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antimicrobials 1

general antimicrobial classes, etc

QuestionAnswer
macrophage/monocyte binds to and presents antigens to other WBCs
neutrophils defends against bacteria and fungi
eosonophils responds as part of allergic reaction, defends against parasites
B lymphocytes antibody production, antigen presenting cell; may increase with viral infections
T lymphocytss regulates immune system, provides cellular immunity against viruses and tumors; low #s may predispose to fungal and Listeria infections (AIDS, chemo, etc)
left shift an increase in the number/proportion of immature WBCs (bands)vs mature ones; sign of infection
Normal Flora: Staphylococcus spp. found on skin
Normal flora: Haemophilus spp found in the mouth
Normal flora: Enterococcus spp., E.Coli found in the GI tract
Normal flora: Enterobacteriaceae found in the genital tract
Gram stain steps 1 Specimen dyed with crystal violet and iodine 2 Decolorized with alcohol 3 Then stained with safranin
gram positive bacteria are purple when gram stained (because they don't decolorize w alcohol), outer layer is thick peptidoglycan
gram negative bacteria color red in gram stains (decolorizes w alcohol and picks up red safranin color), cell wall has additional lipopolysaccharide
Ziehl-Neelsen stain used for mycobacteria (tuberculosis)
post-antibiotic effect Persistent suppression of organism growth after exposure and removal of an antibiotic (most seen with DNA/protein synthesis inhibiting drugs and gram + bugs)
PCN/cephalosporin MOA inhibits peptidoglycan synthesis (can't make a cell wall)
Vancomycin MOA inhibits peptidoglycan cross-linkage
aminoglycosyde MOA binds and inhibits 30S ribosome site
tetracycline MOA blocks tRNA from binding to 30S ribosome component
chloramphenicol MOA binds to 50S ribosome and inhibits peptide elongation
macrolide MOA reversible binding to 50S ribosome component
clindamycin MOA Interference with binding of amino acid-acyl-tRNA complex
Polymixins MOA acts like detergent- breaks open cell walls
bacitracin MOA disruption of cytoplasmic membranes, inhibits RNA transcription
quinolone MOA Inhibition of DNA gyrases or topoisomerases needed for supercoiling of DNA
metronidozole MOA Metabolic cytotoxic byproducts disrupt DNA (has to be metabolized by the bacteria)
rifampin MOA Binding to DNA-dependent RNA polymerase inhibiting initiation of RNA synthesis
sulfonomide MOA Compete with para-aminobenzoic acid (PABA) preventing synthesis of folic acid
trimethoprim MOA Inhibit dihydrofolate reductase
tetracycline: static or cidal? static
chloramphenocol: static or cidal? static
macrolide: static or cidal? static
beta lactams: static or cidal? cidal
aminoglycosides: static or cidal? cidal
beta-lactimase inhibitors used in combo with PCNs to lower drug breakdown by bacteria
natural PCNs (Pen G, Pen K) coverage Gram-positive rods Spirochetes Syphilis Limited gram-negative coverage
Beta-lactimase resistant PCNs coverage Beta lactimase resistant Staph.
Beta-lactimase resistant PCN examples Nafcillin (Nafcil) Methicillin (Staphcillin) Oxacillin (Bactocill) Cloxacillin (Cloxapen) Dicloxacillin (Dyanapen)
aminoPCNs coverage Adds some gram-negative coverage H. influenzae E. coli Proteus mirabilis less gram + coverage
aminoPCN examples ampicillin amoxicillin
carboxyPCNs coverage Gram-negative coverage further extended Pseudomonas Enterobacter and other Proteus species Some anaerobic coverage
carboxyPCN examples Carbenicillin (Geocillin) Ticarcillin (Ticar)
ureidoPCN coverage Superior activity against Pseudomonas Activity against Klebsiella species Some anaerobic coverage
ureidoPCN examples piperacilin
Beta lactimase inhibitor examples Clavulonic acid Amoxacillin/clavulanate (Augmentin) Ticarcillin/clavulanate (Timentin) Sulbactam Ampicillin/sulbactam (Unasyn) Tazobactam Piperacillin/tazolbactam (Zosyn)
long acting PCNs Penicillin procaine (24 hrs) Penicillin benzathine (10 days)
1st generation cephalosporin coverage Gram-positive cocci Some gram-negative coverage Some anaerobic coverage
2nd generation cephalosporin coverage Increased gram-negative coverage
3rd generation cephalosporin coverage Extended gram-negative coverage
1st generation cephalosporin examples Cephalothin (Keflin) Cefazolin (Ancef) Cephalexin (Keflex) Cefadroxil (Duricef‏) Cephradine (Velocef)
2nd generation cephalosporin examples Cefuroxime (Ceftin, Zinacef) Cefoxitin (Mefoxin) Cefaclor (Ceclor) Cefotetan (Cefotan) Cefprozil (Cefzil) Loracarbef (Lorabid)
