mycelia acids. Prodrug, activated by KatG. Active form binds AcpM and KasA --> inhibits mycolic acid synthesis
122
Isoniazid, Resistance
mutation or deletion of katG gene overexertion of inca and aphid mutation in kasA
123
Isoniazid, ADRs
hepatotoxicity (minor elevation in LFTs 10-20%), clinical hepatitis (1%) peripheral neuropathy CNS toxicity (memory loss, psychosis, seizures) Fever, skin rashes, drug-induced SLE
124
Rifampin, MOA
inhibits RNA synthesis (binds B-subunit of DNA-dependent RNA polymerase rpoB)
125
Rifampin, resistance
reduced binding affinity to RNA polymerase --> point mutations within rpoB gene
126
Rifampin, ADRs
``` Harmless red/orange color to secretions N/V (1.5%) rash fever hepatotoxicity flu-like syndrome (20%) in those tied <2x/week DDI: induces CYPs ```
127
Pyrazinamide, MOA
disrupts mycobacterial cell membrane synthesis and transport functions (exact mechanism unknown)
128
Pyrazinamide, Resistance
impaired biotransformation, mutation in pncA
129
Pyrazinamide, ADRs
hepatotoxicity (1-5%)!! Gi upset hyperuricemia (gouty arthritis)
130
Ethambutol, MOA
disrupts synthesis or arabinoglycan. inhibits mycobacterial arabinosyl transferase (encoded by embCAB operon)
131
Ethambutol, resistance
overexpression fo emb gene products | mutation in embB gene
132
Ethambutol, ADRs
retrobulbar neuritis (loss of visual acuity, red-green color blindness) rash drug fever
133
Streptomycin, Drug class=]
Aminoglycoside
134
Streptomycin, MOA
irreversible inhibitor of protein synthesis. binds S12 ribosomal protein of 30S subunit
135
Streptomycin, resistance
mutations in rpsL or rrs gene which alter binding site
136
Streptomycin, ADRs
ototoxicity (vertigo and hearing loss) nephrotoxicity relatively C/I in pregnancy (newborn deafness)
137
Latent TB infection treatment options
Isoniazid x9 mths QD or bi-weekly Isoniazid & Rifapentine QW x12 by DOT (for pt's 12+ y/o and HIV pt's not on ART) Rifampin QD x4 mths (pt's intolerant or resistant to INH) or x6 mths in peds
138
Active TB initial therapy
``` x2 months INH rifampin pyrazinamide ethambutol ```

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