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42 Cards in this Set

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ampicillin
extended spectrum penicillin. IV form

(aminopenicillin)

broader range of activity for GN bacteria like E. coli, Proteus miravilis and Haemophilus influenzae

amino makes it more hydrophilic and it can go through porins in the outer membrane of GN bacteria

often used with sulbactam (betalactamase inhibitor)

for endocarditis from enterococcus faecalis, use ampicillin and an aminoglycoside (gentamycin)

beta lactam + aminoglycoside (30S inhibitor) exhibit synergism

aminoglycoside cant penetrate the cell wall, but beta lactam helps it get in. combo is A+
amoxicillin
extended spectrum penicillin. oral form

(aminopenicillin)

borader range of activity for GN bacteria like E. coli and Proteus mirabilis and Haemophilus influenzae

drug of choice for group A strep pharyngitis

you go to your pediatrician with strep throat and he gives you AMOXACILLIN!!!
penicillin G benzathine
penicillin G= benzylpenicillin = IV penicillin

natural penicillin
good for group A strep and meningococcus, normal oral flora

treatment of choice for syphilis. WILLIAM NEALY - syphilis large dose of penicillin
penicillin V
penicillin V = phenoxymethylpenicillin

administered orally

natural penicillin
piperacillin
extended spectrum penicillin
(ureidopenicillin family)

active against GN like E. coli, H. influenzae, and P. mirabilis

often used with tazobactam (betalactamase inhibitor)
ticarcillin
extended spectrum penicillin
(ureidopenicillin family)

ticarcillin is used for P aeruginosa especially and is almost always used with clavulanate (betalactamase inhibitor)
cephalexin
first gen cephalosporin

active against group A streptococci, MSSA, and some GN

3 times when cephalosporins ARE NOT USEFUL
1. MRSA (all betalactams useless)
2. enterococci
3. Listeria monocytogenes
cefotetan
second gen cephalosporin

TETON = 2nd

additional activity against anaerobes (some second gen have additional activity against GN bacilli)
ceftriaxone
third generation cephalosporin (TRI)
broader range for GN enteric bacteria. less active against GP. dont use by themselves. use to treat mixed infection with S. aureus and GN bacilli. notorious for selecting for resistant bacteria

very similar: cefotaximine

for community acquired pneumonia, use a 3rd gen cephalosporin like cefotaxine with a macrolide (azithromycin), and this will work well w/o even knowing what caused the infection.

cefotaximine is treatment of choice for UTI patients admitted to hospital

treatment of choice for gonorrhea

for endocarditis (commonly caused by viridans streptococci), ceftriaxone and gentamycin are given in combo.

for endocarditis from enterococcus faecalis, also use a beta lactam (ampicillin!) and an aminoglycoside (gentamycin)

beta lactam + aminoglycoside (30S inhibitor) exhibit synergism

aminoglycoside cant penetrate the cell wall, but beta lactam helps it get in. combo is A+
aztreonam
aztreonam is the only monobactam (unique)

ARIZONA is UNIQUE!!!
IT IS A SHIT HOLE - GN bacilli of the bowel. E. coli, etc. FUCK ARIZONA.

one use: aerobin GN bacilli of bowel
imipenem/cilastatin
carbapenem

broad action against
1. GP (except MRSA and VRE)
2. GN bacilli incl P. aeruginosa
3. anaerobes (inc. bowel flora)

cilistatin inhibits metabolism of imipenem

excellent drugs but induce resistance. dont use them unless you have to!
amoxicillin/potassium clavanulate
combo: extended spectrum penicillin + betalactamase inhibitor
phenoxymethylpenicillin
=penicillin V = natural penicillin oral penicilin
nafcillin
penicillinase resistant penicillin for MSSA
cefotaxine
3rd gen cephalosporin

for community acquired pneumonia, use a 3rd gen cephalosporin like cefotaxine with a macrolide (azithromycin = 50S), and this will work well w/o even knowing what caused the infection. LIKE OUR IC patient!

cefotaximine is treatment of choice for UTI patients admitted to hospital

VAC - meninigitis, until cultures can be obtained, vancomycin (pneumococci), cefotaximine (meningococci, H. influenzae), and ampicillin (Listeria monocytogens) are used
vancomycin
glycopeptide antibiotic

binds D-ala D-ala and inhibits PG polymerase and transpeptidase

bactericidal, except for enterococci where it is only bacteriostatic

VRE- the only bugs really vanc resistant - vanc resistance comes from mutation in Dala-Dala. no cross resistance to beta lactams

use:
1. MRSA pneumonia
2. meningitis -V,A,C. V is for pneumococcus
3. Clostridium difficile diarrhea (PO instead of IV)

drug works while above MIC + 2 hours after

s/e
sterile phlebitis, red man syndrome (too fast infusion), fever, drug rash, hearing prob

spectrum:
useful vs GP bacteria
streptococci incl. drug res pneumococcus
staphylocci incl. MRSA and MRSE
enterococcus fecalis
C. difficile

