Pharm Abx

Front 1

2 most common staphylococcus organisms

(Gram +)

Back 1

staph. aureus
staph. epidermidis

Front 2

2 popular streptococci

(Gram +)

Back 2

1. streptococcus pyogenes (most common cause of strep throat)

2. streptococcus pneumoniae (#1 cause of pneumonia in elderly)

side 3: treatment?

Hint 2

Strep pyogenes: penicillin V (oral)

Strep pneumoniae:

Front 3

2 popular Gram + bacilli

Back 3

Bacillus anthracis

Listeria - serious disease - sepsis and meningitis

side 3 treatments?

Hint 3

B. anthracis -- a fluoroquinalone like ciprofloxacin

Listeria - ampicillin

Front 4

an example of a Gram + anaerobe

Back 4

Clostridium difficile

side 3: treatment?

Hint 4

C. difficile - treat with

1. metronidazole (flagyl) and if that fails,

2. vancomycin

Front 5

what are 3 popular Gram - cocci?

Back 5

Moraxella catarrhalis (common cause of CAP)

Neisseria gonorrehae (#1 STI)


side 3 - treatments?

Hint 5

M. cat - fluoroquinolones (cipro), 3rd and 4th gen cephalosporins

N. gonorrheae - penecillin. if that doesn't work, ceftriaxone.

Front 6

drug of choice for URI?

Back 6

amoxicillin

Front 7

What's considered MRSA?

Back 7

IV: Methicillin, Nafcillin, Oxacillin

If resistant to any of these, it's called MRSA.

Front 8

how do you treat staphylococcus cellulitis?

Back 8

if no PCN allergy, nafcillin

Front 9

what's the prototype anti-staph penicillin?

Back 9

nafcillin

Front 10

prototype anti-pseudomonal penicillin?

Back 10

pipperacillin.

side 3: almost always used in combination with.....

Hint 10

tazobactam (beta-lactamase inhibitor). this combo is called Zosyn.

Front 11

describe pseudomonas

Back 11

tough Gram - infection.

takes 2 or 3 drugs with pseudomonas coverage to treat.

side 3: drugs with pseudomonas coverage are...

Hint 11

Zosyn (piperacillin + tazobactam)

ceftazidime

azteronam (a monobactam)

Front 12

4 other popular gram - aerobes?

Back 12

E. coli
Klebsiella
Serratia
H. influenzae

Front 13

what's the main culprit antibiotic for C. diff infections?

Back 13

clindomycin (a lincosamide)

Front 14

3 types of adverse reactions to antibiotics

Back 14

1. allergic (common). A. anaphylactic (immediate) B. something milder like pruritis, intolerable side effect.
2. Biologic issues - overgrowth
3. Resistance

Front 15

4 types of beta-lactams

Back 15

penecillins

cephalosporins

carbapenems

monobactams

Front 16

3 classes of penicillins

Back 16

traditional penicillins

anti-staphylococcal penicillins

antipseudomonal penicillins

Front 17

beta-lactam MOA

Back 17

Site is bacterial peptidoglycan cell wall. bacteriocidal.

Front 18

2 penicillin scientists

Back 18

1929 - Alexander Fleming
Penicillium mold & the petri dish

1940 - Howard Florey
Penicillin & the patient

Front 19

what are the drugs of choice for syphillis?

Back 19

procaine penicillin G

benzathine penicillin G

how are they given?

Hint 19

must be given IM.

IV will kill patient.

Front 20

what's special about nafcillin and methicillin?

Back 20

these are anti-staph penicillins.

BUT they have no gram - coverage

Front 21

2 first-gen cephalosporins to know

Back 21

Cephalexin (Keflex) oral!
Cephazolin (Ancef, Kefzol) IV

coverage?

Hint 21

good gram + coverage

except group D strep

Front 22

2 third-generation cephalosporins to know

Back 22

Ceftriaxone (Rocephin)** Ceftazidime (Fortaz, Tazidime)**

coverage?

Hint 22

improved gram - activity at the expense of gram + activity

*ceftazidime covers pseudomonas

Front 23

what's the best antibiotic to treat something serious with until you know what it is?

Back 23

a carbapenem, like imipenem

good gram + and - coverage

Front 24

describe the monobactams

Back 24

narrow spectrum beta lactams

only good against Gram - (including pseudomonas)

Front 25

describe macrolides

MOA?

