Glossary of Antibiotic Pharmacology
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- Which ABX inhibit or disrupt cell wall production?
- Which drugs are considered beta-lactams?
- Penicillins, cephalosporins, and carbapenems
- What drug is a glycopeptide?
- Which drugs inhibit protein synthesis by interfering with bacterial ribosomes?
- Which drugs inhibit DNA synthesis?
- Which drug inhibits folic acid synthesis?
- When are bacteriocidal agents prefered over static?
- 1) host is compromised (e.g. neutropenic)
2) host defenses do not operate well in that area (e.g. endocarditis, meningitis)
3) critical condition
- Which ABX are generally considered bacteriocidal?
- Beta lactams
- Which ABX are generally considered bacteriostatic?
- Sulfonamides (TMP-SMX?)
- 3 examples of concentration-dependent ABX.
- 3 examples of Time-Dependent ABX.
- Beta lactams
- Which drugs will inc -cidal effects when you increase the dosage? C-D or T-D?
- Concentration Dependent
- Which drugs have post ABX effect?
Cyclic lipopeptides (daptomycin)
- Which ABX are active against Intracellular Organisms?
- Which organisms are intracellular?
- Chlamydia pneumoniae
Mycobacteria (TB and others)
- Which ABX achieve equivalent levels PO and IV?
- Which ABX undergo renal excretion?
- Beta lactams (except two)
- Which Beta lactams are not excreted by the kidney? (2)
- Which ABX are excreted hepatically?
- ABX associated with ototoxicity (3)
- Which ABX are associated with nephrotoxicity?
- Amphotericin B
- Which ABX is associated with ATN (acute proximal tubular necrosis)?
- Which ABX causes AIN (acute interstitial nephritis)?
- Which drug is associated w/Fanconi syndrome?
- What are the main ABX associated with psychiatric symptoms?
- *Fluoroquinolones*(esp levo)
- Which ABX are associated with chemical phlebitis?
- Which ABX is associated w/a disulfiram like rxn?
- What should you educate a patient about if you prescribe Metronidazole?
- No ETOH for 3 days after they complete therapy
- Associated with yellow babies
- Which drugs are sulfonamides?
- What are sulfonamides often used to treat?
- Urinary tract infections
- What ABX are associated with gray babies?
- What is red man syndrome associated with?
- How can you decrease the chance of a person developing "red neck syndrome" from vancomycin?
- Slow infusion
give diphenhydramine to tx
- What drug is associated with Red Lobster syndrome? And what IS red lobster syndrome?
- Rifampin --> red-orange discoloration or urine, tears, and sweat
- What drug causes discolored teeth?
- What drugs may cause pt to lose red/green color perception?
- What ABX may cause Hyperkalemia?
- Trimethoprim (usually TMP-SMX)
- What ABX may cause hypokalemia?
- Associated with causing C. dif?
- Aminopenicillins (amox, augmentin, ampicillin, amp/sulfabactam)
- Main drugs associated with rash when used in Infectious Mono?
- When else might a rash occur when taking ampicillin?
coadministration of allopurinol
- What drugs does a true penicllin allergy apply to?
- Can you use aztreonam (a monobactam) if pt had anaphylactic rxn to penicillin?
- Yes - but no carbapenems
- If pt had rash from penicillin what could you use?
- possibly cephalosporins, carbapenems, if necessary
- What Oral ABX are effective against pseudomonas?
- What oral ABX is gold standard to treat Methicillin susceptible Staph aureus?
- What IV ABX should be used for MSSA?
- What other IV drug can be used for MSSA if gold standard (naf) isn't used?
- Cephazolin (2nd choice)
Vanco (3rd choice)
- What oral drug should be used for MRSA?
maybe TMP-SMX (not good choice)
- What oral ABX work for MSSA but are not gold standard? (dicloxacillin)
- cephalexin (2nd choice)
- What oral ABX can be used if enterococcus is resistant to vanco?
- What are the 2 best anti-anaerobic oral ABX?
- What is the silver standard to tx of anaerobic infxn w/oral ABX?
- If cephalexin is less active against MSSA than dicloxacillin then shy is it used often?
