Antibiotics Flashcards
Gram Positive Aerobes
COCCI Clusters - staphylococci Pairs - S. pneumoniae chains - group and viridans streptococci pairs and chains - Enterococcus sp. BACILLI Bacillus sp. Corynebacterium sp Listeria monocytogenes Nocardia sp
Gram-Negative Aerobes
COCCI Morexella catarrhalis Neisseria gonorrhoeae Neisseria meningitidis Haemophilus influenzae BACILLI E. coli, Enterobacter sp Citrobacter, Klebsiella sp Proteus sp., Serratia Salmonella, Shigella Acinetobacter, Helicobacter Pseudomonas aerusinosa
Above the diaphragm Anaerobes
Peptococcus Peptostreptococcus Prevotella Veillonella Actinomyces
Anaerobes below the diaphragm
Clostridium perfringens, tetani and diff.
Bacteroides fragilis, disastonis, ovatus, thetaiotamicron
Fusobacterium
Atypical Bacteria
Legionella pneumophila
Mycoplasma pneumoniae
Chlamydia pneumoniae
Spirochetes - Treponema pallidum (syphilis)
Skin/soft tissue infection causing bacteria
S. aureus, S. pyogenes
S. epidermidis
Pasteurella
Bone and Joint infection causing bacteria
S. aureus, S. epidermidis
Streptococci
N. gonorrheoeae
Gram-negative rods
Abdomen bacteria causing infection
E. coli, proteus
Klebsiella
Enterococcus
Bacteroides sp
Bacteria causing Urinary tract infection
E. coli, Proteus
Klebsiella
Enterococcus
Staph saprophyticus
Upper respiratory infection causing bacteria
S. pneumoniae
H. influenzae
M. catarrhalis
S. pyogenes
H
Lower respiratory Community infection caused by which bacteria
S.pneumoniae H. influenzae K pneumoniae Legionella pneumophila Mycoplasma, Chlamydia
Meningitis
S. pneumoniae N. meningitidis H. influenza Group B Strep E. coli Listeria
systems commonly adversely effected by anti-infective therapy
neuro/CNS - potential for seizure and neurotoxicity, esp in elderly and CKD, drug accumulates quickly, adjust dose. CIPRO is classic, meripenem and eripenim
nephro - most common
GI (direct toxic effect to cells),
hepatic - some toxic to liver cells, hepatitis or liver failure
Broad Spec penicillins
beta-lactamase inhib (PCN)
common combinations of these
amoxicillin (oral) Ampicillin (IV)
Clavulanic acid, Sulbactam
Amox/Clav acid - AUGMENTIN
ampicillin/sulbactam - UNISYN
hypersensitivity reaction
rash, pruritus, fever, urticaria
mild allergic reaction
anaphylaxic-5-10%
First Gen cephalosporins, examples, used for what?
same gram + as penicillicn
cefazolin (IV, IM) = ANCEF
cephalexin / KEFLEX
2nd Gen cephalosporins, examples, used for what?
