Antibiotic resistance threats

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  1. Gram positive stain color
  2. Gram negative stain color
  3. gram positive aerobes
    • enterococcus
    • listeria
    • staphylcoccus
    • streptococcus
  4. gram positive anaerobes
    clostridium (c-diff)
  5. Intracellular bacteria have no ____?

    cell wall

    • Rickettsia
    • Legionella
    • Mycoplasm
  6. Examples of protozoa with antibacterial susceptibility
    • chlamydia
    • malaria
    • pnemocystis
  7. Gram negative anaerobes
    bacteroides- below belt, usually peritoneal or gynecological
  8. Protozoa with limited susceptibility
    • giardia
    • trichimonas
  9. Gram positive are ____ soluble
  10. gram negative are ____ soluble
  11. Side effects of all antibiotics

    • superinfection- broad spectrum, higher risk
    • ex-oral candidis, yeast infection, c-diff
    • -diarrhea
    • -gi upset
    • - allergy
    • -
  12. SE of FQ and Macrolides
    prolong QT interval
  13. SE of beta-lactams and FQ
  14. SE - FQ, Sulfa, Tetracycline
  15. SE- FQ and tetracylcine
  16. SE- AG and IV vanco
  17. SE IV Vanc
    red mans syndrome
  18. drugs that are safe with renal impairment
    • azithromycin
    • ceftriaxone
    • clindamycin
    • metronidazole
    • tetracycline
  19. bactericidal drugs
    kill the organism, but the organism must be growing generally
  20. bacteriostatic drugs
    inhibit growth, allowing host responses to overcome infection
  21. Cell wall active drugs (generally bactericidal)
    • Beta lactams:
    • PCN derivatives
    • Cephalosporins (1st and 3rd generation better for gram + drugs) 2nd generation better for gram - drugs
  22. anti staph drug DOC
    oral dicloxacillin (beta-lactam)
  23. Protein synthesis inhibitors
    • macrolide (static)
    • clindamycin (static)
    • linezolid (static)
    • aminoglycosides (cidal)
    • tetracyclines (static)
  24. DNA disrupters
    sulfamethoxazole/trimethroprim- septra or bactrim

    fluoroquinolones- cipro, levaquin, avelox

    metronidalzole -flagyl

  25. bacteriostatic antibiotics are _______ spectrum
  26. # 1 way to prevent spread of infection
  27. Colonization
    don't have sx
  28. PCN drugs are bactericidal so bacteria must be ______ in order to kill them
  29. Beta lactams will not work if bacteria does not have _____?
    • cell wall.
    • will not kill pnemonia
  30. Drug that is contradicted in neonates because it can displace bilirubin and cause kenicterus
  31. way to remember anti staph drugs
    ox, diclox, meth, naf all antistaph
  32. If pregnant women has syphilis and has an allergy to PCN what do you treat her with?
    PCN just desensitize her first.
  33. Empiric therapy is for how long?
    TX based on
    72 hours

    • likely pathogens, local susceptibility trends, and patient specific factors, (allergies, organ dysfunction)
    • Broad coverage antibiotics until specific pathogen is identified.

    Get cultures on front end and then start antibiotic asap
  34. Definitive tx with antibiotics
    • identify organism (microbiology, or serologic testing)
    • Use most effective, least toxic, narrowest spectrum, and most cost effective agent
    • (may be a combination of drugs)
  35. Penicillin benzathine procaine
    penicillin benzathine

    Know for test
    pcn benz procaine- treats strept pharyngitis, has local antisthetic effect

    pcn benz- used to treat syphillis
  36. First line tx for AOM and neonatal meningitis
    aminopenicllins (ampicillin, or amoxicillin)
  37. First line cephalosporin
    Tx's gram + or gram - ?
    • gram +
    • keflex

    tx-strep, uti
  38. 2nd generation cephalosporins
    • better for gram -, some anaerobes, less gram+
    • cefuroxime (ceftin)

    • tx- early lyme disease
    • aom/ uri
  39. mycin means that
  40. compound was originally isolated from a microorganism
  41. first line tx c-diff
  42. What to do with expired tetracyclines
    throw away
  43. SE of tetracycline
    photosensitivity, chelation

    don't give to kids under 8 years b/c stains teeth
  44. aminoglycosides enter through where?

    Give what with if treating gram + bacteria
    enter through pores in gram negative cell wall

    Have to give with betalactam if gram + so it can break down cell wall first.
  45. aminoglycoside spectrum
    aerobic gram negative, give with cell wall agent if gram +
  46. aminoglycoside toxicity
    neuromuscular blockade
  47. clindamycin  (above the belt) does not work on
  48. what abx stains contact lenses orange and makes body fluids orange
  49. do not use rifampin alone, it is only used alone ______
  50. Food or drug interaction with Flagyl
    • no ETOH for 72 hours after tx.
    • will make them very sick- called disulfiram reaction
  51. Listeria
    gram positive that is not a coccus
  52. Drugs with cell wall synthesis
    • beta lactams- pcn, cephalosporins
    • Vanc
    • Isoniazid
    • polymixin
    • bacitracin
  53. Nitrofurantoin (Macrobid, macrodantin)
    tx's what
    • E-coli
    • enterococci

    only tx local cystitis
  54. Drugs that inhibit DNA replication

    • Metronidazole
    • Cipro
    • Levaquin
  55. Drugs that inhibit RNA synthesis
  56. Drugs that inibit protein synthesis (50S) ribosome
  57. macrolides
  58. Drugs that inhibit protein synthesis (30S) ribosomes
    • Aminoglycosides
    • Tetracyclines
  59. Drugs that are antimetabolites
    • Sulfonamides
    • Tremethoprim
  60. Cells must be actively growing for _____?
    penicillin to do the killing
  61. What organisms are resistant to beta-lactams
    organisms without cell walls
  62. Do not use ___ to treat mononucleosis
    amoxicillin, will cause rash
  63. Most beta lactams are ____ cleared?

