Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 4 gram negative non-enteric rods |
|
Definition
| influenza, pseudomonas, legionella, other ellas |
|
|
Term
| 7 gram negative enteric rods |
|
Definition
e. coli
klebsiella
proteus
h pylori
salmonella
shigella
bacteroides |
|
|
Term
|
Definition
|
|
Term
|
Definition
| actinomyces, bacteroides, blostridium |
|
|
Term
| 2 microbes without cell wall |
|
Definition
|
|
Term
| 2 obligigate intracellular parasite bacteria |
|
Definition
|
|
Term
| what can misuse of antibiotics cause (2) |
|
Definition
| resistance and life threatning infections |
|
|
Term
| why do microbes cause symotoms (5) |
|
Definition
tissue injury: endo and exotoxins
host response; cytokines, hydrolytic enzymes, PMN |
|
|
Term
| what are the 8 steps in antibiotic perscribing |
|
Definition
perform h+p
collect specimine and send for diagnosis - if you dont know what it is already by symptoms, probablly begin treatment before the results
use epidemology to choose correct drug
tailor drug to the host immune system and diseases
move from broad/empiric to specific/narrow spectrum once etiology or microbe has been identified
monitor for reaction or treatment failure
assess risk of infection to the ocmmunity
assess opportunity for prevention in the patient and others |
|
|
Term
| where do immunocompitent patients get microbes |
|
Definition
| external enivornment (pathogenic microbes) |
|
|
Term
| where do immunocompormised patients get microbes |
|
Definition
| from their own body (endogenous flora) |
|
|
Term
| how can bacteria be acquired |
|
Definition
| contact, inhalation, common vehicle, vectors, food, water, sex |
|
|
Term
| what do you need to collect from a patient when you suspect an infection (3), why |
|
Definition
| when where and whith who, helps find best treatment |
|
|
Term
| hospital acquired infections; what are they associated with, what is a concern, what do you do |
|
Definition
associated with procedures
more likley to be resistant
know what infections are are your institution |
|
|
Term
| what are the 5 parts to determining susceptability |
|
Definition
| MIC, MBC, tolerance, bactriostatic, bacteriocidial |
|
|
Term
|
Definition
minimum inhibitory concentration
lowest concentration of antibiotic that inhibits bacterial growth after 24 hours on a specific medium |
|
|
Term
|
Definition
minimum bactericidial concentration
lowest concentration that prevents growtn on antibiotic free medium, then culture with antibiotic and re-plate on antibiotic free medium if there is no growth it is dead |
|
|
Term
|
Definition
| microbe is tolerante to the antibiotic when it needs 32x more than the MIC to be killed |
|
|
Term
|
Definition
only kills in suprapharamacological doses
inhibits microbe growth |
|
|
Term
|
Definition
have MBC 405x the MIC
kill microbes |
|
|
Term
| what are the 5 pharamacologic factors that effect antibiotic activity |
|
Definition
choose a drug that is selectivly active for the infecting organism
absorption from the site of administration
delivery to the infected region
penetration to the site of infection
maintience of adequate amounts of active drug |
|
|
Term
| what is the point of a microbiostatic agent if it dosent kill |
|
Definition
| stops growth then the immune system can kill |
|
|
Term
| if someone is immune compormized what kind of drug do they need |
|
Definition
| microbicidial, static depends on the immune system to finish the job |
|
|
Term
| why would you use paraentral for administration |
|
Definition
| life threatning infection |
|
|
Term
| which mode of administration is preferred, why (3) |
|
Definition
|
|
Term
| when a patient is critically ill, how can you make extra sure you drug is being absorbed |
|
Definition
| check plasma concentrations |
|
|
Term
| what affects delivery of a drug to the approporate region |
|
Definition
|
|
Term
| which three infections is penetration to the site of infection critical |
|
Definition
| suprelative meningitis, bacterial endocarditis, septic arthritis |
|
|
Term
| what are 4 types of toxicity antibiotics can cause, which is the most common |
|
Definition
dose related: most common
allergic reaction
toxic to altered host
toxic in pregnacy |
|
|
Term
| what antibiotics are known for causing allergic reactions (2) |
|
Definition
| penicillin, cephalosporins |
|
|
Term
| what does it mean "toxicity due to altered host" (4) |
|
Definition
action of the drug is affected by genetics, other drugs, or altered elimination
they antibiotic may alter normal flora and promote selection of anaerobic infection (C. diff) |
|
|
Term
| why cant you use tetracyclins in pregnacy (2) |
|
Definition
| tooth malformation, staining |
|
|
Term
| why cant you use aminoglycosides in pregnacy (2) |
|
Definition
| nephrotoxicity, ototoxicity |
|
|
Term
| why cant you use quinolones in pregnacy (1) |
|
Definition
|
|
Term
| why cant you use sulfonamides in pregnacy (2) |
|
Definition
displace bilirubin from albumin
produce ketones |
|
|
Term
| why cant you use chloramphenicol in pregnacy (1) |
|
Definition
| gray baby syndrome: baby cannot glucuronate the drug due to lack of transferase so it accumulates and looks gray |
|
|
Term
