Term
| When are carbapenems indicated? |
|
Definition
-serious polymicrobial and nosocomial infections due to highly resistant bacteria
-imipinem and meropenem (but not ertapenem) also have activity against pseudomonas |
|
|
Term
| What are 4 down sides of carbapenems? |
|
Definition
-can be neurotoxic at higher doses (seizures)
-greater chance of superinfections
-high cost
-cross sensitivity in penillin-allergic pts |
|
|
Term
Which of the following is bacitracin active against:
gram + bacteria
gram - bacteria
anaerobic bacteria |
|
Definition
| active against gram + bacteria only |
|
|
Term
| What is a side affect if bacitracin is given systemically? |
|
Definition
| highly nephrotoxic if given systemically |
|
|
Term
| How is bacitracin administered? |
|
Definition
used in topical preparations
one of the ingredients in triple antibiotic ointment (also includes neomycin and polymyxin)
highly nephrotoxic if given systemically
poorly absorbed if given orally |
|
|
Term
| When is bacitracin administered? |
|
Definition
| only used in topical preparations to tx skin infections due to strep and staph |
|
|
Term
| What medication is a unique cyclic lipopeptide active against g+ bacteria? |
|
Definition
|
|
Term
| How is Daptomycin administered? |
|
Definition
|
|
Term
| When is daptomycin indicated? |
|
Definition
| old drug making comeback for tx vancomycin-resistant bacteria |
|
|
Term
What is the method of action of the following medications:
-bacitracin
-daptomycin (cubicin)
-vancomycin |
|
Definition
| inhibitors of cell wall synthesis |
|
|
Term
| What medication is a glycopeptide with a high molecular weight? |
|
Definition
|
|
Term
| What is the method of action of vancomycin? |
|
Definition
| inhibits cell wall synthesis by blocking elongation of peptoglycan molecule |
|
|
Term
Which of the following are susceptible to vancomycin:
gram+
gram- |
|
Definition
-bactericidal against most gram+ including those resistant to β-lactam Abiotics
-no activity against gram- bacteria |
|
|
Term
| Is vancomycin bactericidal or bacteriostatic? |
|
Definition
| bactericidal against most g+ bacteria including those resistant to β-lactam Abiotics |
|
|
Term
| What bacteria are resistant to vancomycin and what concern involves this resistance? |
|
Definition
some enterococci have become resistant and are known as vancomycin-resistant enterococci or VRE
-Big worry that this mutant gene will be transferred to staph |
|
|
Term
| How is vancomycin usually administered? |
|
Definition
-usually given IV
-not absorbed orally
-oral vancomycin remains in GI tract and only used to tx C. dif colitis |
|
|
Term
| ***How is vancomycin eliminated? |
|
Definition
| -eliminated by kidney in direct proportion to creatinine clearance |
|
|
Term
| Why must peak and trough levels be monitored in vancomycin tx? |
|
Definition
| narrow TI- must monitor peak and trough levels |
|
|
Term
| ***What are 2 important adverse rxns associated w/vancomycin? |
|
Definition
| 1. Red man syndrome: infusion rxn due to massive histamine release if given too fast or in too high a dose (tx w/antihistamines) 2. Ototoxicity at higher doses |
|
|
Term
| How do the following classes of drugs act against bacteria? -macrolides -ketolides -tetracyclines -aminoglycosides -misc: -clindamycin -quinupristin-dalfopristin -linezolid -mupirocin |
|
Definition
| inhibitors of bacterial protein synthesis |
|
|
Term
| ***When is vancomycin indicated? |
|
Definition
-reserved for known or suspected infections due to MRSA
-also used in combination w/aminoglycoside for enterococcus infections
-oral vancomycin only used to tx pseudomembranous colitis secondary to C.dif (colitis caused by bacterial toxin) |
|
|
Term
| What are 3 macrolides and how do they act against bacteria? |
|
Definition
-erythromycin
-clarithromycin
-azithromycin
inhibitor of bacterial protein synthesis |
|
|
Term
| What is a ketolide and how does it act against bacteria? |
|
Definition
| telithromycin (ketek): inhibitor of bacterial protein synthesis |
|
|
Term
| What are some tetracycline medications and how do they act against bacteria? |
|
Definition
-tetracycline
-doxycycline
[also minocycline and tigecycline (tygacil)]
inhibitors of protein synthesis |
|
|
Term
| What are 5 aminoglycosides and how do they act against bacteria? |
