DCPA Antibiotics

Description:	DCPA Antibiotics
Category:	Clinical Skills
Created by:	Amanda Leigh Brooks on 2009-09-19

Question	Answer
Colonization	Presence of microbe in a host does not cause a specific immune reaction or infection (Do NOT Tx w/ Abx)
Empiric Therapy	Abx choice based on clinically most likely pathogen
Definitive Therapy	Abx choise based on identified pathogen & susceptibilty patterns
De-escalation	Adjustment of Abx regimen from broad to narrow spectrum
Collateral Damage	Unwanted negative effect of an Abx on NMF
Minimum Inhibitory Concentration (MIC)	Minimum [] that inhibits groth of organism
Antibiogram	Compilation of data for bacteria vs. abx
Gram (+) Cocci bacteria	S. Aureus, Staph Epidermidis, Strept Pyogenes, Strep Agalactiae, S. pneumoniae, enterococci, Strp bovis, Viridans Strep, Strep intermedius
S. Epidermidis infections	Associated with "hardware"
Enterococci infections	UTI, appendicitis
Strep Bovis Infections	Bowel lesion = spread of infection
Strep. Intermedius Infections	Abcess Formers
Gram (+) Bacilli Bacteria	Usually erroneous Sample Corneybacterium Diptheriae, Listeria Monocytogenes, Bacillus Antracis, Erysipelothrix Rhusiopathiae
Listeria Monocytogenes Infections	Meningitis (Can't eat cheese in 2nd/3rd trimester)
Gram (-) Cocci Bacteria	Neisseria Meningitidis, Neisseria Gonorrhoeae, Moraxella (Branhamella) Catarrhalis
Gram (-) Bacilli Bacteria	Vibrio cholerae, Campylobacter jejuni, H. Pylori, Pseudomonas Aeruginosa, Salmonella, H. Influenza, Brucella, Francisella Tularensis (Tularemia), Pasturella Multocida, Legionella Pneumophilia, Bartonella, Shigella, Enterobacter (E. Coli, etc.)
Pasturella Multocida Caused by...	Bites (Mouths) or Cats & dogs
Bartonella caused by...	Cat scratch
Anaerobes	Clostridium tetani, C. botulinum, C. Difficile, C. Perfringens, Bacteroides, Fusobacterium, Peptostreptococcus, Prevotella
Clostridium Perfringens Infection	Gas Gangrene
Beta-Lactum Drugs	Penicillin, Cephalosporin, Carbapenems, Aztreonam
Beta-Lactums MOA	Interferes with cell wall synthesis
Glycoprotein MOA	Interferes with cell wall synthesis
Fluoroquinolones MOA	Interferes with DNA replication, transcription
Rifampin MOA	Interferes with DNA replication, transcription
Aminoglycosides MOA	Binds to 30s/50s Ribosomal Subunit
Macrolides MOA	Binds to 30s/50s Ribosomal Subunit
Ketolides MOA	Binds to 30s/50s Ribosomal Subunit
Oxazolidinones MOA	Binds to 30s/50s Ribosomal Subunit
Tetracyclines MOA	Binds to 30s/50s Ribosomal Subunit
Streptogramins MOA	Binds to 30s/50s Ribosomal Subunit
Broad Spectrum Drugs	PCN (Penicillin), 3rd/4th generation Cephalosporins, Carbapenems
Narrow Spectrum Gram(+) Drugs	Vancomycin
Narrow Spectrum Gram(-) Drugs	Aminoglycosides, Aztreonam
Narrow Spectrum Anaerobes Drugs	Metronidazole (Flagyl)
Pharmacokinetics	Absorption (Bioavailability), Distribution, Metabolism, Elimination
Pharmodynamics	Relationship between drug concentration & effect "Antibiotic Potency"
Bioavailability	% of oral dose available compared to IV form (100%)
Clearance	Determines steady state of drug (determined by blood flow to metabolizing organ & rate of extraction of the drug from blood)
Volume of Distribution	Relates the amount of drug in the body to the serum drug concentration (Dependent on BMI)
Steady State	After 3 half lives
Postantibiotic Effect (PAE)	Delay before organisms recover & begin growing despite decrease concentration of drug
Four Primary Machanisms of Resistance.	Alterations in outer membrane permeability. Alteration in drug binding sites, Production of molecules capable of inactivating drug molecules. Active efflux of antibiotic from the bacteria.
