Antimicrobials 1 Flashcards
What is the MOA of penicillin
Disrupt the synthesis of the cell wall
what must be happening for penicillin to be effective
Bacteria must be growing and dividing
6 Classes of drugs that inhibit cell wall synthesis
Penicillins Cephalosporins Carbapenems Vancomycin Aztreonam Televancin
what does penicillin inhibit
transpeptidases which are essential for cell wall synthesis
penicillin activates what
autolysis
T/F penicillin has low toxicity
TRue
Penicillin A/E (3)
urticaria
pruritis
angioedema
6 indications for penicillin
Gonorrhea
perionitis
UTI
Pneumonia and other Resp Infections
Septicemia
Meningitis
S/E for Penicillin (5)
GI distress
oral/vaginal candidiasis
general rash
Anaphylaxis
Itchiness
4 Types of Penicillins
Natural
Penicillinase-Resistant
Aminopenicillins
Extended-Spectrum
2 Natural penicillins
PCN G
PCN V
Penicillinase-Resistant drug
nafcillin
2 aminopenicillin drugs
amoxicillin
ampicillin
Extended-spectrum penicillin
piperacillin
how are Natural pcns: penicillin g& V given
IV/IM (PO avaliable)
what does Natural pcns work on
Works on Gram +, gram – cocci, anaerobic bacteria, spirochetes
what is 1.2 life of natural pcn
30 minutes
what can natural pcn be used with
aminoglycosides - disrupts protein synthesis
T/F Nafcillin is the drug of choice for this class of PCNs
TRUE
T/F Nafcillin is IV only
TRUE
T/F Nafcillin Resist breakdown by the penicillanse enzyme
True
What is a common adverse effect with Ampicillin
diarrhea and rash
how is ampicillin administered
PO/IV
T/F ampicillin is renal sensitive
True
T/F Amoxicillin has less SE than ampicillin
True
Who is amoxicillin common in
pediatrics
route of amoxicillin
PO
What areas are amoxicillin common for treating
ear
nose
throat
genitourinary
skin infections
T/F piperacillin is Always given with a beta lactamase inhibitor
True
What infection is piperacillin good for
pseudomonas
what should you watch for with piperacillin
patients with renal dysfunction as it also affects platelet function
5 classes of Cephalosporins
1st gen
2nd gen
3rd gen
4th gen
5th gen
what is the MOA of cephalosporins
Structurally similar to PCNs
Inhibit cell wall synthesis through same penicillin-binding protein -> activate autolysis
T/F cephalosporins have a low toxicity
TRUE
most common A/E of cephalosporins
Mild diarrhea
abdominal cramps
rash
pruritis
redness
edema
indications of cephalosporins
same as penicillins
pregnancy category of cephalosporins
Category B
T/F Cephalosporins have poor oral absorption
True
2 1st Generation cephalosporin drugs
Cefazolin
cephalexin
what do 1st gen cephalosporin drugs work well for
gram + bacteria
staph and non-enterococcal strep infections
route of 1st gen cephalosporin drugs
PO or IV
Cefazolin only IV
What is cefazolin common for
surgical prophylaxis
2nd generation cephalosporin drugs
cefuroxime
cefotetan
coverage for 2nd generation cephalosporin drugs
More gram – coverage AND the gram + coverage
Route of 2nd gen cephalosporins
IV/PO
What does Cefuroxime not kill
anerobic bacteria
Name the 3 3rd generation drugs
ceftriaxone
ceftazidime
Cefotaxine
Action of 3rd generation cephalosporins
Most potent in fighting gram – bacteria BUT much less activity against gram +
routes avaliable for 3rd gen cephalosporins
IV/IM
Other forms available in PO
T/F Ceftriaxone is EXTREMELY long-acting (once per day dosing benefit)
True
Are 3rd gen cephalosporins able to cross the BBB
Able to cross the blood brain barrier so effective in treating meningitis and other infections within the CNS
Who do we not give give 3rd gen cephalosporins to
patients with liver failure
what does ceftazidime work well for
pseudomonas
what is the 4th generation drug
Cefepime
what does cefepime work against
