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Antibiotics
Major classes of antibiotics, treatments, side effects, dosage form, etc
| Question | Answer |
|---|---|
| Sulfonamides | One of oldest antibiotics on the market. Effective against a broad spectrum of microorganisms. |
| Antibiotics that work by blocking bacteria from making folic acid. | Sulfonamides |
| Most often used to treat UTIs | Sulfa drugs |
| Used to treat community acquired methicillin resistant Staphylococcus (MRSA) | Sulfa drugs |
| Similar to sulfa drugs and works best if taken with food and plenty of fluids | nitrofurantoin |
| Macrobid/Macrodantin | nitrofurantoin |
| Bactrim (DS) and Septra (DS) | sulfamethoxazole-trimethoprim |
| Therapeutic uses for sulfonamides | UTIs, otitis media, lower respiratory tract infections, phrophylaxis in Pneumocystis carinii pneumonia |
| Most common side effect of a sulfa drug | Rash |
| Possible side effects of sulfa drugs | nausea, drug fever, vomiting, jaundice, blood complications, and kidney damage |
| Possible fatal side effect of sulfa drugs | Stevens-Johnson syndrome, characteristic of large red blotches on skin |
| Possible side effects of nitrofurantoin | nausea and vomiting. unique side effect is urine discoloration (brown). Can also cause false urine glucose tests. |
| Auxiliary labels for sulfonamides | Do not drink alcohol. Take with fluids. Take with food. Avoid sun exposure. Take with food. |
| Contraindications for sulfamethoxazole-trimethoprim | in patients with history of drug induced immune thrombocytopenia; in megaloblastic anemia due to folate deficiency; infants younger than 2 months; and in marked liver or kidney dysfunction |
| Contraindications for nitrofurantoin | anuria (producing no urine); oliguria (having little urine); impairment of kidney function; previous history of jaundice/hepatic dysfunction w/ prior nitrofurantoin use; pregnant patients at term , during labor and delivery; neonates younger than 1 month |
| Mainly treats Gram + bacteria | Penicillins |
| Kills bacteria by inhibiting formation of their wall, weakened cell wall allows an excessive amount water to enter the bacterium through osmosis | Penicillins |
| Beta-lactam ring | Present in the molecular structure of all penicillins |
| Therapeutic uses of penicillins | abscesses, beta-hemolytic streptococcus, meningitis, otitis media, pneumonia, respiratory tract infections, Strep pharyngitis, tooth and gum infections, STIs, endocarditis due to streptococci |
| Common side effects of penicillins | Stomach upset and diarrhea; rare side effects usually with high dosing/IV infusion: mental disturbances, seizures, kidney damage, and bleeding abnormalities |
| Contraindications of penicillins | If person has allergy to one penicillin, all others are contraindicated. Amoxicillin-clavulanate is contraindicated in patients w/ liver dysfunction and severe renal impairment |
| Black box warning for Penicillin G benzathine | not for IV use, administered only by deep IM injection |
| If allergic to penicillin | may also be allergic to cephalosporins |
| Penicillin form that works best on empty stomach | Oral |
| Acid in what type of beverage can deactivate penicillin | fruit juice or carbonated drinks |
| Amoxil/Moxatag | amoxicillin |
| ampicillin | no brand drug |
| penicillin G | no brand drug |
| Pen VK | penicillin V |
| dicloxacillin | no brand drug |
| Aminopenicillins | amoxicillin (Amoxil and Moxatag) and ampicillin |
| Natural Penicillins | penicillin G and penicillin V (Pen VK) |
| Antistaphylococcal Penicillins | dicloxacillin, nafcillin, and oxacillin |
| Extended Spectrum Penicillins | piperacillin and ticarcillin |
| Combination Penicillins | amoxicillin-clavulanate (Augmentin), ampicillin-sulbactam (Unasyn), piperacillin-tazobactam (Zosyn), ticarcillin-clavulanate (Timentin) |
| Augmentin | amoxicillin-clavulanate |
| Unasyn | ampicillin-sulbactam |
| Zosyn | piperacillin-tazobactam |