- better absorbed, don't need emty stomach
- What is the problem with using minocycline and TMP-SMX for MSSA?
- They are static drugs while the first and second choice (dicloxacillin and cephalexin) are cidal
- IV drugs for pseudomonas
carbapenems (mero moreso than imipenem)
- Top choices (in order) for IV drug against MSSA
- #1) nafcillin
- What is the gold standard parenteral ABX for anaerobes? (there are three)
- beta-lactam/beta-lactamase inhibitor
- What are the silver and bronze standard anti-anaerobes (IV form)
- 2nd choice - clindamycin
3rd choice - cefotetan, or cefoxitin
- Are penicillins excreted by kidney or liver?
- What is the difference between penicillin G and VK? what MO(s) do they cover?
- VK is PO
G is IV
- What is the difference between penicillin G and penicillin G benzathine?
- benzathine is IM and long acting. . . also it covers treponema pallidum
- When might penicillin V be used?
- strep pharyngitis
- Which penicillin is associated with Hoignes syndrome?
- penicillin C procaine (IM)
- What drugs are considered anti-staph penicillins?
- Which anti-staph penicillin is PO?
- What MOs do aminopenicillins cover?
- s. pyogenes
SOME h.flu and e.coli
- In what situations might you use an anti-staph penicillin?
staph aureus meningitis
- What MOs are added by "augmenting" aminopenicillins?
- h.flu and m.cat (even amox resistant strains)
some e.coli and klebsiella
group B strep (agalactiae)
- Name two augmented aminoPCNs
- What drug is a Ureidopenicillin?
- piperacillin = ureido
- what organisms do augmented extended-spectrum penicillins cover that other penicillins do not?
- is piperacillin-tazobactam (extended-spectrum penicillin) IV or PO?
- IV - only used in hospitals
- Are cephalosporins excreted by the liver or kidney?
- Name two 1st generation cephalosporins and whether they are IV or PO
- Cefazolin (IV)
- What MOs do the 1st generation cephalosporins (like cefazolin and cefalexin) cover?
- s. pyogenes
- what might a 1st generation cephalosporin be used for?
- strep pharyngitis
- Name a 2nd generation cephalosporin
- What formulations is cefuroxime available in?
- What are possible indications for the use of a second generation cephalosporin?
- otitis, sinus infections, pneumonia
- What is the big difference between first and second generation cephalosporins?
- 2nd generation get pneumococcus
- but also m. cat, h.flu, and pasteurella
- Name 4 3rd generation cephalosporins
- Ceftriaxone (IV) - rocephen
- What would make you use Ceftazidime instead of Ceftriaxone (IV Rocephen)?
- Ceftazidime covers resistant gram negatives like pseudomonas, enterobacter, and serratia but Ceftriaxone does not.
- Name the only 4th generation cephalosporin we discussed
- Cefepime (IV)
- What is the difference between cefepime (4th gen) and 3rd generation cephalosporin?
- Cefepime, like 3rd generation cephalosporins cover gram negatives, like ceftazidime it covers the "nasty" gram negatives (pseudomonas, enterobacter, serratia)
but. . . it ALSO has better staph aureus and s. pneumo coverage than 3rd generation cephalosporins
- What drug class is aztreonam?
- What should monobactams be used for?
other resistant gram neg. (enterobacter, serratia)
- What are 3 Carbapenems?
- What MOs do carbapenems cover?
- MDR Gram negatives
Extended spectrum beta lactase gram negatives
- How are monobactams excreted?
- renal excretion
- How are carbapenems excreted?
- renal excretion
- Which carbapenem is available only IV, not IM?
- What is the difference between ertapenem and the other two carbapemens (Imi and Mero)?
- Ertapenem does not cover pseudomonas, Enterococci, or Acinetobacter
- What ABX is a glycopeptide?
What formulations are avail?
PO, IV, suspension
- What should oral or suspension vanco be used for?
- refractory c. dif
- MOs covered by vancomycin
enterococci (in PCN allergic pts)
clostridial species (perfringens and dif)
coagulase negative staph
- What gram neg organisms does vanco cover?
only G+ aerobes and anaerobes
- Is vancomycin time-dependent or concentration-dependent?
