Unit 3: Overview Flashcards
Name 3 ways antibiotics fight against bacteria
- Attacking the cell wall
- Interfering with protein synthesis (in the ribosomes)
- Interfering with nucleotide synthesis and DNA replication
Name some antibiotic groupings that attack the cell wall
- Beta-Lactams:
a. Penicillins
b. Cephalosporins
c. Carbapenems - Others
a. Glycopeptides (like vancomycin)
b. Lipopeptides (like Daptomycin)
c. Monobactams (Aztreonam)
What enhances the action of some penicillins and cephalosporins?
Beta-lactamase inhibitors
Name some groups of antibiotics that interfere with ribosomes and/or protein synthesis
- 30s Ribosome:
a. Tetracyclines
b. Aminoglycosides - 50s Ribosome:
a. Macrolides
b. Lincomycins (Clindamycin)
c. Streptogramins (Synercid)
d. Chloramphenicol - Other
a. Spectinomycin (aminocyclitol antibiotic)
Name some antibiotic groupings that interfere with Nucleotide Synthesis and/or DNA Replication
- Folate Production inhibition
a. Sulfonamides - DNA inhibition
a. Trimethoprim + Mixtures
b. Fluoroquinolones
Name the Beta-Lactam groups
a. Penicillins
b. Cephalosporins
c. Carbapenems
What groups of antimicrobial drugs interfere with the 30s ribosome?
30s Ribosome:
a. Tetracyclines
b. Aminoglycosides
What drugs/groups of antimicrobial drugs interfere with the 50s ribosome?
50s Ribosome:
a. Macrolides
b. Lincomycins (Clindamycin)
c. Streptogramins (Synercid)
d. Chloramphenicol
What group of antimicrobial drugs inhibits folate production?
Folate Production inhibition
a. Sulfonamides
What groups of antimicrobial drugs inhibit DNA?
DNA inhibition
a. Trimethoprim + Mixtures
b. Fluoroquinolones
Name 2 penicillins
Penicillin G
Penicillin V
Name 5 Antistaphylococcal Penicillins
Nafcillin Oxacillin Cloxacillin Dicloxacillin Methicillin
What is the advantage of ANTISTAPHYLOCOCCAL PENICILLINS?
they are resistant to beta-lactamases
Name 5 extended spectrum penicillins
Amoxicillin Amoxicillin/Potassium Clavulanate Piperacillin/Tazobactam Ampicillin Ampicillin/Sulbactam
Amoxicillin/Potassium Clavulanate is known as…
AUGMENTIN
Piperacillin/Tazobactam is known as…
ZOSYN
Ampicillin/Sulbactam is known as…
UNASYN
What is the advantage of extended spectrum penicillins?
increased activity against GRAM - rods
What is the disadvantage of extended spectrum penicillins?
susceptible to beta-lactamase
What is the advantage of the CEPHALOSPORINS over PENICILLLINS?
similar to penicillins
more stable to beta-lactamases
broader spectrum
Classify each CEPHALOSPORIN generation as narrow, intermediate, or broad spectrum
1st: NARROW
2nd: INTERMEDIATE
3rd: BROAD
4th: BROAD
What do 1st GENERATION CEPHALOSPORINS treat?
GRAM+ cocci
What do 2nd GENERATION CEPHALOSPORINS treat?
same as 1st generation
extended GRAM - coverage
What do 3rd GENERATION CEPHALOSPORINS treat?
expanded GRAM -
SOME CROSS THE BLOOD-BRAIN BARRIER
What do 4th GENERATION CEPHALOSPORINS treat?
P aeruginosa, enterorbacteriaeae, MSSA, S pneumonia, Haemophilus, Nisseria sp
What generation of CEPHALOSPORINS can treat brain infections?
3rd generation
4th generation
What should you avoid treating with Ceftriaxone (Rocephin)?
enterobacter due to resistance
What antibiotics are highly active against Enterobacter?
CARBAPENEMS
Name 4 CARBAPENEMS
Ertapenem (Invanz)
Doripenem
Imipenem
Meropenem (Merrem)
What does Imipenem require?
An inhibitor (cilastatin)
What CARBAPENEMS doe not require an inhibitor?
Doripenem
Meropenem
Name some GLYCOPEPTIDES
Vancomycin Bacitracin Cycloserine Telavancin Dalbavancin
Name the only MONOBACTAM available in the U.S.
Aztreonam
What does Aztreonam treat?
aerobic GRAM -
NO ACTIVITY against GRAM + or anaerobes
What is vancomycin good for?
GRAM +
bloodstream infections
MRSA endocarditis
What was the 1st (Cephalosporin) drug approved in the USA against MRSA?