|
Definition
-gentamycin
-tobramycin
-amikacin
-streptomycin
-neomycin
inhibitors of bacterial protein synthesis |
|
|
Term
| ***What are 4 misc inhibitors of bacterial protein synthesis? |
|
Definition
| -clindamycin -quinupristin-dalfopristin -linezolid -mupirocin |
|
|
Term
| What is the method of action of macrolide antibiotics? |
|
Definition
| reversibly bind to 50s ribosomal subunit |
|
|
Term
| Do macrolide antibiotics act via bacteriostatic or bactericidal mechanisms? |
|
Definition
| usually bacteriostatic effect |
|
|
Term
| ***When are macrolide Abiotics indicated? |
|
Definition
1. Strep and staph
-resistance gradually increasing
2. some activity against h. influenzae and bordetella
3. Activity against atypical bacteria (mycoplasm, legionella, chlamydophyla) that cause atypcial pneumonia
4. for upper and lower respiratory infections potentially due to atypical bacteria
-azithromycin used extensively in hospitals for pneumonia
5. for penicillin-allergic pts
6. For Chalmydia trachomatis STD infections
7. Clarithromycin for Mycobacterium Avian Complex (MAC) |
|
|
Term
| How is erythromycin administered? |
|
Definition
-IV form rarely used anymore
-orally available as base, stearate, estolate, and ethylsuccinated salts |
|
|
Term
| How frequently must erythromycin be administered? |
|
Definition
|
|
Term
| ***What are some adverse effects of erythromycin? |
|
Definition
-oral form has dose-dependent effect on intestinal peristalsis causing ab pain and diarrhea
-high doses can cause ototoxicity |
|
|
Term
| What are some drug interactions involved with erythromycin and clarithromycin? |
|
Definition
clarithromycin has the same drug interactions as erythromycin!
1. inhibits CYP 450 3A4 enzyme reponsible for metabolizing 50% of drugs
2. will increase serum levels of
statins,
bezodiazepines,
Ca2+ channel blockers,
cyclosporine, and many more |
|
|
Term
| Which is absorbed better: Clarithromycin (biaxin) or erythromycin? |
|
Definition
Clarithromycin (biaxin)- now generic
-very similar to erythromycin but better absorbed
-higher serum levels and lower GI levels
-less GI adverse effects |
|
|
Term
| How is clarithromycin administered, and how frequently is it administered? |
|
Definition
not available as IV
can be given bid |
|
|
Term
| What is the most popular and the safest macrolide Abiotic? |
|
Definition
|
|
Term
| How is Azithromycin (Zithromax) administered? |
|
Definition
|
|
Term
What is the T1/2 of Azithromycin (Zithromax)?
How frequently is it administered?
For how long must it be administered? |
|
Definition
has T1/2 of 60 hrs,
requires loading dose and once daily dosing (Z-pack)
only have to give for 3 to 5 days |
|
|
Term
| What are the adverse reactions of Azithromycin? |
|
Definition
|
|
Term
| What are the drug interactions of Azithromycin (Zithromax)? |
|
Definition
|
|
Term
| What non-macrolide Abiotic is very similar in structure and function to erythromycin? |
|
Definition
| Telithromycin (Ketek), a Ketolide Abiotic |
|
|
Term
| Which has a higher affinity for the 50s ribosomal subunit: erythromycin or telithromycin? |
|
Definition
|
|
Term
| ***Describe the activity of Telithromycin (Ketek). |
|
Definition
| Same activity as macrolides but has activity against penicillin and macrolide-resistant Strep pneumonia |
|
|
Term
| ***Describe the adverse rxns and drug interactions of Telithromycin (Ketek). |
|
Definition
same adverse rxns and drug interactions as erythromycin:
-oral form has dose-dependent effect on intestinal peristalsis causing ab pain and diarrhea
-higher doses cause otoxicity
-inhibits CYP 450 3A4 enzyme responsible for metabolizing 50% of drugs
-will increase serum levels of statins, benzodiazepines, Ca2+ channel blockers, cyclosporines, and many more
ALSO, recent concern regarding cases of hepatotoxicity and whether safety studies were properly performed |
|
|
Term
| What drug was involved in fabrication of study results by Dr. Maria "Anne" Kirkman Campbell? |
|
Definition
|
|
Term
| What is the method of action of tetracyclines? |
|
Definition
| reversibly bind to the 30s ribosomal subunit of bacteria |
|
|
Term
| Do tetracyclines act via a bactericidal or bacteriostatic mechanism? |
|
Definition
| usually bacteriostatic effect |
|
|
Term
| When are tetracyclines indicated? |
|
Definition