H. flu, Nesseria, Entreobacter aerogenes
less effective against gran +
cefixitin
3rd Gen cephalosporins, example, used for what
gonorrhea, PID, PNA,
weak gram +
potent against gram-
Serratia marcenscens
cefotaxime (neonates, intra ab, diabetic)
cefpodoxime (oral)
CEFTRIAXONE - the best one, once a day dosing
4th gen cephalosporins, example, used for what
gram- bacteria,
keflex
1st gen,
look this up
cefoxitin
2nd gen cephalosporin
look this up
cephalosporin CI
allergies to cephalosporins and penicillins
if hypersensitivity rxn to PCN, like rash/pruritis, ok to give cephalosporins
cephalosporin AE and drug-drug
GI - n/v/d, abd pain, flatulence, anorexia
CNS - HA, dizzy, lethargy, paresthesias
Renal - nephrotoxicity in indiv with pre-existing renal disease
hypersensitivity
ETOH- disulfiram-like rxn with some
AE can occur up to 72 h after d/c
monobactams
Aztreonam
Used for gram neg aerobes, not active against Gram + or anaerobes
ONLY one that can be used if PCN or cephalosporin allergies
Gram -
E. coli, H, influ, M catarrhalis, Enterobacter, Salmonella, Shigella
seudomonas aeruginosa
Aminoglycosides
bacteriocidal, very potent, little resistance
severe SE
all IV or nebulized
Gentamycin, Tobramycin
SE OTOTOXICITY, RENAL TOXICITY, can progress to renal failure, elderly more susceptible, dose and duraiton related
CNS - irreversible deafness, confusion, depression, numbness, tingling, weakness, paralysis
HEMA - bone marrow suppression,, immune suppression, super-infection
WEAR SUNSCREEN, photosensitivity, rash/urticaria, exfoliative dermatitis
Cardiac - palpitations, hypotension or HTN
drug-drug- Diuretics
Synergistic, with PCN
Examples of macrolides, and use
Azythromycin (bronchitis, COPD) Clarithromycin (H. pylori protocol only, cheap) Erythromycin (OB prefer this) Streptococcal infection Mycoplasma infection Listeria GROUP A BETA HEMOLYTI strep infection
macrolide CI, caution, AE
caution with hepatic dysfunction, lactating women/pregnancy
CI - allergy to any macrolide
AE - GI, abd cramping, diarrhea, vomitting, anorexia, pseudomembranous colitis
HEPATOTOXICITY - if taken with other hepatotoxic drugs
CNS - confusion, abnormal thinking, uncontrollable emotions
Lincosamine, one drug
more toxic than macrolides, but similar
CLINDAMYCIN - most commonly assoc with C.diff, lots of GI SE
Tetracyclines, examples, CI, precautions
long acting-
DOXYCYCLINE - good for MRSA, bronchitis, URI
MINOCYCLINE - Derm likes, antiinflammatory
Not recommended in preg/lactation
Avoid in kids < 8
AE - Photosensitivitiy and rash, GI-N/V/D, abd pain, glossitis, dysphagia. FETAL hepatotoxicity.
SKELETON - weakening of bone/teeth, staining, pitting
DRUG-DRUG; PCN (dec. PCN)
decreased effectiveness of OCPs
DIGOXIN toxicity
dairy binds to it, unabsorbable
take on empty stomach, 1h before food or 2-3 h after meal or meds
fluoroquinolones
Broad spectrum of activity
good bioavailability
tissue penetration,
prolonged half-lives
RESISTENCE is a major issue
CIPROFLOXACIN (older) PO, IV, complicated UTI, second line or sulfa allergy, abd infection, below diaphragm
LEVOFLOXACIN - (newer) PO, IV, excellent for resp, $$
AE- GI, n/v/d/dyspepsia, CNS- HA, agitation, insomnia, dizzy, seizures (elderly), rare hallucinations
Hepatotoxicty - LFT elevation
Variable QTc complex
Fluoroquinolones drug-drug interactions
zinc, iron, ca, aluminum, mag,
antacids, sucralfate, ENTERAL FEEDINGS will impair oral absorption, CLINICAL failure, 2 to 4 h interval
Theophylline and cyclosporine, inhib metabolism, inc levels, inc toxicity
WARFARIN - idiosyncratic
Macrolides
Erythromycin, narrow spectrum, short 1/2 life, poor GI SE,
Clarithromycin and azithromycin - broader spectrum, longer half-life, availability, more toleratework d
what good macrolides for? SE?
