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95 Cards in this Set
- Front
- Back
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What should we learn from this lecture?
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contraindications and major clinical points, do NOT memorize what drugs go in what category... hmmm.
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What dosage:time of treatment ratio is beneficial to reduce antibiotic resistance?
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higher dosage, shorter time
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What is a WASP antibiotic?
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Avoidance of antibiotic resistance technique called Wait and See Prescription which gives a short time of waiting and criteria before an antibiotic is filled to see if the infection is self-limiting.
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What are the statistics for upper respiratory infections?
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1 in 4000 that antibiotic will help
1 in 4 chance of diarrhea 1 in 50 chance of skin reaction 1 in 1000 chance it'll cause an ER visit |
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What timing is most practical to give antibiotics in regard to procedures and anesthesia?
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at time of anesthesia or within 60 minutes of first incision.
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What are the three most common super-imposed infections?
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1. vaginal candidiasis or "yeast" infection
2. diarrhea leading to pseudomembranous colitis due to overgrowth of clostridium difficile |
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What is an antibiogram?
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method of determining antibiotic sensitivity
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What are the four catagories of beta-lactam antibiotics?
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1. penicillins
2. carbapenams 3. carbacephems 4. cephalosporins |
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What is the distinct about beta-lactam antibiotics?
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beta lactam ring which is susceptible to beta-lactamase rendering it useless with certain bacteria
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What are beta-lactamase inhibitors?
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protects antibiotics against beta-lactamase and dosed with beta-lactam antibiotics
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What three beta-lactamase inhibitors are coupled with beta-lactam antibiotics?
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1. clavulanate
2. taxobactam 3. sulbactam |
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What two forms of penicillin are used today as IM and oral formulations?
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Pen G and Pen V are the only stable versions
IM 1. Pen G benzathine - long acting 2. Pen G benzathin + Pen G procain 3. Pen G procain Oral 1. Pen G potassium 2. Pen V potassium (more acid resistance than Pen G) |
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What are the four catagores of aminopenicillins?
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1. ampicillin
2. ampicillin sulbactam 3. amoxicillin 4. amoxicillin clavulanate |
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What are the IV extended spectrum penicillins?
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1. ticarcillin
2. ticarcillin clavulanate 3. piperacillin 4. piperacillin tazobactam 5. mezlocillin |
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What are the pinicillinase-resistant penicillins?
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1. cloxcillin
2. dicloxacillin 3. nafcillin 4. methicillin |
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What are significant characteristics of carbapenems?
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broad-spectrum, IV only, Gram(+) and Gram(-) anerobes. they do have beta-lactam agents, so they still cause a penicillin allergy
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What are the two carbapenems?
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1. imipenem cilastatin
2. meropenem 3. ertapenem 4. doripenem |
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What is the one carbacephems?
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loracarbef
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What GI effects do cephalosporins have?
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diarrhea, thrombophlebitis, N & V, cross-sensitivity in penicillin-allergic. not contraindicated with penicillin allergy patients, but use with caution. qualify what "allergy" means with your pts.
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What are us the uses of first gen cephalosporins?
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1st gen: used against most Gram(+) except eterococci and MRSA. used against non-methicillin resistant staph. used against oral cavity anerobes, Moraxella catarrhalis, E. coli, K. pneumoniae, Proteus mirabilis
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What are us the uses of second gen cephalosporins?
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slightly more enhanced Gram(+) activity, usually used when treating otitis media. lower respiratory, pneumonia, pharyngitis, tonsillitis, UTI, skin infections
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What are us the uses of third gen cephalosporins?
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less active than 1st gen against Gram(+) cocci, more active against Enterobacteriacae including those that produce beta-lactamase
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What are us the uses of fourth gen cephalosporins?
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similar to 3rd
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What are the first gen cephalosporins?
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cephalexin
cefadroxil cefazolin cephradine |
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What are the most used second gen cephalorsporins?
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cefaclor
cefuroxime |
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What are the most used injection third gen cephalorsporins?
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ceftriaxone
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What are the most used oral third gen cephalorsporins?
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cefixime - gonorrhea
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What is the only monobactam available and why is it used?
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aztreonam injection used against beta-lactamase enzymes, has no Gram(+) activity, safe for penicillin allergies
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What is the mechanism of action of beta-lactams?
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inhibition of cell wall synthesis in bacteria
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What is cross-sensitivity?
