Antimicrobials Flashcards by Amber "Gifted" Trathen

antibiotics which inhibit cell wall synthesis

glycopeptides

beta lactams

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sub groups glycopeptides

vancomycin

teicoplanin

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when would you use glycopeptides

severe staph infections

e.g. MRSA / C diff

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why must glycopeptide use be monitored

to prevent ototoxicity and nephrotoxicity

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3 sub groups of beta lactams

penicillins
cephalosporins
carbapanems

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sub groups of the penicillins

benzylpenicillin
flucloxacillin
ampicillin / amoxicillin

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uses benzylpenicillin

strep infections
pneumococcal pneumonia
meningococcal meningitis 
gonococcal infection
syphilis

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uses flucloxacillin

Staph. Aureus,

Strep. Pyogenes.

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uses ampicillin / amoxicillin

UTIs
RTIs
Listeria meningitis
enterococci infections

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sub groups cephalosporins (1st, 2nd and 3rd gen)

1st gen: Cephalexin
2nd : Cefuroxime
3rd : Ceftazidime

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uses cephalosporins

Staph. Aureus
streptococci
nisseriae
Haemophillus
coliforms

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sub groups carbapenems

Imipenem,

Ertapenem

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uses carbapenems

very broad spectrum
Enterobacteriae
anaerobic bacteria

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Cautions glycopeptides (vancomycin/ teicoplanin)

Renal impairment, history of deafness, pregnancy.

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SEs: glycopeptides (vancomycin/ teicoplanin)

Nephrotoxicity, ototoxicity, blood disorders eg neutropenia

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CI’s benzylpenicillin and flucoxacillin

Penicillin hypersensitivity

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SE’s benzylpenicillin and flucoxacillin

Hypersensitivity reactions (angioedema, anaphylaxis, urticaria etc.)

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CI’s Ampicillin/Amoxicillin

Penicillin hypersensitivity.

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SEs Ampicillin/Amoxicillin

Nausea, vomiting

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CIs cephalosporins

Cephalosporin sensitivity (10% allergic to penicillin will also be ceph sensitive).

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SEs cephalosporins

Antibiotic associated colitis, Stephens-Johnson syndrome.

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CIs carbapanems

breast feeding

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SEs carbapanems

Increased Platelet count (Ertapenem), neurotoxicity at very high doses.

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Antibiotics which inhibit nucleic acid synthesis

trimethoprim
sulfonamides 
co-trimoxacole (trimethoprim and sulfonamides)
fluoroquinolones
rifampicin
nitroidimazoles: metronidazole

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how do trimethoprim and sulfonamides inhibit nucleic acid synthesis?

inhibit folate synthesis

how do the fluoroquinolones inhibit nucleic acid synthesis?

inhibit DNA gyrase

how does rifampicin inhibit nucleic acid synthesis?

binds to RNA polymerase

how do the nitroidimazoles inhibit nucleic acid synthesis?

DNA strand breaks

Uses trimethoprim

UTI (NOT IN PREGNANCY due to folate synthesis inhibition) Prostatitis Acute / chronic bronchitis

Uses co-trimoxazole (trimethoprim and sulfamethoxazole)

Pneumocystis pneumonia (PCP) treatment and prophylaxis

Sub groups fluoroquinolones

ciprofloxacin ofloxacin levofloxacin

uses fluoroquinolones

``` Strep viridians Strep pyogenes Pseudamonas H. influenza Campylobacter Chlamydia sp. ```

uses rifampicin

Staph. And Strep. Mycobacteria used as part of the quadruple TB treatment. NB. Is an enzyme inducer.

uses Nitroidimazoles: Metronidazole

Anaerobes, parasites eg Giardia lamblia. Prophylaxis in GI surgery.

CIs trimethoprim

blood dyscrasias Caution: pregnancy

SEs trimethoprim

hyperkalaemia, depression of haematopoesis

CIs co-trimoxazole

Porphyria NB porphyria is a rare hereditary disease in which there is abnormal metabolism of the blood pigment haemoglobin. Porphyrins are excreted in the urine, which becomes dark; other symptoms include mental disturbances and extreme sensitivity of the skin to light.

SEs co-trimoxazole

hyperkalaemia, rash

Cautions for fluoroquinolone use

Epilepsy, G6PD deficiency, myasthenia gravis

SEs fluoroquinolones

Dyspepsia, sleep disorders, rash, pruritus

why are pts predisposed to MRSA when on fluroquinolones?

As they're excreted through the skin and kill commensal organisms

CIs rifampicin

jaundice

SEs rifampicin

orange discolouration of saliva and urine anorexia nausea and vomiting haemolytic anaemia

CIs nitroidimazoles (metronidazole)

interaction with alcohol = profuse vomiting

SEs nitroidimazoles (metronidazole)

taste disturbance | anorexia

Which antibiotics inhibit protein synthesis?

chloramphenicol macrolides tetracyclines aminoglycosides

uses chloramephenicol

H influenza meningitis, epiglottis, chlamydia, rickettsiae | Used widely in the developing world

what can extended periods of chloramephenicol use cause

bone marrow depression | neonatal toxicity = grey baby syndrome

Sub groups macrolides

clarithromycin | erythromycin

uses macrolides

``` strep pneumoniae staph aureus legionella chlamydia mycoplasma pneumoniae ```

sub groups tetracyclines

tetracycline | doxycycline

uses tetracyclines

broad spectrum ``` strep pneumonia strep viridans strep pyogenes staph aureus chlamydia mycoplasma ```

subgroups aminoglycosides

gentamycin | streptomycin

uses gentamycin

staph aureus gram -ve bacilli used for severe sepsis

uses streptomycin

CIs chloramphenicol

pregnancy, breast feeding

SEs chloramphenicol

``` Blood disorders eg aplastic anaemia, optic neuritis, erythema multiforme, grey syndrome (abdominal distension, cyanosis & circulatory collapse) ```

CIs macrolides (clarithromycin and erythromycin)

Hepatic impairment (azithromycin) Caution: neonates

SEs macrolides (clarithromycin and erythromycin)

Rash, arrhythmias, Stephens- Johnson syndrome.

CIs tetracyclines (tetracycline and doxycycline)

Children

SEs tetracyclines (tetracycline and doxycycline)

Dysphagia, oesophageal irritation. Photosensitivity. Headache, visual disturbance.

CIs aminoglycosides (gentamycin and strepomycin)

myasthenia gravis

SEs aminoglycosides (gentamycin and strepomycin)

nephrotoxicity, auditory and vestibular damage. Prolonged therapy = hypomagnesaemia.

what are the 3 ways antibiotics can cause their effects?

1. inhibition of protein synthesis 2. inhibition of nucleic acid synthesis 3. inhibition of cell wall synthesis

bacteristatic

means prevents growth of bacteria and is defined as: the minimum bacteriacidal conc / minimum inhibatory concentration MBC:MIC

MRSA is resistant to

all beta lactams