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102 Cards in this Set

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  • Back
Which narrow spectrum drugs work against gram positive organisms?
Penicillin G and V
Penicillinase
Vancomycin
Erythromycin
Clindamycin
Which narrow spectrum drugs work against gram negatives?
Aminoglycosides
Cephalosporins
Which drugs work against mycobaterium tuberculosis?
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
What are the broad spectum drugs that work against gram positive and gram negative organisms?
Broad spectrum penicillins like ampicillin
Extended spectrum penicillins
cephalosporins (3rd gen)
Tetracyclines
imipenem, peropenem
Trimethoprim
Sulfonamides
Floroquinolones
What is the difference between bacteriostatic rx and bactericidal ones?
Bacteriostatic rx inhibit growth of bacteria where bactericidal ones kill bacteria, more effective
There are 5 ways that antibiotics work, what are they?
1. Inhibition of bacterial cell wall synthesis
2. Altration in cell membrane function
3. Inhibition of protein synthesis
4. Interference of ncucleic acid metabolism
5. Interference with intermdediate cell metabolism
What factors should be considered when selecting an antibiotic?
signs/symptoms
Suspected site of infection
Suspected causative organims
antibiotic suscetibilities
prior antibiotic usage
pt allergies
cost
pt age
renal/hepatic insufficiency
pregnancy/lactation
What classes of antibiotics have a beta-lactam ring in their structure? What is their MOA? Bactericidal or bacteristatic?
Penicillins
cephalosporins
aztreonam
imipenem
Carbapenem
MOA: Disruption of bacterial cell wall, therefore they are bactericidal.
Penicillins
Spectrum:
MOA: Inhibits cell wall synthesis and activates autolysins which punch holes in cell wall.
Spectrum: gram +/-, anaerobes
MOR of penecillins:
MOR: Bacterial production of an enzyme that cleaves the beta-lactam ring and inactivates the drug.
How are penicillins given?
IV
PO
IM
Do penicillins penetrate the CSF?
YES
How are Penicillins exreted?
They are metabolized hepatically and excreted renally.
What a/e are experienced with penicillins?
hypersensitivity rxns: rash, angeioedema, interstitial nephritis, anaphylaxis
GI: n/v/d
phebitis
seizures
Hematologic: hemolysis, neutropenia, thrombocytopenia
superinfection with candida
Rx interactions with penicillins?
Bacteriostatic antibiotics (tetracycline)
Uricosuric agents like benemid and indocin
aminoglycosides, penicillins will inactivate them
OCs, less effective
What are beta-lactamase inhibitors?
These are drugs added to penicillins that save the drug from being eaten by the bacteria itself, like a booster.
Examples of betalactamase containing agents?
Augmentin
Unasyn
Timentin
Zosyn
What about cephalosprorins?
Class?
MOA?
MOR?
Class? beta lactam
MOA? same as penicillin, inhibit cell wall synthesis and autolysin action
MOR? Prevents rx from reaching its site of action
What is the significance of the generations of cephalosporins?
There are 4 generations and as we move through there is an increasing activity toward anaerobes and gram neg orgs.
Increased resistance to destruction of betalactimase
Increased ability to penetrate CSF
Increased permeability of BBB.
So first generation ones (cefalzolin, cephalexin and cefadroxil area active against what?
Gram + orgs. except MRSA
Activity against simple grm neg orgs )E. coli, K. pneumoniae
Are second generation cephalosporins as good against gram positives as first genreation?
No, less so, but better coverage of many grm neg and anaerobes.
Which generation is active against pseudomonas?
Third, can penetrate CSF readily.
Fourth generation cephalosporins are what? (CSF? spectrum?)
Able to cross CSF
Very Broad spectrum
Absorption of cephalosporins?
Must begive IM or IV due to poor PO absorption
Excretion/metabolism?
Renally excreted, hepatically metabolized.
Adverse effects of cephalosporins?
Like penicillins, hypersensitivty
Px at injection site, phebitis
Hematologic: neutropenia, thrombocytopenia
Elevated PT
GI: n/v/d
What are carbapenems? examples?
MOA?
A class of betalactam antibiotics.
Ex: Ertapenem, Imipenem "gorillacillin" - very broad spectrum.
MOA? Same as others
Resistance and carbapenems?
So, used for?
Resistant to most betalactamases.
Used for infections resistant to other drugs
Active against?
not active against?
Gram positive
gram begatuve
anaerobes
Not active against MRSA, MRSE
A/e?
