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46 Cards in this Set
- Front
- Back
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Narrow-spectrum penicillinase-susceptible b-lactams?
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Penicillin G, Penicillin V
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Penicillin G uses?
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common strep, meningococci, G+bacilli, spirochetes
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What organisms are resistant to Penicillin G?
Mech of resistance? |
S. pneumoniae, S. aureus, N. gonorrhoeae
production of b-lactamases |
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Drug of choice in syphilis?
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Penicillin G
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Very-narrow-spectrum, penicillinase-resistant drugs?
Use against? |
methicillin, nafcillin, oxacillin
staphylococci (except MRSA, MRSE) |
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Wider-spectrum penicillinase-susceptible drugs?
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Ampicillin, Amoxicillin, Piperacillin, Ticarcillin
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What drugs used to increase abx-activity of wider-spectrum b-lactams?
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penicillinase inhibitors
(clavulanic acid, sulbactam, tazobactam) |
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What drugs used with Ampicillin in enterococcal and listerial infections?
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aminoglycosides
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what are Amoxicillin and Ampicillin used against?
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same as penicillin G (common strep, meningococci, G+bacilli, spirochetes) but also: enterococci, Listeria, E. coli, proteus, H. influenzae, M. catarrhalis
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What are piperacillin and ticarcillin used against?
What drugs are they used with? |
G- rods (Pseudomonas, Enterobacter, Klebsiella)
aminoglycosides, penicillinase inhibitors |
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MOA cephalosporins?
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bind PBPs on cell membranes to inhibit bacterial cell wall synthesis
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1st Gen cephalosporins?
Use against? |
Cefazolin (IV)
Cephalexin (oral) G+ cocci (staph, strep) E coli, K pneumoniae do not work against G-cocci, enterococci, MRSs and G-rods |
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2nd gen cephalosporins?
Use against? |
Cefotetan, Cefoxitin
Cefamandole, cefuroxime, cefaclor less G+ action than 1st gen, but more G- action; B. fragilis, H. influenzae, M. catarrhalis |
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3rd gen cephalosporins?
Use against? |
Ceftazidime, cefoperazone, cefotaxime: increased G- action, esp b-lactam resistant, many can penetrate BBB.
ceftriaxone (parenteral), cefixime (oral): gonorrhea |
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Which class of cephalosporins should be reserved for tx of serious infections?
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3rd gen
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4th gen cephalosporins?
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Cefepime
G+ action of 1st gen with G- action of 3rd gen; more resistant to b-lactamases produced by G-'s (Enterobacter, Haemophilus, Neisseria and PRSP) |
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When should one be concerned about cross-reactivity between penicillins and cephalosporins?
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when pt has hx of anaphylaxis to penicillins
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Aztreonam?
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resistant to b-lactamases made by aerobic G-rods (Klebsiella, Pseudomonas, Serratia)
no action against G+ or anaerobes IV admin, prolonged excretion in renal failure |
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Carbapenems?
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Imipenem, Meropenem, Ertapenem
Good against drug resitant organisms (except MRSA); G+ cocci, G-rods and anaerobes Use with aminoglycosides against Pseudomonas |
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Drugs of choice against Enterobacter?
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Carbapenems
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Imipenem is used with what to increase its half-life and avoid a nephrotoxic metabolite?
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Cilastatin
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Serious side effect of Imipenem/Cilastatin?
Which drug of this class is better? |
CNS toxicity (confusion, encephalopathy, seizures)
Meropenem has less seizures |
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Vancomycin MOA?
Use against? |
binds D-ala-D-ala terminal of peptidoglycan to inhibit elongation of chain and cross-linking
Use against drug resistant G+'s (MRSA) and with a 3rd gen cephalosporin for PRSP |
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Vanco side effects?
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chills, fever, phlebitis, ototoxicity, nephrotoxicity, red-man syndrome (flushing from histamine)
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Fosfomycin?
Effects of multiple dosing? |
prevents formation of NAM, preventing peptidoglycan chain formation
resistance emerges rapidly with multiple dosing |
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Topical drug used against G+'s?
why topical? |
Bacitracin
nephrotoxicity |
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drug that blocks incorporation of D-ala into peptidoglycan side chain?
what is its only use? |
Cycloserine
only used to tx TB that is resistant to first-line anti-TB drugs |
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drug used against vancomycin resistant strains of Enterococci and Staph?
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Daptomycin
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What should be monitored with Daptomycin use and why?
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monitor CPK b/c it can cause myopathy
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Dose effect on abx action of Aminoglycosides?
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as dose increases, they kill more and do it faster
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Drug class that is more efficient in a single large dose than multiple small doses?
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Aminoglycosides
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Excretion of aminoglycosides is directly proportionate to what?
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creatinine clearance
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MOA aminoglycosides?
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bactericidal inhibitors of protein synthesis (bind to 30S ribosomal subunit)
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Mechanisms of resistance to Aminoglycosides?
aminoglycoside that is less susceptible to resistance? |
Enterococci and Streptococci form inactivating enzymes
netilmicin |
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Aminoglycosides used against aerobic G-s?
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Gentamicin
Tobramycin amikacin |
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drug often used with aminoglycosides?
why? |
b-lactams
aminoglycosides do not effectively treat infections with G+ cocci |
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drug combo used in enterococcal carditis, TB, plague and tularemia?
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Streptomycin + penicillin
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streptomycin-resistant strains of M. tuberculosis may be resistant to what drug?
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Amikacin
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biggest side effect risk with streptomycin?
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ototoxicity
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aminoglycoside reserved for serious infections with organisms resistant to other aminoglycosides?
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Netilmicin
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drug related to aminoglycosides used in a single dose for gonorrhea in penicillin-allergic pts?
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Spectinomycin
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Auditory impairment is more likely with which drugs?
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amikacin, kanamycin
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vestibular dysfunction is more likely with which drugs?
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gentamicin, tobramycin
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ototoxicity of aminoglycosides may be enhanced due to what condition?
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renal dysfunction or use of loop diuretics
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Most nephrotoxic aminoglycosides?
In what conditions can nephrotoxicity be enhanced? |
gentamicin, tobramycin
elderly pts and those receiving amphotericin B, cephalosporins or vancomycin |
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what rare condition can occur at high doses of aminoglycosides?
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respiratory paralysis
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