Examples of Bacteriostatic Medications T____ D____ C____ A____ C____ E____

Tetracycline Doxycycline Clindamycin Azithromycin Clarithromycin Erythromycin

Cell Wall Inhibitors 1. ____ 2. ____ 3. Others (____, ____, ____,)

1. Beta-Lactam Antibiotics 2. Beta-Lactamase Inhibitors 3. Others (Bactiracin, Vancomycin, Daptomycin)

Examples of Beta-Lactam Antibiotics 1. ____ 2. ____ 3. ____ 4. ____

1. Penicillins 2. Cephalosporins 3. Carbapenems 4. Monobactams

[3] PRELIMS | (P1) ANTIBACTERIAL & ANTI-INFECTIVES Flashcards by Rayben William Sanchez

Can eradicate an infection in the absence of host defense mechanisms
Kills bacteria

Bactericidal

‘Cidal’ - kills; LYSE

High Concentrations

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Inhibits microbial grwoth but requires host defense mechanism to eradicate the infection
Does not kill bacteria

Bacteriostatic

‘Static’ - inhibits

Low Concentrations

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Examples of Bactericidal Medications

(1) ____ - Tobramycin, Gentamicin, Amikacin
(2) ____ - Penicillins (Amoxicillin), Cephalosporins (Cefazolin), Carbapenems (Meropenems),
(3) ____ - Ciprofloxacin, Levofloxacin. Moxifloxacin

(1) Aminoglycosides
(2) Beta-Lactams
(3) Fluoroquinolones

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Examples of Bactericidal Medications

Aminoglycosides - (1) ____
Beta-Lactams - (2) ____
Fluoroquinolones - (3) ____

(1) Tobramycin, Gentamicin, Amikacin
(2) Penicillins (Amoxicillin), Cephalosporins (Cefazolin), Carbapenems (Meropenems)
(3) Ciprofloxacin, Levofloxacin, Moxifloxacin

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Examples of Bacteriostatic Medications

T____
D____
C____
A____
C____
E____

Tetracycline
Doxycycline
Clindamycin
Azithromycin
Clarithromycin
Erythromycin

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Lowest concentration of antimicrobial drug capable of inhibiting growth of an organism in a defined growth medium

Minimum Inhibitory Concentration

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Cell Wall Inhibitors

____
____
Others (____, ____, ____,)

Beta-Lactam Antibiotics
Beta-Lactamase Inhibitors
Others (Bactiracin, Vancomycin, Daptomycin)

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Examples of Beta-Lactam Antibiotics

____
____
____
____

Penicillins
Cephalosporins
Carbapenems
Monobactams

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Targets the cell walls of the organism
Some antimicrobial drugs selectively interfere with the synthesis of the bacterial cell wall

Beta-Lactam Antibiotics

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Beta-Lactam antibiotics contain ____ that are essential for antibacterial activity

beta-lactam rings

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The mechanism of action (MOA) of Beta-Lactam Antibiotics by (1) ____ by binding to (2) ____

(1) inhibiting cell wall synthesis
(2) proteins in cell membrane

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Beta-Lactam Antibiotics are most effective when ____

bacterial cells are dividing

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Beta-Lactam Antibiotics

The cell wall is composed of (1) ____ which are joined to each other by (2) ____
Beta lactamases in (3) ____ bacteria are found in the periplasmic space

(1) polymer (peptidoglycan)
(2) peptide cross-links
(3) gram-negative

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PENICILLINS - MOA

Bactericidal

Binding to (1) ____ located in the bacterial cytoplasmic membrane
Inhibition of (2) ____
Production of (3) ____

(1) specific receptors (Penicillin-binding proteins or PBPs)
(2) transpeptidases
(3) autolysins

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Penicillins are derived from ____

fungus

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Prototype of Penicillin

Pen. G

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Penicillin is widely distributed except in the ____

Cerebrospinal Fluid (CSF)

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The most serious complication of penicillin is ____

hypersensitivity (allergy)

causes anaphylactic reaction

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PENICILLIN - Classifications

Narrow Spectrum: (1) ____
Very Narrow Spectrum: (2) ____
Extended Spectrum Penicillins: (3) ____
Anti-pseudomonal Penicillins: (4) ____

