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78 Cards in this Set

  • Front
  • Back
Which ABx act by inhibiting Cells wall synthesis?
-bata lactames (penicillins, cephalosporins, monobactams, cerbepenams)
-glycopeptides (vancomycin, teichoplanin)
Which Abx act by affecting DNA gyrase?
Which Abx act by affecting RNA polymerase?
Which Abx act by inhibiting the 30S subunit of protein synthesis?
Which Abx act by inhibiting the 50S subunit of protein synthesis?
Which Abx act by affecting folate metabolism?
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?
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
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 (Imipenem): Representative Agents
-imipenem/cilastatin (Primaxin)
-Ertapenem (Invanz), once daily IV
Carbapenems (Imipenem): Resistant organisms
-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
-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)
-Neomycin (neobiotic)
-Tobramycin (Trobicin)
-Spectinomycin (Trobicin)
Macroslides: properties
-bind to 50S subunit and inhibit protein synthesis
Macroslides: Representative Agents
-Azithromycin (Zithromax)/ Clarithromycin (Biaxin)
-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)
-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
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)
-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)
-oral vancomycine is an alternative to metronidazole (flagyl) for treatment or c difficile colitis
-not absorbed from GI tract
-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