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112 Cards in this Set

  • Front
  • Back
What is the MOA of Cephalosporins?
• inhibitors of cell wall synthesis

* same MOA as PCN
Generally, first generation cephalosporin activity is effective against which organisms?
• great for gram-positive (majority of action to gram +)
• some activity against some gram-negative
Second generation cephalosporin activity is effective against which organisms?
• stronger gram-negative coverage
• weaker gram-positive
Generally, third generation cephalosporins have activity against which organisms?
• even stronger gram-negative bacilli (rods) coverage
• much weaker gram-positive cooci
First generation cephalosporins are good to treat which organisms?
Pneumonic: PEK

• Proteus mirabilis
• E. Coli
• Klebsiella (1st gen. are DOC)
1st generation cephalosporins are good agents to use for what patients?
• Surgical prophylaxis (Cefazolin/Ancef: 1 gm, ½ hr befor surgery)

* if PCN allergic, give Vancomycin
What antibiotic would use for abdominal surgery prophylaxis?
• Cefoxitin (covers more gram-negative & anaerobes)

* if allergic to PCN, use Levaquin + Metronidazole (Flagyl)
List examples of 1st generation cephalosporins
Oral: Cephalexin (Keflex), Cefadroxil (Duricef)

IV: Cefazolin (Ancef)
2nd generation cephalosporins are good for what organisms?
Pneumonic: HEN PEK

• H. Flu
• Enterbacter
• Neisseria
• Proteus mirabilis
• E. Coli
• Klebsiella
True/False: Cephalosporins are good agents against enterococcus
• Cephalosporins are not good agents against enterococcus

• The correct answer is: False
List examples of oral 2nd generation cephalosporins
• Cefaclor
• Loracarbef
• Cefpodoxime
Cefuroxime is a 2nd generation cephalosporin that come in IV and PO formulations. What is the name of Cefuroxime IV and PO?
• IV: Zinacef
• PO: Ceftin
Name 2nd generation cephalosporins that have mixed anaerobe/aerobe coverage?
Hint: Metal tan fox

• Cefmetazole (hardly ever used)
• Cefotetan *
• Cefoxitin *

* both come in IV formulation
Give examples of 3rd generation cephalosporins
• Cefotaxime
• Ceftriaxone (Rocephin)
• Cefixime
• Ceftazadime
What is DOC for gonorrhea?
Ceftriaxone (Rocephin)
What is the DOC for meningitis? What is the dosage?
Ceftriaxone (Rocephin) 2 gm IV Q 12
3rd generation cephalosporins are good against which bacteria?
Pneumonic: PEEK

• Proteus
• E. Coli
• Enterobacter
• Klebsiella

• very effective against gram-negative rods (not that good for gram-positive)
• used for serious infection
What are the 3 cephalosporins that are effective against pseudomonas?
• Cefoperazone
• Ceftriaxone/Ceftazidime (cross BBB)
• Cefipime (only 4th gen.)
Which cephalosporins cross the blood-brain barrier?
• Cefuroxime
• Cefotaxime
• Ceftazidime
• Ceftriaxone
• Cefepime (4th gen)
What cephalosporins can you use empirically on infants (less than 3 months) for meningitis?
• Cefuroxime
• Cefotaxime
Which cephalosporins do not need to be dose adjusted for renal failure patients?
• Cefoperazone
• Cefaclor
• Ceftriaxone
Which cephalosporin has the longest half-life?
Ceftriaxone (half-life 14-24 hrs)
What is the chance of being allergic to cephalosporins with a prior allergy to PCN? without allergy to PCN?
• if allergic to PCN, 15% chance of being allergic

