Drug cards 1 Flashcards
Penicliin
pen G (IV or IM) pen V(oral),
MOA: binds PBP (transpetidase) and blocks cross linking, activating autolytic enzymes
Clinical:gram positives, N meningiditis, treponema,
Bactericidal for gram postive
Toxicity: HEMOLYTIDC ANEMIA
Resistance: beta lactamase
Penicillinase resistant pen
Oxacillin, naf, dicloxacillin
MOA: same as pen, but NARROW spectrum as bulky R group access to beta lactamase
Clinical: S aureus (except MRSA)
Toxicity: Interstitial nephritis
Aminopenicillin
Ampicillin, amoxicillin
MOA: same as penn, but WIDER spectrum, also combined with clavulanic acid
“AmOxicilian has greater Oral bioavailability than amp”
Clinical: EXTENDED spectrum,
H influenza, E coli, Listeria, Proteus, Salmonella, Shigella, enteroccoci
“HELPSS”
Antipseudomonal amp
Ticarcillin, piperacillin
MOA: same as pen, extended spectrum
Clinical: pseudomonas, gram negative rods, susceptible to penicillinase so used with clavulanic acid
Beta lactamase inhibitor
Clavulanic acid, sulbactam, tazobactam
“CAST”
Cephalosporins
MOA: less susceptible to penicillinase, bactericidal
Clinical:
- 1st: (cefazolin, cephalexin): gram positives; Proteus, E coli, Klebsiella. used prior to surgery to prevent S aureus
“1st gen = PEcK”
-2nd (cefoxitin, cefaclor, cefuroxime): gram positive cocci; H influenza, Enterobacter, Neisseria spp, Proteus, E coli, Klebsiella, Serratia
“2nd gen= HEN PEcKs”
3rd (ceftriazone, cefotaxime, ceftazidime): serious gram negative infections resistant to other beta lactams
“Ceftriaxone - meningitis, gonorrhea”
4th (cefepime): increased activity against pseudomonas and gram positive
“Ceftazidime - pseudomonas”
Toxicity: Low cross reactivity with pen, INCREASED nephrotoxicity with penicillin
Aztreonam
MOA: Monobactam resistant to beta lactamase, binds to PBP3, SYNERGISTIC with aminoglycosides. NO CROSS REACTION with pen
Clinical: gram NEGATIVES ONLY. NO activity against gram positives or anaerobes.
“For penicillin allergic pts and those with renal insufficiency who cannot tolerate aminoglycosides”
Imipenem/cilastatin, meropenem
MOA: Imipenem is BROAD spectru, beta lactamase resistant carbapenem, always administered with cilastatin (inhibitor of dehydropeptidase I) to decrease inactivation of drug in renal tubes.
” With imipenem, the kill is LASTING with ciLASTatin.”
Newer carabapenem: ertapenem and doripenem
Clinical: gram positive cocci, gram negative rods, and anaerobes. Wide spectrum. but side effects have limited its use for imipenem. But Meropenem has reduced risk of seizure and stable to dehydropeptidase I
Toxicity: CNS toxicity (seizure) at high plasma level, skin rash.
Vanc
Inhibit cell wall formation by binding to Dala Dala, bactericidal
Clinical: gram positive only, serious multidrug resistant organisms, such as MRSA, enterococci and C diff.
Toxic: NEPHRO, OTOTOXICITY, THROMBOPHLEBITIS, diffuse flushing (red man syndrome, preventable by anti histamine and low infusion rate). Well tolerated in general
“NOT many problems”
Resistance: occurs from Dala Dala to Dala D-LAC
Protein synthesis inhibitor
buy AT 30, CCEL at 50
30S inhibitors
A: aminoglycosides: bactericidal
T: tetracyclin: bacteriostatic
50S inhibitors
C: chloramph, clinda (bacteriostatic)
E: erythromycin/macrolides (bacteriostatic)
L: linzolin (variable)
Aminoglycosides
Gentamicin, neomycin, amikacin, tobramycin, streptomycin
MOA: bactericidal, inhibit the formation of initiation complex, cause misleading of mRNA, and blocks trnaslocation. Requires O2 for reuptake, so ineffectie against anaerobes
Clinical: severe gram negative rod, SYNERGISTIC with beta lactam Abx, “Neomcin for BOWEL surgery”
Toxicity: NEPHRO (esp when used with cephalosporin), neuromuscular blockage, ototoxicity (esp when used with loop diuretics), TERATOGEN
Resistance: transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation
“Mean (aMINon) GNATS caNNOT kill anaerobes”
Tetracyclin
Tetracyclin, doxy, demeclocyclin, minocyclin
MOA: bacteriostatic, binds to 30S and prevent attachemnt of aminoacryl tRNA, but LIMITED CNS penetration.
Doxy is FECALLY eliminated so used in patients with RENAL FAILURE.
Do not take with milk, antiacid, or iron containing prep because divalent cations inhibit its absorption in the gut
Clinical: lyme, M pneumo, drugs ability to accumulate intracellularly makes it very effective against RICKETTISA and CHLAMYDIA
Toxicity: discoloration of teeth and inhibition of bone growth in children, photosentivity and contraindicated in pregos
Resistance: decrease uptake or increased efflux
Demeclocyclin: ADH antagonist, acts as a diuretic in SAID, rarely used as Abx
Macrolides
Azithromycin, clarithromycin, erythromycin
MOA: blocks translocation (macroslides), binds to 23S rRNA of the 50S ribosomal subunit, bacteriostatic
Clinical: atypical pneumo (mycoplasma, chlaamydia, legionella), STD (for chlamydia), and gram posstive cocci
Toxicity: MACRO: motility issue, arrythmias (caused by prolonged QT), acute Cholestatic hepatitis, Rash and eOsinophilia
Also, increases serum concentration of theophyllines, oral anticoagulants
Resistance: methylation of 23S rRNA binding site
Chloramphenicol
Blocks peptidyltransferase at 50S ribosome, bacteriostatic
Clininical: meningitis (H influenza, N meningiditis, strep pneumo). Conservative use due to toxicity but widely used in others for low cost
Toxicity: anemia (dose dependent), aplsatic anemia (dose independent), GRAY BABY SYNDROME (in premature infants because they lack UDP-glucuronyl transferase)
Resistance: plasmid encoded acetyltransferase that inactivate drug
Clinda
Blocks peptide transfer (transpeptidation) at 50S, bacteriostatic.
Clinical: anaerobic infection (Bacteroides, C. perfringe) in aspiration pneumo, lung abscess, oral infections with mouth anaerobes.
“Treat anaerobes above the diaphragm, vs metronidazole (anaerobic below diaphragm)”
