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126 Cards in this Set
- Front
- Back
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monobactams
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aztreonam
no cross-resistance w/beta-lactams only one ring |
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b-lactam AEs
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hypersensitivity reactions
seizures w/high doses |
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B-lactams
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lack acitivity agianst
mycoplasma pneumoniae chlamydophila pneumoniae MRSA both cause community-acquired pneumoniae |
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new cephlosporins
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cover MRSA
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Penicillins
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very short t1/2 of <2 hours, prolonged w/renal dysfunction
multiple dosing poor absorbtion especially PO |
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Natural penicillins
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penicillin G
penicillin V |
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natural penicillin specrturm
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GOOD: treponema pallidum, most streptococci
moderate: streptococcus pneumoniae, enterococi |
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peniciiin V
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PO form of penicillin G
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penicillin G
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DOC for syphillis
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anstaphylococcal penicillines
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methicillin
cloxacillin dicloxacillin nafcillin oxacillin |
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antisphyloccal penicillins spectrum
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GOOD: mssa & streptococci
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antistaphylococcal penicillines AEs
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acute interstitial nephritis
phlebtitis (patient has phlebitis give them a cephlosporin) |
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phlebitis
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nflammation of a vein (usually in the legs)
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antistaphylococcal penicillins
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eliminated by liver
do not need to be adjusted for renal dysfunction interchangeable agents |
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staphylococcus spectrym
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MSSA
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aminopenicillines
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amoxicillin
ampicillin |
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aminopenicilines
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more water soulble
can diffuse through porins so have some gram - activity beta-lacmase sensitive, cannot treat staphylococci |
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aminopenicillines spectrum
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GOOD: streptococci, enterocci
moderate: enteric gram - rods, haemophilus |
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ampicillin
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aminopenicillinase
DOC: enterococci better IV bioavailability safe amoxicillin PO |
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amoxicillin
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used for URT infections
streptococcal pharyngitis otitis media |
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bateriocidal activity w;enterococcis
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beta-lactam + aminoglycoside to treat serious infections like endocarditis
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antipseudomonal penicillins
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piperacillin (most frequently prescribed, better activity)
mezocillin carbenicillin ticarcillin |
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antispeudomal penicillins
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poor staphylococci activity
susceptible b-lactamases not good for empiric therapy, doesn't cover e. coli |
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antipseudomal penicillins activity
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GOOD: PSEUDOMONAS AERUGINOSA, streptococci, enterococci
moderate: enteric gram - rods, haemophilus |
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beta-lactame
beta-lactamse inhibitor combos |
ampicillin/sulbactam
amoxicilline/clavulanate ticarcillin/clavulanate piperacillin/tazobactam |
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aminopenicillins & antipseudomonal penicillins
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beta-lactamase sensitive
gram - rods, staphylococci, and anaerobes produce beta-lactamases |
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ampicllin/sulbactam
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active agaisnt e. coli
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zosyn and ticarcillin;clavulanate
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to treat p. aeruginosa
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activity of beta-lactams + beta-lactamase inhibitor
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MSSA, streptococci, enterococci, many anaerobes, enteric gram - rods
moderate: gram - rods w/advanced beta-lactamases |
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ampicillin/sulbactam
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active agaisnt acinetobacter baumanni (gram - rod)
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uses of beta-lactam + beta-lactam inhibitor
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empiric therapy of nosocmial infections (pnuemonia)
activity anaerobes & aerobes good for mixed infections like intra-abdominal infections, diabetic ulcers, and aspiration peumonia |
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ampicillin/sulbactam
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aminopenicillin, poor choice for pneumonia once empiric therapy is over
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zosyn
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overkill for community-acquired pneumonia once empiric therapy is over
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cephlosporins
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all have reduced cross-allerencity w/penicillins
do not give if get hives and anaphlaxis w/penicllin just nausae can get away w/cephlosporin |
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cephlaosprins
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none can be used for enterococci
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1st generation cephlosporins
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cefazolin
cephalexin cefadroxil cephalothin |
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1st gen. cephlosporins
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used for prophlyaxis in surgery
cheap low incidence of AEs |
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1st gen. cephlosprin activity
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good: MSSA, streptococci
moderate: enteric gram - rods good for SSTI, prophylaxis(usually only 1 dose), staphlococcal enocarditis |
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1st gen cephlosprins
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cannot cross BBB like antistaphlococcal pencillins, cannot treat meninigitis
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2nd generation cephalosporins
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cefamandole
cefuroxime cefoxitin cefotetan loracarbe cefdinir cefmetzole cefonicid cefaclor cefprozil |
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2nd generation cephlaosporins
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better gram - than 1st gen.
