Antimicrobials Flashcards by Savannah Smith

oseltamivir

PO
inhibition of release of influenza from infected cell
Tx: Influenza A and B
AE: skin rxn rare
Ci: dose adjust in renal impairment, neuropsychiatric

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zanamivir

inhalation
inhibition of release of influenza from infected cell
Tx: Influenza A and B
AE: viral infection
CI: PULMONARY (bronchospasm: need bronchodilator)

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amantadine

PO
inhibition of viral entry or uncoating
Tx: Influenza A, PARKINSONS 
AE: neuro, orthostatic hypotension
CI: narrow angle glaucoma, breastfeeding
Excretion: RENAL

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rimantadine

PO
inhibition of viral entry or uncoating
Tx: Influenza A

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ribavirin

inhalation, IV
inhibition of viral nucleic acid synthesis
Tx: RSV, human metapenumovirus, hantavirus
AE: fatigue, myalgia, BBB: HEMOLYTIC ANEMIA and TERATOGEN (all trimesters and M/F)
Need routine: CBC and Hct/Hgb

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cidofovir

IV
inhibition of viral DNA synthesis (DNA polymerase inhibition)
Tx: Adenovirus
AE: neuro, hematologic, BBB: RENAL

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acyclovir

IV
inhibition of viral DNA synthesis (DNA polymerase inhibition)
viral thimidylate kinaseactivate to triphosphate form
Tx: Varicella-zoster virus
AE: elevated hepatic enzymes, HYDRATE to prevent renal precipitation, neutropenia

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valacyclovir

prodrug for acyclovir

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flucytosine

PO
converted to 5-FU
noncompetitive inhibitor thymidylate synthase
Tx: cryptococcus
AE: anemia, BLOOD DYSCRASIAS, agranulocytosis

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amphotericin B

IV
bind sterols and increase membrane permeability
Tx: severe fungal infections
AE: metabolite nephrotoxic (pore in membrane); anemia (due to kidney damage)
lipid formula: less nephrotoxic
CI: hypokalemic drugs
lpid formula: less nephrotoxic

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azoles

inhibition of lanosterol-14a-sterol demethylase: inhibition of ergosterol synthesis
CYP metabolism: 2C9, 2C19, 3A4
Res: Aspergillus: mutation in promoter region of CYP51A that encodes MOA enzyme

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itraconazole

azole

low oral absorption

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fluconazole

azole

crosses BBB

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isoniazid

PO
inhibit mycolic acid synthesis
induces CYP, distributes to CSF, placenta, breastmilk
AE: peripheral neruopathy (use B6: PYRIDOXINE), hepatotoxicity, allergic rxn
CI: antacids, LEVODOPA, increases acetaminophen toxicity
Tx: TB
fast ACETYLATORS: less effective

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rifampin

PO: impaired by food, para-aminosalicylic acid
inhibits beta subunit of DNA-dependent RNA pol
CSF distribution
CYP inducer (NOT 2D6)
Tx: TB, meningococcal infection, MRSA
AE: ORANGE secretions, HEPATOTOXIC, GI, nervous system, chills, aches, fever
CI: CYP drugs, oral anticoagulants, oral contraceptives, probenecid

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pyrazinamide

PO
unknown MoA: pyrazinamidase converts to pyrazinoic acid (pH too low for growth)
CSF, breast milk distribution
Tx: TB
AE: HEPATOTOXICITY, ARTHRALGIA, HYPERURICEMIA

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ethambutol

PO
inhibits arabinosyl transferase: increased all permeability
CSF, placenta, breastmilk distribution
Tx: TB adjunct
AE: OPTIC neuritis (acuity, color discrimination, reduced visual field), allergic rxn, HYPERURICEMIA
CI: antacids

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macrolides

MYCIN
50s ribosomal inhibitor: blocks translation
Tx: CAP and/or bronchitis
AE: cholestatic jaundice, QT PROLONGATION

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erythromycin

1st gen. macrolide
Tx: CAP
CYP3A4/Pgp inhibitior
AE: hepatotoxicity in pregnant women

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azithromycin

3rd gen. macrolide

Tx: CAP, bronchitis

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tetracycline

CYCLINE
30s ribosomal inhibitor: block translation
AE: TEETH DISCOLORATION, GI, PHOTOSENSITIVITY, CARDIOTOXIC, decrease bone growth
CI: pregnancy (bone, teeth), nursing (photosensitive infant)

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doxycycline

tetracyline

Tx: CAP, bronchitis

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fluoroquiniolones

FLOXACIN
DNA gyrase inhibitor preventing DNA replication
Tx: CAP
AE: tendon rupture, cartilage damage in children, QT PROLONGATION
CI: adjust for renal impairment, pregnancy

