Combine Antibacterials And Antifungals

Front 1

Macrolides:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 1

Prototype= azithromycin
Bacteriacidal/static? Dose, strain dependent
Mode of Action=Reversibly binds 50S ribosomal subunit
Time/Concentration Dependent= time

Front 2

azithromycin:
Administration?
Absorbtion?
Distribution?
Metabolism/Excretion?

Back 2

Administration= oral/IV
Absorbtion= good oral absorption
Distribution= Wide, large Vd, low serum levels because drug concentrates in neutrophils, macrophages
Metabolism/Excretion= liver/ bile+urine

Front 3

azithromycin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 3

Macrolides:
Spectrum= gram +/– aerobes, mycoplasma, legionella, chlamydia
Use=resp infection, use in penicillan allergics
Adverse Effects/Drug Interaction= CYP3A4 inhibitor increases drug concentrations, GI tox

Front 4

Clindamycin:
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 4

Clindamycin:
Bacteriostatic
Mode of Action= bind inhibits 50S
Time/Concentration Dependent= time

Front 5

Clindamycin:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 5

Administration= IV/PO
Absorbtion= good oral absorption
Distribution= most tissues "save" CSF
Metabolism/Excretion= phase 1 liver/ bile +urine

Front 6

Clindamycin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 6

Clindamycin:
Spectrum= gram + cocci, Gram +/– anaerobes
Use= pulm/abd/ pelvic infections
Adverse Effects/Drug Interaction= GI disturbances, c.diff overgrowth

Front 7

Nitroimidazole:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 7

Nitroimidazole
Prototype= metronidazole
Bacteriacidal
Mode of Action= damages DNA, cytotoxic
Concentration Dependent

Front 8

metronidazole:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 8

Administration= IV/PO
Absorption= complete oral absorption
Distribution= well into most tissue AND CSF
Metabolism/Excretion= liver w/ active metabolites/ urine, feces

Front 9

metronidazole:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 9

Nitroimidazole:
Spectrum= gram +/– anaerobes (gold standard for gram neg), protazoa
Use= c.diff colitis, other anaerobes
Adverse Effects/Drug Interaction= metallic taste, GI disturb

Front 10

Quinolones:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 10

Quinolones:
Prototype= levofloxacin
Bacteriacidal (high concentrations)
Mode of Action= topoisomerase inhibitor
concentration dependent

Front 11

levofloxacin:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 11

Administration= IV/PO
Absorbtion= good oral.
Distribution= well in most tissues including bone, prostate
Metabolism/Excretion= minimal/ urine

Front 12

levofloxacin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 12

Spectrum= broad gram –, moderate gram +
Use= resp inf, anthrax exposure, gastroenteritis, osteomyelitis, prostatitis
Adverse Effects/Drug Interaction= GI disturb, CNS, rash, photosensitivity, QT prolongation, tendon rupture, glucose homeostasis

Front 13

Antifolate:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 13

Antifolate
Prototype: trimethaprim/sulfamethoxazole
Bacteriostatic
Mode of Action= inhibit dihydropteroate synthase: dihydrofolate reductase

Front 14

trimethaprim/sulfamethoxazole:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 14

Administration= oral
Absorbtion= good oral
Distribution= wide, some into CSF
Metabolism/Excretion= minimal/ urine

Front 15

trimethaprim/sulfamethoxazole:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 15

Spectrum= gram +/– aerobes, listeria, shigella, pseudomonas
Use= UTIs, stenotrophomonas, pneumocystis jiroveci
Adverse Effects/Drug Interaction= allergies, pancytopenia, photosensitivity

Front 16

Isonazid
class?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 16

antimycobacterial
Bacteriacidal
Mode of Action= inhibits mycolic acid synthesis

Front 17

Isonazid
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 17

Administration=PO
Absorption= good oral absorption
Distribution= widely distributed, includes CSF
Metabolism/Excretion= liver acetylation / renal

