Exam Review Flashcards
2 ways of Mechanism of Bacterial Resistance
- if the bacteria can prevent penicillin from getting to Penicillin Binding Protein, they will win
- Bacteria have developed defense against pencillins by creating BETA-LACTAMASES (aka penicillinase) which the bug makes, gets in and tears up the Beta Lactam Ring
Penicillin G
the golden standard, narrow spectrum, antibiotic of choice to this day
Penicillin G
Antimicrobial Spectrum
Gram+ bacteria; Gram- cocci! Still considered a narrow spectrum antibiotic meaning it’s going to do it’s job correctly without killing the good guys as well
Penicillin G
Therapeutic Use
pneumonias and different meningitis, pharyngitis; Used prophylactically in pts at risk for bacterial endocarditis, w/infected sex partners, and recurrent attacks of Rheumatic Fever
Penicillin G
Pharmacokinetics
well distributed, minimal metabolism via the kidney as unchanged drug;
1/2 life is about 30 minutes
Penicillin G
Potential SIde Effects
considered least toxic of all antibiotics; perhaps the safest if you have side effects it is usually do to the stuff that it’s compounded with;
Pain at the IM site—> biggest side effect
Penicillin G
Allergies
Don’t give to pt w/hx of allergies; nearly allergy free even though anaphylactic reactions occur more frequently w/penicillin that other antibiotics, the incidence is still very low;
VERY SAFE COMPARED TO OTHER ANTIBIOTICS; HAS MORE REACTIONS BUT IT HAS A VERY SMALL PERCENTAGE OF REACTIONS
Penicillin G
Drug Interactions
no alcohol, monitor I&O, not all drug interactions are bad
AMPICiLLIN
SEMI-SYNTHETIC PENICILLIN
broad spectrum penicillin; it has little additional amino acid; bacteria cell wall inhibitor….the additional amino acid allows it to be effective against more organism, it will kill more different types of bugs; works with the cell wall of trans peptidase
Ampicillin
Potential side effects
rash diarrhea, can be given PO and IV, may decrease the effective of contraceptives
4 pharmacologic targets
DNA synthesis, bacterial cell wall, folic acid, portent synthesis
Cephalosporine
broad spectrum, semi synthetic beta lactam antibiotic. beta lactam rings in cephalosporins are quite often beta lactamase (penicillinase) resistant
Cephalosporine
Mechanism of Action
bactericidal (destroying the cell walls); go to bind with PBP, which is a transport system (otherwise they won’t get to their target);; most effectives against cells that are active/growing/dividing
Given PO most are given parentally (IV)
Cephalosporine
Pharmacokinetics
distributie well, lungs, kidneys, and urine;
synovial, pleural and pericardial fluids; elimination via the kidneys–> not good to use if pt has kidney problems
Cephalosporine
Microbial Resistance
beta lactmases, but these drugs are a little stronger against beta lactamases
Cephalosporine
Cross Sensitivity
due to potential for cross sensitivity reactions in its allergic to penicillin, are generally not given cephalosporins because their chemical makeup is very similar; They
Cephalosporine
Allergic Reaction
small chance of allergic reaction, pretty safe
Cephalosporine
Potential Adverse Effects
can impair hemostasis so there is a risk of serious bleeding in patients that take this w/ an anticoagulant (BLOOD THINNER)
Greater risk for C. Diff
Risk for Thromnophletbitis (Seen with IV therapy)
All broad spectrum penicillins
Cephalosporine
Drug Interactions
can’t be used with blood thinners or alcohol
Three anticoagulants
ASA, warfarin, plavix, heparin
FIRST GENERATION CEPHALOSPORINES
ANCEF(CEFAZOLIN)
KEFZOL(CEFAZOLIN)
KEFLEX (CEPHALEXIN)
SECOND GENERATION CEPHALOSPORINES
CEFZIL (CEFPROZIL)
CECLOR (CEFACLOR)
CEFOTETAN (CEFOTAN)
THIRD GENERATION CEPHALOSPORINES
OMINEF
ROCEPHIN (CEFTRIAXONE)–> WHEN COMBINED WITH CALCIUM IT IS FATAL, ESPECIALLY WITH NEONATES
SUPRAX (CEFIXIME)
FOURTH GENERATION CEPHALOSPORINES
CEFEPIME (MAXIPIME)
CEFPIROME (CEFROM, KEITEN, BROACT)
Carbapenems
block growth of bacterial cell wall
Carbapenems
Mechanism of Action
destroy bacterial cell wall; weaken and then lyse it; BROAD SPECTRUM, low toxicity, all given parenterally, only used with patients that can’t be treated with more narrow spectrum drug
CARBAPENEMS
IMIPENEM (PRIMAXIM)
always given with Cilastatin, inhibits cell wall synthesis, does pretty good again a lot of bacteria;
Carbapenems- Imipenem (primaxim)
Pharmacokinetics
Not absorbed in the GI, administered IV and IM.
Carbapenems-Imipenem(primaxim)
Metabolism/excretion
rapidly degraded by renal enzyme when administered alone, so it is always given with Cilastatin ; protects the renal tubules and the kidneys
Carbapenems -Imipenem (primaxim)
Potential Adverse Effects
GI problems, pregnancy C
Carbapenems
Meropenem (Merem)
good for bacterial meningitis in kids 3 or older; that’s good news; PREGNANCY B
Carbapenems
ERTAPENEM (INVANZ)
given by injection into muscle or vein; 1 daily that’s pretty cool, pregnancy B
Carbapenems- DORIPENEM (Doribax)
good for complicated intrabdominal infections and complicated UTIS, given IV, has a 1/2 life of 1 hour; pregnancy baker
MONOBACTAMS
Azetreonam (Azactam)
only binds to PBP of gram - bacteria; has a single ring pretty stable again most beta lactamases
Vancomycein
Miscellaneous Cell Wall Inhibitors
does not have a beta lactam ring, it is a glycopeptide antibiotic;
Good with gram +, C.diff, MRSA, and patients with serious infections that are allergic to penicillin;
will mess up synthesis
Vancomycein
Potential adverse Effects
ototoxicity, loss of hearing, confusion, and hallucinations;
Serious side effects, pretty easily toxic; only used for serious infections not common infections!
if infused rapidly may cause infusion reactions–> sometimes called redneck syndrome;
Rashes, flushing, tachycardia, and hypotention, administered slowly over 60 minutes, pregnancy , also renal toxicity
What three combination of medicines will enhance effectiveness?
Bling, potassium, probenicid
Tetracycline
work by suppressing growth and replication rather than out right killing of the bug;
Not 1st line drugs, we don’t reach for these immediately.
Tetracycline is used for?
rocky mountain spotted fever, typhus, Q fever cholera, some pneumonia, acne, rheumatoid arthritis, periodontal disease, also used for treatment/prevention of inflation anthrax
