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102 Cards in this Set
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- 3rd side (hint)
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Penicillin G
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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 |
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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 |
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Methicillin, naficillin, oxacillin, dicloxicillin (PO)
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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 |
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Ticarcillin, piperacillin
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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 |
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Cefazolin, cephalothin
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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 |
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Cefuroxime, cefoxitin, cefotetan
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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 |
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Ceftriaxone, ceftazidime
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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 |
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Cefepime
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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 |
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Imipenem, meropenem, ertapenem
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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 |
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Aztreonam
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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 |
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Vancomycin
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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 |
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Bacitracin
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Class: polypeptide
Binds undecaprenyl pyrophosphate so it can't carry cell wall precursors |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Levofloxacin
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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 |
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Moxyfloxacin
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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 |
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Ciprofloxacin
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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 |
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Rifampin
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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 |
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Metronidazole
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Spectrum: anaerobes below diaphragm, protazoa, C.difficle, H. pylori
Indications: bacterial vaginosis, colitis, botulism Mechanism: DNA strand breaking |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Daptomycin
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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 |
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Colistin
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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 |
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Erythromycin
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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 |
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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 |
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Clindamycin
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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 |
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Linezolid
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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 |
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Chloramphenicol
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Gram + and Gram -
Indications: RMSF, meningitis, salmonella Limitations: aplastic anemia, vasomotor collapse Time dependent |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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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 |
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Gentamycin, tobramycin, streptomycin, amikacin
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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 |
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Doxycycline, tetracycline, minocycline
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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 |
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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 |
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Isoniazid
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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 |
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Pyrazinamide
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1st line mycobacterial drug
Unknown mechanism Metabolized in liver Resistance is rare Hepatitis |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Ethambutol
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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 |
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Streptomycin
Cycloserine PAS Ethinoamide Amikacin Capreomycin Moxiflocicin |
2nd line TB drugs
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Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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TB treatment guidelines
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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 |
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Acyclovir
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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 |
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Valacyclovir
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Esterfied version of Acyclovir to make it more bioavailable
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Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Famciclovir
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Anti-herpetic with mechanism like acyclovir
Esterfied pencyclovir for bioavailability |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Gancyclovir
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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 |
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Valgancyclovir
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Esterfied gancyclovir
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Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Foscarnet
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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 |
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Cidofovir
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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 |
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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 |
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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 |
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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 |
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Ribavirin
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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 |
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INF-alpha
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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 |
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Enfuvirtide
(Fuzeon) |
HIV drug
Fusion inhibitor |
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Maraviroc
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HIV drug
CCR5 antagonist |
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Vicriviroc
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HIV drug
CCR5 antagonist |
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Abacavir
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HIV drug
NRTI Must be phosphorylated Hypersensitivity = flu-like |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Didanosine
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HIV drug
NRTI Must be phosphorylated |
Class
Spectrum Indications Mechanism Resistance Pharmacodynamics |
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Emtricitabine
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HIV drug
NRTI Must be phosphorylated |
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Lamivudine
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HIV drug
NRTI Must be phosphorylated |
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Stavudine
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HIV drug
NRTI Must be phosphorylated |
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Tenofovir
