Week 2 Drug List: Antibiotics Flashcards
What classes of drugs are Beta-Lactams?
Penicillins
Cephalosporins
What are 4 drugs in the Penicillin subclass?
Penicillin V (PO)
Penicillin G (IM)
Amoxicillin
Amoxicillin/Clavulanate
What 2 drugs are in the 1st-generation Cephalosporin subclass?
Cephalexin
Cefazolin (IM/IV)
What drug is in the 2nd-generation Cephalosporin subclass?
Cefuroxime
What 3 drugs are in the 3rd-generation Cephalosporin subclass?
Cefdinir
Cefpodoxime
Ceftriaxone (IM/IV)
Name 2 Fluoroquinolones
Ciprofloxacin
Levofloxacin
What drug has a high potential to cause severe diarrhea and C.diff?
Clindamycin
Name 3 Macrolides
Azithromycin
Erythromycin
Clarithromycin
Name an Oxazolidanone
Linezolid
Sun sensitivity is significant with which drug class?
Tetracyclines (Doxycycline and Tetracycline)
Which drugs have a higher number of drug interactions due to being strong inhibitors of the CYP enzymes?
Erythromycin
Clarithromycin
(Both Macrolides)
What drugs should be stopped while taking Erythromycin and Clindamycin, and what is the risk if continued?
HMG-CoA Reductase Inhibitors (Statins)
Risk of severe myopathy or rhabdomyolysis
In which drug classes do dairy products/antacids interfere with GI absorption?
Fluoroquinolones
Tetracyclines
What drug class is Vancomycin Oral in?
Glycopeptides
What is the drug treatment of C. diff?
Oral Vancomycin (Poor oral absorption)
Name the 4 Antimycobacterials (“RIPE”)
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
What drug class is mainly used to treat Tuberculosis?
Antimycobacterials
What is the main use of Nitrofurantoin?
Lower UTI’s because it rapidly concentrates in the urinary tract
What is the MOA of Beta Lactams?
Bactericidal
Bind PBP (tanspeptidase, carboxypeptidase, endopeptidase), which are involved in terminal formation of cell wall.
**PCNs enter CSF poorly
Common side effects of Penicillins
N/V/D
Maculopapular rash with amoxicillin
Major side effects of PCN
Type 1 hypersensitivity
C. diff
Seizure/neurotoxicity
Hyperkalemia
How is PCN excreted?
Renally
Indications for PCN
Group A/B strep
Bacterial URI
PNA
STI (Syphillus Pen G)
UTI
Wound Infections
Endocarditis Prophylaxis
Which generation of Cephalosporins generally has more Gram negative coverage?
3rd gen Cephalosporins
Indications for Cephalosporins
Acute Otitis Media
Sinusitis
PNA
GAS (group A strep)
Chronic Bronchitis
UTI- Cefixime 1st line for upper UTI
Gonorrhea- Ceftriaxone/Azithromycin
Cephalosporin side effects
Common: Diarrhea
MAJOR: Allergy and seizure sickness
Seizure with renal impairment
C. diff
Hemolytic Anemia (watch for bleeding, bruising, yellowing, lethargy)
Clindamycin MOA:
Binds to bacterial ribosome to suppress synthesis
Metabolized by the liver
MOA of Fluoroquinalones
Bactericidal
Interfere with DNA synthesis, preventing replication and transcription
Concentration-dependent killing of bacteria.
Side effects of Fluoroquinolones
Common: Photosensitivity and Phototoxicity, Dizziness, Crystalluria
MAJOR: QTC prolongation, Liver Failure, Avoid in pregnancy, Avoid in <18 year olds, C. diff.
Fluoroquinalones: BLACK BOX WARNING
Tendon Rupture/tendinitis
Myasthenia Gravis Precipitation
Clindamycin side effects
Common: Diarrhea, N/V/ bitter taste, dizziness, vertigo, headache, hypotension
MAJOR: C. diff, intensify neuromuscular blockade, cardiac arrhythmia (rare)
Macrolide indications
1st line for uncomplicated CAP or mycoplasma PNA in peds.
