1Which drug classes are beta lactams?
natural penicillins
antistaphylococcal penicillins
aminopenicillins
antipseudomonal penicillins
cephalosporins
carbapenems
monobactams
2What is the MOA of beta lactams?
cell wall inhibitors
3Which bacteria do natural pencillins work against?
gram postive aerobes (strep pyogenes and strep pneumoniae)
gram negative cocci (N. meningitidis)
spirochetes (T. pallidum)
brnaching gram-positive anaerobes (actinomyces)
4What are the AE of natural penicillins?
hypersensitivity
hemoytic anemia positive direct Coombs test
interstitial nephritis
seizures
GI SE
5Which drugs do natural penicillins increase the effect of?
methotrexate
warfarin
6What is an anti staphylococcal penicillin drug?
nafcillin
dicloxacillin
oxacillin
7What is the clinical use of nafcillin?
skin and soft tissue MSSA
S. aureus
8What are the two aminopenicillins?
amoxicillin
ampicillin
9What is a tip to remeber how amoxicillin and ampicillin are administered?
amOxicillin is administered orally and amPICillin is administered by a prick
10What does HHEELPSSS stand for with aminopenicillin therapy?
H. pylori
H. influenzae
E. coli
enterococci
listeria monocytogenes
proteus mirabilis
salmonella
shigella
spirochetes
11What are aminopenicillins used for in adults?
ENT
GU tract
skin and skin structure
Gonorrhea
H. pylori
lower respiratory tract
pharyngitis
12What are aminopenicillins used for in pediatrics?
ENT
GU tract
skin and skin structure
acute otitis media
gonorrhea
13What are some adverse effects of aminopenicillins?
pseudomembranous colitis
hypersensitivity
drug induced rash
14Which drugs interact with aminopenicillins and increases aminopenicillin concentrations?
allopurinol
probenecid
15Which drugs interact with aminopenicillins and their effect is increased?
warfarin
methotrexate
16What are the antipseudomonal drugs?
Augmentin
zosyn
unasyn
timentin
17What is zosyn a combination of?
piperacillin and tazobactam
18What is augmentin a combination of?
clavulanic acid and amoxicillin
19What is unasyn a combination of?
sulbactam and ampicillin
20What bacteria are treated w/ antipseudomonal penicillins?
gram negative rods (pseudomonas)
anaerobes (bacteroides fragilis)
gram positive aerobes but not effective against S. viridans
21What is the clinical use of augmentin?
ear infections that are resistant to amoxicillin alone
sore throats
eye infections and bronchitis
22What is zosyn used for
HAP
CAP
female pelvic infections
skin and skin structure infections
intra-abdominal infections
nosocomial infections
23What bacteria does zosyn work against?
gram positive, gram negative and anaerobes
24All beta-lactams are excreted ____?
renally
25What are the exceptions to the beta lactam renal excretion rule?
nafcillin is excreted through the biliary system
anti-staphylococcal penicillins are excreted renally and biliary
ceftriaxone is excreted renally and biliary
26Which two beta-lactams have good CNS penetration?
ceftriaxone
aztreonam
27What are the carbapenems?
imipenem
meropenem
ertapenem
doripenem
28Are carbapenems bactericidal or bacteriostatic?
bactericidal
29What is imipenem always given with? Why?
cilastatin
it inhibits human dehydropeptidase I that breaks down imipenem
30What is the main clinical use of carbapenems?
life threatening infections
31What bacteria is carbapenems used for?
gram positive cocci
gram negative rods (pseudomonas aeruginosa)
anaerobes
32Which carbapenem does not have activity against pseudomonas?
ertapenem
33Which gram positive cocci do carbapenems not cover?
MRSA
enterococcus faecalis
34What is a major AE of carbapenems?
CNS toxicity
can lower seizure threshold at serum concentrations
35Imipenem/cilastatin is used for?
serious infections
intra-abdominal infections
pseudomonas
36What is an AE with imipenem/cilastatin?
seizures
37What are the therapeutic uses for meropenem?
serious infections
febrile neutropenia
pneumonia
38What are the therapeutic uses for ertapenem?
intra-abdominal infection
community acquired pneumonia
39What medication is a monobactam?
aztreonam
40What bacteria do monobactams cover?
gram negative bacteria only (pseudomonas, H. influenzae, N meningitidis)
41What are the clinical uses for monobactams (pugs bas)?
pneumonia
bronchitits
upper UTI
sepsis
skin infection
gynecological infection
abdominal infection
42What are the first generation cephalosporins?
cephalexin
cefazolin
43Which gram negative bacteria do 1st generation cephalosporins cover?
proteus mirabilis
E. coli
Klebsiella pneumoniae
44What other bacteria do first generation cephalosporins cover?
gram positive bacteria
45What is cefazolin (ancef) used for?