| what are three symptoms of gray baby syndrome |
|
Definition
| flaccidity, ashen color, cardiovascular collapse |
|
|
Term
|
Definition
| two antibiotics work n different sites and cause a greater effect when working together |
|
|
Term
| what are 4 reasons we use antibiotics in combination |
|
Definition
synergy
extent antimicrobial spectrum
prevent resistance
treat mixed inections |
|
|
Term
| how can using more than one antibiotic reduce resistance |
|
Definition
| probability of resistance spontaneously forming to two drugs is equal to the product of both probabilities alone |
|
|
Term
| what are examples of conditions we treat with combinations of drugs to decrease resistance (2) |
|
Definition
|
|
Term
| why do you need more than one antibiotic for mixed infections (2) |
|
Definition
cover aerobic and anaerobic
cover gram negative and positive
lower doses and decrease toxicity |
|
|
Term
| what is the problem with long term antibiotic therapy |
|
Definition
| increases risk for side effects |
|
|
Term
| what are the two types of inappropirate antibiotic use |
|
Definition
error of omossion: treatment needed isnt given
error of comission: treatment is given but is inawequate or inappropirate (physician error) |
|
|
Term
| what are 5 signs of infections (5) |
|
Definition
fever > 98.6 oral
increased WBC 4000-10000 cells/mm3
increased band neutrophils
pain
inflammation |
|
|
Term
| what is the functions of folates (5) |
|
Definition
make purines and primidines
growth
replication
cell division |
|
|
Term
|
Definition
|
|
Term
| how do bacteria get folate (3) |
|
Definition
| make it from PABA, pteridine, glutamine |
|
|
Term
| what are the 6 antifolate drugs |
|
Definition
sulfonamide/trimethoprim
silver sulfadizine
sulfacetamidine
pyrimetnamine
dapsone
methotraxate |
|
|
Term
| what does pyrimetnamine treat |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what does methotrexate treat (2) |
|
Definition
|
|
Term
| what are the 3 DNA antibiotics |
|
Definition
metronidazole
daptomycin
floroquinolones |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the 1st gen floroquinolones |
|
Definition
|
|
Term
| what are the 2st gen floroquinolones (2) |
|
Definition
|
|
Term
| what are the 3st gen floroquinolones (2) |
|
Definition
|
|
Term
| what are the 4st gen floroquinolones |
|
Definition
|
|
Term
| is sulfonamide bacteriostatic or cidial |
|
Definition
|
|
Term
| is metronidazole bacteriostatic or cidial |
|
Definition
|
|
Term
| is nitrofurantoin bacteriostatic or cidial |
|
Definition
|
|
Term
| what is the MOA of trimethoprim sulfamethoxazole |
|
Definition
| competitive inhibitor for dihydrofolate reductase in conversion of folic acid to nucleotides |
|
|
Term
| why is TMP/SMX in the combo (2) |
|
Definition
prevents formation of tetrahydrofolic acid
have greater activity together |
|
|
Term
| what can cause resistance to TMP/SMX (2) |
|
Definition
not common with two drugs
over use
alteration of dihydrofolate reductase |
|
|
Term
| how is TMP/SMX administered (2) |
|
Definition
|
|
Term
| where does TMP/SMX distribute to |
|
Definition
| trimethloprim part concentrates in prostatic and vaginal fluid |
|
|
Term
| what are 4 adverse effects of TMP/SMX |
|
Definition
all the sulfonamide side effects
in G6PDH deficiency it causes anemia
rash: commonly in elderly and HIV
marrow supression |
|
|
Term
| what types of marrow suppression occur with TMP/SMX (3), how can you fix it |
|
Definition
megaloblastic aemia
leukopenia
thrombocytopenia
give folic A |
|
|
Term
| in general what does TMP/SMX work on (5) |
|
Definition
broad spectrum - but lots resistant
gram positive, negative, rod, cocci |
|
|
Term
| what is TMP/SMX the drug of choice for |
|
Definition
| prevention and tx of PJ pneumonia |
|
|
Term
| what is TMP/SMX the second in line for drug of choice for |
|
Definition
|
|
Term
| what specific microbes does TMP/SMX treat (5) |
|
Definition
listeria
CA-MRSA
moraxella
E. coli (UTI)
PJ pneumonia |
|
|
Term
| what is the MOA of sulfonamides |
|
Definition
compete with PABA for dihydroperoate synthase
stop folic A synthesis |
|
|
Term
| how do you get resistance to sulfonamides (3) |
|
Definition
altered dihydroperoate synthesis via mutation or plasmid transfer
decreased sulfonamide uptake
increased PABA |
|
|
Term
| what are the type types of sulfonamides, how are they administered |
|
Definition
sulfacetamide: ointment, drops
silver sulfadiazine: cream |
|
|
Term
| what are the side effects of sulfonamides (6) |
|
Definition
burning brown gray discoloration
blurred vision
hypersensitivity - oral rash, angioedema, steven johnson syndrome |
|
|
Term
| what are three symptoms of steven johnson syndrome |
|
Definition
| erythema, hemorrhages, crust on lips |
|
|
Term
| what has cross allergenicity with sulfonamides (4) |
|
Definition
carbonic anhydase inhibitors
thiazide diruetics
loop duiruetics
sulfonyl urea hypoglycemia drugs |
|
|
Term
| what in general are sulfanomides used for (5 conditions, 3 organisms) |
|
Definition
gram negative and positive
yeast
sepsis prevention in burns
conjunctivitis
corneal infection
UTI |
|
|
Term
| what is the MOA of maternidazole (2) |
|
Definition
activated by ferrdoxin in anaerobes via reduction