Front 18

Isonazid agents:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 18

Antimycobacterial:
Spectrum= mycobacterium
Use= TB, both phases of treatment
Adverse Effects/Drug Interaction= hepatotoxicity, urticaria, peripheral neuropathy

Front 19

Rifampin:
class?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 19

Antimycobacterial
Bacteriacidal
Mode of Action= block RNA polymerase

Front 20

Rifampin
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 20

Administration= PO
Absorption= good oral
Distribution=wide including CSF
Metabolism/Excretion=Liver/ bile

Front 21

Rifampin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 21

Antimycobacterial agents:
Spectrum=mycobacterium, gram +/–
Use=TB, must be given in combination for gram+
Adverse Effects/Drug Interaction= induces CYP450

Front 22

Polyenes:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 22

polyenes:
Prototype= amphotericin B
Fungicidal
Mode of Action= binds ergosterol causes lysis

Front 23

amphotericin B:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 23

Administration= IV
Absorption= poor oral
Distribution= wide
Metabolism/Excretion= bile

Front 24

amphotericin B:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 24

polyenes:
Spectrum= yeast and mold
Use= Candida, Cryptococcus, histoplasmosis, blastomycoses, aspergillus, mucormycosis
Adverse Effects/Drug Interaction= nephrotoxicity, infusion reaction, Mg and K wasting

Front 25

Azoles:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 25

Azoles:
Prototype= fluconazole
fungistatic
Mode of Action= inhibits P450, decreasing ergosterol

Front 26

fluconazole:
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 26

Administration= IV/PO
Absorbtion= good oral
Distribution= well into tissues and CSF
Metabolism/Excretion= minimal/ eliminated in urine

Front 27

fluconazole:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 27

Azole: fluconazole
Spectrum=Candida, coccidioides, cryptococcus
Use=Antifungal
Adverse Effects/Drug Interaction=Well tolerated

Front 28

Echinocandins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 28

Echinocandins:
Prototype= Caspofungin
Fungicidal
Mode of Action=inhibit glucan synthesis

Front 29

Caspofungin:
Administration?
Absorbtion?
Distribution?
Metabolism/Excretion?

Back 29

Administration= IV
Absorbtion= poor oral
Distribution= protein bound, wide
Metabolism/Excretion= liver/ renal (active metabolites)

Front 30

Caspofungin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 30

Echinocandins:
Spectrum= broad candida coverage, aspergillus
Use=invasive candidiasis, 2nd line for invasive aspergillosis
Adverse Effects/Drug Interaction=Well tolerated, hypersensitivity, nausea, nephrotoxicty, inc. ALT/AST

Front 31

Flucytosine:
Bacteriacidal/Bacteriostatic?
Mode of Action?

Back 31

fungicidal?
Mode of Action=Becomes fluorouracil, blocks DNA synthesis

Front 32

Flucytosine
Administration?
Absorption?
Distribution?
Metabolism/Excretion?

Back 32

Administration=PO
Absorption= good oral
Distribution= good including CSF
Metabolism/Excretion=minimal/urine

Front 33

Flucytosine:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 33

Flucytosine:
Spectrum=Candida, cryptococcus
Use=Used in combination as an antifungal
Adverse Effects/Drug Interaction=Toxic in bone marrow, can cause hepatic dysfunction

Front 34

Natural Penicillins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 34

Prototype = Penicillin G
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 35

Penicillin G:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 35

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues + CSF
Metabolism/Excretion = Unchanged into urine

Front 36

Penicillin G:
Spectrum?
Use?
Adverse Effects/Drug Interaction?"

Back 36

Spectrum = gram +
Use = Streptococcus/Syphilis/Neissaria Meningitidis
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 37

Aminopenicillins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 37

Prototype = Ampicillin
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 38

Ampicillin:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 38

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Tissues, CSF 5–20% unless inflamed meninges = more CSF
Metabolism/Excretion = Unchanged into Urine

Front 39

ampicillin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?"