MSSA infection
perioperative prophylaxis
46What is cephalexin (keflex) used for?
cellulitis
skin infections
strep pharyngitis
uncomplicated cystitis
47What are the oral second generation cephalosporins
cefaclor
cefuroxime
48What are the IV second generation cephalosporins?
cefuroxime
cefoxitin
cefotetan
49Which is more active against gram postive bacteria second generation or first generation cephalosporins?
first generation
50What gram negative bacteria are covered with second generation cephalosporins?
proteus mirabilis
E. coli
Klemsiella pneumoniae
H influenzae
Klebsiella aerogenes
neisseria
serratia marcescens
51What are the therapeutic uses for cefaclor (ppile)
intra-abdominal infections
perioperative prophylaxis
pneumonia
lower respiratory tract infections
ear
52What are the third generation cephalosporins?
cefdinir
ceftriaxone
53What is cefdinir used for?
acute pharyngitis
sinusitis
54What is ceftriaxone used for (mag cuss)
meningitis
acute uncomplicated pyelonephritis
syphillis
gonococcal infections
CAP
UTI
streptococcal endocarditis
55What is a fourth generation cephalosporin?
cefepime
56What bacteria is cefepime good for?
highly active against gram positive bacteria
pseudomonas
57What are the therapeutic uses for cefepime?
nonsocomial
UTI
intra-abdominal
febrile neutropenia
pneumonia
58What is a fifth generation cephalosporins?
ceftaroline
59What bacteria does fifth generation cephalosporins cover?
gram positive bacteria
MRSA
listeria
enterococcus
60What are fifth generation cephalosporins used for?
CAP
skin and soft tissue infections
61Which two drugs increases nephrotoxic effect when prescribed together?
aminoglycosides and cephalosporins
62What are the glycopeptides?
vancomycin
bacitracin
telavancin
dalbavancin
oritavancin
63Glycopeptides are bactericidal or bacteriostatic? What is the exception?
bactericidal
bacteriostatic against C. diff
64When can glycopeptides penetrate the CNS?
when there is increased permeability of the meningeal vessels
65What are the adverse effects of glycopeptides?
nephrotoxicity
ototoxicity/vestibular toxicity
thrombophlebitis
red man syndrome
66How can red man syndrome be prevented?
slowing the rate of infusion and pretreating with antihistamines
67What is bacitracin used for?
minor skin infections
68What is the goal level for therapy with vancomycin?
15-20 mcg/mL
69What is an epoxide?
fosfomycin
70What is the MOA of fosfomycin?
inhibition of cell wall synthesis
71Is fosfomycin bactericidal or bacteriostatic?
bactericidal
72What is the clinical use of fosfomycin (epoxides)?
uncomplicated UTI
cystitis due to E. coli or E. faecalis
73What is an example of a lipopeptide?
daptomycin
74What is the MOA of daptomycin?
inhibition of synthesis of DNA, RNA and proteins (bactericidal)
75What is the clinical use of daptomycin?
skin and skin structure infections
bacteremia
endocarditis
vancomycin-resistant enterococci
76What is a condition lipopeptides (daptomycin) cannot be used for?
pneumonia
77What are the AE of lipopeptides?
reversible myopathy
rhabdomyolysis
78What is the MOA of polymyxins?
increased membrane permeability which leads to leakage of cell contents causing cell death
binds to and inactivates endotoxins
79When should you be cautious in using polymyxins?
patients with renal dysfunction
80What are the clinical uses of polymyxins?
severe infections caused by multidrug-resistant gram negative bacteria
disinfect bowel
superficial skin infections (part of triple antibiotic)
81What bacteria are polymyxins effective against?
gram negative bacteria
P aeruginosa
K pneumoniae
E coli
acinetobacter baumannii
enterobacteriaceae spp
82What is a common use for oral polymyxin B?
disinfect the bowel to prevent ICU infections
83What are the AE of polymyxins?
nephrotoxicity
neurotoxicity
84What three drug classes work by inhibition of protein synthesis (30s ribosomal subunit)?
aminoglycosides
tetracyclines
glycylcyclines
85What are the types of aminoglycosides?
gentamicin
amikacin
tobramycin
streptomycin
neomycin
86What are the two oral aminoglycosides?
streptomycin
neomycin
87What is the route of elimination for aminoglycosides?
renal
88What are the therapeutic uses for aminoglycosides?
