Antimicrobials Flashcards
PCNase-Susceptible
Narrow Spectrum
Tx: Gonorrhea, Syphilis
PCN G, PCN V, Benzathine PCN
Natural Penicillins
PCNase-Resistant
Narrow Spectrum (minimal to no gram - activity)
MSSA
Methicillin, nafcillin, oxacillin, dicloxacillin
Hepatic excretion: nafcillin, oxacillin
Anti/staphylococcal Penicillins
PCNase-Susceptible Aminopenicillins Broad Spectrum Similar to PCN G, more gram- bacilli coverage Amoxicillin, ampicillin
Extended Coverage Penicillins
PCNase-Susceptible Extended Spectrum Broad + pseudomonas coverage Piperacillin, ticarcillin Parenteral only
Anti/pseudomonal Penicillins
Beta-lactam Bactericidal Stronger resistance against B-lactamases 5 generations Gen 1→5 = + gram- and anaerobe coverage Gen 1→5 = + resistance against B-lactamases
Cephalosporins
Only commercially available b-lactam of its class that can take on MRSA. Reserved for complicated skin conditions as well as community-acquired pneumonia. Broad spectrum. Advanced generation. Pro-drug.
Ceftaroline
Renal dosage adjustments for cephalosporins except for 3rd generation _____, which is hepatically metabolized.
Ceftriaxone
Extremely broad coverage (nearly than all other antimicrobials. Pseudomonas coverage. None active against MRSA, though. Renal adjustments. Imipenem, Meropenem, Ertapenem, Doripenem.
Carbapenems
Aztreonam Relatively B-lactamase resistant Gram - coverage Renal adjustment Not resistant to ESBLs
Monobactams
Non-B-lactam Gram + Glycopeptide Most widely used in US hospitals Tx: C. difficle, MRSA Binds precursors for cell wall biosynthesis MRSE Nephrotoxic, ototoxic, RED MAN
Vancomycin
Non-B-lactam Gram + \$\$$ Tx of skin, skin MRSA, Skin VRE [dependent] Cell membrane rapid depolarization No good for tx of peneumonia due to surfactants Can cause rhabdo Stop Statins
Daptomycin
Non-B-lactam Vanco/Dapto alternative for resistant gram+ including MRSA [dependent] Vanco synthetic derivative fetal risk QT interval prolongation foamy urine
Telavancin
Non-B-lactam
treatment UTI due to E. coli/E. faecalis
Fosfomycin
Non-B-lactam
“detergent-like” effect
[dependent]
Gram -
Polymyxin
Tetracyclines: “Like My Chronic CRAP”
Lyme, Mycoplasma Pneumonia, Cholera, Chlamydia, Rocky Mtn Spotted Fever, Acne, Peptic Ulcer
Protein Synthesis Inhibitor
Broad specturm
Bacteriostatic
Gram +/-, others
Crosses placenta
Enters bones and dentition due to calcification
Avoid dairy, antacids, iron while taking
Demeclocycline, doxycycline, minocycline, tetracycline
Tetracyclines
___cycline can be taken with/or without food.
Minocycline
Absorption of demclocycline, doxycycline and tetracycline are ____ by food.
reduced
Only minocycline and doxycycline achieve therapeutic levels in ____.
CSF
_____ is a drug of choice in renal impairment.
Doxycycline
Gastric discomfort Limit in pediatrics (discolored teeth) Hepatotoxicity Phototoxicity (sunburn) Dizziness, vertigo, tinnitus Contraindicated for pregnancy, breast-feeding
Tetracyclines
Protein Synthesis Inhibitor
Tigecycline (minocycline derivative)
Tx for complicated skin and soft tissue infections
Tx for intra-abd infections
Developed for TCN class resistant organisms**
Glycylcyclines (Tigecycline)
Protein Synthesis Inhibitor Broad spectrum (MRSA, VRE, b-lactamase gram -, resistant strep) Penetrates tissues well, low [plasma] adverse: n/v, pancreatitis hepatotoxic,
Glycylcyclines (Tigecycline)
Protein Synthesis Inhibitor Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin Parenteral, EXCEPT neomycin (top/oral) Often combined with B-lactams Nephro/ototoxic Neomycin: contact derm
Aminoglycosides
Protein Synthesis Inhibitor Azithromycin, Clarithromycin, Erythromycin, Telithromycin Broad spectrum Bacteriostatic Bactericidal at higher does 50s binding Hepatic metabolism CP450, EXCEPT azithromycin Can lead to drug toxicities
Macrolides
Azithromycin and erythromycin should be taken ____ food.
