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98 Cards in this Set
- Front
- Back
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what is the chemical group that is characteristic of penicillins?
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beta-lactam ring
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what is transpeptidase in a bacteria?
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enzyme that enables the linking of amino acids and disaccharides in the production of cell walls
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how do beta-lactam rings KILL bacteria (bacteriCIDAL)?
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competitively inhibit transpeptidase enzyme
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can penicillin kill gram negative bacteria?
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YES, by getting to the cell via the porins
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what are the 5 types of penicillins?
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PAPA C
Penicillin G Aminopenicillins Penicillinase-resistant penicillins Anti-pseudomonal penicillin Cephalosporins |
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how are aminopenicillins different than penicillin G?
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better coverage against gram-negative bugs
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give an example of a bug that produces beta-lactamase (or penicillinase). what type of drug do you give to fight it?
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Staphylococcus aureus
penicillinase-resistant penicillins |
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name the 3 types of penicillins that offer gram-negative coverage (in order of increasing coverage).
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aminopenicillins
anti-pseudomonals cephalosporins |
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how is penicillin G usually given? give an example of when penicillin G is indicated.
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IV or IM
penicillin G is given in pts with pneumonia due to Streptococcus pneumoniae |
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what are the two common aminopenicillins?
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ampicillin and amoxicillin
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are aminopenicillins sensitive to penicillinase?
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YES.
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name the two aminopenicillins. which is best taken orally? which is best taken IV?
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amOxicillin - Oral
ampIcillin - IV |
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"note that aminopenicillins are one of the few drugs effective against the ........."
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"gram-positive enterococcus"
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what gram negative bugs are killed by the aminopenicillins?
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E. coli and other enterics (Proteus, Salmonella, Shigella etc.)
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name 3 penicillinase-resistant penicillins.
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M, N, O (i MET a NAsty OX)
Methicillin Nafcillin Oxacillin |
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methcillin, nafcillin and oxacillin are penicillinase resistant penicillins. against what bug are they particularly effective?
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Staphylococcal infections
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why is methcillin no longer used?
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side effect is interstitial nephritis
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what is the DOC for serious Staphylococcus aureus infections (cellulitis, endocarditis, sepsis)?
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nafcillin
"to fight the NAsty infection" |
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name 2 oral beta-lactamase resistant penicillins.
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cloxacillin
dicloxacillin |
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are penicillinase-resistant penicillins good against gram-negative bugs?
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NO. mostly for gram positive bacteria, especially those producing penicillinase (Staphylococcus aureus)
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if a patient has an infected skin wound (cellulitis, impetigo etc.), what are the causative bugs and how do you cover them?
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bugs: Staphylococcus aureus or group A beta-hemolytic streptococcus
treat with one of the oral penicillinase-resistant penicillins to cover both: dicloxacillin or cloxacillin |
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what type of penicillins are Ticarcillin, Carbenicillin and Piperacillin? what do they cover?
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anti-pseudomonal penicillins
Pseudomonas aeruginosa, anaerobes (Bacteroides fragilis), and many gram positives |
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name three anti-pseudomonals.
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Ticarcillin
Carbenicillin Piperacillin |
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name 3 enzymes that inhibit beta-lactamase.
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Clavulanic Acid
Sulbactam Tazobactam |
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what is special about Augmentin, Timentin, Unasyn, and Zosyn?
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combination pencillins plus beta-lactamase inhibitor enzymes
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what bugs do Augmentin, Unasyn, Zosyn, and Timentin cover?
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- beta-lactamase producing Staph. aureus
- gram negatives (Haemophilus influenza) - anaerobes (Bacteroides fragilis) |
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2 advantages of cephalosporins over penicillins?
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1. added group/ring makes them more resistant to beta-lactamases
2. extra group makes them easier to manipulate in the lab |
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name 2 bugs that are resistant to all cephalosporins.
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MRSA
Enterococci (including Streptococcus faecalis) |
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what is the matrix of efficacy for cephalosporins by generation (Y-axis) and bugs (X-axis).
X-axis: gram negatives; streptococci; gram positives |
1st: +, +++, +++
2nd: ++, ++, ++ 3rd: +++, +++, + |
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how do you remember 1st generation cephalosporins? any exceptions to remember?
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all have PH in the name, EXCEPT ceFAZolin:
cePHalothin cePHapirin cePHradine cePHalexin |
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name 5 2nd generation cephalosporins.
