Antibiotics/Antivirals/Antifungals Flashcards
B-Lactams (class)
Inhibit cell wall synthesis
BACTERICIDAL
Synergist with aminoglycosides
Ex. Penicillins, cephalosporins, carbapenems, monobactams
Categories of Antibiotics (5)
B-Lactams (inhibit cell wall synthesis) BACTERICIDAL
Aminoglycosides (Inhibit RNA translation/destabilize cell wall) BACTERICIDAL
Tertracyclines (Inhibit RNA attachment to acceptor site) BACTERIOSTATIC
Macrolides (Dissociation of RNA from ribosome during elongation) BACTERIOSTATIC
Quinolones (Inhibit DNA synthesis)
BACTERICIDAL
Penicillins (B-Lactam)
End in “cillin”
Commonly used against P. aeruginosa, enterobacteriaceae, S. aureus
Hypersensitivity most common side effect
Cephalosporins (B-Lactam)
First generation- gram positive
Second generation- gram positive and some negative
Third generation- most gram negative
Fourth generation- extended negative and positive coverage (clinical)
NO ALCOHOL
Ex. Cefotetan, cefoperazone
Carbapenems (B-Lactam)
Broad spectrum antibiotic for gram negative and positive AND anaerobic bacterias like P. aeruginosa, MRSA, community and nosocomial pneumonias
Can cause seizures in patients with renal dysfunction
Ex. Imipenem-cilastatin (Primaxin), Meropenem, Entrapenem, Doripenem)
Monobactams (L-Bactam) aka Aztreonam (aerosolized)
Gram negative aerobic bacilli like Enterobacteriacae and P. aeruginosa
Rare rash as side effect
Aerosolized to treat pulmonary infections in CF, improves symptoms in CF patients with colonized P. aeruginosa, NOT indicated for children under 7.
2ml(75mg) vial mixed with 1mL sterile diluent
Pretreat w/ bronchodilator, TID 28days on/off, refrigerate
Side effects include bronchospasm and decrease in FEV1
Aminoglycosides (class)
BACTERICIDAL
Inhibit RNA translation, cell wall destabilization
Used clinically for gram negative nosocomial infections like Vent. associated pneumonia
Ototoxicity, nephrotoxicity
Ex. Gentamicin, Tobramycin (aerosolized), Netilmicin, amikacin
Tobramycin (aerosolized aminoglycoside)
Pulmonary infections in CF, to treat or prevent colonization with P. aeruginosa and to maintain current lung function or reduce rate of deterioration.
Dose; 300mgBID, 28days on/off
Administered with PARI LC Plus
(IV route) Ototoxicity, nephrotoxicity, NM blockade
Tinnitus and voice alteration (SVN)
Tetracyclines (class)
BACTERIOSTATIC
Inhibit attachment of RNA to acceptor site
Broad spectrum gram positive and negative
Used against rickettsiae, chlamydiae, mycoplasmas, spirochetes, PROTOZOA (first line), mycobacteria.
Contraindicated in pregnancy and breastfeeding mothers, and children under 8. Rare nausea, vomiting, diarrhea.
Tigecycline (Tetracycline)
BACTERIOSTATIC
Inhibits protein synthesis, even against tetracycline resistant organisms, bactericidal against S. pneumoniae
Used for complicated skin and intraabdominal infections
Macrolides (class)
BACTERIOSTATIC
Induce dissociation of RNA from ribosome during elongation
Clinical uses include rickettsiae, chlamydia (in pregnant women), mycoplasmas, LEGIONELLA
May increase concentration of drugs like Theophylline, Warfarin, Triazolam
Ex. Erythromycin, clarithromycin, azithromycin
Telithromycin (Macrolide)
Inhibits bacterial protein synthesis
Used for sinusitis and community acquired pneumonia
Adverse rxns; nausea, diarrhea, visual disturbances, prolonged Q-T interval
Quinolones (class)
aka Fluoroquinolones
BACTERICIDAL
Inhibit DNA synthesis
Used for upper/lower respiratory infections, GI infections, skin infections
Side effects, one of the safest, maybe GI issues, prolonged Q-T
Ex. Levofloxacin, Moxifloxacin (-xacin)…
TMP-SMX (specific)
BACTERIOSTATIC
blocks enzymes needed by bacteria
First-line drug for PCP
Clindamycin (specific)
BACTERIOSTATIC
Inhibits protein synthesis
Used against gram positive and anaerobic bacteria, MRSA
Metronidazole (specific)
BACTERICIDAL
Unknown mechanism
Used for anaerobic infections (C. difficile)
side effects include metallic taste, vomiting, peripheral neuropathy (long-term)