messes with DNA |
|
|
Term
| how is metronidazole administered |
|
Definition
|
|
Term
| how is metronidazole metabolized |
|
Definition
|
|
Term
| what are the adverse effects of metronidazole (4) |
|
Definition
gi upset
metalic taste
red brown urine
disulfrum reaction |
|
|
Term
| what causes resistance to metronidazole/what is it not good against (3) |
|
Definition
oxygen inhibits
no aerobic activity
no pesudomonas |
|
|
Term
| explain the disulfrim reaction |
|
Definition
| blocks acetylaldehyde DH and acid aldehyde builds up |
|
|
Term
| what in general does metronidazole kill (5) |
|
Definition
| anaerobes, parasites, protozoa, empiric for anaerobic and mixed infections |
|
|
Term
| what are specific organisms matronidazole kills (6) |
|
Definition
giardia
etenobea
trichomonas
bacteroides
anaerobes
clostridium
on the
metronidazole
gardenela (bacterial vaginosis) |
|
|
Term
|
Definition
| binds bacterial cell membrane and depolarizes it causing loss of potential and inhibiting DnA/RNA synthesis |
|
|
Term
| how is daptomycin administered, how long |
|
Definition
| IV over 30 minutes once a day for 1-2 weeks |
|
|
Term
| what are the 5 adverse effects of daptomycin |
|
Definition
constipation
nausea
abnormal LFT
muscle pain
weakness |
|
|
Term
| what is daptomycin used for (5) |
|
Definition
complicated skin and skin structure infections
staph
MRSA
gram positive cocci |
|
|
Term
| what is the MOA of flouroquinolones |
|
Definition
inhibit DNA gyrase (topoisomerase II) preventing relaxation of supercoils stipping transcription
prevents joining of gyrase |
|
|
Term
| what does DNA gyrase normally do |
|
Definition
| changes DNA configuration by nicking, pass through, and resealing |
|
|
Term
| what can cause resistance to flouroquinolones (3) |
|
Definition
mutation of DNA gyrase
eflux of the drug
prevention of drug penetration |
|
|
Term
| how are flouroquinolones administered |
|
Definition
|
|
Term
| where do flouroquinolones distribute to (6) |
|
Definition
| tissue, bone, urine, kidney, prostate, lung |
|
|
Term
| where are foluroquinolones excreted |
|
Definition
|
|
Term
| what are the adverse effects of foluroquinolones (6) |
|
Definition
generally well tolerated
gi upset
phototoxicity
tendinitis
rupture
affects collagen metabolism
affects cartiladge development |
|
|
Term
| what interacts with foluroquinolones |
|
Definition
avoid antacidsL Mg, Al, Zn, Fe
cipro inhibits P450 and interferes with theophylline metabolism |
|
|
Term
| what can foluroquinolone generations 1 and 2 kill that the others cant (2) |
|
Definition
| cipro can kill bacillus anthracis, pseudomonas |
|
|
Term
| what can gen 3 and 4 fouroquinolones kill that the others cant(5) |
|
Definition
strep, enterococcus, fecalis
anaerobes: c not diff, bacteroides |
|
|
Term
| what general categories can foluroquinolones kill |
|
Definition
gram negative first choice except pseudomonas
atypicals
newer drugs gram positives |
|
|
Term
| what are flouroquinolones first choice for |
|
Definition
|
|
Term
| what atypicals can fouroquinolones kill (3) |
|
Definition
| candidia, mycoplasma, legionalla |
|
|
Term
| what do you use when a pneumonia is resistant to macrolides and penicillins |
|
Definition
|
|
Term
| what random microbes can all foluroquinolones kill that are not atypical (6) |
|
Definition
listeria
strep pneumonia
neisseria
moraxella
chylamydia
MSSA |
|
|
Term
|
Definition
boys <6yo without circumcision
girls 1-5yo, teens, puberty, and sexually active women
eldery |
|
|
Term
|
Definition
| e. coli, staph saphrophiticus, klevsiella, proteus, pseudomonas aeruginosa |
|
|
Term
| what are the symptoms of UTI (5) |
|
Definition
| asymptomatic, urgency, frequency, nocturia, suprapubic heaviness |
|
|
Term
| what are the symptoms of UTI in the elderly (2) |
|
Definition
| altered mental status, changes in eating |
|
|
Term
| what is used to treat a complicated UTI (2) |
|
Definition
| TMP/SMX, foluroquinolones |
|
|
Term
| what is used to treat a uncomplicated UTI (3) |
|
Definition
| gentamycin, anti-pseudomonal penicillin, nitrofurantoin |
|
|
Term
| what is the MOA of nitrofurantoin (3) |
|
Definition
bacteria activate the drug
it inhibits enzymes and damaes DNA |
|
|
Term
| how do you get resistance to nitrofurantoin |
|
Definition
|
|
Term
| how is nitrofurantoin administered |
|
Definition
|
|
Term
| is nitrofurantoin teratogenic |
|
Definition
|
|
Term
| what are the adverse effects of nitrofurantoin (4) |
|
Definition
GI upset- take with food
pulmonary: pneumonitis, fibrosis with chronic treatment
turns urine brown |
|
|
Term
| what does nitrofurantoin kill ((4) |
|
Definition
e. coli
gonorrhea
MSSA
strep |
|
|
Term
| what is hte MOA of probencid |
|
Definition
| inhibit tubular reabsorption of uric acid and increase excretion |
|
|
Term
| what does probencid interact with (4) |
|
Definition
inhibits secretion of penicillins, cephalosporins, and foluroquinolones
increases half life of WA antibiotics |
|
|
Term
| what is the number one and two choice of tx for gonorrhea |
|
Definition
1. ceftriaxone
2. flouroquinolone |
|
|
Term
| what is the treatment for syphilos |
|
Definition
|
|
Term
| what is the number 1 and 2 treatment for chalmydia trachomatis |
