Antibiotics Flashcards
Very Fine Proficient At Cell Murder
V - Vancomycin F - Fluoroquinolones P - Penicillin A - Aminoglycosides C - Cephalosporins M - Metronidazole
Contraindicated in pregnancy M C A T
M - Metronidazole
C - Chloramphenicol
A - Aminoglycosides
T - Tetracyclines
ABX that inhibit bacterial folate synthesis
Stop That Pholate
S
T
P
S - Sulfonamides
T - Trimethoprim
P - Pyrimethamine
ABX that inhibit bacterial Cell Wall synthesis
I’M A Vixon @ Crushing People
I’M - Imipenem/Meropenem A - Aztreonam V - Vancomycin C - Cephalosporins P - Penicillin
Bacitracin
Isoniazid
Ethambutol
ABX that inhibit bacterial protein synthesis
My Abx Could Literally Stop That Crap
M - Macrolides A - Aminoglycosides C - Chloramphenicol L - Linezolid S - Streptogramins T - Tetracyclines C - Clindamycin
30s binders
Tetracyclines
Aminoglycosides
Contraindicated in pregnancy
Safe ct
S - Sulfanomide A - Aminoglycosides F - Fluroquinolones E - Erithromycin C - Chloramphenicol T - Tetracycline
Initial resistance
When bacteria always has resistance
Developed resistance
When mutations occurs over time
Acquired resistance
When the mother cell passed on mutation to daughter cell
Vertical transmission.
Mother to child; random mutation that passed on as cell replicates
Horizontal transmission
The transfer of plasma DNA to other bacteria
Bacterial can pass on resistance to other species of bacteria through transfer of plasmids
Inhibition of DNA or RNA synthesis
Actinomycin Nucleotide Analogs Quinolone Rifampin
Inhibition of general metabolic pathway
Sulfonamides
Trimetgoprim
Adverse effects for Cephalosporins
GI upset including c.diff
Combo with alcohol : disulfiram
Allergies: cross sensitivity is 10% of those allergic to penicillin
Less crossover with higher generations
Not recommended in pts with anaphylactic reaction to penicillin
Cephalosporin contraindications
Extended half-life with renal and hepatic insufficiency
Alterations in clotting
Nephrotoxicity with renal insufficiency (decrease dose by 50% if GFR <10
Superinfection
Cephalosporin drug interactions
Probenecid Loop diuretics (increased nephrotoxicity risk)
Indication of use for Cephalosporins
Surgery prophylaxis Respiratory infection Strep, pharyngitis, sinusitis Community acquired pneumonia Skin Soft tissue Bones and joints UTI STDs
About Vanco (glycopeptide)
Narrow-spectrum against gram positive (bactericidal)
Can cause red man syndrome
Penetrates CSF
Glycopeptides (Vanco) adverse effects
Nephrotoxic
Transient ototoxicity
Hypersensitivity
Phlebitis at injection site
Pregnancy B
Glycopeptides (vanco)
Clinical indication
Second line for c.diff
Staph enterocolitis
Gram positive infections such as MRSA resistant to first line antibiotics
Synergistic when combined with Rifampin or Ceftriaxone
Penicillin/aminopenicillin sensitivity
Aminopenicillin best against gram negative GI pathogens, e.coli, salmonella, flu type B
Take on empty stomach
30m prior or 2 hours after: oral, ampicillin, cloxacillin, dicloxacillin
Penicillin/aminopenicillin indications
Acute otitis media Pharyngitis UTI (second line) STD treponema pallium PNA Augmentin H.pylori Bacterial endocarditis
Penicillin/aminopenicillin drug/drug interactions
Diuretics
Tetracyclines
Warfarin
Cephalosporin gen 1 use
Used for skin and soft tissue infections
Active against gram-positive
S.aureus and s.epidermidis
Cephalosporin gen 2
Active against s.aureus, s.epidermis, proteus, e.coli
Cephalosporin gen 3
Used for broader spectrum
More active against gram negative
Cephalosporin gen 4
Resistant to beta-lactamase
Primary active against gram positive
Glycopeptides (Vanco)
Dx/Dx interactions
Aminoglycosides - risk of ototoxicity and neurotoxicity
Cholestyramine binds Vanco - needs to be given several hours apart
About Macrolides
Reversibly binds 50s Inactivated by acid Typically bacteriostatic Cross resistance with penicillin Given to people with allergies to penicillin No beta-lactam ring
Macrolides: Erythromicin
Most important Macrolide Bactericidal at high concentrations Used for: mycoplasm, Chlamydia, upper resp infection,sinusitis, otitis, pertussis Poor CSF penetration Pregnancy B
Macrolides
Cautions and Adverse Effects and Dx/Dx interactions
Prolong QT interval Clarithromycin CCr <30mL/mob requires dosing to be cut in half Pregnancy: Clarithromycin class C Safe in lactation Safe in >6 months old child GI upset Severe explosive diarrhea Cholesteric hepatitis
Dx/Dx interactions: colochicine, warfarin,dig
1st line treatment for MRSA
Lincosamides
Lincosamide: cautions and adverse effects
Asthma or severe allergies Severe renal or liver impairment Pregnancy B, present in breast milk, used in severe childhood infections GI upset C.diff
Oxazolidinones (Zyvox)
Cautions
Pregnancy C - excreted in milk.