active agaisnt haemophilus influenza & neisseria gonorrhea least utilized in hospital seeting like 1st gen. do cross BBB, cannot treat CNS infections |
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2nd generation cephlosporins activity
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spectrum: some enteric gram - rods, haemophilus, neisseria
moderate: streptococci, staphylococci, and anaerobes (cefotetan, cefoxitin, cefmetazole) |
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2nd generation cephlosporins (cephamycins) often used for prophylaxis good anaerobic activity in gi tract
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cefamandole, cwfmetazole and cefotetan have N-methylthiotetrazole side chains thatn inhibit vit. K production and disulfuram raction w/alcohol
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2nd generation cephlosporins
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good fro URT infections, communtiy-acquired pnuemonia, gonorrhea, surgical prophylaxis
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3rd generation cephlosporins
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ceftriaxone, cefotaxime, ceftazidime, cefpodoxime, cefixime, ceftibuten
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3rd gen. cephlosporins
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better gram - workse staphylococcal activity
broad spectrum |
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3rd gen. cephlosporins coverage
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GOOD: streptococci, enteric gram - rods, ceftazdime pseudomonas
moderate MSSA |
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ceftazidime
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3rd gen. cephlosporin
good pseudomonas activity |
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3rd gen. ceph.
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strong association of CDAD
cefpodxime has MTT side chain that can inhibit vit. K |
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ceftriaxone
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3rd. gen. ceph. elimated both renally and biliary does not need to be adjusted for renal dysfunction
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3rd gen. cephlosporins good for
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LRT infections, pyelonepritis, nosocimal infections, lyme disease (ceftriaxone) menigitis
SSTIs, febrile neutropenia |
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treat lyme
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doxycycline
ceftriaxone |
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treat meninigitis
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ceftriaxone (usually QD but for this BID)
vancomycin ampicillin |
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4th gen. cephlospoirns
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cefepime
broadest spectrum cephlosporin good emprirc choise for nosomial infectionsm, overkill for community-acquired |
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cefepime spectrum
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GOOD: MSSA, streptococcus, pseudomonas, enteric gram - rods
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3rd gen. cephlosporins
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know to induce resistance agaisnt gram - rods
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carbapenems
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primaxin, meropenem, ertapenem, doripenem
broast-spectrum beta-lactam have 6 membered ring next to b-lactam instead of 5- membered ring |
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carbapenems
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higher propencity to induce seizures especially imipenem
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cilastin
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prevents imipenem from being metabolism in kidnety to nephrotoxic product by dehydropeptidase
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carbapenems
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overkill for community-acquired
use for nosocomial infections particurally for patients who have received many other classes of ab.s during their hospital stay |
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carbapenems
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good for mixed aerobic/anaerobic infections, intrabdominal infections
imipenem, doripenem, meropenem: good for nosocomial pneumonia, fevrile neutropenia, and other nosocomial infections |
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carbapenems
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check dosing in patients w/renal dysfunction associated w/seizure
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ertapenem
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weaker activity than most carbs
once daily dosing can use of home infusion |
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monobactam (onlyb-lactam ring)
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azeotrenam, only cross-reacts w/ceftazidime (same side chain)
same spectrum: GOOD: pseudomonas, gram - rod use for penicillin allergies |
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glycopeptides
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vancomycin
teicoplanin(not used in US) invaluable activity against all gram + some VRE especially E. faecium) rare staphylococi resistant |
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vancomycin dosing
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time/concentration independent killing but is doses as cocentration dependent(big doses less frequently)
even though active agiasnt MSSA, use b-lactam instead |
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vanco
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DOC for MRSA infections and used for emperic therapy where MRSA is concerned
use for gram + infections w/beta-lactam allergy |