without
Clarithromycin should be taken ____ food.
with
Protein Synthesis Inhibitor
Hepatic Metabolism
CP450
Strong inhibitors: medication hx/reconciliation is important.
Clarithromycin is eliminated by the kidneys and the liver
Can prolong QT (ketolides also can do this)
Ototoxic, Gastric distress, jaundice
Hepatic contraindications
Macrolides
Telithromycin: box warning for pts with ____ ____.
myasthenia gravis
Corynebacterium diphtheriae, Bordatella pertussis
Erythromycin
Good choice for those patients with B-lactam PCN allergy
Erythromycin
Chlamydial infection, legionnaires, mycoplasma pneumonia
Azithromycin
Z-pack loading dose on day one, then four more; commonly prescribed; long half-life
Azithromycin
Mycobacterium Avium Complex (MAC)
Azithromycin
Protein Synthesis Inhibitor Macrocyclic Narrow Spectrum (gram +/anaerobes) Costly RNA polymerase inhibitor C.diff tx Adverse: n/v, abd pain, hyper. rxns Not recommended for pts w/ macrolide allergies
Fidaxomycin (Dificid)
Protein Synthesis Inhibitor Broad spectrum Reserved for life threatening infections, IV Intensive care 50s, peptidyl transferase inhibitor
Chloramphenicol
Protein Synthesis Inhibitor
Bacteriostatic, with +dose could become ~cidal
CSRA (Chlamydia, Spirochetes, Ricketessiae, anaerobes)
Hepatically metabolized
Adverse: Anemias, GRAY BABY
Weak inhibition of CYP2C9
Chloramphenicol
Protein Synthesis Inhibitor Lincosamide IV/oral GI intolerance Cross-resistance with erythromycin Bacteriostatic gram + (MRSA, anaerobes)
Clindamycin
Protein Synthesis Inhibitor
Distributes well, poor CSF
Adverse: diarrhea, causes C. diff
Accumulation in renal/hepatic impairment
Clindamycin
What beta-lactamase inhibitor was known to cause diarrhea?
Clavulanic acid
Protein Synthesis Inhibitor
Developed to combat resistant gram + organisms
(MRSA, VRE, PCN resistant strep)
Binds to the “23s Ribosomal RNA” of the 50s subunit, which inhibits 70s action
Mycobacterium tuberculosis tx
Dapto alternative for tx of VRE
Linezolid
Protein Synthesis Inhibitor no required renal adjustments Oral/IV Bacteriostatic Bacteriocidal against Streptocooci Gram + main clinical use adverse: n/v/d/headache; rash; thrombocytopenia MAO activity
Linezolid
Glycopeptide
Vancomycin
Tigecycline
Glycylcycline
Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin
Aminoglycosides
Azithromycin, Clarithromycin, Erythromycin, Telithromycin
Macrolides
____ derived from erythromycin.
Ketolide
50s subunit (ex: erythromycin)
Macrolides
costly Macrocyclic (similar macrolide structure)
Fidaxomycin (dificid)
50s; peptidyl transferase inhibitor
Chloramphenicol
tx: CSRA
Chloramphenicol
Lincosamide
Clindamycin
“23s of rRNA” of the 50s→70s formation inhibition
Linezolid
Main clinical use = tx for drug resistant gram +
Linezolid
MAO activity
Linezolid
Used only against PCNase producing strands of S. aureus; MSSA
Anti/staphylococcal penicillins
Amoxicillin/clavulanate (augmentin)
PCN Combo with B-lactamase inhibitor
Cephalosporin eliminated by the liver; 3rd gen
Ceftriaxone
