Shared Flashcard Set

Details

Pharm Exam 3
Antibiotics Part I
74
Pharmacology
Graduate
11/06/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
Antibiotic classes
Definition

1. Penicillin

2. cephalosporin

3. carbapenems & monobactams

4. Vancomycin

5. Vancomycin Alternatives: Linezolid, quinupristin/dalfopristin, daptomycin, telavancin 

6. Fluroquinolones

Term
Penicillin CLassification
Definition

-narrow spectrum penicillin (natural penicillins)

 

-Penicilinase-Resistant penicillins

 (Anti-staph penicillins)

 

-Extended spectrum penicillins

(Amino-penicillins, anti-pseudomonal penicillin, B-lactamase inhibitor combinations)

-

Term
Narrow Spectrum Penicillins (Natural Penicillins)
Definition

Penicillin G-IV, IM, PO

Penicillin V-PO

Term
Spectrum of activity of Penicillins
Definition

Gram + (Steptococcus, Enterococcus)

Gram - (Neisseria meningitidis)

Anaerobes (peptostreptococcis, clostridiium non-deficil)

Other (troponema pallidum, listeria)

Term
Common use of penicillins:
Definition

1. Step pharynitis

2. strep pneumoniae infections

3. endocarditis due to strept viridans

4. endocarditis prophylaxis

5. meningitis due to neisseria meningtidis

6. Syphilis=DOC

7. Lymes disease (carditis, meningitis, arthritis, high dose)

Term

benzathine pen

procaine pen

benzathine/procaine penicillin

Penicillin G potassium or sodium

Penicillin V potassium

Definition
Penicillin products
Term
Dose for strep pharyngitis
Definition
Penicillin V potassium PO 500 mg BID x 10days
Term

Methicillin

nafcillin

oxacillin

Dicloxacillin

cloxacillin

Definition
Penicillinase-resistance penicillins
Term
Spectrum of activity of penicillinase-resistant penicillins
Definition

G+ (MSSA, streptococcus, MSSE)

Anaerobes (Peptostreptococcus)

Term
Common uses of penicillinase resistant penicillin
Definition

1.Skin and skin structures infections due to stap areus (MSSA, or MSSE)

 

2.osteomyelitis dues to MSSA or MSSE

 

3.Infection of prosthetic joint due to MSSA or MSSE

 

4.Line infections due to staph

 

Term

Nafcillin and oxacillin

dicloxacillin

Definition
Penicillinase Resistant penicillins
Term

Amoxicillin

Ampicillin

Definition

Extended Spectrum Penicillins

 

Amino-penicillins

Term
Spectrum of activity for amino-penicillins
Definition

G+ = streptococcus, enterococcus

G- = H.flu, Neisseria, proteus

Anaerobes = Peptostreptococcus, clostridium (non deficil)

 

Other = listeria, H.pylori

Term
Common use of Amino-penicillins
Definition

1.Upper respiratory tract infections

-otitis media (amoxicillin DOC)

-Strep pharyngitis (strep pyogenes)

2. enterococcus infection

3. UTI

4. Meningtits due to listeria monocytogenes

5. H. pylori (with PPI and other abx)

6. Lymes disease

 

 

Term

Amoxicillin

ampicillin

Definition

 

Amino-penicillins

Term

Amoxicillin/clavulanate (augmentin)

Ampicillin/sulbactam (Unasyn)

Definition
Amino-penicillin + B lactamase inhibitor
Term
Amino-penicillins + B lactamase inhibitor spectrum of activity
Definition

G+ = Staph, Strep, Enterococcus

G- = H.flu, neisseria, m.cat, E.coli, Klbsiella, proteus

anaerobes = peptostreptococcus, clostridium, B.fragilis

 

Term
Common uses of Amino-Penicillins + b-lactamase inhibitor
Definition

Otitis media

Sinusitis

aspiration pneumonia

Bites (cat, dog, human)

Urinary tract infections

Anearobic infections (abscess)

Term

Amoxicillin/clavulanate (augmentin)

 

Ampicillin Ampicillin/sulbactam

Definition
Amino-Penicillins + B-lactamase inhibitor
Term

Ticarcillin

Piperacillin

Carbenicillin

Mezlocillin

Definition
Anti-pseudomonal penicillin
Term
Anti-pseudomonal penicillins spectrum of activity
Definition

G+ = Staph, Step, enterococcus

G- = h. flu, neisseria, m.cat, e.coli, klebsiella, proteus, pseudomonas

Anaerobes = peptostreptocuccus, clostridium, B. fragilis

 

Broadest spectrum

Term
Common uses of anti-pseudomonal penicillins + B-lactamase inhibitor
Definition

1. Ticacillin and piperacillin are rarely used w/out B-lactamase inhibitors

2. Empiric broad spectrum coverage +/- other antimicrobials

-Gi organisms: ruptured appy, gi surgery, diverticulitis

-nosocomial pneumonia (hospital aquired)

