Therapeutics Id Bergman Test Questions Flashcard

Penicillin G and V

Beta Lactam Antibiotic

 

Only effective against Beta Hemolytic, Groups A and B Streptococcus

DOC for syphilis

Oxacillin

Beta Lactam

 

Anti-Staph Drug

DOC for MSSA

Nafcillin

Beta Lactam

 

Anti-Staph Drug

DOC for MSSA

Dicloxacillin

Beta Lactam

 

Anti-Staph Drug

DOC for MSSA

Ampicillin

Beta Lactam

 

  • Aminopenicillin Drug
  • Designed against G- organisms –> not effective anymore because of Beta-Lactamase produced by enteric G- bacteria
  • Effective against Alpha Hemolytic Streptococcus (S. pneumoniae, Viridans group)
  • Effective against Enterococcus faecalis in the blood –> give IV

 

Amoxicillin

Beta Lactam

  • Aminopenicillin Drug
  • Designed against G- organisms –> not effective anymore because of Beta-Lactamase produced by enteric G- bacteria
  • Effective against Alpha Hemolytic Streptococcus (S. pneumoniae, Viridans group)

 

Piperacillin

Beta Lactam

  • Anti-Pseudomonal Drug
  • Effective against Enteric bacteria (E. coli, Klebsiella) and Pseudomonas aeruginosa
  • Drug is still susceptible to Beta Lactamase so it is usually combined with Ticarcillin

Ticarcillin

Beta Lactam

  • Anti-Pseudomonal Drug
  • Effective against Enteric bacteria (E. coli, Klebsiella) and Pseudomonas aeruginosa
  • Drug is still susceptible to Beta Lactamase so it is usually combined with Piperacillin

Sulbactam

Beta Lactamase Inhibitor

  • Usually combined with Ampicillin (Ampicillin/Sulbactam)
  • Inhibits beta lactamase so the antibiotic can work on bacteria
  • Improved activity against organisms that produce beta-lactamase such as:

1. Staphylococcus aureus

2. Enteric G- Bacteria (E. coli, Klebsiella)

3. Respiratory G-

4. Anaerobes

Clavulanate

Beta Lactamase Inhibitor

  • Usually combined with Amoxicillin and Ticarcillin
  • Inhibits beta lactamase so the antibiotic can work on bacteria
  • Improved activity against organisms that produce beta-lactamase such as:

1. Staphylococcus aureus

2. Enteric G- Bacteria (E. coli, Klebsiella)

3. Respiratory G-

4. Anaerobes

Tazobactam

Beta Lactamase Inhibitor

  • Usually combined with Piperacillin
  • Inhibits beta lactamase so the antibiotic can work on bacteria
  • Improved activity against organisms that produce beta-lactamase such as:

1. Staphylococcus aureus

2. Enteric G- Bacteria (E. coli, Klebsiella)

3. Respiratory G-

4. Anaerobes

Cefazolin

Beta Lactam

  • 1st Generation Cephalosporin
  • Administered IV
  • Effective against MSSA, Beta Hemolytic Group A and B Strep.
  • Prophylaxis prior to surgery to prevent infections from skin flora

Cephalexin

Beta Lactam

  • 1st Generation Cephalosporin
  • Administered PO
  • Effective against MSSA, Beta Hemolytic Group A and B Strep.
  • Same spectrum of activity as Cefazolin

Cefuroxime

Beta Lactam

  • 2nd Generation Cephalosporin
  • Administered IV and PO
  • Effective against Alpha Hemolytic Strep. (Streptococcus pneumoniae, Viridans), Respiratory G- cocci (H. influenzae)
  • Used in COPD
  • However, not DOC for any infection?

