Pm_Cardiopulm_Pharma_Antibiotics

Front 1

List the 3 Beta Lactamase Inhibitors

Back 1

Clavulanic acid
Sulbactam
Tazobactom

Front 2

Vancomycin major use bug?
Activity on Gram-Neg Aerobes?
on Gram-Neg Anaerobes?

Back 2

MRSA & Coagulase Neg. Staph
-no
-no

Front 3

SoA (Spectrum of Activity)
for Bacitracin?

Back 3

Many Gram +
-some Gram Neg
---diff from Vanco/Telav which do NOt have gram-neg

Front 4

Bacitracin admin?

Back 4

Topical
--think Eye infxn, skin
--systemic not used often due to nephrotoxicity

Front 5

What common catagory do Bacitracin, Vancomycin & Telavancin fall into?

Back 5

They are all Cell Wall Syn Ibxn.
--Vanco/Telav are Glycopeptides.

--all other Cell Walls syns are the Beta lactams

Front 6

List the 8 Groups of Bucket 2...The Protein Syn Ibxns

Back 6

1. Clindamycin
2. Quinupristin/Dalfopristin
3. Chloramphenicol
4. Aminoglycosides
5. Macrolides/Ketolides
6. Tetracyclines
7. Glycylcyclines (tigecycline)
8. Linezolid
---don't confuse 4/Aminoglycosides with Glycopeptides, which are Bucket 1

Front 7

List the 5 Aminoglycosides of Bucket 2 (Pr Syn.)

Back 7

1. Amikacin
2. Gentamicin
3. Neomycin
4. Streptomycin
5. Tobramycin

Front 8

List the 4 Macro/Ketolides of Bucket 2 (Pr Syn.)

Back 8

1. Azithromycin
2. Clarithromycin
3. Erythromycin
4. Telithromycin

Front 9

List the 4 drugs in Tetracyclines of Bucket 2 (Pr Syn)

Back 9

1. Demeclocycline
2. Doxycycline
3. Minocycline
4. Tetracycline

Front 10

Drug of choice for MRSA

Back 10

Vancomycin
--Telavancin works too

Front 11

SoA.: Gram + & Gram Neg.
--Rickettsiae
-Spirochetes
-Mycoplasma
-Chlamydia (genital)

Back 11

Tetracyclines

Front 12

This Group and its sole drug is a modification of Tetracycline.
-Bucket 3

Back 12

Glycylcyclines
-Tigecycline
----dec. susceptability to resistance as with Tetras

Front 13

SoA for Tigecycline (Glycylcycline)

Back 13

Gram +, includes MRSA
Gram -, includes anaerobes

Front 14

Which drug has wide SoA...some coverage in most all major groups.
--works on Clostridium perfringens,
Bacteroides

Back 14

Tigecycline
under Glycylcyclin

Front 15

Of the 8 Groups of Bucket 2, which 3 are 30S SU Inbx.?

Back 15

Tetracyclines
Glcylcyclines
Aminoglycosides

Front 16

Of the 8 Groups of Bucket 2, which 5 are 50S SU Inbx.?

Back 16

1. Macro/Ketolides
2. Chloramphenicol
3. Clindamycin
4. Quinupritin/Dalfopristin=syncercid
5. Linezolid

Front 17

Aminoglycosides: Inbx what?
Gram +/_ ???
Air or NoAir?

-unique part of mechanism

Back 17

30S of Bucket 2__02 depletion
-Gram Positive Aerobes
-Gram Neg Aerobes
----NO Anaerobes, part of Mechanism is 02 depletion

Front 18

For the 50s SU Inbx of Bucket 2, the Macrolide/Ketolides contain which four drugs?
Which is the Keto?

Back 18

Erythromycin
Azitrhomycin &
Clarithromycin are Macros

-Telithromycin is Keto

Front 19

SoA of Macro/Ketos__50s SU Inbx?
Macros SoA?
Ketos SoA?

Back 19

Macros: Erythro, Azitro, Clarithro:
Good Gram +, Some Gram Neg

Keto: Telithromycin: Strong Gram Neg and Pos.

Front 20

The Z-pack is name for which drug. Which subgroup, group and bucket is it in?

Back 20

Azithromycin:
Bucket 2/Pr Syn Inbx
Macrolide
50s SU

Front 21

Chlormaphenical:
Bucket? Group?