Rx interactions?
Hypersensitivity and cross reactivity with other betalactams
n/v/d
Seizures
Rx interactions: probenecid
What about azactam? What is it and what is it active against?
It is a betalactam. It is activea gainst wide spectrum of gram negative bacteria. No Gm positive or anaerobic coverage. crosses CSF
A/e?
Rx interactions?
Same as other betalactams, elavation of liver enzymes
No rx interactions
_______________ are narrow spectrum antibiotics used against gram-neg bacilli.
Aminoglycosides.
Aminoglycosides work by...
Disrupting protein synthesis (ribosomal activity) resulting in cell death, bactericidal.
They can cause serious injury to....
Kidney and inner ear
Aminoglycosides are (well/poorly) absorbed via the GI tract. Distribution? Excretion?
Poorly, therefore must be given IM or IV. Distributed poorly, does not penetrate broncial secretions or CSSF. Renally excreted.
Aminoglycosides are effective against...
Gram negative microbes only. Synergy wtih beta-lactams.
What is important about serum levels with aminoglycosides?
Peak-traugh levels differ so blood levels should be drawn one hour after the start of an IV or IM and trough levels should be drawn prior to infusion. Random draws 6-14 hours after first dose.
What a/e are associated with aminoglycosides?
Nephrotoxicity, ototoxicity, neuromuscular blockade --> acute musculare paralysis.
Vancomycin is used in treatment of serious infections like_____________ and _________.
C. difficille and MRSA
Vanco works by...and is considered (bactericidal/bacteristatic).
Inhibiting cell wall synthesis, bactericidal.
Resistance and vanco?
RARE!
The microbiological spectrum of vanco includes...
Gram positive organisms (including MRSA) AND C. dif.
Absorption of vanco...
Distribution?
Poor absorption, must be given IV for systemic treatment (orally available for GI infections).
Well distributed.
Elimination of vanco?
Orally eliminated via GI, IV gorm is renally eliminated (decrease dose if pt is renally insufficient).
A/e of vanco...
Red man syndrome - associated with rapid infusion, assco with histamine release. Otto and ne[hrotoxicity
Macrolides
MOA:
Bacteriostatic, slows groth of cells and body clears the organism. Binds to bacterial ribosomes and inhibits protein synthesis.
Microbiological spectrum of macrolides?
Some gram pos and some gram negative
ex: Clamydia, legionnaire's disease, walking pneumonia. NO GI BUGS!
Absorption?
Distribution?
Elimination?
Adequate
Benetrates most fluids but CSF
Liver adn biliary
a/e?
GI distress n/v/d
ototoxicity
phlebitis
cholestatic hepatitis - hypersensitivity reaction
QT prolongation
Rx interactions?
Theophylline (may increase serum lvls)
Cyclosporine
Warfarin (prolonged bleeding time)
Antiarrhythmatics
Tetracyclines
MOA:
Same as macrolides, bacteriostatic, bind to ribosomes nad inhibit protein synthesis.
MOR of tetracyclines:
Interference of drug transport into bacyterial cell, alteratino of binding site to ribosome
Microbiological spectrum of tetracyclines?
Some gram positive and gram negative coverage...lots of resistance
Absorption?
Distribution?
Elimination?
Adequatelu absorbed but incomplete, impaired by dairy products and food with Ca
Penetrates into all fluids, including CSF
Renally eliminated.
A/e?
GI
Photosensitivity
Hepatotpxicity
Effects calcified tissue so do not give to pregnant womena nd young children
Development of superinfection with candida
Nephrotoxic
Rx interactions?
antacids
OCs - decreases efficacy
Glycycline - Tygacil (only one in class)
MOA:
This is like a super tetracycline, good for bugs resistant to tetras:
Bacteriostatic
Binds to ribosomes and inhibits protein synthesis
Not affected by resistance mechanisms like beta-lactamases
Spectrum?
Many gram + and gram - organisms including MRSA and VRE and anaerobes.
Used against multiagent resistant organisms
Administered?
Distributed?
Elimination?
IV
Widely distrubted
Biliary excretion
A/e?
GI: n/v/d
Photosensitivity
Effects on calcified tissues
Development of superinfection with candida
Anti-anabolic action: increased BUN, azotemia, acidosis
Rx interactions?
OCs
Increased levels of oral anticoagulants
Ketolides: Telithromycin (Ketek)
MOA?
MOA: Similar to macrolides, binds to bacterial ribosomes nad inhibit protein synthesis.