3rd generation cephalosporin examples Ceftazidime (Fortaz) Ceftriaxone (Rocephin) Cefotaxime (Claforan) Ceftizoxime (Cefizox) Cefixime (Suprax) Ceftibuten (Cedax) Cefdinir (Omnicef) Cefditoren (Spectracef) Cefoperazone (Cefobid) Cefpodoxime (Vantin) Cefepime (Maxipime)
what antibiotics have good CSF penetration? 3rd generation cephalosporins, metronidazole
carbapenem MOA inhibits cell wall synthesis
carbapenem examples Imipenem/cilastatin (Primaxin)‏ Ertapenem (Invanz)‏ Meropenem (Merrem)‏ Doripenem (Doribax)
carbapenem coverage Broad-spectrum Gram-positive Gram-negative Anaerobic Resitant to beta-lactamases
how are most cephalosporins metabolized? most aren't- excreted unchanged by kidney (Ceftriaxone is an exception)
how are PCNs metabolized? most aren't- excreted unchanged by kidney
how are carbapenems metabolized? most aren't- excreted by kidney unchanged. Imepenem is metabolized in renal tubules
Aztreonam MOA inhibits cell wall synthesis
Aztreonam coverage gram negatives
quinolone coverage Gram-positive, gram-negative, some anaerobes
How are quinolones metabolized? Special considerations? lots of liver metabolism. not to be given to children or pregnant women
quinolone examples Ciprofloxacin (Cipro) Levofloxacin (Levaquin, Iquix) Ofloxacin (Floxin) Lomefloxacin (Maxaquin) Moxifloxacin (Avelox, Vigamox) Gatifloxacin (Tequin) Gemifloxacin (Factive) Norfloxacin (Noroxin) Trovafloxacin (Trovan) Besifloxacin (Besivance)
sulfonomide coverage gram + gram -
sulfonomide examples Sulfisoxazole/erythromycin (Pediazole) Sulfamethoxazole/trimethoprim (Bactrim, Septra) Sulfacetamide (Bleph-10) Ophthalmic Sulfadiazine
aminoglycoside coverage Gram – negative aerobes
how are aminoglycosides handled in the body? no liver metabolism. not absorbed PO. can cause neuromuscular blockade if given with neuromuscular blockers.
aminoglycoside examples Gentamicin Topical, IV, IM Tobramycin Topical, IV, IM Amikacin IV, IM Streptomycin IM Netilmicin Neomycin Oral, topical Paromycin (Humatin)‏ Spectinomycin (Trobicin)‏
macrolide coverage Gram-positive, gram-negative, some anaerobes
how are macrolides metabolized? lots of liver metabolism, excreted in the kidney
macrolide examples the 'mycins': Erythromycin Azithromycin (Zithromax) Clarithromycin (Biaxin) Azithromycin (Zithromax)
tetracycline coverage Some gram – positive Some gram – negative Some anaerobes
special tetracycline considerations Tooth discoloration Photosensitivity
tetracycline examples Tetracycline (Sumycin)‏ Doxycyline (Vibramycin)‏ Minocycline (Minocin)‏ Demeclocyline (Declomycin) Tigecycline (Tygacil) Minocyline derivative – not a true tetracycline Extended spectrum of activity
metronidazole coverage Anaerobes Gram positive Gram negative Amoeba
clindamycin coverage Gram – positives, Anaerobes
biggest culprit for C diff after antibiotics? clinda
vancomycin coverage Gram – positives MRSA
how is vanc metabolized? not absorbed orally (but can directly treat gut infections if taken orally), renally excreted
zyvox MOA binds to 50s ribosome
zyvox coverage Staph. and Strep. including MRSA, MRSE VRE
Quinupristin / Dalfopristin (Synercid) MOA inhibits protein synthesis
Quinupristin / Dalfopristin (Synercid) coverage Gram – positives, including VRE
Azoles MOA Inhibition of fungal cell membrane formation
Azoles examples Fluconazole (Diflucan)‏ Ketoconazole (Nizoral)‏ Itraconazole (Sporanox)‏ Voriconazole (V - Fend)‏ Clotrimazole (Mycelex)
Nystatin MOA Increased cell membrane permeability of fungi
Terbinafine (Lamisil) decreases cell wall synthesis of fungi
Amphotericin MOA disrupts fungal cell wall
Amphotericin special considerations can cause nephrotoxicity, chills, thrombophlebitis and low K/Mg
Anti-RNA MOA blocks uncoating of the virus
Anti-RNA examples/coverage Amantadine (Symmetrel)‏ Influenza A only Rimantadine (Fluvadine) Influenza A and B
neuroaminidase inhibitors MOA Selective inhibitor of influenza A and B virus neuraminidase Inhibits the release of newly formed virus from the surface of infected cells
neuroaminidase inhibitor coverage Flu A and B
neuroaminidase inhibitor examples Zanamivir (Relenza)- only given nasally/no metabolism, Aseltamivir (Tamiflu)
DNA synthesis inhibitor examples Acyclovir (Zovirax) Valacylovir (Valtrex) Famciclovir (Famvir) Penciclovir (Denavir) Ganciclovir (Cytovene)
DNA synthesis inhibitor coverage Herpes Simplex type I and II Herpes Zoster CMV Ganciclovir
Created by: khilovsky
 

 



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