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Antibiotics - Comp.
A compiliation of multiple study stacks on antibiotics - much repetition
| Question | Answer |
|---|---|
| What drugs target cell wall synthesis? | beta lactams, cephalosporins |
| What drugs target protein synthesis? | chloramphenicols (50s), macrolides (50s), tetracylines (30s) |
| What drugs target DNA replication | quinolones |
| What is the target of quinolines? What do they inhbit? | DNA gyrase, relaxation of supercoiling |
| What drugs target nucleic acid synthesis? | sulfa drugs, trimethoprim |
| What drugs target RNA synthesis? | rifamycin, rifampin |
| What drugs target membranes? | polymixins, detergents, ionophores |
| What is the target of polymixins? | cell membranes |
| Do polymixins have a good therapeutic ratio? Why? | no, neurotoxic, nephrotoxic - use only in extreme circumstances or topically |
| How do polymixins work? | make cell membranes leaky (large cyclic protein head, long hydrophobic tail) |
| What is the target of detergents? | cell membrane |
| Do detergents have a good therapeutic ratio? Why? | no, membranes are same in humans and bacteria - use only on skin, cells are already dead |
| Disinfectant/Antiseptic: how does alcohol work? | denatures proteins at 70% concentration |
| Disinfectant/Antiseptic: how does silver, colloidal silver work? | binds proteins in cell membranes, interferes with respiration (takes place at membranes) |
| What is silver nitrate used to treat? | eye infections |
| What is colloidal silver used to treat? | bed sores |
| Disinfectant/Antiseptic: how does Triclosan work? | inhibits fatty acid biosynthesis - very good specificity - could be antibiotic in the future |
| Where is triclosan found? | soaps, toothpastes, mouthwash, shampoo |
| Disinfectant/Antiseptic: How does iodine work? | binds to histidine, tyrosine, tryptophan (all have ring structures), denatures proteins, highly effective against viruses, fungi, spores |
| Disinfectant/Antiseptic: will 70% alcohol kills spores? | no |
| Disinfectant/Antiseptic: what will work on spores? | iodine |
| Disinfectant/Antiseptic: How does hydrogen peroxide work? | releases oxygen, creates radicals, effervesces, effervescence lifts away fomites |
| Disinfectant/Antiseptic: How does benzalkonium chloride work? | probably denatures proteins, destabilizes membranes |
| Disinfectant/Antiseptic: What is benzalkonium chloride? | quaternary ammonium (NR4), surfactant, hand scrub, facial wash |
| Disinfectant/Antiseptic: How does formaldehyde work? | very reactive with proteins and nucliec acids, cross-links P-P and N-N with covalent bonds, can wipe out a genome! |
| Disinfectant/Antiseptic: How is formaldehyde used? | preservative, fixative for tissues (but not for tissues whose genetic material needs to be preserved) |
| Disinfectant/Antiseptic: How does irradiation work? | causes double strand breaks to DNA (only takes 2 breaks to kill) |
| Disinfectant/Antiseptic: how does alcohol work? | denatures protein at 70% concentration |
| What four ways can antibiotics kill bacteria? | Inhibit cell wall synthesis, inhibit protein synthesis, interfere w/ DNA synthesis, and inhibit folic acid synthesis |
| As an awesome nurse, what actions do you take prior to giving an antibiotic? | ask about drug allergies (ask about trade name AND drug class), obtain ordered cultures BEFORE 1st dose is administered, obtain a baseline CBC, make patient is not renal insufficient (most antibiotics are renally sucreted) |
| What is Antibiotic-associated pseudomembranous colitis (AAPC)? | an opportunistic infection caused by clostridium difficile that causes mucus-like, watery, bloody, foul-smelling stool (umm, nasty). FYI: spores can be spread in stools to other patients |
| Beta Lactam Antibiotics are composed of what two subclasses? | Penicillins & Cephalosporins |
| How to Beta Lactam Antibiotics work? | The beta lactam ring inhibits cell wall synthesis |
| Bacteria that are resistant to Beta Lactam Antibiotics have what feature? Give two examples of bacteria that are resistant. | Resistant bacteria have beta lactamases, enzymes that destroy the beta lactam rings. Staphylococcus & Streptococcus. |
| Name two narrow spectrum penicillins. | Penicillin G and Penicillin V |
| Narrow Spectrum penicillins are effective against what kind of bacteria, and ineffective against what kind of bacteria? | effective against strep, Neisseria gonorrhea, Neisseria meningitis, and Treponema pallidum. Ineffective against staph |
| What are the routes of administration for Penicillin G? | IV (Penicilin G aqueous only) or IM |
| What are Penicillinase-Resistant Penicillins? | Penicillins that are resistant to bacteria that produce beta lactamases |
| List three examples of Penicillinase-Resistant Penicillins. | nafcillin, oxacillin, discloxacillin |
| What are Broad Spectrum Penicillins (aminopenicillins) used to treat? | gram + and common gram - infections such as flu, shigella, salmonella, E. coli |
| Name two broad spectrum penicillins. | amoxicillin, ampicillin |
| Patients with renal insufficiency who are on a high dose of beta lactams are at risk for what? | seizures |
| What is a drug interaction with the cephalosporins Cefotan and Cefoid (cefoperazone)? | These drugs, when mixed with alcohol produce effects similar to that of Antabuse |
| What are some side effects associated with Cephalosporins? | Superinfections (AAPC), Nephrotoxicity, Thromboplebitis |
| How do Quinolones work? | interrupt DNA gyrase (an enzyme that coils DNA) |
| What are Quinolones used for? | To treat prostates, urinary tract, lung, and skin infections, and diarrhea from food bacteria |
| List side effects associated with Quinolone therapy. | Photosensitivity, N/V, diarrhea, CNS changes (agitation, confusion, paranoia), Interference w/ cartilaginous matrix, Hypoglycemia, Cardiac dysrhythmias, |
| Why shouldn't children under 12 be given Quinolones? | they can impair cartilage growth in children this young |
| Vitamins such as iron, calcium, magnesium, and aluminum have what affect on the bioavailability of Quinolones? | decreases bioavailability |
| How do Quinolones affect the metabolism of theophylline? Why is this important? | Quinolones decrease the metabolism of theophylline, which can cause theophylline toxicity. This can result in tachycardia, restlessness, agitation, seizure, and cardiac dysrhythmias |
| Macrolides in high doses are _________ while in low doses they are __________. | bacterocidal, bacteriostatic |
| Name three Macrolides. | Erythromycin, Zithromax (azithromycin), Biaxin (clarithromycin) |
| Which is the oldest Macrolide? Which is relatively new? | old: Erythromyci, new: azithromycin |
| Why are Macrolides AWESOME? | They are a good alternative for patient who are allergic to pencillin, and they treat atypical bacteria (Legionella, Chlamydia, Mycoplasma) |
| Why is Erythromycin estolate dangerous? | Is can cause obstructive hepatitis |
| What are side effects of Macrolides? | Diarrhea, Hepatotoxicity, Nausea, Abdominal Cramping, Thromboplebitis (w/ IV erythromycin) |
| How does Clindamycin work? | Prevents protein synthesis by binding to bacterial ribosomes |
| What is Clindamycin used for? | to treat anaerobic infections |
| What are side effects of Clindamycin? | AAPC ( never give antidiarrheals, as they increase the time clostridium difficile is in the colon!) |
| How does Vancomycin work? | Inhibits cell wall synthesis |
| What can happen if Vancomycin is given by IV too fast? How can this be avoided? | Red Man Syndrome (causes massive vasodilation). Prevent by giving IV over 1 -1.5 hrs |
| When is Vancomycin given PO? | If the patient has AAPC |
| What are side effects of Vancomycin? | Nephrotoxicity, ototoxicity |
| How do Tetracyclines work? | Interfere w/ protein synthesis |
| What are tetracyclines used for? | STDs, GI infections, skin infections |
| What specific infections do tetracyclines treat? | H. pylori (causes PUD), Acne, Mycoplasma pneumonia, Rickettsial diseases (Rocky Mountain Spotted Fever, Typhus), Lyme Disease, Cholera, Chylamydia |
| Why should children under 8 not take tetracyclines? | Can cause permanent tooth discoloration (grey/red), and they irreversibly slow bone growth |
| What substances decrease the bioavailability of tetracyclines? | iron, magnesium, calcium, and aluminum |
| What are side effects of tetracyclines? | photosensitivity, superinfection, hepatotoxicity, nephrotoxicity |
| What are Aminoglycosides used for? | serious infections (sepsis) |
| What are side effects of aminoglycosides? | Nephrotoxicity, ototoxicity, weakness, paralysis, respiratory depression |
| How can aminoglycoside toxicity be detected? | By monitoring peak and trough levels. If the trough is elevated then the patient is toxic. |
| How do Sulfonamides work? | block folic acid production |
| What are Sulfonamides used for? | UTIs, gram - infections, burned skin infections |
| Side effects of sulfonamides. | rash in sun/artificial light, Steven-Johnson syndrome (severe skin reaction), Kidney crystals |
| What is Flagyl used for? | drug of choice for Clostridium difficile and AAPC, also used for gynecologic infections |
| Why should Flagyl not be taken with alcohol? | reaction similar to taking alcohol with Antabuse |
| synthetic antibiotics | 1. quinolones/ fluoroquinolones 2. oxazolidinone 3. nitroimidazole 4. nitrofurane 5. sulfonamide 6. trimetoprim |
| antibiotics - mechanism of action | 1. inhibition of proteoglycan synthesis 2. inhibition of DNA replication 3. inhibition of RNA polymerase 4. destruction of cell membrane 5. inhibition of folic acid pathway 6. inhibition of protein synthesis (30S, 50S) |
| antibiotics that inhibit proteoglycan synthesis (cell wall synthesis) | 1. penicillins 2. cephalosporins 3. vancomycin 4. bacitracin 5. monobactams 6. fosfomycin 7. cycloserine |
| antibiotics that inhibit folic acid metabolism | 1. sulfonamide 2. trimethoprim |
| antibiotics that inhibit DNA replication (bacterial gyrase) | 1. quinolone 2. fluoroquinolone |
