Anibiotics Flashcards
what are some of the advantages of oral administration
decreases cost less resources, IV, pumps etc patient preferred reduced phlebitis increased pt mobility earlier discharge
What is the MOA for Beta-Lactams
Bind to pencillin binding proteins and inhibit cell wall synthesis
what makes up the class of beta-lactams
penicillins, Cephalosporins, beta-lactamase inhibitors, aztreonam
what are natural penicillins used for
treat pharyngitis, erysipelas and syphillis
what is the Jarisch -Herxheimer rxn
with treatment of spirochetal inf.
reaction due to release of large amount of toxin after bacterial killing
Fever, Chills, Myalgia
What are the 1st Gen cephalosproins
Cephalexin-oral
Cefazolin-IV
What are the 2nd Gen cephalosproins
Cefuroxime-oral
Cefoxitin-IV
What are the 3rd Gen cephalosproins
Cefpodoxime
Ceftriaxone
What are the 4th Gen cephalosproins
Cefepime
Ceftaroline
What makes cephalosporin activity better
they are less susceptible to beta-lactamases giving them broader spectrum of action compared to penicillins
what is the spectrum of activity for 1st Gen Cephalosporin
SPEcK
Staph,Strep(+)
Proteus, E. Coli, Klebsiella(-)
what is the spectrum of 2nd gen Cephalosproin
HMSPEcK
Staph, Strep(+)
Harmophilus, Morazell Catarrhalis, Proteus, E coli, Kleb (-)
What are 1st gen ceph used for
UTI, Pharyngitis, mild skin or soft tissue, and upper and lower respiratory tract
What does 2nd gen ceph used for
sinusitis, pharyngitis, otitis media, lower respiratory tract inf,
Cefuroxime- lyme
what does 3rd gen cover
Strep pneumo (+)
Enterobacteriacease, H. influenzae, M. cararhalis (-)
what are 3rd gen ceph used for
CAP, OM, URI, Meningitis, Neutropenia,
what do 4 gen ceph cover
Strep and Staph(+)
Enterobacreriaxease, H. influ, M catarhalis, Psudomonas aerug,
Bacterocides
what has the highest incidence of GI effects
cefixime
what has the lowest incidence of diarrhea
cefprozil
what has the highest incidence of rash
cefaclor
what is the benefit of probenicid with cephalosporins
increases concentration
what are rates of allergic reactions like with chepalosporin
low about 1%
which generation of chepalosporin have higher risk of reaction
1st gen
what is a mono bactam an what is their MOA
Aztreonam
bind to penicillin binding protein and inhibit cell wall synthesis which causes cell death
what selectivity does Aztreonam have? what type of infections is it good for? What does it need dose adjustment for? what is the cross sensitivity like for it? what are the adverse effects like?
only monobactam in US
gram (-) coverage including pseudomonas, does not cover anaerobic or gram (+)
Good for resistant infections b/c it is resistant to many beta lactamases produced by gram (-) bacteria
decreased renal function
low incidence of adverse effects-diarrhea
What drugs are part of the carbapems
Imipenem/ Cilastatin
Meropenem
Doripenem
Ertapenem
what is the MOA for carbapenems
bind to penicillin binding protein and inhibit cell wall synthesis which leads to cell death
What bacteria are carbapenems good for
resistant to most beta-lactamases and the drug of choice for infection caused by ESBL
What do carbapenems cover
Staph, Strep, Listeria (+)
Gram (-)
anaerobes
Pseudomonas except ertapenem
what are clinical uses of carbapenems
UTI, lower respiratory infections, intra-abdominal and gynecological infections, skin, soft tissue, bone, and joint inf
what are the adverse effects of carbapenems
N/V, seizures-highest with imipenem with pts that have renal failure
what drugs are part of the glycopeptide antibiotics
Vancomycin, Telavancin
what is the MOA of glycopeptide antibiotics
prevents cross linking of the cell wall peptidoglycan during cell wall synthesis
What does Vancomycin cover
gram (+) only
what type of infections does Vancomycin cover
MRSA infection- sepsis, endocarditis, meningitis, skin and soft tissue infections
USED to treat C. Diff only
What is the dosing regimen for Vancomycin
dosing is variable based on body weight and renal function
what level should vancomycin be above to prevent resistance
10-20mcg/ml
what are the adverse Rxn of vancomycin
ototoxicity, nephrotoxicit, and injection site rxn
what increases the risk of nephrotoxicity
when administered with other nephrotoxic drugs
What drug causes red man syndrome
Vancomycin
infusion related reaction that is caused by the release of histamine.