• without allergy to PCN, have 3% chance of allergy
Which cephalosporin could you use for resistant organisms, like extended-spectrum beta-lactamase organisms (ESBL)?
Cefipime (4th gen)
Which drugs are the "last resort" beta-lactams?
List 2 Carbapenems
• Imipenem-Cilastatin (Primaxin)
• Aztreonam (a Monbactam)
What are available formulations of Imipenem-Cilastatin (Primaxin)?
IV only
What is MOA of Cilastatin?
inhibits dipeptidase enzyme of the bacteria (metabolizes a side chain)
What are indications for using Imipenem-Cilastatin (Primaxin)?
• indicated to use for multi-bacterial infections that are resistance to other antimicrobials
• broadest spectrum of all beta lactams (gram+/-, anaerobes, B. frag, pseudomonas)
• not effective against enterococcus
What can be complications of Imipenem-Cilastatin (Primaxin)?
• high sodium content (may not be good for elderly, CHF, HTN patients)
• lowers seizure threshold (more prone to seizures)
• nephrotoxicity (may have to dose adjust for renal patients)
Aztreonam covers what type of organisms?
only gram-negative
What is indication for using Aztreonam?
• used for gram-negative organisms and the patient is truely penicillin allergic
• Aztreonam has no cross sensitivty with PCN-allergic patients
What are available formulations of Aztreonam?
IV only
How is Aztreonam eliminated?
renally eliminated (has to be dose adjusted for renal disease)
What is the MOA of Vancomycin?
inhibits synthesis of bacterial cell wall, phospholipids, and peptidglycan
Is Vancomycin bacteriostatic or bacteriocidal?
What causes resistance to Vancomycin?
What is Vancomycin used to treat?
• used as prophylaxis in PCN allergic patients undergoing surgery (1 gm one time dose)
What is the dosing for Vancomycin?
• 15 mg/kg

* if CrCl > 50, dose Q12; if CrCl < 50, dose Q24
* always use actual body weight
How do you monitor Vancomycin?
• order peaks and troughs
• get trough level ½ hr before the 3rd dose
• get peak level 1 hr after infusion
What should the trough level be in a patient receiving Vancomycin?
What are the situations where the trough level should be 15 - 20?
• area of high penetration (such as a lung infection)
• bacterial endocarditis
• very septic ICU patient w/ multi-organ failure
In older patients, a clinician can monitor only troughs for Vancomycin. What are 3 scearios when peaks & troughs should be monitored?
• pts w/ ever changing volume of distribution (ex. dialysis patient)
• burn patient
• very septic ICU patient w/ mult-organ failure
What are available formulations of Vancomycin?
• only IV
• can make oral Vancomycin from IV solution to treat C. Difficile
What are adverse effects of Vancomycin?
• allergy
• nephrotoxicity (need to dose adjust with rapid changing serum creatinine)
• ototoxicity (need to stop drug)
How do you dose adjust Vancomycin if the trough is high?
• increase to the next dosing interval
• Q12»Q24; Q24»Q36; Q36»Q48
How do you dose adjust Vancomycin if the trough is low?
• decrease to the next dosing level
• Q24»Q12; Q12»Q8
What is Red-mans Syndrome?
• an infusion-related toxicity to Vancomycin
• not an allergic reaction
How do you treat Redman's Syndrome?
• stop Vancomycin for ½hr and infuse at a slower rate
• can give Benadryl for itching
What is the MOA of Tetracyclines?
protein synthesis inhibitor
Tetracyclines are broad spectrum antibiotics used first line to treat what?
• Bacteria that causes acne
• Cholera
• Chlamydia
• Lyme Disease
• Mycoplasma Pneumoniae
• Rocky mountain spotted fever
Why should a patient taking Tetracyclines avoid dairy products?
the drug will bind to calcium, causing the body to eliminate both the drug and calcium
Where does Tetracycline concentrate in the body?
• bones
• kidney
• liver
• spleen
• teeth
True/False: Tetracycline does not cross the blood-brain barrier enough to treat meningeal disease.
The correct answer is: True
What are adverse effects of Tetracyclines?
• Avoid in pregnant females
• Discoloration of teeth
• Dizziness
• Hepatotoxicity
• Irritation to gastric mucosa
• Phototoxicity
• Superinfections (can get C. Diff from long-term use)
• Stunt growth in children
Name 2 examples of Tetracyclines
• Doxycycline (PO, IV)
• Tetracycline
List examples of aminoglycosides
• Amikacin
• Gentamycin
• Neomycin
• Streptomycin
• Tobramycin
What is the MOA of Aminoglycosides?
• transported across bacterial membrane by a transport system that requires oxygen
• binds to the bacterial 30S and 50S ribosomal subunit
• inhibits protein synthesis
How does resistance to Aminoglycosides develop?
resistance develops by eliminating the energy needed to transport the drug across the bacterial membrane
How are aminoglycosides eliminated from the body?
• renally excreted
• would get peaks & troughs for Gentomycin and Tobramycin
• troughs should be < 2
What is the spectrum of activity for aminoglycosides?
• good gram-negative, no anaerobic, fewer gram-positive