- time-dependent (measure troughs)
- do tetracyclines have a long or short half life?
- What decreases the absorption of tetracyclines?
- Ca, Fe, Mg, Zn (di and trivalent cations)
- What side effects of tetracycline is seen with minocycline in particular?
- 1) vestibular
2) purple/blue hyperpigmentation of skin
3) drug-induced lupus
- What are the three tetracyclines?
minocycline (only PO)
- What organisms are covered by tetracyclines?
- strep pneumo
most staph aureus (+MRSA)
- What might you prescribe a tetracycline for?
- works just as well as azithromycin for otitis, sinusitis
can use for walking pneumonia, dog/cat bite, tick bite
- Where are the macrolides metabolized?
- Which macrolide does not have P450 interactions?
- Are macrolides static or cidal?
- Why wouldn't a macrolide work well for a bacteremia from pneumonia?
- high tissue levels but low serum levels
- What unpleasant characteristic is associated with clarithromycin?
- metallic taste
- Rank the 3 macrolides in order of potency
- clarithro > azithro > erythro
- Which macrolide is only available PO?
- clarithromycin (Biaxin)
- What MOs are covered by macrolides
- s. pneumo
- What drug is like a "supercharged biaxin"?
biaxin = clarithromycin
- An example of a ketolide.
- What is covered by ketolides but not by macrolides?
- s. pneumo (even macrolide resistant)
h flu (drug unaffected by beta lactamase)
m cat (" ")
s. pyogenes (macrolide resistant)
**all the same MOs as macrolides
- Which patients should not recieve a ketolide?
- 1. Class Ia or III antiarrhythmics
2. pts w/prolonged QT
- How are aminoglycosides excreted?
- Are aminoglycosides concentration or time dependent?
- Adverse effects of aminoglycosides?
- ototoxicity or vestibular damage
Neuromuscular blockade in myasthenia gravis pts
- What are the two main examples of aminoglycosides and their formulations?
- gentamycin (IV)
tobramycin (inhaled, IV)
- What organisms are covered by Aminoglycosides?
- aerobic gram negatives (proteus, e. coli, klebsiella, enterobacter, pseudomonas, serratia)
- what anaerobic organisms are covered by aminoglycosides?
- Can aminoglycosides be used for gram positives?
- Not most - except enterococcus
but. . . . must give in combination with PCN or ampicillin or vanco
- Which aminoglycoside is most effective against pseudomonas? (gram neg aerobe)
- Are fluoroquinolones cidal or static?
- What is the similarity between fluoroquinolones and tetracyclines in terms of absorption?
- multivalent cations decrease absorption
- Adverse effects of fluoroquinolones
- 1. arthropathy
- CI if <18. . . except maybe cipro for complicated UTI or anthrax
2. CNS toxocity - watch kidney fcn
4. QT prolongation
- Hypoglycemia is most common with which fluoroquinolone?
- What are the clinical uses of 1st generation quinolones?
- none really
- Name a 2nd generation fluoroquinolone
- Ciprofloxacin (Cipro) - PO/IV
- What organisms are covered by 2nd generation fluroquinolones?
- gram negatives (e. coli, klebsiella, enterobacter, pseudomonas, proteus, serratia, gonorrhea, pasteurella, m. cat, h. flu)
- Name 3 3rd generation fluoroquinolones
- levofloxacin (PO/susp/IV)
- What is the difference between 2nd and 3rd generation fluoroquinolones in terms of coverage?
- 3rd offer great coverage of respiratory pathogens including atypicals (s. pneumo, s. pyogenes, legionella, mycoplasma, chlamydia)
Also - 3rd generation have significant anaerobic activity
- Which fluoroquinolone would you choose to treat CAP?
- levaquin, not cipro
- What might you use ciprofloxacin to treat?
- UTI, aspiration, perforation (diverticulosis, PUD), anthrax
- Is TMP-SMX static or cidal?
- How is TMP-SMX excreted?
- What organisms does Bactrim cover?
Bactrim = TMP-SMX
- s. pneumo
- Which patients cannot take TMP-SMX
- sulfa allergy (have to use just trimethoprim)
G6PD deficiency (will cause hemolytic anemia)
- What might you treat with TMP-SMX?