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ceFAMandole
ceFOXitin ceFURoxime cefoTEtan cefaCLOR the FAMily of FOXes wore FUR, drank some TEa, y se hecharon un CLORo |
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what is the only 4th generation cephalosporin? what is it good for?
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ceFEPime
effective against Pseudomonas aeruginosa |
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what are the only 3 cephalosporins that can kill Pseudomonas aeruginosa?
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ceFEPime (4th)
cefTAZidime (3rd) ceFOPerazone (3rd) |
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what cephalosporin has great CSF penetration and is used to fight bugs that frequently cause meningitis?
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cefTRIaxone
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what is the first line drug for meningitis in neonates, children and adults?
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cefTRIaxone
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which cephalosporin is often given IM to fight Neisseria gonorrhea?
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cefTRIaxone
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when are first generation cephalosporins used?
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alternatives to penicillin for Staphylococcal and Streptococcal infx due to penicillin allergies
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are all pts with penicillin allergies also allergic to cephalosporins?
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NO. 10% are also allergic to cephalosporins
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which 2nd generation cephalosporin is a good choice to fight community acquired pneumonia when the bug isn't known?
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ceFURoxime
good coverage against BOTH Streptococcus pneumoniae AND Haemophilus influenzae |
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sinusitis and otitis media are often caused by Haemophilus influenzae and Branhamella catarrhalis. which 2nd generation cephalosporin is effective against both bugs?
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ceFURoxime
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which are the 3 second generation cephalosporins that cover anaerobic bacteria, such as Bacteroides fragilis?
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ceFOXitin
cefoTEtan cefMETazole i MET the FOX for TEa |
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what 3 second generation cephalosporins can be used for intra-abdominal infx, aspiration pneumonias, colorectal surgery ppx - all of which involve anaerobic contamination from the GI tract?
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ceFOXitin
cefoTEtan cefMETazole |
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when do you use 3rd generation cephalosporins?
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multi-drug resistant aerobic gram-negative organisms that cause nosocomial pneumonia, meningitis, sepsis, and UTI's
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name 3 third generation cephalosporins.
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cefTRIaxone
cefTAZidime cefTAXime |
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name 2 obligate aerobic gram (+) bugs.
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Nocardia (weakly acid fast)
Bacillus cereus |
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name 5 obligate aerobic gram (-) bugs
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Neisseria
Bordetella Brucella Legionella Pseudomonas |
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what are 5 facultative anaerobes that are gram (+)?
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Actinomyces
Bacillus anthracis Corynebacterium Listeria Staphylococcus |
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name the gram (+) obligate anaerobe. the gram (-) anaerobe.
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Clostridium
Bacteroides |
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what are the 2 acid fast obligate aerobes that are gram (+)?
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Mycobacterium
Nocardia |
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what 2 gram (+) bugs undergo filamentous growth like fungi?
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Actinomyces (anaerobic)
Nocardia (partially acid fast) |
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name both gram (+) cocci.
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Streptococcus
Staphylococcus |
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Name all gram (+) bacilli (rods).
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Corynebacterium
Listeria Bacillus Clostridium Mycobacterium (acid fast) |
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what has the broadest antibacterial activity of any antibiotic known to man?
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imipenem
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what strong antibiotic lowers the seizure threshold?
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imipenem
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what antibiotic is given with cilastin to avoid breakdown?
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imipenem
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what drug is considered a magic bullet for gram (-) aerobic bacteria?
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aztreonam
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why give the following combos?
vancomycin + aztreonam clindamycin + aztreonam |
vanc and clinda: gram (+)
aztreonam: gram (-) |
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what drug kills MRSA?
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vancomycin
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what drug kills methcillin resistant Staphylococcus epidermidis?
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vancomycin
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what drugs kill the Enterococci (Group D Streptococci)?
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1. Ampicillin
2. (Vanco) increasing resistance 3. Imipenem and Meropenem 4. Piperacillin 5. Levofloxacin |
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what are the 5 anti-ribosomal drugs?
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CLEan TAG
Chloramphenicol and Clindamycin Linezolid Erythromycin Tetracycline AminoGlycosides |
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which of the anti-ribosomal drugs cannot be absorbed orally?
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aminoglycosides
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which drug kills "most clinically important" bacteria? (incl. gram (+), gram (-), anaerobes)
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chloramphenicol
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when is chloramphenicol used to treat meningitis? why?
