Antibiotics Flashcards
Bind PBPs to inhibit cross-linking of PG. Used for some gram +, N meningitis, T pallidum. Beta-lactamase sensitive
Penicillin G, V
PCN SE
HSR, hemolytic anemia
PCN MOR
Beta lactamase
Bind PBPs to inhibit cross-linking of PG. Used for H flu, E coli, Listeria, Proteus, Salmonella, Shigella, enterococci (HELPSS kille enterococci). Beta lactamase sensitive.
Ampicillin, Amoxicillin (better oral availability)
Ampicillin SE
HSR, rash, pseudomembraous colitis
Ampicillin MOR
Beta lactamase
Bind PBPs to inhibit cross-linking of PG. Resistant to beta-lactamase due to bulky R group
oxacillin, nafcillin, dicloxacillin
Oxacillin CU
MSSA (MRSA has an altered PBP target site)
Oxacillin SE
HSR, interstitial nephritis
Antipseudomonals
Ticarcillin, piperacillin
Piperacillin CU
Pseudomonas and gram negative rods, with beta-lactamase inhibitors
Beta lactamase inhibitors
Clavulanic acid, sulbactam, taxobactam
Pipercillin SE
HSR
Cefazolin, Cephalein
1G - Gram + and Proteus, E coli, Klebsiella (PEcK)
Cefoxitin, Cefaclor, Cefuroxime
2G - H flu, Enterobacter, Neisseria, Proteus, E coli, Klebsiella, Serratia (HEN PEcKS)
Ceftriaxone
3G - Serious gram negative infections, esp meningitis and gonorrhea
Ceftazidime
3G - Serious gram negative infections, esp Pseudomonas
Cefepime
4G - increased activity against Pseudomonas and gram +
Ceftaroline
5G - MRSA (broad gram + and - coverage, but not pseudomonas)
Cephalosporin SE
HSR, vitamin K deficiency, increase nephrotoxicity of aminoglycosides
Monobactam that binds PBP3 to inhibit cross-linking of PG. Beta-lactmase resistant. Synergistic with aminoglycosides
Aztreonam
Aztreonam CU
Gram neg rods only!
Carbapenem must be administered with this inhibitor of renal dehydropeptidase I to decrease inactivation of drug in renal tubuels
cilastin
Carbapenem SE
CNS toxicity (seizures) at high plasma levels.
Binds D-Ala-D-Ala to prevent PG synthesis
Vanco
Vanco CU
GRAM POS ONLY
- MRSA
- Enterococci
- C diff
Vanco SE
Nephrotoxicity, Ototoxicity, Thrombophlebitis, Red man syndrome (prevent with anti-histamine pretreatment)
Van MOR
D-ala-D-ala to D-ala-D-lac
30S inhibitors
Aminoglycosides and tetracyclines
50S inhibitors
Chloramphenicol, Clindamycin, Macrolides, Linezolid
Aminoglycosides (Mean GNATS cannot kill anaerobes)
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
Prevent formation of inhibition complex –> misreading of mRNA, block translation
Aminoglycosides
Aminoglycoside CU
Severe gram neg rod infxns. Ineffective against anaerobes
Aminoglycoside SE
Nephrotoxicity, NMB, Ototoxicity, Teratogen
Aminoglycoside MOR
Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation
Binds 30s and prevents attachment of aa-tRNA
Tetracycline
tetracycline CU
Borrelia, M pneumo, Rickettsia, Chlamydia (concentrates intracellularly)
tetracycline SE
Discoloration of teeth and inhibition of bone growth in kids and fetuses, GI distress, photosensitivity
tetracycline MOR
decreased uptake or increased efflux out of bacterial cells by plasmid-encoded transport pumps
Macrolides
Azithromycin, Clarithromycin, Erythromycin
Bind 50S. Inhibit protein synthesis by blocking translocation
Macrolides (macroslides)
Macrolide CU
Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (Chlamydia), gram positive cocci (strep infection in pats allergic to PCN)
Macrolide SE
MACRO Motility Arrhythmia (prolonged QT) Cholestatic hepatitis Rash eOsinophilia P450 inhibitor
Macrolide MOR
Methylation of 23S binding site prevents bidng of drug
Blocks peptidyltransferase at 50s (blocks peptide bond formation)
Chloramphenicol
Chloramphenicol CU
Meningitis (H. flu, Neisseria, Strep pneumo) and Rickettsia rickettsii
Chloramphenicol SE
Anemia, aplastic anemia, gray baby (baby lacks liver UDP -glucuronyl transferase)
Chloramphenicol MOR
Plasmid encoded acetyltransferase inactivates the drug
Blocks peptide transfer (translocation) at 50S.