(1) Penicillin G and Penicillin V
(2) Methicillin
(3) Ampicillin, Amoxicillin, Piperacillin, Ticarcillin
(4) Carbenicillin, Ticarcillin

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Narrow Spectrum Penicillins

Highly effective against (1) ____ except (2) ____, Meningococci, spirochetes, anaerobic cocci

(1) gram-positive cocci
(2) penicillinase producing bacteria

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Very Narrow Spectrum Penicillins

Active against most ____ producing ____

penicillinase producing staphylococci

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Extended Spectrum Penicillins

Effective against (1) ____, (2) ____ and (3) ____

(1) gram-positive cocci
(2) enterococci
(3) Listeria monocytogenes

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Anti-pseudomonal Penicillins

(1) ____, ____, and ____ – active against P. aeruginosa, P. vulgaris, Providencia, Morganella, and Enterobacter sp. but less potent than the (2) ____ against Streptococci and Enterococci

(1) Sulbenicillin, Carbenicillin and Ticarcillin
(2) extended-spectrum penicillins

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Narrow Spectrum Penicillins

Syphilis:
(1) ____ 2.4 million units IM as single dose (SD)
Prophylaxis for Recurrent Rheumatic Fever:
(2) ____ 250 mg PO BID

(1) Pen G
(2) Pen V

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# Very Narrow Spectrum Penicillins **Cellulitis**: ____ 500 mg QID

Cloxacillin

# Extended Spectrum Penicillins Cellulitis ____ 500 mg TID

Amoxicillin

# Antipseudomonal Penicillins **Bone and Joint; Skin Structure Infections**: (1) ____ 3.1 g IV q4-q6 **Severe Infections; Nosocomial Pneumonia**: (2) ____ 4.5 g IV q6 (CrCl > 40ml/min)

(1) Ticarcillin/Clavulanate (2) Piperacillin/Tazobactam

# PENICILLINS - Adverse Reactions 1. ____ – Most important 2. ____ 3. ____ – All Penicillins, but particularly ____ (thus methicillin is no longer available) 4. ____ 5. ____ (primarily in antipseudomonal Penicillins – Carbenicillin and Ticarcillin) 6. ____

(1) Hypersensitivity (2) Diarrhea / methicillin (3) Nephritis (4) Neurotoxicity (5) Hematologic toxicities (6) Cation toxicity

# PENICILLINS - Nursing Implications * Carefully monitor for an allergic reaction for at least (1) ____ after its administration * Effectiveness of oral penicillins is decreased when taken with (2) ____ * Given (3) ____ to prevent ____

(1) 30 minutes (2) caffeine, citrus fruit, cola beverages, fruit juices, or tomato juices (3) after meals / GI irritations

# PENICILLINS Symptoms of hypersensitivity

Fever, Rashes, Pruritus

* Are similar to penicillins, but more stable to many bacterial betalactamses and therefore have a broader spectrum of activity

Cephalosporins

# CEPHALOSPORINS - Other Characteristics * Derived from (1) ____ * (2) ____ * Does not penetrate (3) ____

(1) fungus (2) Broad spectrum (can be used for + / - ) (3) CSF (except cefuroxime & 3rd generation agents)

# CEPHALOSPORINS * The nucleus of the cephalosporins, (1) ____ bears a close resemblance to 6-amino-penicillanic acid. * Cephalosporins can be classified into (2) ____, depending on the spectrum of their antimicrobial activity

(1) 7-aminocephalo-sporanic acid (2) five major groups or generations

# CEPHALOSPORINS - MOA Bactericidal * Inhibit (1) ____ similar to penicillin, less susceptible to (2) ____

(1) cell wall synthesis (2) penicillinases

First-Generation Cephalosporins

* Cefazolin * Cephalexin * Cephalothin * Cefadroxil * Cephapirin

Second-Generation Cephalosporins

* Cefoxitin * Cefaclor * Cefuroxime * Cefamandole * Cefonizid * Cefotetan * Cefprozil