SoA: narrow or wide?
Grams and Airs?

limitations?

Back 21

Bucket 2/Pr. Syn. Inbx.
50s SU

-Wide
-Good Gram Pos/Neg and
-Anaerobes
-----toxicity problems

Front 22

Clindamycin:
Type of Bucket 2?
Grams?
Airs?

Back 22

50S SU Inbx.
-Aerobic Gram Positive
--Anaerobes
---NO Gram Negs

Front 23

Quinopristin/Dalfopristin:
Type of Bucket 2?
SoA designed for

Back 23

50S SU
-Developed for Gram + w/ Resis.
---MRSA & VR
vr is vancoresitant

-thus limited gram neg act

Front 24

Linezolid:
Type of Bucket to

SoA designed for

Back 24

50S SU
--as w/ Quino/Dalfo, designed for 'nasty gram pos bugs"
-MRSA
-VR

Front 25

The Bucket 3 Metabolic Inhibitors include what group
--2 drugs within group

Back 25

Only Group is Inbx of Folate Synthesis
-Sulfonamide:
-Sulfamethoxazole
-Trimethoprim

Front 26

When Folate Syns Antiobiotics are administered, what is most common combination?

Back 26

TMP/SMX

Trimethoprime/Sulfamethoxazole
---"bactrim or Septra"

Front 27

What is SoA for TMP/SMX?

Limitations

Back 27

Gram Positive--strep/staph
Gram Negative--good

NO anaerobes
Resistance is Very common.. limits its use

Front 28

Name the 5 drugs and Major group that make up the Nucleic Acid Syn. Inbx.

Back 28

1. Polymixin B
2. Metronidazole
3. Nitrofurantoin
4. Daptomycin
Major Group is Fluoroquinolones--has 4 generations

Front 29

Ciprofloxacin,
Norfloxacin &
Ofloxacin
are members of what generation of Fluoroquinolones

Back 29

2nd Gen Fluoroquinolones of Bucket 4

Front 30

Infection with PCP/ Pneumocystis jirovecii can be treated with what drug?

Back 30

TMP/SMX

Trimethoprime/Sulfamethoxazole

Front 31

Name the 1 drug that makes up the 1st Gen. Fluoroquinolones

Back 31

Nalidixic acid

Front 32

Name the 1 drug that comprises the 3rd Gen. of Fluoroquins

Back 32

3rd Gen is
Levofloxacin

Front 33

List the 2 Drugs that make up the 4th generation of Fluoroquinolones of Bucket 4

Back 33

Moxifloxacin
Gatifloxacin

Front 34

Nalidixic acid, Ciprofloxacin, Norflaxacin, Ofloxacin, Levofloxacin, Moxifloxacin and Gatifloxacin are members of what group? Which Bucket

Back 34

Nucleic Acid Syn Inbx./Bucket 4

1st-4th Generations of Fluoroquinolones

Front 35

Which group of bacteria has excellent coverage for ALL generations of Fluoroquins?

Back 35

Atypical Bacteria
-Legionella pneumophilia,
-Chlamydia sp.
-Mycoplasma sp.
--though no one uses the 1st genation drug Nalidixic Acid (only drug in 1st gen)

Front 36

Which 2nd generation Fluoroquin covers Pseudomonas?

Oflox, Ciproflox, Norflox

Back 36

Ciprofloxacin covers Pseudomonas

For inc. Gram +/- coverage, use "new" gen. Fluoros,= 3&4th gens

Front 37

Metronidazole: Bucket/Groups?

SoA

Back 37

4th Bucket/NA Syn. No Group

Prodrug- only Anaerobes can convert it.
Protazoa (Trichromas vagninalis, Amebiasis, giardiasis)

-NO use on Aerobes

Front 38

Daptomyocin: Bucket/Groups?
SoA?
Used for?

Back 38

4th Bucket/NA Syn. No Group
developed for tough Gram Pos
-MRSA
-VRE

Front 39

Polymixin B: Bucket/Groups?
Systemic Use?

SoA?

Back 39

4th Bucket. No Group
No, Topical & Ointments

Gram Negative Bacteria

Front 40

This drug is Primarily Used for UTI, because its:
-SoA covers Gram +/- in Lower UTIs
-Has low [Plasm] but conc. in urine

Back 40

Nitrofurantoin
4th Bucket, No Group

Front 41

Name for PKin where you dose to Peak/MIC then let wane.