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levofloxacin

fluoroquinolone

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penicillins

CILLIN block cell wall cross-linking by binding to PBP AE: hypersensitivity

amoxicillin

broad spectrum penicillin Tx: CAP, bronchitis with CLAVULONIC ACID better oral bioavailability than ampicillin

piperacillin

broad spectrum penicillin with TAZOBACTAM Tx: nocosomial pneumonia AE: decreased coagulation

clavulanic acid

B-lacatmase inhibitor | with AMOXICILLIN or AMPICILLIN

tazobactam

beta lactamase inhibitor | with PIPERACILLIN

carbopenem

blocks cell wall cross linking AE: penicillin hypersensitivity, SEIZURES CI: adjust for renal CILASTATIN

meropenem

carbopenem Tx: CAP CILASTATIN

cephalosporins

CEF or CEPH inhibition of cell wall cross-linking by binding PCB AE: GI, hypersensitivity CI: adjust for renal impairment (not needed for cefuroxime or ceftriaxone) resistance: alter permeablility of outer membrane in gram -

cefazolin

1st gen. cephalosporin | Tx: CAP

cefuroxime

2nd generation cephalosporin | Tx: CAP

3rd generation cephalosporin

ceftriaxone ceftazidime Tx: CAP, nocosomial pneumonia

ciprofloxacin

fluoroquinolone | Tx: CAP (reserved for ICU), P. aeurginosa, bronchitis

ceftriaxone

3rd gen cephalosporin | Tx: lung abscess

ceftazidime

3rd gen cephalosporin | Tx: pseudomonas

cefepime

4th gen. cephalosporin | Tx: CAP, nocosomial pneumonia, pseudomonas

aminoglycosides

gentamicin | 30s ribosomal inhibitor

gentamicin

aminoglycoside

Tx of outpatient CAP

macrolide or doxycycline

Tx of outpatient CAP with COPD with steroids with steroids or antibiotics in last 3 months

fluoroquinolone or amox/clav or 2nd gen macrolide with/out cephalosporin

Tx of outpatient Cap with COPD (no steroids or antibiotics in 3 months)

2nd gen macrolide or doxycycline

Tx of CAP in nursing home

fluoroquinolone or amox/clav or 2nd gen macrolide with/out cephalosporin

Tx of hospital ward CAP

fluoroquinolone or amox/clav or 2nd or 3rd gen macrolide with/out cephalosporin

Tx of CAP in ICU

3rd gen cephalosporin | with/out macrolide or piperacillin/tazobactam or flouroquinolone

Tx of CAP in ICU with P. aeruginosa

antipseudomonal fluoroquinolone with B-lactam or | macrolide and 2 antipsuedomonal agents

antipseudomoal agents

``` ciprofloxacin aminoglycosides meopenem piperacillin/tazobactam 3rd gen cephalosporins ```

posaconazole

azole

voriconazole

azole

cycloserine

``` PO cell wall synthesis inhibitor: D-ala analog CSF, placenta, breast milk distribution Tx: TB (MDR), M. avium complex, UTI AE: CNS CI: alcohol (seizures), epileptics ```

ethionamide

peptide synthesis inhibitor: analog of isoniazid CSF distribution AE: GI, neuro (give PYRIDOXINE), hepatic Tx: TB

capreomycin

IM MoA unknown Tx: TB (XDR): LAST LINE AE: nephrotoxic, ototoxic, eosinophilia, electrolytes, acute RTN

clarithomycin

macrolide Tx: bronchitis AE: TERATOGEN, caution with breastfeeding

aminoglycosides

30s ribosomal inhibitor Tx: CAP AE: NEPHROTOXIC, OTOTOXIC, neuromuscular paralysis, TERATOGEN CI: adjust for renal impair

imipenem

carbopenem Tx: nocosomial pneumonia give with: CILASTATIN

cilastatin

inhibitor of renal dehydropeptidase I | stops renal inactivation of CARBAPENEMS

aztreonam

monobactam: PCB inhibitor Tx: nosocomial pneumonia

ampicillin

broad spectrum penicillin with CLAVULANIC ACID Tx: aspiration pneumonia

vancomycin

inhibits cell wall peptidoglycan synthesis: D-ala, D-ala Tx: nosocomial pneumonia AE: RED MAN syndrome, NEPHROTOXIC, OTOTOXIC

clindamycin

lincosamide: inhibits 50s Tx: aspiration pneumonia, lung abscess AE: GI

metronidazole

nitroimidazole: free radical metabolites in cell that damages DNA Tx: lung abscess, nosocomial infection AE: metallic taste, DISULFIRAM rxn, expiramental mutagen/carcinogen