Antibiotic Agents Flashcards
Bactericidal Antibiotics
Very Finely Proficient At Cell Murder Vancomycin Fluoroquinolones Penicillins Aminoglycosides Cephalosporins Metronidazole
Bacteriostatic Antibiotics
ECSTaTiC Erythromycin Clindamycin Sulfamethoxazole Trimetoprim Tetracycline Chloramphenicol
What Bacteriostatic antibiotics become bactericidal when combined?
TMP - SMX
Define: Lowest concentration capable of inhibiting growth of an organism
Minimum Inhibitory Concentration
MOA of Which Class of Drugs?
Binds to PBP
Inhibits Transpeptidation Reation
Activates Autolytic Enzymes
Beta Lactams
Mechanisms for Penicillin Resistance
Beta-lactamases
Structural changes in target PBPs
Changes in porin structures
Narrow spectrum Penicillin
Drug of Choice for Syphilis
SE: Hypersensitivity, cross-allergenicity with similar drugs, GI disturbances
Penicillin G
Renal Tubular Reabsorption of this drug is inhibited by Probenecid
Penicillin G
VERY NARROW spectrum Penicillin
DOC for Staphylococcal infections
SE: Hypersensitivity, cross allergenicity with similar drugs, GI disturbances, INTERSTITIAL NEPHRITIS, NEUTROPENIA
Resistant to beta-lactamase
Methicillin
(Naf/Oxa/Cloxacillin)
Use Naf for Staph.
Extended spectrum Penicillin Drug for Enterococci, Listeria, E. Coli, Proteus, H. Influenzae, MORAXELLA SE: Pseudomembranous Colitis, Rash Inactivated by beta-lactamase Enhanced with beta-lactamase inhibitors Synergistic effect with aminoglycosides
AMPicillin (AMPed up Penicillin)
AmOxicillin) (greater Oral bioavailability
Extended spectrum penicillins are effective for the following organisms
Hemophilus influenza E. Coli Listeria Proteus Salmonella spp. Enterococci
Amoxicillin HELPS kill Enterococci
Anti-pseudomonal Penicillin
Drug for Pseudomonas, Enterobacter, Klebsiella
SE: Hypersensitivity, Cross-allergenicity with similar drugs, GI disturbances
Inactivated by beta-lactamase
Enhanced with beta-lactamase inhibitors
Synergistic effect with aminoglycosides vs. Pseudomonas
Piperacillin
Ticarcillin, Carbenicillin
Anti-pseudomonal antibiotic with anti-platelet activity
Ticarcillin
Drugs for Pseudomonas
Takes Care of Pseudomonas
Ticarcillin
Carbenicillin
Piperacillin
First Generation Cephalosporin
Binds to PBP, inhibits transpeptidation
Drug for Surgical Prophylaxis, Bone Infection, E. Coli, Klebsiella, Proteus
SE: Hypersensitivity, partial cross-allergenicity with penicillins
Increases nephrotoxicity of aminoglycosides
CeFAZolin
FADer help me FAZ my PHarmacology boards
First Generation Cephalosporins
FADer help me FAZ my PHarmacology boards CeFADroxil CeFAZolin CePHalothin CePHradine CePHalexine
Second Generation Cephalosporin
Can cross BBB
Drug for Haemophilus, Enterobacter, and Neisseria
SE: Hypersensitivity, Disulfiram reaction with CefaMANdole and CefoTETan
Increases nephrogenicity of aminoglycosides
Cefamandole
FOXy FAMily in FUR, drinking TEa
CeFOXitin, CeFAMandole, CeFURoxime, CefoTEtan
FAC! LORA the PROfessional AZhOLE is on the FONe.
CeFAClor, LORAcarbef, CefPROzil, CefmetaZOLE, CeFONicid
Second Generation Cephalosporins
FOXy FAMily in FUR, drinking TEa
CeFOXitin, CeFAMandole, CeFURoxime, CefoTEtan
FAC! LORA the PROfessional AZhOLE is on the FONe.
