Antimicrobials

Front 1

Abx that Inhibit or disrupt Cell wall growth

Back 1

Beta Lactams (pen, ceph, carbapenems)
Monobactams (aztreonam)
Glycopeptides (vanco)

Front 2

Abx that Inhibit protien synthesis

Back 2

50s (macro, ketoli,lincosamides,chloramphenicol)
30s (amino,tetracy)

Front 3

Abx that Inhibit DNA or RNA synthesis

Back 3

DNA gyrase/topoisomerase-->fluroquinolines
DNA dependent RNA polymerase -->rifampin
DNA alteration (metronidazole)

Front 4

Abx that Inhibit folic acid synthesis

Back 4

trimethoprim-sulfamethoxazole

Front 5

Bacteriocidal abx

Back 5

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)

Front 6

bactriostatic Abx

Back 6

tetracyclines, macrolides, ketolides, lincosamides, sulfonamides

Front 7

concentration-Dependent Effects

Back 7

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

Front 8

Time-dependent Effects

Back 8

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)

Front 9

Abx active against intracellular organisms (legionella, rikettsia, chlymidia)

Back 9

tetracyline, TMP-SMX, fluroquinolones,macrolides, clinda, rifampin

Front 10

antimicrobials associated with nephrotoxicity

Back 10

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B,aminoglycosides (proximal tubular necrosis ATN), naficillin (acute interstitial nephritis AIN), Tetracycline (only in outdated preps can cause fraconi syndrome (reversible proximal renal tubular dysfunx with glucosuria and hyperphosphaturia)), vanco (problems arise only when admin with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)

Front 11

abx associate with psychiatric sx

Back 11

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)

Front 12

abx associated with chemical phlebitis

Back 12

nafcillin (extravasation may result in tissue necrosis, cefepime, vanco, clindamyocin,

Front 13

abx associated with a disulfiram like rxn with concomitant ETOH
(tachycardia,flushing, HA, abdominal cramps, N/V/D)

Back 13

B-lactams with methylthioterazole (MTT) side chain (cefamandole, cefotetan. cefoperazone,cefazolin)

Front 14

-Anti-Pseudomonal Oral ABX

Back 14

-ciprofloxacin & levofloxacin

Front 15

-Anti-Staphylococcal Oral ABX

Back 15

dicloxacillin is the most active
-cephalexin is less active
-minocycline > TMP-SMX are also fairly effective (bacteriostatic)

Front 16

-Anti-MRSA Oral ABX

Back 16

-linezolid
-minocycline > TMP-SMX are also fairly effective (check sensitivity pattern)

Front 17

-Anti-Anaerobic Oral ABX

Back 17

-metronidazole & amoxicillin / clavulanate (Augmentin) are gold standard
-clindamycin is silver standard

Front 18

-Parenteral Antibiotic Pearls

-Anti-Pseudomonal IV ABX

Back 18

-piperacillin / tazobactam
-aztreonam
-ceftazidime
-cefepime
-ciprofloxacin & levofloxacin
-tobramycin
-carbapenems (meropenem > imipenem)

Front 19

-Anti-Staphylococcal IV ABX

Back 19

-nafcillin is most active
-cefazolin is less active
-vancomycin
Note: there are many anti-staphylococcal ABX, but these are generally regarded as the top choices (listed in order)

Front 20

-Anti-MRSA IV ABX

Back 20

-vancomycin
-dalfopristin / quinopristin
-linezolid
-daptomycin

Front 21

-Anti-VRE IV ABX

Back 21

-linezolid

Front 22

-Anti-Anaerobic IV ABX

Back 22

Gold Standard
-β-lactam / β-lactamase inhibitor combination
ex. ampicillin/sulbactam or piperacillin/tazobactam

carbapenems
ex. imipenem, meropenem, ertapenem

metronidazole

Silver Standard
clindamycin

Bronze Standard
-cephamycins (cefotetan or cefoxitin

Front 23

-Antibiotics Associated with Color Associations
-Yellow Babies

Back 23

-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

Front 24

-Antibiotics Associated with Color Associations
-Gray Babies

Back 24

-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

Front 25

-Antibiotics Associated with Color Associations
-Red Man Syndrome / Red Neck Syndrome

Back 25

-rapid infusion of vancomycin releases histamine –> vasodilation –> flushing face, neck, upper torso
-wheezing and hypotension possible
-treat by slowing infusion down and give diphenhydramine

Front 26

-Antibiotics Associated with Color Associations
-Red Lobster Syndrome

Back 26

-rifampin causes a red-orange discoloration of urine, tears, and sweat

Front 27

-Antibiotics Associated with Color Associations
-Discolored Teeth

Back 27

-tetracyclines may cause darkening of developing teeth (brown to greenish)
-contraindicated in kids < 8 yrs.

Front 28

-Antibiotics Associated with Color Associations
-Loss of Red/Green Color Perception

Back 28

-high-dose ethambutol may cause optic neuritis (↓ visual acuity, central scotoma, & loss of red/green color perception)

Front 29

Antibiotics Associated with Potassium Dysregulation

Back 29

Hyperkalemia
-trimethoprim (usually as TMP-SMX) blocks distal tubular reabsorption of Na+ and secretion of K+
Hypokalemia
-various penicillins, especially nafcillin and piperacillin, may act as non-reabsorbed anions in the kidney

Front 30

Antibiotics Associated with Clostridium difficile diarrhea

Back 30

Aminopenicillin products
-amoxicillin, amoxicillin / clavulanate, ampicillin, ampicillin / sulbactam

Oral cephalosporins (especially cephalexin)

Clindamycin

Note: almost any ABX can cause C. difficile colitis

Front 31

Antibiotics Associated with Rash when Concurrently used in Infectious Mononucleosis

Back 31

-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
-CLL
-coadministration of allopurinol

Front 32

PENICILLIN
MOA

Back 32

-arrests cell wall synthesis by binding to penicillin-binding proteins (PBPs)
-bacteria need to be actively dividing for β-lactams to work

Front 33

PENICILLIN
Mech of bact resistance

Back 33

-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

Front 34

PENICILLIN
Pharmacology

Back 34

-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

Front 35

PENICILLIN
major adverse effects

Back 35

-hypersensitivity reactions (rash –> immediate anaphylaxis)
-N/V/D
-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

Front 36

PENICILLIN
natural penicillins

Back 36

-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

Front 37

PENICILLIN
anti-staph (stable against B-lactamases)

Back 37

-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

Front 38

PENICILLIN
Aminopenicillins

Back 38

-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

Front 39

PENICILLIN
Augmented Aminopenicillins

Back 39

-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

Front 40

PENICILLIN
Carboxypenicillins

Back 40

-ticarcillin (IV) –> Ticar
-carbenicillin (PO–> Geocillin

Front 41

PENICILLIN
Ureidopenicillins

Back 41

-piperacillin (IV) –>Piperacil
-mezlocillin (IV) –> Mezlin

Front 42

Renally Excreted Abx

Back 42

B-lactams (NOT nafcillin,ceftriaxone), aztreonam, vancomyocin, aminoglycosides, fluoroquinolones,trimethoprim, tetracyclines

Front 43

Hepatically excreted Abx

Back 43

ceftriaxone, nafcillin,clindamycin, macrolides,rifampin,metronidazole,sulfamethoxazole

Front 44

Abx associated with ototoxicity

Back 44

aminoglycosides, vancomycin, erythromycin/azithromycin (transient associated with prolonged high doses (usually IV)), Minocycline (vestibular dysfunx (dizziness,ataxia, N/V) especially older women)