| antibiotic that inhibits RNA polymerase | 1. rifampicin |
| antibiotics that inhibit protein synthesis 50S | 1. chloramphenicol 2. erythromycin 3. clindamycin 4. oxazolidinones |
| antibiotics that inhibit protein synthesis 30S | 1. aminoglycosides 2. tetracyclines 3. streptomycin 4. amikacin |
| antibiotics that destroy cell membrane | 1. polymyxins |
| semisynthetic drugs - definition | drugs, which are chemically modified in the lab after being isolated from NATURAL SOURCES |
| synthetic drug - definition | chemically synthetized drug (without any pattern in nature) |
| antimicrobial drug - definition | a chemical that inhibits the growth or kills bacteria regardeless of its origin - antibiotics - semisynthetic or synthetic drugs |
| chemotherapeutic drug - definition | any chemical used in the treatment, relief or prophylaxis of a disease |
| antimicrobial chemotherapy | the use of chemotherapeutical drugs to control infection |
| selective toxicity - meaning | drug is toxic to microbes, not host cells |
| bacteriostatic drugs | 1. macrolides/ketolides 2. lincosamides 3. streptogramines 4. tetracyclines 5. chloramphenicol 6. trimethoprim 7. sulfonamides 8. glycylcycline (tigecycline) 9. oxazolidinones |
| bacteriocidal drugs | Depending on time when C>MIC: 1. B- lactams 2. fluoroquinolones 3. glycopeptides Depending on maximal concentration 1. aminoglycosides 2. fluoroquinolones 3. dalbavancin 4. daptomycin 5. metronidazole |
| Aminoglycosides - general information | BACTERIOCIDAL inhibition of protein synthesis 30S Natural : 1. streptomicin 2. gentamicin 3. tobramicin 4. kanamicin 5. neomycin Semisynthetic: 1. netilmycin 2. amikacin |
| Aminoglycosides - spectrum | 1. GRAM (-) 2. Mycobacterium 3. Staphylococci |
| Aminoglycosides - resistancy | 1. modification of antibiotic by bacterial: - acetyltransferase - phosphotransferase - adenyltransferase 2. modification of a place where antibiotic attaches 3. inhibition of transport of antibiotic to the cell 4. active efflux of antibiotic |
| Tetracyclines - general information | BACTERIOSTATIC inhibition of protein synthesis 30S doxycycline tetracycline |
| Tetracyclines - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ATYPICAL (Mycoplasma, Chlamydia, Rickettsia, Borrelia, Coxiella) 4. ANAEROBES 5. Protozoa They dont work on: Legionella pneumophila Pseudomonas aeruginosa 4. |
| Tetracyclines - resistancy | 1. active efflux of antibiotic 2. modification of a place where antibiotic attaches (tet genes on transposon) 3. enzymatic inactivation |
| Glycylcyclines - general information | BACTERIOSTATIC inhibition of protein synthesis 30S tigecycline |
| Glycylcyclines - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES 4. Mycobacterium 5. ATYPICAL - Mycoplasma, Chlamydophila They dont work on: - Pseudomonas aeruginosa - Proteus mirabilis - Providencia - Morganella morganii |
| Glycylcyclines - resistancy | very rare, only in clinical strains of Klebsiella pneumoniae and Acinetobacter - overexpression of efflux pump (gene mefA) |
| Macrolides/ ketolides - general information | BACTERIOSTATIC inhibition of protein synthesis 50S Natural macrolides: erythromycin, josamycin, spiramycin Semisynthetic macrolides: roxithromycin, azithromycin, clarithromycin, davercin Ketolides: telithromycin |
| Macrolides/ ketolides - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES 4. Spirochetaceae 5. Mycobacterium 6. ATYPICAL 7. Protozoa |
| Macrolides / ketolides - resistancy | MLSb - modification of the place where antibiotic attaches by methylation of 23S rRNA in 50S subunit MLSb - Macrolides, Lincosamides, Streptogramin B resistancy |
| Lincosamides - general information | BACTERIOSTATIC inhibition of protein synthesis 50S (elongation) lincomycin clindamycin |
| Lincosamides - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES 4. Protozoa They dont work on: - Enterobacteriaceae - Enterococcus - Pseudomonas - Haemophilus - Neisseria - Moraxella |
| Lincosamides - resistancy | MLSb |
| Streptogramin - general information | BACTERIOSTATIC inhibition of protein synthesis 50S dalfopristin quinupristin dalfopristin + quinupristin -> Synercid |
| Synercid (dalfopristin/quinupristin) - spectrum | 1. MRSA, ORSA, PRSP, VRE, VISA 2. GRAM (+) 3. GRAM (-) 4. ANAEROBES 5. ATYPICAL They dont work on: - Enterobacteriaceae - Enterococcus faecalis - Pseudomonas |
| Streptogramin - resistancy | 1. Modification of a place where antibiotic attaches (MLSb) 2. inactivation of antibiotic 3. active efflux 4. inhibition of antibiotic transport to the cell |
| Oxazolidinones - general information | BACTERIOSTATIC inhibition of protein synthesis (it blocks the creation of initial complex - 30S and 50 S cannot connect) linezolid |
| Oxazolidinones - spectrum | 1. MRSA, PRSP, VRE, VISA, VRSA 2. GRAM (+) 3. ANAEROBES |
| Oxazolidinones - resistancy | Very rare, spontaneous in 23S r RNA gene (Enterococcus faecalis) |
| Lipoglycopeptides - general information | BACTERIOCIDAL dalbavancin |
| Lipoglycopeptides - spectrum | 1. GRAM (+) ONLY!!! - MRSA, MRCNS, VRE (without VanA mechanism), PRSP - other aerobic GRAM (+) |
| Cyclic lipopeptides - general information | BACTERIOCIDAL irreversibly binds to cell membrane with use of Ca2+ -> makes holes in cell membrane -> depolarization of cell membrane and leak of ions -> destruction of cell membrane daptomicin |
| Cyclic lipopeptides - spectrum | 1. GRAM (+): - MRSA, MRSE, VRE, VISA 2. ANAEROBES |
| Chloramphenicol - general information | BACTERIOSTATIC inhibits protein synthesis 50S potentially hematotoxic |
| Chloramphenicol - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES It doesnt work on: - Pseudomonas aeruginosa - Nocardia - Acinetobacter |
| Chloramphenicol - resistancy | 1. modification of antibiotic |
| Polymyxin - general information, spectrum, resistancy | inactivates LPS - it binds to lipid A polymyxin B polymyxin E (colistin) Spectrum: 1. GRAM (-) 2. ANAEROBES Resistancy: inhibition of antibiotic transport to the cell |
| Ansamycin - general information, spectrum, resistancy | BACTERIOCIDAL inhibition of RNA polymerase rifampicin Spectrum: 1. GRAM (+) cocci 2. Mycobacterium Resistancy: synthesis of modified polymerase that is resistant to rifampicin |
| Sulfonamides/ trimethoprim - general information | BACTERIOSTATIC Sulfonamides-compete with PABA and create modified acid instead of folic acid which leads to folic acid and nucleotides deficiency (bacteria cannot use egzogenic folic acid) sulfamethoxazole Trimethoprim-inhibits dihydrofolate reductase |
| Sulfonamides / trimethoprim - spectrum | Sulfamethoxazol + trimethoprim -> cotrimoxazol 1. GRAM (+) 2. GRAM (-) 3. ATYPICAL 4. Protozoa |
| Sulfonamides / trimethoprim - resistancy | Determined by plasmids or transposons 1. increased synthesis of PABA 2. synthesis of an enzyme that is resistant to trimethoprim 3. decreased antibiotic transport to the cell |
| Nitroimidazoles - general information | BACTERIOCIDAL inhibition of DNA synthesis (antibiotic goes into the cell -> reduction of antibiotic -> DNA destruction) metronidazole, ornidazole, tynidazole, nimorazole |
| Nitroimidazole - spectrum | 1. ANAEROBES 2. Protozoa |
| Nitroimidazole - resistancy | 1. inactivation of nitroreductase (antibiotic cannot be reduced -> DNA synthesis is not inhibited) |
| Nitrofurans - general information, spectrum, resistancy | BACTERIOCIDAL -inhibition of DNA synthesis -nitrofurantoin Spectrum: 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES They dont work on: - Pseudomonas aeruginosa - Acinetobacter Resistancy: 1. decrease in antibiotic transport 2. lack of reductase |
| Quinolones and fluoroquinolones - general information | BACTERIOCIDAL - inhibition of DNA replication (DNA gyrase) Quinolones: I generation - nalidixic acid - pipemidic acid Fluoroquinolones: II generation - norfloxacin - ofloxacin - pefloxacin - cyprofloxacin III generation: - levofloxacin |
| Quinolones and fluoroquinolones - spectrum | I generation - very narrow II generation: 1. AEROBIC GRAM (-) 2. ATYPICAL 3. Mycobacterium III generation: II gen. + GRAM (+) cocci |
| Quinolones and fluoroquinolones - resistancy | 1. active efflux 2. modification on DNA gyrase, so that its resistant to antibiotic |
| Fusidines - general information | BACTERIOSTATIC, in high concentrations bacteriocidal inhibition of protein synthesis fusidic acid |
| Fusidines - spectrum | 1. GRAM (+) 2. GRAM (-) 3. ANAEROBES 4. Mycobacterium 5. Protozoa |
| Fusidines - resistancy | 1. decreased transport of antibiotic into the cell 2. modification of the place where antibiotic attaches |
| gram positive cocci | staph aureus, mrsa, staph epi, strep abcg, strep viridans, strep penumo, enterococcus faecalis/faceium |
| gram positive bacilli | listeria monocytogenes |
| gram neg cocci | neisseria meningitis, neisseria gonorrhea, moraxella catarrhalis |
| gram positive bacilli | enterbacter proteus, enterobacter coli, enterobacter klebsiella, pseudomonas aeruginosa, legionella pneumophilia |
| anaerobic bacteria | bacteroides fragilis, clostridium difficile |
| atypical bacteria | mycoplasma, chlamydia, legionella, ricketsia |
| pcn allergy cross reactivity | 10% with ceph, carbapenem case report, aztreonam rare |
| cephalasporin pearls | all renall dosed except for ceftriaxone. 1st gen= g+ basic g-, 2nd gen less staph greater g- some anaerobic. 3rd gen less staph aureus greater g- some pseudomonas |
| Iv Ceph 1st gen | cefazolin (ancef), doc for surgical prophy 1 g x 1 dose |
| po ceph 1st gen | cephalexin, keflex......cefadroxil, duricef.... |
| po ceph 2nd gen | cefprozil, cefzil...cefuroxime, ceftin......cefaclor, ceclor. |
| po ceph 3rd gen | cefdinir, omnicef....cefpodoxime, vantin......cefixime, suprax.... |
| IV ceph 2nd gen | cefuroxime, cefoxitin, cefamandole, cefmetazole, ceotetan |
| iv ceph 3rd gen | ceftriaxone, ceftazidime, cefotaxime, ceftizoxime |
| iv ceph 4th gen | cefepime, only ceph that covers enterobacter!!!! cns toxicity, sz risk!!! |
| iv ceph 5th gen | ceftaroline, first ceph for MDR like MRSA, cap, hcap... |