Third-Generation Cephalosporins

* Ceftriaxone * Ceftazidime * Cefixime * Ceftizoxime * Cefpodoxime proxetil * Cefotaxime * Cefoperazone * Moxalactam

Fourth-Generation Cephalosporins

* Cefepime * Cefpirome

Fifth-Generation Cephalosporins

* Ceftobiprole * Ceftaroline fosamil

# First-Generation Cephalosporins * Active against most gram-positive cocci including (1) ____ but not against (2) ____, ____, and ____ * Also active against some gram-negative bacilli: (3) ____, ____, and ____

(1) penicillin-resistant S. aureus (2) enterococcus, Methicillin-resistant S. aureus (MRSA) and Methicillin-resistant S. epidermidis (MRSE) (3) E. coli, K. pneumonia, and P. mirabilis

# Second-Generation Cephalosporins * (1) ____ – resistant to beta-lactamase producing gram-negative bacilli * Improved activity against (2) ____ * Enhanced against (3) ____, ____, and some ____

(1) Cefoxitin (2) H. influenza, M. catarrhalis, Neisseria meningitides and N. gonorrhea (3) staphylococci, non-enterococci streptococci, and some enterobacteriaceae

# Third-Generation Cephalosporins * Effective against (1) ____, ____, and other streptococci (with exception of Ceftazidime) and have modest activity against (2) ____ * Excellent activity against N. gonorrhea, H. influenza, M. catarrhalis, and Enterobacteriaceae

(1) S. pneumoniae, S. pyogenes (2) Methicillin sensitive S. aureus

# Fourth-Generation Cephalosporins * Active against both (1) ____ (but not MRSA) and (2) ____, including P. aeruginosa * Inactive against (3) ____, ____, ____, ____, and ____

(1) aerobic gram-positive organisms (2) gram-negative organisms (3) MRSA, MRSE, Enterococcus sp., B. fragilis and ESBL

# Fifth-Generation Cephalosporins * Specifically developed to target (1) ____ * (2) ____ – active against MRSA, Penicillin-resistant S. pneumoniae, P. aeruginosa and enterococci * (3) ____ – for acute bacterial skin and skin structure infections (ABSSSI) caused by MSSA, MRSA, S. pyogenes, E. coli and CAP caused by S. pneumoniae, S. aureus, H. influenza, K. pneumoniae, and E. coli

(1) resistant strains of bacteria (2) Ceftobiprole (3) Ceftaroline fosamil

# First-Generation Cephalosporins **Prophylaxis for Cardiovascular and General Surgeries (Biliary Tract, Esophageal, Appendectomy or Laparoscopic Surgery):** Usually (1) ____ 1-2 g IV pre-op (single-dose) **Respiratory Infections:** (2) ____ 250 mg PO q6

(1) Cefazolin (2) Cephalexin

# Second-Generation Cephalosporins **Prophylaxis for Non-perforated appendicitis**: (1) ____ 1-2 g IV pre-op **Pharyngitis/Tonsillitis**: (2) ____ 250 mg PO q12 for 10 days

(1) Cefoxitin (2) Cefuroxime

# Third-Generation Cephalosporins **CAP Mod Risk**: (1) ____ 2g IV q24 **CAP High Risk + Risk for P. aeruginosa infection**: (2) ____ 2 g IV q8

(1) Ceftriaxone (2) Ceftazidime

# Fourth-Generation Cephalosporins **CAP High Risk + Risk for P. aeruginosa infection**: (1) ____ 1 – 2 g IV q8-12 up to 21 days

(1) Cefepime

# Fifth-Generation Cephalosporins **Skin and Soft Tissue Infections**: (1) ____ 500 mg IV infusion q12

(1) Ceftobiprole

# CEPHALOSPORINS - Adverse Effects * (1) ____ (identical to those of penicillins) * (2) ____: Cephalotin (high doses lead to acute tubular necrosis) * (3) ____ (Cefamandole, Cefotetan, Cefoperazone)

(1) Allergic manifestations (2) Nephrotoxicity (3) Disulfiram-like reactions

# CEPHALOSPORINS - Nursing Implications * Orally administered forms should be given with food to decrease (1) ____, even though this will delay absorption * Some of these agents may cause an (2) ____ when taken with alcohol * Monitor (3) ____