Vancomycin (specific)
Prevents formation of cell wall
BACTERICIDAL against gram positive
BACTERIOSTATIC against enterococci
Used against MRSA, oral for C. difficile
Side effects include ototoxicity, nephrotoxicity
Quinupristin and Dalfopristin (specific)
Usually last treatment option because of side-effects
Inhibit protein synthesis
BACTERICIDAL against MRSA
BACTERIOSTATIC against VREF
Linezolid (specific)
Prevents RNA translation
Used against VREF (last choice for treatment)
Antimycobacterials
Used against mycobacterium tuberculosis (TB)
multiple antibiotic regiments for 6-12 months
4 drugs used in combination and a fifth added if need
First 4; Isonazid, Rifampin and Rifabutin, Pyrazinamide (first three BACTERICIDAL), Ethambutal (BACTERIOSTATIC)
Isoniazid (antimycobacterial, TB)
Inhibits cell wall synthesis, BACTERICIDAL
Hepatotoxicity, neurotoxicity
Rifampin and Rifabutin (antimycobaterial, TB)
Inhibit ENA polymerase, BACTERICIDAL
Hepatotoxicity, Fever, chills, nausea, vomiting
Pyrazinamide (antimycobacterial, TB)
Unknown mechanism, BACTERICIDAL
Hapatotoxicity, nausea vomiting
Ethambutol (antimycobacterial, TB)
BACTERIOSTATIC, decreases cell wall polysaccharides
Optic-neuropathy side effect
Streptomycin (antimycobacterial, TB)
Added fifth drug if needed, similar to aminoglycosides
Nephrotoxicity, ototoxicity
Antifungal Agents
Polyenes, Azoles, Echinocandins, “OTHER”
Polyenes (amphotericin B and nystatin) (antifungal)
Fungicidal
Used against Aspergillosis (can digest lung tissue)
Severe adverse reactions may include flushing, fever, chills, renal impairment
Least safe of antifungals
Azoles (antifungal)
Fungistatic against Candidiasis
Safest of the antifungals
Echinocandins
Fungicidal or fungistatic depending on isolate
Used against Candida and Aspergillus
Reactions include fever, rash, flushing, thrombophlebitis
2nd safest antifungal
1st choice in patients with kidney dysfunction
Flucytosine (“other” antifungal)
Inhibits fungal RNA formation
Fungistatic against Candida, Cryptococcus (only drug for treating this), Aspergillus
Adverse rxns, bone marrow supression
Griseofluvin and Terbinafine (“other” antifungal)
Used for fungal infections of skin, hair, nails
Antiviral agents
Acyclovir (HSV, HZV, VZV) and Valacyclovir
Gangciclovir (CMV) and Valganciclovir
Oseltamivir
Acyclovir and Valacyclovir (Antiviral)
Terminate viral replication
Used for HSV, EBV, Cytomegalovirus (CMV), VZV
Ganciclovir and valgangciclovir (antiviral)
Terminates viral DNA synthesis/replication
Used for HSV, VZV, CMV
Bone marrow supression
Oseltamivir (antiviral)
Inhibits Influenza A and B, prevents virus from leaving host cell
Used to treat Influenza A and B
Nausea and vomiting may occur in first days of therapy.
Aerosolized Antiinfective agents
Pentamidine, Ribavirin, Tobramycin, Aztreonam, Zanamivir
Pentamidine (antiinfective)
Prevention of PCP and immunodeficient patients
Second line treatment for patients who could not tolerate oral TMP-SMX (1st line)
Brand name NebuPent, given 300mg inhalation once every 4 weeks, reconstituted in 6ml sterile water NOT SALINE.
Administered only with Respirgard II (5-7 L/min, 1-2MMAD)
Blocks RNA and DNA synthesis, inhibits oxidative phosphorylation
Ribavirin (antiinfective)
Treatment of infants with severe lower respiratory tract infection caused by respiratory syncytial virus (RSV)
NOT recommended for routine RSV infection
20mg/mL delivered 12-18hrs/day for 3-7 days only with a SPAG-2 (1.3MMAD)
Tobramycin (antiinfective)
Management of chronic P. aeruginosa in CF
300mgBID, 28days on/off
Given with PARI LC Plus
Aztreonam (antiinfective)
Used for pulmonary infections in CF patients to improve symptoms in P. aeruginosa. Delivered with Altera Nebulizer system
TID for 28 days off/on
Zanamivir (antiinfective)
Treatment of uncomplicated influenza in adults/children over 5.
Off label treatment of H1N1 influenza A
DPI (Diskhaler) 2 blisters, 2x’s a day for 5 days.