UTI
pneumonia
meningitis
peritonitis
bacterial endocarditis
sepsis
CF
89What bacteria are aminoglycosides effective against?
severe gram negative rods
90Neiomycin is used specifically for?
prepare the gut for bowel surgery
91Which aminoglycoside is second line treatment for mycobacterium tuberculosis and M. avium-intracellulare?
streptomycin
92What are the AE of aminoglycosides?
nephrotoxicity
ototoxicity/vestubulotoxicity
93When should you be cautious when using aminoglycosides?
in patients with renal dysfunction
94What are the common aminoglycosides that are inhale and what are they prescirbed for?
tobramycin or amkacin
used for CF patients with chronic pseudomonas aeruginosa pulmonary infections
95What type of therapeutic index do aminoglycosides have?
narrow
96What must you use to determine dosing of aminoglycosides?
adjusted body weight
97What are aminoglycosides commonly used with to treat what?
beta-lactams
endocarditis
98What are the therapeutic uses for gentamicin?
synergy
endocarditis
sepsis
99What is tobramycin used for?
UTI
synergy
endocarditis
sepsis
CF
100What are examples of tetracyclines?
minocycline
tetracycline
doxycycline
demeclocycline
101What is the MOA of tetracyclines?
bind 30S subunit
102What is the route of eliminaton for tetracyclines?
renal
103Which tetracycline is the only one that is GI eliminated and not contraindicated in patients with renal failure?
doxycycline
104What bacteria are tetracyclines effective against?
bacteria that lack a cell wall (mycoplasma pneumoniae, ureaplasma)
intrecellular bacteria (rickettsia, chlamydia, or anaplasma)
borrelia burgdorferi
ehrlichia
vibrio cholerae
francisella tularensis
cutibacterium acnes
community acquired MRSA
105What specific tetracycline is used to treat community acquired MRSA?
doxycycline
106What is a caution with oral tetracyclines?
patient should not take with large amounts of Ca2+, Mg2+, Fe2+ because divalent cations inhibit the intestinal absorption of tetracyclines
107What are the AE with tetracyclines?
deposition in bones and teeth (ca complexes) causing inhibition of bone growth and teeth discoloration
photosensitivity
108How should patients take tetracyclines and what should they avoid after taking?
take with water and avoid lying down for 30 minutes after ingestions
109What are the contraindications of tetracyclines?
children less than 8 (except doxy)
pregnant women (except doxy)
breastfeeding women
patients with renal failure (except doxy)
hepatic dysfunction
110What are the therapeutic use of doxycycline?
1st line for community acquired pneumonia
lyme disease
malaria prophylaxis
rickettsial disease
cholerae
plaque
111What are the AE of doxycycline?
GI upset
n/v/d
hepatotoxicity
ARF
phototoxicity
increased BUN
112What are the therapeutic uses of minocycline?
acne
syphilis
113What are the therapeutic uses of tetracycline?
acne
peptic ulcer disease
vibrio chollerae
114What is an example of glycylcyclines?
tigecycline
115What is the MOA of tigecycline?
bind to 30s subunit
116What is the route of elimination of tigecycline?
biliary
117What are the AE of glycylcyclines?
hepatotoxicity
118What are the therapeutic uses for tigecycline?
skin and soft tissue infections
complicated intra-abdominal infections
119Which drug classes have the MOA of inhibition of protein sythesis by inhibiting 50S ribosomal subunit?
macroides
lincosamides
oxazolidinones
amphenicols
120What are examples of macrolides?
erythromycin
azithromycin
121What bacteria does macrolides work against?
mycoplasma pneumonia
legionella oneumophila
chlamydophila pneumoniae
bordetella pertussis
chamydia
H pylori
122What are the AE of macrolides?
increased intestinal motility causing GI upset
QT interval prolongation causing arrhythmias
acute cholestatic hepatitis
rash
eosinophilia
123What is a DDI with erythromycin?
oral anticoagulants
increased theophylline serum concentrations
cytochrome P450 inhibitors
124What are the DDI with clarithromycin?
