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Pharm Abx I
Fall 2011, pharm I
| Question | Answer |
|---|---|
| MOA for penicillins | Inhibit cell wall formation (when pen binds to PBP, prevents CW from forming = bacteria cannot replicate) |
| Mech of Resistance for penicillins | 1. Enzyme inactivation: =B-lactamase 2. Altered target (PBPs) |
| Ex of Narrow Spectrum Penicillins? Spectrum? | (aka Natural) 1. Penicillin G (IV, IM) 2. Penicillin V (PO) *Pretty good G+ coverage |
| Penicillin V is the DOC for? | -Strep pharyngitis -Syphilis |
| Pathogen of syphilis? | Treponema pallidum |
| Trade name of penicillin? | Pen VK (Penicillin V Potassium) |
| Penicillinase-resistant penicillins aka? Examples? | Anti-staph penicillins 1. Nafcillin (IV) 2. Dicloxacillin (PO) |
| Penicillinase-resis penicillins common uses? | MSSE, MSSA, staph infex (skin, osteomyelitis, line infex, prosthetic jnts) |
| What are the subtypes of the extended spectrum penicillins? | 1. Amino-penicillins 2. Amino-penicillins + B-lactamase inhib 3. Anti-pseudomonal 4. Anti-pseudomonal + B-lactamase inhib |
| Amino-penicillin ex's? | 1. Ampicillin (IV, IM) 2. Amoxicillin (PO) |
| What is amoxicillin the DOC for? | Otitis Media |
| Common uses of amino-penicillins? | URI, UTI, Lyme dz |
| Amino-penicillin + B-lactamase inhib ex's? Trade name? | Amoxicillin/clavulanate (Augmentin) - PO (Good G- coverage) |
| Uses for Augmentin? | Sinusitis, OM, Bites, UTI.. |
| Anti-pseudomonal ex's? | 1. Piperacillin (IV) 2. Ticarcillin (IV) |
| Anti-pseudomonal + B-lac inhib ex? Coverage? | Piperacillin + tazobactam (IV) -Good G- coverage + anaerobe coverage (B. fragilis) |
| AE's of penicillins? CI when? | -AEs: GI upset (Diarrhea), allergic rxn (rash, anaphylaxis, hives), seizures w/ high doses, neutropenia, thrombocytopenia, thrombophlebitis -CI: Hypersensitivity to any Penicillin |
| Penicillin dose adjustment req for who? | -Renal dysfxn |
| Which organism is becoming increasingly resistant to penicillin? | Strep pneumo |
| What is critical for the success of penicillins? | Time above MIC! (dosing will be frequent) |
| All penicillins are elimanated from kidneys, except? | Nafcillin |
| Cephalosporins also belong in which large category? | B-lactams (similar strux & fxn to penicillins) |
| Cephalosporins MOA? | Bind to PBPs & interfere w/ cell wall synthesis |
| What is the relationship bw Cephalosporins and B-lactamase? | -Significantly ^ stable in the presence of B-lactamase |
| Spectrum of activity of Cephalosporin generations? | 3 generations: 1=better against G+ 3=better against G- |
| 1st Gen cephalosporins? Activity? | -Cefazolin IV -Cephalexin PO OK gram + |
| 2nd Gen cephalosporins? | -Cefoxitin IV -Cefuroxime PO |
| 3rd Gen cephalosporins? Activity? | -CEFTRIAXONE IV -Ceftazidime IV -Cefpodoxime PO *GOOD G- activity! |
| Cephalosporin against MRSA? | Ceftaroline (NO other sig activity against MRSA or enterococ) |
| What is IV cephalosporin a DOC for? | -Meningitis (but +Vancomycin) -N.gonorrhea (treat 4 chlamydia too) |
| Trade name of Ceftriaxone? | -Rocephin |
| Dosing for ceftriaxone? | -For meningitis: 2g IV q12hr +Vanco -Gonorrhea: 250mg IM x1 + Azithromycin OR Doxy (For co-infex chlamydia) |
| AEs of Cephalosporins? | -Diarrhea, neutropenia, platelet dysfxn, thrombocytopenia -Cross-reactivity w/ PCN = 5-10%:dont use in pt w/ anaphylaxis or hives d/t PCN |