(1) GI upset (2) Antabuse-like reaction (3) CBC

Fused beta lactam ring and a 5-membered ring system that differs from penicillin in being saturated and containing a carbon atom instead of a sulfur atom

Carbapenems

# CARBAPENEMS * (1) ____ of activity * Effective against (2) ____, and treatment for mix ____ * Drug of choice for (3) ____ (resistant to beta lactamase)

(1) Broad spectrum (2) P. aeruginosa / aerobic and anaerobic infections (3) enterobacter infections

Carbapenems

* Meropenem * Imipenem * Doripenem * Ertapenem

# CARBAPENEM - MOA Inhibit (1) ____, and are highly resistant to degradation by (2) ____

(1) cell wall synthesis (2) beta lactamases

* Interact with PBPs induces formation of long, filamentous bacterial structures * Extremely resistant to beta lactamases

Monobactam

Aztreonam

# MONOBACTAM - MOA Inhibit ____ (binds to PBP3)

cell wall synthesis

# Carbapenem * (1) ____ caused by multiple-resistant and complicated polymicrobial infections caused by aerobic gram positive, gram-negative organisms, anaerobic bacteria and (2) ____ * All are recommended for (3) ____ except ____

(1) Nosocomial infections (2) ESBL-positive organisms (3) pseudomonal infections / Ertapenem

# Monobactams Activity limited to ____ including most Enterobacteriaceae, Aeromonas sp., N. gonorrhea, H. influenza, and P. aeruginosa

gram-negative bacilli

# Carbapenem **Intraabdominal infections**: (1) ____ 1 g IV q8; (2) ____ 500 mg IV q6 or 1 g IV q8 for 4-7 days **Complicated Skin/Skin Structure Infections**: (3) ____ 500 mg IV q8

(1) Meropenem (2) Imipenem (3) Meropenem

# Monobactams **Pseudomonal infections**: ____ 2 g IV/IM q6-8

Aztreonam

# CARBAPENEMS - Side Effects * ____ and ____ * ____ * ____ allergic reactions * Contraindicated in ____

* Nausea and vomiting (most common) * Seizures * Cross-sensitivity allergic reactions * Contraindicated in epilepsy

# MONOBACTAM - Side Effects * No cross reactivity with (1) ____ * (2) ____ and ____ superinfections * Elevation of (3) ____ * Can cause (4) test

(1) penicillin and cephalosporin (2) Streptococcus and enterococci superinfections (3) transaminases (4) abnormal liver function

* Resemble beta-lactam molecules, weak antibacterials * May inhibit bacterial beta lactamases thus protecting penicillin from inactivation

Beta Lactamase Inhibitors

# Beta Lactamase Inhibitors Fixed combinations with specific penicillins – extend spectrum of a penicillin provided that inactivity of that penicillin is due to (1) ____ and the inhibitor is active against that beta lactamase produced

(1) beta lactamase destruction

Beta-Lactamase Inhibitors

* Clavulanic acid (Usually with Amoxicillin, Ticarcillin) * Sulbactam (Usually with Ampicillin) * Tazobactam (Usually with Piperacillin

# BETA-LACTAMASE INHIBITORS Inhibits (1) ____ which then restores the antibacterial activity of (2) ____, ____, ____, and ____

(1) beta-lactamases (2) amoxicillin, ampicillin, Ticarcillin and piperacillin

# BETA-LACTAMASE INHIBITORS Against beta-lactamase producing strains of ____, ____, ____, ____, ____, ____, and ____

staphylococci, gonococci, H. influenza, M. catarrhalis, Bacteroides, Klebsiella sp., and E. coli

# BETA-LACTAMASE INHIBITORS **Exacerbation of chronic bronchitis**: (1) ____ 1 g BID **Severe infections; Nosocomial Pneumonia**: (2) ____ 4.5 g IV q6 (CrCl >40ml/min)

(1) Co-amoxiclav (2) Piperacillin/Tazobactam

Inhibit cell wall mucopeptide formation by binding D-ala-D-ala portion of cell wall precursors