|
Definition
1. asithromycin
2. doxycycline |
|
|
Term
| what are the 5 antibiotics that are not excreted renal |
|
Definition
anti-staph penicillins
cephtriaxone
doxycycline
macrolides
clindamycin
metronidazole |
|
|
Term
| what are the 4 categories of B-lacctam drugs |
|
Definition
| penicillins, cephalosporins, carbapentems, monobactams |
|
|
Term
| what are the 4 types of penicillins, what is the penicillinase resistance status |
|
Definition
natural - susceptible
anti-staph - resistant
amino - susceptible
anti-pseudomonas - susceptible |
|
|
Term
| what kind of antibiotic is penicillin (2) |
|
Definition
B-lactam cell wall drug
bactericidal |
|
|
Term
| what are the 2 natural penicillins |
|
Definition
| penicillin G, penicillin V |
|
|
Term
| what are the 4 anti-staph penicillins |
|
Definition
| naficillin, methacillin, oxacillin, dicloacollin |
|
|
Term
| what are the 2 amino penicillins |
|
Definition
| amoxicilliin and ampicillin |
|
|
Term
| what are the 2 anti-pseudomonas penicillins |
|
Definition
|
|
Term
| what parts of the body does penicillin distribute to (3) |
|
Definition
| bones, CNS, placenta (not tertogenic) |
|
|
Term
| how are penicillins metabolized and excreted |
|
Definition
little metabolism
WA excreted in PCT of kidney (adjust for renal dysfunction) |
|
|
Term
| what are the three parts to the MOA of all penicillins |
|
Definition
inactivate PBP on cell memrane stopping cell wall synthsis, allowing autolysins to proceede, breaking cross links in peptidoglycan
stop trans-peptidase preventing cross linking
active against peptidoglycan wall |
|
|
Term
| what 4 ways can a microbe get resistance to a B-lactam |
|
Definition
has no cell wall
plasmid B-lactaminase transfer
porin mutation: drug can't get through LPS to PBP
modify PBP so drug cannot bind |
|
|
Term
| what 3 side effects to penicillins cause, what triggers them |
|
Definition
hypersensitivity: triggered by penicilloic acid. maculopapular rash, angioedema, anaphylaxis
GI reaction (especially ampicillin)
acute interstitial nephritis (rare) |
|
|
Term
| can someone have penicillin after an allergic reaction, how does this change other drug perscriptions |
|
Definition
if they had a mild reaction (rash) they don't get penicilliin anymore but can have other B-lactams
if they had a severe reaction (anaphylaxis) they can never have all B-lactam drugs |
|
|
Term
| what are the 2 MOA of B-lactaminase inhibitors |
|
Definition
irreversibly bind B-lactaminase and alter its structure
allows for antibiotics to kill, not killers |
|
|
Term
| do B-lactaminase inhibitors penetrate the CNS well |
|
Definition
|
|
Term
| what are B-lactaminase / penicillin combos, what is their method of administration (4) |
|
Definition
cavulanic A / amoxicillin - oral
cavulanic A / tricarcillin - IV or IM
taxobactam / piperacillin - IV or IM
sublactam / ampicillin - parentrail |
|
|
Term
| what are the five categories of cephalosporins, what is their penicillinase resistance status |
|
Definition
1st generation - none really
2nd generation - some
3rd generation - basically all resistant
4th generation - resistant
5th generation - resistant? |
|
|
Term
| what 2 drugs are 1st generation cephalosporins |
|
Definition
|
|
Term
| what 4 drugs are 2nd generation cephalosporins |
|
Definition
cefaclor
cegoxitin
cefuroxime
cefmandole |
|
|
Term
| what 4 drugs are 3rd generation cephalosporins |
|
Definition
ceftaxime
ceftazidime
ceftriaxone
cefoperazone |
|
|
Term
| what 1 drug is a 4th generation cephalosporin |
|
Definition
|
|
Term
| what 2 drug is a 5th generation cephalosporin |
|
Definition
|
|
Term
| what type of antibiotic is a cephalosporin (2) |
|
Definition
b-lactam cell wall drug
bactericidial |
|
|
Term
| how are cephalosporins administered, why |
|
Definition
| IV or IM because they are absorbed poorly |
|
|
Term
| what pharmological principals to cephalosporins have in common with penicillins |
|
Definition
| MOA, resistance issues, side effects, metabolism, clearance |
|
|
Term
| what happens when a patient overuses cephalosporins |
|
Definition
| enterococcal superinfections |
|
|
Term
| what three drugs are cerbapenems, what are their B-lactaminase resistances |
|
Definition
imipenem
neropenem
entrapenem
all resistant |
|
|
Term
| how are carbapenems administered |
|
Definition
|
|
Term
| what side effect do carbapenems do that isnt the same as penicillin |
|
Definition
| seizures (especially imipenem) |
|
|
Term
| what pharmological principals to carbapenems have in common with penicillins |
|
Definition
| MOA, resistance issues, side effects, metabolism, clearance |
|
|
Term
| what drugs are monobactams, what are their B-lactaminase resistance status |
|
Definition
|
|
Term
| what pharmological principals to monobactams have in common with penicillins |
|
Definition
| MOA, resistance issues, metabolism, clearance |
|
|
Term
| why are monobactams different from all the other B-lactams |
|
Definition
| they only have one ring (B-lactam), their allergies do not cross react with other B-lactam drugs |
|
|
Term
| what side effects do monobactams cause (2) |
|
Definition
|
|
Term
| how are monobactams administered |
|
Definition
|
|
Term
