Antibiotic Charts Flashcards
What is the MOA of penicillins?
inhibition of bacterial wall synthesis (stage 3)
-Bactericidal
*The primary mechanism of antibacterial action of the
penicillins involves inhibition of reactions involving transpeptidation
What is bactericidal vs bacteriostatic
- cidal: organisms are killed
- static: organisms are prevented from growing
Describe the absorption of penicillins
-optimal absorption on an empty stomach
Pen G: IM/IV (poor oral)
Pen V: good oral
amox: good oral
Penicillinase-resistant: good oral (not methicillin or nafcillin)
Oral absorption of penicillins varies depending on __
acid stability
*use of insoluble salts to reduce absorption and extend duration of action
Describe the distribution of penicillins
- Penetrate into tissue poorly
- can enter inflamed tissues or membranes more readily than normal
Describe the metabolism/excretion of penicillins
- 90% Renal excretion
- excreted in breast milk
Common adverse reactions of penicillins
*Virtually non-toxic, except for hypersensitivity rxn
- anaphylaxis (type I, rare but life threatening)
- maculopapular or morbilliform skin rash
- Diarrhea (Amoxicillin-clavulanate > Ampicillin > Amoxicillin > Pen V)
- Seizures/convulsions or encephalopathy (high doses)
- “Salt effect” due to high doses of K+ or Na+ salts
- Jarisch-Herxheimer reaction during syphilis treatment
Classes of penicillins
- Prototype: pen G (IV)
- Prototype/Acid-stable: pen V (PO)
- Penicillinase-Resistant: Methicillin, dicloxacillin
- Extended spectrum: amoxicillin, amox-clavulanate, ampicillin
- Anti-pseudomonal: Pip-taz, Ticarcillin-clavulante
- Beta-lactamase inhibitor: clavulanic acid, sulbactam
What is the spectrum coverage of prototype penicillins (penicillin G and V)
*Relatively narrow spectrum
- Cocci: gram + (Staph / Strep / Entero)
- Cocci: gram - (Neisseria, M. catarrhalis)
- Rods: gram +
- Anerobes (most but NOT Bacteroides)
What is Penicillin V commonly used to treat?
acute pharyngitis (S. pyogenes)
*or amoxicillin is used
What are penicillinase-resistant antibiotics?
- Oxacillin
- Dicloxacillin**
- Methicillin
- Nafcillin
*NOTE: All other PCN classes are penicillinase (β-lactamase) susceptible; unless combined w/β-lactamase inhibitor (amoxicillin-clavulanate [34] or piperacillin/tazobactam)
Describe the absorption of penicillinase-resistant antibiotics
(Oxacillin, Dicloxacillin, Methicillin, Nafcillin)
Good oral (NOT methicillin or nafcillin)
Describe the spectrum coverage of penicillinase-resistant antibiotics
*relatively narrow spectrum agents
penicillinase-producing S. aureus (MSSA**)
- skin infections (NOT MRSA)
- Gram + and gram - cocci
*No anerobes, no Gram negative rods
What is the clinical use of dicloxacillin?
MSSA
What are the extended spectrum penicillins?
- Amoxicillin
- amoxicillin-clavulanate
- ampicillin
Describe the absorption of extended spectrum penicillins
- good oral
- increased hydrophilicity (due to presence of amino (NH2) or carboxyl (COOH) groups) allowing penetration through porins out outer membrane of gram-neg. organisms
-increased hydrophilicity (due to presence of amino (NH2) or carboxyl (COOH) groups) allowing penetration through porins out outer membrane of gram-neg. organisms
extended spectrum penicillins
What is the spectrum of coverage for extended spectrum penicillins
- Rods: gram - (H. flu, E. coli, Proteus) gram neg bacilli
- Cocci: gram + (less than PenG/V)
*can be given w/ B-lactamase inhibitors to further extend their antimicrobial spectrum
Adverse reactions with extended spectrum penicillins
- diarrhea (less w/ amoxicillin)
2. superinfection (CDAD) possible
Clinical use of amoxicillin and ampicillin
- E. coli
- UTIs
- MSSA
- AOM
- acute pharyngitis
Examples of antipseudomonal pencillins
(Piperacillin / Ticarcillin ± β-lactamase inhibitor)
- Piperacillin-Tazobactam
- Ticarcillin-Clavulante
Describe the administration of antipseudomonal pencillins
IV (parenteral) only
Describe the spectrum coverage of antipseudomonal pencillins
- Pseudomonas aeruginosa
- Anaerobes including Bacteriodes fragilis
- Enterococci
What are the beta-lactamase inhibitors?
