Antibiotics Flashcards
1
Q
cell wall synthesis inhibitors
A
PCNs CEPHALOSPORINS CARBAPENEMS VANCOMYCIN BACITRACIN POLYMYXIN
2
Q
PENICILLINS
vk - oral
g - IM/IV
A
- natural penicillins
- gram positive, gram-positive anaerobes
Ind:
STREP PARYNGITIS
ORAL/DENTAL INFX
SYPHILIS
3
Q
NAFCILLIN (IV)
DICLOXACILLIN (PO)
OXACILLIN (IV)
A
- penicillinase-resistant “anti-stapholococcus”
- gram positive, designed PRIMARILY VS B-LACTAMASE PRODUCING STAPHYLOCOCCUS
Ind:
STAPHYLOCOCCAL SKIN/SOFT TISSUE INFX
ONLY PCNs EFFECTIVE VS. B-LACTAMASE BACTERIA ON OWN
4
Q
AMOXICILLIN (PO)
AMPICILLIN (PO, IM, IV)
A
- amino penicillins
- gram positive and negative coverage
Ind: UTI IN PREGNANCY AOM ACTIVE VS ENTEROCOCCUS H.FLU E.COLI LISTERIA GBS SALMONELLA PROTEUS
5
Q
AUGMENTIN (AMOXICILLIN + CLAVULANATE)
UNASYN (AMPICILLIN + SULBACTAM)
A
- amino-penicillins w/ B-lactamase inhibitor
- ENHANCED COVERAGE INCLUDING B-LACTAMASE producing m. catarrhalis, h.influ, e.coli, b.fragilis, anaerobes
Augmentin Ind: AOM SINUSISITUS ABECB DENTAL INFX BITE WOUNDS
Unasyn Ind:
SKIN/SOFT TISSUE INFX
INTRABDOMINAL/PERIONITIS
6
Q
ZOSYN (PIPERACILLIN / TAZOBACTAM IV)
TIMENTIN (TICARCILLIN / CLAVULANATE IV)
CARBENICILLIN (PO)
A
- ANTI-PSEUDOMONAL PCNs
- BROADEST SPECTRUM PCNs
7
Q
CEFALEXIN (KEFLEX) - PO
CEFAZOLIN (ANCEF) - IV
CEFADROXIL (DURICEF) - PO
A
1ST GEN - SKIN/SOFT TISSUE
-gram-positive cocci (including B-lactamase), anaerobes
Ind:
SKIN/SOFT TISSUE INFX (STAPH/STREP)
SURGICAL PROPHYLAXIS
8
Q
CEFACLOR (CECLOR)
CEFUROXIME (EFTIN PO or ZINACEF IV, IM)
CEFOXITIN - IV
CEFOTETAN
A
2ND GEN - SKIN, RESPIRATORY/ENT, UTI ANAEROBES
-increasing level of gram-negative activity and loss of gram-positive as you go from 1st to 4th gen
Ind: AOM PNEUMONIA UTI ABDOMINAL INFX (ANAEROBES) SKIN/SOFT TISSUE
CEFUROXIME: ACUTE EPIGLOTITIS, EARLY LYMES DZ
9
Q
CEFTRIAXONE (ROCEPHIN) - IM/IV CEFTAZIDIME CEFIBUTEN CEFOTAXIME CEFIXIME
A
3RD GEN - PNA, CNS, GRAM NEGATIVE, BROAD SPECT
Ind:
MENINGITIS (GOOD CNS PENETRATION)
GONORRHEA
CAP (HOSPITALIZED)
-CEFTAZIDIME COVERAGE VS PSEUDOMONAS
10
Q
IMIPENEM - IV
MEROPENEM - IV
A
CARBAPENEMS
- BROADEST SPECTRUM OF ALL ABX!
