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136 Cards in this Set
- Front
- Back
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listeria monocytogenes
-classification -DOC |
G+ bacilli
ampicillin |
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methicillin resistant staph aureus
-classification -DOC |
G+ cocci
vancomycin + gentamicin + rifampicin |
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surgical prophylaxis DOC against staph aureus
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cefazolin
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streptococcus pneumoniae
-classification -DOC |
G+ cocci
penG or penV amoxicillin or ampicillin |
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low resistance strep pneumoniae DOC
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penG
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medium resistance strep pneumoniae DOC
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higher dose of penG
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high resistance strep pneumoniae DOC
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vancomycin + ceftriaxone
levofloxacin/moxifloxacin alternative |
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peptococcus/peptostreptococcus
-classification -DOC |
G+ cocci
penG |
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salmonella
-classification -DOC |
G- bacilli
ceftaxime |
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G- bacilli (15)
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SSSH KeeP C PEACE +B
Salmonella Shigella Serratia H.Flu Klebsiella Citrobacter Proteus E.Coli Acinetobacter Campylobacter Enterobacter B.frag |
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shigella
-classification -DOC |
G- bacilli
ceftriaxone |
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haemophilus influenzae (H.flu)
-classification -drugs |
G- bacilli
-ampicillin/amoxicillin -cefepime -carbapenems -aztreonam -azithromycin -clarithromycin -doxycycline -2nd/3rd gen cephalosporins -quinolones |
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pseudomonas aeruginosa DOC
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-piperacillin/tazobactam (zosyn)
or -ticarcillin/clavulonic acid (timentin) + aminoglycoside |
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pseudomonas aeruginosa drugs
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-PM CAT penicillins (non-meningetal only)
-amoniglycosides -cefepime/ceftazidime (meningitis) -cefoperazone -aztreonam -cipro (UTI only) |
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pseudomonas characteristics
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-loves moisture
-slime coat -easily transferred -mutates rapidly -efflux pumps |
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what 2 drugs do NOT cover pseudomonas
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-sulfonamides
-ertapenem |
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B.frag
-classification -DOC |
G- bacillus
metronidazole |
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B.frag drugs
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-clindamycin
-carbapenems -piperacillin/ticarcillin -ticarcillin+clavulonic acid (timentin) -tigecycline -ampicillin+sulbactam (unasyn) |
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what drugs used for abdominal surgery prophylaxis against B.frag
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cefuroxime + metronidazole
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neisseria gonorrheae
-classification -DOC |
G- cocci
ceftriaxone single injection |
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neisseria meningitidis
-classification -DOC |
G- cocci
penG |
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pneumocystis carnii (jiroveckii)
-classification -disease -DOC |
reclassified as a fungus (protozoa)
pneumonia (PCP in AIDS pts) SMZ/TMP |
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toxoplasma gondii
-classification -DOC |
protozoa
sulfadiazine + pyrimethamine |
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sulfonamides effective against (4)
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G+/G- aerobes, atypicals, B-lactamases
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sulfonamides NOT effective against (3)
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anaerobes, campylobacter jejuni, pseudomonas aeruginosa
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sulfonamides distribution
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ALL body fluids, tissues, and BBB
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sulfonamides MOA
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competitive inhibition of dihydropteroate synthase
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trimethoprim MOA
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competitive inhibition of dihydrofolate reductase
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trimethoprim selectivity
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selective for bacterial DHFR at lower doses; starts to inhibit human DHFR at higher doses and causes BM suppression and megaloblastic anemia
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sulfonamides adverse effects
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"CRYSTAL KERN likes her HEMlines HYPERshort"
-crystalluria: less common with modern sulfonamides; give NaCO3 -kernicterus: sulfonamides displace bilirubin from albumin in neonates and it enters the brain -hematopoietic rxns: hemolytic/ megaloblastic anemia, thrombocytopenia, granulocytopenia in G6PDH deficient people -hypersensitivity rxns: most likely to cause SJ syndrome (more likely with long acting drugs) |
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which sulfonamide treats burns
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silver sulfadiazine
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which sulfonamide treats UTI
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SMZ/TMP
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which sulfonamide treats colitis
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"SAL has colitis"
sulfaSALazine |
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which sulfonamide treats ocular chlamydia trachomatis
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#1 preventable cause of blindness worldwide
sulfacetamide drops (but PO azithromycin is DOC) |
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which sulfonamide is DOC for nocardia
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SMZ/TMP
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which sulfonamide is DOC for upper resp. tract infection (H.flu related)
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SMZ/TMP
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which sulfonamide treats taxoplasma gondii (protozoan)
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sulfadiazine + pyrimethamine
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which sulfonamide is DOC for penumocystis jeroveckii
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SMZ/TMP
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what drugs work at stage 1 of bacterial cell wall synthesis
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fosfomycin
D-cycloserine |
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what drugs work at stage 2 of bacterial cell wall synthesis
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vancomycin
teichoplanin bacitracin |
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what drugs work at stage 3 of bacterial cell wall synthesis
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B-lactam antibiotics
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fosfomycin MOA
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inhibits addition of lactoyl group to NAG to make NAM
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D-cycloserine
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reversibly inhibits D-Ala-D-Ala synthase