anaerobes (upper airway)
atypical bacteria - legionella, Chlamydia, Mycoplasma, campylobacter, borrelia, bordetella, pasteurella
SE - GI, most common with erythro, QTc prolongation
Clindamycin, uses, AE
gram +, C. diff, GI SE
gram + aerobes, MSSA, Strep pneumoniae- resistence is starting
Group and viridans streptococci
most freq caused c diff colitis (treat with metrondazole), N/v/d/d
rare hepatotoxicity and allergy
Metronidazole, uses, AE
used for anaerobes
GI-n/v, stomatitis, metallic tast
CNS- MOST SERIOUS, peripheral neuro (if used long term), encephalopathy, seixures. caution with preexisting CNS d/o
Mutagenicity, carcinogenicity, avoid preg, commonly used with BF
Metronidazole drug-drug interactions
warfarin, inc aticoag effect etoh - disulfiram rxn Phenytoing - inc phenytoin conc Lithium, inc lithium conc Phenobarbital, dec. metro conc Rifampin - dec, metro conc
Sulfonamides, moities, ci
Different moeities Sulfazalazine, sulfamethoxazole, sulfadiazine, sulfixoxazole prevents the synthesis of folic acid CI, thiazide diuretic allergy CI in pregnancy, lactation
sulfonamide SE
GI, n/v/d/abd pain, anorexia, stomatitis, hepatic injury d/t direct irritation of GIT
RENAL - crystalluria / proteinuria, hematuria –> can cause nephrotic syndrome (drink tons of water), dizzy, vertigo, ataxia, convulsions, depression (effects nerves)
HEMA-bone marrow depression
DERM - photosensitivity and rash and hypersensitivity
Take with food, no etoh
specific anti-tubercular drugs
isoniazid (liver tox, rx with B6, or else peripheral neuritis)
rifampicin (lots of drug-drug, stain contacts, hepatitis, red-orange discoloration of secretions)
pyrazinamide (uric acid goes up, gout/preg prec)
ethambutol (optic neuritis, eye exam, not kids < 6 yo)
worry about liver impairment with all of these, check LFT periodically
multiple drugs to prevent resistence
Abx in pregnancy relatively safe
PCN, cephalosporing, erythromycin base
ABX in pregnancy, CI and caution
CAUTION
Bactrim (dong give 1st and 3rd), Metronidazole,
Aminoglycosides (could probably give), chloramphenicol (no, no)
CI
tetracyclines, erythromycin estolate, fluoroquinolones
Amantadine and Rimantadine
antiviral - inhibs strains of Influenza A also used for parkinsons must adjust for renal can cause confusion, not commonly used high conc in renal secretions
interferons
host species specific
lmw proteins made my mammals in response to viral infections
produced by recombinant genetic techniques
Interferon-alpha
renders cells resistant to many viruses used for Hep B and C Hairy cell leukemia Karpsoi's sarcoma IV AE; flu-like sx, depression, (responds to SSRI, should have MH care, caution if SI), hypotension Hep C tx, combined with ribavirin, depends on virus genotype long-acting; pegylated, once weekly
Acyclovir, action, doses for diff. diseases
HSV>VZV>CMV>EBV, herpes viruses differ in their degree of sensitivity to ACV
inhibits DNA polymerase and blocks replication
200-400 mg HSV (very sensitive, suppression tx if >6/year)
VZV needs high dose 800 mg 4x/day
encephalitis IV only 700-800 mg (low absorption, IV to get to CNS)
drug resistence in immunocompromised hosts
drug resistent strains less virulent
topical doesn’t work
toxicity - well-tolerated, safe in pregnancy,
hydration imp if taking high doses, LOTS of WATER, could crystalize in high doses
Amphotericin B
dont’ rx this, get ID consult,
nephrotoxicity - dec GFR, renal tubular acidosis, dec renal conc ability, hypoK, hypoMAG
infusion-related rxns - chills/rigors, fever, n/v, cardiorespiratory rxn, phlebitis
drug of choice for systemic fungal infection.
Ketoconazole
tons of drug-drug, P450 very active
injuries that decrease fungal defenses
cutaneous injury - catheters, burns, surgery
mucosal injury - mucositis, GI surgery, GI perf
FUNGAL factors - proteinases, phospholipases, lipases
Fluconazole, use for what, clearance, AE,
C. albicans, C. tropicalis, NO C. krusei/Aspergillus
Renal clearance (80%)
Clearance - renal (80%)
AE N&V, hepatic
Voriconazole
used to treat Aspergillus
AE: N/V, visual dist, hepatic, rash, QTC prolongation
Echinocandin Antifungals
very safe, lon inc of hepatotoxicity, only IV
small drug-drug
micafungin more commonly used
used mostly in transplant or renal patient
anidulafungin - lots of etoh in each dose
