ID: Antibiotic Classes Flashcards
1
Q
B-Lactam MoA/Info
A
- MoA: Inhibit cell wall synthesis by binding to PBPs and inhibiting final step of peptidoglycan synthesis
- TIME-dependent (extend inf. times, esp. ES-cillins)
- Avoid if PCN/B-lactam allergy present
- Caution if pt is a seizure risk
- Probenecid increases B-lactam levels
- *Includes PCN/Cephalosporins/Carbapenems**
2
Q
B-Lactam Med Notes
A
- NEVER give Bicillin IV => death
- Nafcillin is a vesicant, give with central line
- Ampicillin is diluted in NS ONLY
3
Q
Cephalosporin Drug Notes
A
- PO options only in Group 1 third generation and earlier (rest are IV)
- Ceftin (cefuroxime) comes in IV, IM, and PO
- CefOtetan and CefOxitin have anaerObic activity (B. fragilis)
- Ceftriaxone is only med that DOESN’T need renal dose adjustment
4
Q
Carbapenem Information
A
- Used for ESBL-producing organisms and Pseudomonas
- Avoid in B-lactam allergies
- Caution in seizure risk pts (esp. renal failure)
- ALL are IV
- DON’T cover atypicals, MRSA, VRE
5
Q
Carbapenem Med Information
A
- ErtAPpenem doesn’t cover PEA: pseudomonas, enterococcus, actinobacter
- Ertapenem is NS stable only
6
Q
Aztreonam
A
- IV only
- Monobactam
- Can be used in pts with B-lactam allergy
- G”-“ coverage including pseudomonas
7
Q
Aminoglycoside MoA/Info
A
- MoA: bind to ribosome and interfere with bacterial protein synthesis (leads to defective cell membrane)
- Cover G”-“ organisms including pseudomonas, synergy for G”+”
- Traditional and Extended-interval dosing ([higher] given Q24H)
- Renal and ototoxicity
8
Q
Traditional vs Extended-Interval
A
- Traditional: peaks and troughs (<2 mcg/mL), given q8H
- Extended-interval: random intervals/nomograms (On line? go up level), less accumulation/nephrotoxic risk/cost
9
Q
Quinolones MoA/Information
A
- MoA: inhibit DNA topoisomerase and DNA gyrase which prevents bacterial DNA coiling (breaks)
- Boxed warning: tendon rupture!, peripheral neuropathy, use LAST LINE
- Warning: QT prolongation (avoid mult. prolonging drugs), psychiatric disturbance, photosensitivity
- DON’T use in kids (effects bones/teeth/etc)
- Chelates with divalent cations (iron/calcium/etc)
10
Q
Quinolone Med Info
A
- Respiratory Quinolones: Moxifloxacin, gemifloxacin, levofloxacin (“my good lungs,” activity against S pneumonia)
- Moxifloxacin ISN’T renally adjusted; therefore, don’t use for UTIs
- Antipseudomonals: Levofloxacin, Ciprofloxacin
- IV:PO 1:1 => moxi and levo
11
Q
Macrolide MoA/Info
A
- MoA: binds to 50s ribosome and inhibits RNA-dependent protein synthesis
- GREAT atypical coverage
- Important brand/generic drugs to know, all top sellers (Zithromax, Biaxin, E.E.S.)
- Commonly used for CAP, strep throat, and some others (diff. slide)
- QT prolongation!
- Clarithromycin and erythromycin are STRONG CYP3A4i (CI with sim/lovastatin)
12
Q
Macrolide Med Info
A
- Azithromycin uses: STIs (chlamydia, gonorrhea), MAC prophylaxis
- Clarithromycin uses: H. pylori
- Erythromycin uses: increases gastric mobility
13
Q
Tetracyclines MoA/Info
A
- MoA: binds reversibly with 30s ribosome unit
- Covers CA-MRSA, Rickettsiae disease, STIs, VRE, acne (common use)
- Know brand names: Vibramycin, Minocin, Solodyn
- Safety issues: avoid in kids <8 yo (bone/muscle development), photosensitivity, divalent interactions
14
Q
Tetracycline Med Info
A
- Doxycycline uses: tick-borne disease, CAP, chlamydia, gonorrhea
- Doxycycline and minocycline are IV:PO 1:1
- Minocycline is a DILE risk
15
Q
Sulfonamide MoA/Med/Info
A
- MoA: inhibits part of folic acid pathway to stop bacterial folic acid synthesis
- Main drug: Bactrim (SMX/TMP) - dose based on TMP (5:1 SMX:TMP)
- Do not use with sulfa allergy
- Not safe in preggo/BF
- SJS/TEN risk
- Don’t use in G6PD deficiency (hemolytic anemia - “+” Coombs)
- Elevates INR when used with warfarin (inhibitor)
16
Q
Oral Refrigerated Abx
A
After reconstitution:
- Penicillin VK
- Ampicillin
- Augmentin
17
Q
Abx to NOT Refrigerate
A
- Cefdinir (oral)
- Metronidazole
- Moxifloxacin
- Bactrim
18
Q
Abx w/o Renal Adjustments
A
- Antistaph. penicillins**
- Ceftriaxone**
- Clindamycin**
- Doxycycline
- Macrolides (azith and erythromycin only)
- Metronidazole
- Moxifloxacin**
- Linezolid**
19
Q
Empty Stomach Abx
A
- Ampicillin (oral soln/capsules)
- Cefibuten susp
- Levofloxacin oral soln
- Penicillin VK
- Rifampin
- Isoniazid
- Itraconazole soln
- Voriconazole
20
Q
1:1 IV:PO Abx
A
- Levofloxacin (also moxi)
- Doxy and minocycline
- Linezolid
- Metronidazole
- Bactrim
21
Q
Light Protection during Admin Abx
A
- Doxycycline
- Micafungin
22
Q
Dextrose only Abx
A
- Synercid
- Bactrim
- Amphotericin B
23
Q
NS Only Abx
A
- Ampicillin
- Ampicillin/Sulbactam
- Ertapenem
- Daptomycin (RF - water for reconstitution)
24
Q
NS/LR Only Abx
A
- Caspofungin
- Daptomycin
25
Vancomycin MoA/Info
- MoA: inhibits cell wall synthesis by binding to d-alanine-d-alanine
- PO: covers C.diff only, QID x 10d
- 1st line choice for MRSA
- IV dose: 15-20 mg/kg Q8-12H, TBW!