- cilastatin added to imipenem to reduce renal clearance of imipenem
SE: ASSOC W/ LOWERING OF SEIZURE THRESHOLD
11
Q
AZTREONAM - IV
A
MONOBACTAM
- GRAM-NEGATIVE AEROBES ONLY, INC PSEUDOMONAS
- beta lactam w/ no cross reactivity with other beta lactams
SE: GI UPSET, VERTIGO
12
Q
VANCOMYCIN
A
- GRAM POS ONLY
- inhibits phospholipids/PEPTIDOGLYCANS
Ind:
IV: MRSA, MRSE
PO: C.DIFF (not absorbed)
13
Q
BACITRACIN
A
- GRAM POS
- little effect vs. anaerobes or gram neg
NEPHROTOXIC SO PRIMARILY USED AS TOPICAL
14
Q
POLYMYXIN
A
- GRAM NEGATIVE
- disrupt cell membrane and outer membrane permeability of gram negatives
IM/IV PREPARATIONS ARE NEPHROTOXIC AND NEUROTOXIC –> TOPICAL, OPHTHALMIC & OTIC FORMS
15
Q
protein synthesis inhibitors
A
MACROLIDES TETRACYCLINES CLINDAMYCIN (LINCOSAMIDE) AMINOGLYCOSIDES LINEZOLID CHLORAMPHENICOL
16
Q
MACROLIDES (GENERAL)
A
-bind to 50S ribosomal unit
- SE: GI & MANY DRUG-DRUG INTERACTIONS, ESP ERYTHRO (CYP P450 INHIB); caution w/ pt taking warfarin, theophylline, carbamazepine (may increase levels)
- CAUTION IF PT ON NIACIN OR STATINS (INC MUSCLE TOXICITY)
- PROLONGED QT INTERVAL
17
Q
ERYTHROMYCIN (MACROLIDE)
A
- good gram-negative and gram-positive (strep/staph)
- atypicals: MYCOPLASMA, LEGIONELLA, CHLAMYDOPHILA
Ind: STREP THROAT (IF PCN ALLERGIC) CAP TOPICAL FOR ACNE SAFE IN PREGNANCY
SE: POOR GI TOLERANCE
18
Q
AZITHROMYCIN (MACROLIDE)
A
- same as erythro, also: H.FLU, MORAXELLA
- BEST ATYPICAL COVERAGE (MYCOPLASMA, CHLAMYDIA, LEGIONELLA)
Ind: CAP ABECB 1ST TIME 1g DOSE CHLAMYDIA ANTI-INFLAMMATORY IN LUNG
19
Q
CLARITHROMYCIN (MARCROLIDE)
A
-same as azithro
Ind: CAP LEGIONELLA H.PYLORI SINUSITIS, BRONCHITIS, ABECB
20
Q
TETRACYCLINES (GENERAL)
A
- bind to 30S ribosomal subunit (bactericidal)
- GOOD VS GRAM-POS AND GRAM-NEG, INTRACELLULAR ORGANISMS
- SE: GI disturbances, PHOTOSENSITIVITY, DENTAL STAINING
- NOT USED IN CHILDREN <8y OR IN PREGNANCY, HEPATOTOXIC
- DON’T GIVE W/ DAIRY PRODUCTS (Ca, Mg, Al, Fe)
- safe w/ renal failure
21
Q
DOXYCYCLINE (TETRACYCLINE)
A
Ind: CHLAMYDIA Q-FEVER BUBONIC PLAGUE CAT SCRATCH FEVER RMSF LYME DISEASE PID
22
Q
TETRACYCLINE ((TETRACYCLINE)
A
Ind: ACNE
23
Q
MINOCYCLINE (TETRACYCLINE)
A
Ind: ACNE
24
Q
CLINDAMYCIN
A
- covers GRAM-POS
- MOST ANAEROBES ABOVE DIAPHRAGM (little gram-neg)
SE: MAY CAUSE C. DIFF!!!
25
AMINOGLYCOSIDES (GENERAL)
- bind to 30S ribosomal subunit (bactericidal)
- GRAM-NEG AEROBES ONLY!