-active against rickettsiae, chlamydiae, mycoplasma, and some protozoa
-lyme disease (tick-borne)
-erichiosis (tick-borne)
-rocky mt spotted fever (tick-borne)
-atypical pneumonia
-pid
-tetracycline and monocycline for acne |
|
|
Term
| ***What are 4 important adverse rxns of tetracyclines? |
|
Definition
-GI irritation
-Photosensitivity rxns
-Discoloration of tooth enamel in children and fetus -Hepatotoxicity possible w/extended use |
|
|
Term
| What is an important drug interaction with tetracyclines? |
|
Definition
-cations such as ca2+ will bind to tetracyclines and prevent absorption
-avoid giving dairy products or antacids |
|
|
Term
| ***Which drug from the tetracycline class is rarely used now and why is this? |
|
Definition
| tetracyline is rarely used now b/c of lower bioavailability and short T1/2- have to give qid |
|
|
Term
| Which medication is the most popular tetracycline? |
|
Definition
|
|
Term
| How is doxycycline administered? |
|
Definition
| give both IV and oral (good bioequivalence) |
|
|
Term
| ***What is the T1/2 of doxycycline? How frequently must it be administered? |
|
Definition
| long T1/2 and can be given qd or bid depending on infection |
|
|
Term
| Minocycline is popular for what disease? |
|
Definition
| popular for acne due to high distribution to skin |
|
|
Term
| How expensive is minocycline? |
|
Definition
|
|
Term
| What is a new tetracycline that was derived from minocycline and approved in 2005? |
|
Definition
|
|
Term
| How is tigecycline (tygacil) administered? |
|
Definition
|
|
Term
What drug is not affected by the 2 major mechanisms of tetracycline resistance?
Is this medication bactericidal or bacteriostatic? |
|
Definition
Tigecycline (Tygacil)
- but still only bacteriostatic activity |
|
|
Term
| Is Tigecycline (Tygacil) active against g+, g- or anaerobic bacteria? |
|
Definition
| Active against g+ including MRSA, g-, and anaerobic bacteria |
|
|
Term
| Tigecycline (Tygacil) is inactive against what 2 bacterial spp? |
|
Definition
|
|
Term
| ***When is Tigecycline (Tygacil) indicated? |
|
Definition
g+ (including MRSA), g-, anaerobic
not active against pseudomonas or proteus spp
reserve for Abiotic-resistant infections |
|
|
Term
| What is the MOA of Aminoglycoside Abiotics? |
|
Definition
| bind irreversibly to 30s ribosomal subunit of bacteria |
|
|
Term
| Do Aminoglycoside Abiotics act via bactericidal or bacteriostatic mechanisms? |
|
Definition
|
|
Term
***When are Aminoglycoside Abiotics indicated?
|
|
Definition
g-, including pseudomonas
strep are resistant to agents when used alone
synergistic activity when combined w/β-lactam Abiotics
bacteremia, pneumonia, intra-ab infections, and other serious infections due to g- bacteria |
|
|
Term
| How are aminoglycoside Abiotics administered? |
|
Definition
| only available for IV or IM use- unable to be absorbed orally |
|
|
Term
| What is the T1/2 of Aminoglycoside Abiotics? |
|
Definition
|
|
Term
| How frequently are aminoglycoside Abiotics administered? |
|
Definition
give high dose qd due to concentration-dependent effect on bacterial killing
monitor peak and trough levels due to narrow therapeutic index |
|
|
Term
| How are aminoglycoside Abiotics eliminated? |
|
Definition
eliminated renally and accumulate in renal failure
monitor peak and trough levels due to narrow TI |
|
|
Term
| Does clindamycin act via bactericidal or bacteriostatic mechanisms? |
|
Definition
|
|
Term
| What are 2 drugs with a narrow TI? |
|
Definition
| Vancomycin, Aminoglycoside Abiotics |
|
|
Term
| ***What are some adverse rxns of Aminoglycoside Abiotics? |
|
Definition
very nephrotoxic- can accumulate in renal tubules and cause acute renal failure
also ototoxic at high doses for extended periods of time
|
|
|
Term
| What are the 3 most common aminoglycoside Abiotics? |
|
Definition
gentamicin
tobramcin
amikacin |
|
|
Term
| When is tobramycin indicated? |
|
Definition
most active fro Pseudomoas aeruginosa
also available as inhaled form for cystic fibrosis pts w/pseudomonas pneumonia |
|
|
Term
| How is neomycin administered? |
|
Definition
most toxic and never administered IV
used in topical formulas in combination w/other Abiotics
oral form sometimes used for prophylaxis before elective bowel surgery |
|
|
Term
What was the first aminoglycoside?