- Clavulanic acid
- Sulbactam
*often given with antipseudomonal penicillins
Clavulanic acid + amoxicillin = ____
Sulbactam + ampicillin = ____
Augmentin
Unasyn
What is the clinical use of antipseudomonal pencillins (Pip-Taz)
Pip-Taz: pseudomonas/opportunistic infection, B. Fragilis (intraabdominal and brain abscess)
What is the MOA of cephalosporins?
Inhibits bacterial wall synthesis (stage 3)
-bactericidal
*similar to penicillins but:
-Broader spectrum of action vs gram-negative bacteria
-Less susceptibility to narrow spectrum β-lactamases
but ESBLs are emerging
- Less cross-reactivity in penicillin sensitive patients
What is the metabolism/excretion of cephalosporins
renal excretion (almost all except ceftriaxone)
Describe the distribution of cephalosporins
- penetrate well into most tissues and fluids (including placenta) except brain and CSF
- *Major feature of 3rd generations–> penetrate into CSF
What is the spectrum coverage of cephalosporins
extended spectrum
-NOT susceptible to penicillinase
What are adverse reactions of cephalosporins?
- hypersensitivity allergies (skin rash)
* less severe than penicillins (increased risk w/ 1st generations)–> should not be given to pts w/ hx of immediate sensitivity to penicillin - superinfection w/ 2nd and 3rd generation agents
- action to suppress flora can intensify effect of oral anicoagulants (warfarin)
What are 1st generation cephalosporins
- Cephalexin
- Cefazolin
- Cephradine
What are 2nd generation cephalosporins
- Cefaclor
- Cefuroxime
- Cefoxitin
What are 3rd generation cephalosporins
- Ceftriaxone
- Cefdinir
- Ceftazidime
What are 4th generation cephalosporins
- Cefepime
Describe the PK of 1st generation cephalosporins
- good oral
2. Cefazolin in IV/IM only
Describe the PK of 2nd generation cephalosporins
- good oral
2. Cefoxitin in IV/IM only
Describe the PK of 3rd generation cephalosporins
- good oral
2. good CNS penetration
Describe the spectrum coverage of 1st generation cephalosporins
- Cocci: gram + cocci
* have greater activity against S. aureus (MSSA) than pen G - Rods: gram − bacilli (Proteus, E. coli, Klebsiella)
- Similar to amoxicillin
- more stable then penicillins to many beta-lactamases
Describe the adverse reactions of 1st generation cephalosporins
- diarrhea
2. increased risk of cross-hypersensitivity w/ penicillins
Describe the spectrum coverage of 2nd generation cephalosporins
- Rods: GREATER activity against gram − (H. flu, Enterobacter)
- Anaerobes including bacterocides fragilis*
Describe DDI and adverse reactions of 2nd generation cephalosporins
- enhancement of warfarin anticoagulant activity
2. superinfection (CDAD) possible
Describe the spectrum coverage of 3rd generation cephalosporins
- Rods: expanded gram − (excellent against pneumococci)– more active against enteric gram neg than 2nd generation
- good gram + cocci for ceftriaxone
- moderate antipseudomonal (Ceftazidime)
Describe adverse reaction of 3rd generation cephalosporins
- superinfection (CDAD) possible
What antibiotics work best against N. gonorrhea and N. menigitis
3rd generation cephalosporins
Clinical uses of 1st generation cephalosporins
Gram pos. cocci:
- MSSA (strep. staph.)–> surgical prophylaxis
- skin infection
Gram neg. bacilli
- pneumonia
- UTI
Clinical uses of 2nd generation cephalosporins
Gram neg. bacilli
- pneumonia
- UTIs
- AOM
- sinusitis
Anaerobes:
- peritonitis
- diverticulitis
Clinical uses of 3rd generation cephalosporins
Gram + cocci
1. pneumonia
Gram - cocci
- gonorrhea
- meningitis
Gram - bacilli
- UTIs
- pneumonia
