Antibiotics - Pharm

Front 1

Hypersinsitivity reaction. Severe type I (urticaria (hives), anaphylactic shock - shortness of breath and hypotension. Low: skin rash

Back 1

Penicillins (all)
Cephlosporins (rare): cross sensitivity if severe rxn to penicillins.
Imipenem: cross sensitive to penicillin
Vancomycin, aztreonam: no cross sensitivity with penicillin

Front 2

Nephrotoxicity

Back 2

Aminglycosides (acute tubular necrosis).
Vancomycin enhances toxicity by other drugs (amphotericin B)

VAN

Front 3

Ototoxicity

Back 3

Aminglycosides (cochlear toxicity, not reversible. Bestibular tox, reversible)
Erythromycin (high dose)

EAO

Front 4

Phototoxicity

Back 4

Tetracyclines and fluoroquinolones

FTP

Front 5

Kernicterus

Back 5

Sulfonamides (sulfer is yellow)

Front 6

Red man syndrome

Back 6

Vancomycin (infusion related toxicity)

Front 7

Hepatitis

Back 7

Isoniazid and rifampin (high risk > 50 yo and alcoholic)
Tetracyclins: pregnent women

HITR

Front 8

Gray baby syndrome

Back 8

Chloramphenicol.

Chlorine baby sitting in a pool

Front 9

Arthropathy

Back 9

Fluoroquinolones (ciprofloxacin)

Front 10

Peripheral neuropathy

Back 10

Isoniazid (more slow acetylators)
INH = injures nerves and hepatocytes

Front 11

Discoloration of body fluids

Back 11

Rifampin (turns things red)

Front 12

Optic neuritis

Back 12

Ethambutol (cant discriminate red and green)

Front 13

Acute gout

Back 13

Ethambutol, pyrazinamide

Front 14

Renal vs. Biliary excretion

Back 14

RED CAN: Rifampin, Erythromycin, Doxycycline, Ceftriaxone, Ampicillin, Nafcillin

Front 15

Otitis Media (symptoms / microbes)

Back 15

Inflammed tympanic membrane. Middle ear effusion, otalgia, fever, irratability
S. pneumonia (+), H. Influenzae (-), M. catarrhalis (-)

Front 16

Otitis media (treatment)

Back 16

Amoxicillin (+-) 10-14 days - need orally administered drug.
Atl: B lactmase resistance = Amoxicillin + clauvanate
Amoxicillin causes diarrhea: Cefprozil, cefuroxime (2nd gen cep) (++--).
TMP-SMX - causes rash

Front 17

Surgical prophylaxis: cardiac, vascular (prosthetic), orthopedic, nurosurgery, etc (Biliary tract and C section)

Back 17

Only IV (oral not reliable) - in therapeutic concn at time of incision and until wound closed - 2 hr before surgery.

S. aureas (+), S. epidermis (+), Overall (+++-).

Cefazolin (+++-). IV 1st gen cephlosporin - plasma t1/2 = 2 hr.

Alt: severe penicillin allergy or methicillin-resistant S. Aureas (MRSA): Vancomycin (+) - red man (IV)

Front 18

Surgical prophylaxis: colorectal and appendectomy

Back 18

Concn of bacteria in colon high - Oral ( 1 day before) and IV 2 hr before


E. coli, Bacteroides fragilis (anaerobic g-) overall (+-----)

Oral: Neomycin (-) and Erythromycin base (++-) plus IV cefoxitin (++--) - 2nd gen ceph. t1/2 = 1 hr

If surgery > 3 hr cefoxitin reinjected OR cefotetan (t1/2 = 3 hr) - causes hypothrombinemia

Front 19

Community acquired pneumonia (outpatient with no comorbid illness <60 yrs)

Back 19

Symptoms: chest pain, feer, teeth-chattering chill, productive cough. Lab: G+ cocci Leukocytosis. X-ray: pleural effusion.

S. pneumoniae (+), Legionella spp (-), M. pneumoniae

Erythromycin (++-) or other macrolide.

If patient neutropenic: Levofloxacin

Front 20

Community acquired pneumonia requiring hospitalization

Back 20

S. pneumoniae (+), Legionella spp (-), M. Pneumoniae AND
S. aureas (+), H. Influenzae (-)

Erythromycin + Cefotaxime (3rd ceph.)