| carbapenems coverage | g+,g-, anaerobes. all cover pseudo except ertapenem (invanz). sz risk high for imipenem/cilastatin and merrem |
| monobactam | aztreonam, g- including pseudo....rescue drug for aminoglycoside nephrotox |
| aminoglycosides | g-, esp pseudomonas, synergy with pcn and vanco against g+. inc risk for nephrotoxicity, ototoxity (bbws) and neuromuscular block. |
| floroquinolones risks | bbw for tendon rupture... qt prolongation increase..2nd gen g-, 3rd gen g- and g+ including staph aureus and pneumo, 4th gen is 3rd gen + inc strep pneumo and dec pseudo. all renal BUT moxiflox |
| macrolides | azithromycin, clairithromycin, erythromycin. risk for qt prolongation, covers g+, some g- and atypicals (mycoplasma, legionella, ricketssia. clari and ery are 3a4 inhibitors |
| tetracycline | doxy, mino, tetra. preg cat g, do not use in <8 yo due to teeth staining. all renal BUT doxy. Doxy DOC for rickettsia, lyme dz, chlamydia |
| clindamycin | BBW, prolonged use can cause fungal or bacterial super infection |
| Daptomycin | cubicin, not indicated for pneumonia. for g+, including vre |
| tigecycline | tygacil. no PSEUDO. not renally dosed. |
| anti fungals | fungus classified into yeasts (candida, cocci, crypto, histo, sporothrix) and molds (aspergillus, fusarium, pseudallescheria boydii, zygomycetes) |
| fluconazole | most activity against most candida other than krusei and glabatra. not clinically active against most molds including aspergillus |
| itraconazole | (sporanox) broad spectrum of activity, most candida species and aspergillus, BBW for heart failure risk, serious CV side effects. capsule wf, solution without |
| voriconazole | vfend; broad spectrum of activity, more aspergillus activity, refrigerate before suspension is mixed |
| posaconazole | noxafil, broad spec, some aspergillus activity. |
| caspofungin | cancidas, second line tx usually used when intolerant/refractory to other tx. |
| amphotericin b | d5 only, watch for infusion reactions. may DECREASE K and MG. saved for life threatening fungal infections |
| inhibitors of cell wall synthesis | B Lactam (pcn, ceph, monobacam), glycopeptides (vanco), bacitracin, isoniazid |
| inhibitors of folate metabolism | trimethoprim, sulfonamides |
| inhibitors of ribosome fxn | 30s ribo= streptomycin, gentamicin, tobramycin, amikacin, tcn |
| inhibitors of ribosome fxn | 50s ribo= clindamycin, macrolides, erythromycin, chloramhenicol |
| inhibitors of nucleic acid synthesis | quinolones (DNA gyrase), rifampin (dna dependant rna polymerase) |
| antifungal lanosterol 14 alpha demthylase inhib | miconazole, ketconazole, clotrimazole, fluconazole, itraconazole, posaconazole, voriconazole |
| antifungal 1,3 b glucan synthase inhib | anidulafungin, capsofungin, micofungin |
| antifungal ergosterol binders | amphotericin b, nystatin |
| photosensitivity abx | fluoroquinolones, tcn, bactrim, tigecycline |
| antacid interaction abx | fq, tcn, azit (except zmax), cefdinir, inh |
| change urine color abx | metronidazole (dark), nitrofurantoin (dark yellow, brown), rifampin (orange), rifapentine (orange-red) |
| take wf abx | augmentin (dec GI se, inc absorption), clarithromycin xl, nitrofurantoin, cefuroxime suspension formulation, itraconazole cap formulation, posaconazole, rifapentine |
| take on empty stomach abx | rifampin, inh |
| drink lots of water abx | tcn (esophageal irritation), bactrim or septra (avoid crystalluria), clindamycin |
| avoid during pregnancy abx | FQ (arthropathies), clairithromycin (cat c, azit and ery are b cat), metronidazole (1st trimester), nitrofurantoin (>38 weeks), bactrim/septra and tcn |
| avoid alcohol abx | metronidazole, linezolid (htn crisis), inh (monoamine poison) |
| Do not refigerate antibiotics | suspension: clarithromycin (thicken and poor taste), clindamycin |
| No renal adjustments antibiotics | linezolid, tigecycline, synercid, clindamycin, metronidazole, ceftriax (only cephalasporin), doxycycline (only tcn), moxifloxacin (only fq), nafcillin and oxacllin (only pcns) |
| Hepatic adjustments antibiotics | tigecycline, capsofungin |
| same iv to po abx | linezolid, levofloxacin, moxifloxacin, doxycycline, metronidazole, isoniazid (im to po), rifampin, fluconazole |
| Sulfonamides: Action? | Inhibit bacterial growth |
| Sulfonamides: Indications? | UTI's, respiratory infections, pneumonias |
| Sulfonamides: SE/AE? | Delayed reactions: fever, rash, GI, hepatic, renal, hematologic complications |
| Sulfonamides: Interactions? | Significant reactions with many meds. Hypoglycemics, warfarin, phenytoin, immunosuppressants |
| Sulfonamides: Labs? | Increased AST (asparatate aminotransferase); alkaline phosphate |
| Sulfonmides: Prototype? | Sulfamethoxazole |
| Sulfamethoxazole: Indications? | UTIs, ear infections, bronchitis, gonorrhea, general infections. Prophylaxis of HIV. |
| Sulfamethoxazole: Contraindications? | Pregnancy at term, infants under 2 mo. Liver, renal disease, severe allergies. Drug to drug allergies. |
| 4 classes of Beta-Lactams? | Penicillin Cephalosporins Carbapenems Monbactams |
| Penicillins: Action? | Inhibit cell wall synthesis. Limited to killing bacterial cells, not other cells in body. |
| Penicillins: Indications? | Gram-positive strep, staph. Pneumonia, strep, syphillis |
| Penicillins: SE/AE? | Hypersensitivity: uticaria, pruritis, angioedema. 10% are life threatening. |
| Penicillins: Interactions? | Decrease effectiveness of warfarin, contraceptives. |
| Penicillins: Prototype? | Amoxicillin |
| Which antibiotic (according to powerpoints) is used to treat cat scratch fever? | Amoxicillin (really, it's azithromycin, a macrolide) |
| Amoxicillin: Indications? | Ear, nose, throat, GU, skin infections. |
| Amoxicillin: Administration? | 500 mg and 875 mg tablets. Avail in chewable tablets and pediatric drops. |
| Cephalosporins: What are they? | Synthetic antibiotic derivative of cephalosporin C |
| Cephalosporins: Action? | Bactericidal, interfere w/ bacterial cell wall synthesis. |
| Cephalosporins: Indications? | Wide spectrum bacteria: gram-pos, gram-neg |
| What is the differentiation b/w 1st, 2nd, 3rd generation cephalosporins? | 3rd generation is more effective on gram negatives. |
| Cephalosproins: SE/AE? | Similar to penicillin. Diarrhea, abdominal cramps, rash, pruritus, redness. |
| Cephalosporin: Prototype? | Cefazolin. First-generation cephalosporin |
| Trade names for cefazolin? | Ancef, Kefzol |
| Cefazolin: indications? | Gram-positive. Skin infections, pneumonia, UTI, bone/joint infections, septicemia, perioperative prophylaxis, billiary and genital infections. Bacterial endocarditis, prophylaxis for dental and upper respiratory tract procedures |
| Cefazolin: Routes? | IM, IV. Parenteral |
| Carbapenems: Action? | Interferes to cell wall synthesis. (like other beta-lactams) |
| Carbapenems: indications? | very broad antimicrobial spectrum; most bacterial pathogens. Highly active against gram-positive cocci, Most gram-negative cocci and bacilli. Most effective beta-lactam against anaerobic bacteria |
| Carbapenems: contraindications? | allergies to other beta-lactams may be cross-allergic |
| Carbapenems: SE/AE? | Nausea, vomiting, diarrhea. Hypersensitivity reactions, rashes, pruritus, drug fever, suprainfections and rarely seizures |
| Carbapenems: Prototype? | Imipenem (Primaxin) |
| Monobactams: | I have no idea what we are supposed to know for these... |
| Macrolides: Action? | Prevents bacterial protein synthesis |
| Macrolides: Protoypes? | Erythromycin. Azithromycin (Zithromax) |
| Macrolides: Indications? | Respiratory infections, skin infections, soft tissue infections. |
| Macrolides: SE/AE? | GI are primary. Adverse effects include CV-palpitations,CNS- headache, rash, hearing loss. |
| Macrolides: Contraindications: | Liver problems, drug to drug interactions. |
| Erythromycin: Indications? | Diptheria, pneumonia, strep throat. Legionnaires’ disease, Bordatella pertussis (whooping cough), urethritis, cervicitis, respiratory infections, rheumatic fever, bacterial endocarditis. |
| Tetracyclines: Action? | Inhibit protein synthesis. Prevent growth and repair of bacteria. |
| Tetracyclines: Indications? | Wide range. Chlamydia, pneumonia, rickettsia, (Rocky Mountain spotted fever, typhus fever, Q fever), brucellosis, cholera, LYME DISEASE, ANTHRAX, gastric infection w/ H. pylori (peptic ulcer) Topically used for acne. Periodontal disease |
| Tetracyclines: Contraindications? | Known drug allergy. Dairy products, antacids, penicillins, anticoags. Winnie: contraindicated in pregnant women and children under 8 y/o |
| Tetracyclines: SE/AE? | Photosensitivity, discoloration of teeth, candida, diarrhea, pseudo colitis. hepatotoxicity, renal toxicity |
| Tetracycines: Prototypes? | Doxycycline |
| Doxycycline: Indications? | periodontal disease Lyme disease, anthrax, chlamydial infections, sexually acquired proctitis |
| Doxycycline: Side effects? | Photosensitivity, candida, discoloration of teeth, diarrhea |
| Aminoglycosides: Protoype? | Tobramycin |
| Aminoglycosides: Action? | Bind to ribosomes and prevent protein synthesis |
| Aminoglycosides: Indications? | Gram negative infections and some gram positive. Pseudomonas. Winnie: Ear infection, eye, skin. |
| Which aminoglycoside is used for TB? | streptomycin (Winnie) |
| Aminoglycosides: SE/AE? | Very potent, therefore can cause serious toxicities to kidneys (nephrotoxicity) and ears (ototoxicity) |
| Aminoglycosides: Interactions? | Diuretics, skeletal muscle relaxants, anticoags. |
| Fluroquinolones: Action? | Alters DNA of bacteria. Book says: disrupts DNA replication and cell division |
| Fluroquinolones: Indications? | Bacterial infections (S. aureous), wide variety of gram pos and gram neg bacteria. |
| Fluroquinalones: SE/AE? | Cardiac effects: prolonged QT interval. CNS, GI, skin. Book- can cause tendon rupture, i.e. Achilles |
| Fluroquinolones: Protoype/example? | Ciprofloxacin |
| Ciprofloxacin: Indications? | infections of respiratory tract, urinary tract, GI tract, bones, joints, skin and soft tissues, prevention of anthrax |
