1. Antibiotics Slackers Facts by Mike Ori

2. Disclaimer The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes. The document can mostly be used forward and backward. I tried to mark questionable stuff with (?). If you want it to look pretty, steal some crayons and go to town. Finally… If you’re a gunner, buck up and do your own work.

3. What are the types of beta lactam antibiotics

4. Penicillins Cephalosporins Carbapenems Monobactams

5. Name the classes of penicillins

6. Standard Antistaphylococcal Amino Antipseudomonal

7. What are the anti-staph penicillins and their routes

8. Nafcillin - IV Dicloxacillin - PO

9. What are the standard penicillins and routes

10. Penicillin V – PO Penicillin G - IV

11. Which bacteria are exquisitely sensitive to standard penicillins

12. Group A strep (pyogenes)

13. Amino penicillins names and routes

14. Ampicillin – PO,IV Amoxicillin – PO

15. What is typically coadministered with the aminopenicillins

16. Beta lactamase inhibitors Amoxicillin – clavulanate Ampicillin - sulbactam

17. What is the CSF action of aminopenicillins

18. Can reach CSF if the meninges are inflamed

19. What side effect can happen when giving aminopenicillins to pt with infectious mononucleosis, chronic lymphocitic leukemia, allopurinol

20. Rash Lowest incidence with allopurinol, others are very high.

21. Cephalosporins names, generation, routes, and gram positive/negative effectiveness

22. GenerationRoutePositiveNegative Cefazolin1IM, IV++++ Cephalexin1PO None tested2++ Ceftriaxone3IM, IV+++++ Ceftazidime3IM, IV Cefepime4IM, IV+++ Susceptibility by generation. General trend is down with gram positives and up with gram negatives.

23. Which generation reaches effective levels in the CSF

24. Third gen

25. Your patient has an allergy to penicillin G can you administer cephalosporins

26. Maybe. Contraindicated if the pt experienced an IgE mediated rash. Caution with other penicillin type reaction.

27. Carbapenems names, routes, and spectrum

28. Imipenem, IV Broadest range of all available antibiotics. Excellent penetration through porins into gram negative periplasmic space

29. What is cilastin

30. A drug coadministered with imipenem to inhibit kidney ezymes that breakdown imipenem into nephrotoxic metabolites

31. Imipenem ADR

32. Seizures

33. Monbactam names, routes, spectrum

34. Aztreonam, IV gram negatives including P aeruginosa. Ineffective against gram positives or anaerobes

35. Glycopeptides name, route, spectrum

36. Vancomycin, IV, Gram positives only

37. Vanco has poor oral availability so why do the dosing instructions include oral administration?

38. Vanco is useful for treatment of gram positive anaerobic infections of the GI tract such as C. difficile infections.

39. Describe the ADR from rapid infusion of vancomycin

40. Rapid infusion results in histamine release that cause flushing of the skin of the neck and upper trunk that can result in hypotension. AKA red man or red neck syndome

41. List the protein inhibitory antibiotic classes and their action

42. Aminoglycosides – 30s Macrolides – 50s Lincosamides – 50s Tetracyclines – 30s Chloramphenicol – 50s Streptogramins – 50s Oxazolidinones – ribosome assembly

43. Aminoglycoside names, routes, spectrum

44. Gentamicin, IV Tobramycin, IV Both are effective against aerobic gram negative and mycobacterium

45. Aminoglycoside toxicity characteristics

46. Nephrotoxic and ototoxic above an patient variable threshold in time dependent manner

47. Aminoglycoside dosing characteristics

48. Concentration dependent killing with significant post antibiotic effect allows for once daily dosing. Note: This contrasts to most others that are both time and concentration dependent.