- Causes nephro/ototoxicity (adjust for renal failure)
- Red Man Syndrome: slow inf. rate
- Don't use if MIC >= 2
26
Lipoglycopeptides MoA/Info
- Similar MoA and coverage to vanco
- Approved for skin infections
- All meds end in "-vancin"
- All cause red man syndrome
27
Lipoglycopeptide Med Info
- Telavancin approved for HAP/VAP
- Orita and dalbavancin are single-dose regimens
- Telavancin warnings: fetal and kidney risk, avoid if CrCl =< 50
- Don't use telavancin with UFH or oritavancin w/in 5d of UFH use (related to effects on aPTT/PT/INR)
- Tela: increases aPTT/PT/INR
- Orita: increases PT/INR (acute) and aPTT (more chronically, 120 hours)9
28
Daptomycin MoA/Info
- MoA: binds to cell membrane and causes rapid depolarization and inhibits intracellular replication process
- Brand names: Cubicin +/- RF
- Similar activity to Vanco: minus C.diff and PLUS VRE
- Do NOT use for pneumonia (inactivated lung surfactant)
- Warning: myopathy/rhabdo
- Compatible with NS or LR (NO dextrose)
29
Oxazolidinones MoA/Info
- MoA: Binds to 50s ribosome to inhibit translation/protein synthesis
- Coverage similar to vanco + VRE
- Linezolid (Zyvox) is approved for more indications and is 1:1 IV:PO
- No MAOi use w/in 14 days (avoid methylene blue and other serotonergic drugs)
- Myelosuppression and optic neuropathy risk
- Avoid tyramine-containing foods
30
Synercid MoA/Info
- Quinupristin/Dalfopristin
- MoA: streptogramin that binds to 50s ribosome to inhibit protein synthesis
- Poorly tolerated: arthralgias/myalgias, infusion rxns, hyperbilirubiemia
- D5W compatible ONLY
- Phlebitis risk => central line only
31
Tigecycline MoA/Info
- MoA: glycylcycline binds to to 30s unit to inhibit protein synthesis (similar to tetracyclines)
- Covers almost everything'
- Don't use in bloodstream infections
- No activity against "3 Ps:" Proteus, pseudomonas, providencia
- Yellow-orange color
32
Polymixin Info
- Main meds: polymixin B or colistin (colisimethate sodium)
- Broad spectrum coverage
- Complicated dosing
- Toxicity: nephrotoxicity, neurotoxicity
33
Chloramphenicol
- Broad spectrum coverage
- Risk for gray syndrome
- Many blood dyscrasias
34
Cleocin
- Clindamycin
- MoA: lincosamide that binds to 50s and inhibits protein synthesis
- Covers anaerobes! and some staph/strep
- No renal dose adjustment!
- D-test (positive means don't take it)
35
Flagyl
- Metronidazole
- Anaerobic and protozoal infections coverage
- IV:PO 1:1
- CI: disulfiram rxn with alcohol, avoid in preggo (esp. 1st trimester)
- Increases INR (2C9 inhibitor)
36
Dificid
- First-line treatment for C.diff now
| - PO only
37
Rifaximin
- Treats E.coli
- Used for traveler's diarrhea and IBS with diarrhea
- Less than 1% absorption
38
Nitrofurantoin
- MacroBID: BID
- Macrodantin: QID
- Drug of choice for uncomplicated UTI
- Avoid w/ G6PD deficiency (hemolytic anemia, Coombs +)
- Take with food
- Discolors urine as brown
39
Fosfomycin
- Used for E.Coli, including ESBL and E.faecalis (including VRE)
- Single-dose regimen
40
Bactroban
- Mupirocin
- Topical
- Used to eliminate MRSA in nares
- Single use tubes, 5d therapy