Cefoxitin

Beta Lactam

  • 2nd Generation Cephalosporin (Cephamycin)
  • Administered IV
  • Effective against Enteric bacteria (E. coli, Klebsiella) and Anaerobes (Clostridium, Bacteroides, Peptostreptococcus)
  • Prophylaxis prior to surgery to prevent intra-abdominal infections
  • Does not have good G+ activity

Cefotetan

Beta Lactam

  • 2nd Generation Cephalosporin (Cephamycin)
  • Administered IV
  • Effective against Enteric bacteria (E. coli, Klebsiella) and Anaerobes (Clostridium, Bacteroides, Peptostreptococcus)
  • Prophylaxis prior to surgery to prevent intra-abdominal infections
  • Does not have good G+ activity

Ceftriaxone

Beta Lactam

  • 3rd Generation Cephalosporin
  • Administered IV
  • Effective against Alpha Hemolytic Strep. (S. pneumoniae, Viridans group), Enteric bacteria (E. coli, Klebsiella)
  • Very commonly used in hospital setting, plus QD dosing
  • Not for newborns –> excreted biliary, not well developed in newborns

Cefotaxime

Beta Lactam

  • 3rd Generation Cephalosporin
  • Administered IV
  • Effective against Alpha Hemolytic Strep. (S. pneumoniae, Viridans group), Enteric bacteria (E. coli, Klebsiella)
  • Commonly used in hospital setting
  • Not for newborns –> excreted biliary, not well developed in newborns

Ceftazidime

Beta Lactam

  • 3rd Generation Cephalosporin
  • Administered IV
  • Effective against Enteric bacteria (E. coli, Klebsiella), Pseudomonas aeruginosa
  • G- activity

Cefepime

Beta Lactam

  • 4th Generation Cephalosporin
  • Administered IV
  • Effective against Alpha Hemolytic Strep. (S. pneumoniae, Viridans group), Enteric bacteria (E. coli, Klebsiella), Pseudomonas aeruginosa
  • Sounds good to have all 3 covered but usually one will not need that kind of coverage

Ceftobiprole

Beta Lactam

  • 5th Generation Cephalosporin 
  • 1st Beta Lactam with MRSA activity
  • Has pseudomonas activity

Ceftaroline

Beta Lactam

  • 5th Generation Cephalosporin 
  • 1st Beta Lactam with MRSA activity

Imipenem

Beta Lactam

  • Carbapenem
  • Activity against Enteric bacteria (E. coli, Klebsiella), Pseudomonas aeruginosa, Anaerobes (Clostridium, Bacteroides, Peptostreptococcus)
  • DOC for Extended Spectrum Beta Lactamase (produced by E. coli and Klebsiella)

Meropenem

Beta Lactam

  • Carbapenem
  • Activity against Enteric bacteria (E. coli, Klebsiella), Pseudomonas aeruginosa, Anaerobes (Clostridium, Bacteroides, Peptostreptococcus)
  • DOC for Extended Spectrum Beta Lactamase (produced by E. coli and Klebsiella)

Doripenem

Beta Lactam

  • Carbapenem
  • Activity against Enteric bacteria (E. coli, Klebsiella), Pseudomonas aeruginosa, Anaerobes (Clostridium, Bacteroides, Peptostreptococcus)
  • DOC for Extended Spectrum Beta Lactamase (produced by E. coli and Klebsiella)

Ertapenem

Beta Lactam

  • Carbapenem
  • Activity against Enteric bacteria (E. coli, Klebsiella), Anaerobes (Clostridium, Bacteroides, Peptostreptococcus), Streptococcus
  • Does NOT cover Pseudomonas aeruginosa (different from other carbapenem drugs), Enterococcus, or A. baumanii
  • Advantage over other carbepenems is it is QD dosing, but it has a narrower spectrum
  • Used for plain G- Enterics
  • DOC for Extended Spectrum Beta Lactamase (produced by E. coli and Klebsiella)

Aztreonam

Beta Lactam

  • Monobactam (only one ring)
  • Similar to ceftazidime
  • Activity against enterics (Not ESBLs), Pseudomonas aeruginosa

Aminoglycosides

  • Inhibits ribosomes
  • Penetrates G- cell walls
  • Does not work by itself against G+
  • Works in synergy with beta lactams to target G+ bacteria
  • IV Only
  • A good back up when bacteria is resistant to beta lactam antibiotics

Gentamicin

Aminoglycoside

  • Not effective by themselves because of poor tissue penetration, but OK in urine (eliminated renally)
  • Administered IV
  • Synergy for Enterococcus, Staphylococcus aureus
  • Double coverage for potentially resistant enteric G- bacteria, Pseudomonas aeruginosa

Tobramycin

Aminoglycoside

  • Not effective by themselves because of poor tissue penetration, but OK in urine (eliminated renally)
  • Administered IV
  • Synergy for Enterococcus, Staphylococcus aureus
  • Double coverage for potentially resistant enteric G- bacteria, Pseudomonas aeruginosa