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since all beta-lactams (penicillin being the poster child) have the lactam ring, pts with penicillin allergies may have reactions to other beta-lactams
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What is the mechanism of action of the aminoglycosides?
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not known, but something to do with 30S ribosomal subunit to inhibit bacterial protein synthesis
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What kinda of bacteria are aminoglycosides effective in treating?
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severe aerobic Gram(-) bacteria like
E. coli Klebisella Proteus Pseudomonas |
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what is concentration-dependent killing and the post-antibiotic effect?
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concentration-dependent killing - concentration of antibiotic /\, bactericidal effect /\
PAE - once antibiotic is cleared, bacterial inhibition is still present |
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What aminoglycoside is used in TB infection?
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streptomycin
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What is the main aminoglycoside used?
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gentamicin
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What are the side effects of aminoglycosides?
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notorious causing
1. ototoxicity (vestibular and 8th nerve damage) causing ataxia and hearing loss 2. renal toxicity |
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How can you avoid renal toxicity in aminoglycoside use?
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monitor serum creatinine levels over time after establishing a baseline
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What antibiotic when given in conjunction with aminoglycosides can increase nephrotoxicity?
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vancomycin
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What is tetracyclines?
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class of antibiotics as well as an antibiotic itself that acts by protein synthesis inhibition by binding transfer RNA which produces a bacteriostatic effect
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What adverse reactions and contraindications are present with tetracyclines?
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1. photosensitivity
2. contraindicated in pregnancy, can cause neonate teeth staining and stunted growth |
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What should you NOT take with tetracyclines?
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antacids, milk because of chelation with divalent & trivalent ions in antacids and milk products. decreases absorption by 50%
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What is significant about doxycycline?
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less chelation with antacids and foods
good for chlamydia, malaria, typhoid, anthrax |
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What is significant about demeclocycline?
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VERY phototoxic
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What is a macrolide?
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antibiotic class that binds to 50-S ribosomal subunits inhibiting bacterial protein synthesis
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What is the spectrum of macrolides?
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mycoplasma, H. flu
great for gram(+) some gram(-) Upper Respiratory Infections mainly |
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What are the adverse effects of the macrolide Erythromycin?
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GI effects are common for over 20%
some hepatotoxicity causes P450 inhibition option other than erythromycin? azythromycin! |
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What is clarithromycin?
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kind of the middle of the road between erythromycin and azythromycin
adverse effect? dysgeusia (bad taste in the mouth) don't refrigerate, it will get too thick |
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What is significant about azithromycin?
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azalide subclass of macrolides that is used in Z-pak formulation. NOT teratogenic, NOT affect CYP P450
adverse effects: some GI, but not as much as erythro |
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What is a lincosamide?
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a macrolide-like antibiotic class that has limited use because of diarrhea, pseudomembrane colitis when taken orally
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What is the ketolide telithromycin?
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macrolide subclass that has a dual mechanism of action so effective against major drug resistance strains, BUT a LOT of liver toxicity! no longer used.
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What are fluoroquinolones or quinolones?
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class of antibiotic that is a nalidixic acid with a flourine group. this compounds blocks DNA gyrase to inhibit DNA synthesis in bacteria. some concern about how that might interact with our own DNA. no kids or preggos.
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What are the drug interactions of quinolones?
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1. QT prolongation when combined with a P-450 enzyme inhibitor
2. bind with divalent and trivalent cations which decreases bioavailability by 90% |
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What does quinolones cause to show up on a UA?
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false positive for opiate use. usually ofloxacin and levofloxacin
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What adverse reactions of fluoroquinolones?
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arthropathy (joint disease)
tendon rupture, tendonitis blood glucose changes CNS effects photosensitivity (so take at bedtime) |
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What is the most common second gen quinilone
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ciprofloxacin
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what are the respiratory quinolones?
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third gen with better gram(-) coverage. levofloxacin is most commonly used
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What is besivloxacin?
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newest, unclassified quinolone that is used exclusively ophthalmically used for bacterial conjunctivitis
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What is a sulfonamide?
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bacteriostatic antibiotics that inhibit folic acid synthesis in bacteria
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What type of infections are sulonamides commonly used?
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UTI, prostatitis, otitis media, URI
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Why is fluid forcing necessary in conjunction with sulfonamide tx?
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prevent crystalluria in the urinary tract, but does not really occur with the newest soluble abilities of common day sulfonamides
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What is the main sulonamide used?