| Systemic infection in which pathogens are present in the circulating bloodstream | Septicemia /Bacteriemie |
| Syndrome involving multiple system organ involvement that is a result of microorganisms or their toxins circulating in the blood | Sepsis |
| Invasion of body by pathogenic microorgs that reproduce and multiply, causing disease | Infection |
| Localized presence and multipication of microorgs w/out invasion or damage | Colonization |
| Presence of viable bacteria in the blood | Bacteremia |
| Staphylococcus category | Gram-positive cocci |
| Streptococcus category | Gram-positive cocci |
| Escherichia coli category | Enteric gram-negative Bacilli |
| Haemophilus influenza category | Gram-negative Bacilli |
| Pseudomonas category | Gram-negative Bacilli |
| Mycobacterium category | Acid-Fast Bacilli (AFB) |
| Aqueous penicillin G, type & coverage | Natural penicillin, gm+ anaerobes |
| Procain pen G, type & coverage | Natural penicillin, gm+ anaerobes |
| Benzathine pen G, type & coverage | Natural penicillin, gm+ anaerobes |
| Oxacillin, type & coverage | Penicillinase resistant, penicillinase producing gm+ orgs |
| Nafcillin, type & coverage | Penicillinase resistant, penicillinase producing gm+ orgs |
| Dicloxacillin, type & coverage | Penicillinase resistant, penicillinase producing gm+ orgs |
| Cloxacillin, type & coverage | Penicillinase resistant, penicillinase producing gm+ orgs |
| Ampicillin, Ampicillin/sulbactam, type & coverage | Aminopenicillin (Extended Spectrum), same gm+ as pen G, some gm- (E. coli, H. flu) |
| Amoxicillin, Amoxicillin/clavulanate, type & coverage | Aminopenicillin (Extended Spectrum) Same gm- as pen G, some gm- (E. coli, H. flu) |
| Carbenicillin, type & coverage | Antipseudomonal Penicillin, pseudomonas |
| Ticarcillin, type & coverage | Antipseudomonal Penicillin, pseudomonas |
| Piperacillin, Piperacillin/tazobactam, type & coverage | Antipseudomonal Penicillin, pseudomonas |
| Cephalexin, type & coverage | Cephalosporins-1st gen, gm+, little gm-, no H. flu, no B. fragilis |
| Cephradine, type & coverage | Cephalosporins-1st gen, gm+, little gm-, no H. flu, no B. fragilis |
| Cefadroxil, type & coverage | Cephalosporins-1st gen, gm+, little gm-, no H. flu, no B. fragilis |
| Cefaclor, type & coverage | Cephalosporins-2nd gen, same gm+ as 1st gen, addit gm- (H. flu) |
| Cefuroxime axetil, type & coverage | Cephalosporins-2nd gen, same gm+ as 1st gen, addit gm- (H. flu) |
| Cefprozil, type & coverage | Cephalosporins-2nd gen, same gm+ as 1st gen, addit gm- (H. flu) |
| Loracarbef, type & coverage | Cephalosporins-2nd gen, same gm+ as 1st gen, addit gm- (H. flu) |
| Cefixime, type & coverage | Cephalosporins-3rd gen, more gm-, less gm+, moderate against pseudomonas |
| Cefpodoxime, type & coverage | Cephalosporins-3rd gen, more gm-, less gm+, moderate against pseudomonas |
| Ciprofloxacin, type & coverage | Fluoroquinolones, excellent gm- (H. flu), decent gm+, excellent shigella & salmonella |
| Ofloxacin, type & coverage | Fluoroquinolones, excellent gm- (H. flu), decent gm+, excellent shigella & salmonella |
| Lomefloxacin, type & coverage | Fluoroquinolones, excellent gm- (H. flu), decent gm+, excellent shigella & salmonella |
| Trovafloxacin, type & coverage | Fluoroquinolones, excellent gm- (H. flu), decent gm+, excellent shigella & salmonella |
| Gatifloxacin, type & coverage | Fluoroquinolones, excellent gm- (H. flu), decent gm+, excellent shigella & salmonella |
| Erythromycin, type & coverage | Macrolides, gm+, gm- (H. flu), genital pathogens |
| Clarithromycin, type & coverage | Macrolides, gm+, gm- (H. flu), genital pathogens |
| Azithromycin, type & coverage | Macrolides, gm+, gm- (H. flu), genital pathogens |
| Tetracycline, type & coverage | Tetracyclines, gm+, gm-, acne |
| Metronidazole (Flagyl), type & coverage | Misc, gm+ and gm- anaerobes |
| Clindamycin, type & coverage | Misc, gm+ and gm- aerobes and anaerobes (better than Flagyl against), protozoa |
| SMX-TMP, type & coverage | Misc, gm+ and gm- aerobes, chlamydia, protozoa, UTI & PCP infections |
| Imipenem/cilastin, type & coverage | Carbapenems, wide spectrum, powerful |
| Aztreonam, type & coverage | Monobactams, powerful gm-, high resistance |
| Vancomycin, type & coverage | Glycopeptides, powerful gm+, high resistance |
| Teicoplanin, type & coverage | Glycopeptides, powerful gm+, MRSA |
| Gentamicin, type & coverage | Aminoglycosides, powerful gm-, low resistance |
| Tobramycin, type & coverage | Aminoglycosides, powerful gm-, low resistance |
| Gentamicin & Tobramycin (Aminoglycosides) toxicity, type & coverage | otoxicity, nephrotoxicty |
| Natural Penicillins Spectrum, type & coverage | Gm+ anaerobes |
| Penicillinase resistant spectrum, type & coverage | penicillinase producing gm+ |
| Amonopenicillin (Extended Spectrum) spectrum, type & coverage | Same Gm+ as pen G, Gm- (salmonella, shigella, some E. coli, & H. flu) |
| Antipseudomonal Penicillin spectrum, type & coverage | Pseudomonas (gm-) |
| Cephalosporins-1st gen spectrum, type & coverage | gm+, little gm-, no H. flu, no B. fragillis |
| Cephalosporins-2nd gen spectrum, type & coverage | same gm+, addit gm- (H. flu) |
| Cephalosporins-3rd gen spectrum, type & coverage | gm-, less gm+, moderate against pesudomonas |
| Fluoroquinolones spectrum, type & coverage | excellent gm- (H. flu), decent gm+, shigella, salmonella |
| Macrolides spectrum, type & coverage | gm+, gm- (H. flu), genital pathogens, others: MAC, legionella, mycoplasma pneumonia, helicobacter pylori |
| Tetracyclines spectrum, type & coverage | decent gm+ and gm-, acne |
| Metronidazole spectrum, type & coverage | gm+ and gm- anaerobes |
| Clindamycin spectrum, type & coverage | gm+ and gm- anaerobes (better) and aerobes, protozoa |
| SMX-TMP spectrum, type & coverage | gm+ and gm- aerobes, chlamydia, protozoa, *UTIs, PCP* |
| Carbapenems/Imipenem/cilastin spectrum, type & coverage | wide, powerful, high resistance |
| Monobactams/Aztreonam spectrum, type & coverage | powerful gm-, high resistance |
| Glycopeptides/Vancomycin & Teicoplanin spectrum, type & coverage | powerful gm+, MRSA |
| Aminoglycosides/Gentamicin & Tobramycin spectrum, type & coverage | powerful gm-, low resistance |
| Oxacillin, Nafcillin, Dicloxacillin, Cloxacillin, type & coverage | Penicillinase resistant, penicillinase producing gm+ orgs |
| Ampicillin, Amoxicillin, type & coverage | Aminopenicillin, gm+ and gm- (more gm-) |
| Carbenicillin, Ticarcillin, Piperacillin, type & coverage | Antipseudomonal Penicillins |
| Cephalexin, Cephradine, Cefradoxil, type & coverage | 1st gen Cephalosporins, gm+. little gm-, no H. flu, no B. fragilis |
| Cefaclor, Cefuroxime axetil, Cefprozil, Loracarbef, type & coverage | Cephalosporins-2nd gen, same gm+ as 1st gen, addit gm- (H. flu) |
| Cefixime, Cefpodoxime, type & coverage | Cephalosporins-3rd gen, gm-, less gm+ |
| Imipenem/cilastin, type & coverage | Carbapenem |
| Axtrepnam, type & coverage | Monobactam, gm- |
| Vancomycin, Teicoplanin, type & coverage | Glycopeptides, gm+, MRSA |
| Gentamicin, Tobramycin, type & coverage | Aminoglycosides, gm- |
| Penicillin G kind of ab? | Natural Penicillin's |
| Penicillin V kind of ab? | Natural Penicillin's |
| What do Natural Penicillin's treat? | Gram (+) bacteria like Strep, Staph, pneumonia, Meningitis |
| Natural Penicillin's memorize? | Penicillin GV |
| Cloxacillin, type | Anti-Staph Penicillin |
| Dicloxacillin, type | Anti-Staph Penicillin |
| Nafcillin, type | Anti-Staph Penicillin |
| Oxacillin, type | Anti-Staph Penicillin |
| Methicillin, type | Anti-Staph Penicillin |
| What are Anti-Staph Penicillin used to treat? | Osteomyelitis Endocarditis Pneumonia Skin / Soft tissue infections |
| Anti-Staph Penicillin memorize? | Cloxacillin and Naffa likes meth with oxygen |
| Amoxicillin, type | Amino Penicillin's |
| Ampicillin, type | Amino Penicillin's |
| What are Amino Penicillin's used to treat? | URI UTI Pneumonia Otitis |
| Amino Penicillin's memorize? | I'm sick with Pneumonia so I need to amp up my immune system with Amoxicillin. |
| Piperacillin/Tazobactam, type | Anti-Pseudomanal Penicillins |
| Ticarcillin/Clavulanate, type | Anti-Pseudomanal Penicillins |
| Anti-Pseudomanal Penicillins memorize? | I got a tic from Piperline Shoes. |
| Cefadroxil | 1st generation Cephalosporin |
| Cefazolin | 1st generation Cephalosporin |
| Ceohalexin, type | 1st generation Cephalosporin |
| What are 1st generation Cephalosporin used to treat? | Skin / Soft tissue infections UTI |
| 1st generation Cephalosporin memorize? | LEXI never followed FADs but she got FAZ |
| Cefactor | 2nd Generation Cephalosporins |
| Cefprozil, type | 2nd Generation Cephalosporins |
| Cefuroxime, type | 2nd Generation Cephalosporins |
| Cefoxitin, type | 2nd Generation Cephalosporins |
| Cefotetan, type | 2nd Generation Cephalosporins |
| 2nd Generation Cephalosporins memorize? | The tan fur fox was a pro at his factors. |
| Cefixime, type | 3rd Generation Cephalosporins |
| Cefoperazone, type | 3rd Generation Cephalosporins |
| Cefotaxime, type | 3rd Generation Cephalosporins |
| Ceftriaxone, type | 3rd Generation Cephalosporins |
| 3rd Generation Cephalosporins memorize? | Zone one needs to fix their tax. |
| Cefapime, type | 4th Generation Cephalosporins |
| 4th Generation Cephalosporins memorize | Four Pime Neighborhood |
| Amikacin, type | Aminoglycosides |
| Gentamicin, type | Aminoglycosides |
| Kanamycin, type | Aminoglycosides |
| Neomycin, type | Aminoglycosides |
| Streptomycin, type | Aminoglycosides |
| Tobramycin, type | Aminoglycosides |
| Aminoglycosides treatment? | Plague Tuberculosis Pseudomonas Serious G (-) infections |
| Aminoglycosides memorize? | My sin (MYCIN) |
| Demeclocycline, type | Tetracyclines |
| Doxycycline, type | Tetracyclines |
| Minocycline, type | Tetracyclines |
| Oxytetracycline, type | Tetracyclines |
| Tetracycline, type | Tetracyclines |
| What are Tetracyclines used to treat? | Rocky Mountain Spotted Fever Lyme disease Acne Cholera Chlamydia |
| Tetracycline memorize?, type | My dad get's absolute tetanus when he cycles. |