CeFAClor, LORAcarbef, CefPROzil, CefmetaZOLE, CeFONicid
Third Generation Cephalosporin
Drugs for Pseudomonas and Bacteroides
SE: Hypersensitivity, Disulfiram reaction with Cefoperazone
Synergistic with AMINOGLYCOSIDES
FEnge Po ng PERA to FIX my TTTTTv CeFEtamet CefPOdoxin CefoPERAzone CeFIXime CefTriaxone CefTazidime CefoTaxime CefTizoxime CefTibuten
Third Generation Cephalosporin
FEnge Po ng PERA to FIX my TTTTTv CeFEtamet CefPOdoxin CefoPERAzone CeFIXime CefTriaxone CefTazidime CefoTaxime CefTizoxime CefTibuten
Wide coverage against gram positive and gram negative bacteria
SE: Hypersensitivity
Resistant to Beta-lactamase
CefePime
Porth (4th)
Anti-Pseudomonal Cephalosporins
CefTAZidime 3rd
CeFEPime 4th
CefoPERAzone 3rd
Carbapenem
Wide coverage against gram positive and gram negative bacteria
SE: Hypersensitivity, CNS Toxicity (Confusion, Enceph, Seizures)
Reserved for serious life threatening conditions
Imipenem-Cilastatin
This drug inhibits renal metabolism of Imipenem
Cilastatin
With Imipenem, Kill is LASTIN with CiLAStaTIN
Monobactam Drug for Gram (-) Rods, NO GRAM +/Anaerobe COVERAGE SE: superinfection Resistant to Beta-lactamase No cross allergenicity with penicillins
Aztreonam
Beta-lactamase inhibitor
Inhibits inactivation of penicillins by bacterial penicillinase
SE: Hypersensitivity
Usually combined with Amoxicillin, Ampicillin, and Piperacillin
Clavulanic Acid
Sulbactam, Tazobactam
Glycopeptide
Inhibits D-Ala D-Ala terminus of nascent peptidoglycan
Drug for MRSA, Pseudomembranous colitis
SE: Redman Syndrome, Nephrotoxicity, Ototoxicity
Reserved for serious life threatening infections
Vancomycin
First line drug for Pseudomembranous Colitis
Metronidazole
Tx for Redman syndrome
Slow down infusion rate
Drugs of Last Resort
I AM your Last Shot at Victory Imipenem Amikacin Meropenem Linezolid Streptogrammins Vancomycin
Peptide Antibiotic
Interferes with late-stage cel wall synthesis in Gram + bacteria
SE: Nephrotoxicity
Reserved for Topical Use only due to marked nephrotoxicity
Bacitracin
Antimetabolite
Blocks incorporation of D-Ala
2nd line drug for Drug-Resistant TB
SE: Neurotoxicity
Cycloserine
30s Inhibitors
Aminoglycosides
Tetracyclines
Buy AT 30
50s Inhibitors
Chloramphenicol Erythromycin (Macrolides) Lincosamides (Clindamycin) Linezolid Streptogrammins
CELLS at 50
Bactericidal Protein Synthesis Inhibitors
Aminoglycosides
Streptogrammins
Broad Spectrum Antibiotic Bacteriostatic Inhibits 50s Drug for Meningitis (esp Neisseria), Backup for Salmonella Rickettsia, Bacteroides SE: Aplastic Anemia, Gray Baby Syndrome
Chloramphenicol
Decreased RBC, Cyanosis and Cardiovascular Collapse
Ashen Gray Skin
Premature neonates with deficient glucuronosyltransferase
Gray Baby Syndrome
Binds to 30s subunit, Bacteriostatic
Drug for M. Pneumoniae, Chlamydia, Rickettsiae, Vibrio, PUD, SIADH
SE: Tooth enamel dysplasia/dyscoloration, Photosensitivity
Tigecycline has broadest spectrum
Tetracycline
(Doxycycline, Minocycline, Tigecycline, Demeclocyline)
LAHAT NG MAY -CYCLINE
Tetracycline with broadest spectrum
Tigecycline
Antibiotic that should NOT be take with Milk
Tetracyclines
Decreased absorption
Tetracycline for Acne
Doxycycline
Drug of Choice for Cholera
Class?
