Antibiotics Flashcards
Primaxin: Gorillamycin What is it? MOA? Coverage? Doseage?
Risk:
- Imipenem and cilastatin (inhibits dehydropeptidase)
- bind PCN binding proteins inhibiting cell wall synthesis
- Coverage: very broad spectrum of activity, serious systemic infections, for use with very resistant bugs
500mg IV q6h
High risk of seizures
Meropenem What is it? MOA? Coverage? Doseage?
- A carbapenem
- binds PCN binding proteins to inhibit cell wall synthesis
- Coverage: strep, pseudomonas, bacteroides
- 500mg IV q8: 1g IV q8
Invanz What is it? MOA? Coverage? Doseage?
Ertapenem
- binds PCN binding proteins to inhibit cell wall synthesis
- Coverage: MSSA, Strep, Aerobes. Used for moderate-severe foot infections
DOES NOT COVER PSEUDO
Dose: 1g IM/IV qday
Gentamicin What is it? MOA? Coverage? Doseage?
Side effects?
an Aminoglycoside
- Protein synthesis inhibitor, binds irreversibly to 30S
- Covers: serratia
- Dose: 1-1.7mg/kg IM/IV q8
Side effects: ototoxicity, nephrotoxicity
Tobramycin What is it? MOA? Coverage? Doseage?
an aminoglycoside
- Protein synthesis inhibitor, binds irreversibly to 30S
- Covers pseduo aeruginosa
Dose: 1-1.7mg/kg IM/IV q8
Side effects: ototoxicity, and nephrotoxicity
Amikacin What is it? MOA? Coverage? Doseage?
An aminoglycoside
- protein synthesis inhibitor, binds irreversibly to 30S
- reserved for organisms resistant to gentamycin and tobramycin
Dose: 7.5 mg/kg IM/IV q12h
Side effects: ototoxicity and nephrotoxicity
Penicillin G
- MOA
- Coverage
- Doseage
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
-Coverage: anaerobes, Strep, nonpenicillinase staph, nonpenicillinase gonococci
Dose: 1.2-40million units IM or IV qd
Penicllin V
- MOA
- Coverage
- Doseage
acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: anaerobes, strep, nonpenicillinase staph, and nonpenicillinase gonococci
Dose: 250-500 mg po qd
Ampicillin
- MOA
- Coverage
- Doseage
acts on penicillin binding protein to inhibit cell wall synthesis
-coverage: E.coli, P.mirabilis, Shigella , Salmonella, bacteroides, enterococci
Dose: 250-1000mg PO, IM, IV q4-6
COverage
Amoxicillin
- MOA
- Coverage
- Doseage
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: E.coli, P.mirabilis, Shigella, Salmonella, bacteroides, enterococci
Dose: 250-500mg PO TID
Dicloxacillin/Cloxacillin
- MOA
- Coverage
- Doseage
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: DOC for MSSA
Dose: 250-500mg po bid/qid oral
Nafcillin
- MOA
- Coverage
- Doseage
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: DOC for MSSA
Dose 1-2grams IV q4-q6
Oxacillin (Bactocill)
- MOA
- Coverage
- Doseage
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
- Dose: 250-500mg IV/IM q4-6
Timentin
- Makeup
- MOA
- Coverage
- Doseage
What to look out for?