    with the exception of ______

    ceftriaxone (rocephin)- undergoes biliary elimination (causes kernicterus in neonates)
  64. 3rd line cephalosporin
    IV/IM ceftriaxone- rocephin

    • CAP- community acquired pnemonia
    • gonorrhea
    • meningitis
    • AOM
  65. Tetracycline
    bacteriostatic, or cidal?
    narrow or broad spectrum

    tetracycline (PO), doxycycline (IV or PO), minocycline (IV or PO).

    broad spectrum- many gram +, gram -, toxin secreters (cholera), rickettsia, sphirochetes, mycoplasma, and chlamydia (intracellular)

    Often effective against community acquired MRSA
  66. First line tx for COPD exacerbation
    Tetracyclines (bacteriostatic)
  67. Aminoglycosides
    cidal or static ?
    requires what to work?

    Gentamycin, Neomycin, streptomycin,

    MOA-binds to irreversibly to a site of 30S subunit, preventing inhibition of protein synthesis, leading to cell death.

    requires 02, will not work against anaerobic infections.
  68. Aminoglycosides spectrum

    • aerobic gram negative, including pseudomonas
    • Give with cell wall agent (beta lactam) if gram +
  69. Macrolides (bacteriostatic)
    Azithromycin (Zithromax), clarithromycin, erythromycin

    MOA- bind to 50S ribosome subunit, inhibit peptidyl transferase and blocks release of peptide chain

    Spectrum- some gram +, gram -, and intracellulars, h pylori
  70. 2nd line tx for c-diff
    oral vancomycin
  71. Adverse effects of macrolides (Zithromax, clarithromycin)
    • ototoxicity
    • hepatotoxic
    • diarrhea, cramping
  72. Clindamycin (macrolide)
    MOA- binds with 50S, preventing translocation

    Spectrum- gram +, some gram -, including anaerobes, but NOT c-diff

    Tx's stuff above the belt, ie- skin infections with pcn allergy.

    Cleared hepatically so safe in renal impaired
  73. Treatment for VRE
    Linezolid (zyvox) - Macrolide

    Don't want to get linezolid resistance because VRE is very hard to treat
  74. Linezolid SE
    MAOI inhibitor

    Head ache, thrombocytopenia, neuropathy
  75. Don't take quinolones or flouroquinolones if .....
    pregnant or with a glass of milk
  76. FQ drugs
    • cipro- usually tx gram -
    • Levoflox
    • Moxiflox- covers bacteroides (a below the belt anaerobe) but does not achieve urinary levels
  77. adverse effects of FQ
    • chelation
    • photosensitivity
    • QT prolongation
    • tendinitis
  78. Folate antagonists drugs

    • sulfonamides- sulfa, silvadene, sulfadoxine
    • DHFR inhibitors- Pyrimehtamine (malaria), trimethoprim

    • Pneumocystis jiroveci
    • CA-MRSA
    • protozoa
    • UTI
    • toxoplasma
  79. Adverse effects of folate antagonists
    • Sunburn
    • anemia
    • Steven Johnson syndrome
    • LOTS OF SE
  80. Rifampin- drug that interferes with RNA polymerase
    Adverse Effects:
    MOA- form very stable complex with RNA polymerase. low affinity for human enzyme

    Spectrum- love to kill bacteria in the phagasome- very broad including mycobacterium

    • USE- monotherapy is only for prophylaxis for meningitis
    • Combo tx for tb, leprosy, bone infections

    • Adverse effects- body fluids orange/red
    • hepatotoxic, flu like hypersensitivity, many drug interactions (decrease effectiveness of oral contraceptives)
  81. Flagyl (metronidazole) (below the belt)
    Adverse effects:
    spectrum: protozoa, anaerobes, h pylori, FIRST LINE FOR C-DIFF, diverticulitis.

    • Adverse effects- neurotoxic effects- ototoxicity, and neuropathy.
    • NO alcohol within 72 hours of treatment, will make patient deathly ill.
  82. Nitrofurantoin (Macrobid and Macrodantin)
    Adverse effects
    • spectrum- e coli, enterococci

    AE- pneumonitits, pulmonary fibrosis, neurotoxicity.
  83. Drugs for TB
    • never monotherapy for active infection
    • rifampin
    • isoniazid
    • pyrazinamide
    • ethambutol- test for color blindness before use

  84. Tx for vaginal candidis
    oral fluconazole (diflucan)
  85. Drug for viral herpes
    Acyclovir and valacyclovir

    Remember hydration, hydration, hydration
  86. What is dual tropism
    • can use both doors to enter cell!!
    • Assess for this when treating HIV
  87. What is used to reduce odds of passing HIV from mother to newborn

    Zidovidine- used during labor and delivery as prophylaxis for maternal to fetal transmission
  88. Treatment for HIV
    • highly active antiretroviral therapy
    • -partial therapy and non compliance causes resistance.

    If you discontinue these drugs you must consider the half life of each drug

    Don't use rifampin with these drugs (enzyme inducer)
Card Set
Antibiotic resistance threats
pharm midterm fall 2013
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