- NOT outpatient CAP (despite pathogens covered) b/c resistance is too high
ok for ears and sinuses
UTIs (covers gram negs)
- Which drug is a Lincosamide?
- What organisms are covered by clinda?
- anaerobes (best for above the diaphragm)
s. aureus and strep pyogenes in those with PCN allergies
- Are lincosamides (clindamycin) cidal or static?
- What is a major adverse effect of lincosamides?
- diarrhea ( + C. dif colitis)
- What categories of pathogens does clindamycin cover?
- G + cocci
NOT gram negatives!
- What is the difference between linezolid against staph, enterococci, and streptococci?
- static against staph/entero
but cidal against strep
- What category of drug is linezolid?
- 2 side effects of linezolid?
- reversible thrombocytopenia
reversible inhibition of MAO (watch dietary tyramine)
- What is linezolid used for ?
- What drug is a cyclic lipopeptide?
- What is the main indication for daptomycin? (cyclic lipopeptide)
vanco is still standard of care in this situation - but this is another IV option
- Why must you be careful with daptomycin if pt is on a statin?
- --> myalgias
monitor the CPK more closely
- Where is metronidazole excreted?
- Is metronidazole cidal or static?
- What MOs are covered by metronidazole?
- anaerobes (esp below diaphragm)
some protozoa (trichomonas, giardia, entamoeba)
- 2 main side effects of metronidazole?
- disulfiram-like rxn
metallic taste if you give too much
- Possible long term side effect of Nitrofurantoin?
- pulmonary fibrosis
- What does nitrofurantoin cover?
- gram negatives
- What organisms are covered by chloramphenicol?
- h. flu
- Why isn't chloramphenicol used much?
- toxicities - but used as last resort in CNS infxn because it reaches therapeutic levels in CNS
- What is Fosfomycin used for?
- uncomplicated UTIs due to enterococci or e. coli
- What is Polymyxin B used for?
- only against gram negatives
- What is Methanamine used for?
- uncomplicated/chronic UTIs
(no systemic effects)
- What is Rifaximin used for?
- Traveler's diarrhea from noninvasive strains of e. coli
- Which diarrheal infections can Rifaximin not be used for?
- those associated w/fever or bloody stools
- What are 2 ABX associated with hemolytic anemia in pts with G6PD deficiency?
- Sulfa (Bactrim)
- What ABX are most commonly associated with immune-mediated urticaria?
- Beta lactams and sulfonamides
- What ABX is associated with nonimmune-mediated urticaria?
- Vanco (red neck syndrome)
- With what ABX do you worry most about anaphylaxis?
- Beta lactams
- What drugs are associated with Drug-induced exanthems? (a drug eruption)
- beta lactams and sulfonamides
- What ABX are associated with hypersensitivity vasculitis?
- Beta lactams and sulfonamides
- What drugs are associated with exfoliative dermatitis/erythroderma?
- Penicillins mostly
but also sulfa
- What ABX is associated with SJS (Stevens Johnson Syndrome) and TEN (toxic epidermal necrolysis)?
- How is SJS from a sulfonamide managed?
- stop drug
tx like burn
high dose steroids
- What two ABX are associated witha fixed drug eruption? (plaques with grayish center or frank bullae)
- What abx is classically associated with serum sickness
- cefaclor (2nd gen cephalosporin)
also. . .sulfonamides of course
- Which ABX have photosensitivity as a side effect?
- What ABX might be associaled with drug-induced lupus?
- What ABX are associate with drug fever?
- beta lactams
- What ABX cause yellow-brown urine?
- What abx causes orange/pink urine?
- What 2 abx cause brown-black urine?
- What is the P450 action of rifampin?
- inducer of 3A4 and 2C9
- What is the P450 action of macrolides?
- Both substrates and inhibitors of 3A4
- The elimination of which ABX is affected by glomerular filtration?
(will build up if filtration is affected)
- What ABX (IV and oral) work against pseudomonas?
tobramycin (not gent)
- What ABX cover strep pneumo?
