antibiotics mod 2 Flashcards
Beta-Lactamase inhibitor combinations
Ampicillin-sulbactam
Amoxicillin-clavulanic acid (Augmentin)
Ticarcillin-clavulanic acid (Timentin)
Piperacillin-tazobactam (Zosyn)
Ceftazidime-avibactam (Avycaz)
penicillin
MOA:
- Disrupt the synthesis of the cell wall
- Bacteria must be growing and dividing
- Inhibit transpeptidases
- —Essential for cell wall synthesis
- Activates autolysis
Works against many different organisms
Low toxicity
Adverse effects: urticaria, pruritis, angioedema
penicillin: uses and SE/AE
Different Types of PCNS
Natural Penicillins:
- PCN G & PCN V
Penicillinase-Resistant Penicillins:
- nafcillin
Aminopenicillins:
- amoxicillin & ampicillin
Extended-Spectrum Penicillins:
- Piperacillin
Natural pcns:
penicillin g& V
Indications: Gram +, gram – cocci, anaerobic bacteria, spirochetes
Can be used with aminoglycosides
- gets into the cell and disrupts protein synthesis
½ life about 30 minutes (unless kidney dysfunction)
Least toxic
SE:
Rash to anaphylaxis allergy to 1 PCN, allergy to ALL
Usually given IV/IM (PO forms available)
Penicillanse resistant PCNs:
nafcillin (iv)
Nafcillin is the drug of choice for this class of PCNs
Nafcillin is IV only
Cloxacillin & oxacillin are the oral formulations
Resist breakdown by the penicillanse enzyme
Aminopenicillins:
ampicillin (Augmentin) & amoxicillin
ampicillin (Augmentin)
- 1st broad spectrum
AE: Diarrhea and rash
Given PO or IV
If oral, amoxicillin usually better option
Renal sensitive
ampicillin/sulbactam (Unasyn)
amoxicillin
- Indications: Common for ear, nose, throat, genitourinary and skin infections
- Less SE compared to ampicillin
- Very common in pediatric patients
- Doses are sometimes higher because of strep resistant organisms
- ONLY PO
Extended-spectrum:
piperacillin (Zosyn)
liver and renal function monitor
Wider spectrum than other penicillins
Both ticarcillin & piperacillin ALWAYS given with a beta-lactamase inhibitor
Anti-pseudomonal
Ticarcillin unique side effect: sodium overload & interferes with platelet function
Piperacillin very good for pseudomonas infection
Also affects platelet function
Watch for patients with renal dysfunction
Cephalosporins
1-5 generations
bacterial infections, bacterial cell wall
NO ETOH
Structurally similar to PCNs
Inhibit cell wall synthesis through same penicillin-binding protein - activate autolysis
Often resistant to beta-lactamase - cephalosprinase
Low-toxicity
Some cross-sensitivity with PCN allergy
Avoid if PCN anaphylaxis
5 generations:
Increase the spectrum/activity/and ability to penetrate CSF
Cephalosporins
Most common adverse effects of all: mild diarrhea, abdominal cramps, rash, pruritis, redness, edema
ok for pregnancy
same indications as PCN
1st generation cephalosporin:
cefazolin & cephalexin (Keflex)
Works well for gram + bacteria
Staph and non-enterococcal strep infections
Given PO or IV
Cefazolin is only IV
Cefazolin common for surgical prophylaxis
**no BBB crossing
2nd generation: cephalosporin
cefuroxime& cefotetan
More gram – coverage AND the gram + coverage
IV and PO forms available
Cefuroxime does not kill anerobic bacteria
No BBB or pseudomonas
3rd generation: cephalosporins
ceftriaxone
ceftazidime
Cefotaxine
NO LIVER
Most potent in fighting gram – bacteria BUT much less activity against gram +
These 2 drugs are IV/IM only
Ceftriaxone is EXTREMELY long-acting (once per day dosing benefit)
BBB - effective in treating meningitis and other infections within the CNS
NO LIVER FAILURE
Ceftazidime works well for pseudomonas
4th generation: cephalosporin
cefepime
Works against gram - & + (very broad spectrum)
Uncomplicated/complicated UTIs, skin infections and pneumonia
Also crosses the BBB
5th generation: cephalosporins
ceftaroline
Treats MRSA and MSSA works again some VRSA/VISA
***No Enterobacter, Pseudomonas, ESBL, Klebsiella coverage
Needs to be renally dosed
Only IV form
Ceftolozane/tazobactam (Zerbaxa) NEWEST cephalosporin
Treats complicated infections
Carbapenems
imipenem/cilastin (Primaxin)
meropenem
**potential seizure activity infused over 60 mins
BROADEST spectrum of ALL antibiotics
Bactericidal & cell wall inhibitor (same as previous two classes)
Typically used as a ‘last resort’ medication
Biggest AE: drug-induced seizure activity (not super common)
ALL are IV and must be INFUSED OVER 60 MINUTES
carbapenems
Imipenem/cilastin (primaxin)
what for seizures
Combo of the carbapenem with an inhibitor of enzyme that breaks down imipenem
MOST broad spectrum
Binds to penicillin-binding proteins
VERY RESISTANT TO BETA-LACTAMASE
IV administration only
Can penetrate BBB and meninges
WATCH FOR SEIZURES especially in elderly and with other meds that can induce seizures
Used for complicated infections
carbapenems:
meropenem
A little less coverage than imipenem; but still gram + and – aerobes and anaerobes
Doesn’t degrade in kidneys
Less seizure activity
Rash and diarrhea most common side effects
Ertapenem- less spectrum; but only have to give once a day
Doripenem- newest; less seizure activity; NOT FOR PNEUMONIA
carbapenems
imipenem/cilastin (Primaxin)
meropenem
Imipenem/cilastin (primaxin)
Meropenem
Vancomycin
gram + ; no BBB; kidney dosing
Glycopeptide antibiotic
Destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
Works on gram + infections - including MRSA and PCN resistant pneumococcus
Oral vancomycin is given to treat clostridium difficile and pseudomembranous colitis
Doesn’t work for CNS infections
Kidneys eliminate drug; decrease doses for renal dysfunction
Aminoglycosides Lincosamides: clindamycin Macrolides Oxazolindinones Streptogramins Tetracyclines Glycylcycline Fluoroquinolones Cycliclipopeptides Sulfonamides Metronidazole
All of these Drugs Work by Inhibiting/Altering Protein Synthesis: transcription - Nucleus - Messenger RNA - Cytoplasm
translation
- Cytoplasm
- Ribosomes
- mRNA
- Add amino acids
- —-In a specific sequence
- Protein synthesis
Aminoglycosides:
gentamycin
amikacin
tobramycin
gram - and + with combo therapy
Potent antibiotics that work well on gram (–) bacteria
Also work on gram + but need other anti-biotics for synergistic effect
UTIs/pyelonephritis, gynecological infections, peritonitis, endocarditis, PNA, osteomyelitis (DM related infections)
Severe side effect profile:
Nephrotoxicity- 5-25%, usually reversible
Ototoxicity- 3-14%, usually permanent
Therapeutic drug monitoring - peak/trough levels
Transitioned from 3x/day dosing to 1x/day dosing
abx classes
class
abx moa
gram coverage
