Antibiotics Flashcards
Gram positive (continued)
Staph saprophyticus (young female,aggressively sexually active) Nocardia sp Corynebacterium sp Lactobacillus sp Listeria monocytogenes Mycobacterium aviu Propionibacterium acne Clostridium botulinum, tetani and difficile
Gram Positive ( thick peptidoglycan layer)
Strep pneumoniae
Strep pyogenes (Group A Hemolytic strep)
Strep agalactiae ( Group B Hemolytic strep)
Strep bovis ( associated with colon cancer)
Viridans strep
Enterococcus faecalis
Enterococcus faecium
Staph aureus
Staph epidermis (prosthetic devices and catheters)
Gram negative (thin peptidoglycan layer)
Nisseria meningitidis
Nisseria gonnorrhea
Moxarella catarrhalis Pseudomonas aeruginosa Bordatella pertussis Legionella pneumophilia Haemophilus influenzae Acinetobacter baumannii, calcoaceticus Serration marcescens Pasturella multocida (main bug in animal bites) E. Coli
Gram negative (continued)
Klebsiella pneumoniae Proteus mirabilis Proteus vulgaris Shigella Salmonella Bacteroides Species: B. fragilis B. faecalis B. vulgaris B. adolescentia
Common Anaerobes
Enterbacteriaceae species Lactobacillus species Clostridium species Bacteroides species Enterococci species
Encapsulated ( ability to evade immune system so have vaccines for)
Streptococcus pneumoniae
Nisseria meningitidis
Haemophilus influenzae (type B)
Klebsiella pneumoniae
Atypical
Chlamydia
Legionella
Mycoplasma pneumoniae ( no cell wall)
Normal microbial flora in the body
Skin
Staph epidermis Staph aureus Strep pyogenes (can cause impetigo) Corynebacterium Propionibacterium acnes Candida species
Normal microbial flora in the body
Mouth and oropharynx
Staph epidermis Staph aureus Beta Hemolytic streptococci Strep pneumoniae Strep viridans Strep mutans (dental plaque) Mozzarella catarrhalis Haemophilus influenzae Bacteroides species
Normal microbial flora in the body
Nose
Staph epidermis Strep pneumoniae Strep viridans Staph aureus Haemophilus influenzae Nisseria meningitidis
Normal microbial flora in the body
GI tract
Lactobacillus sp Clostridium sp Enterococci sp Bacteroides sp - B vulgatus/ B fragilis Enterobacteriaceae- E. coli Proteus mirabilis
Normal microbial flora in the body
Urethra
Staph epidermis Step sp Bacteroides sp Fusobacterium sp F nucleatum Peptostreptococcos sp
Normal microbial flora in the body
Vagina
Lactobacillus acidophilus Group B hemolytic strep Bacteroides sp Peptostreptococcus sp Gardnerella vaginalis Staph epidermis Enterococcus
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Penicillins
Aque. PCN G
Benzathine PCN G/ PCN V potassium
PCN-Resistant PCN (Gr+): Dicloxacillin, Nafcillin, Oxacillin
AminoPCN (Gr+&-): Amoxicillin, Ampicillin
Extended spectrum PCN (+,-,anaerobic): Ticarcillin,Pipercilin
BL inhibitors ( +,-,anaerobes,pseudo,enterococcus): Amoxicillin/Clav(no pseudo), Amp/SUB, Ticar/CA, Piper/TZ
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Cephalosporins 1st generation (mostly Gr+ coverage)
Cephalexin Cefadroxil Cefazolin Ceflothin Cephradine
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Cephalosporins 2nd Generation (mostly gram+ but some gram-)
Cefaclor Cefuroxime Cefprozil Loracarbef Cefoxitin Cefotetan
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Cephalosporins 3rd Generation ( reduction in Gr+ coverage and increase in Gr- coverage including pseudomonas)
Cefdinir Cefixime Ceftibuten Cefotaxime Cefoperazone Ceftazidine Ceftriaxone
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Cephalosporins 4th Generation ( improved both Gr+&- coverage including pseudomonas)
Cefepime
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Monobactams ( cover one type of bacteria Gr - infection, cover pseudomonas)
Azactam
Class of drugs (Beta Lactamase)
Cell wall synthesis inhibitors
Carbapenems ( covers MDR, pseudomonas,no coverage for enterococcus)
Imipenem/ Cilastatin( cilastatin prevents Imipenem induced nephrotoxicity
Meropenem
Ertapenem( no coverage over pseudomonas)
Doripenem
Classes of Drugs (other types of cell wall synthesis inhibitors)
Glycopeptide
Vancomycin
MRSA (IV)
C-diff (PO)
SE: Anaphylactoid reaction (red face,torso), nephrotoxicity,ototoxicity, thrombophlebitis
Classes of Drugs (other types of cell wall synthesis inhibitors)
Lipoglycopeptide (Telavancin)Vanco derivative
Skin infection caused by MRSA, strep pyogenes, enterococcus
SE: nephrotoxicity, c-diff, torsades,interference with some anticoagulantion testing
Bacteriostatic
Do not kill bacteria, rely on existing immune system
ECSTaTiC
Erythromycin, Clindamycin, Sulfamethoxazole, Trimethroprim, Tetracycline, Chloramphenicol
Bacteriocidal
Kills bacteria regardless of immune system
Very Finely Proficient At Cell Murder
Vancomycin, Fluroquinolones, Penicillin, Aminoglycosides, Cephalosporins, Metronidazole
Class of drugs
Protein synthesis inhibitors
Macrolides
Gr+&-, atypical, good cellular penetration 50S
Erythromycin
Clarythromycin
Azithromycin
Class of drugs
Protein synthesis inhibitors
Ketolides ( Gr +&-‘ atypical, MDR Strep pneumoniae) 50S
Telithromycin
Watch for liver toxicity, MG is a CI, visual disturbances
Class of drugs
Protein synthesis inhibitors
Tetracyclines ( Gr -, anaerobes, atypical, MRSA, spores) 30 S
Tetracycline
Minocycline
Doxycycline
( teeth staining, decrease bone growth, chelates cations, DO NOT GIVE
Class of drugs
Protein synthesis inhibitors
Glycylcyclines ( Gr+, -, anaerobes,MRSA, enterococcus)
Derivatives of Tretra. 30S
Tigercycline
Treats MRSA , enterococcus faecalis, may discolor teeth, solution red-orange
Class of drugs
Protein synthesis inhibitors Anaerobic agents( Gr +, some MRSA) bacteroides species that cause BV
Clindamycin
Lincomycin
SE: c diff, neutropenia,risk for pre term birth if cam used for BV
Class of drugs
Protein synthesis inhibitors
Oxazolidinone ( Gr +, VRE, MDRs, pneumonia, diabetic foot infection, MRSA, CAP, ) 50S
Linezolid ( has MAO inhibitor properties may cause thrombocytopenia and myelosupression)
Class of drugs
Protein synthesis inhibitors
Streptogramins ( Gr +, -, VRE, MRSA, MDRs, S. pneumoniae) 50 S
Quinupristin/dalfopristin ( phlebitis, incompatible with. NS, hyperbilirubinemia, arthralgias, myalgia so.