Abx. dosing & duration	DONT under dose/increase duration = resistance
Bacterocidal Drugs	Beta Lactams, Cephalosporins, quinolones, aminoglycosides
Bacterostatic Drugs	Clindamycin, macrolides, sulfonamides, Tetracycline
Aminoglyc. Accumulation	Nephrotoxic (reversible) & Toxic to the Ear (irreversible)
Drugs that penatrate the BBB to the CSF	AG's, clindamycin
Difficult tissue to penetrate	Bone, synovial fluid, prostate, Abscesses, Peritoneal Fluid
DOC	Drug of Choice
IND	Indications
ADR	Adverse Reactions
W/P	Warnings & Precautions
SSSI	Skin & Soft Tissue Infections
Anaphylaxis	(IgE) Hives (Uticaria). Respiratory Difficulty (Bronchospasm). Swelling. Occurs within the first 72 hours.
Most common drug allergy	Penicillin
Penicillin ADR	Maculopapular rash, rash, uticarial rash, fever, bronchospasm, vasculitis, serum sickness, exfoliative dermatitis, Stevens-Johnson, Anaphylaxis (ordered in decreasing frequency & increasing severity.)
Penicillin half life	Short: 30-60 minutes (rapid renal excretion)
Penicillin Types	Natural, Penicillinase-resistant, Aminopenicillins, Extrended-spectrum ureidopenicillins, B-lactam/B-lactamase Inhibitors
Natural Penicillin Drugs & forms	Penicillin G (IV/IM) & Penicillin V (PO)
Natural Penicillin effective against...	B-hemolytic strept, most anaerobes, viridans strep, N. meningitidis.
Natural Penicillin DOC	Strep. Pneumoniae
Natural Penicillin R	Actinomyces, meningococcus, Pasteurella, S. Pneumoniae, S. pyogenes, T. Pallidum.
Natural Penicillin Pregnancy Category	C
Natural Penicillin ADR	Seizures or hemolytic anemia
Penicillinase-resistant penicillins drugs & forms	Oxacillin/Nafcillin (IV) & Dicloxacillin (PO-empty stomach)
Penicillinase-resistant penicillins effective against...	?
Penicillinase-resistant penicillins ADR	GI cramps, rash, neutropenia (prolonged Rx - especially with nafcillin), acute interstitial nephritis
Aminopenicillin Drugs	Ampicillin (IV/PO), Amoxicillin (PO)
Aminopenicillin covers	Enterococci, E.coli, H. influenza, Proteus, Klebsiella
Aminopenicillin W/P	Renal Insufficiency & Cephalosporin allergy
Aminopenicillin ADR	Rash & GI upset
Extended-spectrum ureidopenicillins drugs & forms	Pipercillin (IV) usually used in combination!
Extended-spectrum ureidopenicillins covers	Anaerobes, enterobactericacae & pseudomonas
Extended-spectrum ureidopenicillins W/P	Severe renal impairment & allergies to cephalosporins
Extended-spectrum ureidopenicillins ADRs	GI & dermatology
B-lactamase inhibitor drugs	ampicillin/sulbactam (Unasyn - IV) Pipercillin/Tazobactam (Zosyn-IV) Aoxicillin/clavulante (Augmentin-PO)
Unasyn ingrediants	Ampicillin & sulbactam
Zosyn ingrediants	Pipercillin & tazobactam
Augmentin ingrediants	Amoxicillin & Clavulanate
B-lactamase inhibitor SE	Diarrhea (increased with clavulanate)
Penicillin Class drug interactions	Decrease OCP efficiancy. Increases warfarins effect.
