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78 Cards in this Set

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Which ABx act by inhibiting Cells wall synthesis?
-bata lactames (penicillins, cephalosporins, monobactams, cerbepenams)
-glycopeptides (vancomycin, teichoplanin)
Which Abx act by affecting DNA gyrase?
fluoroquinolones
Which Abx act by affecting RNA polymerase?
Rifampin
Which Abx act by inhibiting the 30S subunit of protein synthesis?
-aminoglycosides
-tetracyclines
Which Abx act by inhibiting the 50S subunit of protein synthesis?
-macroslides
-clindomycin
-chloramphenicol
Which Abx act by affecting folate metabolism?
-sulfonamides
-trimethoprim
Natural Penicillins: Properties
-beta lactame ring that looks like a square adjacent to a pentagon
-affect protein call wall synthesis
Natural Penicillins: Coverage
-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
Natural Penicillins: Representative Agents
-Penicillin V (oral)
-Penicillin G (bicillin), IV/IM, short half life, poor oral absroption, excreted unchanges by kidneys
Penicillinase Resistant Penicillins: Properties
-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
Penicillinase Resistant Penicillins: Coverage
-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
Penicillinase Resistant Penicillins: Representative Agents
-Dicloxacillin (Dynapen), oral
-Cloxacillin (Tegopen), oral
-Oxacillin (Prostaphon, Bactocil) IV
-Nafcillin (Nafcil, Unipen), IV
-Methicillin (Staphcillin)
Which PNC is metabolized in the liver?
Nafcillin
Amino Penicillins: Properties
-allow for more gram negative coverage than PCN-G
-still vulnerable to beta lactamase inactivation
Amino Penicillins: Coverage
-e coli (GN bacilli glucose)
-shigella (GN bacilli glucose)
-salmonella (GN bacilli glucose)
-proteus (GN bacilli glucose)
-h influenza (GN baciili non-glucose)
Amino Penicillins: Representative Agents
-amoxicillin (better absorped by GI tract than ampicillin)
-ampicillin, PO or IV
-bacampicillin (Spectrobid)
Anti-Pseudomonal Penicillins: Properties
-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)
Anti-Pseudomonal Penicillins: Coverage
-psuedomonos (GN bacilli non-glucose)
-gram negative rods (klebsiella, proteus, enterobacter, serratia)
-gram negative anaerobes(bacteriodes)
Anti-Pseudomonal Penicillins: Representative Agents
-piperacillin (pipracil)
more potent than tiracillin against pseudomonos
-tiracillin (Ticar)
-Mexlocillin (Mezlin)
Beta Lactamase Inhibitor/Penicillin Combiniation Agents: Properties
-broaden the spectrum of agents with which they are combined
-limited antibacterial activity
-inhibit plasmid mediated rather than chromosomal mediated enzymes
Beta Lactamase Inhibitor/Penicillin Combiniation Agents: Representative agents
-clavulanic acid
-sulbactam
-tazobactam
Cephalosporins: Properties
-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
1st Generation Cephalosporins: Properties/Coverage
-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
1st Generation Cephalosporins: Representative Agents
-cephalothin (Keflin)
-cefazolin (Ancef, Kefzol), IV/IM
-Cephaprin (Cefadyl)
-Cephraine (Velosef, Anspor)
-Cephalexin (Keflex), oral
-Cefadroxil (Duricef, Ultracef)
-Cephradine (generic)
2nd Generation Cephalosporins: Properties/Coverage
-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)
2nd Generation Cephalosporins: Representative Agents
-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)
3rd Generation Cephalosporins: Properties/Coverage
-Even more gram neg coverage than 2nd gen
-even less gram positive coverage
-all have good CNS penetration (esp ceftriaxone and cefotaxine)
3rd Generation Cephalosporins: Representative Agents with good gram positive coverage but poor pseudomonos
-Cefotaxime (Claforan)
-Ceftizoxime (Cefizox)
-Ceftriaxone (Rocephin) (empiric coverage of meningitis except listeria)(good coverage of gram negative with gentamycin)
3rd Generation Cephalosporins: Representative Agents with poor gram positive coverage but good pseudomonos coverage
-ceftazidime (Fortax, Taricef, Tazadime)

-excellent against pseudomonos, but lose almost all gram positive coverage
-Fortaz is frequently utilized in gram negative neutropenic sepsis
3rd Generation Cephalosporins: Other Representative Agents
-Cefetamet pivoxil
-Cefoperazone (Cefobid)
-Cefixime (Suprax)
-Cefpodoxime proxetil (Vantin)
-Cefsulodin (Cefomonil)
-Ceftibuten (Cedax)
-Cefdinir (omnicef)
-Cefditoren picoxil (Spectracelf) oral
4th Generation Cephalosporins: Perperties/Coverage
-good gram positive and pseudomonas (GN bacilli non glucose) coverage
4th Generation Cephalosporins: Representative Agents
-Cefepime (Maxipime)
Carbapenems (Imipenem): Properties
-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)
Carbapenems (Imipenem): Coverage
-broad spectrum of coverage aginst gram postiive and gram negative aerobes and anaerobes
-drug of choice for enterobacter
What is the drug of choice for enterobacter?