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fluoroquinolones = 2nd generation quinolones
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ciprofloxacin
levofloxacin moxifloxacin gemifloxacin |
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quinolones
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excellent PO bioavailability
broad-spectrum include gram +, gram -, and atypical organism low incidence of AEs |
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Cipro
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GOOD: gram - rods, H. influenza
moderate: pseudomonas, atypical like mycoplasma, chlamydia, legionella |
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levofloxacin/moxifloxacin
newer fluoronquinolones |
GOOD: gram - inlcuding e. coli and klebsiella, good s pnuemoniae, atypical like mycoplasma, chlamdia, and legionella, and good h. influenzae
levo has moderate pseudomonas coverage |
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levofloxacin and ciprofloxacin
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have moderate activity agaisnt pseudomonas
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flouroquinolones
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chelate cations
separate agents by at least 2 hours by cautious is adminstering to patients w/ prolonged QT interval- bad is cations got chelated |
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moxifloxacin
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not excreted in urine
cannot use of UTIs |
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Cipro uses
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UTI, intra-abdominal infection, systemic gram -, single dose for gonorrhea, pseudomonas w/w/o b-lactam
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levo, moxi, and gemifloxacin uses
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CAP, sinusitis, intrabdominal infection, systemic gram - infections, SSTi
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levo uses
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CAP, sinusitis, intrabdominal infections, systemic gram -, SSTI, psuedomonas
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aminoglycosides
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gentamicin
tobramycin amikacin streptomycin spectinomycin |
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aminoglycosides
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toxic
NTW, closely monitored psuedomonas and acinetobacter activity good syngergistically with b-lactams and glycopepetides |
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amikacin
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reserved for pathogens resistant to gentamacin and tobramycin
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streptomycin uses
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enterococcus, TB (1st drug for TB), and the plague
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spectinomycin uses
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gonorrhea
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gent/tobr/amikacin spectrum
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GOOD: gram - (e.coli, klebsiella, pseudomonoas, acinetobacter)
moderate: in combo w/b-lactam/vanco for staphylococci, MRSA, viridians streptococci, and enterococci |
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aminoglycosides
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moving towards once a day dosing
lower troughs, higher peaks, less toxicity few studies |
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aminoglycosides penetration
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poor especially in lungs, CNS
not optimal for monotherapy for pneumonia/menigitis means dose based on IBW not TBW due to poor penetration of all body tissues overdoes patient if use TBW!!! |
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aminoglycoside + b-lactam uses
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gram - pathogen including febrile neutropenia, spsis, exacerbations of cystic fibrosis, and ventilator-associated pneumonia
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aminoglycoside +b-lactam/vanco uses
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gram + infections like endocarditis, osteomyelitis, and sepsis
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tetracyclines
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doxycycline
minocycline tetracycline |
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glycyycline
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tigecycyline
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tetracycline uses
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URT infections
DOC is doxy many tetracycline resistant mechanism which limit use to niche indications |
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tetra/doxy/minocyclien spectrum
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GOOD: atypicals, rickettsia, spritochetes like t.palidium, b.burgdorferi, h. pylori, & lime
moderate: MRSA, staphylococci, s. pnueomia, s. pyogenes |
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tigeycycline spectrume
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GOOD: atypicals, enterococci including VRE, staphylococci include MRSA, S. pnuemonia, S. pyogenes
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doxy and minocycline
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oral bioaviailibility is 100%
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tetracyclines
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chelate cations
separate by at least 2 hours |
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doxy
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adjust dose for renal functions
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tetrcycline uses
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respiratory tract infections like chronic bronchitis, sinusitis, CAP.
