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81 Cards in this Set

  • Front
  • Back
gp 2b/3a receptor inhibitors (3)
abciximab, eptifibatide, tirofiban
Heparin
do NOT cross placenta, reversed by protamine.
heparin side effects
HIT/HAT, hypersensitivity, thrombocytopenia, osteoporosis
HIT
BAD. IgG complex w/ heparin + PF4. onset: 7--14 days
LMWH (3)
enoxaparin, tinzaparin, dalteparin
LMWH when Renal dx
adjust dosage if Renal dx
warfarin MOA
inhibit factor 7, 9, 10, 2 (vit K dependent)
warfarin reversed by
reversed by oral phytonadione.
warfarin protein binding
displaced by ASA, Sulfonamides, phenytoin, increase warfarin activity
warfarin inducers
carbamepzine, barbiturates, rifampin, decrease activities
warfarin inhibitiors
cimentidine, macrolides, antifungal (azoles), metronidazole. increase warfarin activities
direct thrombin inhibitors (3)
argatroban, lepirudin, bivalrudin
argatroban
for HIT
4 newer anti-coag drugs
ximelagatran, dabigatran, rivaxaban, apixaban
thromolytics (4)
streptokinase, alteplase, tenecteplase, reteplase
thrombolytics reversed by
aminocaproic acid, or cryoprecipiatate
thrombolytics/anti-fibrinolytic (3)
anistreplase, dutelplase, transexamic acid
asa
anti-platelet. irreversibly inhibits COX in platelet. Low dose: selectively block TXA2.
salicylism
vomit, tinititus, dizzy
ADP inhibitors (3)
clopidogrel, ticlopidine, prasugrel
if chemo/ neutropenic/ bacteremia, then pick
bacterialcidal
if ascites/ abcess/ endocarditis/ meningitis, then pick
pick bacertialcidal
inhibit wall synthesis
beta-lactam agents, vancomycin
affect permeability of cell membrane
amphotericin B
inhibit protein synthesis
macrolides, tetracycline, aminoglycosides, clindamycin, chloramphenicol
affect nucleic synthesis
quinolones, trimethoprim, sulfonamides
plasmid-mediated resistance
transferrable, usually >1 class of antibiotics
chromosomal-mediated resistance
generally not transferrable
procain penicilin G
gonorrhea
benzathine penicilin G
syphilis
beta-lactam
bacterialcidal, only work on active bacteria
cycloserine
for TB
Transpeptidase
for cross-linking, (penicilin-binding proteins), target of beta-lactam
resistance to beta-lactams (3)
altered target, decreased penetration, enzyme inactivation
altered target site eg:
MRSA, penicilin-resistant pneumococci, enterococcus resistant to penicilin
decreased penetration eg:
G (-) outer membrane impermeable, no porin / altered porin protein
enzymatic inactivation eg:
beta-lactamases. Staph aureus has plasmid encode extracellular penicillinase; beta-lactamases in G(-)'s periplasmid space (plasmid or chromosome)
penicilin side effect
leukopenia. IV: irritation to vein
penicilin G side effect
CNS more irritable --> seizure
penicilin allergy
IgE mediated, mast cell degranulation, anaphylaxis
penicilin family
penicilin G (benzylpenicilin), oxacillin, cloxacillin, dicloxacillin, fluocloxacillin, nafcillin, ampicillin, ticarcillin, amoxicillin
penicillin G, V
NOT effecitive against staph
penicillinase-resistant penicillins (kill staph)
oxacillin, methicillin, dicloxacillin, nafcillin
ampicillin, amoxicillin
kill G(-), eg: H. flu, E. Coli, proteus mirabilis. But NOT staph or anything has broad-spec beta-lactamase
piperacillin
kill G(-)
oral penicillin: protein bound
Poor penetration in: CSF, Brain, Ocular fluid, prostate, phagocytic cells
oxacillin (metabolized by)
liver. Other penicillins are NOT
penicillin excreted in
Urine (Glomerular filtration, tublular secretion). Urine level > serum level
penicillin side effects
hypersensitivity, serum sickness, allergic vasculitis, fever, eosinophilia, bone marrow suppress, thrombophlebitis, seizure (inhibit GABA receptors), hyperKalemia
suicide inhibitors
ciavulanic acid+amoxicilin, sulbactam + ampicillin, tazobactam + piperacillin
cephalosporin 1st gen
kill G(+) even penicillin-resistant staph, G(-) like E. Coli, K. pneumoniae
cephalosporin 2nd gen
better kill G(+) than 1st gen, but less than 3rd gen
cephalosporin 3rd gen
resistant to broad beta-penicilinase, but kill most G(-) like P. aeruginosa. best kill G(+)
cephalosporin 3rd gen
good penetration into CSF, DOC for meningitis
cephalosporin 1st gen drugs
cefazolin, cephalexin
cepha 2nd gen drugs
cefuroxime, cefaclor, ceftoxitin ( mefoxin), cefotetan
cepha 3rd gen drugs
cefotaxime, ceftriaxone, ceftazidime
cepha 4th gen drugs
cefepime, more resistant to B-lactamases than 3rd gen
1st gen cepha drugs treat
non-penicillin resistant strep, non-MRSA staph. NOT enterococci, listeria
2nd gen cepha drugs treat
E coli, klebsiella, proteus, H flu, Moraxella catarrhalis. less active against G + than 1st gen
3rd gen cepha drugs treat
serratia, N. Gonorrhea,
cefotaxime
3rd gen, treat staph aureus, strep pyogens
ceftazidime
3rd gen, treat pseudomonas aeruginosa
cefepime
4th gen, more resistant to some beta-lactamase
methicillin-resistant staph, and enterococci are resistant to
cepha
cepha drugs metabolized by
liver
cepha drugs excreted by
kidneys, concentrated in urine like penicillins
side effects of cepha
hypersensitivity/cross react w/ penicillin. bone marrow suppression. disulfiram-like rxn. sodium load (avoid using in CHF pts)
aztreonam
mono-bactam. NO cross-rxn w/ penicillin/cepha. ONLY aerobic G(-) rods (e coli, kleb, enterobacter, pseudomonas)
imipenem
has a specific porin in G(-) bacilli, penetrate CSF. broad spec, G(+), G(-), anaerobes, stuff resistant to cepha
imipenem metabolized in
Urine by brush border dipeptidase. To treat UTI: must use cilastin to inhibit dipeptidase in brush border.
imipenem tox
hypersensitivity
vacomycin
NOT beta-lactam. inhibit end-stage cell wall synthesis (inhibit transglycosylation)
vancomycin delivery & excretion
No oral, must be IV. Excretion is by glomerular filtration
vancomycin tox
ototoxicity, nephrotoxicity when combined w/ aminoglycosides
vancomycin resistance problem
all G(+) except vancomycin resistant enterococci (VRE)
vancomycin use
G(+) like MRSA, c. diff enterocolitis (use Oral vanco as 2nd line, 1st line is metronedizole to avoid VRE)
polymyxins
polymyxin B, colistin. "detergent", disrupt cell membrane. No oral absorbtion, renal excretion, nephrotox/neurotox. Use for MDR G(-) bacilli (eg acinetobacter)
daptomycin
not beta-lactam. target cell membrane. renal excretion. tox: myositis (mm enzymes leak). cannot use in pneumonia, use as alternative to vanco for MRSA/enterococci
daptomycin resistance:
thru change of cytoplasmic membrane voltage
bacitracin
topical use only. for staph. Rarely causes hypersensitivity