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BR-Antimicrobials
5/21/06
| Question | Answer |
|---|---|
| Drugs that block cell wall synthesis by inhibiting peptidoglycan x-linking | PCN, Ampicillin, Ticarcillin, Piperacillin, Imipenem, Aztreonam, Cephalosporins |
| Drugs that block peptidoglycan synthesis | Bacitracin, Vancomycin, Cycloserine |
| Drugs that block protein synthesis at 50S ribosomal subunit | Chloramphenicol, Erythromycin/Macrolides, Lincomycin, Clindamycin, Streptogramins (Quinupristin, Dalfopristin), Linezolid |
| Drugs that block protein synthesis at 30S ribosomal subunit | Aminoglycosides, Tetracyclines |
| Drugs that block nucleotide synthesis | Sulfonamides, Trimethoprim (TMP) |
| Drugs that block DNA topoisomerases | Quinolones |
| Drugs that block mRNA synthesis | Rifampin |
| Bactericidal antibiotics | Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole |
| Drugs that disrupt bacterial/fungal cell wall membranes | Polymyxins |
| Drugs that disrupt fungal cell wall membranes | Amphotericin B, Nystatin, Fluconazole/azoles |
| PCN (G = IV, V = oral); hypersensitivity rxn and hemolytic anemia | Bactericidal for G+ cocci (1st line for Pneumococcal Pneumonia); G+ rods, G- cocci, Spirochetes (syphilis, lyme dz) |
| Methicillin, Nafcillin, Dicloxacillin (hypersensitivity rxn; meth = interstitial nephritis) | Narrow spectrum Abx; Penicillinase Resistant d/t bulkier R group; use for Staph aureus |
| Ampicillin, AmOxicillin (better oral availability); (hypersensitivity, amp rash, pseudomembranous colitis) | Wider spectrum HELPS kill enterococci (Haemophilus, E. coli, Listeria, Proteus, Salmonella, enterococcus); sensitive to penicillinase, but can combine with Clavulanic Acid (inhibitor); |
| Carbenicillin, Piperacillin, Ticarcillin (hypersensitivity) | Extented spectrum (Pseudomonas, G- rods); use with Clavulanic acid |
| Cephalosporins | b-lactam drugs inhibit cell wall synthesis but are less susceptible to penicillinases; bactericidal |
| 1st generation cephalosporins (Cephalexin, Cefadroxil, Cefazolin): PEcK | Proteus, E. coli, Klebsiella |
| 2nd generation cephalosporins (Loracarbef, Cefprozil, Cefuroxime, Cefaclor): HEN PEcKS | Haemophilus, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia |
| 3rd generation cephalosporins (Ceftazidime, Ceftriaxone) | great G- coverage; Tx meningitis, Pseudomonas, Gonorrhea |
| 4th generation cephalosporins | increased activity against Pseudomonas and G+ bugs |
| Cefoperazone | 2nd generation cephalosporin; use in pts with decreased renal failure; HEN PEcKS |
| Ceftazidime | 3rd generation cephalosporin; use for Pseudomonas (and other G-s) |
| Ceftriaxone | 3rd generation cephalosporin; use for GONORRHEA (and other G-s) |
| Cephalosproin toxicity | Disulfiram-like rxn w/ethanol (ex: Cefamandole d/t methylthiotetrazole grp); hypersensitivity rxns d/t x-reactivity w/PCNs in some pts; They increase nephrotoxicity of aminoglycosides |
| Aztreonam | G- rods ONLY: Klebsiella, Pseudomonas, Serratia; Good for RENAL PTs who can't tolerate aminoglycosides; resistant to b-lactamase; no PCN x-allergenicity |
| Imipenem/Cilastatin (imipenem is renally longer LASTIN' with ciLASTIN) | #1 for ENTEROBACTER; Broad spectrum (G+ cocci, G- rods, Anaerobes); can cause seizures |
| Vancomycin (nephrotoxic, ototoxic, thrombophlebitis, "red man syndrome" from fast infusion) | Save for SERIOUS G+ MULTI-DRUG RESISTANT bugs: S. aureus and Clostridium difficile; changes AAs from D-ala to D-lac; |
| Protein Synthesis Inhibitors: "Buy AT 30, CELL at 50" | 30s (Aminoglycosides - bactericidal, Tetracyclines); 50S (Chloramphenicol, Erythromycin, Lincomycin, cLindamycin); all except aminoglycosides are bacteriostatic |
| Gentamicin, Neomycin, Tobramycin, Streptomycin, Amikacin | Aminoglycosides; Good for SEVERE G- Rod infxns; bactericidal - no initiation complex/misread mRNA; synergistic with b-lactams; requires O2 for uptake (no anaerobic coverage); |
| Neomycin | used for bowel surgery |
| Toxicity of Aminoglycosides + Cephalosporins | Nephrotoxicity |
| Toxicity of Aminoglycosides + Loop diuretics | Ototoxicity |
| Tetracycline, Doxycycline, Demeclocycline (VACUUM your BedRoom Tonight) | Vibrio, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Borrelia, Rickettsia, Tularemia; Bacteriostatic; bind 30S/prevent tRNA attachment; don't take with Ca or Fe b/c divalent cations bind in gut |
| Doxycycline | safe to use in renal patients |