| ticarcillin-clavulanate | Timentin |
| What penicillins are injectible | ampicillin, penicillin G, nafcillin*, oxacillin, piperacillin*, ticarcillin*, ampicillin-sulbactam*, amoxicillin-clavulanate, piperacillin-tazobactam*, ticarcillin-clavulanate* (* only in injectible form) |
| methicillin | older penicillin used for difficult staphylococcal infections, some bacteria has become resistant to it. replaced by antistaphylococcal penicillins |
| Methicillin-resistant Staphylococcus aureus (MRSA) | This type of infection is resistant to all antistaphylococcal penicillins, few drugs can treat. |
| Drug interactions with Penicillins | reduce the efficacy of oral contraceptives. May increase the risk of bleeding when used w/ anticoagulants such as heparin and warfarin. Live vaccine effectiveness may be decreased so coadministration should be avoided. |
| mechanism of action similar to penicillins, but differ in antibacterial spectrum, resistance to beta-lactamase, and pharmacokinetics | cephalosporins |
| divided into 5 groups, called generations | cephalosporins |
| first generation cephalosporins | work best on Gram + bacteria, work best on mild to moderate community acquired infections |
| cefazolin (Ancef) | only administered IV or deep IM injection |
| second generation cephalosporins | increased activity against Haemophilus influenzae (important pathogen in pediatric group) |
| therapeutic uses for second generation cephalosporins | otitis media (in children) and for respiratory and urinary tract infections |
| third generation cephalosporins | active against wide spectrum of Gram - organisms and used in severe infections |
| third generation cephalosporins only available in injectable forms | cefotaxime (Claforan), ceftazidime (Fortaz/Tazifcef), and ceftriaxone (Rocephin) |
| ceftriaxone | often mixed w/ lidocaine as injection is painful; frequently used in ER settings and to treat STIs. |
| First generation Cephalosporins | cefazolin (Ancef), cephalexin (Keflex) |
| Injection only cephalosporins | cefazolin (Ancef), cefotetan (Cefotan), cefoxitin (Mefoxin), cefotaxime (Claforan), ceftazidime (Fortaz/Tazicef), ceftriaxone (Rocephin), cefepime (Maxipime), ceftaroline (Teflaro) |
| Second generation Cephalosporins | cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefuroxime (Zinacef) |
| Third generation Cephalosporins | cefdinir (Omnicef), cefditoren (Spectracef), cefixime (Suprax), cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (Fortaz, Tazicef), ceftibuten (Cedax), ceftriaxone (Rocephin) |
| Fourth generation Cephalosporin | cefepime (Maxipime) |
| Fifth generation Cephalosporin | ceftaroline (Teflaro) |
| Used for treating pneumonia, UTIs, and sepsis caused by Gram - bacteria | cefepime (Maxipime), injectible 4th generation cephalosporin |
| Therapeutic uses for oral 1st and 2nd generation cephalosporins | dental work, oral infections |
| Used for heart and pacemaker procedures, neurosurgical operations, obstetric/gynecologic procedures and surgery, orthopedic surgery | cefazolin |
| Used for upper respiratory tract and sinus infections | Oral second generation |
| Used for UTIs and meningitis | parenteral third generation |
| Used for intra-abdominal infections | cefoxitin, cefotetan |
| Side effects of Cephalosporins | share same side effects as penicillins, cross sensitivity with penicillin allergy. commonside effects: nausea, vomiting, diarrhea, headache and dizziness. Rare, but severe: mental disturbances, seizures, heart palpitations, and bleeding abnormalities. |
| Auxiliary label for Cephalosporins | Avoid use of alcohol. |
| High sugar content in oral suspension form, patients w/ diabetes need to be informed | cefdinir |
| Oral suspension form of cephalosporins, stored at room temp | cefdinir and cefixime |
