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136 Cards in this Set

  • Front
  • Back
How is gram - bacteria different from gram +?
Gram - has 2 membranes with a thinner peptidoglycan layer (harder to treat than gram +)
What are the 3 most important things to know when perscribing antibiotics?
Know the patient
Know the microbiology
Know the drugs
What is the definition of an ANTIMICROBIAL?
Antibacterial, antiviral and antifungals
Natural or SYNTHETIC compounds that kill or suppress growth of microorganisms
What is the definition of ANTIBIOTIC
NATURAL compounds made by microorganisms that have the ability to harm another microorganism
Name 3 types of AntiBIOTIC therapy?
1. Empiric: presumptive ( not sure of the microorganism)
2. Documented: know the culture and treating it
3. Prophylaxis: prevent the infection
Describe Bacteriocidal activity
Bacteriocial drugs kill organisms so that the # of viable organisms decrease rapidly
Describe BacterioSTATIC activity
BacterioStatic drugs inhibit the gorwth of bacteria but do not kill them.
Encourage the body to the do the killing
What are narrow spectrum antimicrobials?
Active against a single species or limited group of pathogens
Used for DOCUMENTED therapy
What are broad spectrum drugs?
Active against wide range of pathogens
often for empiric therapy
Describe the Minimal inhibitory concentration (MIC)
Lowest concetration of drug that prevents visible vacterial growth after 24 hours of inculbation in a specified growth medium
How does the lab report drug cultures?
1. Susceptible
2. Intermediate
3. Resistant
What are the 2 bugs have resistance over drugs?
1. Intrinsic: lack of activity before antibiotic exposure
2. Acquired: develops during therapy through mutations or transformations
Does the dose matter for Concentraiton-dependent antibiotics? Give some exs
Yes, the concentration must stay above the MIC
ex. Aminoglycosides, Quinolones, Datomycin
What the amount of antibiotic in the system matter for time-dependent antiobiotics? Give some examples
No, just the time it stays above the MIC, not the level above the MIC
Ex. Penicillins, Cephalosporins
What are the 5 classes of Antimicrobials?
1. Cell Wall Synthesis Inhibitors
2. Protein Synthesis Inhibitors
3. Alter nucleic acid metabolism
4. folate metabolism inhibitors
5. Miscellaneous mechanisms
What classes of drugs are cell wall synthesis inhibitors?
1. Beta Lactams
2. Glycopeptides
What classes of drugs are Beta Lactams?
1. Penecillins
2. Cephalosporins
3. Monobactam (azetreonam)
4. Carbapenems
What is the MOA of B-Lactams? Time or concentration dependent? Bacteriostatic or cidal?
Interfere with the last step of bacterial cell wasll synthesis
-Time dependent killing
-bactericidal
What areas is penecillin not optimal for treating?
1. Eye
2. brain
3. CSF
4.prostate in the absence of inflammation
What type of penecillins are hepatically metabilized and excreted in the bile?
Semi-sythetic penecillins
What is the pregnancy category for B-Lactam antibiotics?
Category B
What are the adverse effects of Penecillins?>
1. Anaphylaxis
2. Diarrhea
3. Interstital nephritis
4. CNS effects: seizures
5. increased liver enzymes
What is the spectrum of activity for Natural Penecillins?
Narrow Spectrum
-Select gram +, select gram -, few anaerobes, spirochetes
What is the drug of choice for syphilis?
Penecillin G
Which Natural Penecillin can be given PO
Penecillin V
What is the spectrum of activity for penecillin-resistant penecillins?
Narrow!
GRAM POSITIVE ONLY
-used to treat MSSA, not MSRA
Describe the spectrum of activity for Aminopenecillins
Narrow
considered extended spectrum but still narrow
-similar to PCN G but more GRAM +s ad -s
What is the spectrum for pseudomonal Penicillins?
Broad Spectrum
-increased activity against gram -'s
ONLY ONES THAT CAN BE USED FOR PSEUDOMONALS!
Ex. Piperacillin (zosin)
What is the spectrum for B-Lactamase Inhibitors?
Broad Spectrum
-depends on the parent B-lactam
-Gram +, gram -, anareobic orgs
What is the spectrum trend for 1st - 4th generation Cephalosporins?
First Generation is more gram + and narrow spectrum
-4th spectrum is more gram - and broad
What is the spectrum exception for 1st generation cephalosporins?
Cefazolin is the only broad spectrum 1st gen
What generation of cephalosporins can enter the CNS?
1st generation ONLY
What generations of cephalosporins are used to treat meningitis?
3rd and 4th
What is the primary excretion for cephalosporins? Are there any exceptions?
Primary: urine
Exceptions: Ceftriaxone and cefoprazone (biliary excretion)
What are some adverse effects of Cephalosporins?