increased theophylline serum concentrations
cytochrome P450 inhibitors
125Which macrolide does not have a short half life?
azithromycin
126What are the CI of erythromycin estolate and clarithromycin?
pregnant women
127What is a CI with azithromycin and clarithromycin
hepatic failure
128At what age should you consider use of erythromycin in children?
less than 12
129at what age should you consider use of clarithromycin and azithromycin in children?
less than 6 months
130What is a CI for all macrolides?
breast feeding
131What is a CI of clarithromycin?
renal failure
132What are the indications for erythromycin?
respiratory, GI, GU, skin and soft tissue infections
syphilis
acute chronic bronchitis
pertussis
133What drugs should you not use with erythromycin?
lovastatin/simvastatin
QT prolongation agens
carbamezapine
corticosteroids
cyclosporine
digoxin
valproate
warfarin
134What are the AE of erythromycin/azithromycin?
N/V/D
abdominal pain
QTc prolongation
135What PE should you provide for patients taking erythromycin?
take with food to decrease GI upset
136What are the therapeutic uses of azithromycin?
CAP
disseminated mycobacterium avium in HIV postitive patients
gonococcal infections
acute exacerbation chronic bronchitis
137What are common conditions to use a Z pack for?
acute bacterial sinusitis
CAP
138What drug is a lincosamide?
clindamycin
139What are the clinical uses for clindamycin?
aspiration pneumonia
cellulitis due to MRSA infections
orofacial infection
acne
140What are the AE of lincosamides?
GI upset
pseudomembranous colitis
141What are the CI of lincosamides?
pregnant women during 1st trimester
breastfeeding women
142What should patients be told about clindamycin?
they can take with food to decrease GI upset
143What is an eample of oxazolidinones?
linezolid
144What is the clinical uses of oxazolidinones?
multidrug-resistant gram positive bacteria (VRE, MRSA)
complicated skin and soft tissue infections
bacteremia
145What is a major AE ith oxazolidinones?
serotonin syndrome- partially inhibits monoamine oxidase which is responsible for the breakdown of neurotransmitters like serotonin
146What are the CI (including DDIs) with linezolid?
SSRIs
MAOIs
pregnant women
147When are amphenicols CI?
infancy
pregnancy
renal or hepatic dysfunction
148What is an example of an amphenicol?
chloramphenicol
149What are the 2nd generation floroquinolones?
ciprofloxacin
ofloxacin
150What is a 3rd generation floroquinolone?
levofloxacin
151What is a 4th generation floroquinolone?
moxifloxacin
152What is the MOA of fluoroquinolones?
inhibits DNA gyrase which causes inhibition of DNA replication and transciption
153How is CNS penetration with floroquinolones?
good
154What is the common route of elimination for floroquinolones? What is the exception?
renal
moxifloxacin undergoes biliary excretion
155What PE do you need to provide for patients with fluoroquinolones?
Absoprtion is reduced when coadministered with polyvalent cations like magnesium, calcium and iron
156What are the clinical uses for norfloxacin, ciprofloxacin and ofloxacin (2nd generation fluoroquinolones)?
gram negative rods causing urinary and GI infections
some gram positive pathogens
GU infections causes by N gonorrheae, chlamydia trachomatis and ureaplasm urealyticum
157What specifically does ciprofloxacin cover?
pseudomonas aeruginosa
158What are the clinical uses for levofloxacin and moxifloxacin?
atypical bacteria
anaerobes
159Which fluoroquinolone is the 2nd line for TB in patients who cannot tolerate antitubercular drugs and in multidrug resistant TB?
moxifloxacin
160What are the AE of fluoroquinolones?
GI upset
peripheral neuropathy
can lower seizure threshold
hyper/hypoglycemia
QT prolongation
photosensitivity
muscle aches
leg cramps
tendinitis
tendon rupture
161What is the box warning for fluoroquinolones?
rupture is higher for individuals over 60 and individuals on steroid therapy
162What is a CI of fluoroquinolones?
myasthenia gravis
known QT prolongation
163What are the DDIs with fluoroquinolones?
antacids
warfarin
164What are the therapeutic uses for ciprofloxacin?
UTI
prostatitis
GI infections
pseudomonal activity
165What are the therapeutic uses for levofloxacin?