Vancomycin

# VANCOMYCIN Active against MSSA, MRSA, (1) ____, enterococci, streptococci, ____, ____, and ____

(1) coagulase-negative staphylococci (2) C. diphtheria, C. difficile, and Listeria

# VANCOMYCIN **____ infections**: Vancomycin 15-20 mg/kg IV q12 (adjust accordingly based on creatinine clearance)

MRSA

# VANCOMYCIN - Side Effects * (1) ____ at injection site – chills and fever * (2) ____ (rare) * (3) ____ – infusion related flushing (histamine induced) prolong infusion or increase dose intervals

(1) Phlebitis (2) Ototoxicity and nephrotoxicity (3) “Red man” or “Red neck syndrome”

# Protein Synthesis Inhibitors 1. ____ 2. ____ 3. ____ 4. ____ 5. ____ 6. ____ 7. ____

1. Tetracyclines 2. Aminoglycosides 3. Macrolides/Ketolides 4. Chloramphenicol 5. Clindamycin 6. Quinupristin/Dalfopristin 7. Linezolid

# TETRACYCLINE * (1) ____ - Tetracycline, Oxytetracycline * (2) ____ - Demeclocycline, Methacycline * (3) ____ - Doxycycline, Minocycline, Tigecycline

(1) **Short Acting** (2) **Intermediate Acting** (3) **Long Acting**

# TETRACYCLINE * **Short Acting**- (1) ____, ____ * **Intermediate Acting** - (2) ____, ____ * **Long Acting** - (3) ____, ____, ____

(1) Tetracycline, Oxytetracycline (2) Demeclocycline, Methacycline (3) Doxycycline, Minocycline, Tigecycline

Tetracyclines

* Doxycycline * Minocycline * Oxtetracycline * Tetracycline * Tigecycline

# TETRACYCLINES - MOA Binds to (1) ____ to block binding of (2) ____ to acceptor site ribosome-mRNA complex

(1) 30S subunit (2) aminoacyl-tRNA

# TETRACYCLINES Drug of choice for (1) ____, ____, ____, some ____ and ____, Mycoplasmas (2) ____ patients with leptospirosis, syphilis, actinomycosis, tularemia, melioidosis and skin and soft tissue infections

(1) V. cholera, V. culnificus, B. burgdorferi, some Aeromonas and Xanthomas sp., (2) Penicillin allergic

# TETRACYCLINES **Cervicitis/Nongonococcal urethritis/Chlmaydia infections**: Doxycycline 100 mg PO BID x (1) ____ **Donovanosis**: Doxycycline 100 mg PO BID x (2) ____ until all lesions have completely healed **Lymphogranuloma venereum**: Doxycycline 100 mg PO BID x (3) ____

(1) 7 days (2) 3-4 weeks (3) 21 days

# TETRACYCLINE - Adverse Effects * ____ * ____ * ____ * ____ * ____ * ____ * ____

* Gastric discomfort * Deposition in the bone and primary dentition * Fatal hepatotoxicity * Phototoxicity * Vestibular problems * Pseudotumor cerebri * Superinfections

# TETRACYCLINES * (1) ____, ____, ____, and ____ should be avoided because of the chelation and drug-binding that occurs. * All medications should be taken with (2) ____. * Due to photosensitivity, avoid (3) ____

(1) Milk products, iron preparations, antacids, and other dairy products (2) 6 to 8 ounces of fluid, preferably water (3) sunlight and tanning beds

Mainstay for the treatment of aerobic, Gram negative bacilli

Aminoglycosides

# AMINOGLYCOSIDES A group of bactericidal inhibitors of protein synthesis originally obtained from various ____ and ____. And sharing chemical, antimicrobial, pharmacologic and toxic characteristics

Streptomyces and Micromonospora spp

# AMINOGLYCOSIDES - MOA * Diffuse through (1) ____ in the outer membrane of gram negative bacteria to enter the periplasmic space. * Irreversible inhibition of (2) ____. * Once inside the cell, aminoglycosides bind to (3) ____ and interfere with ____. Causes misreading and premature termination of (4) ____

(1) aqueous channels formed by porin proteins (2) protein synthesis (3) polysomes / protein synthesis (4) mRNA translation

