Pharmacology

Front 1

which goups of Beta lactams are cross-allergenic and should be avoided if patient has known drug allergy to penicillin

Back 1

Penicillins
Cephalosporins
Carbapenems

Front 2

Which group of Beta lactam is non cross-allergenic and may be administered even if the patient has a known drug allergy to penicillin

Back 2

Monobactams Ie(aztreonam)

Front 3

What are the General properties of Beta Lactams
Bactericidal
Interfere with cell wall Synthesis
Effective and Safe
Widely prescribed

Back 3

General properties of B-lactams

Front 4

Most B-lactams require dosage adjustments for renal insufficiency

Back 4

B-lactams and renal function

Front 5

Drug of choice for
syphilis-by T. pallidum
Pharyngitis-by GAS
Mouth infections-by anaerobic gram + cocci

Back 5

Natural Penicillins

Front 6

Azithromycin(Zithromax), clarithoromycin(Biaxin), Dirithromycin(Dynabac),
Erythromycin, Troelandomycin(TAO),
Inhibit protien Synthesis by reversibly binding to 50s subunit.
Usually bactriostatic/Can be cidal depending on conc. at site of action, organism, and inoculum size.
Good Gram + and some Gram -, not a good choice for Staphs. or anerobes.
Lipophilic and penetrate tissues well. excreted in bile and feces. only clarithormycin needs to be adjusted for renal insufficiency. prophylaxis for those at risk for endocarditis.
Multiple drug interactions, ie Warfarin(disturbs dosing), proteus inhibitors in HIV

Back 6

Macrolides

Front 7

Drug of Choice for infections caused by many gram + and other organisms in patients with Penicillin allergies.
Spectrum: Many Gram + organisms plus Gram - cocci, also Chlamydia spp., Legionella spp., and M. pneumoniae. T. pallidum prophylaxis for endocarditis. H. influenzae has developed resistance.
*take w/o regard to meals

Back 7

Erythromycin

Front 8

Spectrum: More activity against gram -, includes M. catarrhalis, H. influenzae, and C. trachomatis. Effective against MAC.
Adverse: diarrhea, Nausea, abdominal pain
long half-life 68 hours (~only x5day), not metabolized through Cytochrome 450c system.
*Take on empty stomach

Back 8

Azithromycin (Zithromax)

Front 9

Spectrum: Same in vitro as erythromycin but increased potency. effective against MAC.
Adverse: D/N, abnormal taste up to 8%, dyspepsia, abdominal pain/dicomfort, headache-2%, NN to dose adjust for renal.
*Take w/o regard to meals

Back 9

Clarithromycin (Biaxin)

Front 10

May be bacteriostatic or cidal depending on site of infection conc. and suseptibility. Inhibits protein synthesis by binding to 50s subunit.
Spectrum: Gram + (esp cocci & anerobes/ Does not cover Gram - anaerobes. IV against CAq-MRSA(but not orally).
very good penetration except CSF, gets into bone well, ~50%serum level crosses placenta, Good for diabetic foot.
does not NN to be adjusted for renal insuf.
Adverse: N/V/D up to 30%, Pseudomembranous colitis up to 10%, and 3-4x more likely with oral. Can be serious and sypmtoms ~2-9days after initiation but can be up to several weeks after conclusion, hypersensitivity (morbilliform rash), hepatic, localized rxns induration and sterilized abscess following IM.
Oral hard to tolerate so not 1:1 from IV. Resistance induced by erythromycin (D-test)
*~think above the diapraghm

Back 10

Clindamycin (Cleocin)

Front 11

Inhibits DNA Synthesis in cells with nitroreductase.
Spectrum: Only anaerbic activity, potentially H. pylori, trichomonas vaginalis(protozoa), Entomeba histolitica(Amobiosis), Girardia.
80% of oral dose absorbed from GI, Food decreases rate but not amount. distributes widely to body fluids and tissues, including CSF(D.O.C) regardless if IV or oral. up to 60%metabolized in liver, no NN to adjust for renal insuf.
Adverse: GI N&headace, metallic taste, Hypersensitivty(rash, pruritis), Nervous-seizures and neuropahthy(peripheral), T-wave flattening, Disulfiram-like rxn(EtOH detox) in up to 25% N&V, flushing, sweating, palpitations. DONT DRINK W THIS DRUG,OR COUGH SYRUP, LISTERINE etc.
Uses: Trichomoiasis, Amebiasis, Giardiasis, Ameobic bacterial infs esp w cancer pts.,PID, Bacterial vaginosis, AB associated Psudomembranous colitis-(D.O.C) but now see C. dif resistance...may want vancomycin

Back 11

Metronidazole (Flagyl)

Front 12

Conc. independant Bactericidal except static against enterococci. Inhibits cell wall synthesis.
Spectrum: Gram + aerobics, and C. difficile but orally only (IV no enterohepatic circulation so ineffective against C. dif) /Not active against Gram -, fungi, yeasts.
Not absorbed well from GI. Distributes widely but not into CSF, and not lung very well.
Excrected 1 by kidneys so must be dosage adjusted, Oral doses 1 by feces.
Adverse: ototoxicity, Nephrotoxicity, localized Im irritation and necrosis, RED MANs due to too rapid infusion, macular rash,
Uses: Severe Staph infs. MRSA PEN/Ceph allergies (D.O.C), Strep endocarditis when PEN allergies, Pseudomembranous colitis (orally),

Back 12

Vancomycin (Vancocin)

Front 13

Bactericidal when combined, but if one is not working then static. Both inhibit cell wall synthesis Qunipristin (later phase), while dalforpristin(earlier phase).
Spectrum: Gram

Back 13

Quinupristin/Dalfopristin (Synercid)