| Contraindications of Cephalosporins | not be used in neonates w/ elevated bilirubin levels or if receiving IV calcium-containing products; patients w/ milk protein hypersensitivity or carnitine deficiency; patients w/ penicillin or beta-lactam hypersensititity |
| Cephalosporin taken w/ food but not with antacids | cefditoren |
| Antibiotics w/ beta-lactam ring, referred to as beta-lactams | penicillins, cephalosporins, mono-bactams, carbapenems |
| drug interactions w/ cephalosporins | alcohol w/ or w/in 72 hours of use; may increase activity of anticoagulant warfarin; loop diuretics (furosemide) should be used in caution, due to increased risk of nephrotoxicity (kidney damage); not used in neonates receiving any calcium products |
| differ only slightly in molecular structure from penicillins and cephalosporins | carbapenems and monobactams |
| Drug class that kill bacteria by inhibiting formation of cell wall | Carbapenems and monobactams |
| Used for mixed infections w/ Gram + and Gram - bacteria | Carbapenems |
| Used only for Gram - bacterial infections | Monobactams |
| Therapeutic uses for Carbapenems and Monobactams | special situation serious healthcare-associated infections (HAIs); intra-abdominal infections, complicated skin/skin structure infections, complicated UTIs |
| doripenem | Doribax |
| Carbapenems only administered | by injection |
| ertapenem | Invanz |
| imipenem-cilastatin | Primaxin |
| meropenem | Merrem IV |
| aztreonam | Azactam |
| active only against Gram - bacilli, used to treat serious infections, sepsis, intra-abdominal infections, peritonitis, skin and soft tissue infections and UTIs | aztreonam |
| Side effects of carbapenems | skin rash, headache, anemia, pain; aztreonam inhalation can cause sore throat, cough, nasal congestion, wheezing, fever, and chest discomfort. IV form of aztreonam may cause neutropenia (increased liver enzymes) and skin rash. |
| cross-allergenicity to penicillins, cephalosporins, or carbapenems, should be used w/ caution in patients w/ history of beta-lactam hypersensitivity | aztreonam |
| Drug interactions with carbapenems | CNS side effect may be potentiated by co current cyclosporine use. when used w/ ganciclovir may result in seizures. may decrease levels of antiseizure medication valproic acid |
| vancomycin | Vancocin |
| mechanism of action not fully understand, but probably works by inhibiting cell-wall formation | vancomycin |
| has antimicrobial activity against Gram + bacteria, used primarily to treat MRSA infections | vancomycin |
| VRE | vancomycin resistant enterococcus |
| derived from word vanquish, "to defeat", originally discovered in 1950s, used to combat penicillin resistant Staphylococcus aureus | vancomycin |
| Therapeutic uses of vancomycin | MRSA infections, endocarditits, Clostridium difficile infections |
| Side effects of vancomycin | nephrotoxicity (kidney damage) and ototoxicity (hearing loss). |
| Drug interactions with vancomycin | May decrease effectiveness of live vaccines. Oral vancomycin should not be coadministered with bile acid sequestrants as will diminish vancomycin effect. |
| work by blocking bacteria's ability to produce needed proteins for survival | Lincosamides and macrolides |
| Low doses = bacteriostatic High doses = bactericidal | Lincosamides and macrolides |
| lincosamide commonly prescribed to treat infections Staphylococcus aureus, streptococcus pneumoniae and streptococcus pyogenes | clindamycin (Cleocin) |
| used for bone and joint infections, gynecologic infections, intra-abdominal infections, sepsis, and skin and soft tissue infections | clindamycin |
| broad spectrum of activity, work against some Gram + and Gram - bacteria | Macrolides |
| used mainly to treat respiratory tract infections and pneumonia, used with other drugs to treat infection caused by Helicobacter pylori, found in association w/ stomach ulcers | Macrolides |
| duration of therapy 3-5 days, compared to other antibiotics (7-14 days) | azithromycin (Zithromax) |
| Lincosamide | clindamycin (Cleocin) |
