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94 Cards in this Set
- Front
- Back
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Which Antimicrobial class works by inhibiting the final step of peptidoglycan synthesis by inhibiting transpeptidase blocking cross links
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Beta-Lactams
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What do beta-lactams bind in the bacteria to exert their effect
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penicillin binding proteins
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Which penicillin is given IV or IM and which is given PO only
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IV/IM is Penicillin G, PO is penicillin VK
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What is the primary organism that benzathine penicillin is given IM for
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syphilis (T. Pallidum)
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Why would you likely prescribe Penicillin V
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Strep Throat, and dental infections
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Why are penicillins no longer very effective (name the moa that bacteria have developed to overcome them)
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bacteria have developed penicillinase, and beta-lactamase and altered penicillin binding proteins
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What type of drug is oxacillin
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antistaphylococcal penicillin (Beta-lactam)
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What type of drug is Nafcillin
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antistaphylococcal penicillin (Beta-lactam)
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What type of drug is dicloxacillin
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antistaphylococcal penicillin (Beta-lactam)
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what type of drug is cloxacillin
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antistaphylococcal penicillin (Beta-lactam)
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what type of drug is methicillin
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antistaphylococcal penicillin (Beta-lactam)
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You are prescrbing Nafcillin to a patient in the ICU they are a life long alcoholic what do you need to be aware of in this situation
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Nafcillin is primarily metabolized in the liver and needs to be adjusted for hepatic impairment
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What organisms would you likely prescribe Oxacillin/Nafcillin or Dicloxacillin for
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Strep. Species, MSSA/MSSE spp. Not HA/CA MRSA or enterococcus
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What type of drug is amoxicillin
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extended spectrum penicillin (aminopenicillin)
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Of the aminopenicillins which is better absorbed amoxicillin or ampicillin
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ampicillin
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What is the primary use for amoxicillin
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high dose for otitis media, and endocarditis prophylaxis
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What do you need to be aware of when dosing the aminopenicillins (amoxicillin and ampicillin)
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they are cleared renally and need to be adjusted in renal impairment
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What is the DOC for Listeria meningitis (CNS) infection
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Ampicillin
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What is the DOC of enterococcus infections
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ampicillin
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What are the three beta-lactamase inhibitors
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Clavulanic acid, sulbactam, tazobactam
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What is the drug that is a combination of ampicillin and sulbactam
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Unasyn (IV only)
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What is the drug that combines amoxicillin and clavulanic acid
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Augmentin (PO only)
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what is the drug of choice when switching from IV Unasyn to a PO drug
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Augmentin this switches you to another drug containing beta lactamase inhibitor
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What organism do Amoxicillin/ampicillin + beta lactamase inhibitors cover
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these drugs are work horses and cover Gram + (strep and staph spp. Except MRSA), Enterococcus spp., Lesser Gram "-" (except Serratia) and anaerobes especially B. Fragilis, and Peptostreptococcus
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Whey would you use combo amoxicillin/ampicillin + beta lactamase inhibitors
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bacteremia, cellulitis/osteomyelitis, HEENT infxns, PNA
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What is the drug that combines piperacillin + tazobactam
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Zosyn
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What is the drug that combines Ticarcillin + Clavulanic acid
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Timentin
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what type of drug is Ticarcillin
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Antispeudomonal Penicillin
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What type of drug is Piperacillin
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Antispeudomonal Penicillin
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What type of drug is Carbenicillin
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Antispeudomonal Penicillin
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What type of drug is Mezlocillin
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Antispeudomonal Penicillin
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What do you need to be aware of when dosing Zosyn and Timentin
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they are excreted renally and will need dosage adjustment in renal impairment and Na+ loading
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What bacteria do antispeudomanals cover
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pretty much everything but MRSA, and atypicals, enterococcus coverage is spotty
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What are the major s/e of using penicillins (all 4 types)
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Allergy, Pancytopenia (neutropenia and thrombocytopenia), hepatotoxicity, and seizures when given to renally impaired w/o adjustment
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what type of drug is impenem-cilstatin (Primaxin)
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Carbapenem
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what type of drug is meropenem (Merrem)
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Carbapenem
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What type of drug is doripenem (doribax)
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Carbapenem
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what type of drug is Ertapenem (Invanz)
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Carbapenems
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What minimum oral dosage should you give of a Carbapenem
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trick question carbapenems are destroyed by gastric acid and are not given orally
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when should you use a Carbapenem
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last-line therapy except ertapenem
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What is the place in therapy of Ertapenem
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often used in outpatient/home health basis for intra-abdominal infection, cSSSI (complicated skin soft tissue infection), complicated UTIs, community-acquired pneumonia
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Why is imipenem always given with cilastatin
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cilastatin inhibits dihydropeptidase-1 a naturally occurring enzyme destroys the drug.