- Cefuroxime (2nd gen)
Ceftriaxone (3rd gen)
Cefepime(4th)*better than 3rd
Fluoroquinolones (3rd gen - not cipro)
TMP-SMX (but not CAP)
Aminopenicillins & augmented
- What ABX cover staph? (MSSA)
Cefazolin (1st gen)
Cephalexin (PO 1st gen)*
Cefuroxime (2nd gen)
Cefepime (IV only)
Doxycycline* (may get MRSA)
- What ABX is the #1 cause of chemical phlebitis?
- How are aminopenicillins excreted?
- What might you treat with amoxicillin or ampicillin?
- Would cover strep throat, pneumo (if strep pneumo), lyme disease, animal bite
- What is the gold standard for treating anaerobic infxns?
**these also cover everything that nL AminoPCNs do plus m. cat and h.flu
- Which augmented aminopenicillin is IV and which is oral?
- Amp/sulf is IV
Amox/Clav is PO
- Piperacillin/tazobactam is the gold standard treatment for which (2) infections?
- Pseudomonas and anaerobes
*the augmented aminoPCNs are also considered gold standard for anaerobes
- Anaerobic organisms include. . . .
- b. fragilis
(above are all gram neg)
- Which cephalosporins are anti-pseudomonal?
- ceftazidime (3rd)
- Examples of infections when anaerobes are suspected
- Diverticulitis (b frag)
GI infections (b frag)
lung or dental infxn (prevotella)
C. dif colitis
brain, liver, lung abscesses?
*anaerobes are nL flora in the oral cavity, GI tract, and vagina
- What is zosyn?
- Piperacillin/tazobactam is ideal for pseudomonas and anaerobic infxns. . . what other organisms does it cover?
- s. pyogenes
m. cat/h. flu
- What are the "gram negative enterics"?
- How are the cephalosporins excreted?
- What is a major SE of cephalosporins?
- Associated with C. dif diarrhea
- which macrolide covers MAC (mycobacterium avium complex)?
- Name two drugs that cover a chlamydia GU infection.
- Azithromycin and Doxycycline
- Doxycycline and Azithromycin can both be used to treat CAP, which one can also be used for animal and tick bites?
- In which patients is doxycycline contraindicated?
- WHich cephalosporins can be used to treat community-acquired pneumonia? and what must they be given with?
- Cefuroxime or Cefpodixime
(give w/macrolide or doxycycline to cover atypicals)
- What infections can be treated with a first or second generation cephalosporin?
- Cystitis or skin/soft tissue infection
- What cephalosporin can be used to treat amoxicillin resistant forms of m. cat and h.flu?
- what organisms do second generation cephalosporins cover that first do not?
- what kind of URI would you use an augmented aminopenicillin for?
- amox. failure URI
(AOM, sinusitis, ABECB)
- What three beta lactams can be used for CAP if you add something to cover atypicals?
- what are clinical indications for use of amoxicillin?
- Tick/dog/cat bites
strep skin infxn
- What does clarithromycin cover that azithromycin does not?
- H. pylori
- Which beta lactam does not cover enterococci or listeria?
(and obviously the nonaminopenicillins)
- Rank the respiratory fluoroquinolones in their efficacy against strep pneumo (greatest to least)
- Moxi > gati > levo
- Which respiratory fluoroquinolone is least effective against resistant gram negatives?
- Which abx covers stenotrophomonas maltophila?
- Which oral abx can be used for traveler's diarrhea?
- quinolones (all)
- What is Pediazole?
(alternative for AOM)
- What two GU infections might you use metronidazole for?
- bacterial vaginosis
- If you use metronidazole for an anaerobic infxn (abscess), what must be added to it?
- beta lactam or fluoroquinolone
- What oral drugs can be used to treat strep pharyngitis in patient w/beta lactam allergy?
- What oral drugs can be used to treat cystitis?
Amoxicillin or Ampicillin
Cephalexin or Cefuroxime
- which abx is used for endocarditis prophylaxis?
- what is the big difference between amox and amox/clav or amp and amp/sul?
- the augmented aminopenicillins also cover m.cat h.flu and anaerobes
- what can you treat with an augmented aminopenicillin that you can't with an aminopenicillin?
- CAP (but must add macrolide or doxy)
(and of course amox failure URIs)
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