Pharmacology Flashcards
Cell wall synthesis inhibitors
Beta lactams
Glycopeptides
Daptomycin
Modifiers of DNA / nucleic acid synthesis
Fluoroquinolones
Metronidazole
Modifiers of protein synthesis
8
Tetracycline Macrolides/Ketolides Aminoglycosides Chloramphenicol Quinupristin/Dalfopristin Clindamycin Linezolid Glycylcycline
Modifiers of energy metabolism
Sulfamethoxazole/Trimethoprim
SMX/TMP
What is the best route for concentration independent killers? Why?
Continuous IV
Needs the most time above the MIC
What is the best route for concentration dependent killers?
Largest dose without toxicity
Given once
Beta lactams
Penicillins
Cephalosporins
Carbapenems
Monobactams
This class of drugs binds to the PBP
Beta lactams
What are beta lactamases?
What produces them?
Enzymes secreted by bacteria
Gram -
Staph
Beta lactamase inhibitors
Clavulanate
Sulbactam
Tazobactam
Natural penicillins are used for__
Group A strep
Aminopenicillins are used for__
Enterococcus faecalis Strep pneumoniae (high dose!!)
Penicillinase resistant penicillins include:
Dicloxacillin (oral)
Oxacillin (IV)
Nafcillin (IV)
Methicillin (IV)
What is the drug of choice for non-MRSA staph aureus infections?
Penicillin
What beta lactams/beta lactamase inhibitor combo is mostly used?
When is it used?
Piperacillin / Tazobactam
Used when pseudomonas is suspected
Broad spectrum
In general, lower generations of cephalosporins have better ___ coverage.
Higher generations have better ___ coverage.
Gram +
Gram -
First generation cephalosporins are active against __
Gram + aerobes
MSSA
E. coli
Second generation cephalosporins Example?
Cefoxitin is active against Bacteroides and Clostridium
BUT NOT C. diff
This is the only one that is below the diaphragm
Third generation cephalosporins
Example?
Mostly gram -
Don’t usually use for gram +
Ceftazidime is the ONLY third gen that can cover pseudomonas
Fourth generation cephalosporins
Example?
Gram -
Stability against beta lactamases
Cefepime
Fifth generation cephalosporins
Example?
Ceftaroline is the only beta lactam that covers MRSA
it can attach to the altered PBP
What gen of cephalosporins is Cefepime?
4th
What gen of cephalosporins is Ceftazidime?
3rd
What gen of cephalosporins is Ceftaroline?
5th
What gen of cephalosporins is Cefoxitin?
2nd
What are the broadest spectrum antibiotics we have?
Carbapenems
What is NOT covered by carbapenems?
MRSA
C. diff
Ertapenem does not cover pseudomonas but the other 3 do
List of carbapenems
Ertapenem
Meropenem
Imipenem-cilastatin
Doripenem
Aztreonam is a __
4 key points
Monobactam
IV only
Covers pseudomonas
Can be safely used in people w/penicillin allergies
Gram - only
Glycopeptides:
Vancomycin and its copy cats:
Televancin
Oritavancin
Dalbavancin
Coverage of vancomycin
Gram + only
Staph aureus
-MRSA
-MSSA but use beta lactam first!
C. diff (ORAL ONLY)
Dosage for vancomycin is based on ___
Kidney function
ADE for vancomycin
Red man syndrome
IV related
ADE for televancin
Foamy urine
Metallic taste
Daptomycin only covers ___ bacteria.
You cannot use it for ___ because ___
Gram +
Pneumonia
It is inactivated by lung surfactant
Tetracyclines
Doxycycline
Minocycline (acne)
Tetracycline (not really used)
Doxycycline covers ___
Gram + aerobes
-staph aureus (MSSA/MRSA)
Gram - aerobes but resistance is common
Atypical bacteria
Doxycycline can interact with ___
ADE?
Divalent and trivalent cations
GI symptoms
Nausea
Vomiting
Diarrhea
Glycylcycline example?
Tigecycline
Limited to severe infections
Macrolides/Ketolides
Erythromycin
Calrithromycin
Azithromycin *
Macrolides/Ketolides spectrum
S. pneumoniae H. influenzae M. catarrhalis Atypicals Mycobacterium
ADE for macrolides/ketolides
QTc prolongation
Nausea
Vomiting
Diarrhea
*Black Box Warning
Aminoglycosides key points
4
Usually only gram -
Only IV
only hospital settings
Severe infections
Aminoglycosides are ___ and ___
Bactericidal and concentration dependent
Aminoglycosides spectrum
Enterococcus - synergy
Gram - aerobes
*rarely monotherapy
Aminoglycosides absorption
Poor GI absorption
No oral options
Dosage based on kidney function
ADE of aminoglycosides
Nephrotoxicity
Ototoxicity
Clindamycin spectrum
Gram + and - aerobes
Staph aureus including MRSA
Anerobes
What is the most common cause of antibiotic associated C. diff?
Clindamycin
Linezolid spectrum
Useful for MRSA
Gram + only
ADE of linezolid
Myelosuppression with >2 weeks use
Monoamine oxidase inhibition
-should not be used with MAOIs and SSRIs
What are the 3 Fluoroquinolones?
Ciprofloxacin
Moxifloxacin
Levofloxacin
Fluoroquinolones spectrum
Gram + and - Enterobacteriaceae Atypicals MSSA AVOID IN MRSA (resistance induced)
Strep pneumoniae (except ciprofloxacin) Pseudomonas (except moxifloxacin)
ADE of fluoroquinolones
QTc prolongation
Can interact with divalent and trivalent cations
QTc prolongation is an ADE for ___ and ___
Macrolides/Ketolides
Fluoroquinolones
Metronidazole spectrum
Anaerobic
Bacteroides
C. diff
Metronidazole can interact with __
Ethanol
Sulfamethoxazole/Trimethoprim inhibits___
Folate synthesis
SMX/TMP covers ___
MRSA
What drug requires dosage adjustment when CrCl <30ml/min?
SMX/TMP
ADE of SMX/TMP
Leukopenia
Thrombocytopenia
Eosinophilia
Epidermal necrolysis
Steven’s-Johnson
Crystalluria
