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102 Cards in this Set

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Penicillin G
Class: Penicillin
Spectrum: Streptococci, Enterococci, Spirochetes
Indications: Empirics for dental work, GAS/GBS, enterococci infection, syphillis, RMSF
Mechanism: binds PBP; bacteriocidal
Resistance: efflux, beta-lactamases, change target; in enterococci, pneumococcus, viridans
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Amoxicillin (PO)
Ampicillin (IV)
Class: Penicillin
Spectrum: Penicillin G + H. flu, H. pylori, anaerobes, listeria
Indications: head, mouth, gut, respiratory infections
Mechanism: Binds PBP; bacteriocidal
Resistance: efflux, beta-lactamases, change target
Time dependent
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Methicillin, naficillin, oxacillin, dicloxicillin (PO)
Class: Anti-staphylococcal penicillin
Spectrum: Staphylococcus
Indications: Staph skin infection
Mechanism: Mechanism: binds PBP; bacteriocidal
Resistance: efflux, beta-lactamases, change target (MecA)
Time dependent, short t1/2
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Ticarcillin, piperacillin
Class: Anti-pseudomonal penicillin
Spectrum: Pseudomonas aruginosa, Gram negatives - aerobic + anaerobic
Indications: mixed nosocomial infections (aspiration pneumonia, intraabdominal...)
Mechanism: binds PBP; bacteriocidal
Resistance: Resistance: efflux, beta-lactamases, change target
Time dependent
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Cefazolin, cephalothin
Class: 1st gen cephalosporins
Spectrum: Gram + (staph, strep, enterococci)
Indications: surgery prophylaxis, penicillin allergy
Mechanism: bind PBP; bacteriocidal
Resistance: beta-lactamases, altered target site
Time dependent
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Cefuroxime, cefoxitin, cefotetan
Class: 2nd gen cephalosporins
Spectrum: Gram +, some anaerobes, H. flu, enterococci
Indications: soft tissue, bone infection, respiratory, intrabdominal
Mechanism: Bind PBP, bacteriocidal
Resistance: beta-lactamases, change target
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Ceftriaxone, ceftazidime
Class: 3rd generation cephalosporins
Spectrum: ceftriaxone: Gram +
ceftazidime: pseudomonas and Gram negatives
Indications: ceftriaxone: CSF G+ infection; ceftazidime: pneumonia, gonorrhea
Mechanism: bind PBP, bacteriocidal
Resistance: beta lactamases
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Cefepime
Class: 4th generation cephalosporin
Spectrum: Gram + and pseudomomas and some gram negatives
Indications: nosocomial pneumonia
Mechanism: 3rd gens combined
Resistance: beta lactamases, altered target
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Imipenem, meropenem, ertapenem
Class: Carbapenem (B-lactam)
Spectrum: broadest of all
NOT MRSA, listeria,
enterococci
Indications: resistant infections, penicillin allergy
Mechanism: PBP binding, bacteriocidal
Imipenem must be given with cilistatin
Ertapenem is not for pseudomonas
Resistance: efflux, altered PBP, carbapenamases, penicillin allergy
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Aztreonam
Class: Monobactam (B-lactam)
Spectrum: Gram negative aerobes
No penicillin x-allergenicity
Indications: penicillin allergy
Mechanism: 4 membered ring, binds PBP, bacteriocidal
Resistance: beta-lactamases, target site alteration
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Vancomycin
Glycopeptide
Gram + only (MRSA, C. difficile)
Used in B-lactam allergy
Prosthetic surgery prophylaxis, MRSA, enterococci, C. difficile
Mechanism: binds D-ala subunit and does not allow x-linking
Less bacteriocidal
Resistance: some enterococci, staph. aureus, D-ala replaced by D-lac
Time dependent
Not removed by dialysis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Bacitracin
Class: polypeptide
Binds undecaprenyl pyrophosphate so it can't carry cell wall precursors
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Levofloxacin
Class: Fluoroquinalone
Spectrum: Gram - , some Gram + (MRSA, pneumococcus), atypicals
INTRACELLULAR BUGS
Indications: UTI, GI infection, respiratory infection
Mechanism: targets DNA gyrase and topoisomerase to prevent packaging of DNA
Resistance: alter gyrase, topoisomerase, efflux
Total area under the curve
No surgical prophylaxis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Moxyfloxacin
Class: Fluoroquinalone
Spectrum: Gram -, some gram +, atypicals, anaerobes
INTRACELLULAR BACTERIA
Indications: UTI,CA-pneumonia
Mechanism: targets DNA gyrase and topoisomerase to prevent packaging of DNA
Resistance: alter gyrase, topoisomerase, efflux
Total area under the curve
No surgical prophylaxis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Ciprofloxacin
Class: Fluoroquinalone
Spectrum: Gram -, atypicals, pseudomonas
INTRACELLULAR BUGS
Indications: UTI, GI infection, HA-pneumonia, GNR osteomyelitis
Mechanism: targets DNA gyrase and topoisomerase to prevent packaging of DNA
Resistance: alter gyrase, topoisomerase, efflux
Total area under the curve
No surgical prophylaxis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Rifampin
Class: Rifamycin
Spectrum: 1st line TB drug, mycobacteria, Gram +, Gram -, meningococcus, legionella, brucella
Indicaions: always use in combination
Penetrates biofilms!!!!