When is it indicated?
How is it administered? |
|
Definition
| Streptomycin used IV or IM as 2nd line therapy for active TB |
|
|
Term
| What is the MOA of clindamycin (cleocin)? |
|
Definition
| binds to the same 50s ribosomal subunit as macrolide Abiotics |
|
|
Term
| When is clindamycin indicated? |
|
Definition
| inhibits strep, staph, pneumococci; inhibits anaerobic bacteria such as bacteroides fragilis and clostridium perfringies; anaerobic infections such as intra-ab wounds, gyn infections, abscesses, and aspiration pneumonia; for g+ infections in penicillin-allergic pts; for newly discovered community-aquired MRSA |
|
|
Term
| ***What are some important adverse rxns associated w/clindamycin (cleocin)? |
|
Definition
| GI upset such as nausea and diarrhea *primary antibiotic to cause antibiotic-associated PMC* |
|
|
Term
| How is clindamycin (cleocin) administered, and how is it metabolized? |
|
Definition
can be given iv or po
metabolized by liver |
|
|
Term
| What is the MOA of quinupristin/dalfopristin? |
|
Definition
| unique streptogramin molicules that act *synergistically* to inhibit bact prot synthesis at 50s ribosomal subunit |
|
|
Term
| When are quinupristin/dalfopristin indicated? Do they act via a bactericidal or bacteriostatic mechanism? |
|
Definition
bactericidal against strep and staph;
bacteriostatic againsts enterococcus faecium;
reserved for use in serious infections caused by multidrug-resistant strep, MRSA and VRE |
|
|
Term
| How are quinupristin/dalfopristin administered? |
|
Definition
|
|
Term
| How frequently must quinupristin/dalfopristin be administered? |
|
Definition
|
|
Term
| How is quinupristin/dalfopristin metabolized? |
|
Definition
|
|
Term
| ***What are important adverse rxns to quinupristin/dalfopristin? |
|
Definition
| infusion-related pain and myalgias |
|
|
Term
| What are some important drug interactions with quinupristin/dalfopristin? |
|
Definition
| like erythromycin, inhibits CYP 450 3A4 enzyme that metabolizes many drugs |
|
|
Term
| What is the MOA of linezolid (zyvox)? |
|
Definition
| oxazolidinedione with unique activity against bacterial 50s subunit of bacteria. |
|
|
Term
| Does linezolid (Zyvox) act via bactericidal or bacteriostatic mechanisms? |
|
Definition
|
|
Term
| When is linezolid indicated? |
|
Definition
active against maost g+, including most strains resistant to other abiotics.
resistance may occur w/overuse.
should be reserved for infections caused by multidrug-resistant bacteria such as VRE and MRSA. |
|
|
Term
| How is linezolid (Zyvox) administered? |
|
Definition
| given oral or IV with 100% bioavailability |
|
|
Term
| How is linezolid (Zyvox) metabolized? |
|
Definition
|
|
Term
| What is the T1/2 of linezolid? |
|
Definition
|
|
Term
| What is an important adverse rxn of linezolid (Zyvox)? |
|
Definition
| *hematologic toxicity* can cause thrombocytopenia and neutropenia w/extended use |
|
|
Term
| What is the cost of linezolid? |
|
Definition
| $1000 for 1 week oral therapy |
|
|
Term
| How is mupirocin (bactroban) related to other Abiotics? |
|
Definition
| unrelated to other Abiotics |
|
|
Term
| ***How is mupirocin (bactroban) administered? |
|
Definition
| only used in *topical* preparations for tx *staph* infections. special *nasal formula* available to eliminate carriage of MRSA |
|
|
Term
| When is mupirocin (bactroban) indicated? |
|
Definition
should be reserved for suspected or definite MRSA to avoid development of resistance.