| Toxicity of Tetracycline, doxycycline, demeclocycline | discoloration of teeth and inhibition of bone growth in kids; photosensitivity; GI distress |
| Erythromycin, Azithromycin, Clarithromycin (GI discomfort is bad; acute cholestatic hepatitis, eosinophilia, rash) | URIs, Pneumonias, STDs, Strep infxns in PCN-allergies; Mycoplasma, Legionella, Chlamydia, Neisseria; Macrolides; block protein translocation (23S rRNA of 50S subunit); Bacteriostatic |
| Chloramphenicol (anemia, aplastic anemia, gray baby d/t lack of liver UDP-glucuronyl transferase) | Meningitis (H. influenza, N. menigitidis, S. pneumoniae); Bacteriostatic; inhibits 50S peptidyltransferase; Toxicity = use conservatively |
| Clindamycin (causes C. difficile overgrowth) | blocks 50S peptide bond; bacteriostatic; Tx ANAEROBIC infxns above diaphragm (Bacteriodes fragilis, Clostridium perfringens |
| Sulfamthoxazole (SMX), Sulfisoxazole, Triple Sulfas, Sulfadiazine | G+, G-, Nocardia, Chlamydia coverage; UTI; bacteriostatic; sulfonamides; PABA-antimetabolites inhibit dihydropteroate synth; hemolysis in G6PD deficiency; nephrotoxic, kernicterus infant, diplaces warfarin from albumin |
| Trimethoprim | Treat recurrent UTIs, Shigella, Salmonella, Pneumocystis carinii; bacteriostatic; inhibits bacterial dihydrofolate reductase; use in combo w/SMX to block folate synth; may cause marrow suppression |
| Ciprofloxacin, Norfloxacin, Ofloxacin, Sparfloxacin, Moxifloxacin, Gatifloxacin, Enoxacin, Nalidixic acid | Treat G- rods in UTI, GI infxns; PSEUDOMONAS, Neisseria, some G+s; Bactericidal; inhibit DNA gyrase (topoisomerase II); Fluoroquinolones; contra in pregnancy; may cause Tendonitis/rupture |
| Metronidazole: GETon the metro! | Antiprotozoal: Giardia, Entamoeba, Trichomonas, Gardernela vaginalis, ANAEROBES (Bacterioides, Clostridium); Use as part of triple therapy for H.pylori (w/bismuth, amoxicillin or tetracycline); Disulfiram-like rxn w/alcohol, HA |
| Polymyxin B, Polymyxin E | Use for resistant G- infections; alter osmotic properties in bacterial membrane; cationic basic ptns that act as detergents; can be neurotoxic, nephrotoxic |
| Anti-TB drugs | RESPIre: rifampin, ethambutol, streptomycin, pyrazinamide, isoniazid (INH); all are hepatotoxic; (2nd line = Cycloserine) |
| Isoniazid | Can solely prophylax against TB; decreases mycolic acid synthesis; "INH" = injures neurons and hepatocytes; also causes hemolysis in G6PD deficiency; B6/pyridoxine can prevent neurotoxicity |
| Rifampin | Treats TB; delays dapsone resistance in leprosy; Meningococcal prophylaxis for Hib; "4 Rs" = RNA polymerase inhibitor, revs up P450; Red/orange body fluids, Rapid resistance if used alone |
| Penicillin/cephalosporin resistance mechanism | b-lactamase cleavage of b-lactam ring |
| Aminoglycoside resistance mechanism | modification via acetylation, adenylation, or phosphorylation |
| Vancomycin resistance mechanism | terminal D-ala of cell wall replaced with D-lac; decreases affinity |
| Chloramphenicol resistance mechanism | modification via acetylation |
| Macrolide resistance mechanism | methylation of rRNA near erythromycin's ribosomal binding site |
| Tetracycline resistance mechanism | decreased or increased transport out of cell |
| Sulfonamide resistance mechanism | altered enzyme (bacterial dihydropteroate synthase); dec uptake or inc PABA synthesis |
| Nonsurgical antimicrobial prophylaxis for Meningococcal infection | Rifampin (drug of choice), minocycline |
| Nonsurgical antimicrobial prophylaxis for Gonorrhea | Ceftriaxone |
| Nonsurgical antimicrobial prophylaxis for Syphilis | Benzathine PCN-G (IV) |
| Nonsurgical antimicrobial prophylaxis for h/o recurrent UTIs | TMP-SMX |
| Nonsurgical antimicrobial prophylaxis for Pneumocystic carinii pneumonia | TMP-SMX (drug of choice), aerosolized pentamidine |
| Amphotericin B | Treat systemic mycoses: Cryptococcus, Blastomycoses, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor; binds ergosterol, "tears" pores in membrane; fever/chills, hypotension, nephrotoxic, Arrhythmias |
| Nystatin | "swish and swallow" for oral candidiasis; binds ergosterol disrupting fungal membranes |
| Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole, Voriconazole | Treat Systemic mycoses and hypercortisolism: inhibit ergosterol synthesi |
| Fluconazole | Treat cryptococcal meningitis in AIDS and all candidiasis infxns (except yeast) |
| Ketoconazle | Treat Blastomyces, Coccidioides, Histoplasma, Candida albicans, hy |
Created by:
bscaryp
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