| What will tetracycline do to your teeth? | stain them blue/brown |
| Erythromycin, type | Macrolides |
| Azithromycin, type | Macrolides |
| Clarithromycin, type | Macrolides |
| Dirinthromycin, type | Macrolides |
| What are Macrolides used to treat? | URI Pneumonia Chlamydia Legionella Otitis Sinusitis |
| Macrolides memorize?, type | Macrobiology Erythromycin |
| Silver sulfadiazine, type | Sulfonamides |
| Sulfacetamide, type | Sulfonamides |
| Sulfisoxazole, type | Sulfonamides |
| Sulfasalazine, type | Sulfonamides |
| Phthalylsulfathiazole, type | Sulfonamides |
| What are Sulfonamides used to treat? | UTI Skin infections Ulcerative colitis Ocular infections |
| Sulfonamides memorize?, type | Sulfa's make my stomach hurt |
| Ciprofloxacin, type | Fluoroquinolones |
| Levofloxacin, type | Fluoroquinolones |
| Lomefloxacin, type | Fluoroquinolones |
| Grepafloxacin, type | Fluoroquinolones |
| Moxifloxacin, type | Fluoroquinolones |
| Sparfloxacin, type | Fluoroquinolones |
| Enoxacin, type | Fluoroquinolones |
| Norfloxacin, type | Fluoroquinolones |
| Ofloxacin, type | Fluoroquinolones |
| What are Fluoroquinolones used to treat? | Variety of urinary, GI, respiratory, bone & joint, skin & soft tissue infections, and gonorrhea |
| Fluroquinolones memorize?, type | Floxacin |
| trimethoprim, type, indication | - DHRFIs - inhibits bacterial dihydrofolate reductase |
| pyrimethamine, type, indication | - DHRFIs - inhibits protozoal dihydrofolate reductase |
| methotrexate, type, indication | - DHRFIs - inhibits mammalian, bacterial and protozoal DHFR - used to treat psoriasis and various cancers |
| Pralatrexate, type, indication | - DHRFI - for t-cell lymphoma |
| Sulfisoxazole, adm route, indication | - ORAL - prophylaxis in kids with recurrent otitis media |
| Sulfamethoxazole, adm route, indication | - ORAL - available with timethroprim - RUG |
| sulfacetamide, adm route, indication | - TOPICAL - ulcerative blepharitis - bacterial conjunctivitis |
| mafenide, adm route, indication | - TOPICAL - burns - inhibits carbonic anhydrase |
| Silver Sulfadiazine, adm route, indication | - TOPICAL - burns to prevent sepsis |
| Ciprofloxacin, type, indication | - 2nd gen FQ - best against G- activity - oral and ophthalmic preparations |
| norfloxacin, type, indication | - 2nd gen FQ - least active - low systemic levels - UTI only |
| Ofloxacin, type, indication | - 2nd gen FQ - oral is generic - ocuflox = ophthalmic |
| gatifloxacin, type, indication | - 3rd gen FQ - opthalmic preparations only! - NOT a respiratory FQ |
| moxifloxacin, type, indication | - 3rd gen respiratory FQ - oral and ophthalmic - good against anaerobes |
| gemifoxacin, type, indication | - 3rd gen FQ - most safe 3rd gen respiratory FQ - for mild-moderate community acquired pneumonia and exacerbations of chronic bronchitis |
| levofloxacin, type, indication | - 3rd gen respiratory FQ - active form of olfoxacin - more side effects |
| besifloxacin, type, indication | - 4th gen FQ - for bacterial conjunctivitis due to susceptible organisms |
| Penicillin G, type, indication | - given IM/IV - distributes into CNS only if the meniges are inflammed - 3 forms: acqueous, procaine, benzathine |
| Penicillin V, type, indication | - aka phenoxymethyl PCN - acid form for oral use - dosed in mgs - food interference with drug- 1 hr before and after meal |
| PCNase (B-lactamase), type, indication | 1. Dicloxacillin (oral) 2. oxacillin (parenteral) 3. nafcillin (parenteral) - MRSA resists DON's - all eliminated by biliary and renal excretion |
| Ampicilin, type, adm route, indication | - PCN - increase gram - coverage - oral or IV - Unasyn = ampicilin + sulbactam |
| amoxicillin, type, adm route, indication | - PCN - oral caps and pediatric drops - used after unasyn for peritonitis - longer half life |
| ticarcillin + clavulanate, type, adm route, indication | - antipseudomonas PCN - against some gram - pseudomonas and some resistant proteus - still susceptible to PCNases - parenteral |
| piperacillin, type, adm route, indication | - antipseudomonas PCN - parenteral - zosyn = piperacillin + tazobactam |
| cefazolin, type, adm route, coverage, extra info | - 1st gen cephalosporins - IV - good against G+ and some G- - PEcK |
| cephalexin, type, adm route, coverage, extra info | - 1st gen cephalosporins - oral - good against G+ and some G- - PEcK |
| cefadroxil, type, adm route, coverage, extra info | - 1st gen cephalosporins - oral - good against G+ and some G- - PEcK |
| cefaclor, type, adm route, coverage, extra info | - 2nd gen cephalosporins - oral - less G+ and more G- - 8 hr interval - HNPEcK |
| cefuroxime, type, adm route, coverage, extra info | - 2nd gen cephalosporins - oral- Ceftin - IV/IM- zinacef - less G+ and more G- - 12 hr interval - HNPEcK |
| cefoxitin, type, adm route, coverage, extra info | - 2nd gen cephalosporins - IV/IM- cephamycin - less G+ and more G- - active against B. fragilis - HNPEcK |
| cefotetan, type, adm route, coverage, extra info | - 2nd gen cephalosporins - IV/IM - less G+ and more G- - antagonizes vitamin K - HNPEcK |
| ceftriaxone, type, adm route, coverage, extra info | - 3rd gen cephalosporins - much less G+ but much more G- - IV/IM - highly protein bound - best against meningitis - good against B. fragilis - 1/2 excreted in bile and 1/2 excreted in urine |
| cefotaxime, type, adm route, coverage, extra info | - 3rd gen cephalosporins - IV/IM - parent and metabolite active --> increase spectrum |
| cefpodoxime, type, adm route, coverage, extra info | - 3rd gen cephalosporins - oral |
| cefdinir, type, adm route, coverage, extra info | - 3rd gen cephalosporins - oral - excreted mostly unchanged - binds Fe and decreases absorption and reddens feces in infants fed formula high in Fe |
| ceftazidime, type, adm route, coverage, extra info | - 3rd gen cephalosporins - IV/IM - neurologic SE - increase risk if pt is epileptic - disorientation |
| cefepime, type, adm route, coverage, extra info | - 4th gen cephalosporins - IV/IM - for gram - rods resistant to 3rd gen - good CNS penetration - mostly renal excretion |
| cefditoren, type, adm route, coverage, extra info | - 4th gen cephalosporins - pro Rx (activated with metabolism) - hydrolyzed by esterases during absorption |
| ceftaroline, type, adm route, coverage, extra info | - advanced cephalosporins - IV pro Rx - given every 12 hr |
| imipenem with cilastatin, type, adm route, coverage, extra info | - carbapenems - IV/IM - inhibits dehydropeptidase - resists most B- lactamases |
| meropenem, type, adm route, coverage, extra info | - carbapenems - not metabolized by dehydropeptidase - fewer seizures |
| ertapenem, type, adm route, coverage, extra info | - carbepenems - 1x/day - advantageous |
| doripenem, type, adm route, coverage, extra info | - carbepenems - parenteral - injection for complicated intra-abdominal infections and UTIs |
| aztreonam, type, adm route, coverage, extra info | - other beta lactums - IV/IM - Gram - aerobes only - resists most b-lactamases of gram - organisms - binds PBP-3 of gram - bacteria --> lyse - excreted unchanged in urine - crosses inflamed meninges |
| vancomycin, type, adm route, coverage, extra info | - not beta lactams - IV for MRSA or MSSA if allergic to b-lactams - used for local action againt pseudomembranous colitis - prevents removal of D-ala terminus - SE: red man syndrome |
| bacitracin, type, adm route, coverage, extra info | - not beta lactams - cidal against G+ cocci and bacilli - topical for inor cuts and scraps - ophthalmic ointment for ulverative blepharitis and bacterial conjunctivitis - complex with pyrophosphate - nephrotoxic |
| fosfomycin, type, adm route, coverage, extra info | - not beta lactams - cidal - short course tx of uncomplicated UTIs in women - inhibits enolpyruvate transferase |
| gentamicin, type, adm route, coverage, extra info | - aminoglycoside - IV - topical cream/ointment for burns, wounds and to prevent catheter infection - ophthalmic for superficial ocular infections |
| tobramycin, type, adm route, coverage, extra info | -aminoglycoside - IV - interchangeable with gentamicin |
| amikacin, type, adm route, coverage, extra info | - aminoglycoside - IV - enzyme resistant - for nosocomial infections that resist gentamycin and tobramycin |
| neomycin, type, adm route, coverage, extra info | - aminoglycoside - oral - prep for bowel surgery and as a topical anti-infectant |
| paromomycin, type, adm route, coverage, extra info | - aminoglycoside - oral - first choice for ameobic dysentery |
| tetracycline, type, adm route, coverage, extra info | - tetracycline - oral or topical for inflammatory acne - short half life |
| demeclocycline, type, adm route, coverage, extra info | - tetracycline - used to treat chornic dilutional hyponatremia associated with SIADH - inhibits protein kinase - not used for antibacterial activity - intermediate half life |
| doxycycline, type, adm route, coverage, extra info | - tetracylcine - highly lipid soluble - oral and IV - significant excretion in feces - long half life |
| minocycline, type, adm route, coverage, extra info | - tetracycline - for acne - huge side effects - blocks synthesis of NO and activation of microglia |
| tigecycline, type, adm route, coverage, extra info | - NOT a tetracyclien - active against sensitive G+/G- and MRSA - derivative of minocylcine - inhibits protein syn by blocking entry of aminoacyl-tRNA to the A site |
| erythromycin, type, adm route, coverage, extra info | - macrolides - now an alternate to leginnaires' disease - inhibits CYP3A - prokinetic |
| azithromycin, type, adm route, coverage, extra info | - macrolides - long half life - concentrates intracellularly - does not inhibit CYP3A - excreted unchanged in the bile |
| clarithromycin, type, adm route, coverage, extra info | - marolides - used for community acquired pneumonia, MAC - inhibit CYP3A - immunomodulatory- inhibits mRNA transcription for pro-inflammatory cytokines |
| Penicillin G, type, adm route, RENAL/HEP ADJ? | Natural Penicillins, IV, Renal Adjustment |
