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102 Cards in this Set
- Front
- Back
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Beta lactams - mechanism
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Inhibit linking of peptide side chains
Stops cell wall synthesis Bactericidal High therapeutic index Safe in pregnancy |
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Beta lactams - clearance
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Kidney
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Beta lactams - side effects
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Rash
Anaphylaxis Hematologic toxicity - anemia, drop in platelets |
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Beta lactams - resistance
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Beta lactamases
Change in penicillin binding sites |
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Penicillins - distribution
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Good tissue distribution
Not prostate or eye Synergy with aminoglycosides |
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Penicillins - clearance
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Kidney
Adjust dose for renal failure |
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Penicillins - side effects
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Anaphylaxis
Rash Diarrhea |
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Standard penicillins - coverage
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Gram positives
Synergy with aminoglycosides |
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Standard penicillins - indications
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Group A strep
Meningococci Syphilis Actinomycosis Combine with aminoglycoside for strep or enterococcal endocarditis |
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Anti-staphylococcal penicillins - coverage
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Gram positives
Staph, but not MRSA Stable to staph beta lactamases |
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Aminopenicillins - coverage
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Gram positives
Some gram negatives (enterococci): E coli H flu Salmonella Shigella |
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Aminopenicillins - indications
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Upper respiratory infection - sinusitis, otitis, bronchitis
UTI Ampicillin and aminoglycoside for enterococci and Listeria |
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Anti-pseudomonal penicillins - coverage
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Gram positives
Gram negatives Pseudomonas B fragilis Enterobacter |
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Anti-pseudomonal penicillins - indications
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IV for serious gram negative infections
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Beta lactamase inhibitors - coverage
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Extend spectrum of beta lactams
Add anaerobic activity |
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Clavulanate-ampicillin (Augmentin) - indications
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Haemophilus and moraxella
Head and neck infection Sinusitis |
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Clavulanate-ticarcillin (Timentin) - indications
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Serious gram negative infections
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Sulbactam-ampicillin (Unasyn) - indications
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Head and neck infections
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Tazobactam-piperacillin (Zosyn) - indications
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Intra-abdominal sepsis
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Cephalosporins - clearance
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Kidney, except ceftriaxone (liver)
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Cephalosporins - side effects
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Cross-reactive allergy with penicillins
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Cephalosporins - coverage
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3rd and 4th gen reach CSF
Higher gen has better gram negative and worse gram positive coverage MRSA, listeria, and enterococci are resistant |
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1st gen cephalosporins - coverage
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Gram positive - staph and strep
Gram negative - E coli, proteus, and klebsiella |
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1st gen cephalosporins - indications
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Surgical prophylaxis
Skin and soft tissue infections |
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2nd gen cephalosporins - indications
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Haemophilus influenza
Sinusitis and otitis |
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2nd gen cephalopsorins - cefoxitin
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Active against anaerobes - B fragilis
Used for intraabdominal infection |
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3rd gen cephalosporins - coverage
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Stable to beta lactamases
Increased gram negative coverage Not enterobacter, citrobacter, or serratia (cephalosporinases) |
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3rd gen cephalosporins - ceftazidime
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Covers pseudomonas
Poor gram positive coverage |
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3rd gen cephalosporins - ceftriaxone
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Once daily use for meningitis, community-acquired pneumonia, and GC
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3rd gen cephalosporins - indications
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Meningitis
Nosocomial pneumonia Serious gram negative infections |
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4th gen cephalosporins - coverage
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Gram positives
Gram negatives Pseudomonas Enterobacteriaceae Stable to beta lactamases |
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4th gen cephalosporins - cefepime
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Empiric treatment of sepsis and nosocomial pneumonia
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Carbapenems - coverage
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Gram positives
Gram negatives Pseudomonas Anaerobes - B fragilis Not MRSA or enterococci Stable to beta lactamases |
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Carbapenems - indications
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Serious infection with resistant bacteria
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Carbapenems - ertapenem
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No pseudomonas coverage
Can be used outpatient |
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Monobactams - coverage
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Gram negatives only
Pseudomonas No penicillin cross-reactivity |
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Vancomycin - mechanism of action
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Binds to terminal D-ala residues and prevents elongation of cell wall
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Vancomycin - coverage
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Gram positives only
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Vancomycin - indications
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C difficile colitis
MRSA Resistant staph aureus or coag-negative staph Penicillin-allergic patients with gram positive infections Resistant strep pneumo JK corynebacteria |
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Vancomycin - clearance
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Kidney
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Vancomycin - resistance
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Altered binding target
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Vancomycin - side effects
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Red man syndrome with rapid infusion
Hematologic, nephrotoxic, and ototoxic |
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Aminoglycosides - mechanism
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Enter bacteria via oxygen-dependent transport
Irreversibly bind to 30S ribosome Bactericidal protein synthesis inhibitor |
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Aminoglycosides - resistance
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Inactivating enzymes
Loss of transport system |
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Aminoglycosides - clearance
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Kidney
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Aminoglycosides - side effects
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Narrow therapeutic index
Nephrotoxicity Ototoxicity |
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Aminoglycosides - coverage
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Some gram positives
Gram negatives Synergy with penicillin and vancomycin |
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Aminoglycosides - gentamicin
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Gram positive cocci - endocarditis
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Aminoglycosides - tobramycin
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More active against pseudomonas
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Aminoglycosides - streptomycin
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TB
Plague Tularemia |
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Aminoglycosides - amikacin
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Least susceptible to inactivating enzymes
