antimicrobials Flashcards
folic acid synthesis inhibitors
sulfonamides (blocks PABA ->DHF)
trimethoprim (blocks DHF -> THF)
peptidoglycan synthesis inhibitors
glycopeptides: Bactracin, Vanco
Peptidoglucan cross linking inhibitors
penicillins antipsuedomonals cephalopsprins carbapenems monobactams
penicillinase-sensitive penicillins
amoxicillin
ampicillin
penicillin G, V
penicillinase-resistant
dicloaxcillin
nafcillin
oxacillin
antipseudomonals
piperacillin
ticarcillin
carbapenems
-penem
monobactams
aztreonam
30s inhibitors
aminoglycosides
tetracycline
aminoglycosides
GNATS genatmicin neomycin amikacin tobramycin streptomycin
tetracyclines
doxycyclin
minocyclin
tetracyclin
50s inhibitors
chloramphenicol clindamycin linezolid macrolides streptogramins
macrolides
azithromycin
clarithromycin
erythromycin
streptogramins
dalfoprisitn
quinupristin
mRNA synthesis inhibitors
rifampin
Damages DNA
metronidazole
DNA topisomerase inhibitors
florquinolones
penicillin G,V mode of admin
penicillin G- IV/IM
penicillin V- PO
penicillin G, V uses
gram +
some gram - cocci (N. meningitidis) and spirochetes (T. pallidum)
bacteriacidal
ADR of penicillin G,V
hypersensitivity rxn
hemolytic anemia
amoxicillin, ampicillin mode of admin
amOxicillin higher oral bioavailability then ampicillin
amoxicillin, ampicillin uses
bactericidal, still penicillinase sensitive wider spectrum then penicillin HHELPSS H. influenza H. pylori E. coli Listeria Proteus Salmonella Shigella enterococci
amoxicillin, ampicillin ADRs
hypersensitivity rxn
rash
pseudomembranous colitis
Dicloxacillin, nafcilllin, oxacillin MOA
same as penicillin
but narrow spectrum
pencillinase resistance d/t bulky R group which blocks access
dicloxacillin, nafcillin, oxacillin uses
S. aureus (not MRSA)
naf for staph
dicloxacillin, nafcillin, oxacillin ADRs
hypersensitivity rxn
interstitial nephritis
piperacillin, ticarcillin MOA
same as penicillin
extended spectrum
piperacillin, ticarcillin uses
pseudomonas
gram neg rods
susceptible to penicillinase so combo w/beta lactamase inhibitor
piperacillin, ticarcillin ADRs
hypersensitivity rxn
beta lactamase inhibitors
CAST
Clavulanic Acid
Sulbactam
Tazobactam
cephalosporins MOA
beta-lactams that inhibit cell wall synthesis, but less susceptible to pencillinases
bactericidal
what organisms are NOT covered by cephalosporins
LAME listeria atypical (Chlaymyida, mycoplasma) MRSA (exception, cefaroline 5th gen does cover MRSA) Enterocicci
1st generation cephalosporins
have pH
cefazolin (exception)
cephalexin
uses of 1st gen
\+PEcK gram + cocci proteus E.coli Klebsiella used prior to surgery to prevent S. aureus
2nd gen
Family celebrating w/Foxy cousin drinking Tea, wearing Fur
cefoxitin
cefuroxime
2nd gen uses
HEN PEcKS H. influenza Enterobacter Neisseria Proteus E.coli Klebsiella Serratia
3rd gen
ceftriaxone
cefotaxime
ceftazidine
3rd gen uses
serious gram neg
ceftriaxone- meningitis, gonorrhea, Lyme
Ceftazidime- pseudo
4th gen
cefepime
4th gen uses
gram neg
increased activity against pseudo and gram +
5th gen
ceftaroline
5th gen uses
broad gram neg and pos
includes MRSA
does NOT cover pseudo
cephalospoin ADRs
hypersensitivity rxn autoimmune hemolytic anemia disulfram-like rxn vit K deficiency cross reactive w/penicillins increase nephrotoxicity of aminoglycosides
carbapenems MOA
broad spectrum, beta lactamase resistant
administer w/cilastatin to decrease inactivation of drug in renal tubules
carbapenems uses
gram + cocci, gram - rods, and anaerobes
significant side effects limit use
carbapenems ADRs
GI
skin rash
CNS toxicity -> seizures
monobactams general
synergistic w/aminoglycosides
no cross reactivity w/penicillin
monobactams uses
gram neg rods only
for penicillin allergic pts and those w/renal insufficiency who cannot tolerate aminoglycosides
monobactams ADRs
usually nontoxic, can cause GI upset