49. Why are aminoglycosides ineffective against anaerobic bacteria?

50. Entry into the cell is mediated by oxygen dependent transport.

51. Aminoglycoside resistance basis

52. Transferase enzymes inactive them. Unlike penicillins, there are variations in the resistance enzymes.

53. Aminoglycoside toxic trough threshold

54. Trough concentrations above 2 mcg/mL are predictive of toxicity

55. Macrolide names, route

56. Azithromycin, PO (Z pack), IV

57. Azithromycin indications

58. Treatment of out of hospital community acquired respiratory infection and in hospital pneumonia in combination. STD’s

59. Macrolide CSF penetration characteristics

60. Poor

61. Azithromycin volume of distribution

62. Extremely high volume of distribution with tissue concentration 10-100x plasma.

63. Azithromycin half life

64. 2-4 days

65. Primary azithromycin caution

66. Caution in PT with prolonged QT interval due to risk of torsades des pointes

67. Lincosamides name, route, spectrum

68. Clindamycin, PO,IV, strep, staph, anaerobes

69. Clindamycin indications

70. Anaerobes above the diaphragm

71. Clindamycin associated disease

72. C-diff enteritis

73. Tetracycline name, route, spectrum

74. Doxycycline, PO, IV, Chlamydia, mycoplasma, spirochetes

75. Tetracyclines contraindication

76. Children and pregnant or breastfeeding women due to staining of developing teeth

77. Tetracycline food cautions

78. Do not take with meals, supplements, or vitamins due to cation chelation

79. Your PT is a lifeguard with chlamydia, should you prescribe doxycycline?

80. No, photosensitivity is a common side effect.

81. Chloramphenicol indication and route

82. Given IV as second line therapy for CSF infections

83. What is the basis of chloramphenicol’s black box warning

84. Causes dose dependent myelosuppression that can lead to aplastic anemia.

85. Fluroquniolones names, route, spectrum

86. Ciprofloxacin Levofloxacin Moxifloxacin Excellent oral availability. IV forms exist. Active against gram negative bacilli

87. Fluroquniolones CSF therapeutic role

88. Unknown. Not recommended for meningitis.

89. What are common ADR to fluoroquinolones

90. CNS: hallucinations, delerium, seizures Bone: Cartilage damage, tendonitis Pregnancy class C

91. Ok Smarty, what is pregnancy class C

92. C = don’t give it to them cause it jacks up animal fetuses and the IRB won’t give you the go ahead to test it on humans.

93. What are the respiratory fluoroquinolones?

94. Levifloxacin Moxifloxacin

95. Fluoroquniolones food cautions

96. Do not take with meals, supplements, vitamins as chelation occurs.

97. Metronidazole route and spectrum

98. Obligate anaerobes, PO and IV

99. Metronidazole function

100. Creates reactive intermediates and free radicals that damage cellular components.

101. Your patient has an anaerobic bacterial infection. He has a small firm micronodular liver. What are the issues for metronidazole?

102. Hepatic metabolism with renal excretion. Disulfiram like effects with alcohol use.

103. Rifmycin antibiotic mechanism

104. Inhibits RNA polymerase

105. Rifampin metabolism

106. Hepatic. Induces microsomal system which increases metabolism of other drugs.

107. Sulfonamide action

108. Inhibits PABA conversion to dihydrofolate by dihydropteroate synthetase

109. Trimethoprim action

110. Inhibits DHF conversion to THF by DHR reductase

111. What is TMP-SMX and why is it given?

112. TMP = trimethoprim SMX = sulfamethoxazole (a sulfonamide) Given in combination to increase their effectiveness by 20-100 times over SMX alone.

113. TMP-SMX indication

114. UTI and pneumocystis jiroveci pneumonia

115. Your patient complains of a rash after starting UTI treatment. What did you prescribe. Are you worried about the rash?

116. You prescribed TMP-SMX. You would be very worried about this rash and would advise your PT to stop taking the drug immediately.

117. Your patient does not stop taking the drug even though you called back later and re-iterated the importance. A few days later you receive a courtesy call from an ER doc advising you that they are admitting your pt. What is a potential admitting diagnosis?

118. Stevens-Johnson syndrome or toxic epidermal necrolysis.

119. Which of the drugs (TMP/SMX) most likely caused the reaction and what is its general class.

120. Sulfamethoxazole. It is a sulfa drug.