• effective against staph and enterococci when used in combination w/ PCN for endocarditis treatment

• pseudomonas (with a beta-lactam; Tobramycin has more specificity for pseudomonas)
What are side-effects of aminoglycosides?
• nephrotoxicity
• neuromuscular blocking activity
• ototoxicity
What is the dosing for Gentamycin or Tobramycin?
5 mg/kg per dose

* use actual body (except for obese patient)
Which side effects of the aminoglycosides are reversible? which are irreversible?
• nephrotoxicity is reversible
• ototoxicity is irreversible
Which aminoglycoside is the most nephrotoxic? least nephrotoxic?
• Neomycin is the most nephrotoxic (when taken PO to sterilize the gut)
• Streptomycin is the least nephrotoxic
Which aminoglycoside is used to sterilize the gut?
Which aminoglycoside can be used to treat pseudmonas?
• Tobramycin (more specific for pseudomonas)
• Gentamycin
What is the MOA for Quinolones?
inhibit DNA gyrase
List some examples of Fluroquinolones
• Ciprofloxin*
• Gatifloxin
• Levofloxaxin*
• Moxifloxin
• Norfloxacin
• Ofloxacin

* most common (Cipro & Levaquin)
How do bacteria build resistance to fluoroquinolones?
resistance is due to aleration of the biding affinity of the enzyme DNA-Gyrase
What is the spectrum of activity of the fluoroquinolones?
• Spectrum of activity: gram-positive & gram-negative

• Cipro and Levaquin have pseudomonal coverage
What are clinical uses for the fluoroquinolones?
• Lower respirory infections
• Osteomyelitis
• Prostate infection
• Upper respiratory infections
List drugs that decreases the GI absorption of fluoroquinolones
• antacids
• Didanosine (DDI)
• Iron salts
• Sucralfate
• Zinc oxide
What is the effect of Theophylline on the fluoroquinolones?
theophylline decreases clearance of the fluoroquinolones and can cause toxicity
What are side effects of fluoroquinolones?
• cartilage damage (can stunt growth in children)
• CNS disturbances
• nausea/vomiting/diarrhea
• phototoxicity
• prolonging of QT interval
• skin rashes
What is the MOA of the macrolides?
binds irreversibly to 50S ribosomal subunit and inhibits protein synthesis
List examples of macrolides
• Azithromycin
• Clarithromycin
• Erythromycin
Are macrolides bacteriocidal or bacteriostatic?
What is the spectrum of activity of marcrolides?
• gram-positive and gram-negative cocci
• gram-positive bacilli
• spirochetes
Macrolides are the DOC for what infections?
• Atypicals
• Chlamydia infections during pregnancy
• Legionairres
• Syphillis (in PCN allergic patients)
What causes resistance to macrolides?
decreased binding to the 50S subunit
True/False: Macrolides cross the blood brain barrier
• Macrolides distributes to all tissues except the brain