DOC for tick-borne illnesses alternatives for SSTIs, syphilis, PID w/cefoxitin |
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macrolides
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erythromycin
clarithryomycin azithromycin |
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ketolides
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teltihromycin
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macrolides
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used frequently outpatient
broad overage of respiratory pathogens increasing resistance especially step. pnuemonia(better coverage w/ketolide) |
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telithromycin
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more heptic toxicity than macrolides
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Prevpac
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treat h.pylori and peptic ulcer disease
clarithromycin, lansoprazole and amoxicillin |
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macrolide usues
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LRT infections (really only nessesary for serious ones), chlamydia, atypical mycobacterial infections, and azothromycin for traveler's diarrhea
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clarithromycin uses
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GI ulcer disease
h. pylori |
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oxazolidinones
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linezolid
excellent bioavailability inhibits MAOIs, serotontin sickness w/SSRIs doesn't need to be adjusted for renal/heptic function expensive |
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linezolid spectrum
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MSS, MRSA, streptococci indcluding MDR s. pneumoniae, enterococci including VRE, NOCARDIA
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linezolid used
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gram +
VRE MRSA nosocomial SSTIs monitor platelets for thrombcytopenia |
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nitroimidazoles
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metronidazole
good anaerobic activity gut anaerobes, parasites for gut diarrhea, 1st line CDAD excellent bioavailability |
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metronidazole AEs
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disulfiarm-like reaction w/alcohol
DI w/warfarin serious |
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metronidazole usues
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suspected abdominal anerobic bacterial
add on to another drug for more coverage for polymicrbial infections vaginal trichomoniasis GI infections by protozoa, amebiaisis, girdiasiis H. pylori in GI ulcer disease |
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streptogramins
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quinupristin/dalfopristin
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synercid
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bactercidal
two drugs are bacteriostatic on own used for VRE & MRSA but are not 1st line, better drugs |
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synercid spectrum
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GOOD: MSSA, MRSA, streptococci, enterococcus faecium including VRE
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synercid AEs
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phlebitis
needs to be administered through central line CYP450 DIs myalgias (significant!!!!) |
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synercid
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mixed w/5% dextrose it crystalizes in NS
not active agaisnt E. faecalis (is active against E. faecium) |
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cyclic lipopeptides
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daptomycin
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daptomycin
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bacteriocidal
causes depolarization of cell membrane leaves cell intact which is weird has better penetration in diabetics than vanco |
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daptomycin spectrum
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GOOD: MSSA, MRSA, streptococci
moderate: enterococci including VRE |
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daptomycin
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DI w/statins and warfarin
increases in CPK monitored for myopathy |
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daptomycin
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one of few antibiotics indicated for right-sided endocarditis
can't treat pneumonia even though it penetrates lungs because its inactivated by pulomonary surfactant |
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daptomycin uses
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SSTIs by resistant gram + (MRSA) staphylococcal bacterimia (very good drug for bacterimia!), right-sided endocarditis
can be used in enterococal bacterimia |
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Bactrim spectrum
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GOOD: staph. aureus including localized SSTI w/ MRSA, H. influenzae, stenotrophomonas maltophilia, listeria, pneumocystis jirovecii
moderate: enteric gram - rods, s. puemonia, salmonella,shigella, nocarida |
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bactrim uses
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UTIs, listeria menigitis, pneumocystis jirovecii pneumonia,
localized SSTI w/MRSA cross-reactions w/other drugs containing sulfur like glipizide, HCT, other sulfonamides, furosemide/lasix |
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lincosamides
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clindamycin
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clindamycin
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is like a mix of vanco and metronidazole, good activity agaisnt many gram + anaerobes
usually used empirically because not ass effective as vanco/metronidazole, and has GI toxicity also antibiotics w/erythromycin resistnce have same genes for clarithromycin resistance use D test |
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clindamycin + beta-lactam
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necrotizing fasciitis and toxin-mediated diseases
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clindamycin uses
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SSTIs, infections of oral cavity, intrabdominal infections
topically for acne |