| Penicillin V K, type, adm route, RENAL/HEP ADJ? | Natural Penicillins, PO, Renal Adjustment |
| Benzathine penicillin G, type, adm route, RENAL/HEP ADJ? | Natural Penicillins, IM, Renal Adjustment |
| Ampicillin, type, adm route, RENAL/HEP ADJ? | Aminopenicillins, IV or PO, Renal Adjustment |
| Amoxicillin, type, adm route, RENAL/HEP ADJ? | Aminopenicillins, PO, Renal Adjustment |
| Oxacillin, type, adm route, RENAL/HEP ADJ? | Penicillinase Resistant Penicillins, IV, Hepatic Adjustment |
| Nafcillin, type, adm route, RENAL/HEP ADJ? | Penicillinase Resistant Penicillins, IV, Hepatic Adjustment |
| Cloxacillin, type, adm route, RENAL/HEP ADJ? | Penicillinase Resistant Penicillins, Hepatic Adjustment |
| Dicloxacillin, type, adm route, RENAL/HEP ADJ? | Penicillinase Resistant Penicillins, PO, Hepatic Adjustment |
| Indanyl Carbenicillin, type, adm route, RENAL/HEP ADJ? | Carboxy-penicillins, PO, renal adjustment |
| Ticarcillin, type, adm route, RENAL/HEP ADJ? | Carboxy-penicillins, IV, renal adjustment |
| Azlocillin, type, adm route, RENAL/HEP ADJ? | Ureido-penicillins, renal adjustment |
| Mezocillin, type, adm route, RENAL/HEP ADJ? | Ureido-penicillins, renal adjustment |
| Piperacillin, type, adm route, RENAL/HEP ADJ? | Ureido-penicillins, IV, renal adjustment |
| Ampicillin/Sulbactam (Unasyn), type, adm route, RENAL/HEP ADJ? | B-Lactam/B-lactamase inhibitor combination, IV, renal adjustment |
| Amoxicillin/Clavulanic Acid (Augmentin), type, adm route, RENAL/HEP ADJ? | B-Lactam/B-lactamase inhibitor combination, PO, renal adjustment |
| Ticarcillin/Clavulanic Acid (Tymentin), type, adm route, RENAL/HEP ADJ? | B-Lactam/B-lactamase inhibitor combination, IV, renal adjustment |
| Piperacillin/Tazobactam (Zosyn), type, adm route, RENAL/HEP ADJ? | B-Lactam/B-lactamase inhibitor combination, IV, renal adjustment |
| Cefazolin, type, adm route, RENAL/HEP ADJ? | 1st generation cephalosporin, IV, renal adjustment |
| Cephalexin, type, adm route, RENAL/HEP ADJ? | 1st generation cephalosporin, PO, renal adjustment |
| Cefadroxil, type, adm route, RENAL/HEP ADJ? | 1st generation cephalosporin, PO, renal adjustment |
| Cefuroxime, type, adm route, RENAL/HEP ADJ? | 2nd generation, group 1 cephalosporin, PO or IV, renal adjustment |
| Cefaclor, type, adm route, RENAL/HEP ADJ? | 2nd generation, group 1 cephalosporin, PO, renal adjustment |
| Cefoxitin, type, adm route, RENAL/HEP ADJ? | 2nd generation, group 2 cephalosporin, IV, renal adjustment |
| Cefotetan, type, adm route, RENAL/HEP ADJ? | 2nd generation, group 2 cephalosporin, IV, renal adjustment |
| Cefmetazole, type, adm route, RENAL/HEP ADJ? | 2nd generation, group 2 cephalosporin, IV, renal adjustment |
| Ceftriaxone, type, adm route, RENAL/HEP ADJ? | 3rd generation cephalosporin, IV - no adjust?? |
| Cefixime, type, adm route, RENAL/HEP ADJ? | 3rd generation cephalosporin, IV -no adjust?? |
| Cefpodoxime proxetil, type, adm route, RENAL/HEP ADJ? | 3rd generation cephalosporin, PO - no adjust?? |
| Cefotaxime, type, adm route, RENAL/HEP ADJ? | 3rd generation cephalosporin, IV - no adjust?? |
| Cefoperazone, type, adm route, RENAL/HEP ADJ? | 3rd generation anti-pseudomonal cephalosporin, IV, renal adjust |
| Ceftazidime, type, adm route, RENAL/HEP ADJ? | 3rd generation anti-pseudomonal cephalosporin, IV, renal adjust |
| Cefepime, type, adm route, RENAL/HEP ADJ? | 4th generation cephalosporin, IV, renal adjust |
| Ceftaroline, type, adm route, RENAL/HEP ADJ? | 5th generation cephalosporin, IV, renal adjust |
| Imipenem/Cilastatin, type, adm route, RENAL/HEP ADJ? | Carbapenem, IV, renal adjust |
| Meropenem, type, adm route, RENAL/HEP ADJ? | Carbapenem, IV, renal adjust |
| Ertapenem, type, adm route, RENAL/HEP ADJ? | Carbapenem, IV, renal adjust |
| Doripenem, type, adm route, RENAL/HEP ADJ? | Carbapenem, IV, renal adjust |
| Aztreonam, type, adm route, RENAL/HEP ADJ? | Monobactam, IV, renal adjust |
| Gentamicin, type, adm route, RENAL/HEP ADJ? | Aminoglycoside, IM or IV, renal adjust <60 ml/min |
| Tobramycin, type, adm route, RENAL/HEP ADJ? | Aminoglycoside, IM or IV, renal adjust <60 ml/min |
| Amikacin, type, adm route, RENAL/HEP ADJ? | Aminoglycoside, IM or IV, renal adjust <60 ml/min |
| Tetracycline, type, adm route, RENAL/HEP ADJ? | Tetracycline, PO, Renal adjust |
| Doxycycline, type, adm route, RENAL/HEP ADJ? | Tetracycline, PO or IV, Hepatically excreted, NOT RENAL ADJUSTMENT |
| Erythromycin, type, adm route, RENAL/HEP ADJ? | Macrolide, PO or IV, Hepatic adjustment |
| Clarithromycin, type, adm route, RENAL/HEP ADJ? | Macrolide, PO, Hepatic adjustment |
| Azithromycin, type, adm route, RENAL/HEP ADJ? | Macrolide, PO or IV, Hepatic adjustment |
| Clindamycin, type, adm route, RENAL/HEP ADJ? | Lincosamides, PO or IV, hepatic adjustment |
| Ciprofloxacin, type, adm route, RENAL/HEP ADJ? | Fluoroquinolones, PO or IV, renal adjust |
| Levofloxacin, type, adm route, RENAL/HEP ADJ? | Fluoroquinolones, PO or IV, renal adjust |
| Gatifloxacin, type, adm route, RENAL/HEP ADJ? | Fluoroquinolones, PO or IV, renal adjust |
| Moxifloxacin (Avelox), type, adm route, RENAL/HEP ADJ? | Fluoroquinolones, PO or IV, renal adjust |
| Gemifloxacin, type, adm route, RENAL/HEP ADJ? | Fluoroquinolones, PO, renal adjust |
| Vancomycin, type, adm route, RENAL/HEP ADJ? | Glycopeptide, PO or IV, renal adjust CrCl<60 ml/min |
| Trimethoprim/Sulfamethoxazole, type, adm route, RENAL/HEP ADJ? | own class, IV or PO, renal adjust |
| Metronidazole, type, adm route, RENAL/HEP ADJ? | Nitroimidazoles, PO or IV, no adjust?? |
| Linezolid, type, adm route, RENAL/HEP ADJ? | Oxazolidinones, PO or IV, no adjust?? |
| Quinupristin/Dalfopristin, type, adm route, RENAL/HEP ADJ? | Streptogramin, IV, no adjust?? |
| Daptomycin (Cubicin), type, adm route, RENAL/HEP ADJ? | Lipopeptide, IV, renal adjust CrCl<30ml/min |
| Tigecycline (Tygacil), type, adm route, RENAL/HEP ADJ? | Glyclcycline (derivative of minocycline), IV, no dose adjust! |
| Telavancin, type, adm route, RENAL/HEP ADJ? | Lipoglycopeptide, IV, renal dose adjust |
| Fidaxomicin, type, adm route, RENAL/HEP ADJ? | Inhibits RNA polymerases, not really a macrolide, PO, no adjust?? |
| Gram positive aerobes | Cocci- Staphylococcus, streptococcus, pnemococcus. Bacilli- corynebacterium, listeria, bacillus anthracis (anthrax) |
| These bacteria require oxygen to survive | Gram positive aerobes |
| These bacteria can live in deep tissue with low levels of oxygen | Gram positive anaerobes |
| Gram positive anaerobes | clostridium, peptococcus, peptostreptococcus |
| Gram negative aerobes | Cocci- oneisseria Bacilli- E. coli, klebsiella, enterobacter,proteus, pseudomonas, serratia, salmonella, shigella, yersinia, helicobacter, aeromonas, campylobacter, haemophilus |
| Gram negative Anaerobes | bacteroides, fusobacterium |
| Penicillinase-resistant penicillins are also known as the | anti-staphylococcal penicillians |
| Bacterialcidal against many gram positive organisms and some gram negative organsisms, primarily known as a gram positive antibiotic | Penicillin G |
| Considered the least toxic of all antibiotics | Penicillin |
| Can be used for prophylaxis against syphillis, rhematic fever, and bacterial endocarditis. | Penicillin G |
| Cross sensitivity with other antibiotics especially cephalosporins occurs with | Penicillin G |
| The only penicillin metabolized by the liver is | Nafcillin |
| Spectrum very limited; should only be used for infections confirmed to be caused by a penicillinase-producing organisms | Penicillianase-resistant penicillins |
| List of Aminopenicillins | amoxicillin, ampicillin |
| Amoxicillin + clavulanate= | Augmentin-oral |
| Ampicillin+ sulbactam= | Unasyn-injectable |
| Aminopenicillins are _____ spectrum | broad; meaning they have the additional ability to penetrate into the cell walls of gram negative bacteria to a greater degree than do the narrow-spectrum penicillins. |
| ______ is limited to 4grams per day | Sulbactam(Unasyn) |
| Aminopenicillins provide good coverage against | Gram positive organisms and additional coverage of some gram negative organisms; specifically, haemophilus influenza, E.coli, salmonella, shigella |
| Ampicillin when given orally commonly causes ______ | diarrhea |
| Amoxicillin commonly causes a ______ | rash (Amoxicillin rash) than can be confused with a penicillin allergy; It is a drug0induced altercation in cutaneous blood flow patterns that does not have immunologic basis. |
| Antipseudomonal drugs include | Piperacillin Piperacillin+tazobactan (zosyn) ticarcillin+ clavulanate ( Timentin) Also known as extended spectrum penicillins |
| The anti-pseudomonals have a good potentiative, pharmacodynamic drug-drug interaction with the _____ class of antibiotics against pseudomonas organisms | aminoglycosides |
| Hypokalemia can occur with this class of antibiotics | Anti-pseudomonals |
| This class of antibiotics is not used for minor infections and can be useful for serious, life threatening infections | Anti-pseudomonals |
| May cause a bleeding diathesis due to platelet dysfunction | Anti-pseudomonals |
| Optimal efficacy of antipseudomonals against pseudomonas usually requires the additional use of an ____ | Aminoglycosides |
| First generation cephalosporins | |
| Useful for minor infections caused nu susceptible organisms, especially skin and soft tissue, urinary tract and upper respiratory tract infections | First generation Cephaloporins. |
| First generation cephalosporins have minimum coverage of ______ organisms | gram negative |
| First generation cephalosporins are not effective against _____ | enterococcus organisms |
| Second generation cephalosporins provide more coverage of gram negative organisms than the _____ | First generation cephaloporins |
| Second generation cephalosporins can be used for treating _______ | severe or life threatening infections and for treating mixed infections; those that are caused by several organisms, both gram negative and positive. |
| Second generation cephalosporins may cause antibiotic-associated colitis(also called pseudomembranous colitis) due to over-growth of ______ | C. difficile |
