Antibiotics Flashcards
What medications inhibit cell wall synthesis?
Penicillin, Cephalosporins, Carbapenems, and Vancomycin
What happens when cell wall synthesis is inhibited?
Weaking of the cell wall, influx of fluid into the cell, cell swells and bursts, cell lysis and death
What are the beta lactam antibiotics?
Sulfabactam, Clavulanic acid, tazobactam, and avibactam. Can be added with other medications to target bacteria that secrete beta lactamase that normally wouldn’t be killed.
What are common combinations for beta-lactamase inhibitors?
Ampicillin-Sulbacam, Amoxicillin-Clavulanic acid, Ticarillin-Clavulanic acid, Pipracillin-Tazobactam, and Ceftazidime-Avidbactam
Penicillin class MOA
Disrupts synthesis of the cell wall by inhibiting the transpeptidases essential for synthesis. Activates autolysis. Bacteria must be growing and dividing
Adverse effects of penicillin class
Urticaria, pruritis, angioedema, GI distress, rash
Indications for penicllins
Gonorrhea, UTI, Peritonitis, Pneumonia and respiratory infections, Septicemia, Meningitis
Different types of penicillin
Natural Penicillins (PCN G and V), Penicillinase-resistant penicillins (nafcillin), Aminopenicillins (amoxicillin and ampicillin), extended-spectrum penicillins (piperacillin)
Natural Penicillin med
PCN G and PCN V
Penicillinase-resistant penicillin med
nafcillin
Aminopenicillin meds
amoxicillin and ampicillin
Extended-spectrum penicillin meds
piperacillin
Penicillin G and V (Natural)
-Given IV/Im
-Works on gram positive and negative
-Half life 30 minutes
-Can be used with aminoglycosides
Nafcillin (Penicillinase resistant PCNs)
-Drug of choice for PCNs
-IV ONLY
-Resistant breakdown by penicillinase enzyme
Ampicillin (Aminopenicillin)
-Diarrhea and rash common SE
-Given PO or IV (if oral amoxicillin is better option)
-Renal sensitive
-Commonly given with sulbactam
Amoxicillin (Aminopenicillin)
-Common for peds pts
-Only given PO
-Common for ear, nose, throat, GI and skin infections
Piperacillin (Extended spectrum)
-ALWAYS given with a beta lactamase inhibitor
-Anti-pseudomonal
-Affects platelet function
-Good for pseudomonas infections
-Monitor renal dysfunction pts
Cephalosporins class MOA
Inhibits cell wall synthesis through same binding proteins as penicillin –> activates autolysis
Generations of cephalosporins
5 generations. Increase the spectrum, activity, and ability to penetrate CNS the higher the number
Cross sensitivity
If you are allergic to one thing, you’re more likely to be allergic to another. PENICILLIN AND CEPHALOSPORINS
Common adverse effects for all cephalosporins
mild diarrhea, abdominal cramps, rash, pruritis, redness, edema
1st generation cephalosporins
Cefazolin and cephalexin
Cefazolin
-Works well for gram +
-Staph and non enterococcal strep infections
-Given IV only
-Common for surgical prophylaxis
Cephalexin
-Works well for gram +
-Staph and non enterococcal strep infections
-PO or IV
2nd generation cephalosporins
Cefuroxime and Cefotetan
Cefuroxime
-Gram + and - coverage
-IV and PO
-Does not kill anerobic bacteria
Cefotetan
-Gram + and -
-IV and PO
3rd generation cephalosporins
Ceftriaxone, ceftazidime, and cefotaxine
Ceftriaxone
-most potent fighting against gram - but still works on +
-IV and IM injection only
-EXTREMELY long-acting (once per day dosing)
-Able to cross blood brain barrier (treat meningitis)
-DO NOT GIVE TO PT WITH LIVER FAILURE
Ceftazidime
-More potent on - but still works on +
-IV and IM injection only
-Works well for pseudomonas
4th generation cephalosporins
Cefepime
Cefepime
-Works against - and +
-Crosses BBB
5th generation cephalosporin
Ceftaroline
Ceftaroline
-Treats MRSA and MSSA, works against some VRSA/VISA
-Needs to be renally dosed
-IV ONLY
Carbapenems MOA
Bactericidal and cell wall inhibitor
Carbapenem meds
imipenem/cilastin and meropenem
What is the broadest spectrum of antibiotics?
Carbapenems
Carbapenem AE
drug-induced seizures
Carbapenem route
IV. MUST BE INFUSED OVER 60 MIN
Imipenem/Cilastin
MOA- binds to penicillin-binding proteins –> inhibits the cell wall synthesis (VERY resistant to beta-lactamas)
-IV only
-Can penetrate BBB
-Used for complicated infections
-MOST broad spectrum
-Cilastin is an inhibitor enzyme that breaks down imipenem
Meropenem
-Less coverage than imipenem
-Gram - and +
-Doesn’t degrade in the kidneys
-less seizure activity
-Rash and diarrhea common SE
CRE
Carbapenem resistant Enterobacteriaceae
Vancomycin MOA
-Destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
What is vancomycin?
glycopeptide antibiotic
Vancomycin
-Works on gram + (MRSA and PCN resistant pneumococcus)
-Oral is given to treat C.diff –> may still need IV antibiotic
-Doesn’t work on CNS infections
-Decrease doses for renal dysfunction (eliminated in kidneys)
Toxic side effects of Vancomycin
Ototoxicity, immune-mediated thrombocytopenia, nephrotoxic, red-man syndrome
Red man syndrome S/S
Flushing, rash, pruritis, urticaria, tachycardia, hypotension
What to do if someone develops red man syndrome
Infuse vancomycin slowly and over longer time periods
When do you draw a peak?
30 minutes after medication administered, or when it theoretically should be the highest concentraion
When do you draw a trough?
Right before administering another dose of meds
What meds cross the BBB?
Ceftriaxone (3rd), Cefepime (4th) and Ceftaroline (3rd) <– cephalosporins, imioenem/cilastin <– carbapenem
What med works best for gram - bacteria?
cefuroxime, cefotetan, ceftriaxone, ceftazidime, cefotaxine
Works well for gram +
cefazolin, cephalexin
Antimicrobial classes
aminoglycosides, lincosamides: clindamycin, macrolides, tetracyclines, fluoroquinolones, sulfonamides, metronidazole
Antimicrobials work by…
inhibiting or altering protein synthesis in transcription or translation
Aminoglycoside meds
gentamycin, amikacin, tobramycin
Aminoglycosides (gentamycin, amikacin, and tobramycin)
-Works well on gram -
-Can work on gram + but needs another antibiotic for synergistic effect
-Used for UTIs, pyelonephritis, gynecological infections, peritonitis, endocarditis, PNA, osteomyelitis
-SE: nephrotoxicity and ototoxicity
-Monitor therapeutic levels
-Start 3x a day dosing and transition to 1x a day
