Spectrum/MOA Flashcards
TMP-SMX
Staph aureus E. coli UTIs Klebsiella H. flu Pneumocystis Toxoplasmosis
Inhibit dihydropteroate synthetase (sulfa) and dihydrofolate (tri)
Acylcovir
HSV
VZV
Nucleic acid analog one activated by viral TK
Ganciclovir
CMV (retinitis)
Guanine analog
Foscarnet
HSV (acyclovir-resistant)
VZV
CMV
Pyrophosphate congener
Oseltamivir
Influenza A/B
Neuroaminidase inhibitor
Zidovudine
HIV
NRTI
Lamivudine
HIV
NRTI
HAART=2NRTIs, NNRTI, and protease inhibitor
Efavirenz
HIV
NNRTI
Amprenavir
Ritonavir
HIV
Protease Inhibitor
Bocepravir
Telepravir
HCV
Protease Inhibitor
Enfurvitide
HIV
Fusion inhibitor
Raltegravir
HIV
Integrase inhibitor
Maraviroc
HIV
CCR5 receptor antagonist
Ciprofloxacin
Gram negatives
P. aeruginosa, E. cloacae has some FQ resistance via alteration of binding site
Inhibits DNA gyrase
Levofloxacin
Gram negatives Strep pnemo (less than 1% are resistant)
Inhibits DNA gyrase and topoisomerase IV
Rifampin
TB Staph aureus (osteomyelitis)
Inhibit DNA-dependent RNA polymerase
Metronidazole
Anaerobes (C. diff)
Giardia, Entamoeba
Toxic to nucleic acids in anerobic environment
Gentamycin/Tobramycin
Aerobic/ fac. aerobic Gram negative rods (enterobacteracaie)
Give quickly for sepsis, works fast
30S codon misreading and initiation
Doxycycline
Intracellular pathogens (mycoplasma, chlamydia, legionella, rikettsia) Gram positives (MRSA, S. pnemo) if resistant to lactams
30S, blocks tRNA access to codon (elongation)
Resistance by pumping drug out of cell
Azithromycin
Intracellular pathogens (mycoplasma, chlamydia, LEGIONELLA) H. flu Gram positives (MRSA, S. pnemo) if resistant to lactams
50S, inhibits translocase enzyme (translocation)
Methylation of 50S at P site- resistant S. aureus and S. pneumo
Linezolid
Gram positives (especially MRSA and VRSA)
50 S, inhibits peptidyl transferase
Methylation of 50S at P site- resistant S. aureus and S. pneumo
Clindamycin
Anaerobes (except C. diff)
Lactam resistant S. pnemo and MRSA
50S, inhibits elongation
Methylation of 50S at P site- resistant S. aureus and S. pneumo
Penicillin
Strep
Oral anerobes
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Penicillinase=resistance: all s. aureaus, b. fragilis, some H. flu
Strep pneumo: resistance thru PBP2b mutation
Dicloxacillin
Oxacillin
(penicillinase-resistant)
Equivalent to 1st gen cephalosporins (according to Lehmann’s chart)
Cefazolin, cephalexin
Strep
MSSA
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Strep pneumo: resistance thru PBP2b mutation
MRSA: resistance thru PBP 2b & 2x mutation
Amoxicillin
Ampicillin
(aminopenicillins)
Equivalent to 2nd gen cephalosporins
Cefuroxime (CNS entry)
Strep
Non-penicillinase H. flu
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Amoxicillin + clavulanate (Augmentin)
Equivalent to 2nd gen cephalosporins
Cefuroxime
Strep
All anerobes
H. flu
MSSA
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Adds back spectrum of penicillinase resistant
Strep pneumo, MRSA still resistant
Piperacillin
(extended spectrum penicillins)
Equivalent to 3rd gen cephalosporins
Ceftriaxone
Ceftazidime
Cefpodoxime
Strep
Gram negative rods (Proteus)
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Some P. aeruginosa and Enterobacter produce ESBLs and are resistant
ESBLs are resistant to ALL LACTAMS
Piperacillin + tazobactam (IV Zosyn)
Equivalent to 4th generation cephalosporins
Cefepime
Strep
Gram - rods
all anerobes
MSSA
Binds to PBP and inhibits transpeptidase and cell wall cross linking
Adds back spectrum of penicillinase resistant
Strep pneumo, MRSA still resistant
Carbapenem
Imipenem
Gram positive (except MRSA) Gram negative
Binds to PBP and inhibits transpeptidase and cell wall cross linking
They are resistant to b-lactamases
Monobactam
Aztreonam
Gram negative rods
Use for patients with penicillin/cephalosporin allergies
Binds to PBP and inhibits transpeptidase and cell wall cross linking
They are resistant to b-lactamases (good for pseudomonas)
Vancomycin
Glycopeptide
MRSA S. epi Ampicillin-resistant Enterococcus Strep pnemo meningitis Metronidazole resistant clostridrium
Binds to D-ala-D-ala to inhibit transglycosylation by competing with L-alanine for access to racemase to convert to D-isomer (slower onset, so only use if you’re sure its MRSA)
Resistance with change to D-ala-D-lac
Daptomycin
Cyclic lipopeptide
Gram positives only that are resistant to vancomycin & lactams or allergies (VRE, VRSA)
Inserts tail thru techie acid backbone, forming channel for leakage
Colistin
Polymixins
Gram negatives
Esp resistant Pseudomonas (CF)
Binds to LPS, disrupting membrane and causing leakage
Clotrimazole
Imidazoles
Broad spectrum: Candida and Dermatophytes
Topical
Inhibit ergosterol synthesis by blocking lanosterol demethylase
Tolnaftate
Allylamines
Dermatophytes
Topical
Inhibit ergosterol synthesis by blocking lanosterol demethylase
Fluconazole
Triazoles
Broad spectrum: deep mycoses and dermatophytes
Systemic
Inhibit ergosterol synthesis by blocking lanosterol demethylase
Terbinafine
Allylamines
Narrow spectrum: nail infections/onychomycoses
Systemic
Inhibit ergosterol synthesis by blocking lanosterol demethylase
Caspofungin
Life threatening fungal infections that are non-responsive (-azole resistant)
Esp candida and aspergillus
Systemic
Inhibits glucan synthesis
Nystatin
Superficial fungal infections
Candida
Topical
Forms pores in cell membranes where K and Mg leak out of cell
Amphotericin B
Life threatening deep mycoses
(sometimes in combo with flucytosine if immunocompromised)
Systemic
Forms pores in cell membranes where K and Mg leak out of cell
Flucytosine
Used in combo with amphotericin B for life threatening systemic infections
Forms 5-FU, converted to nucleoside analog and incorporated into RNA, or inhibits thymidylate synthase
