Overview of antimicrobials Part II, J Kinder, DSA Flashcards
MOA Fluoroquinolones
[ ] dependent, targets DNA gyrase and topoisomerase IV
how does R form to fluoroquinolones
mutation in bacterial chromosome genes encoding DNA gyrase or topoisomerase IV or by active transport out of cell
spectrum of coverage with FQ
E coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas, S aureus
limited Strep
Therapeutic use of FQ
UTI, prostatitis, STI, travelers diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections, propylaxis in neutropenic patients
Respiratory specific FQ cover what pathogens
S pneumoniae, H influenzae, Morazella, S aureus, M pneumoniase, C pneumoniae, Legionella
Cipro covers what additional pathogen
pseudomonas
What are the FQs
Cipro, levofloxacin, moxifloxicin
PO, IV, topical
Adverse effects FQs
GI 3-17% (nausea, comiting
CNS: HA, dizziness, rare halucinations
rash photosensitivity
Achilles tendon rupture
What are the aminoglycosides
gentamycin IV, IM, topical
MOA aminoglycosides
[ ] dependent, bind 30S ribosomes and disrupt normal cycle of ribosomal function by interfering with protein synthesis
how do aminoglycosides reach the site of action
diffusion through porin proteins in outer cell membrane of gram negative bacteria and electron transport/Oxygen dependent movement across cytoplasmic membrane
What is the post antibiotic effect of aminoglycosides
residual bactericidal activity after serum [ ] below MIC
how does R form to aminoglycosides
AG metabolizing enzymes, impaired transport of drug into cell, altered ribosomes
Spectrum covered by aminoglycosides
aerobic gram - bacteria
if combined with B lactam of vancomycin then kill gram +
Gentamycin is really active against what microbe
Serratia
Therapeutic use AGs
UTI
if there is R to other agents
pneumonia, HAP, peritoniitis assoc with dialysis
adverse effects of AGs
ototoxicity, nephrotoxicity, NMblock and apnea
What are the tetracyclines and glycylcyclines
doxycycline PO IV
MOA doxy
bacteriostatic, inhibits bacterial protein synthesis by binding 30S ribosomes and preventing access of aminoacyl tRNA to acceptro site on mRNA complex
R to doxy occurs how
decreased influx, acquisition of energy dependent efflux, ribosomal protection proteins, enzymatic inactivation
spectrum of doxy
wide range aerobic and anaerobic gram + and gram - activity as well as: Rickettsia, Coxeilla, Mycoplasma, Chlamydia spp, Legionella, Pasmodium, Borrelia, Treponema
B anthracic, Listeria, MRSA, H influenza, Helicobacter
What is R to doxy
Pseudomonas spp
Therapeutic use doxy
CAP, atypical CAP, community acquired SSTIs, community acquired MRSA, acne, Rickettsial infections(Rocky mountain spotted fever), Q fever, anthrax
adverse effects doxy
GI (epigastric burining, abdominal discomfort, nausea, vomiting, diarrhea
superinfections of C difficile, photosensitivity, teeth discoloration, thrombophlebitis
What are the macrolides/ketolids
Azithromycin PO IV
MOA zpak
bacteriostatic, binds reversibly to 50S ribosomal unit
inhibits translocation where newly synthesized peptidyl tRNA molecule moves to donor site
R to zpaks occur how
drug efflux, ribosomal protection proteins, hydrolysis, ribosomal mutations
spectrum of zpaks
aerobic gram + cocci and bacilli
Clostridium perfringens, Corynebacterium diphteria, Listeria
Therapeutic use of zpaks
respiratory tract infections, alternative for otitis media, sinusitis, bronchitis, SSTIs, Pertussis, gastroenteritis, H pylori, mycobacterial infections
adverse effects of zpaks
GI: epigastric distress
hepatotoxicity
arrhythmia
QT prolongation
Drug interactions with zpaks
CYP3A4 inhibition
prolongs effects of digoxin, valproate, warfarin, others
What are the lincosamides
Clindamycin PO, IV, IM topical
MOA clinda
binds 50S and suppresses protein synthesis
R to clinda
ribosomal methylation
Spectrum clinda
penumococci, S pyogens, viridans, streptococci, MSSA, anaerobes like B fragilis
What are R to clindamycin
all aerobic gram - bacilli
Therapeutic uses of clinda
SSTIs, nectrotizing SSTIs, lung abscesses, anaerobic lung and pleural space infections, topically for acne vulgaris
adverse effects of clinda
GI diarrhea pseudomembranous colitis skin rashes reversible increase in aminotransferase activity may potentiate neuromuscular blockade
What are the streptogramins
quinipristin/dalfopristin (IV)
*non respiratory
What are the oxazolidinones
Linezolid PO, IV
MOA linezolid
inhibits proteins synthesis binding P of 50S subunits, preventing formatino of larger ribosomal fmet-tRNA complex that initiates protein synthesis
R to linezolid occurs how
ribosomal mutations
Spectrum of linezolid
gram + staphy and strep, enterococci, gram + anaerobic cocci and rods
linezolid is bactericidal against what and bacteriostatic against what
bacteriocidal against strep
bacteriostatic against staphy and enterococci
Therapeutic use of linezolid
CRE faecium, nosocomial pneumonia caused by MSSA and MRSA, CAP, complicated SSTI infections, uncomplicated SSTIS
linezolid is reserved for what
multiple drug resistanc organisms
adverse effects linezolid
myelosuppresion, minor GI complaints, HA, rash
drug interactions with linezolid
weak nonspecific inhibitor monoamine oxidase, concomitant adrenergic or serotonergic may lead to serotonin syndrome (palpitations, HA, HTN crisis)
short term use
What are the polymyxins
Colistin and Polymyxin B
** not respiratory
What are the lipopeptides
daptomycin
** not respiratory