irreversibly inhibits D-Ala racemase (of the host...potential toxicity) |
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bacitracin MOA
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inhibits cleavage of phosphate from NAM-NAG-pentapeptide transporter to be recycled
G+ coverage only |
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vancomycin MOA
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sits on terminal D-Ala-D-Ala so it can't fit into the growing cell wall
G+ coverage only |
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vancomycin resistance MOA
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bacteria mutates the building block precursor from D-Ala-D-Ala to D-Ala-D-lactate so vancomycin can't recognize (VRE)
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DOC for ampicillin-resistant enterococcus
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vancomycin + gentamicin
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vancomycin adverse effects
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"RON"
-red man syndrome: from histamine displacement -ototoxicity: irreversible -nephrotoxicity: reversible |
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DOC for MRSA/MRSE
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vancomycin + rifampin + gentamicin
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polymyxin MOA
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cationic detergent that disrupts bacterial cell membranes
G- coverage only NO effect on cell wall synthesis |
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adverse effects of systemic polymyxin use
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nephrotoxicity and neurotoxicity
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whats the most famous PBP inhibited by B-lactam antibiotics
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transpeptidase...but its not the only one
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what are the only B-lactamase-resistant drugs
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CONDoM drugs
-cloxacillin -oxacillin -nafcillin -dicloxacillin -methicillin G+ coverage only |
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interstitial nephritis is most common with
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methicillin
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neutropenia is most common with
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nafcillin
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oral bioavailability (most to least)
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dicloxacillin > cloxacillin >oxacillin
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DOC for listeria, enterococcus, and proteus mirabilis (LEP)
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ampicillin
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aminopenicillins MOA
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zwitterion so more hydrophilic and able to pass thru aqua-porins of G- cell envelope
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diarrhea is most common with
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ampicillin - erratic absorption
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pseudomembranous colitis is most common with
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ampicillin
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antipseudomonal penicillins
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PM CAT
piperacillin mezlocillin carbenicillin azlocillin ticarcillin |
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antipseudomonal penicillins coverage
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-pseudomonas aeruginosa
-indole + proteus -B.frag |
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Na+ overload, hypkalemia and increased bleeding are most common with
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ticarcillin
carbenicillin |
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DOC for meningeal pseudomonas aeruginosa
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piperacillin + tazobactam (zosyn) + gentamicin
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whats the most important method of resistance to B-lactam antibiotics
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B-lactamase production
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how do G+ bacteria produce/release B-lactamase
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into the surrounding environment as "exoenzymes" that are able to confer B-lactamase activity to other G+ bacteria present that doesn't elaborate B-lactamase
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how do G- bacteria produce/release B-lactamase
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concentrated in the periplasmic space of the cell envelope so infection is harder to treat
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adverse effects of all penicillins (8)
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SNL BB SIN
-sensitivity rxns -neutropenia -leuokopenia -BM suppression -bleeding -seizures -interstitial nephritis -Na+ overload/hypokalema |
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skin rashes (macropapular with itching) most common with
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ampicillin
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anaphylactic shock (10% mortality) most common with
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penG
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hapten that causes penicillin hypersensitivity rxns
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benzylpenicilloyl hapten
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if allergic to 1 penicillin...
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...allergic to all penicillins
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neutropenia most common with
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nafcillin
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seizures most common with
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penG
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which cephalosporins can be cleaved by penicillinases
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NONE :o)
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which drugs does ESBL cleave
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aztreonam
3rd gen cephs |
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which drugs does Amp-C cleave
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3rd gen cephs
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1st gen PO cephs
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"RAD ALEX ROX PO"
cephRADine cephALEXIN cefadROXil |
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2nd gen PO cephs
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"FURious LORd is PRO-POD"
ceFURoxime cefacLOR/LORacarbef cefPROzil cefPODoxime |
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3rd gen PO cephs
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"FIX DINner, BUT DITto!"
ceFIXime cefDINir cefBUTen cefDITOren |
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which cephs are effective against enterococcus (G+)
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NONE :o(
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what 2 cephs are eliminated thru bile
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sounds like "pair of tricks"
cefoPERAzone cefTRIAXone |
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which 2 cephs pass thru BBB so 1st line tx for meningitis
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"TRI EPI for brain"
cefTRIaxone cefEPIme |
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which cephs are resistant to penicillinase produced by staph
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ALL :o)
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which cephs have MTT side chain? what does this mean?