| Macrolides | azithromycin (Zithromax, Z-Pak, Z-Max, Zithromax Tri-Pak), clarithromycin (Biaxin), erythromycin (EES, EryC,, EryPed, Ery-Tab, Erythrocin, Pediazole) |
| Therapeutic uses for Lincosamides | acne, dental work, anaerobic pneumonia, bone infections, bowel infections, female genital infections, intra-abdominal infections |
| Therapeutic uses for Macrolides | STIs, group A beta-hemolytic streptococcus, influenza, Legionnaires' disease, mycoplasma pneumonia, streptococcus pneumonia |
| Common side effects of lincosamides and macrolides | stomach upset, nausea, vomiting, heartburn, abdominal pain, diarrhea. Serious side effect of clindamycin is pseudomembranous colitis (bloody diarrhea) Liver toxicity has occurred w/ use of erythromycin |
| auxiliary label for lincosamides and macrolides | be taken with food |
| Contraindications for Clindamycin | if patients have a hypersensitivity to other lincosamides. |
| Contraindications for macrolides | hypersensitive to one, cannot use any other macrolides |
| Black box warning for Clindamycin | severe and possibly fatal colitis. |
| Drug interactions with clindamycin | should not be used concurrently w/ erythromycin. Clindamycin may increase the neuromuscular blocking effects of mecamylamine |
| Drug interactions with macrolides | Diltiazem. use with methadone can lead to life-threatening arrhythmias. erythromycin and clarithromycin have many drug interactions also. |
| kill bacteria by blocking their ability to make essential proteins for survival | aminoglycosides |
| Common aminoglycosides | amikacin, gentamicin (Garamycin, Gentak), tobramycin (TOBI, Tobrex) |
| Therapeutic uses for aminoglycosides | life-threatening infections due to Gram- aerobes, sepsis, infections in patients w/ a compromised immune system, peritonitis |
| often used in conjunction w/ other antibiotics (penicillins, cephalosporins, and vancomycin) work synergistically | Aminoglycosides |
| used to treat eye infections in patients w/ immunodeficiency | gentamicin and tobramycin |
| Side effects of aminoglycosides | nephrotoxicity (liver damage), ototoxicity (tinnitus, hearing loss, and balance problems), |
| Contraindications w/ aminoglycosides | should be avoided in pregancy due to increased risk of fetal harm, cause neuromuscular blockade, patients w/ myasthenia gravis or Parkinson's disease should not use, |
| Dosage forms of aminoglycosides | injection (all), ophthalmic ointment/solution (gentamicin and tobramycin), solution for nebulizer inhalation (tobramycin) |
| drug interactions with aminoglycosides | when used with NSAIDS (antiinflammatories) there is risk of kidney toxicity; coadministration w/ loop diuretics may increase risk of ototoxicity |
| Therapeutic uses of tetracyclines | acne, anthrax, chonic bronchitis, Lyme disease, mycoplasma pneumoniae (walking pneumonia), Rickettsia (Rocky Mountain spotted fever), some STIs |
| Bacteriostatis drugs that inhibit protein synthesis w/in bacteria cells | tetracyclines |
| Common tetracyclines | doxcycline (VIbramycin, Oracea, Adoxa), minocycline (Minocin, Solodyn), tetracycline (Sumycin) |
| side effects of tetracyclines | upset stomach, nausea, vomiting. photosensitivity |
| avoid sun, dairy, and antacids, and laxatives while on | tetracyclines |
| once expired, medicine degrades to toxic substances | tetracyclines |
| causes permanent tooth discoloration in children younger than 8 years of age and pregnant or lactating women cannot use due to possible permanent damage to teeth | tetracyclines |
| Drug interactions w/ tetracyclines | aluminum, calcium, magnesium, or zinc products (antacids); Retinoids (isotretinoin); digoxin, theophylline w/ concurrent usage |
| Kills bacteria by inhibiting the enzyme that helps DNA to coil. If DNA cannot coil, it is rendered useless and cell dies | Fluoroquinolones (aka quinolones) |
| Therapeutic uses for Quinolones | bone and joint infections, eye infections, serious RTIs, serious UTIs. Also a special use as treatment for anthrax |