| what are the four non-B-lactam cell wall drugs, what type of antibiotic are they |
|
Definition
vancomycin- bactericidia
bacitracin
polymyxins
tricoplanin- bacteriacidial |
|
|
Term
|
Definition
| binds to D-ala-D-ala terminal stopping protein elongation inhibitng cell wall synthesis |
|
|
Term
| vancomycin resistance (3) |
|
Definition
VRSA, VREnterococcus
change binding site to D-ala-D-lactate |
|
|
Term
| how is vancomycin administered |
|
Definition
IV
oral for GI infection (not absorbed. C. diff) |
|
|
Term
|
Definition
| kidney, adjust for failre |
|
|
Term
| vancomycin side effects (4) |
|
Definition
| fever, chills, phlebitis, red man syndrome |
|
|
Term
| what is the cause of red man syndrome, what is the solution |
|
Definition
if IV infusion is too wuick, histamine flushes face via macrophages causing hypotension
infuse of 1h |
|
|
Term
| baitracin: administration, for what microbes, how to use |
|
Definition
topical
for gram positive bacteria
use with neomycin and polymyxins |
|
|
Term
| polymyxins: administration, for what microbes, how to use |
|
Definition
topical
for gram negativebacteria
use with neomycin and polymyxins |
|
|
Term
| trichoplanin: what drug is this like, what does it kill (2) |
|
Definition
| simillar to vancomycin, kills gram positive and MRSA |
|
|
Term
| what is penicillin G combined with (5) and why, when combined like this how is it administered, what is this combination good at treating |
|
Definition
depot forms: procaine or benzathine to increase duration and increase stability
Na or K to increase stability
given IV to treat syphillis |
|
|
Term
| what is the benifit of a penicillin V over G, how is it administered |
|
Definition
oral
more resistant to gastric A |
|
|
Term
| what is the most often used anti-staph drug, why, how is it administered |
|
Definition
| naficillin, it has lower nephrotoxicity, IV |
|
|
Term
| what penicillins are not excreted by the kidney |
|
Definition
| all 4 anti-staph penicillins, do not need to be adjusted in renal failure |
|
|
Term
| what penicllins are only oral (3) |
|
Definition
| penicillin V, amoxicillin, amoxicillin/clavuonic A |
|
|
Term
| what penicillins reach the meninges well |
|
Definition
|
|
Term
| how are aminopenicillins administered |
|
Definition
orally
IV/IM for ampicillin/B-lactaminase inhibitor |
|
|
Term
| what is the most absorbed penicillins, why is this good and bad |
|
Definition
amoxicillin
good because it gets into the body well
bad because it has no effect on gut infections unlike all the other penicillins |
|
|
Term
| what penicillins are only IV/IM (4) |
|
Definition
| antipseudomonals, ampicillin/sublactam, ticaricillin/clauvonic acid, piperacillin/tazobactam |
|
|
Term
| what penicillins are oral, IV, and IM (2) |
|
Definition
ampicillin
anti-staph penicillins |
|
|
Term
| what do aminopenicillins need to wrk |
|
Definition
|
|
Term
| which cephalosporins are not metabolized in the kidney, where is it excreted |
|
Definition
| ceftriaxone, excreted into bile. use for renal disease |
|
|
Term
| which cephalosporins are not IV/IM, they are oral (3) |
|
Definition
| cephalexin, cefaclor, cefuroxime |
|
|
Term
| which cephalosporins penetrate the CNS (6) |
|
Definition
cefuroxime - not as good
ceftaxime, ceftaxidime, fectriaxone, cefperazone
cefepime |
|
|
Term
| which cephalosporins are good for surgical prophylaxis |
|
Definition
|
|
Term
| which cephalospirins are good for skin, UTI, respiratory infections, otitis media |
|
Definition
|
|
Term
| which cephalosporins work for anaerobes |
|
Definition
|
|
Term
| what are the side effects of 2nd gen cephalosporins (2) |
|
Definition
cefmandole: disulfiram (acetylaldehyde accumulation) and anti vitamin K (bleeding)
the rest: same as penicillins |
|
|
Term
| which cephalosporins are used for biliary tract infections |
|
Definition
|
|
Term
| what are 5th generation cephalosporins used for (5) |
|
Definition
acute bacterial and skin structure infections (ABSSI)
community acquired bacterial pneumonia (CABP)
MRSA, enterococci, listeria |
|
|
Term
| what does imipenem have to be combined with to work, why |
|
Definition
| cilastatin (dihydropeptidase inhibitor) to protect from nephrotixic metabolites forming |
|
|
Term
| what is the broadest spectrum B-lactam of the amm |
|
Definition
|
|
Term
| what is used for surgery prophylaxis in a MRSA high area |
|
Definition
| non b-lactam cell wall drugs (vancomycin) |
|
|
Term
| what is used for endocarditis prophylaxis |
|
Definition
| non b-lactam cell wall drugs (vancomycin) |
|
|
Term
| what are anti-staph penicillins used for |
|
Definition
|
|
Term
| what are natural penicillins used for |
|
Definition
| gram positive cocci - strep, enterococcus (but use amino penicillin first), staph (but use anti-staph first), syphillis (pen G). AEROBIC |
|
|
Term
| what are amino penicillins used for |
|
Definition
| strep, enterococci, listeria (ampicillin). AEROBIC |
|
|
Term
| what are anti-pseudomonal penicillins used for |
|
Definition
| MUST be used for pseudomonas, can be used fo all gram negative that are AEROBIC |
|
|
Term
| which penicillins can be used as "broad spectrum" why. how do you determine which one do use |
|
Definition
enough gram negative coverage.