Aminoglycosides ( Gr -, pseudomonas, proteus, serratia, Gr+ staph, anaerobes) 30S
Amikacin
Gentamicyn
Tobramycin( dose depends on peak concentrations needed for a particular infection and based on renal function)
SE: renal and ototoxicity, NEVER used for OM, only for OE
Other classes of Antibiotics
Fluoroquinolones ( Gr+, -, anaerobes , atypicals, pseudomonas ( Cipro, Leva) enterococcus ( good cellular penetration)
Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin Gemifloxacin ( not in pedis, may lead to tendon rupture, not in pregnancy, absorption issues if given with cations. Ophthalmic- frequency may be an issue
Cyclc Lipopeptide ( Gr +, MRSA, enterococcus)
Daptomycin
Anaerobic agents ( alternative agent for H. pylori, Protozoa, BV, FIRST LINE FOR Cdiff colitis, BV, & Parasitic infections
Metronidazole ( prodrug, avoid in 1st trimester, unpleasant taste, peripheral neuropathies, seizures, AVOID ETOH & propylene glycol, inhibitor of CYP2C9- be cautious with WARFARIN
Trimethroprim/ Sulfamethoxazole ( Bactrim)
Bacteroides ( Gr+,-, Fungal, PJP/PCP)
Inhibit folic acid synthesis
SE: mild GI, RASH , BONE MARROW SUPPRESSION
Clinical issues: avoid in the last trimester or breastfeeding. Stephen Johnsons syndrome, inhibitor 2C9 warfarin, increase fluid intake, avoid sun exposure
Sulfones Bacteriostatic ( PJP/PCP) alternative in sulfa allergies
Dapsone
Nitrofurantoin ( Gr +, -, that cause UTIs- prevention and treatment of UTIs)
Clinical issues: hemolytic anemia, prolonged use associated with pulmonary toxicity, peripheral neuropathy. Probenecid can inhibit its excretion, avoid in pregnancy, labor & delivery
Antimycobacterials antitubercular
First line: INH Rifampin PZA Ethambutol
INH ( bacteriocidal)
Clinical issues
Injures neurons and hepatocytes, AVOID ETOH, depletes Vit B 6
Rifampin ( bacteriocidal)
RNA polymerase inhibitor, Red urine/fluids, Ramps up enzymes, Rapid resistance when used alone
Used also as adjunct w beta lactams and glycopeptides for difficult Gr+ infections, Monotherapy only for prophylaxis: given to carries of N. Meningitidis
SE: hepatotoxic , all bodily fluids can became red hue , flulike symptoms.
Clinical issues: CYP3A4 inducer ( can lower concentrations of warfarin, OCs, anticonvulsant)
Pyrazinamide (PZA): bacteriocidal
SE: Hyperuricemia
Ethambutol ( bacteriocidal)
Must be combined with other agents
SE: optic neuritis, Hyperuricemia,
Clinical issues: Renal dose adjust, at least 2 hrs from antacids
Antifungal
Ergosterol inhibitors
MOA: lipophilic drug binds to ergosterol
Amphotericin ( susceptible: Sporothrisx schenckii- from rose bushes thorns)
Dosing: premed w NSAID w or wo Benadryl or APAP
Oral candidiasis
Dermal infection
Clinical issues: give over 4-6 hrs, if given too fast cause chills, hypotension, only compatible with D5W
NEPHROTOXICITY ( bonus 250 cc IVF before and after infusion). MONITOR CBC, CHEM 7 ( can increase toxicity with Digoxin and neuromuscular blockers).
Ergosterol inhibitors
MOA: lipophilic drug binds to ergosterol
Nystatin ( topical cream, powder, swish &swallow or vaginal tablet)
Used for cutaneous, mucocutaneous, and oral fungal infections
Frequency of dosage biggest issue
Ergosterol inhibitors
MOA: lipophilic drug binds to ergosterol
Terbinafine
Treat Candida albicans, onychomycosis,
SE: GI , dysguesia, hepatotoxic ( get a AST, ALT as baseline and periodically thereafter)
Contraindications: CrCl