Osteomyelitis, catheters
Mechanism: binds B-subunit of RNA polymerase; bacteriocidal
Resistance: Pol mutation
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Metronidazole
Spectrum: anaerobes below diaphragm, protazoa, C.difficle, H. pylori
Indications: bacterial vaginosis, colitis, botulism
Mechanism: DNA strand breaking
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Daptomycin
Class: lipopeptide
Spectrum: Gram +, MRSA, enterococci
Indications: vancomycin allergy/resistance
Mechanism: Ca-dependent K+ permeability increase
Bacteriocidal
Not much resistance
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Colistin
Class: Polymyxin, Gram - only
Spectrum: pseudomonas
Indications: old drug, highly toxic, so only for BAD infection
Mechanism: intercalates into LPS membrane
Resistance: little to none
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Erythromycin
Class: Macrolide
Spectrum: Gram +, atypicals (mycoplasma, chlamydia, legionella)
Indications: Upper/lower RT, S. aureus skin infection, STDs
USE IN PENICILLIN ALLERGY
Respiratory and skin infection
Mechanism: binds 50s ribosome
Bacteriostatic
Resistance: drug efflux, ribosomal methylation
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Clarithromycin
Azithromycin
Class: Macrolide
Spectrum: Gram +, atypicals, plus H. flu, moraxalla, s. aureus, H. pylori
Indications: Upper/lower RT, S. aureus skin infection, STDs
Mechanism: binds 50s ribosome
Bacteriostatic
Resistance: drug efflux, ribosomal methylation
Time dependent
Give as Z-pack for sinuses, bronchitis, etc.
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Clindamycin
Class: Lincosamide
Spectrum: Gram + cocci only
Used w/ cell wall drugs
Also for toxoplasma, PCP
Indications: above diaphragm infections (head, neck)
Mechanism: Binds 50s ribosome; bacteriostatic
Resistance: ribosome methylation, efflux
Gives pseudomembranous collitis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Linezolid
Class: Oxazolidine (NEW)
Spectrum: Gram +, MRSA, enterococci (can't get through gram negative membrane)
RESISTANT DRUGS!!!
Indications: Vanc resistance, allergy
Mechanism: binds 50s ribosome
Resistance: None
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Chloramphenicol
Gram + and Gram -
Indications: RMSF, meningitis, salmonella
Limitations: aplastic anemia, vasomotor collapse
Time dependent
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Quinupristin
Dalfopristin
(Synercaid)
Class: Streptogramins
Spectrum: MRSA, enterococci
ONLY RESISTANT BACTERIA!!!
Indications: old drug with high toxicity
Mechanism: binds 50s ribosome
Resistance: none
Muscle aches, $$$$
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Gentamycin, tobramycin, streptomycin, amikacin
Class: Aminoglycosides
Spectrum: Gram -, some gram + when used with cell-wall drugs
Indications: unusual/nosocomial infections
Mechanism: binds 30s ribosome; bacteriocidal
IV ONLY!
Resistance: enzymatic inactivation of drug
Concentration dependent, low TI
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Doxycycline, tetracycline, minocycline
Class: Tetracyclines
Spectrum: Gram +, some gram -, atypicals, anti-malarial, good for vibrios
Indications: CA-pneumonia, skin, soft tissue, STDs, lyme disease, MRSA, cholera
Mechanism: binds 30s ribosome
Bacteriostatic
Resistance: photosensitivity, ribosomal methylation
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Bactrim
(TPM-STX)
Class: Sulfonamides
Spectrum: NOT p. aeruginosa, anaerobes, mycoplasma
Indications: CA-MRSA, UTI, resp. infection, brucellosis, ETEC, meningitis
Mechanism: mimics PABA core
Resistance: increased dihydrofolate reductase
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Isoniazid
1st line TB drug used with rifampin
Indications: active TB cornerstone
Mechanism: inhibits mycolic acid synthesis; targets dividing cells
Resistance: One in 1x10^6 bugs via mutation or catalase-peroxidase genes
Pharmaco: metabolized by liver, so peripheral neuropathies and hepatitis
GIVE WITH VITAMIN B6!
