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78 Cards in this Set
- Front
- Back
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Which ABx act by inhibiting Cells wall synthesis?
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-bata lactames (penicillins, cephalosporins, monobactams, cerbepenams)
-glycopeptides (vancomycin, teichoplanin) |
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Which Abx act by affecting DNA gyrase?
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fluoroquinolones
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Which Abx act by affecting RNA polymerase?
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Rifampin
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Which Abx act by inhibiting the 30S subunit of protein synthesis?
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-aminoglycosides
-tetracyclines |
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Which Abx act by inhibiting the 50S subunit of protein synthesis?
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-macroslides
-clindomycin -chloramphenicol |
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Which Abx act by affecting folate metabolism?
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-sulfonamides
-trimethoprim |
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Natural Penicillins: Properties
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-beta lactame ring that looks like a square adjacent to a pentagon
-affect protein call wall synthesis |
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Natural Penicillins: Coverage
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-group A and B Strep (GP cocci)
-Strep penumonaue (GP cocci) -many gonococci (GN cocci) -meningococci (GN cocci) -listeria (GP bacilli) -many anaerobes -pasturrella multicida (GN bacilli nonl glucose) -treponema pallidum -do NOT cover enterococci -much resistance developed esp with staph aureus (MRSA) which produce beta lactamase enxzyme (penicillinase) which destroys the beta lactame ring |
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Natural Penicillins: Representative Agents
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-Penicillin V (oral)
-Penicillin G (bicillin), IV/IM, short half life, poor oral absroption, excreted unchanges by kidneys |
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Penicillinase Resistant Penicillins: Properties
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-reduced inactivation by beta lactamase producing organisms (esp staph aureus and coag neg staph)
-beta lacatamase resistant -less active than PCN G against strep -active against MSSA, but not enterococci, gonogcocci, meningococci, listeria, gram neg |
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Penicillinase Resistant Penicillins: Coverage
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-staph aureus and coag neg staph (GP cocci)
-less active than PCN G against strep -active against MSSA -NOT active against enterococci (GP cocci), gonococci (GN cocci), meninggococci (GN cocci), listeria (GP bacilli), GNB -Staph that are resistant to these agents (MRSA) need to be treated with glycopeptide |
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Penicillinase Resistant Penicillins: Representative Agents
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-Dicloxacillin (Dynapen), oral
-Cloxacillin (Tegopen), oral -Oxacillin (Prostaphon, Bactocil) IV -Nafcillin (Nafcil, Unipen), IV -Methicillin (Staphcillin) |
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Which PNC is metabolized in the liver?
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Nafcillin
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Amino Penicillins: Properties
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-allow for more gram negative coverage than PCN-G
-still vulnerable to beta lactamase inactivation |
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Amino Penicillins: Coverage
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-e coli (GN bacilli glucose)
-shigella (GN bacilli glucose) -salmonella (GN bacilli glucose) -proteus (GN bacilli glucose) -h influenza (GN baciili non-glucose) |
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Amino Penicillins: Representative Agents
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-amoxicillin (better absorped by GI tract than ampicillin)
-ampicillin, PO or IV -bacampicillin (Spectrobid) |
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Anti-Pseudomonal Penicillins: Properties
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-destroyed by beta lactamases
-better coverage against pseudomonas (GN bacilli non-glucose), other gram negative bacilli (klebsiella, proteus, enterobacter, serratia) and other gram negative anaerobes(bacteriodes) |
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Anti-Pseudomonal Penicillins: Coverage
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-psuedomonos (GN bacilli non-glucose)
-gram negative rods (klebsiella, proteus, enterobacter, serratia) -gram negative anaerobes(bacteriodes) |
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Anti-Pseudomonal Penicillins: Representative Agents
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-piperacillin (pipracil)
more potent than tiracillin against pseudomonos -tiracillin (Ticar) -Mexlocillin (Mezlin) |