• The correct answer is: False
What are adverse effects of macrolides?
• Cholestatic jaundice
• GI effects
• Metallic taste (w/ Clarithromycin)
• Ototoxicity (in very high doses)

* high doses can increase incidence of adverse effects
What is the effects of macrolides on drugs like theophylline and cyclosporine?
macrolides inhibits the metabolism of theophylline and cyclosporine
What is the MOA of Chloramphenicol?
binds to 50S subunit of the bacterial ribosome and inhibits protein synthesis
What is the spectrum of activity of Chloramphenicol? Is it bacteriocidal or bacteriostatic?
• very broad spectrum antimicrobial

• usually bacteiostatic, but is bacteriocidal in some cases
What are adverse effects of Chloramphenicol?
• Anemias (Hemolytic and Aplastic anemia)
• Gray-baby syndrome
What is the MOA of Clindamycin?
protein synthesis inhibitor
What is the spectrum of activity of Clindamycin?
• gram-positive cocci and bacilli
• spirochetes
• anaerobes

* does not cover gram-negative organisms
* drug can be an alternative to PCN for gram-positive infections
What are adverse effects of Clindamycin?
• rashes
• superinfections (C. Difficle/Pseudomembranous Colitis)
If the urinalysis (UA) shows positive nitrates, what is the most likely type of organism present?
If the UA is positive for leukocyte esterase, what is the most likely type of organism present?
What is the MOA, spectrum of activity, and available formulations of Nitrofurantoin (Macrodantin)?
• MOA: inhibits bacterial enzymes and damages bacterial DNA

• Spectrum of Activity: gram-negative & gram-positive (bacteriostatic antimicrobial)

• PO only
What are adverse effects of Nitrofurantoin (Macrodantin)?
• Acute pneumonitis
• GI effects
• Interstitial fibrosis
• Nystagmus
What is the MOA of Isoniazid?
inhibits synthesis of mycoli acid (part of the myobacterial cell wall)
What is the spectrum of activity of Isoniazid?
specificty for myobacterium tuberculosis
What are adverse effects of Isoniazid?
• hypersensitivity
• peripheral neuritis
Is Isoniazid an inhibitor or inducer?
both (can be an inhibtor or inducer)
What are the effects of Isoniazid on Phenytoin?
Isoniazid inhibts the metabolism of Phenytoin
What can be given to patient on Isoniazid to help prevent peripheral neuritis?
Vit B6 (Pyridoxine)
What is the MOA of Rifampin?
inhibits RNA synthesis by inhibiting DNA-dependant RNA polymerase
Is Rifampin bacteriocidal or bacteriostatic?
bacteriocidal to both intracellular and extracellular M. Tuberculosis
Is Rifampin an inducer or inhibitor?
very powerful inducer
What is the MOA of Fluconazole (Diflucan)?
• blocks fungal CYP450 mediated synthesis of ergosterol
• sterols are not available to make fungal membranes
Fluconazole (Diflucan) is the DOC for what patients?
most immunocompromised patients (HIV, chemotherapy pts)
What does an absolute neutrophil count less than 1500 indicate?
indicates high susceptibility to oppurtunistic infection
What is the MOA of Ketoconazole?
• blocks fungal CYP450 mediated synthesis of ergosterol
• sterols are not available to make fungal membranes
• also blocks gonadal and adrenal steroid synthesis in humans
Is Ketoconazole an inhibitor or inducer?
Why should you take Coke with Ketoconazole?
• Ketoconazole needs an acidic environment to be effective
• Coke will increase acidity
What are adverse effects of Ketoconazole?
• GI
• Gynecomastia
• Reduces androgen synthesis
What is the MOA, spectrum of activity, and available formulations of Metronidazole (Flagyl)?
• metabolite binds to proteins and DNA causing cell death
• kills anaerobic bacteria
• oral or IV
What are side effects of Metronidazole (Flagyl)?
• metallic taste in mouth (w/ PO)
• nausea/vomiting