Antimicrobial Drugs Flashcards
Penicillins
Naturally occurring molds
Penicillins MOA
Disrupt synthesis of cell wall in bacteria that are growing and dividing- inhibit transpeptidases and activates autolysis
Penicillins indication
Many different organisms, outpatient settings (low toxicity); UTIs, STIs, sepsis, meningitis, pneumonia; gram +
PCNs adverse reactions
Low toxicity, but urticaria (rash often on kids), pruritus, angioedema (life-threatening allergy)
PCNs NC
- Want to culture first
- Drug interactions; NSAIDs, oral contraceptives, Warfarin
PCN G and PCN V classification and indication
Natural penicillins mostly for gram + bacteria and STDs
PCN G and PCN V adverse reactions and NC
Least toxic, rash to anaphylaxis
- 30 minute half-life
- can be used with aminoglycosides to disrupt protein synthesis
- often IV/IM, PO can be used
nafcillin classification
PCNase-resistant PCNs
nafcillin indications
Staph bacteria
nafcillin NC
- IV only
- good for bacteria that created penicillinase
Amoxicillin and ampicillin class
AminoPCNs
Amoxicillin and ampicillin indications
Ear, nose, throat, GU, skin infections (amoxicillin), gram -
Amoxicillin and ampicillin SE and NC
Diarrhea and rash (ampicillin), amoxicillin has fewer SE
- both combined with beta lactam bac
- ampicillin PO or IV
- amoxicillin only PO
Piperacillin (Zosyn) classification
Extended-spectrum PCNs
Piperacillin (Zosyn) indications
Pseudomonas infection
Piperacillin (Zosyn) SE and NC
Affect platelet function and renal dysfunction
- widest spectrum
- always given with beta lactamase inhibitor
Cephalosporins MOA
Inhibit cell wall synthesis through same PCN binding protein and autolysis
Cephalosporins indications
Broad coverage; often resistant to beta-lactamase bc bac secrete cephalosprinase, pregnancy
Cephalosporins SE and NC
Low toxicity, avoid if PCN anaphylaxis; mild diarrhea, ab cramps, RASH, pruritus, edema
- some cross-sensitivity with PCN allergy
- poor oral absorption
Cefazolin and cephalexin class and indications
Gram +, staph, NOT enterococca strep or CNS (can’t penetrate CSF), cefazolin surgical prophylaxis
Cefazolin and cephalexin NC
- cefazolin IV only
- Cephalexin both
Cefuroxime and cefotetan classification
2nd gen cephalosporins
Cefuroxime and cefotetan indications
Gram - and Gram +, NOT anaerobic bac
Cefuroxime and cefotetan NCs
IV and PO available
Cefriaxone, ceftazidime, cefotaxime classification
3rd gen cephalosporins
Ceftriaxone, ceftazidime, cefotaxime indication
Fights gram -, gram + only a little, CNS patients, pseudomonas (ceftazadine)
Ceftriaxone, ceftazidime, cefotaxime NCs
- IV/IM
- NO liver failure
- Ceftriaxone—very long lasting
Cefepine class and indications
Grame - and +, very broad spectrum; UTIs, skin infections, pneumonias; crosses BBB
Ceftaroline, Ceftazolone classification and indications
5th gen cephalosporins; MRSA, MSSA, some VRSA/VISA
Ceftaroline, Ceftazolone NCs
- only IV
- must be renally dosed; monitor kidney levels
Carbapenems MOA and indication
Imipenem/cilastin and meropenem; Bactericidal and cell wall inhibitor; broadest spectrum
Carbapenems SE and NC
Drug-induced seizure (not super common)
- Last resort med
- IV
- infused over 60 minutes
- carbapenem-resistant bacterias are VERY deadly
imipenem/cilastin indication
Most broad spectrum, can penetrate BBB and meninges, complicated infections
imipenem/cilastin SE and NCs
seizures (esp in elderly and combined with other meds)
- combo of carbapenem with beta lactam inhibitor
- needs cilastin bc stops an enzyme that otherwise degrades imipenem in the kidneys
Meropenem indications and SE
Pretty broad spectrum , gram + and - aerobes and anaerobes; less seizure activity, rash, and diarrhea
Vancomycin class and MOA
Glycopeptide antibiotics; Work on cell wall, causes immediate cell wall death, but not by autolysis
Vancomycin indications
Gram + (MRSA, PCN-resistant drugs), c.diff and pseudomembranous colitis (oral)
Vancomycin SE
Ototoxicity with high levels (reversible), immune-mediated thrombocytopenia, nephrotoxic, red man syndrome (related to giving it fast) - flush, rash, pruritis, urticaria, tachy, hypotension; infuse slow and over longer times, usually NOT harmful