Penicillin Class ADRs	Seizure potential with high doses. Inhibit platelet aggregation.
Cephalosporins types	1st generation-4th generation
Cephalosporins pregnancy categroy	B
Cephalosporins ADRs	Increase C. difficile colitis & VRE
1st generation cephalosporins drugs & forms	Cefazolin - Ancef(IV) & Cephalexin - Keflex (PO)
Cefazolin	Ancef
Cephalexin	Keflex
1st generation cephalosporins coverage	Better gm +
1st generation cephalosporins uses	surgical prophylaxis, SSSIs & UTI
2nd generation cephalosporins coverage	Less gram + & more gram -
2nd generation cephalosporins drugs	Cefuroxime (Ceftin) - PO. Cefotetan (Cefotan) - IV.
Cefuroxime (Ceftin) covers	strep, haemophilus, E. coli, Proteus, Klebsiella
Cefuroxime (Ceftin)uses	URI/L RTIs, Otitis Media, COPD exacerbations, sinusitis.
Cefuroxime	Ceftin
Cefotetan	Cefotan
Cefotetan (Cefotan) covers	B. frgilis & other bowel anaerobes
Cefotetan (Cefotan) uses	abdominal infections, bowel surgery prophylaxis, OB/GYN infections (PID)
3rd generation cephalosporin coverage	weak gram + & good gram -
3rd generation cephalosporin drugs	Ceftriaxone (Rocephin) - IV. Ceftazadime (Fortaz - IV. Cefpodoxime (Vantin) - PO. Cefixime (Suprax) - PO
Ceftriaxone	Rocephin
Ceftriaxone (Rocephin) ADRs	Biliary sludging b/c its eliminated via biliary excretion
Ceftriaxone (Rocephin) coverage	Severe gram (-) infection & Meningitis
Ceftazadime	Fortaz
Ceftazadime (Fortaz) coverage	Pseudomonas
Cefpodoxime	Vantin
Cefixime	Suprax
Cefpodoxime (Vantin) & Cefixime (Suprax) coverage	URIs & RTIs
4th Generation Cephalosporin drug & form	Cefepime (IV)
Cefepime covers	Pseudomonas, gram (-) rods (enterobacter, serratia & citrobacter).
Cefepime uses	Febrile neutropenia, hospital acquired pneumonia, serious gram (-) infections.
Carbapenems drugs	Imipenem/cilastatin (Primaxin) - IV. Meropenem (IV). Ertapenem (Invanz)- IV.
Primaxin	imipenem/cilastatin
Carbapenems covers	gram +'s including MSSA, grams -'s & anaerobes.
Primaxin (Imipenem/cilastatin) uses	pseudomonas & polymicrobial infections.
Primaxin (Imipenem/cilastatin) ADR	N/V & decreases seizure threshhold.