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Beta Lactamase Inhibitor/Penicillin Combiniation Agents: Properties
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-broaden the spectrum of agents with which they are combined
-limited antibacterial activity -inhibit plasmid mediated rather than chromosomal mediated enzymes |
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Beta Lactamase Inhibitor/Penicillin Combiniation Agents: Representative agents
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-clavulanic acid
-sulbactam -tazobactam |
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Cephalosporins: Properties
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-beta lactam ring that looks like a square adjacent to a hexagon (house with a basement)
-affect cell wall synthesis -generally more resistnat to beta lactamases than the penicillins -DO NOT cover enterococci (GP cocci) and listeria (GP bacilli) -10% cross reactivity with the PCNs but can be used with minimal risk in non-anaphylactic PCN-allergic pts |
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1st Generation Cephalosporins: Properties/Coverage
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-good for staph and strep (GP cocci) (good for surgical prophylaxis)
-poor for gram neg coverage (but ok for e coli and proteus) -not effective aginst MRSA -can interfere with PT time |
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1st Generation Cephalosporins: Representative Agents
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-cephalothin (Keflin)
-cefazolin (Ancef, Kefzol), IV/IM -Cephaprin (Cefadyl) -Cephraine (Velosef, Anspor) -Cephalexin (Keflex), oral -Cefadroxil (Duricef, Ultracef) -Cephradine (generic) |
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2nd Generation Cephalosporins: Properties/Coverage
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-less gram pos coverage
-additional gram neg coverage esp for haemophilus (but not for psuedomonos) -Not effective aginst MRSA -some agents cover anaerobes only (cefuroxime) -some cover anerobes and aerobes (cefotetan) |
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2nd Generation Cephalosporins: Representative Agents
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-Cefaclor (Ceclor) (poor coverage against strep pneumonia)
-cefamandole (mandole), increases bleeding time (PT) -cefoxitin (mefoxin) (good for anaerobes such as b fragilis) -cefuroxime (Zinacef, Kefuroz), IV -Cetonicid (Monocid) -Cefmetazole (Zefazone) -Cefotetan (Cefotan) (good for anerobe bacillus cereus) -Cefprozil (Cefzil) -Loracarbef (Lorabid) |
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3rd Generation Cephalosporins: Properties/Coverage
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-Even more gram neg coverage than 2nd gen
-even less gram positive coverage -all have good CNS penetration (esp ceftriaxone and cefotaxine) |
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3rd Generation Cephalosporins: Representative Agents with good gram positive coverage but poor pseudomonos
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-Cefotaxime (Claforan)
-Ceftizoxime (Cefizox) -Ceftriaxone (Rocephin) (empiric coverage of meningitis except listeria)(good coverage of gram negative with gentamycin) |
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3rd Generation Cephalosporins: Representative Agents with poor gram positive coverage but good pseudomonos coverage
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-ceftazidime (Fortax, Taricef, Tazadime)
-excellent against pseudomonos, but lose almost all gram positive coverage -Fortaz is frequently utilized in gram negative neutropenic sepsis |
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3rd Generation Cephalosporins: Other Representative Agents
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-Cefetamet pivoxil
-Cefoperazone (Cefobid) -Cefixime (Suprax) -Cefpodoxime proxetil (Vantin) -Cefsulodin (Cefomonil) -Ceftibuten (Cedax) -Cefdinir (omnicef) -Cefditoren picoxil (Spectracelf) oral |
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4th Generation Cephalosporins: Perperties/Coverage
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-good gram positive and pseudomonas (GN bacilli non glucose) coverage
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4th Generation Cephalosporins: Representative Agents
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-Cefepime (Maxipime)
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Carbapenems (Imipenem): Properties
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-beta lactames
-affect cell wall synthesis -cross reactivit with PNC (like cephalosporins) -broad spectrum of coverage aginst gram postiive and gram negative aerobes and anaerobes -drug of choice for enterobacter (GN bacilli glucose) -epilipetogenic (like high dose PNC) -undego renal metabolism (use with caution in pts with renal insufficiency) |
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Carbapenems (Imipenem): Coverage
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-broad spectrum of coverage aginst gram postiive and gram negative aerobes and anaerobes
-drug of choice for enterobacter |
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What is the drug of choice for enterobacter?