Spectrum
Treatment of bugs resistant to macrolides
MRSA, Legionaires, walking pneumonia, etc.
Absorption?
Distribution?
Elimination?
Adequate
Penetrates well EXCEPT CSF
Hepatic metabolism and renal excretion
A/e:
GI
Acute liver failure
visual disturbances
exacerbates myesthenia gravis
Rx interactions?
Same as macrolides:
theophylines
cyuclosporine
warfarin
antiarrhythmatics
Clindamycin
MOA:
Bacteriostatic: disables organism
Binds to bacterial ribosomes and inhibits pritein synthesis
Spectrum?
Gram + and Gram - anaerobes
Gram + aerobes
Absorption?
Distriubtion?
Elimination?
well absorbed via GI
Widely distributed except into CSF
Hepatically metabolized
A/e?
D/n/v
Antibiotic associated colitis: superinfectino with C diff: treat that with vanco
Rash
Flagyl: antibacterial antiparasitic
MOA:
bactericidal
Selecteively produces cytotoxic effects in anaerobes
Flagyl (metronidazole) spectrum?
Gram+ and gram- anaerobes
Active against vaginitis, giardia, some amoeba
Adsorption?
DistributioN?
Excretion?
Well absorbed
Well distributed including CSF and breast milk
Hepatic metabolism
a/e?
n/v/d
neurotoxicity
dark/reddish urine
mutgenic potential so avoid in pregnancy
Rx interactions?
Anticoagulants
Alcohol
Co-trimoxazole/trimethoprim (Bactrim, Septra)
MOA:
Inhibition of folic acid synthesis --> inhibition of DNA, RNA, and protein synthesis, bactericidal
MOR to bactrim, septra
Chromosomal and plasmid mediated
Spectrum DOESN"T cover?
pseudomonas aeruginosa
enterococcus
group A beta hemolytic streptococci
anaerobes
Absorption?
Distribution?
Excretion?
Well absorbed after oral administration
Well distributed including CSF
Hepatic metabolism and renal excretion
A/E?
hypersensitivity rxns (steven-johnsons syndrome)
GI: N/v
Hematologic toxicity
nephrotoxicity
Rx interactions:
warfarin
Quinolones/Fluoroquinolines
MOA?
bactericidal
inhibits bacterial DNA gyrase an enzyme essential for DNA synthesis
Spectrum?
Gram +, gram -, anaerobes
Absorption?
Distribution?
Excretion?
excellent: iv/PO
widely distributed
Renal elimination
A/E?
GI: n/v
CNS (light headedness, dizziness, headache)
Skin rash
Premature closure of epiphyseal growth plate, don't use in pregnancy
Rx interactions?
These bind to metals so space with administration Ca, Fe
Theophylline
Antacids
Warfarin
Antiarrhythmatics
Oxazolidinones - Linezolid (Zyvox)
MOA:
Bacteriostatic
Inhibits protein synthesis at the bacterial ribosome
Spectrum:
Gram positive, some atypicals
MRSA, GESA, VRE
Absorption
Distribution
Elimination
excellent
well distributed
metabolized in liver and excreted in kidneys
indications for use:
Vanco resistant enterococcal infections
MRSA infectios that don't respond to vanco
a/e:
d/n/v
thrombocytopenia
increased hepatic enzymes
leukopenia
Peripheral neuropathy
Streptogramins - quinupristin/dalfopristin (synercid)
MOA:
Used for seriously resistant bugs
Bacteriostatic, acts at bacterial ribosome to inhibit protein synthesis
spectrum:
Only Gram +, MRSA, VRE,
Absorption:
Distribution:
elimination:
must be given IV
well distributed
metabolized to active metabolites
fecal excretion
a/e
inflammation at infusion site, thrombophlebitis
n/v/d
rash, puritis
arthralgia, myalgia
hyperbilirubinemia
rx interactions:
P450 drugs
cyclosporine
midazolam, diazepam
cisapride
lipopeptides - daptomycin (Cubicin)
MOA:
Binds to bacterial membrane and causes rapid deplarizatin of membrane potential which results in inhibitionofbacterial protein, DNA and RNA synthesis and cell death (punches holes in cell membrane)
Spectrum?
Gram + only
MRSA
GISA
VRE
Treatment of bacteremia and endocarditis
absorption
distribution
elimination
administered IV
92% protein bound
renally excreted
a/e:
Muscle weakness and pain
Rx interactions:
statins