Aminoglycosides

* Amikacin * Streptomycin * Tobramycin * Kanamycin * Netilmycin

# AMINOGLYCOSIDES * Active against aerobic gram-negative bacilli; most are active against (1) ____, ____, ____, and ____ * Useful combination treatment for (2) ____ * (3) ____ against staphylococcal, streptococcal, and enterococcal endocarditis

(1) P. aeruginosa, E.coli, Klebsiella and Proteus sp. (2) serious gram negative infections (3) Synergistic

# AMINOGLYCOSIDES **In addition to an antipseudomonal beta-lactam or carbapenem in HAP**: (1) ____ 20 mg/kg.day IV **Tuberculosis**: (2) ____ 15 (12-18) mg/kg IM per day (max 1 g/day

(1) Amikacin (2) Streptomycin

# AMINOGLYCOSIDES - Adverse Effects * ____ * ____ * ____ * ____

* Ototoxicity * Nephrotoxicity * Neuromuscular paralysis * Allergic reaction

# AMINOGLYCOSIDES - Nursing Implications * (1) ____ of these agents to prevent nephrotoxicity and ototoxicity * Watch out for signs and symptoms of ototoxicity: (2) ____ * Watch out for signs and symptoms of nephrotoxicity: (3) ____

(1) Monitor peak and trough blood levels (2) dizziness, tinnitus, and hearing loss (3) urinary casts, proteinuria, increased BUN and serum creatinine levels

Macrocyclie lactone ring 14-16 atoms with attached deoxy sugars

Macrolides / Ketolides

# Example of Macrolides/Ketolides * Drug of first choice * Alternative to penicillin in patients allergic to beta lactam antibiotics

Erythromycin

More examples of Macrolides/Ketolides

* Clarithromycin (semisynthetic) * Azithromycin (semisynthetic) * Telithromycin

Newer Macrolides

* Clarithromycin * Roxithromycin * Josamycin * Telithromycin * Fidaxomicin

# MACROLIDES/KETOLIDES - MOA * **Bacteriostatic**: Prevents the translocation at the (1) ____ * At higher doses, can be (2) ____

(1) 50s subunit (2) bactericidal

# MACROLIDES/KETOLIDES * Active against (1) ____, Legionella, Mycoplasma, Chlamydia and some gram negative organisms * Often used as alternatives for (2) ____

(1) aerobic gram-positive cocci and bacilli (2) penicillin-allergic patients

# MACROLIDES/KETOLIDES - AZITHROMYCIN * (1) ____: Azithromycin 500 mg PO BID Day 1 then 250 mg PO OD for days 2 to 5 * (2) ____: Azithromycin 500 mg PO single dose

(1) **Acute bronchitis** (2) **Cervicitis; Chancroid**

# MACROLIDES/KETOLIDES - ERYTHROMYCIN * (1) ____: Erythromycin 500 mg PO QID for 7 days * (2) ____: Erythromycin base 500 mg PO QID for 7 days

(1) **Chancroid** (2) **Alternative for nononococcal urethritis**

# MACROLIDES/KETOLIDES - NEWER MACROLIDES * (1) ____: Clarithromycin 500 mg PO BID for 7 days * (2) ____: Clarithromycin 500 mg BID for 2 weeks

(1) **Exacerbation of chronic bronchitis** (2) **H. Pylori (together with Bismuth and Amoxicillin)**

# MACROLIDES/KETOLIDES - Nursing Implications * (1) ____ and will cause severe interactions with ____ * Absorption of oral erythromycin is enhanced when taken (2) ____, but because of the high incidence of GI upset, many agents are taken (3) ____ * (4) ____ destroys erythromycin

(1) Highly protein bound / other protein-bound drugs (2) on an empty stomach (3) after a meal or snack (4) Gastric acid

Inhibits the peptide bond formation at the 50s subunit

Chloramphenicol

# CHLORAMPHENICOL - MOA * Inhibition of (1) ____ at the 50s subunit. * Blocks binding of the (2) ____ of the charged tRNA molecule to the acceptor site of ribosomal mRNA complex.

