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49 Cards in this Set

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Aminoglycosides
-Gentamicin
-Tobramycin
-amikacin
-streptomycin
-neomycin
mycins
Aminoglycosides MOA
Bacteriocidal
-Inhibition of bacterial protien synthysis by interacting withribosomal binding sites
Aminoglycosides MOR
inactivation of drug by bacterial enzymes
-Failure of permeation of the drug across the cell membrane
Aminoglycosides spectrum
-very good against gram negative
-synergy with beta lactam drugs
Aminoglycosides pharmacokinetics
poor absorbtion IM, IV
-no BBB give IT for menegitis
-peak 3-10 mcg/ml
-trough <2mcg/ml
Aminoglycosides AE
-Nephrotoxic
-ototoxic
-neuromuscular blockade avoid myasthenia gravis
Vancomycin
MOA bacteriocidal, cell wall synthisis
-gram pos MRSA, cdiff oral
AE red man, ototoxic, nephrotoxic
Aminoglycosides
Mechanism of Action
Inhibition of protein synthesis
Irreversibly binds to ribosomes
decreases overall protein synthesis, and produces misreading of mRNA
Aminoglycosides Spectrum of Activity
-Gram-Negative Aerobes
Pseudomonas aeroginosa
-Gram-Positive Aerobes
Synergistic activity with beta-lactam antibiotics
Aminoglycosides
Adverse Effects
Nephrotoxicity
Ototoxicity
Aminoglycosides Monitoring Serum Levels
Blood levels drawn at steady state
Peak levels should be drawn:
1 hr after the START of an IV infusion (30-45 minutes)
1 hr after an IM injection
Trough levels just prior to infusion
Random levels are drawn between 6-14 hours after first dose
Aminoglycosides
Clinical Indications
Gram negative
In combination with penicillin, ampicillin or vancomycin for Gram positive infections
Neomycin orally/bowel decontamination
Vancomycin
Mechanism of Action
Inhibits bacterial cell wall synthesis at a site different than beta-lactams
Bactericidal (except for Enterococcus)
cell wall
Vancomycin
Mechanism of Resistance
Prolonged or indiscriminate use may lead to the emergence of resistant bacteria
Clinical resistance is extremely rare
Vancomycin Spectrum of Activity
Gram-positive bacteria
Vancomycin
Clinical Uses
-methicillin-resistant staph, osteomyelitis
Serious gram-positive
-lactam allergic patients
Endocarditis or surgical prophylaxis
-refractory C. difficile
Vancomycin
Adverse Effects
Red-Man Syndrome
Vancomycin
Adverse Effects
Red-Man Syndrome
Nephrotoxicity and Ototoxicity
- rash
neutropenia, thrombocytopenia
Macrolides
Erythromycin
Clarithromycin (Biaxin®)
Azithromycin (Zithromax®)
Macrolides

MOA
Inhibits protein synthesis by reversibly binding to the 50S ribosomal subunit
Suppression of RNA-dependent protein synthesis
Macrolide Spectrum of Activity
Gram-Positive Aerobes
(Clarithro>Erythro>Azithro)
-Gram-Negative Aerobes
Azithro>Clarithro>Erythro)
Macrolides Clinical Indication
Strep infections in pennallergic patients
N. gonorrhea
Legionella, Chlamydia, Mycoplasma spp., or Campylobacter jejuni
Lyme disease:
Macrolides
Adverse Effects
-Gastrointestinal
-Cholestatic hepatitis
-Thrombophlebitis
-ototoxicity
Macrolides
Drug Interactions
Theophylline
Cyclosporine
Warfarin
Antiarrhythmics
Ketolides
Telithromycin (KetekTM)
Ketolides
Mechanism of Action
Similar to macrolides
Binds to bacterial ribosomes and inhibits protein synthesis
Ketolides
Microbiologic Spectrum
Strep Staph
influenzae
Moraxella catarrhalis
gonorrhea
Legionella
Chlamydia
Mycoplasma pneumoniae:
Ketolides
Pharmacokinetics
Absorption:
Adequate but incomplete
Penetrates well into most body fluids no CSF
Hepatic metabolism and renal
Ketolides
Clinical Indications
Treatment of upper and lower respiratory tract infections
Treatment of Legionella, Chlamydia, or Mycoplasma spp.
Ketolides
Adverse Effects
GI: Visual disturbances
Acute liver failure
Exacerbation of myasthenia gravis
Black box warning
Ketolides
Drug Interactions
Theopylline
Cyclosporine
Warfarin
Class IA and III antiarrhythmics
Tetracyclines Pharmacology
Inhibit bacterial protein synthesis
Tetracyclines
Spectrum of Activity
gram positive and gram negative
gonorrhea
Rocky mountain
syphyllis, Lyme
Chlamydia
Mycoplasma
lyme disease
Tetracyclines Drug Interactions
Chelation with multivalent cations:
Mg, Al, Fe, Ca, Zn, Cr
Tetracyclines Side Effects
Inhibit bone growth
Tooth discoloration
Hepatotoxicity
Fungal superinfection
Photosensitivity
Hypersensitivity reactions
Nephrotoxicity
Glycylcycline
Tigeycyline (Tygacil®)
Glycylcycline
Mechanism of Action
Bacteriostatic
Glycylcycline Microbiologic Spectrum
Broad spectrum of activity
Glycylcycline Clinical Indications
Mutlidrug resistant organisms Intra-abdominal infections
Glycylcycline Drug Interactions
Oral anticoagulants – increased risk of bleeding
Glycylcycline Adverse Events
GI: Photosensitivity: “sunburn” Development of superinfection with candida
Anti-anabolic action
Clindamycin Mechanism of Action
Binds to bacterial ribosomes and inhibits protein synthesis
Bacteriostatic
Clindamycin Spectrum of Activity
Gram-Positive Aerobes
Clindamycin Pharmacokinetics
Well absorbed
Widely distributed except into the CSF
Hepatic metabolism
Clindamycin Clinical Indications
Respiratory tract infections
Aspiration pneumonia
Empyema
Skin and soft tissue infections
Intra-abdominal and pelvic infections
Metronidazole Flagyl®
Mechanism of Action
inhibits DNA synthesis
bactericidal
Metronidazole Spectrum of Activity
Anaerobic Bacteria (BDA)
Anaerobic Protozoa
Metronidazole
Pharmacokinetics
Well absorbed
Well distributed including the CSF and breast milk
Hepatic metabolism
Metronidazole
Adverse Effects
Gastrointestinal
metallic taste
CNS
– most serious
Disulfiram reaction with alcohol