| What is a type I allergy to Penicillin? | -Anaphylaxis or Hives |
| CIs for cephalosporins? | -Hypersens to any cephalosp -Type I allerg to any PCN |
| Do cephalosporins req any dosing adjustments? | -for RF, except in Ceftriaxone |
| What drug is useful in OM w/ N&V? | -IM ceftriaxone |
| Carbapenem exs? | -Imipenem+Cilastatin |
| Chemical strux of imipenem? | -Also has B-lactam ring |
| Spectrum of actitity or Imipenem? | -BROAD SPEC ICU COVERAGE! -Good G+,-,anaerobes -Good against pseudomonas -Serious nosocomial infex -not for MRSA, enterococc, VRE.. |
| Which drug/class is known as the "gorilla-cillins"? | -Carbapenems/imipenem -bc strong&cover lots! |
| What is the "other" carbapenem? | -Ertapenem (NO pseudomonas coverage, nor MRSA, enterococ) |
| Which abx CANNOT be used w/ meningitis? | -Ertapenem |
| Which group are considered G- specialists? | Monobactams (bind to PBPs and inhib cell wall formation) -Good activity against pseudomonas |
| Common uses for monobactams? | -G-sepsis -G-osteomyelitis -G-pneumonia ... |
| Vancomycin is what?? | -G+ specialist |
| What is the MOA of vancomycin? | Inhibits bacterial cell wall synthesis at earlier step than B-lactams |
| Spectrum of activity for Vancomycin? | -VERY GOOD AGAINST G+! (no G- or anaerobes) |
| Vancomycin is the DOC for what? | HCA-MRSA, HCA-MRSE, Enterococci (DOC for PCN allergy) -Esp if pt intol of B-lactams for staph, strep, entcoc infex |
| Vancomycin is usually only used via IV route, what is the exception to this? | -PO for 2nd line trtment of C.diff colitis if metronidazole fails |
| Red neck/man syndrome can occur d/t rapid administration of what? | Vancomycin |
| What is important to do when a pt is on Vanco? | Monitor!!! Esp trough levels! |
| 2 common Vanco resistances that can occur? | VRE, VRSA |
| What are some newer options for VRE? | -Linezolid, Quinupristin/ Dalfopristin, Telavancin (Should be strictly reserved for severe infex d/t orgs resistant to other therapies |
| MOA of fluoroquinolones? | -Inhib topoisomerases= rapid&lethal cessation of DNA replication |
| MOR of fluoroquins? | -Efflux pump, gene mutations, permeability (porin channels get blocked) |
| Which drugs end in -floxicin? | Fluoroquinolones |
| Classification of fluoroquins? | 1st Gen: Not used anymore 2nd Gen: Ciprofloxacin and Ofloxacin=strong G-, no G+ 3rd Gen=Levofloxacin 4th Gen=Moxifloxacin= good gram+, not G- |
| Which generation is ciprofloxacin? Trade name? | 2nd Gen; Cipro |
| What are the atypical pneumonia strains and what works against them? | -Chlamydia, Legionella, Mycoplasma -Fluoroquinolones |
| Ciprofloxacin has the best activity against what? (of the fluoroquins) | -Pseudomonas (poor S. pneumo) |
| Common uses of Cipro? | UTI |
| Areas of fluoroq overuse? | AECB, Chronic sinusitis, prophylaxis for traveler's diarrhea |
| Doses of fluoroquin should be adjusted for? | -Renal dysfxn |
| AEs of fluoroquins? | -Limit use in kids <18and preg (bone/jt/cartilage erosion in young animals, GI:N/V, dizzy, light-hded, HA, insomnia |
| Fluoro drug interax? | -decrs absorp w/metal cations (antacids..), cipro reax w/ theophylline, warfarin (can ^INR= can inhib metab) |
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