Anti-Bacterials EC Flashcards
Penicilin (MOA, Use, Tox, Resistance)
Bind transpeptidases and inhibit cross-linking of peptidoglycan (pen.G=IV/IM, pen.V=oral)
Gram +’s (S. pneumo, S. pyogenes, Neisseria meningitidis, Treponema pallidum)
Hypersensitivity, Hemolytic anemia
Beta-lactamases cleave
Oxacillin, Nafcillin, Dicloxacillin (MOA, Use, Tox, Resistance)
Same as penicillin.
Narrow spectrum; penicillinase resistant because bulky R group blocks
S. aureus (except MRSA;altered PBP)
“USE NAF FOR STAPH”
Hypersensitivity reactions, Interstitial nephritis
Ampicillin, Amoxicillin (MOA, Use, Tox, Resistance)
Same as penicillin
Wider spectrum: also combine with clavulanic acid to protect against beta lactamase
“amOxicillin has greater Oral bioavailability”
“ampicillin/amoxicillin HELPSS kill enterococci”
Penicillin +: H. influenzae, E. coli, Listeria, Proteus, Salmonella, Shigella
Hypersensitivity, Ampicillin rash, Pseudomembranous colitis
Beta lactamase + are resistant
Ticarcillin, Pipercillin
Same as penicillin
Extended spectrum
PSEUDOMONAS
Hypersensitivity reactions
Beta-lactamase inhibitors
“CAST”
Clavulanic Acid
Sulbactam
Tazobactam
Cephalosporins
Beta-lactam
Less susceptible to penicillinases
Toxicity:
Hypersensitivity, vit K deficiency, low cross-reactivity w/ pen., increased nephrotoxicity of aminoglycosides
1st generation cephalosporins
PH in name (except ceFAZolin “don’t let that FAZe you”)
Cephalothin, Cephapirin, Cephradine, Cefazolin, Cephalexin
Great gram + coverage and Strep pneumo. Bad gram -
Proteus, E.coli, Klebsiella
Cefazolin prior to surgery to prevent S. aureus infections
2nd generation cephalosporins
Fam, Fa, Fur, Fox, Tea,
ceFAMandole, ceFaclor, ceFURoxime, ceFOXitin, cefoTEAtan
Good gram -, strep. pneumo, gram +
H. influenzae, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
3rd generation cephalosporins
Great for gram -
Ceftriaxone-meningitis and gonorrhea
Ceftazidime-pseudomonas
4th generation cephalosporins
Cefepime- Pseudomonas
Aztreonam
MAGIC BULLET FOR GRAM NEGATIVE AEROBES
Monobactam resistant beta lactamase
Synergistic with aminoglycosides
No cross-allergy w/ penicillins
Penicillin allergic patients
Imipenem/Cilastatin, Meropenem
Imipenem- BROADEST SPECTRUM OF ANY
Always given with CILASTATIN (inhibits renal dehydropeptidase I- decreased inactivation of drug)
Wide spectrum
GI distress, skin rash, CNS toxicity (seizures)
Vancomycin
Inhibits cell wall peptidoglycan formation (binds D-ala-D-ala)
Gram + only: MRSA, enterococci, C. dif
Nephrotoxicity, Ototoxicity, Thrombophlebitis, Red-man syndrome
Change in D-ala-D-ala gives resistance
Chloramphenicol
Binds 50S ribosomal subunit and inhibits protein synthesis
Very wide spectrum (limited by tox.)
Bacterial meningitis
Rickettsial infection in children and preg. women (tetracycline usually first choice)
Bone marrow suppression (aplastic anemia)
Grey baby syndrome
Clindamycin
Binds 50S ribosomal subunit and inhibits protein synthesis
Wounds penetrating abdomen
Female genital tract
Toxo gondii
Toxic shock syndrome
Can cause pseudomenbranous colitis
Linezolid
Bind 50S ribosomal subunit and inhibit protein synthesis
Nocosomial pneumonia
Complicated skin/soft tissue infections
S. aureus pneumonia
MRSA and VRE
Bone marrow suppression
Macrolides (Erythromycin, Azithromycin, Clarithromycin)
Bind 50S ribosomal subunit and inhibit protein synthesis
Outpatient upper and lower respiratory tract infections
Atypicals (Legionella, Mycoplasma, Chlamydia)
Can prolong QT
Tetracycline, Doxycycline, Minocycline
Binds 30S subunits and inhibit protein synthesis
ODD BUGS Rickettsia Chlamydia Mycoplasma pneumoniae E. histolytica Spirochetes (Ance)
Phototoxic dermatitis Renal/Hepatotoxicity FANCONI SYNDROME: ingestion of outdated drugs leads to renal tubule dysfunction TERATOGENIC Discolors teeth
Aminoglycosides (Streptomycin, Gentamycin, Tobramycin, Amikacin, Neomycin)
Bind 30S subunits and inhibit protein synthesis
(Often given w/ penicillin b/c must pass through membrane)
Gram negative enterics
Yersinia pestis, Brucellosis, Mycobacterium tuberculosis
Ototoxicity
Renal toxicity
Neuromuscular blockade
Spectinomycin
Binds 30S subunit and inhibit protein synthesis
Gonorrhea
What is the treatment regimen forTB?
Active infection: Isoniazid Rifampin Pyrazinamide Ethambutol
Prophylaxis:
Isoniazid
” I Saw a Red Pyre burning the liver”
Isoniazid (INH) (MOA, Use, Toxicity)
Decreases MYCOLIC ACID synthesis
TB solo prophylaxis
Part of TB treatment regimen
Hepatotoxicity
Neurotoxicity (can be avoided with vit. B6-pyridoxine)
Lupus
Rifampin (MOA, Use, Toxicity)
Inhibits DNA-dependent RNA-polymerase
Part of TB treatment
Leprosy treatment (delays Dapsone resistance)
Meningococcal prophylaxis
Prophylaxis for contacts around H. influenzae B
Minor hepatotoxicity
Orange body secretions
Revs up P450 (OCPs, warfarin, hypoglycemics, corticosteroids, phenytoin less effective)
"4R's: RNA polymerase inhibitor Revs up P450s Red/orange body fluids Rapid resistance if used alone"
Pyrazinamide (MOA, Use, Tox)
Unknown MOA
TB (rapidly bactericidal)
Hepatotoxicity (limits duration of use)
Hyperuricemia
