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Pharm Block 10
KYCOM Block 10
315
Pharmacology
Graduate
09/22/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
3 gram positive cocci
Definition
strep, staph, entero
Term
2 gram positive rods
Definition
listeria, bolstridium
Term
2 gram negative cocci
Definition
nisseria, moraxella
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
2 filemantous microbes
Definition
mycobacteria actinomyces
Term
3 anaerobes
Definition
actinomyces, bacteroides, blostridium
Term
2 microbes without cell wall
Definition
mycoplasma, ureaplasma
Term
2 obligigate intracellular parasite bacteria
Definition
chlymadia, rickettsia
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
what is MIC
Definition
minimum inhibitory concentration

lowest concentration of antibiotic that inhibits bacterial growth after 24 hours on a specific medium
Term
what is MBC
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
what is tolerance
Definition
microbe is tolerante to the antibiotic when it needs 32x more than the MIC to be killed
Term
define bacteriostatic
Definition
only kills in suprapharamacological doses
inhibits microbe growth
Term
define batericidial
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
oral: easy safe, cheap
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
protein binding
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
arthropathy
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
define synergy
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
TB, HIV
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
how do humans get folate
Definition
diet
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
parasites
Term
what does dapsone treat
Definition
leprosy
Term
what does methotrexate treat (2)
Definition
RA, cancer
Term
what are the 3 DNA antibiotics
Definition
metronidazole
daptomycin
floroquinolones
Term
what is a UTI antiseptic
Definition
nitrofurantoin
Term
what is a gout medicine
Definition
probenecid
Term
what are the 1st gen floroquinolones
Definition
nalidixic acid
Term
what are the 2st gen floroquinolones (2)
Definition
ciproflaxin
oloaxacin
Term
what are the 3st gen floroquinolones (2)
Definition
levoflaxcin
moxifloxacin
Term
what are the 4st gen floroquinolones
Definition
gemifloxacin
Term
is sulfonamide bacteriostatic or cidial
Definition
bacteriostatic
Term
is metronidazole bacteriostatic or cidial
Definition
bacteriocidial
Term
is nitrofurantoin bacteriostatic or cidial
Definition
bacteriocidial
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
oral
IV- for PJ pneumonia
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
listeria
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
oral
Term
how is metronidazole metabolized
Definition
p450 glycornidation
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
daptomycin MOA
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
oral or IV
Term
where do flouroquinolones distribute to (6)
Definition
tissue, bone, urine, kidney, prostate, lung
Term
where are foluroquinolones excreted
Definition
kidney
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
gram negatives
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
use foluroquinolones
Term
what random microbes can all foluroquinolones kill that are not atypical (6)
Definition
listeria
strep pneumonia
neisseria
moraxella
chylamydia
MSSA
Term
who gets UTIs (6)
Definition
boys <6yo without circumcision
girls 1-5yo, teens, puberty, and sexually active women
eldery
Term
what causes UTI (5)
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
you dont
Term
how is nitrofurantoin administered
Definition
oral
Term
is nitrofurantoin teratogenic
Definition
no
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
benzathine penicillin G
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
piperacillin
ticaricillin
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
no
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
cefazolin
cephalexin
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
cefepime
Term
what 2 drug is a 5th generation cephalosporin
Definition
cefaroline
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
iv
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
azerotonam - resistant
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
phelbitis and skin rash
Term
how are monobactams administered
Definition
IV or IM
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
vancomycin MOA
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
vancomycin excretion
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
ampicillin
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
amino-glycosides
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
1st gen
Term
which cephalospirins are good for skin, UTI, respiratory infections, otitis media
Definition
1st gen, 2nd gen
Term
which cephalosporins work for anaerobes
Definition
gen 3 and 4
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
3rd gen
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
imipenem
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
staph (MSSA). AEROBIC
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
natural
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
ampicillin
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
TMP-SMX
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
topical for the eye
Term
what is neomycin used for
Definition
topical for the skin
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
erythromycin
Term
other than antibiotic, what is another use for erythromycin
Definition
increase GI motility
Term
which protein inhibitors are ok to use in pregnacy
Definition
azithromycin
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
tetracyclin, tigecycliin
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
tigecycline MOA (2)
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
use flouroquinolones
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
simillar to macrolides
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
glycycline
IV
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
distribute well, no CNS
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
all but azithromycin
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
erythromycin
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
clindamycin
Term
how is C. diff treated
Definition
metronidazole
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
gram positive cocci
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
influenza
otitis media
Term
what are 5 other microbes macrolides kill
Definition
MRSI
listeria
clostridium
meningitidis
moraxella
Term
what is chloramphenicol an alternative to
Definition
tetracycline
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
gram negative
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