Clindamycin
Clindamycin CU
Anaerobes above the diaphragm (i.e. lung abscess, vs metronidazole for anaerobes below the diaphragm). Also invasive group A strep infection?
Clindamycin SE
Pseudomembranous colitis (C. diff),
Inhibit folate synthesis. PABA antimetabolites inhibits dihydropteroate synthase.
sulfonamides
Sulfonamide SE
HSR, hemolysis if G6PD deficient, nephrotoxicity, kernicterus in infants, photosensitivity, displace other drugs from albumin (warfarin)
p450 inhibitor
Sulfonamide MOR
Altered bacterial dihydropteroate synthase, decreased uptake, or increased PABA synthesis.
Inhibits bacterial DHFR
trimethoprim
TMP-SMX CU
UTIs, shigella, salmonella, PCP tx and prophylaxis, toxo prophylaxis
Trimethoprim SE
Megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid)
Inhibit DNA gyrase (topo II) and topo IV.
Fluoroquinolone
Fluoroquinolone CU
Gram neg robs of Urinary and GI tracts (incl Pseudomonas), Neisseria, some gram pos
Fluoroquinolone SE
tendon rupture, prolonged QT, teratogen
Cipro inhibits P450
Fluoroquinolone MOR
Chromosome encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps
Forms free radical toxic metabolites in the bacterial cell that damage DNA
Metronidazole
Metronidazole CU
GET GEP on the metro!
Giardia, Entamoeba, Trichomonas,
Gardnerella, Anaerobes, Pylori
Metronidazole SE
Disulfiram-like reaction (flushing, tachycardia, hypotension) with alcohol, headache, metallic tast
Decreased synthesis of mycolic acids. Bacterial catalase peroxidase (encoded by KatG) needed to convert this drug to active metabolite.
Isoniazid
INH SE
Neurotoxicity, hepatotoxicity, vitamin B6 deficiency, drug-induced lupus. Pyridoxine can prevent neurotoxicity, lupus
Inhibits DNA-dependent RNAP
Rifampin, rifabutin
Rifampin SE
P450 inducer; orange body fluids; rifabutin favored in HIV+ pts due to less p450 stimulation.
Mechanism uncertain. Though to acidify intracellular environment via conversion to pyrazinoic acid. Effective in acidic pH of phagolysosomes where TB engulfed by macrophages is found
Pyrazinamide
Pyrazinamide SE
Hyperuricemia, hepatotoxicity
Decreased carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase
Ethambutol
Ethambutol SE
Optic neuropathy (red-green color blindness)
Prophylaxis against endocarditis with surgical or dental procedures
PCN
Prophylaxis against gonorrhea
Ceftriaxone
Prophylaxis against recurrent UTIs
TMP-SMX
Prophylaxis against meningococcal infxn
Cipro (DOC, adults); Rifampin (kids)
Prophylaxis against maternal-fetal transmission of group B strep
Ampicillin
Prophylaxis against gonococcal or chlamydial conjunctivitis in newborn
erythromycin eye drops
Prophylaxis against post surgical Staph aureus inxn
Cefazolin
Prophylaxis against strep pharyngitis in child with prior rheumatic fever
PCN
Prophylaxis against syphilus
Benzathine PCN G
Prophylaxis against PCP + Toxo in HIV+ pt
TMP-SMX
Prophylaxis against MAC
Azithromycin
MRSA tx
vanco, (daptomycin, linezolid (can cause serotonin syndrome), tigecyline, ceftaroline
VRE tx
linezolid, streptogramins (quinupriston/dalfopriston)
Daptomycin MOA
depolarizes cell membrane
Daptomycin SE
myopathy, inc CPK, inactivated by pulmonary surfactant
Linezolid MOA
inhibits protein systhesi sby bindg to 50 S
Linezolid SE
Thrombocytopenia, neuritis, serotonin syndrome
Ceftazidime
3G, serious gram negs, esp Pseudomonas