Which drugs have this PK kill?

Back 41

Concentration Dependent Kill, aka

Big Hammer Approach

Aminoglycosides (bucket 2/PR syn.) are Conc Dependent Kills

Front 42

Infection with Atypical bacteria like
(Legionalla, Chlamydia sp, Mycoplasma sp.) or
Antracis might be treated with what group

Back 42

Fluoroquinolones

Front 43

The following use what PK Kill method?
Beta-Lactams
Macrolides
Linezolid
Clndamycin

Back 43

Time-Dependent Kill
--always keep conc above MIC

--ie, time above MIC correlates with efficacy

Front 44

How are almost ALL Beta-Lactams eliminated?
Absorption/Food?

Back 44

By Kidney--must adjust if in renal failure
-Some w/ or w/o food.

Front 45

What is purpose of cilastatin?

Which drug is it combined

Back 45

Imipenem, a Carbapenem group of B-lactams, is combined with Cilastatin (think cilia) to prevent hydrolysis in renal BRush border

Front 46

About 1/2 of all allergic Rnxs in hospitalized Pts are due to what drugs

Back 46

B-Lactams
Rxn in 7-40 per 1000 penicillin treatments

Front 47

Maculopapular Rash indicates what Rxn

Back 47

Allergic Penicillin Rxn due to Hypersensitivity 1-10%

Front 48

What is only b-lactam you can give to someone with a Known anaphylaxis allergy due to penicillin

Back 48

Aztreonam
--A Monobactam

Though other non-penicillin B-lacts exist, ie, cepalosporins, which do evolve increasingly less risk of anaphylaxis.

Front 49

High doses of Penecillins and Imipenem (a Carbapenem, B-lactam) in presence of renal insufficiency can have what Adverse Effect

Back 49

Neurologic: dizzy, headache, insomnia, seizure (imipenem)

Front 50

What unique Adverse Effect can occur with Cefotetan & Cefoperazone

Special Circumstance for Symptoms?

Back 50

Disulfiram like Reaction due to Ethanol
--Sx= nausea/vom, flushing, sweating, tachycardia.

Front 51

Which drug competitively inhibits renal tubular secretion of penicillin
(non-antibiotic)
When is it used?

Back 51

With gout, the drug Probenecid can F with Penicillin clearance
--with comp renal + penicillins
must consider Neurologic A.E.s

Front 52

Admin for Vancomycin (glycopeptide/bucket1)?
Elimination?
2 Adverse Effects Aside from Redman (can be pretreated with Antihistamines)

Back 52

IV (oral if colitis, otherwise negli absb)
Renal elim
A.E.: Nephrotoxic & Ototoxic

Front 53

PK-kill method for Telavancin ?(Glycopeptide/bucket1)
-Unique Adv. Effects?
-Black Box Warning?

Back 53

Conc-Dependent Kill/Hammer
A.E.: Metalic/Soapy Taste, Foamy Urine
BBWarn: Pregnancy

Front 54

Tetracyclines: (bucket 2, 30S)
Absorption/Admin?

Back 54

-Interacts with Cations--take drug 2 hrs before any Supplements/Milk.

Front 55

Adverse Effects of Tetracyclines

Back 55

Photosensitivity--suburn
Hepatoxicity-rare but fatal
Teeth Discoloration in Children

Front 56

Aminoglycosides: bucket 2, 30S)
Unique Distribution?

Adverse Reactions:

Back 56

High Conc in Urine--good for catheter related UTI
-AE:
1. Ototoxicity: irreversible vestibular damage
2. Nephrotoxicity: acute tubular necrosis (delayed onset, reversible)

Front 57

Macro/Ketolides: bucket 2, 50S)
Distribution in CSF?
Elimination

Back 57

Minimal CSF penetration
Hepatically Elim, 100%,--> NO concern for renal failure

Front 58

Macrolide Adverse Effects

which are better tolerated of the 3 macros

Back 58

QTc Prolongation (rare)
Ototoxic, hepato (rare)
thrombophlebitis-IV
--Clarithromycin&Azitrhomycin better tolerated than Erythromycin

Front 59

Ketolide (telithromycin) Adv. Eff.

