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antimicrobials 1
general antimicrobial classes, etc
| Question | Answer |
|---|---|
| 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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