Back 25

Macrolides bind to bigger of the 2 ribosomes, inhibit protein synthesis.
Metabolized through the liver.

notorious for GI upset, mostly diarrhea. Binds to motilin receptor in GI tract, which promotes motility.

examples?

Hint 25

Erythromycin, azithromycin

Front 26

Ketolide MOA

Back 26

binds to 2 sites on the 50S ribosome

cleared hepatically

prototype?

Hint 26

ketek - super liver toxic.

Front 27

describe chloramphenicol

Back 27

Chloraphenicol – can cause aplastic anemia, is not used often in U.S. because of this. Important in other countries. Very cheap, very effective against meningitis.

Front 28

describe clindamycin

Back 28

Clindamycin – can give orally, can give IV, can apply topically (for acne, vaginosis). Good for strep throat, alt. to macrolide or penecillin for prior slide guy. Covers many of the anerobes (except clostridium), also covers gram + staph and strep.

Front 29

describe tetracyclines

2 examples?

Back 29

Tetracyclines work on the 30 S ribosome. Renal clearance, little hepatic metabolism. (little ribosome, little organs).

Doxycycline, minicycline.

adverse effects?

Hint 29

polyvalent cations can bind to this and render it ineffective. Ca, Mg, etc.

can turn teeth - deposition in calcified tissues.

n/v/cramps

photosensitivity

hepatotoxicity if expired! toxic intermediate

Front 30

describe fluoroquinolones

2 examples

Back 30

Fluoroquinolones target DNA gyrase, effectively halting protein synthesis.
good for CA UTIs

ciprofloxacin (cipro)

levafloxacin (levaquin)

coverage?

Hint 30

cipro covers gram -

levaquin covers gram +

Front 31

FQ adverse effects

Back 31

tendonitis and cartilage damage (no use in pedi)

GI: Nausea, vomiting, diarrhea

CNS: Headache, dizziness, vertigo, agitation, insomnia

Skin: Rash, pruritis, photosensitivity

Cardiac: QT prolongation

hepatotoxicity for some

side 3: interactions?

Hint 31

binds to cations

inhibits hepatic enzymes (mostly just cipro) - important for warfarin, cimetidine

Front 32

describe metronidazole (flagyl)

Back 32

Metronidazole
Flagyl. First line for c. diff. toxic to dna

very tough on GI

don't combine with alcohol

Front 33

briefly describe sufonamides

give 1 example

Back 33

lots of resistance

bactrim - good for pneumocystis

Front 34

only indicated for E. coli UTIs. Drug won’t go anywhere else.

Back 34

nitrofurantoin

Front 35

what is the drug of choice for CA MRSA?

Back 35

bactrim

sulfonamide adverse rxns?

Hint 35

Rashes - can be severe**
Photosenstivity**
Anorexia, nausea, vomiting
Bone marrow suppression
Hepatotoxicity - rare
Renal - crystalluria
Kernicterus in infants
Accumulation of bilirubin

Front 36

CAP guidelines

Back 36

1. if otherwise healthy
a. macrolide
b. doxycline

2. Co-morbidity present
a. Respiratory FQ
b. beta-lactam + macrolide

Front 37

aminoglycosides

MOA and 2 examples

Back 37

target 30S ribosome

coverage: very effective against gram -, not often used because of toxicity risk


gentamycin
tobramycin

adverse effects?

Hint 37

ototoxicity - serious

renal toxicity

requires TDM

Front 38

describe vancomycin

MOA

coverage

Back 38

interrupts cell wall synth
covers Gram + (esp. staph)

drug of choice for HA MRSA

also drug of choice for flagyl-resistant C.diff

infuse over at least 1 hour

side 3: adverse effects?

Hint 38

red man syndrome (histamine response)

nephrotoxic, ototoxic

Front 39

drug of choice for Tb?

MOA?

Back 39

Rifampin

Inhibition of DNA-dependent RNA polymerase of mycobacteria

side 3: adverse effects?

Hint 39

Most potent enzyme inducer out there. Induces enzymes and lowers blood levels of other drugs. Wreaks havoc on other drug levels. Can cause body fluids to turn bright orange in color.
Can stain contacts.