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sulfisoxazole
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What is a major concern with sulfonamide adverse reactions?
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allergies/anaphylaxis. symptoms are called Stevens-Johnson syndrome, toxic epidermal necrolysis.
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Are sulfonamides the only cause of Stevens-Johnson Syndrome?
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nope
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sulfa/sulfonamide allergies are confusing sometimes, why?
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a sulfonamide antibiotic has a different chemical structure than some other sulfonamide. thus, if a pt is allergic to a sulfonamide antibiotic that doesn't mean they are allergic to all sulfonamides (celebrex is a sulfonamide, yo) be aware and give informed consent to your patient to cover your hiney
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What drugs are used for UTI?
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fosfomycin tromethamine, nitrofurantoin, methenamine (converted to formaldehyde to denature protein and change pH of urine), trimethoprim
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What is phenazopyridine?
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red azo dye for dysuria and has no antibacterial effects. it's an analgesic that helps with the pain of UTIs. the urine will be reddish/orangish, so let the pts know
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what is chloramphenicol?
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no class used for gram(+) and gram(-) and many anaerobic bacteria, chlamydia, and Rickettsia
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what is the mechanism of action of chloramphenicol?
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binds to the 50S subunit of bacterial ribosomes and inhibits peptide bond formation
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What is an adverse effect of chloramphenicol?
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gray-baby syndrome, failure to feed
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What is metronidazole?
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amebicidal, bactericidal, and trichomonicidal and is taken up by anaerobic organisms and cells and disrupts DNA
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What is the spectrum of metronidazole?
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protozoa and obligate anaerobes. effective in Entamoeba histolytica, Giardia lamblia, and trichomonas vaginalis
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What are adverse effects of metronidazole?
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dysgeusia (metallic taste)
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How is metronidazole related to alcohol?
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metronidazole is an acetaldehyde dehydrogenase inhibitor which prevents metabolism of ethanol and causes increased levels of nausea, headache, sweating
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Is metronidazole ok for pregnancy?
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meh. It's Catagory B, so you could, but it is discouraged.
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What is Tinidazole?
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very similar to metronidazole, but more expensive. Not used much.
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What category of drug is vancomycin similar to but not a part of?
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aminoglycosides
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How does vancomycin used?
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bactericidal and appears to inhibits cell wall synthesis in bacteria as well as RNA synthesis
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What application is vancomycin most helpful?
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antibiotic resistant gram(+)
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What adverse reactions do vancomycin cause?
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1. nephrotoxicity
2. ototoxicity 3. red man syndrome |
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What are tx options for resistant gram(+) MRSA and VRE?
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1. streptogramin which is quinupristin/dalopristin combo
2. oxazolidinones 3. daptomycin 4. Tigecycline 5. Telavancin |
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what side effects does streptogramin display?
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inflammation, pain, myalgia, arthralgia, nausea, edema
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What spectrum does oxazolidinones?
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alternative to vancomycin and is available orally. vanco is NOT. it is injection only.
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What adverse effects does oxazolidinones display?
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myelosuppression
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What is the significance of daptomycin?
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depolarizes membranes and acts as a vanco alternative but not very efficacious
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What is Tigecycline?
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dirivative of minocycline that is used for IV treatment of intra abdominal infections and complicated skin infections. it acts on the 30S subunit of bacterial ribosomes, inhibiting protein production. it should not be given to people who are sensitive to tetracyclines
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What is Telavancin?
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supercharged vancomycin!
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What is mupirocin?
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topical antibiotic used for impetigo and other topical infections as well as some MRSA
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What is Retapamulin?
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topical ointment used treat staph or strep impetigo that binds the 50S subunit and stops protein synthesis
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How is isopropyl alcohol and ethanol used?
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topical antiseptic
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What is rubbing alcohol?
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mix of water and isopropyl alcohol OR ethanol and increases bacteriocidal effect. interesting.
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Tx of Otitis Externa?
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use alcohol-based ear drops to prevent, use azythromycin and neommycin, use ear plugs when swimming, use vinegar
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What is Auralgan?
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old tx for otitis externa that is formulated with anesthetic
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What antibiotics are fine to use in pregnant women?
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penicillins and cephalorporins
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What antibiotics are fine to use up to term, but not during pregnancy?
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sulfonamides
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What antibiotics are contraindicated for pregnant women?
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quinolones, tetracyclines, aminoglycosides
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