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antimicrobial test1

Penicillinase resistant Dicloxacillin
PCNase resistant Nafcillin
PCNase resistant Oxacillin
PCNase resistant Methicillin
Anti-pseudo PCN carboxyPCNs
CarboxyPCNs Ticarcillin, Carbenecillin
Anti-pseudo PCN ticarcillin
Anti-pseduo PCN carbenecillin
Anti-pseudo PCN UreidoPCN
UreidoPCN piperacillin, mexlocillin
Anti-pseudo PCN piperacillin
Anti-pseudo PCN mexlocillin
Augmentin Ampicillin & clavulonic acid
Zosyn Piperacillin & taxobactam
2nd gen Cephs Cefaclor, Cefotoxin, Loracarbef
3rd gen Cephs Ceftriaxone, Ceftazidime, Cefixime
4th gen Ceph Cefepime
5th gen Ceph Ceftaroline
Imipenem combined w/cilastin
50s Chloramphenicol
50S clindamycin
50s linezolid
50s macrolides
50s quinupristin
50s dalfopristin
macrolide erthromycin
macrolide azithromycin
macrolide clarithromycin
30s tetracycline
30s tigecycline
30s spectinomycin
30s aminoglycosides
aminoglycoside streptomycin
aminoglycoside gentamycin
aminoglycoside tobramycin
aminoglycoside amikacin
aminoglycoside neomycin
fluroquinolones naladixic acid
fluroquinolones 'floxins' - Ciprofloxin, Levofloxin, Trovafloxacin
Lipoglycopeptide dalbavancin
lipoglycopeptide telavancin
cyclic lipopeptide daptomycin
tefibazumab staph antibody
anti-Tb Isoniazid
anti-TB rifampin
anti-TB pyrazinamide
anti-TB ethambutol
anti-TB rifabutin
anti-TB streptomycin
Rifapentine latent TB
isoniazid latent TB
mixed amebicide metronidazole
mixed amebicide tinadazole
anti-leprosy sulfones (dapson/sulfoxone)
anti-leprosy rifampin
MOA PCNs inhibit transpeptidases, bind PCN-binding proteins, alter configuration of PG layer
PCN drug of choice for GAS, GBS, T.pallidum
Natural PCN broad spectrum
Aminopencillins better Gm-; Gm+ enterococci increasing resistance
causes interstitial nephritis Methicillin
increases Na overload, platelet dysfunction, hypokalemia carbenecillin
Beta Lactamase inhibitors clavulonic acid, sulbactam, taxobactam
uses for beta lactamase inhibitors hosp acquired pneumo, anaerobes
used for MRSA vancomycin
not absorbed in GI so good for Cdiff vancomycin
CNS penetration vancomycin
causes red man syndrome when used IV vancomycin
red man syndrome nonimmunologic histamine release
MOA vancomycin inhibits prostaglandin biosynthesis a step earlier than PCN and inhibits transpeptidases
uses of vancomycin ALL G+
MOA cephalosporins competitive inhibitor of transpeptidase
PCNs cidal
cephalosporins cidal
vancomycin cidal
monobactams cidal
carbapenems cidal
1st generation Ceph is more blank than blank more Gm+ than Gm-
3rd generation ceph is more blank than blank more Gm- than Gm+
adverse effect of interfering with Vit K dependant clotting 2nd gen ceph (cefaclor, cefoxitin, Loracarbef)
might be good for pseudomonas 3rd gen ceph
good CNS penetration 3rd gen ceph
tx meningitis 3rd gen cep
tx meningitis vancomycin
Cefepime good Gm+ & Gm- coverage
nosocomial pneumonias (pseudomonas) cefepime
empiric tx for febrile neutropenia cefepime
ceftaroline good for community acquired pneumonia
good for MRSA ceftaroline
1st ceph w/activity against MRSA ceftaroline
1st drug for CAP since 1998 ceftaroline
broad spectrum & highly resistant to B lactamases carbapenems
combined with cilastin imipenem
cilastin inhibits kidney enzyme that metabolizes the drug its combined with and protects from toxicity
good for MRSA ertapenem
good for ESBL organisms ertapenem
only Gm- monobactams
used to tx septicemia monobactams
single B lactam ring not fused with another aztreonam
all 50s static except for quinupristin/dalfopristin
