ceclor, cefprozil, caftan - increases risk for bleeding - avoid ETOH - more gram negative, less gram positive indication: URI, UTI, skin infection

ceftriaxone - excellent CNS penetration - use for meningitis - ceftaz has pseudomas activity Drug of choice: gonorrhea

erythromycin, clarithromycin, azithromycing MOA: inhibits protein synthesis - gram postive, some gram negative and atypical indications: resp infections lyme, GI ulcers, MAC chlamydia, skin infections AE: GI, ototoxicity, prolong QT, tate changes DI: inhibit cytochrome P450

antimicrobial therapy Flashcards by claudia franco

pathogens

sterile fluids are CNS, urine, and blood

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classes of abx

cell wall active agents: -bela lactase ( PCN, cephalosporins), Aztreonam, Vancomycin, carbapenems

protein synthesis inhibitors:
macrocodes, clinda, tetracyclines, linezolie

interfere with DNA synthesis: fluroquinolones, rifamycin

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PCN class

MOA: Beta lactam-binds to PCN -binding protein to inhibit cell wall synthesis

spectrum: gram positive gram negative

AE: hypersensitivity, GI, hematologic, lowers seizure threshold

DI: OCs

PCN G- IM, IV

PCN VK:PO- best on empty stomach

antistaph PCN-staph and and fair streptococcal activity

amino PCN: ampicillin amoxicillin
- spectrum: enterococci, listeria, H. pylori

Extended spectrum- zosyn, mezlocillin, azlocillin
- spectrum: anti-pseduomasal coverage
indications: serious infections
Inpatient tx

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beta lactate inhibitors

combined with PCN
sublactam, clavuulanic
activity for wide range of infections, respiratory tract, animal bits, skin infections

SE: diarrhea

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cephalosporins

spectrum: broader are cephalosporin progresses
Gram + –> gram + and gram -
No Enterococcus spp or listeria

eliminated via renal
don’t adjust cefriaxone

MOA: inhibit cell wall synthesis

SE: allergic rnn, cross reactivity with PCN

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first gen cephalosporins

Reflex, Ancef

skin infections, strep, prepop prophylaxis

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second generate

ceclor, cefprozil, caftan

increases risk for bleeding
avoid ETOH
more gram negative, less gram positive

indication: URI, UTI, skin infection

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third generation

ceftriaxone

excellent CNS penetration
use for meningitis
ceftaz has pseudomas activity

Drug of choice: gonorrhea

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fourth/fifth generation

cefepime- gram postive and gram negative

Teflaro- IV
-gram pos, gram neg, MRSA , and resistant to S. pneumonie

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Aztreonam

use for pt who has anaphylactic rx to PCN

cover gram negative including pseudomonas

renally cleared

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carbapenems

broadest class of abx

excellent for gram negative and gram positive
No MRSA, MRE
NO pseudomonas-ertapenems

indications: lower respiratory infections, intra-abdominal infections, bacterial sepsis
UTI
skin/skin structures, endocarditis

meropenem- CNS -related infections
ertapenem- Invanz IM

renal elimination

precipitates seizure activity

cross sensitivity with PCN

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fluroquinolones

cipro, levaquin

MOA: bind and inhibitor DNA synthesis

good tissue penetration
good gram positive
gram negative( cipro)

indications: URI, skin infections, anthrax, traveler’s diarrhea

AE: GI, CNS, cartilage toxicity ( no pets), tendon rupture, photosensitivity, QT prolongation( cipro least), rash, worsens MG

check drug interactions: warfarin, theophylline, drugs affecting blood glucose,

always separate calcium intake with abx

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macrolides

erythromycin, clarithromycin, azithromycing

MOA: inhibits protein synthesis

gram postive, some gram negative and atypical
indications: resp infections lyme, GI ulcers, MAC chlamydia, skin infections

AE: GI, ototoxicity, prolong QT, tate changes

DI: inhibit cytochrome P450

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ketolides

ketek-telithromycin

MOA: protein synthesis inhibitor

spectrum: gram postive,gram negative,

AE: hepatic dysfunction( not used in pads), CI with MG
DI: inhibitor CYP 3A4

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tetracyclines

cover H.pylori, spirochetes, community acquire MRSA

tetracycline, doxycycline ,minocycline

indications: acne, resp tract, lyme, ricettsia

AE: photosensitivity, deposition in teeth and bones ( dont use in peds and preggers)
DI: chelation with calcium supplements, OC, warfarin