Primaxin (Imipenem/cilastatin) W/P	Hx of seizures
Primaxin (Imipenem/cilastatin) pregnancy category	C
Meropenem ADR	Less seizures & N/V
Meropenem pregnancy category	B
Meropenem coverage decreased in	Staph & strep
Ertapenem	Invanz
Ertapenem (Invanz) does not cover	pseudomonas
Monobactam drug & form	Aztreonam (Azactam) - IV
Aztreonam	Azactam
Aztreonam (Azactam) coverage	Gram negative ONLY
Aztreonam (Azactam) pregnancy category	B
Aztreonam (Azactam) SE	Well tolerated
Aminoglycoside drugs	Gentamicin, Tobramycin & amikacin (all IV; not absorbed well)
Aminoglycoside coverage	Gram - (Pseudomonas)
Aminoglycoside decreased effectivness by	Abscesses
Aminoglycoside Pregnancy category	D
Aminoglycoside uses	Always used in combo: serious gram (-) infections or b-lactam for synergy
Macrolides drugs	Erythromycin (Iv, PO, Opth). Clarithromycin (Biaxin) - PO. Azithromycin (Zithromax) - IV/PO
Clarithromycin	Biaxin
Azithromycin	Zithromax
Macrolides Pregnancy category	B (eryth, Azith) & C (Clarith)
Macrolides coverage	pneumococcus, atypicals, H. influenza
Macrolides Uses	OM, CAP, COPD, STD
Macrolides ADR	GI (take with food) & QT prolongation
Clarithromycin (Biaxin) DOC	Eryth-sensitive strains of streptococci
Azithromycin (Zithromax) DOC	H. Influenza & Chlamydia
Azithromycin (Zithromax) half life	68 hours
Fluoroquinolone drugs	Ofloxacin, ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Gatifloxacin (Tequin), Gemifloxacin (Factive)
Fluoroquinolone coverage	good gram (-), alright gram (+)
Fluoroquinolone DOC	Legionella
Cipro & Levaquin cover	Pseudomonas
Fluoroquinolone pregnancy category	C
Fluoroquinolone CI	<18y.o. (arthropathy)
Fluoroquinolone ADR	N/V/D, CNS (HA, restlessness), decrease seizure threshhold, tendon rupture (spontaneous - achilles), increase in AST/ALT
Fluoroquinolone DI	Aluminum/Mg antacids, sulcralfate, Ca2+, Fe2+ & Zinc - decrease absorption. Increases the effect of warfarin (except moxifloxacin & gatifloxacin)
Fluoroquinolone uses	CAP (includes atypicals), UTIs/pyelonephritis, COPD, acute exacerbation of chronic bronchitis, sinusitis
Tetracycline drugs	tetracycline, doxycycline, minocycline
Tetracycline coverage	Broad - including rickettsia, mycoplasma & chlamydia
Tetracycline pregnancy category	D
Tetracycline CI	< 8 y.o. (permanent discoloration of the teeth & inhibits bone growth)
Tetracycline Use	CAP, STD (Chlamydia), syphilis (pen-allergic pts.), Lyme dz, acne, community acquired MRSA
Tetracycline ADR	GI, photosensitivity, erosive esophagitis, vestibular sx (drunk/off balance), liver damage (rare)
Tetracycline DI	Increased effect of warfarin
Vancomycin Forms	IV & PO(C. difficile only)
Vancomycin MOA	Inhibits cell wall growth ("slowly" cidal)
Vancomycin coverage	gram +'s (MRSA, MRSE) & mild-mod anaerobic
Vancomycin pregnancy category	C
Vancomycin ADR	Redman syndrome (nonallergic rash on face/chest, flushing & hypotension), reversible neutopenia
Vancomycin administration	Given slowly (over an hour)
Vancomycin special abilities	Penetrates CSF
Clindamycin	Cleocin
Clindamycin (Cleocin) forms	IV, PO, Topical (acne), Vaginal
Clindamycin (Cleocin) class	Lincomycin
Clindamycin (Cleocin) MOA	Inhibits protein synthesis
Clindamycin (Cleocin) Coverage	anaerobes Strep & S. aureus (MRSA)
Clindamycin (Cleocin) use	anaerobic abscess, abdominal infections & Gyn
Clindamycin (Cleocin) ADR	N/V/D & rash - can cause C. Diff
Metronidazole	Flagyl
Metronidazole (Flagyl) MOA	Inhibits DNA synthesis
Clindamycin (Cleocin) coverage	anaerobes & ameoba
Clindamycin (Cleocin) uses	Abdominal abscess, C. diff, Rx trich, & H. pylori
Clindamycin (Cleocin) Pregnancy category	B (avoid 1st trimester)
Clindamycin (Cleocin) special abilities	Penetrate CSF
Clindamycin (Cleocin) ADR	N/V and alcohol reaction
TMP/SMZ	Trimethoprim/Sulfamethoxazole
TMP/SMZ (Trimethoprim/Sulfamethoxazole) forms	PO or IV
TMP/SMZ (Trimethoprim/Sulfamethoxazole) MOA	Inhibits folic acid synthesis (static)
TMP/SMZ (Trimethoprim/Sulfamethoxazole) pregnancy category	B but at 3rd trimester - term = D
TMP/SMZ (Trimethoprim/Sulfamethoxazole) coverage	Staph, strep, GNR's & Pneumocystis (prophylaxis for HIV pt.)
