Pharmacology - Antimicrobial Therapy I - Jeffrey Steele Flashcards Preview

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1

Class: Penicillins

Beta-lactam

2

Class: Cephalosporins

Beta-lactam

3

Class: Aztreonam

Monobactam

4

Class: Vancomycin

Glycopeptides

5

Class: Telavancin
Dalbavancin
Oritavancin

Lipoglycopeptides

6

Beta lactams, Monobactams, Glycopeptides and Lipoglycopeptides all act:

on the cell wall of bacteria

7

MOA: Beta-lactams

Bind to (acylation of) PBPs (penicillin binding proteins)
--PBPs polymeriza the glycan strand (transglycosylation)
--PBPs cross-link between glycan chains (transpeptidation)

8

What are mechanisms of resistance against beta lactams?

Enzymatic Destruction - by gram negative bacteria;
Reduced permeability;
Target site alteration

9

Beta-lactams do not work on:

Mycoplasma pneumoniae;
Chlamydophilia pneumoniae
--these bugs lack cell walls

Legionella
MRSA (except for ceteroline = 5th gen cephalosporin)

10

Side effects: Beta lactams

Drug fever
Acute interstitial nephritis
Seizures at high doses
Diarrhea
Delayed hypersensitivity reaction - rash

11

What are the natural penicillins?

Penicillin G
Penicillin V

12

Class: Oxacillin
Nafcillin
Dicloxacillin

Penicillinase-resistant penicillins aka antistaphylococcal penicillins

Penicillins - Beta-lactams

13

Class: Ampicillin
Amoxicillin

Aminopenicillins
Amino group increases hydrophilicity - improved penetration into gram negative cell membrane

14

Class: Ticarcillin
Piperacillin

Anti-pseudomonal penicillins

15

Use: Penicillin G, G procaine, G benzthine, V

Streps;
Mostly gram pos aerobic organisms;
Spirochetes - Treponema palladium;
Some enterobacteriaciae

16

Addition of what to Penicillin is recommended for use against odontogenic infections?

Metronidazole
recommended for b-lactamase producing aerobes

17

Use: Anti-staph penicillins ie oxacillin

MSSA - skin and soft tissue infections, joint infection, bacteremia, endocarditis;
(Strep)

18

T/F: Anti-staph penicillins are superior to vancomycin for MSSA infections.

True

Oxacillin
Nafcillin
Dicloxacillin

19

Adverse events: Oxacillin

Hepatotoxicity, neutropenia (delayed)

20

Adverse events: Nafcillin

Hepatotoxicity, neutropenia (delayed) and thrombophlebitis

21

What anti-staph penicillins require frequent dosing due to their short half life?

Oxacillin, Nafcillin

22

What is the drug of choice for enterococci?

Ampicillin (Aminopenicillin class)
--also for Listeria

23

Use: Amoxicillin

Otitis media;
Upper and lower RTI;
Lyme disease;
Streps ie S. Pneumo
**also covers haemophilus which causes upper ear/RTI stuff (for the unvaccinated child)

24

Use: IV Ampicillin

Listeria - meningitis;
Enterococcal infections
Used with gentamycin for endocarditis

25

Which aminopenicillin has better bioavailability?

Amoxicillin > Ampicillin

26

The antipseudomonal penicillins, piperacillin and ticarcillin, are always used in conjunction with:

B-lactamase inhibitors to expand spectrum to include beta-lactamase-producing organisms

27

Class: Ampicillin/sulbactam (IV) (Unasyn)

Extended spectrum penicillin/beta lactamase inhibitor combinations

28

Class: Amoxicillin/clavulanate (PO) (Augmentin)

Extended spectrum penicillin/beta lactamase inhibitor combinations

29

Class: Piperacillin/tazobactam (IV) (Zosyn)

Extended spectrum penicillin/beta lactamase inhibitor combinations

30

Class: Ticarcillin/clavulanate (IV) (Timentin)

Extended spectrum penicillin/beta lactamase inhibitor combinations

31

Uses: Extended spectrum penicillin/beta lactamase inhibitor combinations
ie Ampicillin/sulbactam
Amoxicillin/clavulanate
Piperacillin/tazobactam
Ticarcillin/clavulanate

Gram pos - MSSA;
Gram neg - Enterobacteriaceae;
Anaerobes ie Bacteroides, Fusobacterium, Prevotella

32

What drugs are recommended for Pseudomonas aeruginosa?