Ticarcillin/clavulonic acid
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: covers pseudo
Dose: 3.1gm IV q4-6
Watch for increased NA levels
Zosyn
- Makeup
- MOA
- Coverage
- Doseage
Piperacillin/tazobactam
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Coverage: covers pseudo
Dose: 3.375-4.5 grams IV q8
Unasyn
- Makeup
- MOA
- Coverage
- Doseage
ampicillin/sulbactam
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
Indicated for polymicrobial diabetic foot infections
Dose: 1/5-3.0 grams IV q6
DOC MSSA
Augmentin
- Makeup
- MOA
- Coverage
- Doseage
amoxicillin/clavulonic acid
MOA: acts on penicillin binding protein to inhibit cell wall synthesis
COverage: gram+ and bacteroides
Dose: 875 gm oral BID
Which Penicillins are hepatically cleared (4)
Mezlocillin, Azlocillin, Nafcillin, Piperacillin
First generation Cephalosporins (3)
Cephalexin, Cefadroxil, Cefazolin
Cephalexin Brand name MOA Coverage Doseage
Keflex
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Covers: more Gram +
DOC for staph
Dose: 250mg-500mg PO BID
Cefadroxil Brand name MOA Coverage Doseage
Duricef
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: more Gram +
DOC for staph
Dose: 30mg/kg/day PO BID
Cefazolin Brand name MOA Coverage Doseage
Ancef
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: more Gram +
DOC for staph
Dose 2 grams IV prior to surgery
Second generation cephalosporins (2)
Cefaclor, and Cefuroxime
Cefaclor Brand name MOA Coverage Doseage
Ceclor
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: similar Gram + as 1st generation.
More upper resp coverage
Dose:250-500mg PO q8
Cefuroxime Brand name MOA Coverage Doseage
Ceftin
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: simmilar Gram + as 1st generation.
More upper resp coverage
Dose: 250-500mg PO BID
Third generation Cephalosporins (3)
Ceftriaxone, ceftazidime, cefdinir
Ceftriaxone Brand name MOA Coverage Doseage
Rocephin
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: less gram + than previous gen. But now more gram negative.
Empiric/ DOC for neisseria-septic joint
Dose: 1-2grams IV q day
Ceftazidime Brand name MOA Coverage Doseage
Fortaz
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis.
Coverage: less gram + than previous generations but now more gram -. COVERS PSEUDO
Dose: 1gram IV/IM BID
Cefdinir Brand name MOA Coverage Doseage
Omnicef
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: less gram + than previous generations but now more gram -.
USED BY internal med
Dose: 300mg PO BID
Fourth gen Cephalosporin
Cefepime
Cefepime Brand name MOA Coverage Doseage
Maxipime
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: Similar Gram + to 1st gen and Gram - similar to 3rd gen. INCLUDING PSEUDO
Similar coverage to zosyn
Dose: 2g IV BID
Fifth generation Cephalosporin (1)
Ceftaroline
Ceftaroline Brand name MOA Coverage Doseage
Teflaro
MOA: acts on penicillin binding proteins to inhibit cell wall synthesis
Coverage: broad spectrum similar to fourth gen and active against MRSA.
Dose: 600 mg IV BID
Ciprofloxacin Brand name MOA Coverage Doseage
What to be weary of
Cipro
MOA: inhibit bacterial DNA topoisomerase (gyrase)
Coverage: Gram-.
DOC-pseudo
Dose:250-750mg PO BID
OR 200-400mg IV BID
Be careful: active people, open growth plates, supplements will decrease absorption
Levofloxacin Brand name MOA Coverage Doseage
What to be weary of
Levaquin
MOA: inhibit bacterial DNA topoisomerase (gyrase)
Coverage: empiric antibiotic, mainly Gram-
Dose: 250-500mg PO/IV
Be careful: active people, open growth plates, supplements will decrease absorption.
Moxifloxacin Brand name MOA Coverage Doseage
What to be weary of
Avelox
MOA: inhibit bacterial DNA topoisomerase (gyrase)
Coverage: empiric oral antibiotics. Covers everything but those that are resistant. Better anaerobic coverage in diabetic foot infections.
Dose: 400mg qd PO
Be careful: active people, open growth plates, supplements will decrease absorption.
Macrolides (3)
Azithromycin, clarithromycin, erythromycin
Erythromycin
MOA
Coverage:
Doseage:
Metabolism:
MOA: inhibit protein synthesis by binding to 50 S subunit
Coverage: S.pyogenes, S.pneuomonia, S. aureus.
Chlamydia, gonorrhoeae, syphilis.
Campylobacter
Dose: 250-500mg PO BID
Max: 4g daily
Metabolized by the liver
Azithromycin
MOA
Coverage
Doseage
MOA: inhibit protein synthesis by binding to 50s subunit.