Back 39

Spectrum = narrow gram + and narrow gram –
Use = Same as penicillin, but also enterococcus, listeria, enterobacteriae
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 40

Beta–lactamase inhibitor:
Prototype?
Mode of Action?
Administration?
Use?

Back 40

Prototype = Clavulanic acid
Mode of Action = Inhibits b–lactamases
Administration = with cell wall inhibitor
Use = As an adjunct to b–lactam therapy for resistance strains

Front 41

1st Gen Cephalosporins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 41

Prototype = Cefazolin
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 42

Cefazolin:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 42

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues, CSF 5–20%
Metabolism/Excretion = Unchanged into urine

Front 43

Cefazolin:

Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 43

Spectrum = broad gram + and narrow gram –
Use = Streptococcus, MSSA, skin infections, surgical prophylaxis
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 44

What are the two prototype 2nd generation cephalosporins?

Back 44

cefuroxime

cefloxitin

Front 45

cefuroxime:

class?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 45

2nd generation cephalosporin

Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 46

cefuroxime:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 46

Administration = IV/PO
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues, CSF 5–20%
Metabolism/Excretion = Unchanged into urine

Front 47

cefuroxime:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 47

Spectrum = narrow gram + and broad gram –
Use = Streptococcus, respiratory infections, pnuemonia
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 48

cefloxitin:

class?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?"

Back 48

2nd generation cephalosporin

Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 49

cefloxitin:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 49

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues, CSF 5–20%
Metabolism/Excretion = Unchanged into urine

Front 50

cefloxitin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 50

Spectrum = narrow gram + and broad gram – and anaerobes
Use = Intrabdominal surgical prophylaxis, PID
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte"

Front 51

3rd gen Cephalosporins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Time/Concentration Dependent?

Back 51

Prototype = ceftriaxone
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis

Time Dependent

Front 52

ceftriaxone:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 52

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues, CSF 5–20%
Metabolism/Excretion = Long 1/2 life, biliary excretion

Front 53

ceftriaxone:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 53

Spectrum = narrow gram + and broad gram –
Use = Pnuemonia, gram negative infections, meningitis
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 54

4th gen cephalosporins:
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?

Time/Concentration Dependent?

Back 54

Prototype = cefepime
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 55

cefepime:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 55

Administration = IV
Absorption = Most degraded by gastric acids

Distribution = Well into most tissues, CSF 5–20%
Metabolism/Excretion = Unchanged into Urine

Front 56

cefepime:
Spectrum?
Use?
Adverse Effects/Drug Interaction?"

Back 56

Spectrum = broad gram + and gram –
Use = Hospital acquired infections
Adverse Effects/Drug Interaction = Well tolerated, can see Hypersensitivty, GI, Neurological, Electrolyte

Front 57

Carbapenems
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 57

Prototype = Imipenem/Cilastatin
Bacteriacidal
Mode of Action = Inhibits transpeptidases, causes cell lysis
Time Dependent

Front 58

Imipenem/Cilastatin:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 58

Administration = IV
Absorption = NOT absorbed orally

Distribution = Throughout all tissues
Metabolism/Excretion = Mimally, excreted in urine

Front 59

Imipenem/Cilastatin:
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 59

Spectrum = broad gram + and gram – and anaerobes
Use = Broad spectrum agents for documented resistance
Adverse Effects/Drug Interaction = GI distubances, hypersensitivity, Seizures – Imipenim alone is nephrotoxic

Front 60

Vancomycin
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 60

Bacteriacidal
Mode of Action = Binds to peptidoglycan precursors
Time Dependent

Front 61

Vancomycin

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 61

Administration = IV (PO for c. diff)
Absorption = Poorly absorbed

Distribution = Moderate into most tissues, CSF less than 5%
Metabolism/Excretion = minimally, urine excretion unchanged

Front 62

Vancomycin
Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 62

Spectrum = Gram + aerobes and anaerobes including MRSA
Use = MRSA, Gram + in beta lactam allergic patients, C. Diff
Adverse Effects/Drug Interaction = Phlebitis, Hypersensitivity, hematologic, nephrotoxic, ototoxic