STDs
h. pylori
Gonorrhea- azith/ceftriaxone
Chlamydia/chancroid- azith
MOA of macrolides
Bacteriostatic
Binds to ribosome and inhibits RNA synthesis
Disassociates tRNA from ribosomes
Immunomodulating properties
Side effects of macrolides
Common: NVD, cramping, eczema
MAJOR: QTC prolongation, myasthenia gravis, c. diff, liver problems, Stevens Johnson syndrome.
Side effects of Linezolid
Common: N/D, headache, myelosuppression, c. diff
MAJOR: Neurotoxicity- NO MAOI use, Serotonin Syndrome
MOA of Nitrofurantoin
Alters and inactivates ribosomes–protein synthesis, metabolism, RNA and DNA.
Side effects of Nitrofurantoin
MAJOR: Neuropathy, pulmonary toxicity/risk of fibrosis with long term use, blood dyscrasias
MOA of Trimethoprim/Sulfamethoxazole
Bacteriostatic
Sulfa: inhibit dihydrofolate synthetase, prevents folic acid synthesis
Trim: Inhibits bacterial dihydrofolate acid reductase, prevents purine synthesis.
Side effects of Trimethoprim/Sulfamethoxazole
Common: Folate deficiency, Anorexia, NVD, C diff, Photosensitivity
MAJOR: SJS, hepatotoxicity, QTC prolongation, Blood dyscrasias
Indication for Trimethoprim/Sulfamethoxazole
UTIs
MOA of Tetracyclines
Inhibit protein synthesis of ribosome/prevent amino acid growth
Side effects of Tetracyclines
Common: N/V/D, C diff, photosensitivity, rash
MAJOR: Caution with liver problems, caution <8 years old r/t calcium, Intracracial HTN (benign) causing headache, dizziness, vision changes, SJS
Vancomycin MOA
Weakens call wall and Lysis
Damages cell membraneSE o
SE of Vancomycin
Common: Skin rash, ototoxicity
MAJOR: Nephrotoxic, Vanco infusion syndrome (low BP, flushing)
MOA of Antimycobacterials
Rifampin: Inhibit RNA synthesis
Isoniazid: Interferes with lipid and nucleic acid biosynthesis in growing organisms.
Pyrazinamide: Exact MOA unknown: good activity with macrophages, kills intracellular organisms
Ethambutol: Inhibits synthesis of arabinogalactan, an essential component of mycobateria cell walls
SE of Antimycobacterials
Common: GI upset
MAJOR: Hypersensitivity reactions, ototoxicity, optic neuritis, peripheral neuritis, hepatotoxicity, elevated uric acid levels, body fluid discoloration, blood dyscrasias
Bacteriostatic
Rely on functioning immune system; only suppress cellular activity.
Kills bacteria but less than 99% eradication in 24 hours.
Do NOT use in neutropenic of immunocompromised patients
“We’re ECSTaTiC about Antibiotics”
Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracyclines
Chloramphenicol
Bactericidal
Meds that kill bacteria regardless of a working immune system.
99.9% eradication of bacteria in 24 hours.
“Very Finely Proficient At Cell Murder”
Vancomycin
Fluoroquinolones
Penicillin
Aminoglycosides
Cephalosporin
Metronidazole
Factors contributing to antibiotic resistance
Increases in populations of immunocompromised patients
The number and complexity of invasive medical procedures
Use (appropriate or inappropriate) of antimicrobials
Survival of patients with chronic diseases
Spread of resistant bacteria in day cares, overcrowding, travel, and the use of antibiotics in angriculture.
What are the leading risks of having a drug-resistant pathogen?
Recent use of antimicrobials
Multiple medical comorbidities
Recent hospitalization or other skilled health-care contact
Immunosuppression