- not good CNS penetration
- commonly used w/ PCN for broad empiric coverage (synergism allows for AG gram-pos activity)
SE: OTOTOXIC & NEPHROTOXIC; hearing loss usually irreversible, tinnitus, vertigo, ataxia
26
GENTAMICIN (AMINOGLYCOSIDE)
-GRAM NEG INCLUDING PSEUDOMONAS
```
Ind:
USED W/ AMPICILLIN IN NEONATAL MENINGITIS
SEPTIC SHOCK
PYELO & COMPLICATED UTI
ENDOCARDIDITS (ENTEROCOCCUS)
YERSINIA
TULAREMIA
```
27
TOBRAMYCIN (AMINOGLYCOSIDE)
-slightly inc activity w/ PSEUDOMONAS
Ind:
TOPICAL (ERATITIS)
NOSOCOMIAL PNEUMONIA (GIVEN W/ 3RD GEN CEPH)
28
NEOMYCIN (AMINOGLYCOSIDE)
-GRAM NEG INCLUDING PSEUDOMONAS
Ind:
BOWEL PREP
PART OF NEOSPORIN & CORTISPORIN
OTITIS EXTERNA (but not if TM isn't visualized/rupture)
29
AMIKACIN (AMINOGLYCOSIDE)
-PSEUDOMONAS, ACINETOBACTER, SERRATIA
RESTRICTED USE BY CDC (RESERVED FOR BAD INFX)
30
STREPTOMYCIN (AMINOGLYCOSIDE)
Ind:
TUBERCULOSIS
TULAREMIA
YERSINIA PESTIS
31
LINEZOLID
moa: inhibits protein synthesis (50S ribosomal unit)
- GRAM-POS ONLY: MRSA, VRE, ENTEROCOCCUS FAECIUM AND FAECALIS
* BEST PO COVERAGE AGAINST MRSA
- also covers atypicals: mycoplasma, chlamydophila, legionella
SE: N/V/D, headache thrombocytopenia, MAO inhibition
32
CHLORAMPHENICOL
- moa: inhibits protein synthesis (50S ribosomal unit)
- BROAD SPECTRUM
- usually indicated w/ severe anaerobic infx or unresponsive life-threatening infx
- GOOD CSF PENETRATION
SE: BONE MARROW SUPPRESSION (reversible anemia, hemolytic anemia, aplastic anemia)
-GRAY BABY SYNDROME!!
33
DNA or RNA synthesis inhibitors
FLUOROQUINOLONES
METRONIDAZOLE
DAPTOMYCIN
34
FLUOROQUINOLONES (GENERAL)
-moa: inhibits DNA gyrase (bactericidal)
C/I: PREGNANT FEMALES, <18yo (INTERFERES W/ CARTILAGE)
35
CIPROFLOXACIN (CIPRO)
- BEST GRAM-NEG COVERAGE OF ALL FQ (ENTERIC ORGANISMS, H.flu, Neisseria, Campylobacter)
- EXCELLENT FOR PSEUDOMONAS
- NOT ACTIVE VS S.PNEUMO
```
Ind:
UTI, PYELONEPHRITIS
GASTROENTERITIS
PID
malignant OE, sinusitis
gonococcal arthritis
```
36
NORFLOXACIN (NORFLOX)
| LEVOFLOXACIN (LEVAQUIN)
- better activity vs. gram-positive
- RESPIRATORY FQ - USED FOR CAP
Ind:
CAP
uti, pyelonephritis
gonococcal, gastroenteritis
37
MOXIFLOXACIN (AVELOX)
-BEST GRAM-POSITIVE, ANAEROBIC & ATYPICAL OF FQs
```
Ind:
respiratory: CAP, bronchitis, sinusitis
intrabdominal infx
ophthalmic
skin infx
```
38
OFLOXACIN (FLOXIN)
Gatifloxacin (Tequin)
Lomefloxacin (Maxaquin)
-newer fq, advanced coverage of staph aureus, epidermis, saprophyticus + strep pneumo
Ind: similar to moxi
CAP
ABECB
39
METRONIDAZOLE (FLAGYL)
moa: inhibits DNA synthesis
EFFECTIVE ONLY VS:
-ANAEROBES: B. FRAGILIS, C.DIFF
-PROTOZOA: ENTAMOEBA HISTOLYTIA, GIARDIA LAMBLIA, TRICHOMONADS
```
Ind:
INTRAABDOMINAL
VAGINITIS
PSEUDOMEMBRANOUS COLITIS
AMOEBIC LIVER ABSCESS
```
- DISULFIRAM-LIKE RX IF USED W/ ETOH, NEUROTOXIC
- approved for 1st trimester pregnancy
40
DAPTOMYCIN
-moa: binds + depolarizes bacterial membranes, causing inhibition of protein, DNA and RNA synthesis
- GRAM-POSITIVE ONLY: MRSA, VRE, ENTEROCOCCUS FAECIUM + FAECALIS
- inactivated by surfactant so not used in pneumonia
Ind:
COMPLICATED SKIN INFX
SE: MUSCLE TOXICITY, GI, arthralgias
41
inhibitors of essential metabolites
