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Pharm 2 Antimicrobial Agents (Abx)

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nicoledemott's version from 2017-11-06 00:38

Section

Question Answer
Examples of SULFONAMIDES SMX/TMP (Bactrim) Silvadene (Topical for burns)
Examples of Narrow Spectrum Penicillins PCN G (IV) ; Benzathine PCN G (IM); PCN G (IM); PCN V K (PO)
Examples of Extended Spectrum Penicillins Ampicillin, Amoxicillin, Piperacillin, and Ticarcillin
Examples of Beta- Lactamase (or penicillinase) Resistant Penicillins Methicillin, Oxacillin, Nafcillin, Dicloxacillin
Examples of PCNs + beta-lactamase Inhibitor Amoxicillin/Clavulanate (Augmentin); Ticarcillin/Clavulanate (Timentin); Ampicillin/Sulbactam (unasyn); Piperacillin/tazobactam (Zosyn)
Examples of Monobactam Abx Aztreonam (Azactam)
Examples of Carbapenems AbxImipenem/Cilistatin (Primaxin); Meropenem (Merrem); Ertapenem (Invanz); Doripenem (Doribax)
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Question Answer
Major ADRs of tetracyclinesyellow/gray teeth, weakened bones, N/V/D, fever, rash, photosensitivity, severe nephrotoxicity (esp. with aminoglycosides), and hepatoxicity. Vestibular SEs more common with minocycline
Major ADRs of Aminoglycosidessignificant nephrotoxity, and ototoxicity
Major ADRs of Chlorphenicol Abxvery toxic, last resort drug
Major ADRs fluoroquinolonesGI, rash, photosensitivity, CNS, tendinopathy in elderly
Major ADRs of Macrolidessignificant GI effects, IV form can cause ototoxicity and thrombophlebitis. Estolate salt rarely cause cholestatic hepatitis
Major ADRs of advanced macrolidesless GI effects than erythro, IV form can cause ototoxicity and thrombophlebitis. Estolate salt rarely cause cholestatic hepatitis
Major ADRs of cephalosporinsallergy, rash, GI, hepatic, renal, superinfection, headache, some heme effects rarely
ADRs of sulfonamidesRash (SJS), renal, heme
ADRs of Penicillins (narrow spectrum, extended spectrum, beta- lactamase resistant penicillins, PCNs + beta-lactamase inhibitor)allergy, rash, GI, hepatic, renal, superfinfection
ADRs of monobactamn/v/d, seizure, leukopenia
ADRs of carbapenemsheme, altered bleeding, seizures
ADRs of clindamycinhigh incidence of C. difficile/diarrhea
ADRs of Vancomycin"red man syndrome" ototoxicity, nephrotoxicity
ADRs of MetronidazoleNO ALCOHOL USE
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Section 2

Question Answer
Examples of 1st generation CephalosporinsCefazolin (Ancef), Cephalexin (Keflex)
Examples of 2nd generation CephalosporinsCefaclor; cefotetan and cefoxitin (for anaerobes - PID), Cefuroxime (PO & IV)
Examples of 3rd generation CephalosporinsCefdinir (PO); Ceftazidime, ceftriaxone, cefotaxime, ceftizomine
Examples of 4th generation CephalosporinsCefipime
Examples of 5th generation CephalosporinsCeftaroline
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Section 3

Question Answer
Examples of Fluroquinalonesend in "floxacin" Gemifloxacin, Levofloxacin, and Moxifloxacin (Respiratory)
Examples of MacrolidesErythromycin
Examples of Advanced MacrolidesAzithromycin (Zithromax) (B) Clarithromycin (Biaxin) (C)
Examples of TetracyclinesDoxycycline, Minocycline, Tetracycline
Examples of AminoglycidesStreptomycin, neomycin, gentamicin, tobramycin, amikacin
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Section 4