Amikacin

Aminoglycoside

  • Not effective by themselves because of poor tissue penetration, but OK in urine (eliminated renally)
  • Administered IV
  • Synergy for Enterococcus, Staphylococcus aureus
  • Double coverage for potentially resistant enteric G- bacteria, Pseudomonas aeruginosa

Polymyxin B

  • Effective against resistant G- bacteria and G- bacteria that produce carbopenamase
  • Last line of defense against resistant Pseudomonas aeruginosa and A. baumanii
  • Also found in double and triple antibiotic ointment (neosporin) –> works well topically
  • Also administered IV
  • Toxic side effects

Colistin

  • Polymyxin E
  • Effective against resistant G- bacteria and G- bacteria that produce carbopenamase
  • Last line of defense against resistant Pseudomonas aeruginosa and A. baumanii
  • Also found in double and triple antibiotic ointment (neosporin) –> works well topically
  • Also administered IV
  • Toxic side effects

Trimethoprim-Sulfamethoxazole

Sulfonamide

  • Effective against Staphylococcus aureus and community acquired MRSA
  • Effective against G- enterics, especially UTIs (PK) –> eliminated renally
  • Not the greatest against Strep. anymore

Rifampin

  • Synergy for MRSA
  • Resistance develops if used by itself so use in combo
  • CYP P450 inducer

Azithromycin

Macrolide

  • More commonly used because well tolerated and fewer drug interactions
  • first class with atypical coverage
  • Z pack used commonly in resp. infections
  • Effective against S. pneumoniae, H. influenzae, atypicals
  • Concentration dependent

Doxycycline

Tetracycline

  • Time dependent, bacteriostatic –> longer courses, more frequent dosing
  • Similar to macrolides in that it is effective against S. pneumoniae, H. influenzae, atypicals
  • Has the added coverage of minor MRSA infections
  • Not as common as macrolides

Ciprofloxacin

Fluoroquinolones

  • Only used against G- bacteria (Enterics and Pseudomonas aeruginosa) and Atypicals
  • Good oral bioavailability (the only oral class that has activity against P. aeruginosa)
  • Poor against G+

Levofloxacin

Fluoroquinolones

  • Effective against Streptococcus spp., G- bacteria (Enterics and Pseudomonas aeruginosa), Atypicals
  • Good oral bioavailability (the only oral class that has activity against P. aeruginosa)

Moxifloxacin

Fluoroquinolones

  • Effective against Streptococcus spp., Enterics, Atypicals
  • No activity against Pseudomonas aeruginosa but gains the activity against anaerobes (Clostridium, Bacteroides, Peptostreptococcus)

Clindamycin

  • Effective against S. aureus, including MRSA (esp. in children)
  • Effective against Beta Hemolytic Group A and B Streptococcus and Strep. pneumoniae
  • Effective against anaerobes

Metronidazole

  • DOC for most anaerobic infections (Clostridium, Bacteroides, Peptostreptococcus)
  • Better activity against anaerobes than moxifloxacin

How would you arrange the drugs effective against anaerobic infections from greatest activity to least activity?
Metronidazole > Clindamycin > Moxifloxacin, Beta Lactamase Inhibitors with Penicillin
Vancomycin

  • Effective against all G+ except VRE
  • DOC for MRSA infections but cure rates still not good
  • Very effective against bacteremia (endocarditis)
  • Has poor tissue penetration –> if patient has MRSA in lungs, cannot use Vanco

Quinupristin/Dalfopristin

  • MRSA agent
  • First drug for VRE
  • Not effective against E. faecalis
  • Side effects limits usefulness –> not used clinically

Linezolid

  • MRSA agent
  • Effective against VRE
  • Good tissue penetration –> can be used for MRSA pneumonia
  • Not useful for bacteremia
  • Use caution long term and with SSRIs

Daptomycin

  • MRSA agent
  • essentially the opposite of linezolid (can be used for bacteremia, not for pneumonia)
  • QD and approved for endocarditis

Telavancin

  • MRSA agent
  • similar to vancomycin and daptomycin — has MOA of both
  • Good for pneumonia, not approved yet for bacteremia
  • Also covers anaerobes and G- other than P. aeruginosa

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