S13C158 - Pharmacology of Antimicrobics, antifungals, antivirals Flashcards
-beta-lactams and glycopeptide MOA
- beta-lactam=penicillins and cephalosporins
- glycopeptides = vancomycin, teicoplanin, daptomycin
- cell wall active agents
- bind to bacterial cell wall, weaken it and cell lyses
- glycopeptides prevent cross-linking
- resistance occurs from mutations to the pcn-binding proteins that reduce binding of the abx to the cell wall
-protein synthesis inhibitors
- aminoglycosides, macrolides, linezolid, tetracyclines, clindamycin
- bind to ribosomes w/in bacteria, block protein synthesis
- aminoglycosides/tetracylines = 30S subunit
- macrolide/clindamycin = 50s subunit
- resistance occurs from resistance of cell wall permeability or pump that removes abx from the cell
-fluoroquinolones/rifampin/macrobid MOA
- nucleic acid inhibitors
- fluoroquinolones = inhibits DNA gyrase
- resistance occurs from decreased cell wall permeability
- rifampin inhibits RNA synthesis by binding RNA polymerase
- macrobid damages DNA (bacteria rarely become resistant)
-sulfonamides/trimethoprim
- enzyme inhibitors
- block steps in formation of folic acid
- resistance occurs from enzyme mutations
-examples of: natural penicillins
-pen G and V
-examples of: aminopenicillins
- ampicillin
- amoxicillin
-examples of: penicillinase-resistant penicillins
- oxacillin
- cloxacillin
- dicloxacillin
- nafcillin
-examples of: antipseudomonal penicillins
- piperacillin
- ticarcillin
-examples of: beta lactam/beta lactamase inihibior combos
- amox-clav
- ticarcillin-clavulanic acid
- ampicillin-sulbactam
- pip-tazo
-examples of: monobactams and carbapenems
- aztreonam
- ertapenem
- meropenem
- imipenem
-examples of: aminoglycosides
- gentamicin
- neomycin
- streptomycin
- tobramycin
-examples of: fluoroquinolones
- moxifloxacin
- ciprofloxacin
- levofloxacin
-examples of: 1st gen cephalosporin
- cefazolin (ancef) IV
- cephapirin
- cephalexin
- cefadroxil
-examples of: 2nd gen cephalosporin
- cefaclor PO
- cefotetan IV
- cefuroxime PO
- cefproxil PO
- cefoxitin IV
- cefuroxime IV
-examples of: 3rd gen cephalosporin
- ceftibuten PO
- cefotaxime IV
- ceftazidime IV
- ceftriaxone IV
- cefpodoxime PO
-examples of: 4th generation cephalosporin
-cefepime (IV)
-examples of: macrolides/tetracyclines
- erythromycin IV/PO
- azithromycin IV/PO
- clarithromycin PO
-tetracycline, minocycline, doxycycline
–examples of: folate inhibitors
- septra (trimethroprim-sulfamethoxazole)
- trimpex (trimethoprim)
-Bacteria cause and Abx tx of: pharyngitis
- GAS
- pcn
- alt: macrolide
-Bacteria cause and Abx tx of: sinusitis
- strep pneumo, h flu
- amox or amox-clav, or cefuroxime
- alt: macrolide or doxy
-Bacteria cause and Abx tx of: epiglottitis
- h flu, GAS
- CTX
- alt: cefuroxime
-Bacteria cause and Abx tx of: CAP
- s pneumoniae, viral, mycoplasma
- azithromycin
- alt: levofloxacin
-Bacteria cause and Abx tx of: CAP aspiration
- aerobes, anaerobes
- clindamycin
- alt: pip-taz, or CTX plus flagyl
-Bacteria cause and Abx tx of: CAP EtOH
- s pneumoniae, klebsiella
- CTX
- alt: levofloxacin
-Bacteria cause and Abx tx of: UTI
- e coli, enteric gm- rods
- septra
- alt: cipro, cephalexin, macrobid
-Bacteria cause and Abx tx of: cellulitis
- GAS, staph aureus
- cephalexin
- alt: dicloxacillin, clinda, septra, vanco
-Bacteria cause and Abx tx of: necrotizing fasciitis
- polymicrobial
- imipenem, meropenem plus vanco
-Bacteria cause and Abx tx of: cat bite
- pasteurella, mixed flora
- amox-clav
- clindamycin, cipro
-Bacteria cause and Abx tx of: meningitis
- s pneumoniae, n meningitides, s aureus
- ctx, vanco
-Bacteria cause and Abx tx of: meningitis immunocompromised
- listeria, h flu
- add ampicillin
-Bacteria cause and Abx tx of: acute abdomen
- gm- rods, anaerobes, enterococci
- pip-taz
-Common side effects: aminoglycosides
- nephrotoxicity (usually reversible)
- ototoxicity
-Common side effects: clindamycin
-pseudomembranous colitis (c diff)
-Common side effects: tetracyclines
-deposits and discolors teeth and bone
-Common side effects: vancomycin
-red person syndrome (phlebitis)
-Common side effects: fluoroquinolones
- long QT
- tendonitis, tendon rupture
-Common side effects: sulfonamides
- SJS
- hepatitis
- crystalluria
clindamycin does not cross the BBB effectively
True, therefore not good for meningitis (same with macrolides)
Contraindications: fluoroquinolones
- long QT
- tendonitis
- myasthenia gravis
Contraindications: flagyl
-first trimester of pregnancy
Contraindications: sulfonamides
-pregnancy at term
Abx drug interactions: aminoglycosides
- neuromuscular blockers (prolonged resp depression)
- loop diuretics - increased auditory toxicity
Abx drug interactions: fluoroquinolones
-antacids reduce absorption of fluoroquinolones
Abx drug interactions: macrolides
-clarithromycin increases levels of warfarin, cyclosporin, lovastatin
Abx drug interactions: penicillins
- allopurinol- increased rash with ampicillin
- probenicid reduces renal clearance of the abx
Abx drug interactions: tetracyclines
- antacids reduce oral absorption
- cause OCP failure
-Abx drug interactions: septra
-increases serum levels of phenytoin
