Drugs but for realsies Flashcards by Amitav Rahman

7 common mechanisms of antibiotics

1) Disrupt bacterial cell wall
2) Increase permeability of cell membrane
3) lethal inhibition of bacterial protein synthesis
4) nonlethal inhibition of protein synthesis
5) Inhibit synthesis of nucleic acids
6) Antimetabolites
7) Inhibitors of viral DNA replication

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B lactam antibiotics mechanism of action

Disrupt bacterial cell wall causing them to take up water and burst through inhibiting transpeptidases that catalyze cell wall formation and activation of autolysins that cleave bonds in wall by binding Penicillin binding proteins

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Penicilins are inactive against most….

…gram negative bacteria

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B-lactamases

Coded for by a plasmid between bacteria to promote synthesis of proteins that release into the space around them to cleave certain PCNs

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Narrow spectrum PCN’s that are penicillinase sensitive

PCN-G

- PCN-V

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PCN-G treats what organisms, and is available in what form? Side effects?

Acts mostly on gram positive organisms, plus syphilus! Available in 4 diff salts depending on route of administration and course of action, Least toxic of all antibiotics, can have allergic reaction

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If a patient has a PCN allergy, then how should we use cephalosporins?

Cautiously, probably avoid if severe PCN reaction

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PCN drug interactions (3 to know)

1) probenecid - delay excretion
2) aminoglycosides - inhibed by PCNs and need to be administered separately
3) Bacteriostatic antibiotics - PCNs work best on fast dividing

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PCN-V

Similar to Pen G but soluble in gastric acid so replaced pen G for oral therapy

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Narrow spectrum PCN’s that are penicillinase resistant

oxacillin

- dicloxacillin

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Oxacillin and dicloxacillin treats what pathogens?

S. aureus and S. epidermidis

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Broad spectrum aminopenicllins

ampicillin

- amoxicillin

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Ampicillin and amoxicillin treat what organisms? Side effects?

gram positive plus some gram negative bacilli

- amoxicillin rash (not serious) in children

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Anti pseudomonal penicillins

-Piperacillin

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Cephalosporins mechanism of action

Same as PCN’s, bind PBP and disrupt cell wall snthesis and activate lysins

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1st -5th gen cephalosporins

1st gen most susceptible to B lactamases, 5th is highly resistant
Increased activity against gram - bacteria
increased ability to reach csf

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Cephalexin and what it treats

1st gen cephalospoirin, active against staphyloccoci and nonenterococcal streptococci, treat real easy shit sometimes given before surgery even

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Cefoxitin

2nd gen cephalosporin, Increased activity against gram - bacteria

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Ceftazidime and what it treats

3rd gen cephalosporin, broad spectrum, DOC for gram - bacilli

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Cefipime

4th gen cephalosporin, highly resistant to B lactamases and broad spectrum of activity

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Ceftaroline and what it treats

5th gen cephalosporin, only one active against MRSA

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Cephalosporin absorption method, adverse side effects?

IM or IV required, allergic hypersensitivity, bleeding

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Disulfuram like reaction

Occurs if patient is taking a cephalosporin and ingests alcohol

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Don’t mix ceftriaxone and…

Ca2+, fatal precipitate

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Carbapenems

B-lactam antibiotis that like penicillins and cephalosporins, inhibit bacterial cell wall synthesis, have very broad antimicrobial spectrum

Imipenum

Broad antimicrobial speectrum, can treat mixed infections

Carbapenems method of absorption

Paraenterally (IV)

Meropenum

Active against most gram pos and gram negative organisms

Vancomycin usage

Widely used for C. difficile infections, MRSA, and patients with PCN allergies

Vancomycin antimicrobial spectrum

Primarily gram + bacteria

Vancomycin adverse effects

- Renal failure (dose related) - Ototoxicity - Red man syndrome (histamine release resulting in rashes, flushing, potential to go into shock)

Alternatives to vancomycin

Teicoplanin (no bad side effects really) Fosfomycin Telavancin

Aminoglycosides are primarily effective against...

gram neg aerobes (must be aerobic for uptake)

Aminoglycoside mechanism of action

Disrupt bacterial protein synthesis by byinding the 30S ribosomal subunit, rapidly bacteriocidal

Aminoglycoside absorption, side effects

Paraenterally only (unless intended effect is to act in GI), sometimes topical therapy, ototoxicity nephrotoxicity, neuromuscular blockade

Neommycin, gentamicin

Topical aminoglycoside therapy

Aminoglycoside dosage must be very _____ because it has a _______

personalized, low therapeutic index

These two should never share an IV bag

PCNs and aminoglycosides

Gentamicin treats what organisms?

Treats serious infections caused by aerobic gram neg bacilli

Amikacin characteristics

- Broadest spectrum | - least vulnurable to inactivation

Tetracyclines mechanism of action

Broad spectrum antibiotics that inhibit protein synthesis at the ribosome after being transported via energy dependent processes

Tetracycline is rarely first drug of choice due to resistance in common bacterial diseases, but are still used to treat these few.

- Rickettsial diseases - Chlamydia trachomatis - Brucella - Cholera - Mycoplasma pneumoniae - borelia burgdorferi - H pylori - antrahx - acne vulgaris

Tetracycline absorption

Not bad absorption via GI, but form insoluble chelates with cations preventing absorption and thus require administration 1-2 hours after ingestion of a chelate

Tetracycline side effect

- GI upset - bones and teeth coloraion - suprainfection - hepatotoxicity - photosensitivity

Longest acting tetracycline

Doxycycline

Macrolides mechanism of action

Broad spectrum antibiotics that act by inhibiting bacterial protein synthesis, bind 50S ribosome and are bacteriostatic

Erythromycin spectrum

Similar to penicillin, active against most gram positive, some gram neg

When should erythromycin be used as DOC

Bordatella pertussis, corynebacterium diptheriae

Erythromycin absorption

Food decreases absorption

Erythromycin side effects

GI disturbances, QT prolongation and sudden cardiac death

Clarithromycin

2-4x more active than erythromycin,

Azithromycin

-More potent against specific organisms

Chloramphenicol

Broad spectrum antibiotic with severe risk of causing aplastic anemia

Chloramphenicol is drug of choice for...

Typhoid fever, bacterial meningitis

Gray baby syndrome

Neonates who have been given large doses of chloramphenicol

Dalflopristin/quinipristin, linezolid, treats

VRE

Fluoroquinolones

Broad spectrum PO

Fluoroquinolones side effects

Tendon rupture, peripheral neuropathy,

Cirpofloxacin

takes care of a lot of shit

Fluorquinolones mechanism of action

Passive diffusion, inhibit DNA replication, rapidly bactericidal

Ciprofloxin warfarin interaction

Elevates levels

Metronidazole

Useful for porotozoal infections and obligate anaerobic bacteria

Rifampin side effects

Discolored body fluids

Drugs but for realsies Flashcards

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