Approved for children at birth
Indicated for MRSA and VRE
HTN: caution with sympathomimetics, vasopressors
Dopamine adrenegics, ADD, and anti seizure drugs
SSRI, tricyclics antidepressants, buspirone, methadone, tramadol
Can’t use within 2 weeks of MAOI
Oxazolidinones (Zyvox)
Adverse drug reactions
Myelosuppression Peripheral neuropathy Serotonin Syndrome GI upset Fever
Tetracyclines bind to
30s subunits
Tetracyclines
Indications for use
Chlamydia
Mycoplasma pneumonia
Rocky Mountain spotted fever, Lyme disease, nongonococcal urethritis
Acne
Tetracyclines pharmacokinetics
No dairy, decreases absorption d/t calcium
Impaired by certain foods
Best taken on empty stomach (2 hours before/after meal)
Do not take with electrolytes
Pregnancy D - Passes into placenta and breast milk
Discoloration teeth in children under 8
Causes damage to tooth enamel
Used for acne
Penicillins
Adverse effects
Hypersensitivity Superinfection GI disturbances Maculopapular Rash (amoxicillin and mono) Changes in renal function
Lincosamide (Clindamycin)
Suppressed protein synthesis Gram positive Bacteriostatic Metabolized in liver Highly protein bound
Macrolides
Dx/Dx interactions
Statins
Theophylline, benzodiazepines, colchicine, dig, warfarin
C. Trachomatis, ureaplasma urealyticum, Lyme disease first line abx
Tetracyclines specifically doxycycline
Oxazolidinones (linzeloid)
Indications
PNA
Complicated skin infections
Vanco-resistant enterococcus
Fluoroquinolone
Pharmacokinetics
Cipro: impaired absorption with dairy
Norfloxacin: best on empty stomach
Food doesn’t affect distribution
Fluoroquinolones
Cautions
Renal dysfunction can increase 1/2 life Pre-existing QT prolongation Seizures or other CNS disorders Elderly: increased risk for tendon rupture Pregnancy C and avoid lactating mothers Not recommended in kids <18
Fluoroquinolones
Adverse effects
GI upset CNS confusion dizziness mood change Dysthymias serious side effect Can effect blood sugar Superinfection Skin Photo toxicity
Metronidazole (Flagyl)
Pharmacokinetics
100% bioavailability
Give with food
CNS and most tissues distributed
Hepatic metabolism (30-60%)
Metronidazole (Flagyl)
Cautions and adverse effects
Hx of seizures or other neuro disorders Blood dyscrasias Severe hepatic dysfunction Renal disease Pregnancy B Extreme caution with lactation
Fluoroquinolones
Dx/Dx interactions
Antacids - interfere with absorption
Can increase or decrease glucose
Can prolong QT when given in combo with Amiodarone orpace quinidine sotalol
Glucocorticoids increase risk of tendon rupture
Warfarin - increased anticoagulation
Metronidazole (Flagyl)
Uses
Trichomonas vaginal infections Giardia infections C.difficile infections Bacterial vaginosis Amebiasis dysentery H.pylori duodenal infection
Metronidazole (Flagyl)
Dx/Dx interactions
CYP450 inhibitor (cimetidine)
CYP450 inducer (phenytoin)
Warfarin
Lithium - increases lithium level
Sulfonamides
About
Don’t affect microorganisms that don’t synthesize folic acid
Inhibit bacterial synthesis of folic acid
Alternative to penicillin
Broad spectrum
95% effective against e.coli
Bacteriostatic
Pregnancy C
Skin rash and itching
Caution: G6PD deficiency bone marrow issues renal insufficiency or stones. Folate deficiency
Trimethoprim
About
Antibacterial agent that interferes with bacterial folic acid synthesis (similar to Sulfonamides) Requires increased fluid intake Readily absorbed First pass through liver Bactericidal when combined with sulfa drug <20% hepatic metabolism Used in UTI s Hyperkalemia
Nitrofurantoin
About
Inhibits protein, dna/rna and cell wall synthesis. Aerobic metabolism Good with UTI Body tissue metabolism Peripheral neuropathy
Sulfonamides
Dx/Dx interactions
Cyclosporine Methotrexate Probenicid Uricosurics Indomethacin Thiazides diuretic Warfarin
Nitrofurantoin
Dx/Dx interactions
Antichinergics
Probenicid
Trimethoprim
Dx/Dx interactions
ACE and ARBs increased risk of hyperkalemia
Phenytoin
Meds not to be used in lactation
Antineoplastics Bromocriptine Cyclophosphamide Cyclosporine Ergotamine Lithium Methotrexate Radio pharmaceuticals
Elderly ABCs: the A
Anti arrhythmic Anti anxiety Anticholinergics Anticonvulsants Antidepressants Antihistamines Antihypertensives Antipsychotics and antispasmodic
Elderly ABCs: the B
Barbituates Benzos Belladonna Blockers B-lactams
Meds of concern with elderly
Aminoglycosides
Quinolones, sulfonylureas (hypoglycemia, remind PT to eat)
Cholinesterase inhibitors (interact with P450 inhibitors)
Inotropics (dig, CNS cause dizziness and anorexia)
Tylenol and NSAIDS can cause fluid retention and GI bleeds
Diuretics work by…
Increasing urine output, decreasing fluid volume
