Respiratory Antibiotics Flashcards
amoxicillin
aminopenicillin
PO
ampicillin
aminopenicillin
PO, IV, IM
piperacillin
anti-pseudo penicillin
IV
ceftriaxone
third generation cephalosporin
IV, IM
ceftazidime
third generation cephalosporin
IV, IM
cefepime
fourth generation cephalosporin
IV, IM
meropenem
carbapenem
IV
ertapenem
carbapenem
IV, IM
beta-lactamase inhibitors
sulbactam
clavulinic acid
taxobactam
often given with the PCNs
ciprofloxacin
FQ
PO, IV, topical
levofloxacin
FQ
PO, IV, topical
moxifloxacin
FQ
PO, IV, topical
gentamicin
aminoglycosides
IV, IM, topical
doxycycline
tetracycline
PO, IV
azithromycin
macrolide
PO, IV, topical
clindamycin
lincosamide
linezolid
oxazolidinone
PO, IV
oseltamivir
anti-viral
-PO
flucanozole
antifungal
PO, IV
intraconazole
antifungal
PO
voriconazole
antifungal
PO, IV
penicillin resistance
drug destruction and inactivation by beta-lactamases
aminopenicillins
extended-spectrum
gram positive, gram negatives
upper resp infections with strep pyogenes, strep pneumoia, h flu
ampicillin
amoxicillin
hospital acquired pneumonia
pseudomonas
piperacillin
DOC for serious gram negatives
third gen cephalospirins
-ceftriaxone and ceftazidimine
pseudomonas coverage
cefepime
-4th gen cephalosporin
glycopeptide MOA
vancomycin
inhibit cell wall synthesis binding to D-Ala-D-Ala terminal
cannot penetrate cell wall of gram negatives
vancomycin
glycopeptide
IV***
monitor levels closely
clostridium dificile tx
oral vancomycin
red man syndrome
vancomycin adverse effect - due to rapid infusion - flushing, tachycardia, hypotension
also - macular rash, chills, fever, rash
fluoroquinolone MOA
bacterial DNA gyrase and topoisomerase IV
bactericidal - concentration dependent
ciprofloxacin
covers pseudomonas
respiratory FQs
levofloxacin
moxifloxacin
gemifloxacin
gonorrhea DOC
ceftriaxone
adverse with cephalosporins
GI sx
achilles tendon rupture in children
achilles tendon rupture in children
side effect of cephalosporins
aminoglycoside MOA
bind 30S ribosome subunit
-interfere initiation of protein synthesis
alter membrane permeability
tetractcycline MOA
binding 30S ribosome
-prevent access of aminoacyl tRNA to acceptor A site on mRNA ribosome complex
all strains pseudomonas
resistant to tetracyclines
macrolide MOA
reversibly bind 50S subunit
inhibit translocation where newly synthesized peptidyl tRNA molecule moves from acceptor site on ribosome to peptidyl donor site
atypical pneumonia tx
macrolides
-azithromycin
CYP3A4 inhibition
macrolides
lincosamide MOA
50S binding and suppress protein synthesis
clindamycin
oxazolidinones MOA
linezolid
inhibit protein synthesis - bind 50S subunit
-prevention formation of alrger fmet-tRNA complex that initiates protein synthesis
linezolid use
only MDR organisms
risk fx for drug resistance strep pneumonia
beta-lactam use within 3 months age < 2 or > 65 alcoholic immunosuppressive therapy exposure to day care child
underlying bronchopulmonary disease
h flu
moraxella catarrhalis
outpatient CAP
strep pneumo mycoplasma pneumo h flu chlamydophila pneumo resp viruses
hospitalized CAP
strep pneumo mycoplasma pneumo h flu chlamydophil pneumo resp viruses legionella aspiration
ICU CAP
strep pneumo staph aureus legionella gram negative bacilli h flu
outpatient tx CAP previously healthy
macrolide PO
or
doxycycline PO
outpatient tx CAP at risk for DRSP
resp FQ PO
-levo, moxi, gemi
or
beta-lactam PO + macrolide PO
-amoxicillin
inpatient, non ICU CAP tx
resp FQ IV or PO
or
beta-lactam IV + macrolide IV
inpatient, ICU pt CAP tx
beta-lactam IV + azithromycin IV
or
resp FQ
risk fx for pseudomonas
structural lung disease
COPD exacerbation
frequent corticosteroids and antibiotic use
tx pseudomonas CAP
anti-pseudo beta-lactam IV + cipro (or levofloxacin)
-piperacillin,cefepime
or
beta-lactam + aminoglycoside + azithromycin
or
beta-lactam + aminoglycoside + anti-pseudo FQ
risk fx for MRSA
ESRD - on dialysis
IV drug use
prior influenza
prior antibiotics
tx MRSA
add vancomycin IV or linezolid
panton-valentine leucocidin necrotizing pneumonia - add clindamycin or use linezolid
CAP therapy
minimum 5 days
must be afebrile 48-72 hours
exception - pseudomonas - 8 day course led to more relapse than 15 day course**
hospital acquire pneumonia bugs
pseudomonas E. coli klebsiella acinetobacter MRSA - in ICU, head trauma
pseudomonas resistance
efflux pumps
decreased porin channels
beta-lactamases
MRSA resistanace
reduced PBP affinity for beta-lactams
oseltamivir MOA
neurominidase inhibitor
-interferes with release of progeny influenza virus from infected cells
influenza A and B
oseltamivir adverse effects
N/V/D, psych sx
influenza prophylaxis
oseltamivir
HSV and VZV tx
acyclovir
-inhibit step 1 virus specific thymidine kinase
CMV tx
ganciclovir
-guanosine analog - requires activation by tri-P before inhibiting DNA polymerase
azole MOA
inhibit fungal CYP450 - reducing production of ergosterol
flucanazole, itraconazole, voriconazole
lots of drug interactions**
candida, blastomycosis, coccidiomycosis, histoplasmosis coverase
azoles
strep pneumo resistance
PBP reduced affinity
staph aureus resistance
PBP reduced affinity
gram positive resistance
reduced PBP affinity
gram negative resistance
beta-lactamase production