may cause erythematous or urticarial reactions, flushing tachycardia, hypotension
how do you manage red man syndrome?
stop infusion, wait for it to subside, then slow the infusion rate down no faster than 1gm/hr can also administer benadryl prior to infusion
what is the black box warning with Telavancin
warning in pre pregnancy which may cause abnormal fetal development. Perform pregnancy test in women of child bearing age
what type of infections are Telavacin used for
complicated skin and soft tissue infections.
investigated for nosocomial pneumonia
needs to be dose adjust for renal function
what are the ADRS for Telavacin
Red man syndrome, infuse over 60min, nephrotoxicity, GI upset, metallic taste
What spectrum of activity does Daptomycin have
similar to vancomycin but it also covers vancomycin resistant enterococci vancomycin resistant s. aureus (VRSA)
What conditions is daptomycin used to treat
skin/soft tissue, bacteremia, endocarditis
what are adverse effects of daptomycin
injection site reaction, fever, chills, diarrhea, N/V
muscle cramps/ weakness
must monitor CPK and discontinue drug if muscle pain and elevation of CPK>5x ULN
What is Fosfomycin used to treat
oral formulation
covers Gam (+),(-)
used for UTI in women
what is bacitracin used for
used topically only very nephrotoxic
what is cycloserin used for
what are its ADR?
covers gram (+), (-)
mainly used to treat TB
H/A, Tremors, acute psychosis
what is the MOA for tetracyclines
binds to the 30s ribosomal subunit which prevents binding of the tRNA to the mRNA ribosome complex which interferes with protein synthesis
what is the spectrum of activity for tetracycline?
S. pnemo, S. pyogenes, community acquired Staph (CA-MRSA)
gram (-) ecoli, klebsiella, H influenzae
Atypical: C. pneumonae, M. neumoniae, legionella, C trachmatic, lyme
what are the clinical uses for tetracyclines
Respiratory infections, MRSA, CA-MRSA
anthrax, chlamydia, lyme
what are adverse effects of tetracycline
GI intolerance
Photosensitivity
Tooth discoloration and abnormal bone growth (do not use in second half of pregnancy or kids younger than 8
Vestibular tox.
What are the special considerations of tetracyclines
administration must be separated from food containing aluminum, magnesium, Calcium, and iron by 12 hours
Food: Minocycline: with or without food
Tetracycline: empty stomach
Doxycycline: with food due to GI intolerance
What does tigecycline cover
gram (+),(-) and anaerobes
what is the clinical uses of Tigecycline
used in complicated skin and skin structure inf. and complicated abdominal inf. CAP MRSA MRSE VRE penicillin resistant strep pneumo
what is the MOA for macrolides
bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis
what drugs belong to macrolide class
Fidaxomicin
Azithromycin
Clarithromycin
Erythromycin
What is the spectrum of activity of
Azithro, Clarithromycin, Erythromycin
Strep (+)
H. inf, N gonnorrhoeae (-)
Atypical: Myco, Legionella, Chlamydia
what is the spectrum of activity of Fidaxomicin
C. Diff
What are the common uses for Erythromycin, Calthromycin, Azithromycin
alternate for PCN allergy CAP Pahryngitis OM Azithro- Urethritis
what are the ADR for macrolies
Erythromycin, Azithro, Clarithromycin
N/V Abdominal pain diarrhea renal failure QT prolongation
what are the ADR for fidaxomicin
GI hemorrhage
N/V
abdominal pain
Anemia neutropenia
What are the food interactions
Azithro and Erythro take one hour before or 2 hour after a meal
What are the drug interactions for Eryhtromycin and clarithromycin
inhibit CYP 450 enzyme
what are the drug interactions for azithro
may increase cyclosproine and digoxin levels
what is the MOA for clindaymycin
binds to 50s ribosome subunit and inhibits protein synthesis