1. Anaphylaxis, rash
2. IM pain at injection
3. Diarrhea
4. Intestinal nephritis
5. CNS (seizures)
6. Biliary sludge
What caution should you take with cephalosporins?
If pt has severe allergic rxn. Anaphylaxis (avoid giving to pts with Severe PCN rxn)
What is the spectrum of Monobactam (Azetreonam)?
Relatively Narrow
-ONLY GRAM -
-Has some pseudomonas coverage
Can pts with severe PCN rxns be given Monobactam?
Yes!
Can monobactam be given orally?
What are its adverse effects?
No, only IV or IM because of no GI absorption
-adverse effect: rash
Which B-Lactam has the broadest spectrum of activity?
Carbapenems
-Gram +, gram -, anaerobes
What are the clinical uses for Carbapenems?
1. Reserved for severe, Life threatening, antibiotic resistant infections
2. Only ones for POLYMICROBIAL INFECTIONS!!
What Carbapenem is the exception to the broad spectrum trend of the class?
Ertapenem: it has a narrow spectrum
Which Carbapenem comes as a combination drug?
Imipenem-cilastatin
-Cilastatin has no activity on its own
Which carbapenem is the only category C drug?
Imipenem
What are the adverse effects of Carbapenems?
1.Anaphylaxis, rash
2. Diarrhea
3. Seizures
What type of antibiotic is Vancomycin?
Glycopeptide
What is the MOA of Vancomycin?
Inhibits cell wall synthesis by inhibiting the second state of peptidoglycan synthesis (elongation)
What is the Spectrum of Vancomycin
GRAM + ONLY
-Includes MRSA
-Considered a broad spectrum antibiotic
What is the drug of choice for MRSA?
Vancomycin
What is the drug to treat C. Diff?
Vancomycin PO only
What is Vancomycin's pregnancy category?
C
Can you used PO vancomycin for systemic infections?
No
Is Vancomycin bacteriocidal or static? Time or concentration dependent?
1. BacterioCIDAL
2. Time-dependent Killing!
What are the adverse effects of Vancomycin?
1. Red Man Syndrome
2. Nephrotoxicity
3. Ototoxicity
4. Rash (aside from the RMS symptoms)
What causes Red Man Syndrome?
Pushing vancomycin too quickly in IV
What antibiotics inhibit protein synthesis (8)?
1. Chloramphenicol
2. Tetracyclines
3. Glycyclines (tigecycline)
4.Macrolides
5. Clindamycin
6. Stretogramins
7. Oxazolidinone
8. Aminoglycosides
What is the Spectrum of Chloramphenicol?
Gram +, Gram -, and Anaerobic bacteria
What is the MOA for Chloramphenicol?
Binds to the 50S subunit
Is chloramphenicol bacteriostatic or cidal? What is its pregnancy category?
Bacteriostatic
Pregnancy C
What are the side effects of Chloramphenicol?
1. Hypersensitivity
2. REVERSIBLE BONE MARROW SUPPRESION
3. Rare, potentially fatal aplastic anemia ( can occur during or weeks or months after therapy is over)
4. Gray Baby Syndrome
Can Chloramphenicol be given to babies? Why or why not?
NO!
-causes Gray Baby Syndrome: abdominal distention, vomiting, cyanosis, circulatory collapse and death
What is Tetryclycine's spectrum?
Narrow
-Used for tick bourne illnesses
-Acne
-option for pts allergic to PCN
What is the MOA of tetracyclines?
Binds to the 30S and inhibits tRNA
What is important to remember for tetracyline absorptions?
Decreased absorption if taken with multivalent cations (antacids)
How is tetracycline excreted? What are the unique forms of elimination?
Excreted: bile and urine
Elimination:
1. Tetracycline: renal
2. Minoclycline: liver metabolized
3. Doxycycline: feces
What is Tetracycline's pregnancy category and is it static or cidal?
Category D
-Bacteriostatic
What are some adverse effects of Tetracycline?
1. GI upsets
2. Diarrhea
3. PHOTOSENSITIVITY
4. Liver and Kidney Toxicity
5. PERMANENT BROWN DISCOLORATION OF TEETH (avoid in children up to 8)
Glycylcycline (tigecyclin) have what spectrum? What pregnancy category?
Broad Spectrum: gram +s, gram -s, anaerobes, no pseudomonas
Pregnancy D
What are the adverse effects of glycylcyclines?
Same as tetracyclines
N/V, hepatotoxicty
What is the MOA of Macrolides?
Binds to the 23S rRNA component of the 50S subunit
What are Macrolides' clinical uses?
Respiratory tract infections
-option for penecillin allergic pts.
What's the spectrum for Macrolides?