"vancomycin is widely used, mainly to treat MRSA"

meningitis - could be Haemophilis influenzae (ceftriaxone), Neisseria gonorrhoeae (ceftriaxone),(ceftriaxone), Listeria monocytogenes (ampicillin), or Streptococcus pneumoniae (vancomycin), so give ampicillin, vancomycin, and ceftriaxone IV until the cultures are back from lab
linezolid
LINEZOLID

Z: 50 yard line

oxaolidinone (unique) -50S
USE:
1. MRSA pneumonia (maybe better than vanc)
2. enterococci, incl. VRE!!
bacteriostatic

no cross resistance with other ribosomal inhibitors bc it's unique

s/e: diarrhea, tongue discoloration, headaches, thrombocytopenia, lactic acidosis, peripheral neuropathy

"Linezolid is competing with vancoymycin and is used to treat some MRSA diseases, esp. pneumonia. may be better for pneumonia. Drug of choice for VRE!"
daptomycin
Z: dapper membrane leaks ions

cyclic lipopeptide antibiotic.
depolarizes MEMBRANE and allows cations to LEAK OUT

bactericidal - CONCENTRATION DEPENDENT KILLING!!! with daptomycin, area under the curve is what matters!

qd dosing b/c long t1/2 + long post antibiotic effect

use: MRSA, VRE, drug res pneumococcus

spectrum: GP bacteria, similar to the spectrum of linezolid
metronidazole
the only nitroimidazole (unique)

Z: metro is a radical poison for the anaerobes!!!

MOA: poisons intracellular reduction of free radicals -> damage DNA and proteins

USE: anaerobes!

S/E: metallic taste, nausea, diarrhea, brown urine

*adverse fx w/ alcohol (like disulfuram - feel terrible)

spectrum: anaerobes, esp. fusobacteria
h. pylori
giardia, entamoeba histolytica, trypanosoma cruzi, trichomonas (protozoa)

clinical uses:

1. anaerobic infections below diaphragm (such as bacteroides fraglis)
2. C. difficile colitis (given PO) - also an anaerobe
3. H. pylori!
4. parasitic infections: amebiasis, giardiasis, trichomoniasis

gardnerella vaginosis (generally, bacterial vaginosis)
trichomonas vaginosis
bowel perf- shotgun blast to abdomen
"used for anaerobic bacteria and an assortment of curiosisties"
nitrofurantoin
inhibits bacterial intracellular metabolism

its ONLY use: cystitis (macrobid)

absorption enh by food
low serum levels, but exr. in urine where it works
cycloserine
antibiotic
D alanine mimetic

reversibly inhibits transpeptidase and all nzs that interact with D-ala
tetracyclcine
tetracycline (30S)

doxy is mainly used, tet is weak and is used for acne

NOT safe for pregnancy (bone, teeth, fatty liver of preg)
NOT good for CNS (doesnt penetrate)
pill esophagitis
azithromycin
macrolide (50S) - what's in a z pack

macrolides - primary use is respiratory tract infection.

also used to prevent MAC in AIDS patients - (once a week) mycobacterium avium complex prophylaxis
long half life - z pack - simplified dosing regimen

good for haemophilus influenzae and moraxella catarrhalis UR infection

causes less N/V than erythromycin
erythromycin
macrolide (50S)

macrolides - primary use is respiratory tract infection.

pukogenic - N/V
arrythmias
clindamycin
blocks 50S

2 KEYS to clindamycin!:
1. treat anaerobic infections (e.g. Bacteroides fragilis!) - used with an aminoglycoside (gentamycin) b/c these are mixed infections
2. causes clostridium colitis
doxycycline
a tetracycline (30S)
DRUG OF CHOICE FOR:
1. chlamydia - all its diseases -trachoma, lymphogranuloma inguinale, NGU
2.brucella, erlichiosis, coxiella, tularemia, spirochetes (leptospirosis, ricketssia, syphilis)

doxy (unlikeother tetracyclines) can be used in renal failure b/c it is also excreted by the liver
NOT safe for pregnancy (bone, teeth, fatty liver of preg)
NOT good for CNS (doesnt penetrate)
pill esophagitis


penicillin + tetracyclines are antagonistic

demeclocycline has a s/e of causing diabetes insipidus (dec ADH secn) so it can be used to treat SIADH
clarithromycin
macrolide (50S)

macrolides - primary use is respiratory tract infection.

good for haemophilus influenzae and moraxella catarrhalis UR infection

causes less N/V than erythromycin
sulfadiazine
sulfa drug (inhibits PABA->folate)
**SULFA is oral (outpatient) and penetrates the CNS!!!!!!!!!!!!!!!