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Pyrazinamide
1st line mycobacterial drug
Unknown mechanism
Metabolized in liver
Resistance is rare
Hepatitis
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Ethambutol
1st line mycobacterial drug
Bacteriostatic: inhibits arabinosyl transferase for cell-wall synthesis
Rarely resistant: enzyme mutation
Optic neuritis (color); neuropathy
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Streptomycin
Cycloserine
PAS
Ethinoamide
Amikacin
Capreomycin
Moxiflocicin
2nd line TB drugs
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
TB treatment guidelines
Start with INH, RIF, PZA, ETH
Wait for sensitivity results
If sensitive to INH, RIF, drop PZA, ETH
4 drugs for 2 months
2 drugs for 4 months
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Acyclovir
Class: Anti-herpetic
Spectrum: HSV-1, HSV-2, VZV
Indications: mild or disseminated, give 24-36 hrs in
Mechanism: acyclic guanosine analog, phosphorylated by TK to bind DNA polymerase
Resistance: TK deficiency
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Valacyclovir
Esterfied version of Acyclovir to make it more bioavailable
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Famciclovir
Anti-herpetic with mechanism like acyclovir
Esterfied pencyclovir for bioavailability
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Gancyclovir
Class: anti-herpetic
Spectrum: all herpesviruses
Indicatons: CMV infection, retinitis
IV only
Resistance: UL97 protein kinase mutaton prevents phosphorylation in CMV
Myelosupression
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Valgancyclovir
Esterfied gancyclovir
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Foscarnet
Class: anti-herpetic
Spectrum: all herpes viruses
Indication: resistant infections
Mechanism: inhibits DNA polymerase, no phosphorylation
IV only, electrolyte disturbances
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Cidofovir
Class: Anti-herptic
Spectrum: all herpes, papilloma, pox viruses
Indications: CMV retinitis
Mechanism: nucleotide analog like HIV drugs, phosphorylated by cell kinases
Nephrotoxicity, eye implant
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Rimantadine
Amantadine
Class: anti-influenza
Spectrum: Influenza A
Mechanism: blocks M2 protein preventing uncoating
Resistance: commnn
Leads to mental alteration
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Oseltamivir
(Tamiflu)
Class: Anti-influenza
Spectrum: Influenza A, B
Mechanism: NA inhibitor blocks viral release
Resistance: recent!!!
Given PO; Nausea and vomiting
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Zanamivir
(Relenza)
Class: Anti-influenza
Spectrum: Influenza A, B
Mechanism: NA inhibitor blocks viral release
Resistance: recent!!!
Inhaled mist; bronchospasm
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Ribavirin
Phosphorylated metabolite that blocks nucleic acid synthesis
Used in RNA and DNA viruses, especially RSV
Used with INF-alpha against Hep C
High toxicity
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
INF-alpha
Natural anti-viral peptide
Used with ribavirin for Hep C
Sometimes used for Hep B
Genital warts
Papillomas in RT
Gives flu-like symptoms since it's a natural inducer
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Enfuvirtide
(Fuzeon)
HIV drug
Fusion inhibitor
Maraviroc
HIV drug
CCR5 antagonist
Vicriviroc
HIV drug
CCR5 antagonist
Abacavir
HIV drug
NRTI
Must be phosphorylated
Hypersensitivity = flu-like
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Didanosine
HIV drug
NRTI
Must be phosphorylated
Class
Spectrum
Indications
Mechanism
Resistance
Pharmacodynamics
Emtricitabine
HIV drug
NRTI
Must be phosphorylated
Lamivudine
HIV drug
NRTI
Must be phosphorylated
Stavudine
HIV drug
NRTI
Must be phosphorylated
Tenofovir
HIV drug
NRTI
Must be phosphorylated
Zidovudine (AZT)
HIV drug
NRTI
Must be phosphorylated
Nevirapine
HIV drug
NNRTI
Delavirdine
HIV drug
NNRTI
Efavirenz
HIV drug
NNRTI
Etravirine
HIV drug
NNRTI
Raltegravir
HIV drug
Integrase inhibitor
Elvitegravir
HIV drug
Integrase inhibitor
Atazanavir
HIV drug
Protease inhibitor
Darunavir
HIV drug
Protease inhibitor
Fosamprenavir
HIV drug
Protease inhibitor
Indinavir
HIV drug
Protease inhibitor
Lopinavir
HIV drug
Protease inhibitor
Nelfinavir
HIV drug
Protease inhibitor
Ritonavir
HIV drug
Protease inhibitor
P450 inhbitor
Saquinavir
HIV drug
Protease inhibitor
Tipranavir
HIV drug
Protease inhibitor
HIV treatment regimen
Begin treatment when CD4 count is below 350 or patient shows symptoms
Treat with 2 NRTI's + 1 NNRTI
OR
2 NRTI + 1 protease inhibitor
Amphotercin B
Class: Anti-fungal polyene
Spectrum: Broad
Indications: deep seated infection
Mechanism: Targets ergosterol
Limitations: MANY toxicities due to cholesterol targeting
***Given within liposome to decrease toxitity
Nystatin
Class:Polyene
Topical antifungal
Binds ergosterol
Miconazole (Monistat)
Clotrimazole
Class: Azole
Spectrum: Skin fungal infections
Mechanism: Inhibit funagl P450 to inhibit ergosterol synthesis
Topical only (toxicities)
Fluconazole
Class: Azole
Indications: Candida (C. krusi reistant), cryptococcus post-treatment, YEAST only!!!