Front 63

Aminoglycosides
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 63

Prototype = gentamicin
Bacteriacidal
Mode of Action = Bind to 30S ribosome, causing misreads
Concentration Dependent

Front 64

gentamicin:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 64

Administration = IV
Absorption = Poor oral absorbtion

Distribution = Extracellular space, no CSF
Metabolism/Excretion = unchanged in urine

Front 65

gentamicin:

Spectrum?
Use?
Adverse Effects/Drug Interaction?

Back 65

Spectrum = broad gram – and narrow gram + and can be used against mycobacteria/protozoa
Use = Gram negative treatment; genitourinary infections
Adverse Effects/Drug Interaction = Nephrotoxicity, Ototoxicity

Front 66

Tetracyclines
Prototype?
Bacteriacidal/Bacteriostatic?
Mode of Action?
Time/Concentration Dependent?

Back 66

Prototype = doxycycline
Bacteriostatic
Mode of Action = Reversibly binds to 30S
Time Dependent

Front 67

doxycycline:

Administration?
Absorption?

Distribution?
Metabolism/Excretion?

Back 67

Administration = IV
Absorption = Good Oral absorption

Distribution = Especially in bile, liver, kidney, spleen, skin, bone
Metabolism/Excretion = Glucouronidated, urine/bile excretion

Front 68

doxycycline:
Spectrum?
Use?
Adverse Effects/Drug Interaction?"

Back 68

Spectrum = broad gram + and gram – and anaerobes and lyme disease
Use = Rickettsiae, Brucellosis, Cholera, Syphilis, Chlamydia, Lyme disease
Adverse Effects/Drug Interaction = Photosensitivity, tooth/bone discoloration, GI disturbances

Front 69

Define Concentration Dependent. What ratio is used to describe this parameter?

Back 69

drug works best by achieving a very high peak/Cmax

usually described by Cmax/MIC ratio; ie how many times above the MIC do you need to get your antibiotic to kill bacteria

Front 70

Define Time Dependent

Back 70

work best by maintaining concentrations above the MIC for a certain amount of time; moderate sustained levels are more important than hitting a high peak

Front 71

What ratio is used to describe mixed dependent drugs?

Back 71

"AUC/MIC"

Front 72

When administering a concentration dependent drug you should try to maximize ____?

When administering a time dependent drug you should try to maximize _______?

Back 72

When administering a concentration dependent drug you should try to maximize the single dose concentration.

When administering a time dependent drug you should try to maximize the frequency of administration

Front 73

What are the main mechanisms of resistance to beta–lactam antibiotics

Back 73

–Beta–lactamases
–Extended Spectrum Beta–lactamases – render all PCNs and cephalosporins inactive
–Alterations in PBPs

Front 74

Mechanism of resistance for MRSA and strep pneumoneae?

Back 74

Alteration in PBP

Front 75

When do you give penicillins/cephalosporins from these class IV vs PO?

Back 75

IV is for severe cases

PO is for mild to moderate

Front 76

Why are Imipenem and cilastatin given together?

Back 76

Cilastatin prevents breakdown of imipenem by renal dyhydropeptidases which protexts the kidney from toxic byproducts

Front 77

Aminoglycosides are not used as monotherapy for infections outside _______

Back 77

the urinary tract

Front 78

Post antibiotic effect?

Back 78

Persistent suppression of bacterial growth following exposure to an antimicrobial

you can give a large dose and let it completely clear out of the body because of the PAE. This is thought to reduce toxicity

Front 79

Which class has a long PAE?

Back 79

aminoglycosides

Front 80

What class has notable synergy with Aminoglycosides? Use?

Back 80

Beta–Lactams

Use: endocarditis, endovascular infections

Front 81

Most common method of tetracycline resistance?

Back 81

Drug cannot reach the target site:

Active efflux most common