| These antibiotics do not penetrate the CNS; not generally useful for CNS infections. | Second generation cephalosporins |
| Third generation Cephalosporins | cefixime (suprax); Cefotaxime (claforan); Ceftazidime (ceftaz) (Fortaz) (Tazidime); ceftibutin (cedax); Ceftriaxone (Rocephin) |
| These antibiotics have good penetration of brain tissues and are a good therapy for meningitis | 3rd generation cephalosporins |
| Third generation cephalosporins can be effective in: | serious life threatening infections |
| Third generation cephalosporins are not effective agianst _______ organisms | anaerobic |
| Can cause a disulfiram like reaction if administered concurrently with alcohol | Third generation cephaloporins |
| Fourth generation cephalosporin | Maxipime |
| Fluoroquinolones | Ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin |
| These antibiotics block an enzyme in bacterial cells call DNA-gyrase | The Fluoroquinolones |
| Have a broad spectrum antibacterial spectrum; good coverage of gram positive , gram negative, pseudomonas, chlamydia, rickettsia, and mycoplasma organisms | The fluoroquinolones |
| These antibiotics can damage developing cartilidge; not recommended for patients under 18 years of age. | The fluoroquinolones |
| The fluoroquinolones are pregnancy category | C |
| When giving this class of antibiotics with phenytoin, theophylline or warfarin serum concentrations of the these drugs may change, necessitating dosage adjustment. | The fluoroquinolones ending in floxacin |
| Lincosamides antibiotic | Clindamycin (cleocin) |
| This antibiotic is useful as prophylaxis during dental procedures | Clindamycin |
| Clindamycin is a _______ antibiotic | Bacteriostatic; it has no efficiacy against c.Diff and against enterococci or gram negative aerobic organisms |
| Macrolides antibiotics | Clarithromycin, erythromycin, erythromycin ethylsuccinate. |
| Azalide antibiotic | Zithromax |
| Infxs TX'd by 1st generation Cephalosporins? | Uncomplicated UTIs,skin & SofT tissue infxs (G pos). |
| Name 2 Penicillinase-resistanct PCNs. | Nafcillin & Dicloxacillin |
| Name 4 Beta-lactam antibiotics. | Carbapenems, Cephalosporins, Monobactams, PCN. |
| One portion of the lipopolisaccaride, that can induce fever, platelet agregation, vasc permeability. | Endotoxins. |
| Spectrum of Pen G & Pen V | Narrow. |
| Is Amoxicillin an extended spectrum penicillin. | Yes, it is an extended spectrum PCN. |
| Indications for Pen V? | Pharyngitis, GI infections. |
| Another use for Pen G? | Surgical prophylaxis. |
| 3 ways by which bacteria resit PCN & other Beta-lactam antibiotics? | Inactivation of the drug by beta-lactamase enzymes (cleave amide group), alteration of membrane porin size so drug doesn't go into cell & reduction of afinity of PBP. |
| Streptococcus, Methicillin-resistant staph (G + & -) : enteric bacilli, E. Coli, Klebsiella Pneumoneiae. | Microbes killed by 1st gen Cephalosporins. |
| Route of adimistration for Pen V. | Oral. |
| List major adverse effects of PCNs. | Urticaria, skin rashes & papules, anaphylactic shock, serum sickness, hepatitis & nephritis. |
| Surgical prophylaxis (G neg) | Another use for 2nd gen Cephalosporins. |
| Microbes killed by 1st gen Cephalosporis. | Streptococci, methicillin-sensitive staph. (G + -) enteric bacilli, E. Coli, klebsiella, pneumoneae. |
| Name 2 bacteriocidal drugs | PCN & Streptomycin. |
| Name 2 bacteriostatic drugs | Sulfonomides & Tetracylines. |
| Name the most widely used Beta-lactam abxs. | Penicillins, Cephalosporins, Beta-lactamase inhibitors. |
| Indications for Pen G? | Streptococcus, syphillis, endocarditis (Viridians enterococci), pneumonia & meningitis. |
| Microbes killed by 2nd gen Cephalosporins(Cerufoxime Axetil)? | gram positives & with greater Gram NEGATIVE bacilli efficacy than 1st gen Cephalosporins; inclduing H.I. |
| Procaine Pen G (IM). | Produces STRONG/HIGH plasma concentrations for about 24 hours ONLY. |
| Indications for Doxiciclin? | PCN-resistant staph like Osteomyelitis & skin & soft tissue infxs. |
| Respiratory tract infxs, OM, sinusitis, bronchitis & CAP. | Amoxicillin. |
| Antimicrobial activity of 3rd generation Cephalosporins (Ceftriaxone). | Have a wider range of gram-NEGATIVE microbes including enteric Gram-NEGATIVE bacilli. |
| Antimicrobial activity of 4th gen cephalosporins (Cefepime)? | Many Gram negative bacilli. |
| 1st gen Cephalosporin & its indications? | Cephalexin; skin & ST infxs, uncomplicated UTIs. |
| 2nd Gen Cephlosporin & its indications? | Cefuroxime axetil; OM, URI, CAP, intra abd, GYN & biliary infxs. |
| Gonococci, single-dose gonorrhea, pneumonia, meningitis, abd & GYN infxs. | 3rd gen Cephalosporin (ceftriaxone). |
| Systematic infxs, intra-abd, UTI, pneumonia. May cause encephalopathy? | 4 gen cephlosporin (cefepime) |
| What percentage of pts allergic to pcn will be allergic to cephalosporins? | 5 %. |
| T or F? Persons w/ a mild hypersensitivity to pcn usually are not allergic to cephalosporins. | True. |
| Pts with severe reactions to pcn will most likely react to cephalosporins. | True, especially if the pcn reaction was severe (anaphylactic shock) |
| Antimicrobial use for Vancomycin? | Gram-positive cocci & gram-negative bacilli. |
| Indications for Vancomycin? (MRSA, necrotizing fasciitis) | MRSA, skin & soft tissue infxs, strep, enterococcal infxs that are pcn-resistant. |
| How do aminoglycosides (poorly absorbed in the gut) affect bacterial life? | They interfere w 30S ribosomal subunit & prevent correct protein synthesis. Bactericidal. |
| Name the aminoglycosides (5)"AGNST" | Gentamycin, Amikacin, Neomycin, Streptomycin, Trobamycin. |
| Routes of administration for Aminoglyclides. | Parenterally (for systemic infxs), Oral for GI infxs, Topical for skin, mucous membs & eyes. |
| Major clinical uses of gentamicin(aminoglycoside)? | Aerobic gram-neg bact. When used w PCN, for Enterococcal, staph or viridians strep infections. |
| How are aminoglycosides excreted? | Renally. Its clearance =s GFR. |
| Adverse effects of Gentamacicin. | Nephrotoxic & ototoxic. |
| What is the most common drug-induced renal failure? | Aminoglycosides, they casue acute tubular necrosis when they accumulate in the tubules. |
| What systems are negatively affected by aminoglycosides? | They are neprotoxic ( |
| TB, plague, tuleremia, chlamydia. | Other illnesses cured by aminoglycosides. |
| Neomycin (an aminoglycoside) uses? | Most nephrotoxic! Limited to topical use only. For superficial infxs. Comb w bacitracin & polymyxin for minor skin trauma. |
| Which drug are tetracyclines? | Doxycycline, minocycline, tetracycline & tigecycline. |
| What cations render tetracycles less innefective? | Ca, aluminum & Iron. |
| What food cuts tetracyclines effecacy? | Milk. |
| Spectrum of tetracyclines? | Broad spectrum, bacteriostatic, vs gram + & -. |
| Routes of excretion of tetracyclines? | Urine & feces. |
| Which of the tetracyclines is not renally eliminated & can be give to pts w/ renal insufficiency? | Doxycycline. |
| Bugs killed by tetracyclines? | Rickettsia, spirochetes, mycoplasmas & chlamydiae. |
| What can you tx with tetracyclines? | Chlamydia trachomatis, Rocky mt spotted fever, Lyme dz, acne vulgaris. |
| Which patients should be given tetracylines at risk of side effects? concentrate teeth,bone. | Pregnant women, children under 8. Teeth discoloration & hypoplasia of the enamel. |
| How do bacteria acquire resistance to tetracyline? | They pass each other resistant plasmids to not permit uptake of tetracyclines. They also efflux the drug or alte the durg target. |
| What has increased the resistance to tetracyclines wolrd wide? | Feed lots giving tetracyclines to animals to promote wt gain. |
| Toxicities of tetracyclines? Increased phontosensitivity also. | Nephrotoxi, hepatotoxic-in the form of fatty degeneration. Avoid in pts on aminoglycosides. |
| Macrolides? (affect the 50S ribosomal subunit, interfere w tRNA) | Erythromycin, Azythromycin & Clarithromycin. |
| Clinical uses for Erythromycin (a macrolide). | Resp tract infxs (strep,pneumococci, mycoplasma & Chlamydia pneumoniae), |
| Clinical uses for Azythromycin, clarithromycin. | Resp tract infxs(H.I, Moraxella Catarrhalis, Mycobacterium avium-intracellulare (w aids pt). |
| Especially used for PUD dt H. pylori in comb w Amox? A macrolide. | Clarithromycin. |
| Uses for Azythromycin (macrolide). | Chlamydial urethritis, URIs (pneumonia), sinusitis, OM, bronchitis. |
| Routes of admin of Macrolides? | Orally, but erithromcyin (topical for acne) and azythromycin also avial IV. |
| Routes of excretions of macrolides? | Bile & urine. |
| Gram neg bact (Klebsiella Pneumoniae) causes neumonia in neonates, elders & alcoholics. | Macrolides have little activity agiainst. |
| Bact resistance of macrolides? | Decreased binding to the 50S ribosomal subunit, enz inactivation & ↑ bact efflux. |
| Adverse effects of macrolies (Azythromycin, Erythromycin & clarythromycin? | Stomatitis, HT burn, nausea, anorexia, abd discomfort, diarrhea. |
| Eryth inhinbits Motilin→↓peristalsis. IV ototoxicity of Erythromycin? | Tinnitus or impared hearing. Irritating to veins poss thrombophlebitis. |
| Major clinical uses of Ketolides (Telithromycin).Macrolide-related.acid-stable. | Mild-to-moderate CAP, caused by strep pneumoniae, Chlamydia & mycoplasma. |
| Most common SEs of Telithromycin? | Prolongs QT intervals (EKGs), resp failure in those w myasthenia gravis. LOCNausea & diarrhea, elevated hepatic enzs, some severe liver toxicity. |
| Major uses of clindamycin? | Methicillin-resistant staph & PCN-resistant strep, including NECROTIZING FASCITIS. |
| Adverse effects of Clindamycin. | Super infections→ SEVERE DIARRHEA, & life-threatening pseudomembranous colitis. |
| Clinical uses of Mupirocin? | Impetigo & nasal colonization of methicillin-resistant staphilococci. |
| s it easier to kill Gram - or Gram + bugs? Why? | Easier to kill Gram + bugs because Gram - have an extra polysaccharide layer. |
| First antibiotics were introduced when? | 1929 |