Resistant bacteria |
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Aminoglycosides - neomycin
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Oral gut decontamination
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Tetracyclines - mechanism
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Bind reversibly to 30S ribosome
Block binding of tRNA to mRNA complex Bacteriostatic protein synthesis inhibitor |
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Tetracyclines - resistance
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Changes in transport mechanism
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Tetracyclines - clearance
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Kidney
Gut Antacids and milk decrease absorption Cross placenta and get into fetal bone and teeth |
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Tetracyclines - side effects
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Gastric irritation
Nausea Diarrhea Photosensitivity |
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Tetracyclines - indications
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Atypical pneumonia - chlamydia, mycoplasma, legionella
Rickettsia Lyme disease STDs - chlamydia, gonorrhea, PID, granuloma inguinale |
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Tigecycline - coverage
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Resistant gram positives - MRSA
Resistant gram negatives - acinetobacter Anaerobes Mycobacteria |
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Tigecycline - indications
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Skin and soft tissue infection
Intraabdominal infection |
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Macrolides - mechanism
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Bind reversibly to 50S ribosome
Block translocation Bacteriostatic |
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Macrolides - resistance
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Mutation in 50S ribosomal RNA
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Macrolides - clearance
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Liver metabolism
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Macrolides - coverage
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Staph and strep
Intracellular pathogens - legionella, chlamydia, mycoplasma Not pseudomonas or enterobacteriaceae |
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Macrolides - iondications
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Community acquired pneumonia
Some STDs (chlamydia) Atypical mycobacteria (MAC) Alternative for strep pharyngitis and skin and soft tissue infectionsin penicillin allergic patients Bartonella Pertussis |
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Macrolides - side effects
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GI toxicity - nausea, vomiting, diarrhea
Cytochrome P450 interactions |
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Clindamycin - mechanism of action
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Binds to 50S ribosome
Bacteriostatic |
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Clindamycin - coverage
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Anaerobes - B fragilis
Staph and strep No gram negatives |
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Clindamycin - clearance
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Liver metabolism
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Clindamycin - indications
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Anaerobic infection
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Clindamycin - side effects
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C difficile colitis
Topical (acne) Vaginal (bacterial vaginosis) |
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Quinolones - mechanism
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Block bacterial DNA synthesis by blocking DNA gyrase and topoisomerase
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Quinolones - resistance
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Alterations in DNA gyrase
Decreased permeability Chelated by cations - don't take with iron or antacids |
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Quinolones - clearance
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Kidney
Enters prostate |
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Quinolones - side effects
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Arthropathy in children
Tendonitis and tendon rupture CNS - dizziness, insomnia, and photosensitivity |
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Quinolones - coverage
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Gram negatives
Pseudomonas Intracellular pathogens Some mycobacteria - legionella, mycoplasma, chlamydia |
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Respiratory fluoroquinolones - coverage
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Gram positives
Some anaerobic |
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Respiratory fluoroquinolones - indications
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Bronchitis
Community-acquired pneumonia |
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Fluoroquinolones - indications
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UTI
Prostatitis STDs - chancroid and chlamydia Traveler's diarrhea, shigella, salmonella Cystic fibrosis Gram negative osteomyelitis Anthrax |
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Nitroimidazoles - coverage
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Anaerobes
Some parasites |
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Nitroimidazoles - mechanism
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Reduced by nitroreductase into toxic intermediates that bind to DNA and inhibit synthesis
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Nitroimidazoles - resistance
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Decreased uptake
Decreased nitroreductase |
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Nitroimidazoles - coverage
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Enters CSF and brain
B fragilis C difficile Giardia, amoeba, trichomonas |
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Nitroimidazoles - side effects
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Metallic taste, nausea, seizures, peripheral neuropathy
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Nitroimidazoles - indications
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Anaerobic infections
Brain abscess Bacterial vaginosis C difficile colitis Trichomonas vaginalis Amoebiasis Giardiasis |
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Sulfonamides - mechanism
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Compete with PABA for THPS
Blocks folate synthesis |
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Sulfonamides - resistance
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Overproduction of PABA, altered THPS
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Sulfonamides - coverage
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Gram positives
Some enterobacteriaceae |
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Sulfonamides - side effects
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Rash and hypersensitivity
Stevens-Johnson syndrome Hemolytic anemia Jaundice Neutropenia |
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Sulfonamides - indications
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Nocardia
Toxoplasmosis Pneumocystis Plasmodium falciparum Lymphogranuloma venereum |
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Trimethoprim - mechanism
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Inhibits DHF
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Trimethoprim - coverage
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Enters prostate
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Trimethoprim - indications
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UTI
Prostatitis |
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Trimethoprim-sulfa - side effects
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Rash
Nausea Vomiting Megaloblastic anemia Leukopenia |
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Trimethoprim-sulfa - indications
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PCP
Toxoplasmosis Nocardia Stenotrophomonas Prostatitis Uncomplicated UTI MRSA |
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Linezolid - mechanism
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Binds to 50S ribosome and inhibits protein synthesis
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Linezolid - coverage
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Gram positives - MRSA- VRE, PRSP
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Linezolid - side effects
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Nausea, headache, thrombocytopenia, peripheral and optic neuropathy
Weak MAOI - careful use with SSRIs |
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Linezolid - indications
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MRSA bacteremia
Pneumonia Skin and soft tissue infections Serious VRE infections |
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Daptomycin - mechanism
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Rapdily depolarizes bacterial cell membranes
Bactericidal |
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Daptomycin - coverage
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Gram positives only:
MRSA VRE JK corynebacteria Coagulase-negative staph |
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Daptomycin - side effects
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Myalgias
Weakness Rise in CPK Neuropathy |
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Daptomycin - indications
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MRSA
MSSA bacteremia Right sided endocarditis Complicated skin and soft tissue infections |
