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44 Cards in this Set

  • Front
  • Back
Abx that Inhibit or disrupt Cell wall growth
Beta Lactams (pen, ceph, carbapenems)
Monobactams (aztreonam)
Glycopeptides (vanco)
Abx that Inhibit protien synthesis
50s (macro, ketoli,lincosamides,chloramphenicol)
30s (amino,tetracy)
Abx that Inhibit DNA or RNA synthesis
DNA gyrase/topoisomerase-->fluroquinolines
DNA dependent RNA polymerase -->rifampin
DNA alteration (metronidazole)
Abx that Inhibit folic acid synthesis
Bacteriocidal abx
Beta Lactams, glycopeptides, aminoglycosides, fluroquinolones, metronidazole, cyclic, lipopeptides
-->preferable if the host is compromised or if the host defenses do not operate well (bacterial endocarditis or meningitis)
bactriostatic Abx
tetracyclines, macrolides, ketolides, lincosamides, sulfonamides
concentration-Dependent Effects
inc bacteriocidal effect correlates with inc drug
ie:aminoglycosides, fluoroquinolones
-->should be given in large infrequent doses to acheive high levels but dec pot toxicities
Time-dependent Effects
bacterial killing has little relationship to conc of abx
effective as long as the abx level is above the MIC
ie:B-lactams, monobactams, glycopep
-->dose so that levels are as low as possible to reduce toxicities but remain as long as possible above the MIC (moderate doses at short intervals or more appropriately with a continuos slow influsion)
Abx active against intracellular organisms (legionella, rikettsia, chlymidia)
tetracyline, TMP-SMX, fluroquinolones,macrolides, clinda, rifampin
antimicrobials associated with nephrotoxicity
amphotericin B,aminoglycosides (proximal tubular necrosis ATN), naficillin (acute interstitial nephritis AIN), Tetracycline (only in outdated preps can cause fraconi syndrome (reversible proximal renal tubular dysfunx with glucosuria and hyperphosphaturia)), vanco (problems arise only when admin with other nephrotoxic agents)
abx associate with psychiatric sx
clarithromyocin (mania). isoniazid (psychosis, hallucination, mania), metronidazole (depression, agitation, emotional lability, confusion, hallucinations), TMP-SMX (delirium, psychosis, depression, hallucinations)
fluorquinolones (delirium, agitation, emotional ability, confusion, hallucinations)
abx associated with chemical phlebitis
nafcillin (extravasation may result in tissue necrosis, cefepime, vanco, clindamyocin,
abx associated with a disulfiram like rxn with concomitant ETOH
(tachycardia,flushing, HA, abdominal cramps, N/V/D)
B-lactams with methylthioterazole (MTT) side chain (cefamandole, cefotetan. cefoperazone,cefazolin)
-Anti-Pseudomonal Oral ABX
-ciprofloxacin & levofloxacin
-Anti-Staphylococcal Oral ABX
dicloxacillin is the most active
-cephalexin is less active
-minocycline > TMP-SMX are also fairly effective (bacteriostatic)
-Anti-MRSA Oral ABX
-minocycline > TMP-SMX are also fairly effective (check sensitivity pattern)
-Anti-Anaerobic Oral ABX
-metronidazole & amoxicillin / clavulanate (Augmentin) are gold standard
-clindamycin is silver standard
-Parenteral Antibiotic Pearls

-Anti-Pseudomonal IV ABX
-piperacillin / tazobactam
-ciprofloxacin & levofloxacin
-carbapenems (meropenem > imipenem)
-Anti-Staphylococcal IV ABX
-nafcillin is most active
-cefazolin is less active
Note: there are many anti-staphylococcal ABX, but these are generally regarded as the top choices (listed in order)
-dalfopristin / quinopristin
-Anti-Anaerobic IV ABX
Gold Standard
-β-lactam / β-lactamase inhibitor combination
ex. ampicillin/sulbactam or piperacillin/tazobactam