Tetracycline
Macrolide
Binds 50s, bacteriostatic
Prokinetic agent, stimulates GI motility
SE: Cholestatic hepatitis, QT prolongation, Drug interactions
Erythromycin
(Azithromycin, Clarithromycin, Telithromycin)
LAHAT NG MY -THROMYCIN
All Macrolides inhibit CYP450 EXCEPT
Azithromycin
Macrolide with highest Vd and slowest elimination
Azithromycin
Macrolide used for macrolide resistance
Telithromycin
Lincosamide
Binds 50s subunit, bacteriostatic
Drug for Anaerobic infections, PCP Pneumonia
SE: Pseudomembranous colitis (C. difficile overgrowth)
Cross resistance between macrolides is common
Clindamycin
Lincomycin
DOC for Anaerobic infections ABOVE the diaphragm
Clindamycin
DOC for Anaerobic infections BELOW the diaphragm
Metronidazole
Streptogramin Binds 50s subunit, bactericidal Drug for MRSA, VRSA, VRE SE: Arthralgia-myalgia syndrome Inhibits CYP450 enzymes, causing multiple drug interactions
Quinupristin-Dalfopristin
Oxazolidinone
Binds 50s subunit, bacteriostatic
Drug for MRSA, VRSA, VRE, Listeria, Corynebacteria
Linezolid
Identify Mode of Antibacterial Action:
As the plasma level is above the MIC, an increasing proportion of the bacteria are killed at a more rapid rate
Concentration-Dependent Killing Action
Seen in Aminoglycosides
Identify Mode of Antibacterial Action:
Efficacy is directly related to time above the MIC
Time-Dependent Killing Action
Greater efficacy when administered as a single large dose
Toxicity depends on a critical plasma concentration
Seen in which drug?
Postantibiotic effect
Seen in aminoglycosides and fluoroquinolones
Identify class of Antibiotics:
Not absorbed after oral
Limited Tissue Penetration
Glomerular Filtration is mode of excretion
Aminoglycosides
Aminoglycoside with narrowest therapeutic window
Amikacin
Antibiotics with this MOA are synergistic with Aminoglycosides
Cell Wall Inhibitors
Class of Antibiotics that require oxygen for reuptake
Binds to 30s
Aminoglycosides
Ineffective against anaerobes
Drugs with Postantibiotic Effect
Amikacin
Levofloxacin
Aminoglycosides
Fluoroquinolones
Resistance to this drug arises from
Group Transferases
Changes to ribosomal binding site
Aminoglycosides
Aminoglycosides
mean GNATS canNOT kill anaerobes Gentamicin: Nephrotoxicity Neomycin: Ototoxicity Amikacin: Teratogen Tobramycin Streptomycin
Aminoglycoside that binds to 30s subunit, bactericidal
Drug for aerobic gram - bacteria, endocarditis, ocular infections
SE: Nephrotoxicity, Ototoxicity
Gentamicin
Tobramycin
Most vestibulotoxic and nephrotoxic aminoglycosides
Gentamicin
Tobramycin
Aminoglycoside
Binds to 30s, bactericidal
Drug for Pseudomonas, Drug Resistant TB (2nd line)
SE: Nephrotoxicity, Ototoxicity
Amikacin
Aminoglycoside with the least resistance and narrowest therapeutic window
Amikacin
Aminoglycoside
Binds to 30s, bactericidal
Drug for TB, Tularemia, Bubonic Plague, Brucellosis
SE: Nephrotoxic (reversible), Ototoxic (vestibulotoxic, Irreversible) Teratogen (Congenital Deafness)
Administered IM
Streptomycin
Aminoglycoside Binds to 30s, bactericidal Drug for bowel preparation for elective surgery, hepatic encephalopathy, Visceral Leishmaniasis SE: Neuromuscular blockade Limited to topical and oral use
Neomycin
Kanamycin, Paromomycin
Neuromuscular blockade from Neomycin may be reversed with _____________ and _________
Calcium Gluconate
Neostigmine
Most Ototoxic Aminoglycosides
Kanamycin
Amikacin
Aminoglycoside
Binds to 30s, bactericidal
Drug for gonorrhea in penicillin-allergic and drugresistant pxs
SE: Nephrotoxicity (reversible), Ototoxicity (irreversible), anemia
Spectinomycin
Most Nephrotoxic Aminoglycosides
Tobramycin
Gentamicin
Skin reactions are most common in which Aminoglycosides
Neomycin
Streptomycin
Short acting Sulfonamide
Sulfisoxazole
Intermediate acting Sulfonamide
Sulfamethoxazole
Long acting Sulfonamide
Sulfadioxine
Weakly acidic
Resembles PABA
Decreased solubility in Acidic Urine
Class?