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When are carbapenems contra indicated
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pts w/ epilepsy or seizure history never use imipenem for CNS infections Imipenem>Meropenem=ertapenem
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What are the possible s/e of using carbapenems
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CNS effects (seizures), infusion related reaction (thrombophlebitis), hypersensitivity, hepatotoxicity, thrombocytopenia (meropenem only)
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What type of drug is aztreonam (Azactam)
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monobactam
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What type of bacteria would you use aztreonam (Azactam) for
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only good for gram neg except Acinetobacter
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What do you have to be aware of when dosing Aztreonam (Azactam)
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it is cleared renally so adjust in renal impairment
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When would you use aztreonam (Azactam)
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used in patients with beta lactam allergies it is gen safe to give them to cover greater gram neg bacteria (Pseudomonas, Enterobacter, Citrobacter just not Acinetobacter)
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What is the major s/e of using the monobactam aztreonam (Azactam)
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hepatotoxicity and some hypersensitivity
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What bacteria is resistant to all cephalosporins
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enterococcus
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What type of drug is cefazolin (Ancef/Kefzol)
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1st generation cephalosporin
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what type of drug is cephalexin (Keflex)
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1st generation cephalosporin
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What type of drug is cefadroxil (Duricef)
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1st generation cephalosporin
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What place in therapy do 1st gen cephalosporins take
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cellulitis, puncture wounds, bacteremia, cystitis, surgical prophylaxis,
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What is the drug of choice if you are going to be switching from IV cefazolin (ancef/kefzol) to a PO drug
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Cephalexin
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What type of drug is cefoxitin (Mefoxin)
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2nd gen cephalosporin
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What type of drug is cefotetan (Cefotan)
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2nd gen cephalosporin
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What type of drug is Cefuroxime (Ceftin/Zinacef)
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2nd gen cephalosporin
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What type of drug is Cefprozil (Cefzil)
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2nd gen cephalosporin
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What type of drug is Cefaclor (Ceclor)
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2nd gen cephalosporin
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What type of drug is Loracarbef (Lorabid)
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2nd gen cephalosporin
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What type of drug is Cefamandole (Mandol)
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2nd gen cephalosporin
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What bacteria do 2nd gen cephalosporins cover
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HNM-PEK (H. FLU, E. Coli, N. Gonorrhea, proteus, Klebsiella, M. Catarrhalis)
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When would you use cefotetan and cefoxitin over other 2nd gen cephalosporins
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when you need to cover anaerobic bacteria such as in intra abdominal infections, pelvic inflammatory disease and surgical prophylaxis
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What type of drug is cefotaxime (Claforan)
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3rd gen cephalosporin
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What type of drug is ceftriaxone (Rocephin)
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3rd gen cephalosporin
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What type of drug is cefdinir (Omnicef)
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3rd gen cephalosporin
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What type of drug is Cefpodoxime (Vantin)
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3rd gen cephalosporin
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What type of drug is Ceftazidime (Fortaz)
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3rd gen cephalosporin
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What type of drug is Cefoperazone (Cefobid)
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3rd gen cephalosporin
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What type of drug is Ceftizoxime (Cefizox)
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3rd gen cephalosporin
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What type of drug is Cefixime (Cefizox)
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3rd gen cephalosporin
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What type of drug is Cefditoren (Spectracef)
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3rd gen cephalosporin
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What type of drug is Ceftibuten (Cedax)
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3rd gen cephalosporin
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What bacteria do 3rd gen cephalosporins cover
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covers more gram neg bac than 2nd generation add salmonella, Serratia, Shigella, Enterobacter and Citrobacter
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What place in therapy do cefotaxime and ceftriaxone have
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they are work horses and can be used for meningitis, pneumonia, bacteremia, intra-abdominal infections
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You are sending a pt home from the hospital you have been tx with IV cefotaxime (or ceftriaxone) what drug should you switch them to for PO administration at home
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cefpodoxime, cefdinir, cefditoren, cefixime, or cefprozil
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What 3rd generation cephalosporin is closer to 4th generation because it also covers pseudomonas
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ceftazidime
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What type of drug is cefepime (Maxipime)
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4th generation cephalosporin
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What are the major s/e of using cephalosporins
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allergic rxn (5% cross reactivity with penicillin avoid use in anaphylaxis sensitive penicillin allergies), can cause thrombocytopenia, neutropenia, hemolysis, rare hepatotoxicity, sludging of gall bladder (pseudolithiasis)
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What type of drug is vancomycin (Vancocin)
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Glycopeptide
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What type of drug is Telavancin (Vibativ)
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Glycopeptide
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how would your approach to HA-MRSA vs CA-MRSA differ
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HA you would likely start pt on IV antibiotics since it is more aggressive CA acquired you can start with oral antibiotics
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Which drug would treat MSSA better vancomycin or cephoxamine
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cephoxamine vancomycin is used to treat MRSA it actually is inferior to the beta lactams in treating MSSA
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How does vancomycin differ from the beta lactams in its MOA
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it actually bind the building blocks (nag and nam) crosslinking with them and not the enzyme that forms the cross links (penicillin binding protein) this makes a weak cell wall that is disrupted easily and the bacteria die
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When should you give PO vancomycin
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only given to treat GI infections (colitis) as bioavailability is reduced in oral administration
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When do you need to adjust the dose of vancomycin
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increase dose in obesity and adjust dose in renal impairment
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What is the best way to measure the therapeutic index of vancomycin
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troughs are the best monitoring tool check before 4th dose trough is around 10-20
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What are the major s/e of vancomycin
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ototoxicity, nephrotoxicity, red man's syndrome (not true allergy) due to histamine release by infusing vanco too fast
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What are the s/e of Telavancin (Vibativ)
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nephrotoxicity, prolongation of QT interval, foamy urine, taste disturbances, N/V, avoid use in pregnancy , interferes with INR, aPTT, Xa lab measurements
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What type of drug is daptomycin (Cubicin)
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Cyclin Lipopeptide
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How does daptomycin work
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it binds the bacterial cell wall and rapidly depolarizes the cell membrane destroys ion-concentration causing cell death
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Pt is suffering from hospital acquired pneumonia that is resistant to vancomycin would you prescribe daptomycin or Telavancin
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Telavancin since dapto in never used for pneumonia
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What are the major s/e of using daptomycin
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muscle pain/weakness, CPK elevations
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