Mechanism: Inhibit fungal P450
PO/IV very bioavailable
Penetrates BBB
Watch for drug interactions
Itraconazole
Class: Azole
Spectrum: Mycoses, toenails, aspergillus
Mechanism: inhibits fungal P450
Lower BBB penetration, only IV
Lots of drug interactions
Voriconazole
Very broad antifungal
Inhibits fungal P450
PO/IV
Gets everything with low side effects
Posaconazole
Broad antifungal
Replacing Amphotercin B
Active transport across GI, so PO
Gets everything, bone marrow transplant prophylaxis ($$$)
Flucytosine
Class: antimetabolite
Indications: cryptococcus with amphotercin B
Mechanism: 5-fluorocytosine incorperated into RNA and binds polymerase
Gives photopsia, rash
Capsofungin
Class: glucan synthesis inhibitor
Mechanism: inhibits cell wall synthesis
Good for candida
Terbinafine (Lamisil)
Class: Allylamines
Inhibit ergosterol synthesis differently than azoles
PO or topical
River blindness or toenails
Hepatobiliary dysfunction $$$$
Cryptococcus meningitis treartment
Flucytosine + Amphotercin B
THEN
Fluconazole (BBB) - 8wks
Broadest antifungals
Voriconazole, posconazole

Will get all candida strains
Act by inhibiting P450
Chloroquine
Class: Anti-malarial
Spectrum: blood stages of plasmodium
Mechanism: inhibits heme polymerase making toxic heme
Resistance: mainly falciparum, drug efflux
Weekly prophylaxis
Class
Spectrum
Mechanism
Resistance
Prophylaxis
Mefloquine
Anti-malarial
Works on blood schizont stage only
Works on chloroquine resistance
Weekly prophylaxis
Rare resistance in Thailand
Atovaguone
Proguanil
(Malarone)
Schizont in blood and liver
Works against chloroquine resistance
Prophylaxis for a few days
Doxycycline
Anti-malarial
Erythrocyte stage only
Use alone for prophylaxis
Adjuvant to quinine
Causes photosensitivity with other side effects
Quinine
Anti-malarial
Erythrocyte stages only
Rapidly cidal
Not for prophylaxis
Low TI - causes arrythmias, hypotension
Rare resistance
Adjuvant to doxycycline
Only PO in US
Quinidine
Anti-malarial
Rapidly cidal
IV only
Can cause arrhythmias, hypeotension
Primaquine
Anti-malarial
Active against hypnozoite in liver (vivax and ovale)
Daily PO
Must test for G6PD deficiency!
Terminal prophylaxis
Uncomplicated malaria treatment
Chloroquine
OR
Quinidine + doxycycline
OR
Mefloquine (1 dose)
OR
Malarone (1 dose)
Complicated malaria treatment
IV quinidine + doxycycline
Vivax and ovale
Chloroquine
Can give primaquine
Malaria prophylaxis with chloroquine resistance
Give weekly mefloquine,
daily doxycycline, daily Malarone, daily Primaquine
Malaria prophylaxis without chloroquine resistance
Chloroquine weekly
Metronidazole and Iodoquinol
(Flagile)
Class: Anti-ameoba
Spectrum: Flagile = tissue phase of amoeba (trophozoite)- not cysts
Iodoquinol = cysts stage
Indications: enterolytica, giardia, trichomonas, cryptosporidium
Mebendazole
Class: Anti-helminthic
Spectrum: Most worms
Indications: Pinworm
Typically a single dose
Few to no side effects
Albendazole
Class: Anti-helminthic
Spectrum: Broad (including tapeworm)
Mechanism: blocks worm's glucose uptake
Single dose treatment
Ivermectin
Class: Anti-helminthic
Spectrum: very broad, especially filaria, Norweigan scabies
Limitations: flu-like symptoms with filarial infection
Praziquantel
Class: Anti-helminthic
Spectrum: Blood flukes (schistosomiasis), also tapeworm
Mechanism: cause calcium dependent K+ influx and paralysis of parasite
Side effects: Dizziness, headache
Iodoquinol
Anti-amoeba given with metronidazole
Kills amoeba in their cyst stage!!!
Iodoquinol
Anti-amoeba given with metronidazole
Kills amoeba in their cyst stage!!!