if it is an unknown gram negative use anti-pseudomonas. if it is known to not be pesudomonas than use amino penicillin |
|
|
Term
| explain the general trend of gram negative and positive coverage in penicillins |
|
Definition
| better gram positive - antistaph, natural, amino, antipseudomonas - better gram negative |
|
|
Term
| what is the best penicillin for strep |
|
Definition
|
|
Term
| what is another name for syphillis, what is the best drug for it |
|
Definition
| treponema, benzathine pen G |
|
|
Term
| what penicillin kills lysteria |
|
Definition
|
|
Term
| what are the general trands of the cephalosporins for their clinical actions |
|
Definition
become more broad from 1 to 4 because they increase in gram negative coverage
none kill listeria, enterococci, or MRSA (5th gen kills MRSA) |
|
|
Term
| what cephalosporins killa anaerobic |
|
Definition
| second generation kills bacteroides and clostridium (not diff) |
|
|
Term
| what do 1st gen cephalosporins kill(6) |
|
Definition
staph, strep, E. coli, klebsiella, proteus
best gram positive coverage of the cephalosporiins |
|
|
Term
| what do 2nd gen cephalosporins kill (4) |
|
Definition
| clostridium not diff, bacteroides, everything 1st gen killed, more gram negatitive than 1st gen |
|
|
Term
| what does 3rd and 4th gen cephalosporins kill (7) |
|
Definition
all CNS infections but listeria
more gran negative rods and cocci than 1st and 2nd gen without anaerobic (enteric, pseudomonas, gonorrhea)
3rd does meningitis biliary tract infections
everything 1st gen killed |
|
|
Term
| what drug combo is preferred for an unknown CNS infection |
|
Definition
| ampicillin (to cover listeria) + 3rd gen cephalosporin to cover everything else |
|
|
Term
| what is the back up drug for listeria |
|
Definition
|
|
Term
| carbapenem clinical use (6), what are they not good at (2) |
|
Definition
emperic therapy: b lactaminase resistant, gram positive or negative, klebsiella pneumonia, anaerobes, pseudomonas
not good at enterococci, MRSA |
|
|
Term
| monobactams clinical use (3), what are they not good at (2) |
|
Definition
aerobic gram negative rods including enterics and pseudomonas
not good at gram positive, anaerobes |
|
|
Term
| what is the clinical use of vancomycin (7) |
|
Definition
| MRSA!!, SERIOUS gram positive infections when allergic to b-lactam, C. diff!! that didnt respond to metronidazole, surgical prophylaxis in MRSA high area, gram positive, arobic, anaerobic |
|
|
Term
| what are the two tetracyclins and one honorary (and its category) |
|
Definition
tetracyclin, doxycyclin
tigecyclin - glycyclin antibiotic |
|
|
Term
| what are the 5 aminoglycosides |
|
Definition
streptomycin
amikacin
gentamycin
tobramycin
neomycin |
|
|
Term
| what are the three macrolides and one honorary (and its category) |
|
Definition
azithromycin
erythromycin
clathromycin
trlithromycin - ketolide antibiotic |
|
|
Term
| what are the other 50S antibiotics (4) |
|
Definition
chloramphemicol
clindamycin
streptogramin
linezolid |
|
|
Term
| what protein inhibitors target the 50S subunit |
|
Definition
| macrolides and other 50S category |
|
|
Term
| what protein inhibitors target the 30S subunit |
|
Definition
| tetracyclins and aminoglycosides |
|
|
Term
| which tetracyclin is the drug of choice, why |
|
Definition
| doxycyclin- wider spectrum |
|
|
Term
| which protein inhibitors are bacteriocidial and which are bacteriostatic |
|
Definition
bacteriocidial: aminoglycocides
bacteriostatic; tetracyclins, macrolides, other 50S |
|
|
Term
| what is the main reason to use amikacin |
|
Definition
| stable against R plasmid resistance that occurs in gentamycin and tobramycin |
|
|
Term
| what is the most commonly used aminoglycocide, why |
|
Definition
| gentamycin- cheap, effective |
|
|
Term
| what is tobramycin used for |
|
Definition
|
|
Term
| what is neomycin used for |
|
Definition
|
|
Term
| which macrolides kill MAC |
|
Definition
| azithromycin, clathromycin |
|
|
Term
| how are macrolides absorbed |
|
Definition
azithromycin and clathromycin are absorbed well reducing GI upset
erythromycin is destoried by the GI tract and needs to be enteric coated |
|
|
Term
| what durgs penetrate prostatic fluid |
|
Definition
|
|
Term
| other than antibiotic, what is another use for erythromycin |
|
Definition
|
|
Term
| which protein inhibitors are ok to use in pregnacy |
|
Definition
|
|
Term
| which protein inhibitors are P450 inhibitors (3) |
|
Definition
| erythromycin, clathromycin, streptogramins |
|
|
Term
| what is streptogramin composed of |
|
Definition
30% quinuprostin
70% dalfopristin |
|
|
Term
| what are the three steps in protein production |
|
Definition
growtin chain goes to acceptor site to get new AA molecule (via peptidly transferase)
uncharged tRNA moves to donor site to make space for charged tRNA
charged tRNA comes to acceptor site |
|
|
Term
| which drugs stop peptidyl transferase, what does this stop from happening |
|
Definition
chloramphenicol
growing chain cannot get to the acceptor site to get a new AA |
|
|
Term
| which drugs stop tRNA from moving from acceptor site to donor site, what does this stop from happening |
|
Definition
macrlides, telithromycin, clindamclin, streptogramin
new charged tRNA cant get onto the acceptor site to provide more AA to the chain |
|
|
Term
| what drugs stop tRNA travel to the acceptor site |
