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Antibiotics - Comp.

A compiliation of multiple study stacks on antibiotics - much repetition

QuestionAnswer
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
Created by: pannenkoek
 

 



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