TRIMETHOPRIM / SULFAMETHOXAZOLE (BACTRIM)
| NITROFURANTOIN
42
TRIMETHOPRIM / SULFAMETHOXAZOLE (BACTRIM)
- EFFECTIVE VS GRAM-NEG, STAPH
* 2ND BEST PO AGAINST MRSA
Ind:
UTI
AOM
ABECB
-AVOID IN PREGNANCY + INFANTS - INHIBITS FOLIC ACID SYNTHESIS
SE: GI upset, hepatitis, leukopenia, thrombocytopenia, SJS, hemolysis if G6PD deficiency
43
NITROFURANTOIN
- moa: excreted in urine, where active metabolites attack multiple bacterial sites
- gram-positives, gram-negatives, enterococcus
Ind:
CYSTITIS (not pyelo)
SE: HYPERSENSITIVITY PNEUMONITIS, CHRONIC PULMONARY FIBROSIS
SAFE IN PREGNANCY (except at term)
44
QUINUPRISTIN / DALFOPRISTIN (SYNERCID)
- MOA: STREPTOGRAMIN CLASS - binds 50S subunit to inhibit protein synthesis; bacteriostatic (cidal to some)
- GRAM POSITIVE; MRSA, VRSA
- covers vanc-resistant enterococcus faecium only
- atypicals: mycoplasma + legionella
SE: THROMBOPHLEBITIS (so only given through central line)
45
AMPHOTERICIN B
POLYENE ANTIFUNGALS
-moa: bind to cell membrane sterols (inc permeability/fragility of cell membrane)
Ind:
ANTIFUNGAL OF CHOICE FOR MOST INVASIVE OR LIFE-THREATENING FUNGAL INFX
SE: FEVER/CHILLS DURING INFUSION, HYPOK + MG, NEPHROTOCICITY, hematoxicity, inc BUN/Cr, arrhythmia
*Lipid-based Ampho B: higher tissue concentrations, dec infusion rx, DECREASED NEPHROTOXIC BUT $$$
46
NYSTATIN
POLYENE ANTIFUNGALS
- moa: bind to cell membrane sterols (inc permeability/fragility of cell membrane)
- poor bioavailability
Ind:
ORAL CANDIDIASIS - TOPICAL
topically for vaginal candida
47
"azoles" general
moa: INHIBITIS ERGOSTEROL SYNTHESIS (essential for fungal cell memb stability)
Indications: CANDIDIASIS, CRYPTOCOCCUS, HISTOPLASMOSIS, COCCIDIOIDOMYCOSIS, TINEA
```
Imidazoles:
Clotrimazole (Lotrimin)
Ketoconazole (Nizoral)
Econazole
Miconazole
```
```
Triazoles:
Fluconazole (Diflucan)
Itraconazole
Voriconazole
Posaconazole
```
48
FLUCONAZOLE
DOC:
NONINVASIVE CANDIDA
CRYPTOCOCCAL INFX
-GOOD FOR URINE & CSF INFX (water soluble)
SE: HEPATITIS, nausea, rash, alopecia, headache
49
VORICONAZOLE
-extended-spectrum --> covers ASPERGILLUS
DOC:
ASPERGILLUS
50
ITRACONAZOLE
- extended-spectrum --> covers ASPERGILLUS
- lipid-soluble, poor CSF penetration, inhibits CP450
DOC:
NONINVASIVE HISTOPLASMOSIS, BLASTOMYCOSIS, COCCIDIODOMYCOSIS
SE: may cause CHF
51
KETOCONAZOLE
-lipid-soluble, poor CSF penetration, inhibits CP450
SE: SUPPRESSION OF TT & CORTISOL (used to tx refractory Cushing's), inc LFTs
52
TERBINAFINE (LAMISIL)
| BUTENAFINE (MENTAX)
ALLYLAMINES
-moa: inhibits ergosterol synthesis (by inhibiting squalene epoxidase)
Ind:
DERMATOPHYTE INFX
-ONYCHOMYCOSIS --> Terbinafine PO
-TINEA (corporis, pedis, cruris)--> Terbinafine or Butenafine topical
53
GRISEOFULVIN
- moa: inhibits fungal cell mitosis preventing proliferation and function
- GIVE W/ FATTY MEALS to increase absorption
Ind:
TINEA (CAPITUS, cruris, pedis, unguium
SE: HEPATITIS, TERATOGENIC (males too - avoid conceiving for 6mo after tx)
54
CASPOFUNGIN
ANIDULAFUNGIN
MICAFUNGIN
-moa: inhibits cell wall glucan synthesis
ONLY IV --> $$$
Ind:
AZOLE- + AMPHO B-RESISTANT ASPERGILLUS + CANDIDIASIS
SE: fever, thrombophlebitis, headache, inc LFTs, rash, flushing