Relatively Narrow: select gram + and -
-Can work against Mycobacteria
Which macrolide is best to give as IV?
Azithromycin, because erythromycin causes necrosis at IV site
Which Macrolide is excreted by CYP3A4 and renal?
Clarithromycin
Do macrolides have D/D interactions?
Yes with CYP 450 inhibitor
Eryth and Clarith are potent inhibitors particularily 3A4
Which Macrolide has a prolonged timespan?
Azithromycin (5 day therapy only, but continues to work after)
What is the excretion for Erythromycin, Clarithromycin and Azithromycin?
Eryth: biliary
Clarith: CYP3A4/renal
Azith:Biliary/Fecal
What are the Macrolide pregnancy categories? Adverse effects?
Eryth and Azith: Preg B
Clarith: preg C
Adverse Effects:
1. GI intolerance
2. Cholestatic hepatitis
3. ototoxicity (high doses of eryth)
4. caridac arrythmias (eryth and clarith > azith)
What is the MOA and spectrum of Clindamycin?
Binds to the 50S subunit
-Relatively narrow spectrum: gram + and anaerobic only! (None against gram -)
What are some clinical uses of Clindamycin?
Can PCN allergic use it?
Pregnancy category?
Acne or skin infections
Ok for PCN allergic
-Pregnancy B
What are the adverse effects of Clindamycin? Static or Cidal?
Adverse effects:
1. Diarrhea
2. Rash
-Bacteriostatic
What is unique about the Streptogramins?
They are a combination of 2 antibiotics (quinupristin/dalfopristin)
Work synergistically together
What antibiotics bind to 50S subunit at 2 different sites
Streptogramins
When do we use streptogramins?
Saved for serious gram+ infections (MRSA, VRE)
What drug should be administered ONLY IN CENTRAL LINES AND DILUTED WITH DEXTROSE?
Streptogramins
Are the streptogramins static or cidal?
Separately they are static, may become bacteriocidal when combined
What are some adverse effects of Streptogramins?
1. Thrombophlebitis
2. Arthralgias/myalgias (muscle and joint pain)
3. Increased liver enzymes and hyperbilirubinemia
What is the MOA of Oxazolidinones? Are they synthetic or natural?
Bind to the 50S subunit and inhibits formation of initiation complex
-Synthetic
What are the clinical uses for Oxazolidinones?
Spectrum of Action?
Resistant gram + infections: MRSA and VRE
-For gram + ONLY! Considered broad spectrum gram + drug
What is unique about the oral absorption of oxazolidionoes?
It is 100% bioavailable: same as IV
completely absorbed orally
Are oxazolidinones static or cidal? Preg category? Metabolism?
1. Bacteriostatic
2. Pregnancy C
3. Liver metabolized but nonenzymatic
What are the adverse effects of Oxazolidinones?
GI: N/V/D
Bone marrow suppression: thrombocytopenia, anemia, leukopenia
Aminoglycosides us what MOA?
Spectrum of activity?
MOA: bind to the 30S
Aerobic gram neg only!! (includes pseudomonas)
gram +s only in combination therapy to achieve synergy
What is the unique distribution of aminoglycosides?
It is limited to lean body weight
Are aminoglycosides static or cidal?
Time or concentration dependent?
Preg category?
1. Rapidly bactericidal
2. Concentration dependent killing
3. preg D
What is the Post antibiotic effect of aminoglycosides?
The bacteria fail to grow despite concentrations below MIC
What class of drugs have the following adverse effects?
1. Reversible Nephrotoxicity
2. IRREVERSIBLE Ototoxicity
3 Neuromuscular blockade (rare)
Aminoglycosides
What cautions should you take with administering/dosing of aminoglycosides?
Dosing is based on lean or adjusted body weight (not toal body weight)
Therapeutic levels associated with improved response. (narrow range)
**Extended-interval AMG dosing**
(use 2 different doses, some groups are excluded from this type of dosing)
What antibiotics alter nucleic Acid metabolism?
Fluoroquinolones! "Floxacins"
What is the MOA of Fluoroquinolones?
Inhibits DNA gyrase and topoisomerase IV which are needed for normal replication.
Describe the spectrum of activity for the "floxians"
Gram - organisms, only 2 specific drugs work on pseudomonas
Some newer agents can work against S. pneumonia
Are the floxians time or conentration dependent?
Cidal or Static?
Pregnancy?
1. Concentration
2. Bactericidal
3. Pregnancy C
What are some common uses for Floxians?
TRAVELER'S DIARRHEA, Respiratory and Urinary tract infections. Can be used by PCN allergic
How are Floxian's simiar to tetracyclines?
They both have impaired absorption when taken with multivalent cations (antacids)
Which Floxian has a mixed metabolism?