vanco MOA
D-ala D-ala binding blocks cell wall synthesis
vanco uses
gram + only MRSA S. epidermidis Enterococci C. difficile (PO)
ADRs vanco
Nephrotoxic
Ototoxic
Thrombophlebitis
Red man flush
aminoglycosides MOA
bactericidal
30S
require O2 for uptake, so no effect on anaerobes
aminoglycosides uses
severe gram - rods
synergisitc w/beta lactams
aminoglycoside ADRs
Nephrotoxic
Neuromuscular blockade
Ototoxic
Teratogen
aminoglycoside mechanism of resistance
bacterial transferase enzymes inactivate drug via acetylation, phosphorylation, or adenylation
tetracyclines MOA
bacteriostatic
bind 30s
limited CNS penetration
DO not take w/milk, antacids, or Fe b/c block absorption
Doxy ok in renal failure b/c fecally eliminated
tetracyclines uses
Borrelia burgerdorferi
M. pneumoniae
accumulates intracellularly -> rickettsia and Chlaymida
also for acne
tetracycline ADRs
GI
discoloration of teeth and inhibition of growth in kids
photosensitivity
CI in prego
tetracycline resistance
decrease uptake and/or increase efflux
chloramphenicol MOA
blocks 50s
bacteriostatic
chloramphenicol uses
meningitis (H. influenza, N. meningitidis, S. penumoniae)
RMSF
limited use d/t toxcicities, but good in 3rd world cause cheap
chloramphenicol ADRs
anemia
aplastic anemia
gray baby syndrome (lack UDP-glucuronyl transferase)
chloramphenicol resistance
plasmid encoded acetyltransferase inactivates drug
clindamycin MOA
50s
bacteriostatic
clindamycin uses
anaerobic infections (bacteroides, C. perfringens)
invasive grp A strep
treats anaerobic infections above diaphragm (metronidazole below)
clindamycin ADRs
pseudomembranous colitis
fever
diarrhea
oxazolidinoles (linezolid) MOA
50s
oxazolidinoles uses
gram + including MRSA and VRE
oxazolidinoles ADRs
bone marrow suprresion
peripheral neuropathy
serotonin syndrome
oxazolidinoles resistance
point mutation in ribosomal RNA
Macrolides MOA
50s
bacteriostatic
macrolides uses
atyical penumonias (Chlamydia, legionella, mycoplasma)
STIs (chlamydia)
gram + cocci
B. pertussis
macrolides ADRs
MACRO GI Motility issues Arrhythmia (prolonged QT) acute Cholestatic hepatitis Rash eOsinophilia clarithromycin and erythromycin inhibit cytochrome P-450
macrolides resistance
methylation of 23S rRNA binding site
trimethoprim MOA
inhibits DHF reductase
bacteriostatic
trimethoprim uses
combo w/sulfa (TMP-SMX) UTIs Shigella Salmonella Pneumocystis jirovecii toxoplasmosis prophylaxis
trimethoprim ADRs
megaloblastic anemia
leukopenia
granulocytopenia
TMP - treats marrow poorly
sulfonamides MOA
inhibit folate synthesis
bacteriostatic (bacteriocidal when combo with TMP)
sulfonamide uses
gram + gram - nocardia chlamydia triple sulfas or SMX for UTI
sulfonamide ADRs
hypersensitivity rxn hemolysis if G6PD deficient nephrotoxic photosensitivity kernicterus in infants displace other drugs from albumin (warfarin)
sulfonamides resistance
altered enzyme
decrease uptake
increase PABA synthesis
floroquinlones MOA
inhibit prokaryotic enzymes topoisomerase II (DNA gyrase)
bacteriocidal
cannot be taken w/antacids
floroquinolones uses
gram neg rodes of UTI and GI tract
pseudo, Neisseria
some gram +
floroquinolones ADRs
GI superinfections skin rashes HA dizziness leg commonly leg cramps and myalgias CI in prego, nursing,
floroquinolones resistance
efflux pumps
daptomycin MOA
lipopeptide disrupts cell membrane of gram +
S. aureus skin infections (especially MRSA)
bacterimia
endocarditis
VRE
not used for pneumonia (inactivated by surfactant)
daptomycin ADRs
myopathy
rhabdomyolysis
metronidazole MOA
toxic free radical metabolites that damage DNA
bactericidal
antiprotozoal
metronidazole uses
GET GAP on Metro Giardia Entamoeba Trichomonas Garderelaa Anaerobes (bacteroides, C. diff) H. pylori Tx of anaerobic infection below diaphragm (clindamycin above)
metronidzole ADRs
disulfiram like rxn w/alcohol
HA
metallic taste