Question Answer
Which pregnancy category(ies) are SulfonamidesPregnancy Category C/D
Which pregnancy category(ies) are PenicillinsPregnancy Category B
Which pregnancy category(ies) are CephalosporinsPregnancy Category B
Which pregnancy category(ies) are FluoroquinolonesPregnancy Category C
Which pregnancy category(ies) are MacrolidesPregnancy Category B
Which pregnancy category(ies) are TetracyclinesPregnancy Category D
Which pregnancy category(ies) are AminoglycosidesPregnancy Category D
Which pregnancy category(ies) are ChloramphenicolPregnancy Category C
Which pregnancy category(ies) are VancomycinPregnancy Category C
Which pregnancy category(ies) are Metronidazole (Flagyl)Pregnancy Category B (Some say to avoid in 1st Trimester)
Which pregnancy category(ies) are ClindamycinPregnancy Category B
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Section 5

Question Answer
What is the MOA for SulfonamidesFolic Acid inhibitor
What is the MOA for all penicillin & Cephalosporin & Vancomycin drugsbacterial cell wall synthesis inhibitor
What is the MOA for PCNs + betalactamase inhibitorBacterial cell wall synthesis + beta lactamase inhibitor
What is the MOA for FluoroquinolonesInhibits DNA topisomerase enzyme which is involved in repair and replication of DNA
What is the MOA for Macrolides & Advanced Macrolides & Chloramphenicol & ClindamycinInhibits bacterial protein synthesis on the 50s ribosomal subunit
What is the MOA for TetracyclinesInhibits bacterial protein synthesis and 30s ribosomal, reversible - Bacteriostatic
What is the MOA for Aminoglycosidesinhibit bacterial protein synthesis at 30s ribosomal subunit, irreversible - bactericidal
What is the MOA for Metronidazole (Flagyl)enters anaerobic cells, disrupts DNA and inhibits DNA nucleic acid synthesis
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Section 6

Question Answer
Sulfonamide spectrumgram + ; some gram -
Narrow Spectrum penicillins spectrumgram + ; N. Meningitidis
Extended spectrum penicillin spectrumgram +, gram - (especially E. coli, H. flu, proteus)
Beta lactamase (or penicillinase) resistant penicillins spectrumbeta lactamase producing gram + (staph) and some gram -
PCNs and beta lactamase inhibitor spectrumbeta lactamase producing gram + (especially staph) and gram - (especially, H. flu, gonococci, pseudomonas)
Monobactram penicillin spectrummost gram - (especially pseudomonas)
Carbapenems penicillin spectrumvery broad spectrum, gram + , gram - , aerobic and anaerobic
Cephalosporin spectrumas generation increases, gram - activity increases
1st generation cephalosporin spectrumgram + , gram - (especially E. coli, H. flu, proteus and klesbiella)
2nd generation cephalosporin spectrum gram + , gram - (especially E. coli, H. flu, proteus and klesbiella) and great H. flu coverage
3rd generation cephalosporin spectrumless gram + ; wider range of gram - coverage especially H. flu, M. catarrhalis, pseudomonas
4th and 5th generation cephalosporinsgram - enteric; drug resistant streptococcus
Fluoroquinolones spectrumvery broad spectrum. Good for gram +, gram -, including pseudomonas, enterobacter, and some anaerobes
Macrolides spectrumgram + cocci adn basilli and some gram - cocci and bacilli; chlamydia, spirochetes, and mycobacteria
Advanced macrolides spectrumgram + cocci and basilli and some gram - cocci and bacilli; chlamydia, spirochetes, and mycobacteria broader gram - coverage
tetracycline spectrumsome gram + , some gram -, some anaerobes
Aminoglycosides spectrumbetter gram - coverage than most classes
Chloramphenicol spectrumextremely wide spectrum
Vancomycin spectrumactive vs. gram + and anaerobes, MRSA
Metronidazole (flagyl) spectrumanaerobes and protozoa
Clindamycin spectrumgram + and some anaerobic coverage
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Section 7