ex. imipenem, meropenem, ertapenem


Silver Standard

Bronze Standard
-cephamycins (cefotetan or cefoxitin
-Antibiotics Associated with Color Associations
-Yellow Babies
-sulfonamides pass the placenta & are excreted in milk à they can displace bilirubin from albumin, leading to kernicterus
-don’t use in women near term or neonates
-Antibiotics Associated with Color Associations
-Gray Babies
-progressive ashen cyanosis may appear 3-4 days after high-dose chloramphenicol due to high [serum] of unconjugated drug secondary to immature hepatic & renal function
~40% mortality
-Antibiotics Associated with Color Associations
-Red Man Syndrome / Red Neck Syndrome
-rapid infusion of vancomycin releases histamine –> vasodilation –> flushing face, neck, upper torso
-wheezing and hypotension possible
-treat by slowing infusion down and give diphenhydramine
-Antibiotics Associated with Color Associations
-Red Lobster Syndrome
-rifampin causes a red-orange discoloration of urine, tears, and sweat
-Antibiotics Associated with Color Associations
-Discolored Teeth
-tetracyclines may cause darkening of developing teeth (brown to greenish)
-contraindicated in kids < 8 yrs.
-Antibiotics Associated with Color Associations
-Loss of Red/Green Color Perception
-high-dose ethambutol may cause optic neuritis (↓ visual acuity, central scotoma, & loss of red/green color perception)
Antibiotics Associated with Potassium Dysregulation
-trimethoprim (usually as TMP-SMX) blocks distal tubular reabsorption of Na+ and secretion of K+
-various penicillins, especially nafcillin and piperacillin, may act as non-reabsorbed anions in the kidney
Antibiotics Associated with Clostridium difficile diarrhea
Aminopenicillin products
-amoxicillin, amoxicillin / clavulanate, ampicillin, ampicillin / sulbactam

Oral cephalosporins (especially cephalexin)


Note: almost any ABX can cause C. difficile colitis
Antibiotics Associated with Rash when Concurrently used in Infectious Mononucleosis
-Classic association –> ampicillin plus EBV
-can occur with any aminopenicillin product
-Characterized by a maculopapular, nonurticarial (non-penicillin allergic rash) rash in 65-100% of patients with infectious mononucleosis (usually EBV, but may be CMV)

-Occurs in other situations as well
-coadministration of allopurinol
-arrests cell wall synthesis by binding to penicillin-binding proteins (PBPs)
-bacteria need to be actively dividing for β-lactams to work
Mech of bact resistance
-3 mechanism account for resistance to β-lactams
1)destruction of ABX by β-lactamases
2)failure of the ABX to penetrate to PBP targets
3)low-affinity binding of ABX to PBP
-usually renally excreted
-probenecid blocks secretion -> ­plasma levels
-time-dependent killing
-natural PCNs and anti-staphylococcal PCNs have good G+ activity
-as you ascend generations you lose G+ activity and gain G- activity
major adverse effects
-hypersensitivity reactions (rash –> immediate anaphylaxis)
-drug fever
-thrombocytopenia, hemolytic anemia, neutropenia
-neurotoxicity (irritability, hallucinations, seizures, confusion, etc.)
-associated with high doses or when not renally adjusted
-phlebitis, interstitial nephritis, and hypokalemia possible with nafcillin
-occurs with other PCNs, but this association may be on the boards
natural penicillins
-penicillin V (PO) –> Pen VK, Veetids, generics

-penicillin G (IV) –> generics
Microbial Coverage-S. pyogenes (GAS), Treponema pallidum
Note: an immediate, but transient (5-30 min. after injection with procaine products) reaction with bizarre behavior / neurologic reactions can occur –> Hoignes Syndrome
anti-staph (stable against B-lactamases)
-nafcillin (IV) –> Unipen, Nafcil, generics
-dicloxacillin (PO) –> Dynapen, generics
Microbial Coverage:
-S. pyogenes (GAS), S. aureus
Note: used exclusively when S.aureus is suspected of causing the infection or the presence of S. aureus can not be excluded
-ampicillin (IV) –> Principen, generics
-amoxicillin (PO) –> Amoxil, Trimox, generics
Microbial Coverage:
-S. pyogenes (GAS), S. pneumoniae, S. agalactiae (GBS), Enterococci, Borrelia burgdorferi, Pasteurella multocida, Proteus, Listeria monocytogenes
-some H. influenzae, E. coli
Augmented Aminopenicillins
-amoxicillin / clavulanate (PO) –> Augmentin
-ampicillin / sulbactam IV–> Unasyn
Microbial Coverage:
-S. pyogenes (GAS), S. pneumoniae, S. agalactiae (GBS) , Enterococci, M. catarrhalis (even amoxicillin resistant strains), H. influenzae (even amoxicillin resistant strains),Proteus,Pasteurella multocida
-Covers most anaerobes
-some E. coli, Klebsiella
-ticarcillin (IV) –> Ticar
-carbenicillin (PO–> Geocillin
-piperacillin (IV) –>Piperacil
-mezlocillin (IV) –> Mezlin
Renally Excreted Abx
B-lactams (NOT nafcillin,ceftriaxone), aztreonam, vancomyocin, aminoglycosides, fluoroquinolones,trimethoprim, tetracyclines
Hepatically excreted Abx
ceftriaxone, nafcillin,clindamycin, macrolides,rifampin,metronidazole,sulfamethoxazole
Abx associated with ototoxicity
aminoglycosides, vancomycin, erythromycin/azithromycin (transient associated with prolonged high doses (usually IV)), Minocycline (vestibular dysfunx (dizziness,ataxia, N/V) especially older women)