Vancomycin NCs
- doesn’t work on CNS
- kidneys eliminate drug, decrease dose for renal dysfunction
- has to be oral for c. diff and pseudomembranous colitis
- monitor plt levels
- watch with contrast and neuromuscular blockades
- don’t give dose super fast
- draw peak and trough levels
Gentamycin, amikacin, tobamycin class
aminoglycosides
Gentamycin, amikycin, tobamycin MOA
inhibit/alter protein synthesis; binds to bac ribosomes and prevents protein synthesis
Gentamycin, amikacyin, tobamycin indications
Gram -, complicated infections like UTIs/kidney infx, gynecological infx, peritonitis, endocarditis, PNA, osteomyelitis (DM related)
Gentamycin, amikacin, tobamycin SE and NC
- Nephrotoxicity, ototoxicity (hearing); gentamycin–be careful when giving with neuromuscular blockade bc can cause myasthenia gravis (resp distress), CNS like confusion, depression, numbness, tingle, cochlear damage
- need therapeutic monitoring–peak/trough levels
- often dose according to renal function
- wean from 3x/day to 1x/day
- often used with vanc or beta lactamase (use before aminoglycosides)
Clindamycin class and MOA
Lincosamides; Bactericidal or bacteriostatic; binds to ribosomes and inhibits protein synthesis
Clindamycin SE and NC
Very toxic, can cause pseudomembranous colitis–deadly diarrhea
- PO and IV available
- Monitor use with neuromuscular blockade meds
- therapeutic drug monitoring
- does not work on people with CRE
Erythromycin and azithromycin class and MOA
Macrolides; Bacteriostatic in general, but bactericidal in high concentrations; inhibit protein synthesis by binding to ribosomes
Erythromycin and azithromycin indications
STIs (esp gonorrhea), resp infx, syn infections, soft tissue infections (Legionnaries, listeria, mycoplasma pneumonia)
Erythromycin and azithromycin SE and NC
YUCK drugs - GI prob (esp erythromycin)–N/V/D, upset stomach
Erythromycin
- hypomotility benefit for diabetic gastroparesis and increases gastric motility and emptying
- does not cross BBB
Tetracycline, doxycyclin, minocycline class and MOA
Bacteriostatic that inhibit protein synthesis by binding to ribosomes
Tetracycline, doxycyclin, minocycline indications
Broad spectrum; STIs (doxycycline prophylactically), PID, acne and non-dangerous skin infx (doxycycline and minocycline), rheumatoid arthritis (minocycline)
Tetracycline, doxycyclin, minocycline SE and NC
Not for pregnant women and kids under 8–cause permanent discoloration and tooth enamel hypoplasia in fetus and kids; yeast infection, photosensitivity
Tetracycline SE and NC
N/V/D, HA, photosensitivity, dizziness; anaphylaxis, angioedema; can damage teeth
- can’t be IV
- fasting is best
Fluroquinlones and MOA
Ciprofloxacin and levofloxacin; destroy bacteria by altering DNA–interfere with enzymes
Ciprofloxacin indications
Treat UTIs, STIs, lower and upper resp infx, gonorrhea, other infx, anthrax
Ciprofloxacin SE and NC
Arthropathy (joint disease), often irreversible; prolonged post-abx effect–concentrated in neutrophils
- PO, IV, topica
- minimal usage on BBB/CSF
- good for rapid and slow orgs
- avoid pt under 18 and over 60 (bc bones)
Levofloxacin indications
Most widely used Fluoroquinolones, better for pneumococcal and other atypical resp infections
Levofloxacin SE and NC
CNS dx that cause sz, kidney failure, can cause prolongation of QT interval, photosensitivity
- 100% oral bioavailable
- once daily dose
- less resistance
Sulfamethoxazole + trimethoprim (Bactrim) class and MOA
Sulfonamides; inhibit growth of bacteria and prevent synthesis of folic acid
Sulfamethoxazole + trimethoprim (Bactrim) indications
Uncomplicated UTIs, resp infx, salmonella, shigellosis; HIV
Bactrim SE and NC
- more common in pt with HIV
- pt with Sulfa allergy can’t take
- photosensitivity
Metronidazole (Flagyl) MOA and indications
inhibit DNA synthesis; Candidiasis, h. pylori, crohn’s disease, c. diff
Metronidazole (Flagyl) SE and NC
N/V, xerostomia (dry mouth), vaginal candidasis (yeast infection), abx-assoc diarrhea
- DON’T take with alcohol
How are later generations of abx different?
increased/sepctrum/activity/ability to penetrate CSF
Which drug class is cross-sensitive with PCNs?
Cephalosporins