(1) peptide bond formation (2) aminoacyl moiety

# CHLORAMPHENICOL * (1) ____ and ____ bacteria * Standard therapy for (2) ____, ____, and ____

(1) Aerobic and Anaerobic (2) typhoid fever, ampicillin-resistant H. influenza and intraocular infections

# CHLORAMPHENICOL (1) ____ * Severe and complicated: 100 mg/kg IV x 14-21 days * Uncomplicated: 50-75 mg/kg x 14-21 days

(1) **Fully susceptible typhoid**:

# CHLORAMPHENICOL - Adverse Effects * A____ * G____ * Blocks the metabolism of ____ ____, ____, and ____, elevating their concentrations and potentiating effects

* Anemia * Gray Baby Syndrome * Blocks the metabolism of warfarin, phenytoin, tolbutamide, and chlorpropamide, elevating their concentrations and potentiating effects

* Chlorine-substituted derivative of Lincomycin (from Streptomyces lincolnensis) * Better tolerated than erythromycin

Clindamycin (Lincosamides)

# CLINDAMYCIN (LINCOSAMIDES) - MOA * Interferes with formation of (1) ____ and ____ – inhibition of protein synthesis * Distributes well in the body fluids except in the (2) ____ * Identical binding site with erythromycin on the (3) ____

(1) initiation complexes and aminoacyl translocation reaction (2) CSF (3) 50s bacterial ribosome subunit

# CLINDAMYCIN (LINCOSAMIDES) Useful for (1) ____, some anaerobic gram-negative bacilli and (2) ____

(1) aerobic and anaerobic gram-positive cocci (2) protozoans

# CLINDAMYCIN (LINCOSAMIDES) * (1) ____: Clindamycin 600 mg IV q6-8 * (2) ____: Clindamycin cream 2%, 1 full applicator (5g) intravaginally HS for 7 days **Alternative**: Clindamycin 300 mg PO BID for 7 days or Clindamycin ovules 100 mg intravaginally HS for 3 days * (3) ____: (Except in Beta-lactams that already have anaerobic acvitity) Clndamycin 450-900 mg IV q8

(1) **CA MRSA** (2) **Bacterial Vaginosis** (3) **Add-on Therapy to Aspiration Pneumonia**

# CLINDAMYCIN (LINCOSAMIDES) - Adverse Effects * D____ * N____ * S____ * I____ * N____ * A____ (caused by colonization of C. difficile)

* Diarrhea * Nausea * Skin rashes * Impaired liver function * Neutropenia * Antibiotic-related colitis (caused by colonization of C. difficile)

# CLINDAMYCIN (LINCOSAMIDES) - Adverse Effects * **Antibiotic-related colitis (caused by colonization of C. difficile)** -- Initial treatment would be (1) ____ but in case it’s not effective, (2) ____ can be given as a substitute (to be given orally)

(1) metronidazole (2) vancomycin

* A mixture of two streptogramins in a ratio of thirty to seventy, respectively * Normally reserved for treatment of vancomycin resistant Enterococcus faecium (VRE)

Quinupristin / Dalfopristin

# QUINUPRISTIN / DALFOPRISTIN - MOA * Each component of this combination drug binds to a separate site on the 50S bacterial ribosome, forming a (1) ____ – interrupting protein synthesis * Combination is (2) ____ and has a long (3) ____

(1) stable ternary complex (2) bactericidal / post-antibiotic effect

# QUINUPRISTIN / DALFOPRISTIN - Adverse Effects * V____ * A____ * H____ * Inhibition of ____, drug interaction with ____ appears to occur.

* Venous irritation * Arthralgia and myalgia * Hyperbilirubinemia * Inhibition of cytochrome P450 (CYP3A4) isozyme, drug interaction with digoxin appears to occur.