UTI
acute bacterial sinusitis
CAP
nosocomial pneumonia
166Does levofloxacin have more or less pseudomonal activity than ciprofloxacin?
less
167What are the therapeutic uses of moxifloxacin?
acute bacterial sinusitis
CAP
nosocomial pneumonia
168What does moxifloxacin not cover?
pseudomonas
169What is an example of nitroimidazoles?
metronidazole
170What effect does metronidazole have?
bactericidal and antiprotozoal
171What organisms is metronidazole is used against?
protozoa
anaerobes
facultative anaerobes
gardnerella vaginalis
H pylori
172What is metronidazole not effective against?
aerobes
173What are the AE of nitroimidazoles?
disulfiram like reactions (when consumed with alcohol)
metalic taste
174What are the s/s of a disulfiram-like reaction?
hypotension
flushing
tachycardia
175What are the CI for nitroimidazoles?
breast feeding women
pregnant women
children
176What are the diaminopyramidine deratives?
trimethoprim
177What are the sulfonamides?
sulfamethoxazole
sulfadiazine
sulfisoxazole
178What is an example of sulfonamide and diaminopyrimidine?
TMP/SMX (cotrimoxazole)
179What is the MOA of the sulfonamide?
inhibit dihydropteroate synthase which leads to inhibition of bacterial folic and synthesis
180What is the MOA of diaminopyrmidine?
inhibit dihydrofolate reductase which leads to inhibition of bacterial folic acid synthesis
181What is the primary route of elimanation for TMP/SMX?
renal
182What is CNS penetration for TMP?SMX?
good
183What are the adverse effects of sulfonamides?
photosensitivity
stevens-johnson syndrome
GI upset
nephrotoxicity
184What are the AE of diaminopyrimidine derivates?
artificially increased creatinine
185What are the CI of TMP/SMX?
children under 2
pregnant women
breastfeeding women
hepatic or renal failure
186What is an example of a nitrofuran?
nitrofurantoin
187What is the MOA of nitrofurantoin?
binds to bacterial ribosome which impairs metabolism and impaired synthesis of protein, DNA and RNA
188What are the clinical uses of nitrofurantoin?
enterococci
staphylococcus saprophyticus
group B strep
staphylococcus aureus
staph epidermis
E. coli
enterobacter
shigella
salmonella
citrobacter
neisseria
bacteroides
klebsiella
189What are nitrofurans not effective against?
psuedomonas and proteus
190What are the therapeutic uses for nitrofurans?
treatment and prophylaxis of acute uncomplicated UTIs
asymptomatic bacteriuria and or symptomatic UTI in pregnant women
191What should nitrofurans not be used for?
pyelonephritis
192What are the AE of nitrofurans?
pulmonary fibrosis
hemolytic anemia in patients with G6PD deficiency
GI upset
reversible peripheral neuropathy
193What are the CI of nitrofrans?
children less than one month old
breast feeding women
renal dysfunction with a creatinine clearance less than 60 mL/min
194What drug has increased effects when take with nitrofurans?
spironolactone
195What conditions are indicated for emperic atbx therapy?
meningitis
brain abscess
pneumonia
lung abscess
cellulitis
necrotizing fasciitis
surgical site infection
osteomyelitis
tonsillitis
pharyngitis
infective endocarditis
dysentary
spontaenous bacterial peritonitis
UTI
sepsis
196What drugs are used for broad specturm atbx therapy?
aminopenicillins with beta lactamase inhibitors
antipseudomonal penicillins
carbapenems
3rd, 4th and 5th generation cephalosporins
3rd and 4th generation fluoroquinolones
tetracycline
macrolides
197When is antibiotic prophylaxis indicated?
immunocopromised patients
infective endocarditis
before and after surgical procedures
post exposure prophylaxis
198What are the absolute contraindications for kids?
chloramphenicol
fluoroquinolones
ehambutol: in kids who cant report vision changes
tetracycline and glycylclines in kids under 8
TMP/SMX in kids under 2
nitrofurans in kids under 1 month
199What drugs are safe to use with pregnant women?
beta lactams
epoxide
lipopeptide
macrolides (azithromycin and erythromicyin but not estolate)
200Which atbx are safe to use in breastfeeding women?
beta lactams
lipopeptides
polymyxin
isoniazid
201What are the absolute CI drugs for patients in renal failure (eatt)?
epoxides
aminoglycoside
tetracyclines
TMP/SMX
202What are the absolute CIs in patients with hepatic failure?
tetracyclines
macrolides (except erythromycin)
SMX/TMP
nitrofurans
pyrazinamide