TMP/SMZ (Trimethoprim/Sulfamethoxazole) uses	UTIs, gram - infections, MRSA
TMP/SMZ (Trimethoprim/Sulfamethoxazole) DOC	PCP
TMP/SMZ (Trimethoprim/Sulfamethoxazole) ADR	Rash, CNS disturbances, photosensitivity, GI Sx.
TMP/SMZ (Trimethoprim/Sulfamethoxazole) Increase toxcity of...	warfarin, oral hypoglycemics, phenytoin, methotrexate, cyclosporin
Rifampin Form	PO
Rifampin MOA	Inhibits bacterial synthesis
Rifampin Uses	TB, Meningococcal prophylaxis, nasal carriers of MRSA
Rifampin ADR	GI upset, rash, turns secretions red-orange-brown, hepatotoxic, potent cyt P450 inhibitor
Linezolid	Zyvox
Linezolid (Zyvox) forms	IV & PO (100% available)
Linezolid (Zyvox) class	Oxazolidinone
Linezolid (Zyvox) coverage	Staph (MRSA), Coag (-) staph, strept, enterococci (VRE). Minor against anaerobes
Linezolid (Zyvox) ADR	Thrombocytopenia (reversible) or anemia
Linezolid (Zyvox) uses	variety of infections from MRSA and VRE
Synercid	Quinupristin/Dalfopristin
Synercide Quinupristin/Dalfopristin class	Streptogramin
Synercide Quinupristin/Dalfopristin form	IV via central line only!
Synercide Quinupristin/Dalfopristin coverage	MRSA, VRE
Synercide Quinupristin/Dalfopristin ADR	Myalgia, arthalgia
Synercide Quinupristin/Dalfopristin amount used	Rarely
Daptomycin Form	IV
Daptomycin coverage	MRSA
Daptomycin use	complicated skin & soft tissue infection
Tygecycline coverage	MRSA, VRE, strep, enteric GNRs, bowel anaerobes
Mupirocin	Bactroban
Mupirocin (Bactroban) form	Topical
Mupirocin (Bactroban) use	Impetigo due to S.aureus, group A strept (pyogenese) or decolonize the nasal passages of MRSA carriers (+/-)
Nitrofurantoin	Macrodantin
Nitrofurantoin (Macrodantin) coverage	gram +'s, enterococci, E. coli
Nitrofurantoin (Macrodantin) Pregnancy	B
Nitrofurantoin (Macrodantin) DI	decreased absorption with antacids
Nitrofurantoin (Macrodantin) W/P	G6PD deficiency = interstitial pulmonary fibrosis with chronic use.
Nitrofurantoin (Macrodantin) use	ONLY UTIS - Tx/prophylaxis
Bacteria that must be treated for > 4 weeks	S. Aureus bacteremia, endocarditis, ostomyelitis
Anti-Staphylococcal	**Nafcillin, oxacillin, dicloxacillin, cefazolin
Anti-MRSA	Vancomycin, Clindamycin, Doxycycline, TMP/SMZ, Linezolid, Quinupristin/dalfopristin, daptomycin, tygecycline.
Anti-anaerobic	Metronidazole, clindamycin, carbapenems, ceftotetan, Penicillin, B-lactamase inhibitors
Anti-pseudomonal	pipercillin/tazobactam, aminoglycosides, ceftazadime, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin.