EXAM ONE COVERAGE Flashcards
Skin Normal Flora
- Staphylococcus
- Streptococci
- Diptheroids
Mouth Normal Flora
- Streptococci
- Neisseria Sp.
- Haemophilus Sp.
- Bacteroides Sp.
GU Tract Normal Flora
- Enterobacterales
- Lactobacillus Sp.
- Staphylococci
GI Tract Normal Flora
- Enterobacterales
- Bacteroides Sp.
- Clostridium Sp.
- Streptococci
- Enterococci
Staphylococci Aureus
Gram Pos Cocci
Coagulase +
Rapid Test = PNA-FISH
Can alter PBP to as form of resistance to beta-lactams
Staphylococci Epidermis
Gram Pos Cocci
Coagulase -
Streptococci Pneumoniae
Gram Pos DIPLOcocci
Alpha Hemolytic
Upper Respiratory Tract infection and Otitis Media
Streptococci Pyogenes
Gram Pos Cocci
Beta Hemolytic
Enterococcus Faecalis
Gram Pos Cocci
Gamma Hemolytic
More Sensitive
Enterococcus Faecium
Gram Pos Cocci
Gamma Hemolytic
More Resistant
Peptostreptococcus
Gram Pos Cocci
Anaerobe
Lactobacillus
Gram Pos Bacilli
Concomitant
Diptheroids
Gram Pos Bacilli
Concomitant
Clostridium Difficle
Gram Pos Bacilli
Anaerobe in GI Tract
E.Coli
Gram Neg Bacilli (enterobacterales)
Oxidase Negative
Klebsiella Sp.
Gram Neg Bacilli (enterobacterales)
Oxidase Negative
Proteus Sp.
Gram Neg Bacilli (enterobacterales)
Oxidase Negative
Enterobacter Sp.
Gram Neg Bacilli (enterobacterales)
Oxidase Negative
Pseudomonas Aeruginosa
Gram Neg Bacilli
Oxidase Positive = highly resistant, death in a matter of days
Piperacillin or Ceftazidime has good activity against
Cefepime or Ceftolozane or Cefiderocol has excellent activity against
Acinetobacter Sp.
Gram Neg Bacilli
Oxidase Negative
Bacteroides Fragilis
Gram Neg Bacilli
Strict Anaerobe
Moraxella Catarrhalis
Gram Neg DIPLOcocci
N. Gonorrhae, Meningilidis
Gram Neg DIPLOcocci
Coagulase Properties
Differentiate between STAPH
+ = fibrinogen to fibrin = clots = need treatment
- = no action = rarely causes infection
Hemolytic Properties
Differentiate between STREP
Oxidase Properties
Test gram NEG bacteria for specific electron oxidase pathway
+ = Pathogen
Oxidase Properties
Test gram NEG bacteria for specific electron oxidase pathway
+ = Pathogen
What are the 1st Generation Cephalosporins?
- Cefazolin
- Cefadroxil
- Cephalexin
What are the 2nd Generation Cephalosporins?
- Cefoxitin
- Cefaclor
- Cefuroxime
What are the 3rd Generation Cephalosporins?
- Ceftazidime
- Cefotaxime
- Cefpodoxime
- Ceftriaxone
- Cefdinir
What are the 4th Generation Cephalosporins?
- Cefepime
What are the 5th Generation Cephalosporins?
- Ceftaroline
- Ceftolozane
What are the Siderophore Cephalosporins?
- Cefiderocol
Ceftolozane
5th Generation
Treat Intra-Abdominal and UTIs
Administered with Tazobactam
Most POTENT Anti-Pseudomonal
Tazobactam
Beta-Lactamase Inhibitor
Combo with Ceftolozane
Heavily modified penAM backbone
Ceftazidime
Third Generation
Improved stability against certain beta-lactamases
Administered with AVIBACTAM
Avibactam
Broad Spectrum Inhibitory Activity against beta-lactamases
Bridged BICYCLIC scaffold
NON-BETA-LACTAM INHIBITOR
Reversible mechanism of inhibition, recyclizes
Relebactam
Board spectrum inhibitory activity against beta-lactamases
Bridged BICYCLIC scaffold
Admin with Imipenem/Cilastatin
What are 2 Carbapenems and what can they be administered in combination with?
- Thienamycin
- Imipenem
Admin with Cilastatin Sodium
Aztreonam Disodium
Monobactam
List clinically useful Carbapenems where the SULFA is located outside the ring?
- Ertapenem
- Doripenem
- Meropenem
Vancomycin
Glycopeptide
Narrow G+
Binds D-Ala-D-Ala, does not directly inhibit CMT
IV/PO, PO= C.Diff
TIME DEPENDENT antibiotic
AEs: Nephrotoxicity, Ototoxicity, Infusion Related Effects
Dalbavancin
Second Generation LipoGLYCOPEPTIDE
Gram Positive Bacteria: MRSA and MRSE
MOA: DIMERIZES and Inserts LIPOPHILIC side chain into membrane
Binds D-Ala-D-Ala
ABSSSI
IV once weekly
346 hr half life
Oritavancin
Semisynthetic lipoGLYCOPEPTIDE
Gram Pos SKIN infections
More active than Vanc for certain strains of C.Diff
MOA: disrupts cell membrane, inhibits transglycosylation and transpeptidation
195 hr half life
CAN BIND D-Ala-D-Lactate active against VRSA
Telavancin
LipoGLYCOPEPTIDE
9 hr half life
IV QD
AE: Nephrotoxicity and Teratogenic
Daptomycin
LipoPEPTIDE
Narrow Gram + including MRSA and VRSA, last resort antibiotic
MOA: lipid protein inserts into the bacterial cytoplasmic membrane where it aggregates and forms an ion-conducting channel
1: binds in a calcium dependent manner
2: oligomerizes, disrupts membrane
3: release of intracellular ions causes rapid cell death
IV QD/Infusion
AE: Muscular Toxicity
DDI: STATINS
Linezolid
Oxazolidinone
Narrow Gram +, MRSA, VRSA, Strep Pneumoniae, and VRE
C-Ring provides great flexibility in SAR
MOA: binds to the 23S portion of the 50S ribosomal subunit preventing the formation of the functional 70S initiation complex, intracellular target can bind in Gram + but CANNOT cross Gram - outer membrane
BEST ORAL drug for MRSA
Broken down in the liver = PO BID
AE: bone marrow suppression, peripheral neuropathy
DDI: MAOI monoamine oxidase inhibitor an SSRI
Tedizolid
Second Generation Oxazolidinone
Narrow Gram +, MRSA, VRSA, Strep Pneumoniae, and VRE
More potent against Staphylococci and Enterococci
MOA: binds to 50S subunit, more affinity than Linezolid
IV QD, transported by albumin
AE: same as Linzeolid but less effects due to lower doses
DDI: MAOI and SSRI
Streptogramins
Dalfopristin + Quinupristin = Macrolide Like
MOA: Bind 50S subunit
Always take in combination
Quinupristin
Streptogramin
Narrow Gram +, last resort VRSA, VRE, MRSA
MOA: binds MLSb on bacterial ribosome subunit
IV/3-4x daily
Metabolized in liver
AE: muscular toxicity, infusion related reactions
Dalfopristin
Streptogramin
Narrow Gram +, last resort VRSA, VRE, MRSA
MOA: binds nearby site, increased affinity of Quinupristin for 50S subunit
IV/3-4x daily
Metabolized in liver
AE: muscular toxicity, infusion related reactions
Lincosamides
MOA: Bind 50s subunit
ONLY ACT ON GRAM POS, due to extremely polar structure
Clindamycin
Lincosamide
Narrow Gram +, anaerobic gram + infections, penicillin allergy substitute, and some MRSA
MOA: REVERSIBLY bind 50s subunit
BETTER ORAL absorption and antimicrobial activity than Lincomycin
EXCELLENT penetration in bone, abscesses, macrophages, NOT CNS
AEs: increased risk for C.Diff (not sensitive to Clinda)
Sulfonamides
First Type: aniline substitute
Second Type: PRODRUGS
Third Type: Non-Alanine, no cleavage
Sulfanilamide
Newer versions have lower pKa vales to prevent Crystalluria
MOA: replacement of PABA
Sulfamethoxazole
Sulfonamide
BROAD spectrum, MRSA
Good Oral absorption
AE: nephrotoxicity, hyperkalemia, pancytopenia, photosensitivity, rash, SJS, epidermal necrolysis
KERNICTERUS IN NEONATES
Dihydrofolate Reductase Inhibitiors
Trimethoprime will target dihydrofolate reductase to stop DNA/RNA synthesis
Trimethoprim
Dihydrofolate Reductase Inhibitor
BROAD spectrum, MRSA
Good Oral absorption
AE: nephrotoxicity, hyperkalemia, pancytopenia, photosensitivity, rash, SJS, epidermal necrolysis
KERNICTERUS IN NEONATES
Bactrim
Sulfamethozaole (sulfanilamide) + Trimethoprim
DDI: WARFARIN, slowing drug metabolism
Mupirocin
Monocarboxylic Acid Class
Narrow Gram +
MOA: interrupting peptide-chain elongation, reversibly binds to bacterial isoleucyl-tRNA synthetase
TOPICAL ONLY
AE: allergic reactions, irritation
Teixobactin
MOA: binds to lipid II and lipid III cell wall peptidoglycan precursors
Acts on GRAM POS: Staph Aureus, Enterococci Faecalis, and M. tuberculosis
Penicillin G
Parent Penicillin
Narrow G+
Poor Oral absorption, Continuous IV
Unstable in acidic environments
Penicillin V
Parent Penicillin
Narrow G+
Oral absorption
Pen-VK
Acid Stable Form of Penicillin V
Pen V + Potassium Salt
Parent Penicillin V and G
Short half life 30-60 mins
Accumulate in renal insufficiency
Rapid renal elimination
Narrow G+
Oxacillin
Narrow G+
Penicillinase Resistant
IV
AE: hepatotoxicity
Methicillin
Prototype
Renal toxicity
No longer available
Nafcillin
Narrow G+
Penicillinase Resistant
IV
AE: interstitial nephritis, bone marrow suppression
Dicloxacillin
Narrow G+
Penicillinase Resistant
Oral, take on empty stomach
MRSA Resistant to what?
Oxacillin, Nafcillin, and Dicloxacillin, and other B-Lactams
Ampicillin
Extended G+
Penicillinase Sensitive
IV/PO, limited oral absorption affected by food
Amoxicillin
Extended G+
Penicillinase Sensitive
PO, 100% absorption, no effect with food
Piperacillin
Extended G+, more gram- most extended of ALL penicillins
Penicillinase Sensitive
IV
GOOD ACTIVITY against Pseudomonas Aeruginosa
Unasyn
Ampicillin + Sulbactam
IV
Broad Spectrum
Augmentin
Amoxicillin + Clavulanic Acid
PO
Broad Spectrum
Zosyn
Piperacillin + Tazobactam
IV
Broad Spectrum
Cefazolin
First Generation
Extended G+
IV, longest half life in 1st gen
DDI: Warfarin = increased anticoagulant effect
Cephalexin
First Generation
Extended G+
PO
Most widely used
Cefadroxil
First Generation
Extended G+
PO, best absorbed after oral admin
Cefoxitin
Second Generation
More Extended G+
Less Sensitive to Beta-Lactamases
IV
Cefuroxime
Second Generation
More Extended G+
Less Sensitive to Beta-Lactamases
IV/PO
Cefaclor
Second Generation
More Extended G+
Less Sensitive to Beta-Lactamases
PO
Cefotaxime
Third Generation
Broad Spectrum, Gram + and Enterobacteriaceae Rod Gram -
Resistant to B-Lactamase
Cross BBB
IV
First approved 3rd gen
Ceftriaxone
Third Generation
Broad Spectrum, Gram + and Enterobacteriaceae Rod Gram -
Resistant to B-Lactamase
Cross BBB
IV
Most widely used, long half life
AE: BILIRUBIN DISPLACEMENT
Ceftazidime
Third Generation
Broad Spectrum, Gram + and Enterobacteriaceae Rod Gram -
SENSITIVE to B-Lactamase
Cross BBB
IV, take in combo with AVIBACTAM
HIGH ACTIVITY AGAINST P.Aeruginosa
Cefdinir
Third Generation
Broad Spectrum, Gram + and Enterobacteriaceae Rod Gram -
Resistant to B-Lactamase
Cross BBB
PO
Can chelate with iron = stool discoloration
Cefpodoxime
Third Generation
Broad Spectrum, Gram + and Enterobacteriaceae Rod Gram -
Resistant to B-Lactamase
CANNOT cross BBB
PO
Cefepime
Fourth Generation
Broad Spectrum
Resistant to B-Lactamase
Cross BBB
Excellent activity against P.Aeruginosa
AE: INCREASED risk of seizures
Ceftaroline
Fifth Generation
Broad Spectrum
Resistant to B-Lactamase
NOT effective against P.Aeruginosa but EFFECTIVE against MRSA and VRSA (FDA approved)
Ceftolozane
Fifth Generation
USE IN COMBO with Tazobactam
Sensitive to B-Lactamase
Broad
Cefiderocol
Siderophere Cephalosporin: forms a complex w/iron to cross gram- outer membrane
Resistant B-Lactamase
Narrow Gram -
IV, last resort antibiotic for MDR gram -
Acinetobacter Baumannii
Gram Neg
Rod
Cefiderocol has excellent activity against
Imipenem
Carbapenem
Extreme Broad Spectrim
Resistant B-Lactamase
IV, Metabolites can cause kidney damage
AE: nephrotoxicity
Can use in combo with Cilastatin and Relebactam
Meropenem
Carbapenem
Extreme Broad Spectrim
Resistant B-Lactamase
IV, Resistant to dehydropeptidase
Can use in combo with Vaborbactam to target MDR
Ertapenem
Carbapenem
Extreme Broad Spectrim
Resistant B-Lactamase
IV, resistant to dehydropeptidase
Aztreobactam
Monobactam
Narrow G-
IV
No cross-allergic reactions with other B-Lactams
ALL Penicillin AEs
CNS Excitation and Seizures at HIGH concentrations
ALL Cephalosporins AEs
Rash
Cross Reactivity with penicillin allergy
ALL Carbapenems AEs
INCREASED risk of seizures
Cross Reactivity with penicillin allergy
Beta-Lactamase Inhibitor + Aminopenicillin AEs
Diarrhea
Narrow G+ Penicillins
- Penicillin G (IV/IM)
- Penicillin V (PO empty stomach)
- Oxacillin (IV)
- Nafcillin (IV)
- Dicloxacillin (PO empty stomach)
Extended G+ Penicillins
- Ampicillin (IV, PO empty stomach)
- Amoxicillin (PO)
- Piperacillin (IV), P.Aeruginosa
Broad Spectrum Penicillins
- Unasyn (IV)
- Augmentin (PO)
- Zosyn (IV)
Which beta lactams have the broadest spectrum?
Carbapenems
For CNS Symptoms which beta lactams are the most problematic?
Carbapenems
Lefamulin
Pleuromutilins
Extended Gram +, MRSA, community pneumonia
MOA: unique binding site on 50s bacterial ribosome, inhibit protein synthesis
IV/PO
AE: QT prolongation, teratogenic
Enterococcus vs Enterobacterales
Coccus = gram positive
Bacterales = gram negative
Entero = gut
Pen G, Pen VK Coverage
Gram + Narrow
Gram Pos = Strep/S.Pneumo/E.Faecalis/Listeria
Gram Neg = T.Pallidum
Anaerobes = Gram +
Nafcillin, Oxacillin, and Dicloxacillin Coverage
Gram + Narrow
Gram Pos = Staph/Strep/S.Pneumo
Ampicillin and Amoxicillin Coverage
Extended Gram +
Gram Pos = Strep/S.Pneumo/E.Faecalis/Listeria
Unasyn and Augmentin Coverage
Broad Spectrum
Gram Pos = Strep/S.Pneumo/Staph/E.Faecalis/Listeria
Gram Neg = HENPEcK
Anaerobes = +/-
Zosyn Coverage
Broad Coverage
Gram Pos = Strep/Staph/E.Faecalis/Listeria
Gram Neg = HENPEcK and Pseudomas
Anaerobes = +/-
PEcK
Proteus
E.Coli
Klebsiella
HENPEcK
H.Influenzae
Enterobacter
Neisseria
Proteus
E.Coli
Klebsiella
Cephalexin, Cefadroxil, and Cefazolin Coverage
Gram Pos = Staph, Strep, S.Pneumo
Gram Neg = PEcK
Anaerobe = Peptostrepto
Cefoxitin, Cefuroxime, and Cefaclor Coverage
Gram Pos = Staph, Strep, S.Pneumo
Gram Neg = HENPEcK
Anaerobes = Peptostrepto, Cefoxitin = GN
Cefdinir, Cefpodozime, Ceftriazone, Ceftazidime, and Cefotazime Coverage
Gram Pos = Staph, Strep, S.Pneumo (except Ceftaz)
Gram Neg = HENPEcK (Ceftaz = pseudomonas)
Anaerobes = Peptostrepto, Cefotax = GN
Cefepime Coverage
Gram Pos = Staph, Strep, S.Pneumo
Gram Neg = HENPEcK and Pseudomonas
Anaerobe = Peptostrepto
Ceftaroline +++
Ceftolozane/Taxo —
Coverage
Gram Pos = Staph, S.Pneumo, Ceftaro = Staph/MRSA
Gram Neg = HENPEcK, Ceftolo = Pseudomonas
Anaerobe = Peptostreto, Ceftolol = GN
Cefiderocol Coverage
Gram Neg = Enterics, Pseudomonas
What drugs can cover Pseudomonas?
- Ceftazidime
- Cefepime
- Ceftolozane/Tazobactam
- Cefiderocol
- Zosyn
- Imipenem
- Meropenem
- Aztreonam
Imipenem/Cilstatin Coverage
Gram Pos = Staph, Strep, S.Pneumo, E.Faecalis
Gram Neg = HENPEcK, Pseudomonas
Anaerobe = +/-
Listeria
Meropenem Coverage
Gram Pos = Staph, Strep, S.Pneumo
Gram Neg = HENPEcK, Pseudomonas
Anaerobe = +/-
Ertapenem Coverage
Gram Pos = Staph, Strep, S.Pneumo, E.Faecalis
Gram Neg = HENPEcK
Anaerobe = +/-
Aztreonam Coverage
Gram Neg = Enterics, HENPEcK, and Pseudomonas
Vancomycin Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA, E.Faecalis
Anaerobes = Peptostrepto, Clostridia
Telavancin, Oritavancin, and Dalbavancin Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA, E.Faecalis
Anaerobes = Peptostrepto, Clostridia
Daptomycin Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA, E.Faecalis, VRE
Anaerobes = Peptostrepto
Linezolid and Tedizolid Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA, E.Faecalis,VRE (Linezolid = Listeria)
Anaerobes = Linezolid = Peptostrepto, Clostridia
Quin/Dalfopristin Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA, E.Faecalis, VRE
Clindamycin Coverage
Gram Pos = Strep, S.Pneumo, Staph, MRSA,
Anaerobes = Peptostrep
Bactrim Coverage
Gram Pos = Staph, MRSA, Listeria
Gram Neg = Enterics
Mupirocin Coverage
Gram Pos = Strep, Staph, MRSA
What drugs cover VRE?
- Daptomycin
- Linezolid
- Tedizolid
- Quinupristin/Dalfopristin