Alt: Levofloxacin

Front 21

Nosocomial pneumonia

Back 21

P aeruginosa (-), Klebsiella (-), Serratia (-)

Pipercillin + Gentamicin

Alt: Ceftazidine + gentamicin

Front 22

Gonorrhea (uncomplicated)

Back 22

Dysurea, meatal pain, profuse yellow urethral discharge

N.gonorrhoeae (-) - single dose cephlosporin sufficient

Ceftriaxone (+---) IV - 3rd gen ceph. T1/2 = 9hr or Cefixime (oral)

Alt: Severe penicillin allergy Ciprofloxacin or Spectinomycin

Front 23

Travelers diarrhea

Back 23

Nausea, vomit, fecal urgency, tenesmus

Enterotoxigenic E. coli.

Fluoroquinolone, Ciprofloxacin

Alt: TMP-SMX

Front 24

Pseudomembraneous colitis (AB associated diarrhea)

Back 24

Abdominal pain, diarrhea (green / mucoid stool), Clindamycin, Ampicillin, cephlosporin.

Clostridium difficile (+)

Metronidazole (Biliary excretion and reaches colon)

Alt: Vancomycin (no response, pregnent, <10 years old)

Front 25

UTI

Back 25

Bladder: dysurea, pyuria, increased urgency / frequency.

E.coli (-), Proteus (-), E. fecalis (+), S. Saprophyticus (+)

TMP-SMX

If rash: Fluroquinolone, Ciprofloxacin

If pregnent: Cephalexin (+++-) - beta lactamase stable - 1st gen

Front 26

Tetracycline Contradiction

Back 26

Children <8, pregnent women, nursing mothers. In children tetracyclins deposit in calcifying teeth and bone and cause discoloration of teeth and temporary stunting of growth

Front 27

Fluoroquinolones contradiction

Back 27

Children < 18, pregnent and nursing women. Cause arthropathy in children

Front 28

Sulfonamides (TMP-SMX) contradictions

Back 28

Neonates <2 months, pregnent women (3rd trimester) and nursing moms. Displaces billiruben from albumin and causes kernicterus (encepatholy). Neonates have low levels of glucuronosyl transferase (GUT) to conjugate billiruben

Front 29

Chloramphenicol

Back 29

Neonates only: Gray baby syndrome - low GUT. At high concn inhibits mitochondrial ribosomes and protein synth.

Front 30

Erythromycin

Back 30

Patients with impaired liver function. Accumulates in liver (replace w/doxocyclin in treatment of pneumonia)

Front 31

Isoniazid and rifampin

Back 31

Patients with impared liver function. Metabolized in the liver. There is an increased risk of hepatitis in elderly and alcoholics (decrease dose, dicsontinue)

Front 32

Fluoroquinolones and imipenem

Back 32

Epilectic patients (seizure prone). These 2 have CNS effects.

Front 33

Gentamicin and ____ for good synergestic interaction

Back 33

Ampcillin (penicillin or cephalosporine) and G. or Vancomycin and G (aminoglycoside).

Amp / Van makes pores in bacterial cell wall which Aminogl. can get in. Positively charged aminoglycosides cant readily enter cell.

ADjust: Aminoglycoside dose decreased to minimize nephrotoxicity and ototoxicity.

Front 34

Inhibit P450

Back 34

Erythromycin, fungal azoles, metronidazole in conjunction with: Cyclosporine, Warfarin, H1 antagonists: terfenadine and Astemizole).

Replace Erythromycin with azithromycin. Decrease cyclosporine or warfarin dose

Front 35

Induce P450

Back 35

Rifampin and INH: Warfarin, Fungal azoles, cyclosporine, theophyllin, sulfonulureas, need to increase the dose of these drugs

Front 36

Drug interaction of Sulfonamides
TMP-SMX

Back 36

Occupy more albumin and displace other drugs. Decrease dose of displaced drugs (warfarin, methotrexate, sulfonylurea)

TMP-SMX also inhibits Cyp P450 and prevents metabolism of s-isomer of warfarin to further increase its levels

Front 37

Fluoroquinilones: drug intreactions

Back 37

Caffeine and theophylline. Fluoroquinolones inhibit CYP1A involved in metabolism of caffeine and theophylline and increase their levels. BOth fluoroquinolones and caffeine have CNS effects (additive). Large qty of caffeine avoided (seizures). Decrease dose of theophylline

Front 38

Tetracyclines and Fluoroquinolone drug interactions

Back 38

Milk and antacids are chelated by TC and FQ - interfere with adsorption. (These drugs also cause phototoxicity - sunburn).