Ceftaroline fosamil
Name some beta-lactamase inhibitors
Clavulanic acid
Sulbactam
Tazobactam
Avibactam
Name some CEPHALOSPORIN combinations with BETA-LACTAMASE INHIBITORS
ceftolozane-tazobactam
ceftazidime-avibactam
What are CEPHALOSPORIN combinations with BETA-LACTAMASE INHIBITORS used for?
to combat resistant GRAM - infections
What kind of drug is Daptomycin?
Lipopeptide
Name some TETRACYCLINES
Tetracycline Demeclycycline Doxycycline Minocycline Tigecycline
What do the TETRACYCLINES treat?
rickettsiae Lyme Rocky Mountain Spotted Fever chlamydiae spirochetes H. pylori syphillis with penicillin allergy Mycoplasma pneumoniae
What do the MACROLIDES treat?
GRAM +
some GRAM -
Name some MACROLIDES
erythromycin
Clarithromycin
Azithromycin (Zithromax)
Fidaxomicin
What is a major side effect of erythromycin?
increased GI motility –> GI side effects
What big infection can Fidaxomicin treat?
C. Diff
Name a Ketolide
Telithromycin (Ketek)
What is Telithromycin used for?
nontuberculous mycobacteria
USA: only for bacterial CAP
Name a Lincomycin
Clindamycin
What is important to remember about Clindamycin?
GRAM - organisms are resistant
Name a streptogramin
Quinupristin-dalfopristin (Synercid)
What is important to remember about Quuinupristin-dalfopristin (Synercid)?
inhibits CYP3A4 –> drug interactions
What adverse effects can Chloramphenicol cause?
irreversible aplastic anemia
gray baby syndrome
Name some Aminoglycosides
Streptomycin Neomycin Kanamycin Amikacin Gentamicin Tobramycin Sisomicin Netilmicin
What drugs have a synergistic effect with penicillin or vancomycin?
AMINOGLYCOSIDES
What are the aminoglycosides most widely used to treat?
drug resistant organisims
What is a post-antibiotic effect?
antibacterial activity exists beyond the time that there is measurable drug present
What antibiotics exhibit post-antibiotic effect?
Aminoglycosides
Name an oxazolidinone
Linezolid (Zyvox)
What is linezolid used to treat?
off label: MDR tuberculosis
What is important to remember about streptomycin?
used for 2nd line treatment against tuberculosis; ONLY USE with OTHER AGENTS!
What is Gentamicin used for?
severe infections caused by GRAM - that are often resistant to other drugs
What kind of dosing is typical for aminoglycosides?
single daily dose just as effective–and likely less toxic–that multiple smaller doses
What are the major side effects of the aminoglycosides?
ototoxic and nephrotoxic
What is Spectinomycin used to treat?
drug-resistant gonorrhea OR
gonorrhea in PCN-allergic patients
What sulfonamides are oral and absorbable?
SULFAMETHOXAZOLE (only available as TRIMETHOPRIM-SULFAMETHOXAZOLE (Bactrim) in the US)
SULFADIAZINE + PYRMENTHAMINE
What sulfonamide is oral and non-absorbable, and what does it treat?
sulfasalazine
tx: ulcerative colitis, enteritis, IBD
What sulfonamides are topical?
sodium slufacetamide silver sulfadiazine (Silvadene)
Why are the fluoroquinolone often dosed 1x daily?
long half lives
Name 4 fluoroquinolones
Levofloxacin
Ciprofloxacin
Moxifloxacin
Gemifloxacin
What major infection does ciprofloxacin treat?
anthrax
What is unique about Moxifloxacin?
metabolized in liver; other fluoroquinolones metabolized in kidneys
What to levofloxacin and ciprofloxacin treat?
excellent against GRAM -
good against GRAM +
What are the advantages of moxifloxacin and gemifloxacin?
improved against GRAM +
Name the respiratory fluororquinolones
Levoflaxacin
Gemifloxacin
Moxifloxacin
What are some major adverse effects of the fluoroquinolones?
prolonged QT interval
can cause neuropathy that persists for months - years after stopped
What does trimethoprim treat?
UTI
What does PO Trimethoprim-Sulfamethoxazole treat?
UTI, pneumonia
most staph aureus (MSSA + MRSA)
What does IV Trimethoprim-Sulfamethoxazole treat?
moderately severe to severe pneumocystis PNA
What does PO pyrimethamine + sulfonamide treat?
toxoplasmosis
Name some major adverse effects of the sulfonamides
Stevens Johnson Syndrome hemolytic or aplastic anemia granulocytopenia thrombocytopenia hemolytic reaction in people with a G6PD deficiency