Coverage:
- S.aureus
- S.pyogenes
- Strep agalactiae
Dose:
- 500mg PO day 1
- 250mg qday 2-5
Clarithromycin
Brand name
MOA
Coverage
Doseage
Biaxin
MOA: inhibit protein synthesis by binding to the 50s subunit.
Coverage:
- Staph aureus
- S.pyogenes
- Mycoplasma, chlamydia, mycobacteria
Dose: 250mg PO BID
Tetracyclines
MOA
Coverage
Contraindications
MOA: act on 30 S subunit of bacterial ribosome inhibiting translation
Coverage: broad spectrum
active against community MRSA
Contraindicated in pregnancy
Clindamycin
Brand name
MOA:
Coverage:
Doseage
Metabolism
Cleocin
MOA: inhibits protein synthesis through 50s ribosome subunit
Coverage: most gram positives and anaerobes.
-including bacteroides fragilis
Dose:
–foot infections: 300-450mg tid PO
–osteo due to MRSA: 600mg tid po
Metabolized by liver
Metronidazole
Brand name
MOA
Coverage
Doseage
flagyl
MOA: binds to DNA and disrupts its structure
Coverage: anaerobes (gram+ and gram-)
Dose: 500mg TID PO
Trimethoprim-sulfamethoxazole
Brand name:
MOA:
Spectrum of activity:
Dosing:
Caution?
Bactrim
MOA: inhibit bacterial synthesis of THF
Spectrum of activity: aerobic G+ and G-
-DOC for community acquired MRSA
Dosing:
-TMP/SMX: 80mg/400mg or 160mg/ 800mg
Caution for people with folate deficiency
Daptomycin
Brand name :
MOA:
Spectrum of activity:
Dosing
Cubicin
MOA: depolarizes bacterial membranes, inhibits protein, DNA and RNA synthesis
Spectrum of activity: MSSA, MRSA and VRE.
DOC for MRSA infection when vanco is not allowed
Dosing:
Skin infections: 4mg/kg IV qday
Tigecycline
Brand name:
MOA:
Spectrum of activity:
Dosing:
Side effects
Tygacil
MOA: binds 30s inhibiting protein synthesis
Spectrum: very broad.
- MRSA,MRSE, PRSP, and VRE
- multi-drug resistant organisms
Dose: start at 100mg IV and 50mg IV q12h
Side effects: high seizure rates
Vancomycin
Brand name:
MOA:
Spectrum:
Dosing:
Peaks and troughs
Vancocin
MOA: binds to the building blocks (NAG and NAM) of peptidoglycan to inhibit cell wall synthesis
Spectrum:
-DOC: for MRSA
Also covers enterococcus and Strep
Dosing:
-Oral:125mg and 250mg
-IV: 1g q12 hours (slow infusion over 1 hour)
Must measure peaks and troughs with administration. (10-20mL is normal)
Red man syndrome is treated with diphenhydramine
Rifampin
Brand name:
MOA:
Spectrum
Dosing:
Common Side effects
Rifampicin
MOA: inhibition of DNA-dependent RNA polymerase leading to suppression of RNA synthesis and cell death
Spectrum:
- TB
- Endocarditis
- Hansen Disease
- Anthrex
Dosing: 300mg-600mg PO/IV
Side effects: reddening of the mucosa. As well as urine, sweat, saliva or tears
Linezolid
Brand name
MOA
Spectrum of activity
Dosing:
Zyvox
MOA: binds at the P site at the ribosomal 50S subunit
Spectrum:
- VREF
- Hospital acquired pneumonia
- endocarditis
- anthrax
Dosin: 600mg PO/IV q12 hours
Synercid
Brand name
MOA:
Spectrum of activity
Dosing
Black box:
Quinupristin/dalfopristin
MOA: synergistic
Dalfopristin: binds to the 23 S portion of the 50S ribosomal subunit to change the conformation of it. This will enhance the binding of quinupristin by 100.
Quinupristin: binds to nearby site on 50S ribosomal subunit to prevent elongation of peptide
Spectrum:
- MRSA
- VRA/VRE
Dosing: 7.5mg/kg q8h
Black box for being advanced so quickly through FDA approval.