Question Answer
Sulfonamides common indicationCA- MRSA, UTI, PCP Tx and prophylaxis
Narrow spectrum penicillin common indicationsstrep, syphilis, meningitis, endocarditis, CAP
Extended Spectrum penicillins common indicationserious or resistant infection like endocarditis and osteomyelitis
PCNs + beta-lactamase inhibitor common indicationspneumonia, sinusitis, bite wounds, diabetic foot ulcers
Monobactam common indicationspneumonias and sepsis
Carbapenems common indicationsTx of serious nosocomial infection and intra-abdominal infections
1st generation cephalosporins common indicationsskin and soft tissue infections, UTI, surgical prophylaxis
2nd generation cephalosporin common indicationsURTI, AOM, CAP, PID
3rd generation cephalosporin common indicationsAOM, pneumonias, intra-abdominal infections, sepsis, UTI, lyme, gonorrhea. Certain " " are DOC for serious gram + infections like endocarditis and meningitis
4th and 5th generation cephalosporin common indicationsused to treat infections due to multi-drug resistant bacteria
Fluoroquinolones common indicationsUTI, prostatitis, enteritis, travelers diarrhea, intraabdominal infections, febrile neutropenia, URTI, sinusitis, bronchitis, CAP, Legionella, mycobacterial infections, soft tissue infections, anthrax (DOC for all types of Anthrax)
Macrolides common indicationsURTI, skin and soft tissue infections, AOM, DOC for mycoplasma pneumonia, endocarditis
Advanced macrolides common indicationsURTI, skin and soft tissue infections, AOM, DOC for mycoplasma pneumonia, endocarditis, LRTI, sinusitis, all CAP, genitourinary tract infections, STDs, PID, MAC, and H. pylori in PUD
Tetracyclines common indicationstx for rocky mountain spotted fever, lyme disease, PID, chlamydia, syphilis, acne (oral and topical), anthrax (2nd line)
Aminoglycosides common indicationsserious infections such as septicemia, respiratory tract infections, post- op and intra abdominal infections (including peritonitis) complicated and recurrent UTIs, febrile neutropenia
Chloramphenicol common indicationsonly indication is typhoid fever, but use is increasing because bacteria are becoming resistant to other antibiotics
Vancomycin common indicationsendocarditis, osteomyelitis or other serious infections, often reserved for MRSA infections, can use PO form C. dificile colitis
Metronidazole common indicationsPO for C. dificile (DOC), trichomoniasis, giardiasis, nongonococcal, urethritis, PID, anaerobic adn mixed aerobic anaerobic bacterial infections, amebiasis, and amebic liver abscess cause by entamoeba histolytica, H. pylori PUD, rosacea (topical)
Clindamycin common indicationsUsed to treat strep and staph (MSSA), when allergic to other antibiotics and anaerobic infections; PID, vaginosis
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Section 8

Question Answer
Use (s) of alpha agonistsnasal decongestants (vasoconstriction of swollen tissue) and hypotension (vasoconstriction)
Use (s) of alpha 1 (*Primary receptor for HEENT)hemorrhage (superficial vasoconstriction) (combines with local anesthetic to promote healing) and anaphylaxis (relieve swelling)
use (s) of beta 1anaphylaxis (cardiac stimulation)
Use (s) of beta 2anaphylaxis (bronchodilate)
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Section 9

Question Answer
Indications for nasal prepsnasal disorders
local nasal prep ADRsirritation, stinging, sneezing, and dryness
systemic nasal prep ADRsincrease HR, decreased nasal mucosa absorption due to swallowing excess (more gastric absorption)
ADRs of Rhinitis Medicamentosa"rebound congestion" d/t receptor desensitization/overuse of oxymetazolone or phenylephrine
C/I of nasal prepsMAOI's (catecholamines)
Examples of Topicals (C) Nasal Prep Vasoconstrictor, Oxymetazolone (Afrin), and Phenylephrine
Examples of nasal preps sprayspreferred in adults, better coverage of nasal mucosa
Examples of nasal preps dropspreferred in kids (over 2 years old) ; more easily administered by parents
Indications for optho prepseye disorders
ADRs of local ophto prepsirritation, burning, stinging, visual discturbances
ADRs of systemic optho prepsgreater systemic absorption due to high concentrations and the fact that the drug is absorbed directly into the tear ducts
C/I of optho prepsclosed angle glaucoma
Examples of optho prepsOxymetazolone (ocuclear), phenylephrine (relief), Tetrahyrosaline (Visine), and Naphazoline (clear eyes, naphcon)
Examples of oral prepspseudophedrine, phenylephrine, ephedrine, phenylpropanolamine (off the market)
Combo agents of Oral prepsantihistamines, ibuprofen, and anti-tussives
Uses of pseudophedrinedecongestant
uses of phenylephrinedecongestant
uses of ephedrineappetite suppressant
uses of phenylpropanolamine (off the market)decongestant and appetite suppressant
"complete cold formulas"combo of nasal, optho, and oral preps
Important ADRs of complete cold formulasincreased HR, BP, palpitations, irritability, insomnia, appetite suppression, and CNS stimulation (d/t oral prep relation to amphetamines)
other ADRs of complete cold formulasagitation, restlessness, nervousness, euphoria
What can not be given to children under 2 yocold and cold preps (inclu. antihistamines, deongestants, dexomethorphan
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Section 10

