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19 Cards in this Set

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pro synth inh classes
aminoglycoside, oxazolidinone, tetracycline, chloramphenicol, lincosamide, macrolide, streptogramin, rifamycin

50s: macrolide, chloramphenicol, lincosamide, streptogramin, oxazolidinone
30s: aminoglycoside, spectinomycin, tetracycline

most bacteriostatic v most bac except aminoglycoside
aminoglycoside
inh translation 30s (16s, misread rna, incorporate abn mem transport pro), bactericidal, efficacy conc dep, tox time dep (1ce daily high dose to max eff, min tox), very low ba (only po surg prophylaxis gut), renal elim (nephrotoxic), short hl (few hours, esrd few days), suboptimal penetrateion lung/bone/cns/abscess

good v enterobacteraciae, acinetobacter (gnc), pseudomonas (res gent>tobra>amikacin), other gnr, gpc if combined w/ cell wall drug

use gram neg nosocomial, mycobac (streptomycin, amikacin), pseudomonas, gram pos synergy for endocarditis

ae nephrotox (atn, reversible), ototox (irreversible, less common), neuromuscular block

res enterobacteraciae (enz inact), pseudomonas (alt mem perm), others due to target site mut

gentamicin, tobramycin, amikacin
gentamicin
aminoglycoside
tobramycin
aminoglycoside
amikacin
aminoglycoside
clindamycin
lincosamide, bind 50s, inh peptidyl transferase, bacteriostatic, 90% ba, active v anaerobe (not c. difficil), good v staph incl community mrsa, strep

NOT gram neg aerobe, mrsa pneumonia, atypical

use aspiration pneumonia (good for mouth anaerobe), ssti, anaerobic inf, acne (topical)

ae ***pseudomembranous colitis, diarrhea (common), abd pain, nausea, rash

res alt target site
mlsb res
macrolide, lincosamide, streptogramin b res

inducible by erythromycin/macrolide (strong), clinda (weak), test w/ d test (when erythromycin res and clinda susceptible, clinda clear but when placing discs next to each other nearby erythromycin can induce clinda res locally)
macrolides
bind 50s (23s, blocks exit tunnel), bacteriostatic, high intracellular conc (takes time to leach out of macrophage, esp azithromycin), high ba, very good lung penetration, poor cns penetration, hepatic metab, biliary excrete (don't use uti)

good v strep (pneumo 30-40% res, not group a), atypical, some gnr (h. flu, m. catarrhalis), h. pylori (clarithromycin)

use cap (high res), uri, om, mac/mai (mycobac avium intracellulare), pud (clarithromycin), promotility (erythromycin)

ae gi disturb (n/v/ - zmax/d - erythromycin directly stim motility R), rash

di erythro/clarithro inh cyp1a2, 3a3/4 (verapamil, cyclosporine, bzd, pimozide, statin) and inc qtc (torsades w/ astemizole, cisapride, terfenadine, fluoroquinolone)

res: efflux pump, alt target site

erythromycin, clarithromycin, azithromycin
erythromycin
macrolide, 4x/day, di w/ p450, ae inc qtc (di torsades), promotility (directly stim gi motilin R)
clarithromycin
macrolide, 2ce/day, good v h. pylori (pud), di w/ p450, ae inc qtc (di torsades)
azithromycin
macrolide, low di potential, takes long time to leach out of macrophage
telithromycin
ketek, ketolide, macrolide analogue w/ inc s. pneumoniae act, well abs, not very sol (po only), spectrum/ae/di same as macrolide but also hepatotox, use outpt cap
tetracylines
reversibly bind 30s, block trna bind rna/ribosome, bacteriostatic, time-dep, high ba, poor cns penetration (dizziness but no act)

good v intracellular, atypical, some gnr/gpc (res efflux pump), some mrsa, b. anthracis, b. burgdorferi (lyme, 1st line), y. pestis, t. pallidium, h. pylori

use acne, cap (doxycycline), tick dz, pud, std (clamydia), siadh (demeclocycline's only use)

ae tooth discoloration, gi upset (n/v, borborygmous), photosens

di chelated by multivalent cations --> low abs, inh cell wall inh since bacteriostatic

minocycline, doxycycline
minocycline
tetracycline, best against mrsa
doxycycline
tetracycline, use cap
tigecycline
glycylcycline, from minocycline, inh efflux pump, same as tetracycline but more spectrum (many gnr/gpc incl vre/mrsa, good anaerobic incl c. diff, NOT pseudomonas or proteus), poor abs (iv only), very large vd (low plasma conc), long hl but ae conc dep (30% n/v), hepatic elim

use ssti, intra abd inf
not good for hap, overkill for cap
chloramphenicol
bind 50s (23s, block trna, prevent aa linking), bacteriostatic, high ba (po=iv dose), good cns penetration, hepatic metab through conj (problem for neonate)

good v strep, mssa, enterococci incl *vre, anaerobe, some gnr

ae gray baby syndr (vomit, flaccid, gray, resp distress, metab acidosis), bone marrow supp (reversible, dose-related, can be idiopathic and irreversible)

di inc phenytoin, phenobarbital, warfarin

res due to enz inact
quinupristin/dalfopristin
synercid, streptogramin, bind 50s (23s, prevent elongation), iv only, bacteriostatic v enterococcus facium (NOT faecalis) but when combined bactericidal v mssa/mrsa/strep, hepatic metab, some cns penetration

good v staph incl *mrsa, strep incl pcn-res, **e. faecium inc vre NOT e. faecalis

ae phlebitis (central line), 50% severe myalgia/arthralgia, line crystallizaiton w/ saline (use only d5w)
di inh cyp3a4 (cyclosporine, nefidipine, midazolam, tacrolimus)

res alt target site
linezolid
oxazolidinone, bind 50s (23s, inh 70s formation), bacteriostatic v enterococci/staph, bactericidal v strep, high ba (po=iv dose), dual hepatic/renal elim, weak/reversible maoi (avoid tyramine foods, cautions ssri/tca, can inc pressor effects)

good v gram pos aerobe incl *mrsa, strep incl pc-res, enterococci incl *vre

ae myelosupp, esp thrombocytopenia*** after 2 wks, htn w/ tyr foods or sympathomimetics

res alt target site