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HIV drug
NRTI Must be phosphorylated |
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Zidovudine (AZT)
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HIV drug
NRTI Must be phosphorylated |
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Nevirapine
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HIV drug
NNRTI |
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Delavirdine
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HIV drug
NNRTI |
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Efavirenz
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HIV drug
NNRTI |
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Etravirine
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HIV drug
NNRTI |
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Raltegravir
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HIV drug
Integrase inhibitor |
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Elvitegravir
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HIV drug
Integrase inhibitor |
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Atazanavir
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HIV drug
Protease inhibitor |
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Darunavir
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HIV drug
Protease inhibitor |
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Fosamprenavir
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HIV drug
Protease inhibitor |
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Indinavir
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HIV drug
Protease inhibitor |
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Lopinavir
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HIV drug
Protease inhibitor |
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Nelfinavir
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HIV drug
Protease inhibitor |
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Ritonavir
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HIV drug
Protease inhibitor P450 inhbitor |
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Saquinavir
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HIV drug
Protease inhibitor |
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Tipranavir
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HIV drug
Protease inhibitor |
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HIV treatment regimen
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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 |
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Amphotercin B
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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 |
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Nystatin
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Class:Polyene
Topical antifungal Binds ergosterol |
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Miconazole (Monistat)
Clotrimazole |
Class: Azole
Spectrum: Skin fungal infections Mechanism: Inhibit funagl P450 to inhibit ergosterol synthesis Topical only (toxicities) |
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Fluconazole
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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 |
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Itraconazole
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Class: Azole
Spectrum: Mycoses, toenails, aspergillus Mechanism: inhibits fungal P450 Lower BBB penetration, only IV Lots of drug interactions |
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Voriconazole
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Very broad antifungal
Inhibits fungal P450 PO/IV Gets everything with low side effects |
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Posaconazole
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Broad antifungal
Replacing Amphotercin B Active transport across GI, so PO Gets everything, bone marrow transplant prophylaxis ($$$) |
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Flucytosine
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Class: antimetabolite
Indications: cryptococcus with amphotercin B Mechanism: 5-fluorocytosine incorperated into RNA and binds polymerase Gives photopsia, rash |
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Capsofungin
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Class: glucan synthesis inhibitor
Mechanism: inhibits cell wall synthesis Good for candida |
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Terbinafine (Lamisil)
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Class: Allylamines
Inhibit ergosterol synthesis differently than azoles PO or topical River blindness or toenails Hepatobiliary dysfunction $$$$ |
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Cryptococcus meningitis treartment
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Flucytosine + Amphotercin B
THEN Fluconazole (BBB) - 8wks |
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Broadest antifungals
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Voriconazole, posconazole
Will get all candida strains Act by inhibiting P450 |
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Chloroquine
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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 |
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Mefloquine
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Anti-malarial
Works on blood schizont stage only Works on chloroquine resistance Weekly prophylaxis Rare resistance in Thailand |
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Atovaguone
Proguanil (Malarone) |
Schizont in blood and liver
Works against chloroquine resistance Prophylaxis for a few days |
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Doxycycline
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Anti-malarial
Erythrocyte stage only Use alone for prophylaxis Adjuvant to quinine Causes photosensitivity with other side effects |
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Quinine
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Anti-malarial
Erythrocyte stages only Rapidly cidal Not for prophylaxis Low TI - causes arrythmias, hypotension Rare resistance Adjuvant to doxycycline Only PO in US |
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Quinidine
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Anti-malarial
Rapidly cidal IV only Can cause arrhythmias, hypeotension |
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Primaquine
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Anti-malarial
Active against hypnozoite in liver (vivax and ovale) Daily PO Must test for G6PD deficiency! Terminal prophylaxis |
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Uncomplicated malaria treatment
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Chloroquine
OR Quinidine + doxycycline OR Mefloquine (1 dose) OR Malarone (1 dose) |
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Complicated malaria treatment
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IV quinidine + doxycycline
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Vivax and ovale
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Chloroquine
Can give primaquine |
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Malaria prophylaxis with chloroquine resistance
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Give weekly mefloquine,
daily doxycycline, daily Malarone, daily Primaquine |
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Malaria prophylaxis without chloroquine resistance
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Chloroquine weekly
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Metronidazole and Iodoquinol
(Flagile) |
Class: Anti-ameoba
Spectrum: Flagile = tissue phase of amoeba (trophozoite)- not cysts Iodoquinol = cysts stage Indications: enterolytica, giardia, trichomonas, cryptosporidium |
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Mebendazole
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Class: Anti-helminthic
Spectrum: Most worms Indications: Pinworm Typically a single dose Few to no side effects |
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Albendazole
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Class: Anti-helminthic
Spectrum: Broad (including tapeworm) Mechanism: blocks worm's glucose uptake Single dose treatment |
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Ivermectin
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Class: Anti-helminthic
Spectrum: very broad, especially filaria, Norweigan scabies Limitations: flu-like symptoms with filarial infection |
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Praziquantel
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Class: Anti-helminthic
Spectrum: Blood flukes (schistosomiasis), also tapeworm Mechanism: cause calcium dependent K+ influx and paralysis of parasite Side effects: Dizziness, headache |
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Iodoquinol
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Anti-amoeba given with metronidazole
Kills amoeba in their cyst stage!!! |
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Iodoquinol
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Anti-amoeba given with metronidazole
Kills amoeba in their cyst stage!!! |
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