uses alone (to chase nasty pussy)

toxoplasma, chlamydia, nocardia, plasmodium

s/e:GI probs, vomitting, diarrhea
KERNICTERUS in newborns - not safe for pregnancy
stevens johnson syndrome
hypersensitivity (allergy)

this makes it good for toxoplasma, nocardia
trimethoprim
inhibits DHFR

used with sulfa drugs (S/T)
peds - upper respiratory
UTI
prostatitis
enteric pathogens (shigella, salmonella, e.coli)
pneumocystis carinii pneumonia (AIDS)
CA-MRSA (football team)

pyrimethamine - like trimethorprim but inhibits apicomplexan DHFR (plasmodium and toxoplasma)
trimethoprim / sulfamethoxazole
TMP / SMX

inhibits PABA->folate and DHFR

pharm card:
3 main USES:
1. UTI's (cystitis, prostatitis, & pyelonephritis)
2. enteric pathogens (shigellosis, salmonella, and e.coli)
3. pneumocystis pneumonia!

additional info:
1. peds - resp infection, otitis media
2. CA-MRSA (football team, etc)
ciprofloxacin
quinolone (inhibits gyrase and topo IV)

Z: Mighty Quinn had flocks of penguins and hunted the UTI and Community acquired pneumonias!!!!!!!!!!!

fluoroquinoloone resistance:
gyrase, topo mutation, efflux pumps

other things: skin and soft tissue (not staph aureus)
gonorrhea
bone and joint infections
abdominal infections
pseudomonas bacteremia in neutropenic patient

cipro is good for pseudomonas too
levofloxacin
quinolone (inhibits gyrase and topo IV)

Z: Mighty Quinn had flocks of penguins and hunted the UTI and Community acquired pneumonias!!!!!!!!!!!
pyrazinamide
DHFR inhibitor for apicomplexams

USE:
malaria (plasmodia)
toxoplasma

given with sulfadoxine for malaria and toxoplasma
telithromycin
ketolide (basically same as macrolide)

used for respiratory infections
streptomycin
aminoglycoside (30S) strepto, neo, genta, and tobra

special strepto infor:
2nd line for mycobacteria

USES OF AMINOGLYCOSIDES:
1. severe GN infections
2. severe GP infections with beta lactam (synergistic)

TOXICITIES OF AMINOGLYCOSIDES:
1. reverstibly nephrotoxic
2. irreversibly ototoxic (heather) and vestibulotoxic

resistance is by group transferases, 30s mutations, permeability alterations, anaerobes (O2 dep active transport)
neomycin
aminoglycoside (30S) strepto, neo, genta, and tobra

Neo is particularly good for pre surgical bowel prep (PO)


USES OF AMINOGLYCOSIDES:
1. severe GN infections
2. severe GP infections with beta lactam (synergistic)

TOXICITIES OF AMINOGLYCOSIDES:
1. reverstibly nephrotoxic
2. irreversibly ototoxic (heather) and vestibulotoxic

resistance is by group transferases, 30s mutations, permeability alterations, anaerobes (O2 dep active transport)
gentamycin
aminoglycoside (30S) strepto, neo, genta, and tobra

ALL aminoglycosides work by
1. interfering with intitiation complex
2. misreading of RNA
3. cause breakup of polysomes

special gent info:
ampicillin + gent for endocarditis (enterococcus faecalis)
USES OF AMINOGLYCOSIDES:
1. severe GN infections
2. severe GP infections with beta lactam (synergistic)

TOXICITIES OF AMINOGLYCOSIDES:
1. reverstibly nephrotoxic
2. irreversibly ototoxic (heather) and vestibulotoxic

resistance is by group transferases, 30s mutations, permeability alterations, anaerobes (O2 dep active transport)
tobramycin
aminoglycoside (30S) strepto, neo, genta, and tobra

very similar to gentamycin but maaybe less nephrotoxic

USES OF AMINOGLYCOSIDES:
1. severe GN infections
2. severe GP infections with beta lactam (synergistic)

TOXICITIES OF AMINOGLYCOSIDES:
1. reverstibly nephrotoxic
2. irreversibly ototoxic (heather) and vestibulotoxic

resistance is by group transferases, 30s mutations, permeability alterations, anaerobes (O2 dep active transport)
chloramphenicol
50S binder (peptidyl transferase)

inhibits mitochondrial protein synthesis too which causes bone marrow suppression but NOT aplastic anemai

USE: topical: eye infection
meningococcus, pneumococcus, h influenzae meningitis in people allergic to beta lactams (cant take ampicillin or ceftriaxone)

S/E:
1. bone marrow suppression - dose related
2. **APLASTIC ANEMIA!!!! - ideosyncratic
3. grey baby syndrome - infant liver cant metabolize- toxic levels of drug
rifampin
inhibits RNA polymerase (protein synth = cidal)

USE:
1. TB and leprosy
2. eradicate carriage of H. influenzae or N. meningiditis

S/E:
orange-red secretions (piss)
p450 inducer
rifampin
inhibits RNA polymerase (protein synth = cidal)

USE:
1. TB and leprosy
2. eradicate carriage of H. influenzae or N. meningiditis

S/E:
orange-red secretions (piss)
p450 inducer
clavulanate
beta lactamase inhibitor

similar: sulbactam and tazobactam

used with penicillins except for betalactamase resistant (like nafcillin)