* Introduced to combat resistant gram-positive organisms, such as methicillin- and vancomycin- resistant Staphylococcus aureus, vancomycin-resistant E. faecium and E. faecalis, and penicillin-resistant streptococci * Synthetic of oxazolidinone

Linezolid

# LINEZOLID - MOA * Inhibits bacterial protein synthesis by inhibiting the formation of the (1) ____. * Linezolid binds to a site on the (2) ____ near the interface with the ____

(1) 70s initiation complex (2) 50s subunit / 30s subunit

# LINEZOLID - Adverse Effects * W____ * G____ * H____ * R____ * T____

* Well tolerated * GI upset (nausea and diarrhea) * Headache * Rash * Thrombocytopenia (if taken >2 weeks)

# FLUOROQUINOLONES * (1) ____ - Nalidixic Acid * (2) ____ - Ciprofloxacin, Norfloxacin, Ofloxacin * (3) ____ - Levofloxacin * (4) ____ - Moxifloxacin

(1) **First generation** (2) **Second generation** (3) **Third generation** (4) **Fourth generation**

# FLUOROQUINOLONES * **First generation** - (1) ____ * **Second generation** - (2) ____, ____, ____, ____, ____ * **Third generation** - (3) ____, ____, ____, ____ * **Fourth generation** - (4) ____

(1) Nalidixic Acid (2) Ciprofloxacin, Norfloxacin, Ofloxacin, Enoxacin, Lomefloxacin (3) Levofloxacin, Clinafloxacin, Sparfloxacin, Gatifloxacin (4) Moxifloxacin

Inhibitors of Folate Synthesis

* Mafenide * Silver Sulfadiazine * Succinylsulfathiazole * Sulfacetamide * Sulfamethoxazole * Sulfasalazine * Sulfisoxazole

Inhibitors of Folate Reduction

* Pyrimethamine * Trimethoprim

Combination of Inhibitors of Folate Synthesis and Reduction

Cotrimoxazole

Urinary Tract Antiseptics

Methenamine Nitrofurantoin

# QUINOLONES - MOA * Interfere with **bacterial DNA synthesis** by inhibiting: --- (1) ____ in gram negative organisms > Prevents relaxation of supercoiled DNA ---- (2) ____ in gram-positive organisms > Interfere with the separation of replicated chromosomal DNA during cell division * Usually (3) ____ against susceptible organisms * Exhibit (4) ____ effect

(1) Topoisomerase II (DNA gyrase) (2) Topoisomerase IV (3) bactericidal (4) post-antibiotic

# 1ST GEN - SPECTRUM OF ACTIVITY **NALIDIXIC ACID** * (1) ____ * Narrow (2) ____ coverage

(1) Enterobacteriaceae (2) gram negative

# 2ND GEN - SPECTRUM OF ACTIVITY **CLASS I (NORFLAXACIN, ENOXACIN, LOMEFLOXACIN)** * Gram negative = (1) ____ * Gram Positive = (2) ____

(1) Excellent activity (2) Good but limited activity

# 2ND GEN - SPECTRUM OF ACTIVITY **CLASS II (CIPROFLOXACIN, OFLOXACIN)** * Gram negative = (1) ____ * Gram positive = (2) ____ * Coverage of atypical pathogens: (3) ____ (Ciprofloxacin)

(1) Excellent activity (2) Moderate to good activity (3) Pseudomonas aeruginosa

# 3RD GEN - SPECTRUM OF ACTIVITY **LEVOFLOXACIN CLINAFLOXACIN, SPARFLOXACIN, GATIFLOXACIN** * Gram positive = (1) ____ * (2) ____ = Best agains gram positive cocci * (3) ____ = some anaerobic activity

(1) Improved activity (S. pneumoniae & Staphylococci) (2) Clinafloxacin (3) Sparfloxacin

# 4TH GEN - SPECTRUM OF ACTIVITY **MOXIFLOXACIN** * Gram positive = (1) ____ * Anaerobic bacteria = (2) ____

(1) Enhanced activity (2) Good activity

# QUINOLONES - Adverse Effects * ____ (nausea, vomiting, diarrhea) * ____ (headache and dizziness) * ____ * ____ (avoid in pregnancy and children <18 y/o) * ____ (Moxifloxacin)

* Gastrointestinal (nausea, vomiting, diarrhea) * CNS (headache and dizziness) * Phototoxicity * Connective tissue problems (avoid in pregnancy and children <18 y/o) * QT interval prolongation (Moxifloxacin)

# QUINOLONES - Nursing Implications Should be taken with at least ____ per day, unless otherwise specified

3 L of fluid