chloramphenicol causes bone marrow depression w/aplastic anemia
chloramphenicol causes grey baby syndrome
used in Rickettsia chloramphenicol
used in meningtitis when allergic to PCN, ceph chloramphenicol
side effect of clindamycin pseudomembranous c.diff
used when allergic to PCN & ceph clindamycin
MOA clindamycin inhibits toxin production by blocking protein synthesis
used in strep pyogenes & staph TSS clindamycin
Gm+ clindamycin
side effects of linezolid bone marrow suppression (thrombocytopenia, anemia & leukopenia)
mostly Gm+ linezolid
used for HAP, CAP, staph, MRSA, VRE linezolid
metabolized cyp450 macrolides
metabolized cyp450 erythromyc & clarithromycin
causes QT prolongation macrolides
interaction with anti-epileptics, warfarin, birth control macrolides
have anti-inflammatory properties macrolides
inhibit mononuclear cells, reduce superoxide by PMNs, modify release of cytokines, inhibit biofilms macrolides
binds to 2 separate sites on protein - irreversible quinupristin/dalfopristin
multi-drug resistant Gm+ cocci quinupristin/dalfopristin
VRE static quinupristin/dalfopristin
MSSA, MRSA, S.pyogenes cidal quinupristin/dalfopristin
metabolized cyp450 quinupristin/dalfopristin
side effects of quinupristin/dalfopristin venous irritation
30s all static
tetracycline also includes doxycycline
take this 1 hr before or 3hrs after eating tetracycline
causes photosensitivity, teeth discoloration tetracycline
monocycline side effects lupus like reaction, vertigo, arthritis
tigecycline slow IV infusion
used for MRSA, VRE, ESBL, MDR acinetobacter tigecycline
NO activity against pseudomonas tigecycline
spectinomycin aminocyclitol abx, closely related to aminoglycosides
often used with PCN to facilitate crossing bacterial Cell wall aminoglycosides
crosses CNS only with meningeal inflammation aminoglycosides
oldest aminoglycoside streptomycin
M/C used aminoglycoside gentamycin
aminoglycoside used for pseudomonas tobramycin
aminoglycoside with broadest spectrum amikacin
topical, toxic aminoglycoside neomycin
aminoglycoside side effects vestibular, auditory & nephrotoxicity; neuromuscular blockade
Gm- enteric, Tularemia, tersinia pestis aminoglycosides
Cidal fluroquinolones
safe high blood levels with oral absorption and good tissue penetration fluroquinolones
MOA fluorquinolones inhibit DNA gyrase
good Gm- coverage fluroquinolones
resistance is developind due to mutation in bacterial DNA fluroquinolones
Naladixic acid 1st generation fluroquinolones
side effect fluoroquinilones tendon rupture & tendinitis
causes c.diff fluroquinolones
side effects of ciprofloxin inhibits GABA- and causes seizures in pt with renal insufficiency
used for chronic bone infxns fluroquinolones
moxofloxacin empiric coverage intra-ab infxn & broad spectrum & anaerobes
novel second generation lipoglycopeptide that belongs to same class as Vancomycin dalbavancin
not yet FDA approved dalbavancin
for hospital pt with difficult to tx MRSA dalbavancin
telavancin also a lipoglycopeptide
MOA telavancin dual action - inhibits cell wall synthesis & dissipates cell membrane potential
qualified infectious disease product used @ instutions with a specialist - telavancin
tefibazumab monoclonal antibody that binds to the surface-expressed adhesion protein clumping factor A
daptomycin newer class of cyclic lipopeptide
causes rapid depolarization Gm+ cell membrane potential inhibiting bacterial DNA, RNA & protein synthesis daptomycin
side effect of daptomycin constipation
potential for myopathy daptomycin
monitor CPK when on this daptomycin