| have strong rapid bactericidal activity against Gram -, and some against Gram+ | Quinolones |
| Common Quinolones | ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox) |
| should only be reserved for serious and difficult to treat Gram- bacterial infections, as resistance has developed | Quinolones |
| Side effects of Quinolones | nausea, vomiting, dizziness, diarrhea, and a bitter/unpleasant taste in mouth, less common side effects: Liver toxicity and alterations in glucose metabolism |
| Auxiliary labels for Quinolones | avoid sun exposure, do not take w/ antacids, do not take w/ dairy products |
| Must be dispensed w/ a medication guide | Quinolones |
| Contraindications for Quinolones | Must not be taken while pregnant. Should not be used concurrent with tizanidine. |
| Boxed warnings on quinolones | risk of tendon inflammation and rupture, increased muscle weakness. Changes in mental function and seizures. joint malformation and usually should not be used in children |
| Common Nitromidazole | metronidazole (Flagyl) |
| effective against fungi and protozoa as well as bacteria | metronidazole |
| Therapeutic uses for metronidazole | amebic dysentery, bacteria vaginosis, Clostridium difficile, Giardia infection, Helicobacter pylori ulcers, intestinal infections, rosacea, STIs (Trichomonas) |
| Side effects of metronidazole | headache, anorexia, vomiting, diarrhea, and abdominal cramps. Metallic taste and urine discoloration. |
| Auxilliary labels for metronidazole | take with food, do not use alcohol |
| Contraindications for metronidazole | hypersensitivity to nitroimidazole derivatives, 1st trimester of pregnancy, use of disulfiram w/in past 2 weeks, use of alcohold during or w/in 3 days of therapy discontinuation |
| Drug interactions w/ metronidazole | carbocisteine. patients using QT prolonging agents, mebendazole and ritonavir may enhance toxic effects of metronidazole. may increase serum concentrations of warfarin |
| oxazolidinone | linezolid (Zyvox) |
| inhibits bacterial protein synthesis | linezolid |
| Therapeutic uses of linezolid | MRSA, VRE, other Gram + infections |
| Side effects of linezolid | headache, diarrhea, decreased hemoglobin, leukopenia, and thrombocytopenia |
| Contraindication of linezolid | should not be used w/in 14 days of momamine oxidase inhibitors (MAOIs) |
| Auxiliary label for linezolid | should not be taken with alcohol |
| Drug interactions with linezolid | may increase toxic effects of alcohol, MAOIs should be avoided, may decrease metabolism of triptan meds used for migraines, effectiveness of live vaccines decrease...should postpone vaccine until 3 days after cessation of linezolid |
| daptomycin | Cubicin |
| classified as a cyclic lipopeptide | daptomycin |
| works by binding to bacterial membranes and causing cell membrane depolarization, leading to inhibition of RNA and DNA synthesis | daptomycin |
| Therapeutic uses of daptomycin | complicated skin and skin structure infections, Spaphylococcus aureus blood infections |
| common side effects of daptomycin | anemia, diarrhea, vomiting, constipation. Chest pain, peripheral edema, skin rash, and respiratory side effects may also occur |
| Drug interactions w/ daptomycin | HMG-CoA reductase inhibitors (statins) may enhance adverse effects of daptomycin |
| ophthalmic (eye) antibiotics | azithromycin (AzaSite), bacitracin (AK-Tracin), ciprofloxacin (Giloxan), erythromycin (Ilotycin), gatifloxacin (Zymar), gentamicin (Gentak, Genoptic), moxifloxacin (Vigamox), ofloxacin (Ocuflox), sodium sulfacetamide (Bleph-10), tobramycin (Tobrex) |
| Class: Tetracyclines | - cycline |
| Class: Aminoglycosides | -cin |
| Class: Macrolides | -mycin |
| Class: Lincosamides | -mycin |
| Class: Monobactam | -am |
| Class: Carbapenems | -penem |
| Class: Cephalosporins | -cephs -cef |
| Class: Sulfonamides | sulf |
| Class: Penicillins | Pen or -cillin |