|
Definition
|
|
Term
| what is the MOA of tetracyclins |
|
Definition
| bind 30S and block amino acyl (t)RNA binding |
|
|
Term
| what causes resistance in tetracyclins |
|
Definition
natural R factor makes it so Mg dependent TetA pumps turn on effluxing the drug from the cell
resistance to one = resistance to all |
|
|
Term
|
Definition
same as tetracycline except 5x more affinity for 30S
affects ribosomal protection proteins |
|
|
Term
| what causes resistance to tigecycline |
|
Definition
| minimal - no TegA concerns |
|
|
Term
| how does aminoglycides get into the cell (3) |
|
Definition
passive diffusion through the cell wall, O2 dependent transport through the cell membrane
helped by synergism with penicillin, ampicillin, or vancomycin to break the wall |
|
|
Term
| what are the 4 MOA of aminoglycocides |
|
Definition
interfere with initiation complex of peptide formation on 30S
induce misreading or mRnA making toxic or non functional AA
break polysomes into monomeres
post antibiotic effect |
|
|
Term
| what is the post-antibiotic effect |
|
Definition
| continue to supress growth at sub-inhibitory concentrations because it takes time for bacteria to make new ribosomes |
|
|
Term
| what is the MOA of macrolides |
|
Definition
stops amino acyl(tRNA) translocation
uncharged tRNA cannot move from acceptor to donor site to allow new charged rRNA in |
|
|
Term
| what are 4 ways to get resistance to macrolides |
|
Definition
decrease uptake of drug by microbe
binding site on 50S is methlyated
bacteria make esterase and cleave the macrolide
if there is penicillin resistance there is a 50% chance of macrolide resistance |
|
|
Term
| what do you use if a microbe is macrolide resistant because it is penicillin resistant |
|
Definition
|
|
Term
| what is the MOA of telithromycin |
|
Definition
| same as macrolides but bind to 50S 10x stronger |
|
|
Term
| how can a microbe become resistant to relithromycin |
|
Definition
| less of an issue - methylation of the 50S binding site isnt a problem |
|
|
Term
| why dont protein synthesis drugs stop out ribosomes |
|
Definition
| ours are different from bacterial, out mitochondrial ribosomes are like theirs but they are all safe and hidden |
|
|
Term
| what is the OA of chloramphenicol (2) |
|
Definition
inhibits peptidyl transferase
bacteriostatic |
|
|
Term
| what is the MOA of clindamycin |
|
Definition
| inhibits amino acyl transfer (tRNA) transfer |
|
|
Term
| what is the MOA of streptograims |
|
Definition
|
|
Term
| what are two contraindications to tetracyclines, why |
|
Definition
antacids and dairy: Ca, Mg, and Al chelate with the drug and form a non-absorbable product
less of an issue with doxycycline |
|
|
Term
| where do tetracyclines distribute to in the body (5) |
|
Definition
| liver, spleen, skin, CSF (not well), placenta |
|
|
Term
| what do tetracyclines bind in the body (not the GI) (4) |
|
Definition
| calcification (bone, teeth, tumors, gastric carcinomas) |
|
|
Term
| why cant you take tetracycline if you're pregnant |
|
Definition
| it accumulates in fetal bones and teeth |
|
|
Term
| how are tetracyclines eliminated |
|
Definition
release into bile, reabsorbed into intestines, release into glomerular filtrate
docycycline is not reabsorbed and is released in feces |
|
|
Term
| what are side effects of tetracyclines (4) |
|
Definition
discoloration of bone
discoloration of teeth
phototoxicity
stunts growth via hypoplasia of calcified tissue |
|
|
Term
| what type of antibiotic is tigecycline, how is it administered |
|
Definition
|
|
Term
| what are the side effects of tigecycline (2) |
|
Definition
| discolors teeth, teratogenic |
|
|
Term
| how does resistance develop to tigecycline |
|
Definition
| minimal, no TegA exporter issues |
|
|
Term
| how does tigecycline work (2) |
|
Definition
same as tetracycline except binds with 5x more affinity to 30S
affects ribosomal protection proteins |
|
|
Term
| how are aminoglycosides given, why |
|
Definition
| IV/IM because they are poorly absorbed |
|
|
Term
| how are amino glycosides metabolized and excreted |
|
Definition
not metabolized
excreted in urine |
|
|
Term
| where do aminoglycosides distribute to |
|
Definition
no CNS
dosent enter cells well because its polar
concentrate in renal cortex causing nephrotoxicity |
|
|
Term
| what are aminoglycosides synergistic with (3), why |
|
Definition
penicillin, vancomycin, ampicillin
the helper breaks through the cell wall and then the aminoglycosidestops protein synthesis |
|
|
Term
| what bugs does aminoglycosides use synergy with a cell wall drug to kill (4) |
|
Definition
| strep, enterococcus, endocarditis, listeria |
|
|
Term
| what are the three categories of side effects for aminoglycosides |
|
Definition
nephrotoxicity
ototoxicity
neuromuscular paralysis |
|
|
Term
| how can you tell if someone is getting nephrotoxicity from an aminoglycocide (2), why does this happen, what percautions are taken |
|
Definition
accumulates in cortex of nephron
disrupts ca transport
tubular necrosis
monitor plasma level if getting for >5d |
|
|
Term
| what are 5 signs of ototoxicity when on amino glycocides, what percautions are taken |
|
Definition
tinnitis, high frequency hearing loss, vertigo, ataxia, decreased balance
monitor plasma levels if taking for >5d |
|
|
Term