3. Pseudomonas infections

4. febrile neutropenia

Term

Zosyn (piperacillin/tozobactam)

timentin (ticarcillin/clavulanate)

Definition
Anti-pseudomonal penicillins + B-lactamase inhibitors
Term
Adverse effects: Penicillin
Definition

Generally well tolerated

Allergic rxn: rash, anaphylaxis, increased LFts, interstitial nephritis

Amox/Amp: Maculopapular rash with mono infection, CLLL, allopurinol= not true allergy

diarrhea

seizures with high doses

neutropenia, thrombocytopnia

thrombophlebitis

 

Term
clinical issues of penicillins
Definition

1. Dose changed for renal dysfunction

2. strep pneumo more resistant to pen

3. time above MIC is critical to penicillins success

-frequent doses

-continues infusion pen have to be used

Term
MOA of Cephalosporins:
Definition
Bind to PSPs and interfere with cell wall synthesis- similar to PEN
Term
Mechanism of resistance of cephalosporins:
Definition

-B-lactamase production

(Cephs are more stable with b-lactamse)

-PEn binding protein alteration

Term
Cephalosporin Classification:
Definition

Separated into 3 generations

 

1st generation = G+ best (G-worst) no anaerobes

3rd generation = G- best (G+worst)

 

All cephalosporins dont work against MRSA and enterococcus

Term

Cephalexin (keflex)

 

Cefazolin (ancef, kefzol)

 

Definition
1st generation cephalosporins
Term
Common use of 1st cephalosporin
Definition

Skin and skin structure infections

bone infections

surgical prophylaxis

uncomplicated UTI (EKP)

 

Term

cefuroxime (ceftin)

cefoxitin (mefoxin)

Definition

2nd generation cephalosporins

 

Spectrum of activity in the middle

g+ g- anaerobes

Term
Common uses of 2nd generation cephalosporins
Definition

Respiratory tract infections

otitis media

UTI, cystitis, pyelonephritis

cefoxitin & cefotetan only-GI, GU, GYN, procedures, and tx pelvic inflammatory disease w/doxycycline

Term

PO:  Cefpodoxime (vantin)

cefdinir (omnicef)

 

Iv: Ceftriaxone (rocephin), cefotamime (claforan), cefizoxime (cefizox), ceftazidime (fortaz), cefipime (maxipime)

 

 

Definition

3rd generation cephalosporin

 

Spectrum activity G+ G-

Term
Common use of 3rd generation cephalosporins
Definition

PO agents

-respiratory tract infections

UTI

 

IV agents

Empiric tx of serious infections

Meningitis DOC w/ vancomycin

W/aminoglycoside for pseudomonas

febrile neutopenia

Term
Adverse effects: Cephalosporins
Definition

1.Generally well tolerated

2.hypersensitivity

-cross reactivity with penicillin

-do not use with hives to penicillin

3.diarrhea

4. neutropenia, throbocytopenia

5. platelet dysfunction

 

Term

DOC for N. gonorrhea

Useful in otitis media

 

Need double coverage for pseudomonas

Definition
IM ceftriaxone
Term

imipenem + cilastatin (primaxin)

meropenem (merrem)

doripenem (doribax)

ertapenem (invanz)

 

Definition
Carbapenems
Term
Mechanism of resistance with carbapenems
Definition

generally stable in the presence of most types of b-lactamase

 

pseudomonas has shown altered permeability to imipenem

 

antagonism has been seen when imipenem is use with other b-lactams due to inc B-lactamase production

Term
Spectrum of activity for carbapenems
Definition
G+ G- (good) Anaerobes (good)
Term
Common Uses of carbapenems and monbactams
Definition

- Serious nosocomial infections (hospital acquired)

-serious polymicrobial infections

-intra-abdominal infections (hospital acquireD)

-pseudomonoas infections

-febrile neutropenia

Term

The other carbapenem

 

+spectrum of activity

Definition

Ertapenem

 

Similar to imipenem but no psuedomonas or enterococcis coverage

Term
Common use of Ertapenem
Definition

intra-abdominal infections

Skin and skin structures infections

UTI, pyelonephritis

Term

Adverse effects of Carbapenems

 

Definition

Allergy - rash

 

Seizures-do not use with hx of seizures of meningitis

 

GI problems

Term

Aztreonam (azactam)

 

Definition
Monobactams
Term
Monobactams:  mechanisms of action
Definition

Similar to other B-lactams

binds to PBPs and therefore inhibits call wall formation

Term
Spectrum of activity of monobactams
Definition

considered a g-specialist

good activity against G- aerobes including pseudomonas

Term
Common uses of monobactams
Definition

G- sepsis

urinary tract infection

G- osteomyelitis

G- pneumonia

intra-abdominal infections

CF (inhaled)