Special COntraindication

Back 59

similar to Macros (QTC prolong, ototox, hepato)
Plus
-Ocular: blurred bission

-Contra for Pts with Myasthenia gravis

Front 60

Which Macro/Keto has little concern for drug interactions b/c it is NOT metabed by P450

Back 60

Azithromycin

Front 61

Quinupristin/Dalfopristin (synercid) Bucket? Group?
Administration?
Adverse Effects

Back 61

Bucket 2/50s, no Group
--Use Central Line --NOT peripheral
Venous Irritation
Myalgias/arthralgias, GIs

Front 62

Linezolid (Bucket2/50S)
What type of PK-kill?
Absorption/Admin?
Elimation?

Back 62

Time Dependent= stay above MIC
-PO & IV and 100% bioavail
-Renal and Non-renal

Front 63

Linezolid
1 Unique Adverse Effect

Back 63

Thrombocytopenia (2-4%)
--delayed >2weeks, reversible

Front 64

Clindamycin (Bucket 2/50S)
What specific tissue penetration
Elimination?

Back 64

Can penetrate bone
works with anaerobic bone infections too.
Hepatic

Front 65

Adverse Effects of Clindamycin?
Most Common is?
Worst GI drug induced infxn

Back 65

GI is most common-, includes dyspepsia
-Cause C. difficile colitis--worst offender

Front 66

Chloramphenicol (bucket 2/50S)
Usage?

Common Syndrome caused

Back 66

Limited due to toxicities
--some not even dose dependent

-Causes Gray Baby Syndrome

Front 67

Chloramphenicol AEs
Blood affected how?
Others?

Back 67

Note: primary elim is Hepatic:
-Blood: bone marrow suppression, Aplastic anemia (most serious), Hemolytic anemia

-CNS: optic neuritis, peripheral neuritis, confusion, depression

Front 68

TMP/SMX: Bucket? Group?

Adverse Effects?
Most serious hematologic is?
3 Unique

Back 68

Bucket 3/Metabolic/Folate
-------GOOD for PCP----
--Hematologic: Leukopenia
1. Sulfa Drug, so Sulfa Allergies
2. Steven's Johnson
3. Crystalluria (mild & rare)

Front 69

This group of drugs has High absorption, large volume of distribution and Extensive tissue distribution (organs, liver, skin, bone UT)
Which Bucket, Group?

Back 69

Fluoroquinolone group
Bucket Four

Front 70

3 Main Adverse Effects of Fluoroquinolones (Nuc. Acid Syn Ibx) are?
1 Black Box warning is?

Back 70

1. Articular Damage
3. Cardiac: pronlonged QT
2. Tendonopathies
--BBwarn= tendon rupture

note: also list of other CNS an GI AEs

Front 71

Administration of Fluoroquinolones requires consideration of what other items?

Back 71

Intake of Cations
--Like Tetracyclines, Take Fluoros 2 hours before Cations/Milk

Front 72

Which Bucket 4 drug/N.A. Syn. Inbx Antibiotic?
-Does penetrate CSF
-Anaerobic Coverage
-Metab primarily by Liver

Back 72

Metronidazole

(note, only group in Bucket 4/ Nucleic Acid Syn. Inhibitors is the FLuoros, all others are just drug)

Front 73

Which 2 drug Groups use Conc-Dependent (PEAK/MIC) kill

Back 73

Fluoroquinolones (bucket 4)
Aminoglycosides (bucket 2)
----use higher conc.= higher kill
---note: aminoglycs also show Post AntiBio Effect (persistent dath)

Front 74

Which drug uses Conc-Dependent/Hammer Kill.
AE:
-Myopathy and Creatinine Phosphokinase Elev.
-not great when on statins too

Drug + Bucket =???

Back 74

Daptomyocin
Bucket 4.
N.A. Syn Inbx

Front 75

This group of drugs uses the Time Dependent Kill, where higher conc. do NOT result in higher kill rate

Back 75

The Beta Lactams use
Time > MIC

Front 76

Which Drug causes enamal hypoplasia?
Which group carries risk of deafness?
Which groups are relatively safe in pregnancy

Back 76

Tetracycline - teeth, pregnant -->8yrs
Aminoglycs - deaf
--Penicillins & Cephalosporins (both B-Lacts) safe for preg.