gram - & + (very broad spectrum)
What infections do cefepime work for
Uncomplicated/complicated UTIs, skin infections and pneumonias
does cefepime cross the BBB
yes
5th generation cephalosporin
ceftaroline
what does ceftaroline treat
Treats MRSA and MSSA works again some VRSA/VISA
what does ceftaroline not cover
No Enterobacter, Pseudomonas, ESBL, Klebsiella coverage
how is ceftaroline dosed
renally
route of ceftaroline
IV
what does Ceftolozane/tazobactam (Zerbaxa) NEWEST cephalosporin do
treats complicated infections
name the 2 Carbapenems
imipenem/cilastin (Primaxin)
meropenem
MOA of carbapenems
Bactericidal & cell wall inhibitor (same as previous two classes)
Biggest A/E of carbapenems
drug-induced seizure activity
Caution with carbapenem IVs
ALL are IV and must be INFUSED OVER 60 MINUTES
what are carbapenems usually used as
last resort medication
T/F Carbapenems are the BROADEST spectrum of all antibiotics
True
what does Imipenem/cilastin bind to
penicillin-binding proteins -> inhibits the cell wall synthesis
VERY RESISTANT TO BETA-LACTAMASE
T/F Imipenem/cilastin (primaxin) is the most broad spectrum
TRUE
route of Imipenem/cilastin (primaxin)
IV
T/F Imipenem/cilastin (primaxin) can penetrate BBB and meninges
TRUE
What do we watch for with Imipenem/cilastin (primaxin)
WATCH FOR SEIZURES especially in elderly and with other meds that can induce seizures
what is Imipenem/cilastin (primaxin) used form
complicated infections
coverage for meropenem
A little less coverage than imipenem; but still gram + and – aerobes and anaerobes
facts about meropenem
Doesn’t degrade in kidneys
Less seizure activity
S/E for meropenem
rash and diarrhea
ertapenem
less spectrum; but only have to give once a day
doripenem
newest; less seizure activity; NOT FOR PNEUMONIA
What kind of antibiotic is Vanomycin
Glycopeptide
what is the MOA of Vanomycin
Destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
what does Vanomycin work on
gram + infections -> including MRSA and PCN resistant pneumococcus
what is oral vancomycin given to treat
clostridium difficile and pseudomembranous colitis
what does vancomycin not work for
CNS infections
how is vancomycin eliminated
Kidneys eliminate drug; decrease doses for renal dysfunction
Toxic side effects of vancomycin (5)
Ototoxicity with high levels (can be reversible)
Immune-mediated thrombocytopenia
Nephrotoxic watch when using with other drugs (aminoglycosides, cyclosporin’s, IV contrast) that affect kidneys
Watch with neuromuscular blockades (paralyzers)
what is Red man syndrome
usually related to rapid infusion
Flushing, rash, pruritis, urticaria, tachycardia, hypotension
Infuse slowly and over longer time periods
Usually NOT harmful
Monobactam drug
Aztreonma
what is aztreonma most commonly used for
gram - bacteria
MOA of aztreonam
Still uses the penicillin binding protein; inhibits cell wall synthesis and cell lysis
route of aztreonam
IV/IM
S/E of Aztreonam
thrombophlebitis/pain at injection site
t/f aztreonam Can work for CNS infections- crosses the BBB
True
MOA of televancin
inhibits cell wall synthesis
route of televancin
IV only: usually for skin infections r/t gram + bacteria (works for MRSA)
A/E for televancin
renal toxicity, infusion-related reactions, prolonged QT interval
2 derivatives of televancin
dalbavancin
oritavancin
*long half life
Teicoplanin is a semisynthetic what
glycopeptide
MOA of Teicoplanin
Inhibits peptidoglycan polymerization, results in inhibition of cell wall synthesis and cell death
route of teicoplanin
PO
what does teicoplanin treat (2)
C Diff and pseudomembranous colitis
or
Treats gram-positive bacterial infections like MRSA and Enterococcus [similar to Vanc]
T/F teicoplanin has a long half life
True