Piperacillin/tazobactam;
Ticarcillin/clavulanate

33

What unique strength does sulbactam have?

Activity against nosocomial bug Acinetobacter baumanni

34

What cephalosporins have activity against Pseudomonas aeruginosa?

Ceftazidime;
Cefepime

35

Class: Ceftaroline

5th gen cephalosporin

36

Ceftriaxone should be avoided in neonates because:

AE - biliary sludging

37

What cephalosporins are responsible for causing a disulfiram-like reaction w/ ethanol?

Cefamandole;
Cefotetan;
Cefoperazone

38

Class: Cefazolin (IV)

1st gen cephalosporin

39

Class: Cephalexin (PO)

1st gen cephalosporin

40

Class: Cephadroxil (PO)

1st gen cephalosporin

41

Use: 1st gen cephalosporin
Cefazolin
Cephalexin
Cephadroxil

MSSA - joint, SSTI (skin and soft tissue infections), bacteremia
Streptococci
Some enteric GNRs

42

Side effects: 1st gen cephalosporin
Cefazolin
Cephalexin
Cephadroxil

Hypersensitivity rxns

Better tolerated than anti-staph penicillins (oxacillin, nafcillin)

43

Do 1st gen cephalosporins, is Cefazolin, Cephalexin, Cephadroxil cross the BBB?

No. can't use for CNS infections

44

Class:
Cefuroxime (IV/PO)
Cefaclor (PO)
Loracarbef (PO)
Cephamycins (Cefoxitin, Cefotetan)

2nd gen cephalosporins

45

Use: 2nd gen cephalosporins

Most commonly post colon surgery
Some staph, strep but less active than 1st gen cephalosporins;
Gram neg: some enterobacteriaceae, h. influenzae, m. catarrhalis, N. gonorrheae

46

Class: Cefotaxime (IV)

3rd gen cephalosporin

47

Class: Ceftriaxone (IV)

3rd gen cephalosporin

48

Class: Ceftazidime (IV)

3rd gen cephalosporin

49

Class: Cefdinir (PO)

3rd gen cephalosporin

50

Class: Cefpodoxime (PO)

3rd gen cephalosporin

51

Class: Ceftibutin (PO)

3rd gen cephalosporin

52

Class: Cefixime (PO)

3rd gen cephalosporin

53

Use: Ceftazidime

Pseudomonas
less active against Staph and Strep

3rd gen cephalosporin

54

Which generation of cephalosporins is more active against staphylococci?

1st gen better than 3rd gen

55

Uses: Ceftriaxone (3rd gen)

Community-acquired pneumonia - use w/ azithromycin;
Meningitis;
Complicated UTI;
Intra-abdominal infection w/ metronidazole;
CSF Lyme disease;
Strep endocarditis;
Gonococcal infection and PID

56

Side effects: 3rd gen cephalosporins

Greater correlation w/ C. diff infection than other drugs;
Development of resistant organisms (ESBLs)

57

Side effects: Ceftriaxone (3rd gen)

Concerns in neonates - biliary sludging, kernicterus, interaction with calcium-containing solutions causing precipitation

58

What drug should be used instead of Ceftriaxone in neonates?

Cefotaxime

59

T/F: Ceftriazone, Cefotaxime, Ceftazidime have effective penetration across the BBB.

True

60

Is dose-adjustment necessary for patients with renal dysfunction who are administered Ceftriaxone?

No

61

Class: Cefepime

4th gen cephalosporin

62

MOA: Cefepime (4th gen)

Zwitterion - neutral molecule with pos and neg Q
Permits rapid entry into outer membrane of gram neg bacteria

63

Cephalosporins have notably no effect on what class of bacteria?

Enterococcus

64

Use: Cefepime (4th gen)

Geared toward nosocomial infections

Enterobacteriaceae;
Pseudomonas
Meningitis
MSSA
Strep pneumo, including all strains resistant to penicillin

65

Side effects: Cefepime (4th gen)

Akinetic seizures

66

MOA: Ceftaroline (5th gen)

Has a side chain that mimics a portion of the cell wall structure and acts as a trojan horse allowing access to the PBP2a