- mengitis
- sepsis
A major distinction between 1st and 3rd generation cephalosporins is:
A. 3rd generation agents have less activity against Pseudomonas
B. 3rd generation agents have increased activity against chlamydia
C. 1st generation agents have increased penetration into the CNS
D. 3rd generation agents have increased activity against resistant gram-negative organisms
E. 1st generation agents have greater activity against methicillin-resistant Staphylococcus aureus
D. 3rd generation agents have increased activity against resistant gram-negative organisms
Amoxicillin (extended-spectrum penicillin) shares all of the following properties with cephalexin (1st C ) EXCEPT:
A. Inhibition of cell wall synthesis
B. Bactericidal action
C. Elimination primarily by the kidneys
D. Beta-lactam ring in structure
E. High susceptibility to bacterial beta-lactamases
E. High susceptibility to bacterial beta-lactamases
Select the FALSE statement concerning inhibitors of cell wall synthesis:
A. Second generation cephalosporins have good-to excellent activity against anaerobic organisms.
B. The concentration of penicillin G in the CSF is higher when administered to patients with meningococcal meningitis than it is when given to normal, uninfected patients.
C. First generation cephalosporins have greater activity against Pseudomonal infections than third generation cephalosporins.
D. First generation cephalosporins (e.g., cefazolin) should not be given to patients with a Type I anaphylactic reaction to amoxicillin.
C. First generation cephalosporins have greater activity against Pseudomonal infections than third generation cephalosporins.
Describe the MOA of vancomycin
Inhibits bacterial wall synthesis (stage 2)–> blocks linear polymerization
-Bactericidal
*tricyclic glycopeptides acts by inhibiting cell wall synthesis at site different from pencillin
Describe the administration and elimination/metabolism of vancomycin
- poor oral absorption except for GI tract indications
- renal excretion
Describe the spectrum coverage of vancomycin
- narrow spectrum
1. gram + cocci: MRSA, staph. strep., enterococci
2. Anerobes: C. difficile
Describe the adverse reactions of vancomycin
- infusion related: chills/fever/rash (red man syndrome)
- ototoxicity
- renal toxicity
- routine monitoring of Cp levels
Describe the clinical uses of vancomycin
Gram + cocci: (MRSA)
- severe skin infection
- soft tissue infection
Anaerobes
1. pseudomembranous colitis (C. difficile)
What is the MOA of carbapenems
inhibition of bacterial wall synthesis (stage 3)
-Bactericidal
Describe the MOA of macrolides
Protein synthesis inhibition (50S)– blocks translocation of peptidyl tRNA from acceptor to donor site on ribosome– prevents elongation
-Bacteriostatic
What type of antibiotics are protein synthesis inhibitors?
- Macrolides
- Tetracyclines
- Clindamycin
- Aminoglycosides
- SMX-TMP–> inhibitor of intermediary metabolism
describe the absorption of macrolides
- good oral (also IV)
- concentrates in lungs
Eryth: absorption varies depending on salt form
Clarith: can be taken w/o meals
Azi: should be taken on empty stomach
Describe the metabolism/excretion of Erythromycin
- QID
- Metabolized in liver and excreted in bile
Describe the metabolism/excretion of Azithromycin
- QD
- not metabolized–> biliary excretion
Describe the metabolism/excretion of Clarithromycin
- BID
- metabolism to active compound that is renally eliminated
Describe the distribution of macrolids
- distributed widely, also fetus
2. Azi-Clarith. accumulates in lungs, skin, sputum