| decrease effectiveness in live vaccines | Bactrim |
| can cause low blood sugar | Cipro |
| interferes with oral contraceptives | tetracycline |
| subclass effective against gram + bacteria and has a beta lactam ring in the compound | penicillins |
| which subclass interferes with the coiling and replication of nucleic acid formation in order to kill the bacteria | quinolones |
| subclass effective against acne, Lyme disease, anthrax and is bacteriostatic by binding to the bacteria's ribosomes to inhibit protein synthesis | tetracyclines |
| subclass not given to patient under 9 years old due to permanent tooth discoloration | tetracyclines |
| subclass that requires a medication guide be given with each prescription | quinolones |
| which antibiotic is an intramuscular (IM) injection and is from the beta lactam compound medications | penicillin (Bicillin) |
| which subclass prevents bacterial folic acid synthesis and is effective for treatment of UTIs, pneumonia, and lower respiratory tract infections | sulfonamides |
| anti-microbials | medicines that help stop infections caused by bacteria. they do this by killing the bacteria, viral, fungi...or by keeping them from copying themselves and reproducing |
| antibody | also called immunoglobulins. large Y shaped proteins that can stick to the surface of bacteria and viruses . they are found in the blood or other body fluids of vertebrates |
| antigen | toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies |
| bid | twice a day dosing |
| cytochrome P450 | enzyme within bacteria and humans, also a major drug metabolizing enzyme |
| tid | three times a day dosing |
| bacteria gram + | classification of bacteria, cell walls composed of thick layers of peptidoglycan |
| bacteria gram - | classification of bacteria, cell walls with a thin layer of peptidoglycan |
| DS | stands for double strength |
| N&V | nausea and vomiting |
| prodrug | a medication that needs to be metabolized within the systemic system (body) before it is active |
| anaphylaxis | severe allergic reaction resulting in depressed breathing - life threatening |
| BB (Black Box warning) | severe warning usually seen in the medication guide |
| indications | what the medication is used for |
| cautions | warning of what can happen with a medication |
| MOA | mechanism of action, how the medication works |
| Stevens Johnson syndrome | rare, serious disorder of your skin and mucous membranes. usally a reaction to a medication or an infection, often begins with flu like symptoms followed by a painful red or purplish rash that spreads and blisters |
| immune system | complex network of cells and proteins that defends the body against infection |
| streptococcus pneumoniae | strep. pneumo |
| clostridium difficile | c. diff |
| escherichia coli | e. coli |
| 2 types of bacteria | Aerobic-O2 and Anaerobic |
| 3 shapes of bacteria | cocci (sphere shaped), bacilli (rod shaped), and spirochetes (spiral shaped) |
| nosocomial infections | acquired while in a hospital or nursing home setting, often resistant to antibiotics |
| community infections | acquired outside the hospital setting |
| broad spectrum antibiotic | effective against multiple organisms, usually used with life-threatening infection and bacteria is unknown in the beginning of treatment |
| empirical treatment | uses a broad spectrum antibiotic on an unidentified infection. often used in order to begin therapy immediately when there is not enough time to wait for lab tests. to come back with identifying the causative organism of the infection |
| broad spectrum, bactericidal antibiotics that are commonly prescribed for children, primarily for infections caused by Gram - pathogens | aminoglycosides, include gentamicin, amikacin, tobramycin, neomycin, and streptomycin |
| superbug | anti microbial resistant bacteria, resistant to medicine |
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