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Carbapenems
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Carbapenems (Imipenem): Representative Agents
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-Imipenem
-imipenem/cilastatin (Primaxin) -Ertapenem (Invanz), once daily IV |
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Carbapenems (Imipenem): Resistant organisms
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-MRSA
-pseudomonos cepacia -xanthomonas multiphila |
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Monobactams (Aztreonam): Properties
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-beta lactames
-monobactams so they do NOT cross react with other beta lactames and can be used safely in pts with PNC allergies (EXCEPT ceftazidime) -affect cell wall synthesis -no renal toxicity (whereas aminoglycosides do) -effective only against gram neg aerobes (including pseudomonas aeruginosa) -often combined with another agent that has gram pos and anaerobic coverage (clindamycin) -not effective agasint gram pos or anerobes |
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Monobactams (Aztreonam): Coverage
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-effective only against gram neg aerobes (including pseudomonas aeruginosa)
-not effective agasint gram pos or anerobes |
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Monobactmas (Aztrenam): Representative Agents
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-Astreonam (Azactam)
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Aminoglycosides: Properties
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-Bind to 30S subunit and inhibit protein synthesis
-entry into bacteria is often oxygen dependent (works in aerobic environement only) -often combined with beta lactam which destroys cell wall so aminoglucoside can get gain entry -Administered parenterally d/t poor GI absorption -once daily dose d/t post Abx effect -concentration dependent agents (peak dose more important than duration over MIC) -poor CNS and pulmonary penetration -peak and trough serum levels to measure efficacy and toxicity |
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Aminoglycosides: Side Effects
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-nephrotoxicity
-auditory and vestibular nerve damage |
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Aminoglycosides: Coverage
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-most effective aginst aerobic gram neg rods
-effective against staph aureus (GP cocci) if used with PNCase resistant PNC or a glycopeptide -synergistic effect against enterococci, streptococci, and multi-drug resistant gram neg rods |
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Aminoglycosides: Representative Agents
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-Amikacin (Amikin) (good for multi drug resistant gram neg bacilli)
-gentamycin (garamycin) -karamycin (kantrex) -Neomycin (neobiotic) -Tobramycin (Trobicin) -Spectinomycin (Trobicin) -streptomycin |
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Macroslides: properties
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-bind to 50S subunit and inhibit protein synthesis
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Macroslides: Representative Agents
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-Eryhtromycin
-Azithromycin (Zithromax)/ Clarithromycin (Biaxin) |
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Erythromycin
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MACROSLIDE
-for atypical pneumonia caused by legionella, mycoplasma, or TWAR (GN) -effective against Strep pneumoniae (GP cocci) in skin and soft tissue infections -effective in pts with PNC allergy -losing activity against Strep pneumonia -GI side effects |
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Azithromycin (Zithromax)/ Clarithromycin (Biaxin)
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MACROSLIDE
-less GI effects than erythromycin -decreased dosing frequency as compared to erythromycin -treatment and prophylaxis of mycobacterium avium complex (MAC) -single dose azithromycin used in clhamydial urethritis and cervicitis |
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Tetracyclines: Properties
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-binds to 30S subunit to inhibit protein synthesis
-highly effective against mycoplasma, chlamydia, spirochetes, vibrio, and brucella |
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Tetracyclines: Representative Agents
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-Tetracycline, Oxyytetracycline (Terramycin)
-Doxycycline (Vibramycin, Vibra-tabs, Doryx) (metabolized by liver, longer half live, reduced photosensitivity rxn) -minocycline (minocin) |
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Sulfonamides (TMP/SMX): Properties
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-effects folate metabolism
-inhibit sequential steps in the metabolism of THFA -drug of choce for PCP (most common opportunisitc infection in AIDS) |
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Sulfonamides (TMP/SMX): Coverage
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-effective against gram pos cocci and gram neg UTI pathogens and enterbacteriaceae (GN bacilli glucose)
-not active against pseudomonos aeruginosa -active against p cepacia and x multophilia which may arise during treatment with imipenem |
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Sulfonamides (TMP/SMX): toxicity
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-Steven Johnson Syndrome
-Renal |
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Sulfonamides (TMP/SMX): Representative Agents
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-Trimethoprim-Sulamethoxazole (bactrim, Septra)
-Sulfisoxzole (Gantrisin) -Sulfamethizole (Thiosulfil, Suladyne) -Sulfisomidine (Elkosin) -Sulfachloropyridazine (Sonilyn) -Sulfacytine (Renoquid) -Tresulfa Pyrimidine (Terfonyl) |
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Fluoroquinolones: Properties
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-inhibits DNA gyrase
-avoid in children -therapeutic alternative for gonococcal and chlamydia infections, UTIs, diarrhea syndrome, and chornic deep infection such as osteomyelitis |