| Penicillin covers what microbes? | Gram + coverage, some limited activity against anaerobes. |
| MOA of Penicillin? | Arrests cell wall synthesis by binding to penicillin binding proteins. It is bactericidal. It will attack the bug, but not the human cells because our cells have cell membranes, not cell walls. |
| Cons of Penicillin? | Have to take on an empty stomach, has to be taken around the clock (q6h or q8h), and can cause diarrhea. |
| How is penicillin eliminated? | renally |
| All antibiotics can cause diarrhea. Why is this? | Because antibiotics disrupt the normal flora, causing bacterial overgrowth, resulting in diarrhea. |
| Name some antistaphylococcal penicillins. | Methicillin and Dicloxacillin |
| AE of methicillin? | interstitial nephritis |
| AE of Dicloxacillin? | GI issues and bad taste |
| What antistaphylococcal penicillin was the gold standard? Why is it no longer the gold standard? | methicillin. It is now not the gold standard because MRSA developed. |
| MRSA is resistant to what? | All penicillins and all cephalosporins. |
| What is used to treat MRSA? | Vancomycin |
| Name the aminopenicillins. | Ampicillin and Amoxicillin |
| Aminopenicillins cover what microbes? | The entire penicillin spectrum (gram + coverage and limited activity against anaerobes), with some added activity against specific gram - organisms (such as E. coli, H. flu) |
| Which aminopenicillin can be taken with food? Why? Which one must be taken on an empty stomach. Why? | With food = amoxicillin. Because it has great absorption and penetration. With an empty stomach = ampicillin. Because it has horrible absorption and penetration. |
| How is Ampicillin different than Amoxicillin? | Ampicillin has added coverage against enterococcus and listeria. |
| Most virulent Gram +? | Enterococcus |
| Most virulent Gram -? | Pseudomonas |
| What happens when you give Ampicillin to someone with Epstein-Barr (mononucleosis)? | get a rash on the hands and feet |
| What antibiotics are beta lactams chemically? | penicillin and cephalosporins. |
| How are aminopenicillins eliminated? | renally |
| What is Augmentin? | A combination of amoxicillin and Clavulanic acid. |
| What is clavulanic acid? | a beta-lactamase inhibitor. |
| What effect does beta-lactamase inhibitors have on bacteria? | Beta-lactamase inhibitors increase the antimicrobial spectrum of many antibiotics by binding to and deactivating beta-lactamase enzymes of bacteria. This prevents beta lactam antibiotics from being destroyed and deactivated. |
| Is Augmentin a first or second line of treatment generally? | second line. |
| What conditions would warrant using Augmentin as a first line of treatment? | In the elderly or if the infection is severe. |
| AE of Penicillins? | 1. Have to caution patients on oral contraceptives (to use extra protection for 2 weeks following cessation of antibiotic usage). 2. Anaphylaxis. 3. Drug Fever. 4. C. Diff |
| What are extended spectrum penicillins? | modified penicillin antibiotics that have poor gram + coverage, but has gram negative coverage (including pseudomonas) |
| How are extended spectrum penicillins administered? | Only available parenterally. |
| Extended spectrum penicillins are manufactured in fixed combinations with what? Name two extended spectrum antibiotics. | beta-lactamase inhibitors. Ticarcillin, Piperacillin. |
| What is used to treat nosocomial infections usually? | extended spectrum antibiotics. |
| Name some first generation cephalosporins. | Cefazolin (IV), Cephalexin (PO) |
| MOA of first generation cephalosporins? | gram positive activity similar to the aminopenicillins with coverage of Klebsiella (A big Gram -). It does not cover MRSA. |
| MOA of second generation cephalosporins? How do they compare to first generation and third generation cephalosporins? | Cover Gram + organisms (not as well as first generation) and cover Gram - (not as well as third generation agents). Coverage falls between the first and third generation. |
| Any antibiotic can cause what ailment? | C. diff |
| How do you treat Pseudomonas? | Pseudomonas is a 2-drug bug. It is treated with Extended Spectrum Penicillins and Ceftazadine. |
| Are there allergic reactions that occur with penicillin? | yes. |
| Name some third generation cephalosporins. | Ceftriaxone and Ceftazidime. |
| What cephalosporin is used to treat Gonorrhea and Chlamydia? | Ceftriaxone (Rocephin) |
| MOA of third generation cephalosporins? | Excellent coverage against most gram negative organisms. Some such as ceftriaxone extend to some gram positives. |
| AE of Cephalosporins? | 1. Anaphylaxis (5-15% cross-sensitivity with penicillins). 2. C. diff |
| What is a last-line antibiotic that is only given to people with multi-drug resistances? | Carbapenams |
| AE of Carbapenams? | Lowers seizure threshold, especially in cases of renal dysfunction. |
| What Carbapenams have less of an AE on seizure threshold? | Meropenam |
| Vancomycin MOA? | Coverage of Gram +; but no Gram - coverage. |
| AE of Vancomycin? | nephrotoxicity |
| Why does Vancomycin have restricted use in most hospitals? | Because we don't want bacteria to see Vancomycin until they absolutely have to, so that they can't develop resistance to Vancomycin. |
| If Metrocloniazide treatment does not work against C. diff, what is the next line of treatment? | PO Vancomycin. It is a very hydrophilic drug that is limited to local action. |
| To distribute Vancomycin to an inpatient, what must be involved? | Have to have an infectious disease consult. |
| Can pregnant women have PO Vancomycin? Why or why not? | Yes, because PO vancomycin is hydrophilic, so it isn't absorbed. It has a low Vd. |
| Can patients be allergic to macrolide antibiotics? | No, because it is not antigenic. It does have AE though. |
| Name some macrolide antibiotics. | Erythromycin, Clarithromycin, and Azithromycin. |
| Macrolide antibiotics covers what bugs? | Covers various gram + and gram - organisms. Also, covers atypicals (Legionella, Mycobacterium, Chlamydia). Works intracellularly. |
| In patients allergic to penicillin, how are gram + infections (such as streptococcus) treated? | With macrolides. |
| Macrolides have similar coverage as what other antibiotic? | Second generation cephalosporins. |
| AE of macrolide? | |
| β-Lactams | Cell Wall Synthesis, B'Cidal against a variety of bacteria; inhibit penicillin-binding proteins |
| Penicillins MOA | Cell Wall Synthesis |
| Natural penicillins: penicillin G, penicillin V, coverage | Active against G+ bacteria and some G- cocci |
| Natural penicillins, examples Penicillin G, Penicillin V | |
| Penicillinase-resistant: methicillin, dicloxicillin, coverage | Similar to the natural penicillins, but resistant to inactivation by the penicillinase of staphylococci |
| Penicillinase resistant, examples | Similar to the natural penicillins, but more active against G- organisms |
| Broad-spectrum: ampicillin, amoxicillin, coverage | Methicillin and Dicloxacillin |
| Broad spectrum penicillin, examples | Increased activity against G- rods, including Pseudomonas species, and anaerobes including Bacteroides fragilis. Usually combined with beta-lactamase inhibitors |
| Extended-spectrum: ticarcillin, piperacillin, coverage ampicillin, amoxycillin | |
| Cephalosporins MOA, coverage | Cell Wall Synthesis, Some are more effective against G- bacteria and less susceptible to destruction by β-lactamases |
| Cephalosporins, examples | Cephalexin, cefoxitin, ceftriaxone, cefepime, ceftaroline, ceftolozane |
| Carbapenems MOA, coverage | Cell Wall Synthesis, Resistant to inactivation by β-lactamases. Many G+ and G- bacteria including anaerobes are susceptible |
| Carbapenems examples | Imipenem, meropenem, doripenem, ertapenem |
| Monobactams MOA, coverage | Resistant to β-lactamases. Purely G- coverage, primarily active against members of the family Enterobacteriaceae |
| Monobactam example | Aztreonam |
| Vancomycin, teicoplanin, telavancin effect | B'Cidal against G+ bacteria |
| Bacitracin effect | B'Cidal against G+ bacteria |
| Aminoglycosides MOA, coverage | Protein synthesis, B'Cidal against G- aerobic and facultative bacteria |
| Aminoglycosides examples | Gentamicin, tobramycin |
| Tetracyclines MOA, coverage | Protein synthesis, B'Static against some G+ and G- bacteria |
| Tetracylines examples | Tetracycline, doxycycline, inocycline |
| Chloramphenicol | Protein synthesis, B'Static and broad spectrum |
| Macrolides | Protein synthesis, B'Static against many G+ bacteria as well as some mycobacteria |
| Macrolides examples | Erythromycin, clarithromycin, azithromycin |
| Lincosamides MOA, coverage | B'Static against a variety of G+ and G- bacteria, including anaerobes |
| Oxazolidinones MOA, coverage | B'Static against a variety of G+ bacteria and mycobacteria |
| Oxazolidinones examples | Linezolid |
| Streptogramins MOA, coverage | A synergistic combination of two drugs that bind to two different ribosomal sites. Individually each drug is B'Static, but together they are B'Cidal. Effective against a variety of G+ bacteria, including Enterococcus faecium |
| streptogramins examples | Quinupristin, dalfopristin |
| Fluoroquinolones MOA, coverage | Nucleic Acid Synthesis, B'Cidal against a wide variety of G+ and G- bacteria |
| Fluoroquinolones example | Ciprofloxacin, levofloxacin, moxifloxacin |
| Rifamycins MOA, coverage | Nucleic Acid Synthesis, B'Cidal against G+ and some G- bacteria. Often used to treat infections caused by Mycobacterium tuberculosis and as prophylaxis for close exposure to Neisseria meningitidis |
| Rifamycins examples | Rifampin, rifaximin, rifapentine |
| Sulfonamides | Folate Biosynthesis, B'Static against a variety of G+ and G- bacteria |
| Trimethoprim | Folate Biosynthesis, Often used in combination with a sulfa drug for a synergistic effect |
| Polymyxin B, colistin | Cell Membrane Integrity,B'Cidal against G- cells by damaging cell membranes |
| Daptomycin | Cell Membrane Integrity, B'Cidal against G+ bacteria |
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