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"i MET a TAN MAN in the endZONE"
cefMETazole cefoteTAN cefMANdole cefoperaZONE MTT sidechain causes increased bleeding and disulfuram rxns with EtOH |
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kernicterus is common with
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ceftriaxone and ALL sulfonamides
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biliary sludging is most common with
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ceftriaxone
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1st gen ceph coverage
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G+ aerobes
G- PE (proteus mirabilis + e.coli) NO anaerobes |
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what drug is used for surgical prophylaxis against staph aureus, epidermitis, and strep pyogenes, and enters the bone
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cefazolin
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serum sickness is most common with
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cefaclor
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whats the only 1st or 2nd gen ceph that X BBB
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cefuroxime - PO prodrug
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whats a good drug to treat CAP (community acquired pneumonia)
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cefuroxime
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whats an alternative to cefotoxin for abdominal surgery prophylaxis
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cefuroxime
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DOC for M.cat infection
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cefuroxime
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what are the cephamycins
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"METAL TAN FOX"
cefMETAzole cefoteTAN ceFOXitin |
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what drug is no longer considered to haev reliable coverage against B.frag
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ceFOXitin
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DOC for serious G- nosocomial infections especially enterobacteriacea and neisseria meningitidis
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3rd gen cephs
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what 2 drugs are not very effective against strep pneumoniae
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"BUT FIX"
ceFIXime and ceftiBUTen |
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DOC for penicillin-resistant strep pneumoniae
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ceftriaxone
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what 3rd gen ceph has QD dosing
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ceftriaxone
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DOC against neisseria gonorrhea
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ceftriaxone
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what 3rd gen ceph is active against pseudomonas aeruginosa
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cefoPERAzone
doesn't X BBB so NOT for pseudomonal meningitis |
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DOC for pseudomonal meningitis
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cefTAZidime
X BBB |
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what must you do when covering peripheral pseudomonas infections
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always DOUBLE COVERAGE with aminoglycoside
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cefepime coverage
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G+ and G- aerobes
no anaerobe coverage (B.frag) |
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new DOC for pseudomonal meningitis
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cefepime
X BBB aaaannnddd resistant to ESBL's |
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what B-lactamases are carbapenems stable against
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"PACE"
-penicillinase -Amp-C -cephalosporinase -ESBL |
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what are carbapenems NOT stable against
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"MAME"
-MRSA -atypicals -metallo-B-lactamases -enterococcus faecium |
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seizures are MOST common with
|
imipenem
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aztreonam
-classification -MOA |
monobactam
inhibits PBP-3 which is responsible for septum formation during bacterial division |
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aztreonam coverage
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G- aerobes
pseudomonas aeruginosa no coverage of G+ anaerobes |
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what drug is not stable to ESBL
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aztreonam
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B-lactamase inhibitors
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-clavulonic acid
-sulbactam -tazobactam |
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B-lactamase inhibitors MOA
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irreversible (suicide) inhibition of B-lactamases (penicillinases, cephalosporinases, and ESBLs)
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what drugs are not stable to Amp-C
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B-lactamase inhibitors
carbapenems DOC for Amp-C |
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what drugs are not stable to metallo-B-lactamases
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B-lactamase inhibitors
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what are the drug combos with B-lactamase inhibitors
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amoxicillin+clavulonic acid (augmentin)
ticarcillin+clavulonic acid (timentin) ampicillin+sulbactam (unasyn) piperacillin+tazobactam (zosyn) |
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cephalosporin distribution
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well into most body tissues
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what drug increases amount of "free" penicillin in the body
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probenecid
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what drugs don't require renal dose adjustment
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COND (cloxacillin, oxacillin, nafcillin, dicloxacillin)
ceftriaxone cefoperazone |
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what ceph has the longest half-life
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ceftriaxone
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what happens to carbapenems with metallo-B-lactamases
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cleaved
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what happens to carbapenems with Amp-C
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stable - DOC
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what happens to carbapenems with ESBLs
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stable
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what happens to aztreonam with metallo-B-lactamases
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stable
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what happens to aztreonam with ESBLs
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cleaved
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what do B-lactamases inhibitors NOT inhibit
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"AM"
metallo-B-lactamases Amp-C |
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MOA of VRE
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mutation of D-Ala-D-Ala to D-Ala-D-lactate thus vancomycin doesn't recognize terminal part and can't work
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methenamine MOA
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broken down into 6 molecules of formaldehyde; requires acidic environment
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how can you acidify urine while taking methenamine
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drink cranberry juice
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how is conversion methenamine to formaldehyde in the stomach avoided
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enteric coating
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methenamine interacts with
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sulfonamides form inactive complex with methenamine and can precipitate in the urine
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what organism is resistant to methenamine? MOA?
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proteus elaborates urease, which makes ammonia and basifies urine; methenamine needs acidic medium to be activated
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who shouldn't take methenamine
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patients with pre-existing liver disease because they can't break down NH3 in blood
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what nitrofurantoin salt is nausea/vomiting most common with
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microcrystalline form stimulates CTZ
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what nitrofurantoin salt should you take to avoid nausea/vomiting
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macrocrystalline
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