Question Answer
what is histamineCNS NT produced by mast cells/basophils of skin, GI (paracrine) , respiratory tract
how is histmine formedcarboxylation of histadine
Where is histmine released frommast cells by IgE (degranulation)
what blocks the release of histamine from mast cells by IgEcromolyn
Physiological effects of histaminevasodilation (hypotension), increase vascular permeability (edema), increased HR & contractility , and bronchoconstriction (decrease amount of allergen entering the lungs)
Therapeutic effects of anti-histamineallergic rxns, seasonal & allergic rhinitis, motion sickness , and insomnia
efficacy of anti-histaminePREVENTING histamine mediated rxns & well absorbed PO due to large Vd and effective liver metabolism
ADRs of anti-histaminesedation, anti-sludge, orthostatic hypotension
Histamine receptorsH1, H2, and H3
H1 receptorsmediate allergic rxns (dermatitis, rhinitis, conjunctivitis, pruritus, and shock
H1 receptor anatagonistsblock histamine via competitive inhibition
H2 receptorsgut and GI secretions
H3 receptorspresynaptic NTs
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Question Answer
First generation anti-histamines1st gen. alkylamines, 1st gen. ethanolamines, 1st gen. phenothiazines, 1st gen. piperidines, and 1st gen. piperazines
Example(s) of 1st gen alkylaminesBrompheniramine (Dimetapp) and Triprolindine
Example(s) of 1st gen ethanolaminesDephenhydramine (Benydryl)
Example(s) of 1st gen phenothiazinesPromethazine (phenergen)
Examples (s) of 1st gen piperdinescyproheptadine
Example (s) of 1st gen piperazinesMeclizine (Antivert)
ADRs of 1st gen alkylaminesTripolidine is LEAST sedative of all
ADRs of1st gen ethanolaminesBenadryl is sedating and cholinergic
ADRS of 1st gen phenothiazinessedating and anti-cholinergic
ADRs of 1st gen piperadinesGI effects (slow peristalsis and anti-emetic) and sedating
ADRs of 1st gen Piperazinesfor motion sickness but very sedating
ADRs of First Generation Antihistminessedation, anti- SLUDGE, and Anticholinergic toxicity (--> manifest as overdose--> administer phyostigmine
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Section 11

Question Answer
Second Generation Antihistamines2nd gen. piperidines and 2nd gen. piperazines (little to no sedation)
Example of 2nd generation piperidinesLoratadine (Claritin) and Fexofenadine (Allegra)
Example of 2nd generation piperazinesCetirizine (Zyrtec)
Significant DDIs with "-azoles" antifungals and macrolides -->torsades de pointes lethal ventricular tachy
This 2nd gen piperidine is better as a preventative which takes 7-10 days to reach blood levelLoratadine (Claritin)
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Question Answer
examples of preservativesbenzalkoniums and mercurials
examples of viscosity increasing agentsmethylcellulose, dextran 70, gelatin
examples of antioxidantsEDTA, sulfites
examples of Wetting agentspolysorbate 20 & 80
examples of buffersboric acid, HCl, K and Na salts
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