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Fluoroquinolones: Coverage
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-active against many bacteria, chlamydia, mycoplasma, and mycobacteria
-reduced activity aginst group A strep, strep pneumoniae, s aureus, MRSA -ineffectice against anaerobes |
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Fluoroquinolones: Representative Agents
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-Norfloxacin (Norflox0
-Ciprofloxacin (Cipro) -Oflocacin (Floxin) -Levofloxacin (Levaquin) -Enoxacin (Penetrex) -Lomefloxacin (Maxaquin) -Pefloxacin -Rufloxacin (monos) -Sparfloxacin (Zagam) -Grepafloxacin (Raxar) -Trovafloxacin (Trovan) -Gatifloxacin (Tequin), oral or IV -Moxifloxacin (Avelox), oral |
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Glycopeptides: Properties
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-inhibit cell wall synthesis
-agents of choice againsts MRSA, vancomycin-resistant enterocicci (VRE), and vancomycin resitant s haemolyticus -alternative for PCN allergic pts with gram pos infections |
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Glycopeptides: Coverage
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-agents of choice againsts MRSA, vancomycin-resistant enterocicci (VRE), and vancomycin resitant s haemolyticus
-alternative for PCN allergic pts with gram pos infections |
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Glycopeptides: Toxicity
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-reversible nephrotoxicity (monitor trough levels)
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Glycopeptides: Representative Agents
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-Vancomycin (Vanocin)
-Teichoplanin (Targocid) |
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Vancomycin
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GLYCOPEPTIDE
-oral vancomycine is an alternative to metronidazole (flagyl) for treatment or c difficile colitis -not absorbed from GI tract |
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Techoplanin
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GLYCOPEPTIDE
-best for VRE genotype Van B |
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Polypeptides: properties
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-mostly used as topical antimicrobial agents
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Polypeptides: Representative Agents
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-Bacitracin (affects cell wall synthesis)
-polymyxin B (aerosporin) -colistimethate (coly-mycin-M) |
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Streptogramins: properties
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-inhibits protein synthesis
-IV admin only -bacteriocidal against most gram postive and respiratory pathogens -"last resort" agent for vancomycin-resistant enterococcus faecium -effective against staph (MRSA and strep, CNA, e faecium inclduing VRE strains -elimination by biliary excretion and stools -side effects: rash, GI, arthralgia, mylagia |
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Streptogramins: Representative Agents
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-quinupristin/dalfopristin (Synercid)
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Oxazolidinones: Properties
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-inhibits bacterial protein synthesis
-PO or IV -metabolized in liver -effect against VRE faecium, Staph Aureeus including MRSA nd VISA, s pneum -most useful against serious infections d/t broad range gram-pos organisms, MRSA, PNC resistant pneumococci, macrolide-resistant strep, VRE -side effects: rash GI, thrombocytopenia |
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Oxazolidinones: Representative Agents
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-Linezolid (Zyvox)
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Metronidazole (Flafyl): Properties
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-effective against many anaerobes and parasites (ameba, giardia, trichomonas vaginalis)
-drug of choice to treat C difficile colitis (cheaper than vancomycin and help reduce exposure of organisms to vancomycin thereby reducing development of vancomycin resistant bacteria) |
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What is the treatment of choice for c difficile colitis?
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Metronidazole (Flafyl)
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Clindamycin (Cleocin): Properties
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-inhibits 50S subunit (like the macroslides) inhibiting protein synthesis
-active against gram pos aerobes (but NOT MRSA) ad many anaerobes -when combined with aminoglycoside, monobactam, fluoroquinolone for gram neg coverage, it is effective against many mixed aerobic or anaerobic infections in the mouth, intraabdominal, intrapelvic, infected foot ulcers |
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Choloramphenicol (Cholormycetin): Properties
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-binds 50S subunit to inhibit protein synthesis
-causes bone marrow suppression by dose-dependent suppression and by another rare and irreversible method |
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Isonaizid (INH): Dose/Toxicity
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-300 mg PO, IM, IV
-hepatitis, peripheral neuropathy, hypersensitivity |
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Rifampin: Dose/Toxicity
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-600 mg PO, IV
-orange discoloration of urine, N/V, heptatitis, febrile reaction, purpura (rare) |
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Pyrazinamide (PZA): Dose/Toxicity
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-2 gm, PO
-hepatitis, hyperuricemia |
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Ethambutol: Dose/Toxicity
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-2.5 gm, PO
-optic neuritis, skin rash |
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Streptomycin: Dose/Toxicity
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-1 gm, IM
-ototoxicity, nephrotoxicity |