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glycycyclines

tygvacil
gram positive and gram negative but no pseudomonas

indications: second line agent for CAP or intra-abdominal infections

AE: n/v

ahminoglycosides

gentamicin, tobramycin
IV only

indications: generally gram negative and infections in hospital

AE: neprotoxicty, ototoxic, neuromuscular blockade

sulfonamides

Bacterium

DOC: UTI, PCP
CAP

AE: GI, hypersensitivity, bone marrow suppression, photosensitivity

DI: OC, warfarin, sulfonylureas

metronidazole ( flagyl and Tindzdazole

trichimonas
c.diff

AE: metallic tate, urine changes

DI: ETOH, warfarin

clindamycin

gram postive and anerobic
Community-acquired MRSA
PCN allergic pt

AE: GI, c.diff

fidaxomicin ( difcid)

recurrent C.diff

Rifampin

TB, meningicoccal

AD: organs-red body fluids, hepatotoxicity, GI, flu-like sxs

MRSA abx

vance, zyvox

vancomycin

IV- MRSA
oral - used for C.diff

AE: red man syndrome, thrombophlebitis, nephrotoxicity, toxicity

check trough -10- 20 mg/L , if not then they get resistant

zyvox -linezolid

oral/ IV used for pneumonia AE: myelosuppression until 2 weeks of tx, inhibits MAO, SSRI

UTI managetment

macrobid- avoid if they have renal issues | bactrim

anti-vitals

acyclovir, famvir, valtrex - goal is to tx first episodes herpes zoster- varicella( speeds healing, dec. pain/ neuralgia) severe infection: --> acyclovir AI: GI headache

influenza tx

relenza and tamiflu- cover flu a and b Amantadine and rimantadine- influenza A and prevention AE: GI, CNS

CMV

gancilovir, fosacir, visited manage counts

hep b management

interferon alpha entecavir goal: dec. hep b levels and improve liver histories ``` Interferon ( SQ) 4mon-1 year flu-like scans bone marrow suppressions psych symptoms ```

hep c tx

peg interferon and ribavarin SE: ribavarin- hemolytic anemia, tetragenic neutropenia

anti fungals

azoles, polyenes ( ampotericin- covers everything) lamisil- use for dermatophyte infections AE: ampho- nephrotoxit azoles- hepatic, QT prolongation terbinafine- liver enzymes drugs interactions are common ketokonzaole/ itraconazole- check on h2 blockers, needs acidic environment rifampin- increased cleared for azoles

bug and drugs

MSSA MRSA- vance community -acquired MRSA- clinda, bacterium complicated: vanc, dap strep pyogenies: PCN V or G, for PCN-allergic: clinda or macrolide strep pneumo: PCN V or G or amox moraxella ca- caftan nester gone- ceftrizxone n. meningi- pCN g c.diff- metronidazole, recurrent vanco oral e.coli/kelb- cefrixone proteus mirablis- ampicillin h. flu- URI: bacterium h. pylori: PPI+ clarithro+ amor or flagyl chlaymdia- macrolide mycoplasma pneumonia: macrolides

drug interactions

``` macrocodes- inhibit cytochorne p50 rifampin- induces Cp50 fluroquin and tetracyclines- chelated by divalent cations linezolid- MOA ETOH- flagyl, cefotetan oral contraceptives -amox, PCN ``` photosensitivity: bacterium, tetracycline Rash: fluroquin QT prolongation: fluroquinolones, macrolides, Red man syndrome- vanco, slow down infusion Nephrotoxic/ ototoxic: vanco and aminoglycodies seizures: PCN, fluroqin Mono: amor bone marrow suppression: bacteria, linezolie GI: multiple drugs ( clauvante) taste: clarithromycin, metronidazole tendonitis: fluroquinolodes orange/red-rifampin CI with peds: tetra, fluroquinolones, telithromycin, bacterium

anti fungal efficacy

gold standard: amphotericin B( renal issues) aspergillosis: voriconazole, amphotericin blastomycosis: itraconazole amphoterecin, fluconazole candidemia: fluconazole, amphotereicin, voriconazole coccidiomycosis: itraconazole, fluconazole