what is the spectrum of activity for clindamycin
Stap. aureus, MSSA, CA-MRSA, Strep. ssp, peptostreptococus
ananerobes, C diff, prevotella, fusobacterium
what are the clinical uses for clindamycin
skin and soft tissue inf, CA-MRSA, anaerobes, aspiration PNA, dental prophylaxis in PCN pts
what are the adverse effects of Clindamycine
GI: diarrhea, nausea, dyspnea rash High incidence of C diff heptao tox back pain
how should clindamycin be administered
with food to decrease GI upset and water to decrease esophageal ulceration
what is the spectrum of activity for linezolid
gram (+) only works on staph (methacillin susceptible and resistant) works on staph (vancomycin intermed and resistant) Enterococcus faecium
what are the common uses for linezolid
MRSA, Vancomycin resistant E. faecium
skin inf and soft tissue
bone/ joint inf
bacteremia
what are some of the special considerations of linezolid
good pulm penetration
exhibits weak reversible inhibition of monoamine oxidase
oral form is 100% bioavailable
preferable in PVL and CA-MRSA
what drugs are part of the aminoglycosides
Gentamicin Tobreamycin Amikacin Streptomycin neomycin kenamycin
what is the MOA of aminoglycosides
inhibits 30s ribosomal subunit
what is the spectrum of activity of Gentamicin, tobramycin, amikacin
staph aureus, strep, enterocc
mostly aerobic gram (-) bacilli
what is the clinical uses of gentamicin, tobramycin, amikacin
rarely used alone with gram (+) organisms,
PNA, meningitis
Used with vancomycin or PCN for endocarditis
what are the ADR for aminoglycosides
ototoxicity, nephrotoxocity only occur when used longer than 5 days
what are the benefits of extended interval dosing
probable reduced nephrotoxicity decreased lab monitoring no risk of sub-therapeutic peak level decreased pharmacy time for prep easier for home care
what is the MOA of sulfonamides
competitive antagonist of para-aminobenzoic acid which prevents formation of folic acid
what is the spectrum of activity for sulfonamides
staph, s. pneumo, bacillus anthrasis, clostridium tetani
ecoli, proteus mirabillis, H. influenza
chlamydia trachomatis
what are the common uses of sulfonamides
UTI, toxoplasmosis 1st line for MRSA URI HIV PNA CA-MRSA
what are adverse reactions with sulfonamides
photosensitiviy rash SJS blood dyscrasias sulfa allergies
what drugs make up the fluroquinolones
Ciprofloxacin Olfoxacin Norfloaxin Levofloxacin Moxifloxacin
what is the MOA of fluroquinolones
inhibit bacterial topoisomerase II
what is the spectrum of activity of cipro, ofloxacin, norfloxacin
enterobacteriacase, H. influ, M. catarrhalis, Neisseria,
what are the common uses of norfloxacin
uncomplicated UTI
what is cipro and ofloxacin
complicated UTI, gasteroenteritis, prostatits, STD, skin inf
Cipro for anthrax prep
what is the spec of coverage with
levo, moxifloxacin, gatifloxacin
strep pneumo, enterobacteriacase H.influenzae M. catarrhalis Neisseria,
what is the clinical use of levofloxacin, moxifloxacin
CAP,
URI infections
what are the adverse reactions of fluroquinolones
N/V Diarrhea, constipation tendon rupture photosensitivity prolonged QT
what does metronidazole cover
protoza anaerobes bacteroides Fusobacterium Veillonella C. Diff peptococcus peptostreptococcus
what are the uses of metronidazole
intra abdominal infection Gyn inf pseudomembraneous colitis C. diff H pylori
what are the adverse effects of metronidazole
dry mouth, metallic taste
anorexia abdominal pain
CNS
what is nitrofurantoin used to treat
UTI
what is nitrofurantoin spectrum of activity
e coli klebsiella staph strep Viridians enterococcus
what are some special considerations with nitrofurantoin
CrCl lass than 60ml
Hepatotoxicity and pulmonary toxicity
probenecid may increase serum concentration
