B3.022 - Antimicrobial Drugs Flashcards by Annelise Chaparro

What are the groups of ICWS

Penicillins
Cephalosporins
Beta Lactams
Others

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What are the types of penicillins

Penicillins
Extended spectrum
Anti Staph
Anti Pseudomonal

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What are the Extended spectrum penicillins

Ampicillin

Amoxacillin

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What are the Anti Staph Penecillins

Methicillin
Nafcillin
Oxacillin

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What are the Anti Pseudomonal drugs

Ticarcillin

Piperacillin

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What are the 1st generation cephalosporins

Cephalexin

Cefazolin

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What are the 2nd generation cephalosporins

Cefuroxime
Cefotetan
Cefaclor

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What are the 3rd generation cephalosporins

Cefotaxime
Ceftriaxone
Ceftazidime

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What are the 4th generation cephalosporin drugs

Cefepime

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What are the other beta lactams

Aztreonam
Imipenam
Meropenam
Clavulanic Acid
Tazobactam

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What are the other cell wall synthesis inhibitors

Vancomycin
Bacitracin
Fosfomycin

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What are the agents that affect cell membranes

Polymixin B and E

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What are the types of protein synthesis inhibitors

Tetracyclines
Macrolides
Aminoglycosides
Others

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What are the tetracyclines

Tetracycline
Doxycycline
Tigecycline

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What are the macrolides

Erythromycin
Clarithromycin
Azithromycin
Telithromycin

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What are the aminoglycosides

Gentamicin
Streptomycin
Tobramycin
Neomycin

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What are the other IPSs

Chloramphenicol
Clindamycin
Streptogramins
Oxazolidinones

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What are the types of inhibitors of folate dependent pathways

Sulfonamides

2. Dihydrofolate reductase inhibitors

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What are the sulfonamides

Sulfamethoxazole
Sulfasalazine
Silver sulfadiazine
Co-trimoxazole

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What are the DNA gyrase inhibitors

Ciprofloxacin

Levofloxacin

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What are the UT antiseptics

Nitrofurantoin

Systemic agents

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What are the first line anti-mycobacterial drugs

Isoniazid
Ethambutol
Rifampin
Streptomycin
Pyrazinamide

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What are the second line anti-mycobacterial drugs

Cycloserine
Ethionamide
Capreomycin
PAS

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Describe penicillin toxicity

Ver selective, bacteriocidal in growing and proliferating cells

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What is the MOA of penicillins

Covalent binding to transpeptidases/PBPs Inhibition of cross linking of cell wall Activation of murein hydrolases (autolysins)

Describe the absorption of penicillins

Oral even though they’re acid sensitive IV, IM Depot preparation of penicillin G

Describe the distribution of penicillins

Good to most tissues except eye, prostate and CNS

How are penicillins excreted

Tubular secretion

What can block tubular secretion of penicillins

Probenecid

Which penicillin isn’t excreted tubularly

Nafcillin its excreted by bile

What is the half life of penicillins

1 hour

Do penicillins exhibit time dependent or concentration dependent killing

Time dependent

What are the clinical uses of Pen G and Pen V

Primarily gram + bacteria

What which penicillin class is beta lactamase resistant

Anti staph - nafcillin, methicillin, oxacillin

What are the extended spectrum penicillins used for clinically

Gram + and some Gram -

What are the anti pseudomonal penicillins used for

Proteus sp. and pseudomonas

What is the issue with using antipsudomonal penicillins and what do you have to combine them with

They develop resistance rapidly, combine with aminoglycocides or fluoroquinolones

When should antipseudomonals be used

Only when absolutely indicated to protect their therapeutic value

What are the most common adverse reactions of penicillins

Ampicillin rash | Hypersensitivity

What is resistance to penicillins due to

``` No cell wall No activation of autopsies (murein hydrolases) Metabolically inactive Inaccessible PBPs Beta lactamase production ```

What can you do to prevent resistance due to beta lactamase

Give a beta lactamase inhibitor Clavulanic acid Sulbactam Tazobactam

What are issues associated with overuse of penicillins

Resistance Sensitization Superinfections be resistant organisms

What are cephalosporins used for

In penicillins won’t work, less sensitive to beta lactamase | Broader spectrum of activity

What is a negative about using cephalosporins instead of penicillins

Renal toxicity is more common Poor oral absorption Some cross reactivity with penicillins

As the generation of cephalosporins goes up so does

``` Greater gram - activity Less beta lactamase activity Cephalosporinase resistant Less toxic to patient Better distribution especially to CNS ```

What are adverse effects of cephalosporins

Renal toxicity, enhanced by aminoglycosides Disulfiram effect; bleeding and platelet disorders Hypersensitivity

What is aztreonam used for

Gram - aerobes

How do azteronam and Imipenem respond to beta lactamase

They are resistant

Do aztreonam and imipenem cross the blood brain barrier?

Yes

What is imipenem used for

Broad spectrum gram + and gram -, anaerobes

What should imipenem be used with if treating pseudomonas

Aminoglycosides

How is imipenem administered

IV only

How is imipenem inactivated and how do you prevent that

Renal dipeptidase, co administer with cilastatin

What is meropenem

Dipeptidase resistant carbapenem (as opposed to imipenem)

How does vancomycin work

Inhibits transglycoslylation (step right before transpeptidation)

What is vancomycin used for

Bacteriocidal for gram +

How is vancomycin administered and for what

Orally for C. Diff | IV for systemic infections

What is vancomycin synergistic with when treating MRSA

Aminoglycosides

How is vancomycin cleared from IV administration

Through the kidneys - enhances oto and renal toxicity of aminoglycosides

What is an adverse effect of vancomycin caused by histamine release and how is it avoided

Red man or red neck syndrome, administer slowly or with antihistamines

What is something negative that developed because of vancomycin overuse

Vancomycin depended enterococci

What is fosfomycin used for

Gram + and gram -

What is fosfomycins MOA

inhibits cytoplasmic step in cell wall precursor synthesis

How is fosfomycin taken up

Using G6P transporter

How is fosfomycin taken, excreted and what type of infection is it used for

Oral, kidney, single dose therapy for UTI

What is fosfomycin synergistic with

Beta lactamase, aminoglycosides, fluoroquinolones

What are polymixin B and E used for

Active against gram - except proteus and neisseria | Limited to topical use due to renal toxicity

When is polymixin B and E specifically used for

Salvage therapy