also used for impetigo caused by strep or staph. |
|
|
Term
What class do the following antibiotics fall under?
norfloxacin
ciprofloxacin
ofloxacin
lomefloxacin
enoxacin |
|
Definition
| 1st gen DNA gyrase inhibitors- fluoroquinolone Abiotics |
|
|
Term
Which class do the following medications fall under?
levofloxacin (levauin)
moxifloxacin (avelox)
gemifloxacin (factive) |
|
Definition
| 2nd generation DNA gyrase inhibitors- fluoroquinolone abiotics |
|
|
Term
| What category does trovofloxacin (trovan) fall under? |
|
Definition
| restricted bacterial dna gyrase inhibitor- fluoroquinolone abiotics |
|
|
Term
What category do the following medications fall under?
gatifloxacin (tequin)
sparfloxacin (zagam)
grepafloxacin (raxar) |
|
Definition
| withdrawn dna gyrase inhibitors- fluoroquinolone abiotics |
|
|
Term
| What is the MOA for bacterial dna gyrase inhibitors- fluoroquinolone abiotics? |
|
Definition
| inhibit dna gyrase and topoisomerase that are essential for maintaing bacterial dna structure and function |
|
|
Term
| Do fluoroquinolone abiotics act via bactericidal or bacteriostatic mechanisms? |
|
Definition
| bactericidal activity against most g- bacteria |
|
|
Term
| When are fluoroquinolone abiotics indicated? |
|
Definition
g- active against atypical bacteria;
2nd gen agents also have good activity against g+ bacteria (except staph) complicated UTI and prostatitis;
serious infections secondary to g- bacteria such as bacteriemia and intra-ab infections;
2nd gen agents used for severe pneumonia;
infectious diarrhea secondary to salmonella and shigella;
penicillin-resistant to anthrax |
|
|
Term
| How are fluoroquinolone abiotics administered? |
|
Definition
| most available as both IV and oral forms |
|
|
Term
| How do fluoroquinolones distribute and how are they excreted? |
|
Definition
| distribute well into most tissues; excreted renally |
|
|
Term
| What are some important adverse rxns of fluoroquinolones? |
|
Definition
cause arthropathy in developing animals- avoid in children less than 18 years old and during pregnancy.
achilles tendon rupture.
neurotoxic in high doses (irritability seizures). |
|
|
Term
| ***What are some important drug rxns with fluoroquinolones? |
|
Definition
| absorption of oral dosage forms inhibited by cations such as ca2+, mg2+, Fe, and Zn (multivitamins and anacids). inhibit metabolism of caffeine and theophylline. |
|
|
Term
| What is the most commonly used 1st gen fluoroquinolone abiotic? |
|
Definition
|
|
Term
| What is Ciprofloxacin (Cipro)'s advantage? |
|
Definition
| only quinolone with activity against Pseudomonas aeruginosa |
|
|
Term
| ***What are the disadvantages of ciprofloxacin (cipro)? |
|
Definition
| -poor activity against g+ -shorter T1/2 requires bid dosing IV or oral |
|
|
Term
| What was the 1st fluoroquinolone? |
|
Definition
|
|
Term
| When is norfloxacin indicated? |
|
Definition
| still used for UTI's- does not achieve high enough serum levels for systemic infections. |
|
|
Term
| What are also known as "respiratory fluoroquinolones"? |
|
Definition
| 2nd gen fluoroquinolone abiotics |
|
|
Term
| ***Against what bacteria are 2nd gen fluroquinolones active? |
|
Definition
| besides g- activity, they are active against most bacteria responsible for respiratory infections including atypical bacteria and multidrug-resistant strep pneumonia |
|
|
Term
| What drug ist he L-isomer of ofloxacin? |
|
Definition
|
|
Term
| What is the most common fluoroquinolone used for a variety of serious infections? |
|
Definition
|
|
Term
| What is T1/2 of levofloxacin (levaquin)? |
|
Definition
|
|
Term
| How is levofloxacin (levaquin) eliminated? |
|
Definition
|
|
Term
How frequently is Levofloxacin (Levaquin) administered?