Carbapenems
Carbapenems (Imipenem): Representative Agents
-Imipenem
-imipenem/cilastatin (Primaxin)
-Ertapenem (Invanz), once daily IV
Carbapenems (Imipenem): Resistant organisms
-MRSA
-pseudomonos cepacia
-xanthomonas multiphila
Monobactams (Aztreonam): Properties
-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
Monobactams (Aztreonam): Coverage
-effective only against gram neg aerobes (including pseudomonas aeruginosa)
-not effective agasint gram pos or anerobes
Monobactmas (Aztrenam): Representative Agents
-Astreonam (Azactam)
Aminoglycosides: Properties
-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
Aminoglycosides: Side Effects
-nephrotoxicity
-auditory and vestibular nerve damage
Aminoglycosides: Coverage
-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
Aminoglycosides: Representative Agents
-Amikacin (Amikin) (good for multi drug resistant gram neg bacilli)
-gentamycin (garamycin)
-karamycin
(kantrex)
-Neomycin (neobiotic)
-Tobramycin (Trobicin)
-Spectinomycin (Trobicin)
-streptomycin
Macroslides: properties
-bind to 50S subunit and inhibit protein synthesis
Macroslides: Representative Agents
-Eryhtromycin
-Azithromycin (Zithromax)/ Clarithromycin (Biaxin)
Erythromycin
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
Azithromycin (Zithromax)/ Clarithromycin (Biaxin)
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
Tetracyclines: Properties
-binds to 30S subunit to inhibit protein synthesis
-highly effective against mycoplasma, chlamydia, spirochetes, vibrio, and brucella
Tetracyclines: Representative Agents
-Tetracycline, Oxyytetracycline (Terramycin)
-Doxycycline (Vibramycin, Vibra-tabs, Doryx)
(metabolized by liver, longer half live, reduced photosensitivity rxn)
-minocycline (minocin)
Sulfonamides (TMP/SMX): Properties
-effects folate metabolism
-inhibit sequential steps in the metabolism of THFA
-drug of choce for PCP (most common opportunisitc infection in AIDS)
Sulfonamides (TMP/SMX): Coverage
-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
Sulfonamides (TMP/SMX): toxicity
-Steven Johnson Syndrome
-Renal
Sulfonamides (TMP/SMX): Representative Agents
-Trimethoprim-Sulamethoxazole (bactrim, Septra)
-Sulfisoxzole (Gantrisin)
-Sulfamethizole (Thiosulfil, Suladyne)
-Sulfisomidine (Elkosin)
-Sulfachloropyridazine (Sonilyn)
-Sulfacytine (Renoquid)
-Tresulfa Pyrimidine (Terfonyl)
Fluoroquinolones: Properties
-inhibits DNA gyrase
-avoid in children
-therapeutic alternative for gonococcal and chlamydia infections, UTIs, diarrhea syndrome, and chornic deep infection such as osteomyelitis
Fluoroquinolones: Coverage
-active against many bacteria, chlamydia, mycoplasma, and mycobacteria
-reduced activity aginst group A strep, strep pneumoniae, s aureus, MRSA
-ineffectice against anaerobes
Fluoroquinolones: Representative Agents
-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
Glycopeptides: Properties
-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
Glycopeptides: Coverage
-agents of choice againsts MRSA, vancomycin-resistant enterocicci (VRE), and vancomycin resitant s haemolyticus
-alternative for PCN allergic pts with gram pos infections
Glycopeptides: Toxicity
-reversible nephrotoxicity (monitor trough levels)
Glycopeptides: Representative Agents
-Vancomycin (Vanocin)
-Teichoplanin (Targocid)
Vancomycin
GLYCOPEPTIDE
-oral vancomycine is an alternative to metronidazole (flagyl) for treatment or c difficile colitis
-not absorbed from GI tract
Techoplanin
GLYCOPEPTIDE
-best for VRE genotype Van B
Polypeptides: properties
-mostly used as topical antimicrobial agents
Polypeptides: Representative Agents
-Bacitracin (affects cell wall synthesis)
-polymyxin B (aerosporin)
-colistimethate (coly-mycin-M)
Streptogramins: properties
-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
Streptogramins: Representative Agents
-quinupristin/dalfopristin (Synercid)
Oxazolidinones: Properties
-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
Oxazolidinones: Representative Agents
-Linezolid (Zyvox)
Metronidazole (Flafyl): Properties
-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)
What is the treatment of choice for c difficile colitis?
Metronidazole (Flafyl)
Clindamycin (Cleocin): Properties
-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
Choloramphenicol (Cholormycetin): Properties
-binds 50S subunit to inhibit protein synthesis
-causes bone marrow suppression by dose-dependent suppression and by another rare and irreversible method
Isonaizid (INH): Dose/Toxicity
-300 mg PO, IM, IV
-hepatitis, peripheral neuropathy, hypersensitivity
Rifampin: Dose/Toxicity
-600 mg PO, IV
-orange discoloration of urine, N/V, heptatitis, febrile reaction, purpura (rare)
Pyrazinamide (PZA): Dose/Toxicity
-2 gm, PO
-hepatitis, hyperuricemia
Ethambutol: Dose/Toxicity
-2.5 gm, PO
-optic neuritis, skin rash
Streptomycin: Dose/Toxicity
-1 gm, IM
-ototoxicity, nephrotoxicity