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when it's severe, pt is allergic to alternative tx; chloramphenicol has excellent penetration into CSF
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what are 2 side effects of chloramphenicol?
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1. mild anemia
2. aplastic anemia (fatal, irreversible) |
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what drug causes 'Gray Baby Syndrome'?
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chloramphenicol
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what drug combo do surgeons use for penetrating wound infx of the abdomen?
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clindamycin + aminoglycoside
in a perforation, clinda covers anaerobic gram (+) and aminoglycosides cover aerobic gram (-) |
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what is the spectrum of activity for clindamycin?
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gram positive anaerobes
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what topical solution is used to treat acne vulgaris and rosacea (adult acne)?
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topical clindamycin
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what alternative to metronidazole is used to treat bacterial vaginosis?
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oral clindamycin or clindamycin cream
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what drug is used in septic abortions?
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clindamycin
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clindamycin and what other drug(s) cause C. difficile colitis?
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penicillins
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how do you treat C. difficile colitis?
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vancomycin or metronidazole
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what is the DOC to treat VRE, or vancomycin resistant enterococcus?
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linezolid
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is linezolid used for gram pos. or gram neg. infx?
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gram pos., especially those resistant to other abx
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what is the DOC for community-acquired pneumonia that doesn't require hospitalization?
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erythromycin
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what is the spectrum of coverage for erythromycin?
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gram positive bugs and atypicals (Legionella and Chlamydia)
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what is the DOC for Legionnaires disease?
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erythromycin
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what are the macrolides?
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erythromycin
azithromycin doxycycline |
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what are the uses for doxycycline?
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think of the TET offensive:
1. VD caused by Chlamydia trachomatis 2. Mycoplasma pneumoniae walking pneumonia 3. animal and tick-borne diseases: Brucella and Rickettsia 4. acne |
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what are the toxicities of doxycycline?
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1. GI irritation
2. phototoxic dermatitis 3. renal and hepatic toxicity 4. depressed bone growth |
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what are aminoglycosides good for combating?
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kill aerobic gram negative enteric organisms (E. coli and company), including Pseudomonas aeruginosa.
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name 5 aminoglycosides. on what bugs do they generally act?
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they STANG the enterics:
Streptomycin Tobramycin Amikacin Neomycin Gentamicin |
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which of the aminoglycosides has the broadest spectrum?
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amikacin
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what are the side effects of the 'mean guy', aminoglycoside?
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shot to the head, kidney and out cold:
1. ototoxicity 2. renal toxicity 3. neuromuscular blockade |
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what is the DOC for Neisseria gonorrhea when tetracycline and penicillin don't work?
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spectinomycin
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what are 3 good drugs you can use for N. gonorrhea?
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1. ceftriaxone
2. ciprofloxacin 3. spectinomycin |
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why are fluoroquinolones increasingly popular?
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1. safe
2. high blood levels orally 3. penetrate tissues well |
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how do fluoroquinolones work?
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inhibit DNA gyrase
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what can happen to pts with renal insufficiency who take ciprofloxacin? mxn?
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seizures
inhibit GABA |
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the combination of ciprofloxacin plus what type of drug can lead to seizures?
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NSAIDs
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do fluoroquinolones penetrate well into the bone and prostate?
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YES
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what are fluoroquinolones good for?
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gram negative aerobes
S. aureus chronic osteomyelitis |
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why are fluoroquinolones good for treating aerobic enteric bugs (E. coli, Salmonella, Shigella, Campylobacter)?
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high intestinal drug level
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why is TMP-SMX good for UTI's?
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excreted in the urine
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what drug(s) do you give to prevent Pneumocystis carinii when CD4+ T-cell count drops below 200 in AIDS pts?
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TMP-SMX
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does TMP/SMX cover anaerobes?
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No anaerobes, but wide coverage for gram neg. and gram pos.
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describe the TMP/SMX coverage in more detail.
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T: respiratory Tree; S. pneumoniae, H. influenzae, otitis media, sinusitis, bronchitis, pneumonia
M: Mouth; GI tract bugs that cause diarrhea; Shigella, Salmonella, E. coli P: Pee; UTI's, prostatitis, urethritis caused by enterics S: Syndrome; AIDS pts given to prevent Pneumocystis carinii |