broad Gm+ coverage of org resistant to methicillin & vancomycin daptomycin
used in complicated skin & soft tissue infxn: MRSA, VRE, s.agalactiae daptomycin
isoniazid MOA interferes with biosyn of mycolic acid component of cell wall
isoniazid side effects hepatotoxicity
can induce pyridoxine deficiency (Vit B6), causing pellagra manifested by peripheral neuritis, rash & anemia isoniazid
rifampin MOA inhibits DNA-dependent RNA polymerase
rifampin side effects jaundice, red/orange sweat, urine, tears
used for TB & leprosy rifampin
prophylaxis for exposure to N. meningitides rifampin
induces p450 rifampin
pyrazinamide causes hepatotoxic, gout
ethambutol crosses BBB
visual disturbance side effects ethambutol
only 1st line TB that is bacterostatic ethambutol
rifabutin MOA inhibits DNA-dependent RNA polymerase
side effects rifabutin uveitis, orange urine, sweat, tears
used in combo for prevention & tx M. avium or M. intracellulare rifabutin
increases drug interactions with heart therapy rifapentine & inh (drugs for latent TB)
take for 3 months rifapentine & INH
take for 9 months INH only
sulfonamides MOA competitive inhibition DHPS which converts PABA in folate synthesis (important for DNA synthesis) therfore bacteriostatic
sulfonamides no toxicity
diuretics, sulfonlylureas & acetazolamide sulfa moity also present so beware sulfa allergy
sulfonamides side effects steven-johnson syndrome, severe sun burn
used to treat UTIs, otitis media, sinusitis, bronchitis, MRSA sulfonamides
topical silver sulfadiazine tx burns
sulfadiazine protect ppl w/RF from infx; tx toxoplasmosis
sulfasalazine anti-inflammatory agent
metronidazole MOA binds proteins & DNA - cell death
severe GI side effects metronidazole
severe CNS depression in elderly side effects metronidazole
drug of choice for psudomembranous colitis caused by Gm+ cdiff metronidazole
tinidazole shorter course of tx than the other amebicide
Leprosy hansens disease
lepromatous leprosy low cell-mediated immunity
lepromatous leprosy organisms everywhere, skin, nevers, eyes, testes
lepromatous leprosy leonine facies, saddle nose, peripheral neuropathy, digit absorption, blindness, infertility in men
tuberculoid leprosy intact cell-mediated immunity
tuberculoid leprosy difficult to isolate from skin or blood
tuberculoid leprosy skin & nerves involved (1-2 superficial unilateral lesions)
most common cause of neuropathy worldwide leprosy
Daptomycin no activity against Gm-
becomes inactivated by pulmonary surfactant therefore not appropriate for pneumonia daptomycin
methods to figure out MIC dilution method & disc diffusion method
Bacteriocidal have MBC similar to MIC
bacteriostatic have MBC higher than MIC
stronger ABX have very low MICs
MIC of resistant org >2
four pharmacokinetic processes absorption, distribution, metabolism, excretion
pharmacokinetics how much of drug arrives at destination to have an effect
pharmacokinetics determines time course of drug response & appropriate dosing strategies
pharmacodynamics drug receptor interaction, pt functional status, placebo
pharmacodynamics determines the nature & intensity of the response
pharmacodynamic/pharmacokinetic drug activity ration PD/PK: takes into account the peak drug CONCENTRATION & length of TIME of drug exposure at site of infection - it is time/concentration!!
who produces beta lactamase H. flu, M.catarrhalis, anaerobic bacteria, gonorrhea also now
B-lactamase production binding is irreversible & cannot be overcome with higher dosing but CAN BE OVERCOME WITH B-LACTAMASE INHIBITORS
Created by: jjohrden16