Sulfonamides
Similar to Folic acid
Weak base
High concentrations in prostatic and vaginal fluids
Class?
Trimethoprim
Identify Drug Class:
MOA: competitive inhibitor of dihydropteroate synthesis
Sulfonamides
Identify Drug:
MOA: selective inhibitor of dihydrofolate reductase
Trimethoprim
Building block of DNA
Purines
Resistance to Antifolate drugs
decreased drugs
increased substrate
increased tolerance
Sulfonamide
Bacteriostatic
Drug for Burns
SE: Acute hemolysis in G6PD deficiency, hypersensitivity, kernicterus
Displaces protein binding of other drugs/bilirubin
Silver Sulfadiazine
Sequential blockade of dihydropteroate synthase and dihydrofolate reductase, bactericidal
Drug for urinary tract, P. Jirovecci pneumonia
SE: Acute hemolysis in G6PD deficiency, hypersensitivity, kernicterus
Displaces protein binding of other drugs/bilirubin
Co-Trimoxazole
Toxicity of Sulfonamides
Hypersensitivity GI Distress Hematotoxicity Nephrotoxicity Drug Interactions
Increased levels of unconjugated bilirubin
Due to immature BBB
Bilirubin deposits in basal ganglia and subcortical nuclei
Leading to hypo/hypertonia, lethargy, high-pitched cry, opisthotonos
Identify Disease
Kernicterus
MOA of which class of antibiotics:
Inhibits Topoisomerase II (DNA Gyrase) in Gram (-) organisms, Topoisomerase IV in Gram (+) organism
Usually bactericidal
Exhibits postantibiotic effect
Fluoroquinolones
Resistance of which class of antibiotics Efflux pumps changes in porin structure changes in the sensitivity
Fluoroquinolones
Fluroroquinolones
Nalidixic Acid
Ciprofloxacin, Ofloxacin, Norfloxacin
Levofloxacin
Moxifloxacin, Gatifloxacin
Trend of Fluoroquinolone coverage
_________ generation, ________ Gram + activity
Increasing generation, increasing gram positive activity
Inhibits DNA gyrase and Topisomerase IV, bactericidal
Drug for UTI, Atypical Pneumonia, 2nd line for TB
SE: GI distress, Tendinitis and tendon rupture
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)
Ciprofloxacin
(Ofloxacin, Norfloxacin)
FLUOROquinoBONES!
3rd Generation
Inhibits DNA gyrase and topoisomerase IV, bactericidal
Drug for atypical pneumonia and lung infections
SE: GI distress, tendinitis, QTc prolongation (predispose to torsades)
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)
Levofloxacin
Sparfloxacin, Grepafloxacin
Aminoglycoside that was withdrawn due to severe cardiotoxicity (arrhythmia)
Grepafloxacin
4th Generation
Inhibits DNA gyrase, Topoisomerase IV, Bactericidal
Drug with broad spectrum activity and enhanced activity versus ANAEROBES
SE: GI distress, tendinitis, QTc prolongation, diabetes, hepatotoxicity
Avoid use in children and pregnant
Enhances toxicity of methylxanthines (Theophylline)
Widest spectrum of activity
Moxifloxacin
Disrupts ETC by forming free radicals, Bactericidal
Drug for Anaerobic or mixed intra abdominal infections, Vaginitis, Pseudomembranous colitis
SE: GI Irritation, Metallic taste, Disulfiram Reaction
Metronidazole
Most common drug that causes Pseudomembranous colitis
Clindamycin
2nd line drug for Pseudomembranous colitis
Vancomycin
Dose of Metronidazole for Trichomonas infection
2grams
Bactericidal
Drug used for UTI (except Proteus and Pseudomonas) only uncomplicated
SE: Skin rashes, Pulmonary infiltrates
Nitrofurantoin
Pulmonary FIbrosis can be caused by the following drugs
BBBAN Me Bleomycin Busulfan Bromocriptine Amiodarone Nitrofurantoin Methotrexate