Cipro
List the adverse effects of the Floxians
1. GI (N/V
2. Rashes/hypersensitivity
3. Arthropathy, TENDONITIS
4. increase liver enzyme
5. cardiac arrythmias
6. CNS: dizziness, hallucinations, delirium, seizures
Which drugs inhibit Folate Metabolism?
Trimethoprim/Sulfonamides (BACTRIM)
Some uses of trimethoprim/sulfamethoxazole?
1. PCP pneumonia
2. SALMONELLA AND SHIGELLA
3. Newest use: community associate MRSA
4. option for PCN allergy
What is the spectrum of activity for Trimethoprim/sulfamethoxzole?
NARROW!
-Limited gram + and gram- coverage
DRUG OF CHOICE FOR PCP PNEUMONIA in immunosuppressed patients (treatment and prophylaxis)
Which antibiotic can cause Stevens-Johnson Syndrome and what is it?
Trimethoprim/Sulfonamides (BACTRIM)
-sloughing off of the skin
what are some adverse effects of Trimethoprim/Sulfonamides (BACTRIM)?
1. STEVENS-JOHNSON
2. hypersensitivity
3. hematologic abnormalities
4. kidney inflammation
5. Hepatitis, pancreatitis
6. KERNICTERUS (encephalopathy) in NEWBORNS (preg C)
What are the miscellaneous antiobiotic classes?
1. Metronidazole
2. Daptomycin
3. Polymyxins
what is the MOA for Metronidazole?
Inhibits DNA Synthesis
Which antibiotic can treat anaerobic bacteria ONLY!!?
Metronidazole
What are the important clinical uses for Metronidazole?
1. C. diff
2. anaerobic and parasitic infections
Does metronidazole have good bioavailability orally?
Preg Cat?
YES! >90%
-preg B
What Drug has the following adverse effects?
1. CNS (ataxia, dysarthria, dizziness, confusion, excitation depression, seizures
2. PERIPHERAL NEUROPATHY
3. GI, METALLIC TASTE!!
4. DISULFIRAM-LIKE REACTIONS (vomit with alcohol)
metronidazole
Which drug Inserts its LIPOPHILIC TAIL into gram + cytoplasmic membrane and causes cell death!?
Daptomycin (Cubicin)
What are the pharmokinetics for DAPTOMYCIN?
1. Concentration dep, Bactericidal
2. IV ONLY
3. Preg B
4. small volume of distribution
What are the most unique adverse effects of Daptomycin?
1. Myositis [increase creatine kinase (CK)]
--symptoms of mild/mod muscle pain or weakness plus BPK elevations
REVERSIBLE!!
Which drug is used primarily as eye or ear drops?
Polymyxins
What is the MOA of Polymyxins?
Act on gram - bacterial cell wall to cause permeability changes in the membrane (cationic detergent)
Spectrum of Polymyxins?
Gram-negative ONLY
Are Polymysins time or concentratoin dependent?
Concentration dependent
What are the adverse effects of Polymyxins?
1. Renal toxicity
2. Neurotoxicity: restlessness, paresthesia, weakness, ataxia, seizures, neuromuscular blockade
Which antibiotics act ONLY on Gram +?
-Penecillin-Resistant Penecillins
-Streptogramins
-Oxazolidinones
-Daptomycin
-Vancomycin
Which antibiotics are ONLY for Gram - ?
-Polymyxins
-Aminoglycosides
-Monobactam
Which antibiotic is effect on gram + and anaerobes, not gram -?
Clindamycin
Which antibiotics are considered Broad spectrum?
-Antipseudomonal Penecillins
-B-Lactamase Inhibitors
-3rd and 4th gen of Cephalosporins
-Carbapenems
-Chloramphenicol
-Glycylcycline
-
Which antibiotic is used solely to treat anaerobic bacteria?
Metronidazole
List the antiobiotics that are gram + and gram -, but NARROW?
-Natural Penecillins
-Aminopenecilins
-1st and 2nd gen Cephalosporins
-Tetracyclines
-Macrolides
-Fluoroquinolones (more gram -)
-Trimethoprim/Sulfamethoxazole
-
Which antibiotic can rupture the Achilles Tendon?
Fluoroquinolones
List the Bacteriostatic antiBs
-Chloramphenicol
-Tetracyclines
-Clindamycin
-Oxazolidnones
-
List the Bactericidal antiBs?
-B-Lactams
-Vancomycin
-Aminoglycosides
-Fluoroquinolones
-Daptomycin
Which AntiB's are concentration dependent?
-Aminoglycosides
-Fluoroquinolones
-Daptomycin
-Polymyxins
Which antiBs are time dependent?
-B-Lactams
-Vancomycin