Front 77

This is drug of choice for Pseudomembranous Colitis due to C. difficile (note: this may have been caused by Clindaymcin, which ALSO covers anaerbes)

Back 77

Metronidazole
--PO or IV
Covers anaerobes in many areas, including CNS--think brain abcess-)

Front 78

This drug ("Flagyl ") has: common GI AEs--ie, metallic taste.
CNS--most serious AE, but rare
Mutagenic in Pregnant
Disulfiram Rxn

Back 78

Metronidazole (use for Anaerobes and Protazoa)
--Do NOT use alcohol

Front 79

Which group of drugs should not be given to neonates for they may cause Kernicterus

Back 79

Sulfonamides

Front 80

Which 4 drugs Readily Penetrate CNS
name with bucket

Back 80

Cholramphenicol (Bucket 2)
Tetracycline (Bucket 2)
TMP-SMZ (Bucket 3/Metabo)
Linezolid-30% - (Bucket 2)

Front 81

Administration of Fluoroquinolones requires consideration of what other items?

Back 81

Intake of Cations
--Like Tetracyclines, Take Fluoros 2 hours before Cations/Milk

Front 82

Which Bucket 4 drug/N.A. Syn. Inbx Antibiotic?
-Does penetrate CSF
-Anaerobic Coverage
-Metab primarily by Liver

Back 82

Metronidazole

(note, only group in Bucket 4/ Nucleic Acid Syn. Inhibitors is the FLuoros, all others are just drug)

Front 83

Which 2 drug Groups use Conc-Dependent (PEAK/MIC) kill

Back 83

Fluoroquinolones (bucket 4)
Aminoglycosides (bucket 2)
----use higher conc.= higher kill
---note: aminoglycs also show Post AntiBio Effect (persistent dath)

Front 84

Which drug uses Conc-Dependent/Hammer Kill.
AE:
-Myopathy and Creatinine Phosphokinase Elev.
-not great when on statins too

Drug + Bucket =???

Back 84

Daptomyocin
Bucket 4.
N.A. Syn Inbx

Front 85

This group of drugs uses the Time Dependent Kill, where higher conc. do NOT result in higher kill rate

Back 85

The Beta Lactams use
Time > MIC

Front 86

Which Drug causes enamal hypoplasia?
Which group carries risk of deafness?
Which groups are relatively safe in pregnancy

Back 86

Tetracycline - teeth, pregnant -->8yrs
Aminoglycs - deaf
--Penicillins & Cephalosporins (both B-Lacts) safe for preg.

Front 87

This is drug of choice for Pseudomembranous Colitis due to C. difficile (note: this may have been caused by Clindaymcin, which ALSO covers anaerbes)

Back 87

Metronidazole
--PO or IV
Covers anaerobes in many areas, including CNS--think brain abcess-)

Front 88

This drug ("Flagyl ") has: common GI AEs--ie, metallic taste.
CNS--most serious AE, but rare
Mutagenic in Pregnant
Disulfiram Rxn

Back 88

Metronidazole (use for Anaerobes and Protazoa)
--Do NOT use alcohol

Front 89

Which group of drugs should not be given to neonates for they may cause Kernicterus

Back 89

Sulfonamides

Front 90

Which 4 drugs Readily Penetrate CNS
name with bucket

Back 90

Cholramphenicol (Bucket 2)
Tetracycline (Bucket 2)
TMP-SMZ (Bucket 3/Metabo)
Linezolid-30% - (Bucket 2)

Front 91

Which Generations of Cephalosporins Do NOT cross CNS. Which Gen crosses when meninges are inflammed?

Back 91

1st & 2nd Gen Cephs DO NOT
-3rd gen Cephs will if meninges inflamed

Front 92

Clindamycin, Fluoroquins, Macrolides, Aminoglycosides:
Which describes them
Do Cross CNS, DO NOT -or--
Will Cross if Inflammed

Back 92

Clinda, Fluoros Macs and Aminoglycs DO NOT Cross CNS

Front 93

Penicillin, Metronidazole, Aztreonam, Metropenem, Imipenem:
Which Describes these
Do Cross CNS, DO NOT -or--
Will Cross if Inflammed

Back 93

These WILL Cross if Meninges Inflammed:
Pens, Metro, Aztreo, Merop/Imip-enem
---Also, 3rd Gen Cephs

Front 94

With Vanco as DOC for MRSA-Nosocom, list 5 others that have activity against MRSA

Back 94

1. Linezolid (last resort for superresistant Staph EndoCard)
2. Telavancin
3. Daptomycin
4. Tigecycline
5. Quinupristin/Dalfopristin