| why do you get neuromuscular paralysis on aminoglycocides, how does it happen, what is a concerning side effect of this |
|
Definition
occurs at high doses
blocks ACh receptors
can cause respiratory paralysis |
|
|
Term
| what is the antidote to neuromuscular paralysis on aminoglycocides (2) |
|
Definition
| cholinesterase inhibitor or Ca gluconate |
|
|
Term
| what two drugs interact with aminoglycocides, what is the outcome of each |
|
Definition
loop duruetics increase ototoxicity
cancer drugs increase nephrotoxicity |
|
|
Term
| where do macrolides distribute |
|
Definition
|
|
Term
| where are macrolides excreted |
|
Definition
| kidney but dont need to adjust in renal failure except for clathromycin which needs to be adjusted in severe renal failure |
|
|
Term
| which macrolides are teratogenic |
|
Definition
|
|
Term
| which macrolide is enteric coated, why. what are the others like |
|
Definition
| erythromycin is enteric coated because it is destoried by gastric acid. the others are stable and absorbed well. they decrease GI upset |
|
|
Term
| what drug pepentrates prostatic fluid |
|
Definition
|
|
Term
| explain the metabolism of the three macrolides |
|
Definition
erythromycin: metabolized a lot
azithromycin: not metabolized
clathromycin: metabolized to become active |
|
|
Term
| which macrolides are P450 inhibitors, what drugs do they mess up (3) |
|
Definition
erythromycin and clathromycin
theophyline and warfarin
they also kill the bacterial that inactivate digxin so sort of inhibiting for them too |
|
|
Term
| from lest to most, what is the p450 inhibition rank of the macrolides |
|
Definition
| azithromycin, clathromycin, erythromycin |
|
|
Term
| thlithromycin: type of antibiotic, MOA, resistance, administration |
|
Definition
ketolide antibiotic
MOA the same as macrolides but binds 10X stronger
less resistance - no methlyation issue
oral administration |
|
|
Term
| telithromycin: side effects (5) |
|
Definition
nausea, diarrhea, vomiting
headache, dizzy |
|
|
Term
| chloramphenicol: side effects (3) |
|
Definition
| anemia, marrow toxicity, gray baby (cannot glucorinate) |
|
|
Term
| why is chloramphenicol a bad cjoice |
|
Definition
| toxic, resistance, rare in pharmacy |
|
|
Term
| clindamycin: administration, metabolism, side effects (3) |
|
Definition
oral
cleared in liver
C. diff, fever, cramps |
|
|
Term
| what is the number one medicine that causes C. diff |
|
Definition
|
|
Term
|
Definition
|
|
Term
| streptogrraims: adeministration, side effects (2) |
|
Definition
IV
P450 inhibitor
phlebitis at injection site 10% |
|
|
Term
| inlesolid: administration (2), side effects (2) |
|
Definition
oral, IV
GI upset
tongue discoloration |
|
|
Term
| on a broad level, what do tetracyclines work on (3) |
|
Definition
gram negative and positive
atypicals |
|
|
Term
| what 4 conditions are tetracyclines the drug of choice for |
|
Definition
chlamydia
rickettsia- rocky mt. spotted fever
vrucella- lyme
coxiella- intracellular |
|
|
Term
| what 4 microbes are tetracyclines not the drug of choice for but its pretty good at it |
|
Definition
syphilis- alternative
acne
anthryx
vibro-cholerae |
|
|
Term
| on a broad level, what do tigecyclines work on (3) |
|
Definition
gram negative and positive
anaerobes: bacteroides, C non diff |
|
|
Term
| what specific microbes or types of infections is tigecycline good at (6) |
|
Definition
bacteroides, C non diff
MRSA, VREF
complicated skin infection
intra-abdominal infection |
|
|
Term
| on a broad level what do aminoglycosides work on (3) |
|
Definition
| aerobic gram negative rods |
|
|
Term
| what 3 specific microbes do aminoglycosides work on |
|
Definition
pseudomonas
mycobacterium (streptomycin)
moraxella |
|
|
Term
| on a general level, what does telithromycin kill (2) |
|
Definition
|
|
Term
| what 4 microbes does telithromycin kill |
|
Definition
| moraxella, chalmydia, mycoplasma, legionella |
|
|
Term
| on a general level, what do macrolides kill (4) |
|
Definition
| gram positive and negative rods and cocci |
|
|
Term
| what 5 microbes are important that marolides kill |
|
Definition
| hemophalus, legionella, chladymia pneumonia and STI, MAC |
|
|
Term
| what is an alternative to B-lactams in a non life threatening and life threatening infection |
|
Definition
non: macrolides
life threat: vancomycin |
|
|
Term
| what are the atypical bacteria that macrolides kills (4) |
|
Definition
mycoplasma pneumonia
legionella pneumonia |
|
|
Term
| what are 2 every day infections that macrolides kill |
|
Definition
|
|
Term
| what are 5 other microbes macrolides kill |
|
Definition
MRSI
listeria
clostridium
meningitidis
moraxella |
|
|
Term
| what is chloramphenicol an alternative to |
|
Definition
|
|
Term
| what does chloramphenicol kill (2) |
|
Definition
broad spectrum
rickettsia: typhys, rocky mt fever (when tetracycline resistant) |
|
|
Term
| what does clindamycin kill (5) |
|
Definition
bacteroides, actinomyces
CA-MRSA
strep, staph |
|
|
Term
| when do yo use streptograims (4) |
|
Definition
life threatening vancomycin resistant VREF, VRSA, MSSA
gram positive cocci |
|
|
Term
| what is streptograims not good at (4) |
|
Definition
| gonorrhea,legionella, C not diff |
|
|
Term
| what does linesolid kill (4) |
|
Definition
| c not diff, MRSA, VREF, VRSA, nosocomal pneumonia |
|
|
Term
| what is linesolid not good at |
|
Definition
|
|
