ABX overview Flashcards
bacteriocidal ABX MOA + examples
disrupt cell wall production (B-lactams, monobactams, glycopeptides)
inhibit DNA synthesis (FQ, metronidazole)
destabilize cell membranes (cyclic lipopeptides)
destabilize cell wall + membranes (lipoglycopeptides)
bacteriostatic ABX MOA + examples
inhibit protein synthesis
- 50S - macrolides, lincosamines, oxazolidinones, pleuromutilins
- 30S - AG, TTC, glycylcyclines
inhibit folic acid synthesis - TMP-SMX
B-lactamases mechanism of ABX resistance
drug inactivation by enzymes
3 mechanisms of ABX resistance
decrease intracellular [drug], drug inactivation by enzymes (B-lactamases, aminoglycosides), ABX target modification
list bacteriocidal ABX
*B-lactams monobactams glycopeptides lipoglycopeptides cyclic lipopeptides aminoglycosides *fluoroquinolones nitroimidizoles
list bacteriostatic ABX
*tetracyclines glycylcyclines *macrolides lincosamides oxazolidinones pleuromutilins sulfonamides
concentration-dependent killing drugs
Aminoglycosides
Fluoroquinolones
glycopeptides/lipoglycopeptides
time-dependent killing drugs
B-lactams
ABX against intracellular organisms
FQ, macrolides
TTC, TMP-SMX, clindamycin, rifampin
anti-anaerobic ABX
clindamycin, metronidazole, Augmentin (PO), Unasyn (IV), Zosyn (IV), carbapenems
bioequivalent ABX
*FQ
*TTCs
*Metronidazole
Rifampin
TMP-SMX
linezolid
renal excretion
(most)
B-lactams, monobactams, glycopeptides, cyclic lipopeptides/lipoglycopeptides, AGs, FQs, TTC/Glycylcyclines, oxazolidinones
hepatic excretion
ceftriaxone, all macrolides, metronidazole
oral contraceptives and ABX
recommend back-up birth control while on ALL ABX
ABX that increase INR
metronidazole, TMP-SMX
ABX that decrease INR
rifampin
ABX that cause dysrhythmia
macrolides
fluoroquinolones
ABX associated with ototoxicity
aminoglycosides, vancomycin, minocycline
what ABX can induce seizures
PCNs, CPHs, carbapenems
what ABX is linked to psychosis + cognitive impairment in pts being treated for H. pylori
clarithromycin
what ABX may induce insomnia, confusion, hallucinations, other CNS effects
FQ (levofloxacin»_space;)
what ABX may induce encephalopathy
metronidazole
ABX associated with nephrotoxicity
aminoglycosides (gentamycin)
vancomycin
PCNs (nafcillin > piperacillin) + FQs (ciprofloxacin)
ABX associated with hepatotoxicity
amoxicillin/clavulanate (Augmentin)
TMP-SMX (Bactrim
INH > RIF = PZA
ABX that cause chemical phlebitis
*nafcillin
cefepime
vancomycin
clindamycin
what ABX should you recommend that pt does not drink alcohol while on AND WHY
(usually) Metronidazole - no ETOH while on ABX and for 2-3 days after last dose
causes disulfram-like reactions
red man/neck syndrome
rapid vancomycin infusion
*not an allergy!
red lobster syndrome
rifampin - red/orange discoloration of urine, tears, sweat
discolored teeth
TTCs
loss of red/green color perception
ethambutol
yellow baby syndrome
sulfonamides
ABX that can cause hyperkalemia
Trimethoprim
increased risk with ACEi/ARB/spironolactone
ABX that can cause hypokalemia
PCNs (nafcillin >)
ABX that cause C. diff
Clindamycin (highest incidence) oral aminopenicillins (amoxicillin & amox/clav) oral cephalosporins (cephalexin)
what ABX, when given with an EBV infection, can cause a maculopapular rash
aminopenicillin
ABX to avoid in pregnancy
Fluoroquinolones
Aminoglycosides
Sulfonamides
Tetracyclines
what two ABX have the highest percent of cross-reactivity
aminopenicillins (amoxicillin, ampicillin) and CPHs
combos of penicillins and cephalosproins with identical R1 side chain
ampicillin – cephalexin
amoxicillin – cefprozil
pts with h/o IgE-mediated rxn to PCN management
treated with non-B-lactam ABX or referred to an allergist for skin testing
pts with h/o severe non-IgE mediated rxn to PCN management
should NOT receive PCNs or CPHs in any form
skin testing/desensitization are CONTRAINDICATED
someone has a MP rash to a penicillin… what can they try
CPH, carbapenems, aztreonam
someone anaphylaxes to PCN, what can they try
aztreonam or “non-B-lactam ABX”
cant use PCN, CPH, carbapenems
sulfa reaction characteristics
7-14 days after
fever +/- MP rash
3 classes of sulfa drugs
- sulfonylarylamines (sulfamethoxazole), HIV PIs (darunavir)
- nonsulfonylarylamines - carbonic anhydrase anhibitors, cox-2 inhibitors, loops/thiazides, sulfonylureas, Tamsulosin, -triptans
- sulfonamide-moiety containing drugs - AEDS (topiramate), HCV PIs
anti-MSSA ABX (oral and IV) gold + silver standard
oral - dicloxacillin, cephalexin
IV - nafcillin, cefazolin
anti-MRSA ABX (oral and IV)
oral - linezolid/tedizolid, minocycline/doxycycline, TMP-SMX, clindamycin
IV - vancomycin
anti-pseudomonal ABX (oral and IV) gold + silver
oral - ciprofloxacin & levofloxacin
IV - pip/tazo, aztreonam, ceftazidime/ceftolazone/cefepime, cipro or levo, tobramycin, doripenem
anti-VRE ABX
oral - linezolid/tedizolid
IV - linezolid/tedizolid, daptomycin, tigecycline, telavancin/oritavancin
anti-anaerobic ABX (oral and IV) gold + silver
oral - metronidazole or amox/clav, (silver) clindamycin
IV - b-lactam/b-lactamase inhibitor combo (pip/tazo), carbapenems, metronidazole, (silver) clindamycin