What is the method of administration? |
|
Definition
|
|
Term
| Should Moxifloxacin (Avelox) be used for UTIs? |
|
Definition
|
|
Term
| Which has better activity against anaerobic bacteria: levofloxacin (levaquin) or moxifloxacin (avelox)? |
|
Definition
|
|
Term
| How frequently and by what route is moxifloxacin (avelox) administered? |
|
Definition
|
|
Term
| What is the newest fluoroquinolone? |
|
Definition
|
|
Term
| How is gemifloxacin (factive) administered? |
|
Definition
|
|
Term
| How is gemifloxacin (factive) metabolized? |
|
Definition
|
|
Term
| What is an adverse rxn of gemifloxacin (factive)? |
|
Definition
| greater incidence of rash (32% v. 4% w/cipro in women <40yo) |
|
|
Term
| What is the only oral sulfonamide still used as an abiotic and how is it available? |
|
Definition
| SMX is the only oral sulfonamide still used as an antibacterial agent and is only available in combination w/TMP |
|
|
Term
| What is the MOA of TMP-SMX? |
|
Definition
| sequential inhibition of bacterial folic A synthesis preventing DNA synthesis (human cells do not synthesize this A) |
|
|
Term
| ***What bacteria are susceptible to TMP-SMX? |
|
Definition
| bactericidal activity against most g+ and g- including CA-MRSA. Active against nocardia, pneumoncystis jiroveci. |
|
|
Term
| Does TMP-SMX act via bactericidal or bacteristatic mechanisms? |
|
Definition
|
|
Term
| ***Against what does TMP-SMX have no activity? |
|
Definition
| no activity against enterococci, atypical bacteria, anaerobic bacteria, or P. aeruginosa |
|
|
Term
| ***When is TMP-SMX indicated? |
|
Definition
| primary drug for UTIs. secondary drug for upper and lower respiratory tract infections, sepsis, meningitis, travelers diarrhea, typhoid, cholera |
|
|
Term
| How is TMP-SMX administered? |
|
Definition
|
|
Term
| How is TMP-SMX distributed? |
|
Definition
| well distributed in tissues including CSF |
|
|
Term
|
Definition
| 50% excreted through kidneys |
|
|
Term
| What is T1/2 of TMP-SMX and how frequently is it administered? |
|
Definition
|
|
Term
| ***What are some important adverse rxns to TMP-SMX? |
|
Definition
| hsn- can use TMP alone for UTI's. severe hsn include exfoliative dermatitis and stevens-johnson syndrome. high doses for p jiroveci infections in AIDS: can cause thrombocytopenia and neutropenia, high incidence of allergic rxns, and hyperkalemia. |
|
|
Term
| ***What are some important drug interactions with TMP-SMX? |
|
Definition
| can increase serum levels and toxicity of warfarin, phenytoin, and oral sulfonylureas (for diabetes) |
|
|
Term
| ***When is Nitrofurantoin (macrodantin) indicated? |
|
Definition
| only used for lower UTIs. bactericidal against e.coli, enterococcus, and other common UTI orgs. |
|
|
Term
| Does nitrofurantoin (macrodantin) act via bactericidal or bacteriostatic mechanisms? |
|
Definition
|
|
Term
| What are some side effects of Nitrofurantoin (macrodantin)? |
|
Definition
commonly causes GI irritation, nausea, and vomiting
should avoid in elderly due to increased risk of pneumonitis and neuropathy
contraindicated in renal failure |
|
|
Term
| ***When is nitrofurantoin (macrodantin) contraindicated? |
|
Definition
| should avoid in elderly due to increased risk of pneumonitis and neuropathy. contraindicated in renal failure. |
|
|
Term
| How is Metronidazole (flagyl) administered? |
|
Definition
|
|
Term
| ***When is metronidazole (flagyl) indicated? |
|
Definition
| antiprotozoal drug. best single agent to tx anaerobic infections, including intra-ab infections and c. dif colitis |
|
|
Term
| What is a drug interaction with Metronidazole (flagyl)? |
|
Definition
| avoid EtOH- while taking: disulfiram-like effect |
|
|