Term
vancomycin spectrum of activity
Definition
G+ very active Staph, MRSA, MRSE -DOC; Strep, Enterococcus
Term
Mechanism of action of vancomycin
Definition
Inhibits bacterial cell wall synthesis at earlier step than the b-lactams
Term
PEN allergy - avoid:
Definition
PEN, carbs, cephs, and slightly aztreonam
Term
Pharmacokinetics of vancomycin
Definition

1.Not absorbed from GI

2.Given IV for systemic infections

3.diffuses well into pleural, pericardial, synovial and ascitic fluids

4.therapeutic levels inCSF occur only with inflamed meninges and high doses

5.half-life 6hr with normal renal function upto 7.5 days with renal impairment

6. is not removed by conventional dialysis but is removed by high-flux methods of HD

Term

 

Vancomycin common uses:

Definition

 DOC: HCA-MRSA

MRSE, and enterococci (for PNC-allergy)

 

serious infections caused by s.aureus, enterococcus, or strep intolerant of b-lactams

 

infections caused by g+ organisms

 

clostridiium defficile colitis if metronidazole fails

 

endocarditid prophylaxis- GU or GI procedures in PEN intolerant pts

 

Term
Adverse effects of VANC
Definition

Neohrotixicity

ototoxicity

red man/neck syndrome

Term
VANC resistant enterococcus
Definition

VRE 15% OF ICU STRAINS

 

4 serotypes:

1. VanA type- High level resitence

2. VanB type- resistent to vanco

3. VanC type-low level resistance to vanco only

4. VanD type-similar to VanB

 

Term
VANCO resistance prevention
Definition

Vanco is discouraged in:

-prophylaxis for infection or colonization of vasc catheters

-eradication of MRSA colonization or CA-MSRA

-primary tx for clostridium difficile colitis

-routine prophylaxis for very low birth weight infanst

-routine prophylaxis for peritoneal dialysis

Term
MRSA tx option
Definition

1.Healthcare associated: Vanco =DOC or daptomysin

 

2. Community-associated MRSA = TMP/SMX, clindamycin, doxyclcline

 

 

 

 

Term
VRE tx options
Definition
Linezolid, quinupristin/dalfopristin, daptomycin,telavancin
Term
Linezolid MOA, Spectrum of activity, and use
Definition

moa: protein synthesis inhibitor

 

Spectrum: Staph, strep, enterococcus, resistant organisms

 

Use: should be strictly reserved to serious infections due to organisms resistant to other therapies

 

Term

QUINUPRISTIN/DALFOPRISTIN

 

info:

Definition

MOA: protein synthesis inhibitor combo

Spectrum: staph, step, enter, resistant organisms, VRE

 

Use: should be reserved for serious infections

Term

Telavancin

-info

Definition

MOA: inhibits bacterial cell wall synthesis

Spectrum: gram-positive bacteria, including MRSA

 

Use: strictly reserved to serious infections

Term
Strictly reserved for serious infections
Definition

1. Linezolid

2. Quinupristin/dalfopristin

3.telavancin

Term
Fluoroquinolones MOA
Definition

Inhibits topoisomerases II (supercoil DNA) and IV (separates daughter from parent)

 

Inhibition of topoisomerases results in rapid and lethal cessation of DNA replication

Term
Mechanism of resistance of fluroquinolones
Definition

Efflux pump

gene mutation

permeability

Term

ciprofloxacin (cipro)

ofloxacin (floxin)

norfloxacin (norflox)

Definition

Second generation Fluoroquinolones

g- best

Term
Levofloxacin (levaquin)
Definition
Third generation fluoroquinolones
Term

Moxifloxacin (avelox)

Gemifloxacin (factive)

Definition

Fourth generation fluoroquinolones

 

g+ best

Term
Fluoroquinolones- spectrum
Definition

Other bacteria:

-chlamydia

-legionella

-mycoplasma

-mycobacterium TB, Avium

-H. Pylori: with combo

Term
Ciprofloxacilin:
Definition

best psuedomonal activity of quinolones, poor s. pneumoniae

 

Term
Levofloxacin:
Definition

Better S. pneumoniae than cipro, but ledd than 4th generation

 

Term
Moxifloxacin
Definition
best respiratory quinolones
Term
Quinolones common use:
Definition

UTI (pyelonephritis, cystitis, prostatitis)

Osteomyelitis due to gram -

CAP

M. tuberculosis

complicated gram- and anaerobic abdominal and gyn infections

Term
Overuse of quinolones in:
Definition

acute exacerbations of chronic bronchitis

chronic sinusitis

travelers diarrhea

Term
Adverse effects of quinolones:
Definition

limited in children under 18 and avoided in pregnancy

=bone/joint erosion in young animals

 

-gi problems

 

-cns -dizzy, headache

Term
Drug interactions of quinolones
Definition

chelation (dec absorption)

theophylline (cipro)

warfarin

avoid with meds that prolong QT interval

Supporting users have an ad free experience!