things to remember Flashcards
Natural PCN’s
great for streptococcus species
Aminopenicillins
drug of choice for enterococcus
DONT FOR GET LISTERIA
dicloxacillin
oxacillin
nafacillin
Drug of choice against staphylococcus
DOSE Adjust LIVER
Pipercillin
Streptococcus VSE Neiserria PSUEDOMONAS GP anaerobes
Aminopenicillinase/Beta lactatmase inhibitor
streptococcus VSE GNR HNM Anaerobes (+/-)
Antipusedomonal/betalactamase
Streptococcus VSE MSSA GNR HNM Psuedomonas Anaerobes (+/-)
2nd gen cephs
URI and walking pneumonia
streptococcus
GNR
HNM
Few anaerobes
3rd gen ceph
great empiric therapy
URI/UTI/Otitis media
Ceftazidime
GNR
HNM
psuedomonas
Cefepime
most broad spectrum (great empiric therapy)
Streptococcus MSSA GNR HNM Psuedomonas
Renal dose adjust esp in elderly
Ceftraroline
Streptococcus VSE MSSA GNR HNM
Ceftazadime/Betalactam
GNR
HNM
Psuedomonas
Reserved for SPACE pathogens
Ceftolozane/Tazobactam
Streptococcus
GNR
HNM
Psuedomonas
Carbapenems
SPEFICALLY FOR MDR(SPACE PATHOGENS) or SEPTIC SHOCK
very resistant to betalacamases
streptococcus VSE MSSA GNR HNM Psuedomonas
Ertapenem
streptococcus VSE MSSA GNR HNM
Meropenem/betalactamase inhibitor
Drug of choice for patients wit carbapenem -resistant enterobacter
Aztreonam
Safest drug to give with allergies \$\$\$\$$ Always given in tandem to get with GP covering agent GNR HNM Psuedomonas
Glycopeptides MOA
inhibit PBP from cross linking peptidoglycan
only susceptible to gram pos drugs only (except VRE)
bacteriostatic drugs
Streptococcus VSE MSSA MRSA GP+
Vanco IV vs. PO
infections (random levels vs. troughs
MRSA- 15-20
MSSA 10-20
PO-Cdiff (smaller doses no monitoring )
Tetracycline MOA
inhibit protein synthesis
prevent tRNA binding to 30s ribosomal subunit
bacteriostatic
dose adjustments: liver
Doxycycline and Tetracycline
• Strepto • MSSA • MRSA • HNM • Atypical don't give in children less than 8 because of enamel genesis vestibular toxicity and photosensitivity
dose adjustments: liver
Minocycline
Minocycline (MINO ATYPICAL) • Strepto • MSSA • MRSA • HNM dose adjustments: liver
Tigecycline
everything but VRE and Atypical
dose adjustments: liver
**CAN BE USED FOR MDR GNR INFECTIONS
Omadacycline
Omadacycline: Same + HM and Atypical • Strepto • VRE • MSSA • MRSA • GNR • HM • Atypicals dose adjustments: liver
Eravacycline:
Eravacycline: Same + Anaerobes • Streptococcus • VRE • MSSA • MRSA • GNR • Anaerobes
Fluroqoquinolones
inhibit both DNA gyrase and Topoisomerase
(prevents DNA from Replicating)
Bactericidal
black box warning and lots of bad ADR’s
Ciprofloxacin
Ciprofloxacin -bacteriocidal DOSE ADJUST RENAL
• VSE
• GNRbold
• Psuedomonasbold
Levofloxcain
Levofloxcain-bacteriocidal → RESPIRATORY FLUROQUINOLONE DOSE ADJUST RENAL
- Streptococcus
- VSE
- GNR*
- HNM*
- Psuedomonas*
- Atypicals
Moxifloxacin
Moxifloxacin → Respiriatory Covers: • Streptococcous • GNR* • HNM* • Pseudomonas* • Atypical • Anaerobes
Oxifloxacin
Oxifloxacin – bacteriocidal Covers: • Streptococcous • MSSA • GNR* • HNM* • Pseudomonas*
Delafloxacin
Delafloxacin → Respiratory Fluroquinolone Dose adjust renal Covers • Streptococcus • MSSA • MRSA • GNR* • HNM* • Pseudomonas* • Atypical
Macrolides MAO
inhibits protein synthesis
prevents tRNA binding to 50s ribosomal subunit
bacteriostatic
streptococcus
H+
Atypicals
H. pylori
think Jersey shore StHAHp
clarith and erytho inhibit drug metabolism by CYP enzymes
dose adjustment liver
Clindamycin MOA
inhibit protein synthesis (prevents tRNA binding to 50s ribosomal subunit)
bacteriostatic
streptococcus
MSSA
GP+
multiple day dosing to avoid side effects -associated with c. diff infections
Dose adjustment LIVER
Metronidazole
GP+ anaerobes esp. C. diff
ADRs peripheral neuropathy GI intolerance metallic tase
Bactrim MOA
inhibits formation of nucleic acids by inhibiting folic acid synthesis
SMX inhibits pteroate
***TMP inhibits folate reductase
→ dosing is based on this component
streptococcus MSSA MRSA GNR HNM
AMINOGLYCOSIDES
irreversibly bind with 30s subunit causing mRNA to be misread
Bacteriocidal
Synergistic coverage for GPC endocarditis streptococcus VSE VRE MSSA MRSA
by themselves
GNR
Psuedomonas
MONITOR PEAKS AND TROUGHS
–HAVE POST ANTIBIOTIC EFFECT (2-4hrs)
Aminoglycoside dosing gold standard
high bolus at beginning
Aminoglycoside dosing for people with kidney issues?
give smaller doses more frequently
Nitrofurantoin
SUSCEPTIBLE GNR → used to treat UTI’s (CYSTITIS)
*** CrCl must be greater than 50 – dependent on renal function to be therapeutic in bladder
Nitrofurantoin MOA
Metabolized within the bacterial cell to reactive intermediates that destroy DNA and ribosomal proteins
Bacterialcidal
Oxazolidinones
binds to 5Os subunit and doesn’t let 30s attach → no protein synthesis occurring
bacteriostatic
Streptococcus VSE VRE MSSA MRSA GP+ anaerobes
ADR’s thrombocyopenia and serotonin syndrome
Dose adjust liver
Daptomycin MOA
binds with calcium and creates holes in phospholipid membrane
bacterialcidal
Streptococcus VSE VRE MSSA MRSA GP+ anaerobes
particularly used for MRSA and VRE infections
Quinupristin/Dalfopristin
VSE VRE MSSA MRSA GP+ anaerobes
particularly used for VRE infections
Liver
bactericidal
Rifampin
bactericidal
inhibits RNA polymerase and prevents RNA production
can develop resistance when used for long time
Induces CYP enzymes and increases clearance of many drugs
MSSA
MRSA
+HN
LIVER
Fosfomycin MOA and coverage
Inhibits enzyme Mur A→ inhibits cell wall synthesis
bacterialcidal
VSE VRE MSSA MRSA GNR (accept acinobacter) Pseudomonas
only therapeutic in bladder → used for mild UTI’s
Fidaxomicin MOA
binds to RNA polymerase and doesn’t let transcription occur
covers specifically C-diff (refractory c-diff) very $$$
