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51 Cards in this Set
- Front
- Back
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Inhibition of bacterial cell wall synthesis
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Penicillins, cephalosporins, imipenem/meropenem, aztreonam, vancomycin
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Inhibition of bacterial protein synthesis
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Aminoglycosides, chloramphenicol. Macrolides, tetracyclines, streptogamins, linezolid
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Inhibition of DNA replication or transcription
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Fluoroquinolones, rifampin
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Inhibition of nucleic acid syntheis
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Trimethoprim, flucytosine
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Inhibition of folic acid synthesis
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Sulfonamides, trimethoprim, pyrimethamine
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Disruption of membrane function
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Azole and polyene antifungal agents
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First generation penicillins
(e) toxicity/other notes |
(e) hypersensitivity, hemolytic anemia
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Beta lactam resistant penicillins
(a) examples (b) mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicity/other notes |
(a) nafcillin, methicillin, dicloxacillin
(b) same as penicillin (c) same as penicillin except more resistant to penicillinases due to bulkier R group (d) G+ esp S. aureus (except MRSA which has altered PBP) (e) hypersensitivity; methicillin gives interstitial nephritis |
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Aminopenicillins
(e) toxicity/other notes |
(e) Hypersensitivity rxn; ampicillin rash; pseudomembranous colitis
NOTE: activity may be augmented with clavulanic acid (beta lactamase inhibitor) |
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1st gen cephalosporins
(e) toxicity/other notes |
((e) cross allergenicity with penicillins in some patients; anaphylaxis but NOT rash; contrainidication in penicillin sensitive pt
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Carbapenems
(a) examples (b) mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicity/other notes |
(a) meropenem, imipenem/cilistatin
(b) similar to pen (c) beta lactamase resistant (d) G+, G- rods, anaerobes (e) Nephrotoxicity, GI distress, skin rash, CNS toxicity (seizures) at high plasma levels. NOTE: cilistatin always admin with imipenem to reduce drug's half life and reduce toxicity. |
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Monobactams
(a) examples (b) mechanism of action (c) spectrum (d) toxicity/other notes |
(a) aztreonam
(b) similar to pen (c) G negative rods (NO activity against G+ and anaerobes) (d) GI distress w/superinfection vertigo, headache -Synergistic with aminoglycosides -beta lactamase resistant |
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Vancomycin
(a) mechanism of action (b) spectrum (c) toxicity/other notes |
(a) binds cell wall precursors preventing polymerization
(b) (MRSA) or C diff (orally b/c it is not absorbed from lumen) (c) ototoxicity, nephrotoxicity Red man syndrome Resistant strains emerging |
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Prevent formation of initiation complex
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Aminoglycosides (30s), Linezolid (50s)
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Prevent amino acid incorporation
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Tetracyclines (30s)
Dalfopristin/quinupristin (50s) |
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Prevent formation of peptide bond
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Chloramphenicol (50s)
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Prevent translocation of peptide chain
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Macrolides and clindamycin (50s)
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Chloramphenicol
(a) site/mechanism of action (b) spectrum (d) toxicities |
(a) 50s; inhibit peptidyltransferase
(b) Wide; use limited by toxicity (d) "gray baby" syndrome (due to decreased glycyronyl transferase in neonates); aplastic anemia/bone marrow suppression; GI irritation |
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Tetracyclines
(a) examples (b) site/mechanism of action (d) spectrum (e) toxicities (f) notes |
(a) tetracycline, doxycycline, minocycline
(b) 30 s ribosome; blocks attachment of aminoacyl tRNA; limited CNS penetration (d) G+ and G-: Rickettsia, Borrelia, Acne, Tularemia, Chlamydia, Mycoplasma, H pylori, Brucella, Vibrio (e) GI irritation, tooth discoloration, bone growth irregularities, hepatotoxic, photosensitivity, vestibular toxicity; contraindicated in pregnancy (f) fanconi's syndrome with expired tetracycline; oral absorption limited by multivalent cations (do not take w/milk, antacids, or iron containing preps) |
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Macrolides
(a) examples (b) site/mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicities (f) notes |
(a) erythromycin, azithromycin, clarithromycin
(b) 50s; inhibit translocation of peptidyl tRNA from acceptor to donor site (bacteriostatic) (c) methylation of binding site on 50s; increased efflux from multidrug exporters (d)G+ cocci (give to pts who are alergic to penicillin) and G-; mycoplasma, chlamydia, legionella, Neisseria campylobacter; URI's, pneumonias, STD's (e) GI irritation, cholestasis, hepatitis, skin rashes, decr p450 (f) useful in atypical pneumonia |
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Clindamycin
(a) examples (b) site/mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicities |
(a) n/a
(b) 50s; inhibits translocation of peptidyl tRNA from acceptor to donor site (bacteriostatic) (c) methylation of binding site on 50S (d) narrow spectrum; G+, anaerobes (e) GI irritation, skin rash, C diff superinfection |
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Aminogglycosides
(a) examples (b) site/mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicities (f) notes |
(a) gentamicin, neomycin, tobramycin, streptomycin
(b) 30s; interfere w/initiation of codon fct-locks association of 50s ribosomal subunit with mRNA-30s (bacteriostatic); incorporation of wrong amino acid (bacteriocidal) (c) plasmid mediated group transferase (d)Severe G- rods infections; synergistic with beta lactams (e) ototoxicity, nephrotoxicity (f) neomycin for bowel prep (stays in bowel lumen) |
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Oxazolidinones
(a) examples (b) site/mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicities (f) notes |
(a) linezolid
(b) 50s; interfere w/initiation of codon fct-locks association of 50s ribosomal subunit w/mRNA-30s (bacteriostatic); incorporation of wrong amino acid (bacteriocidal) (c) rare (d) G+ cocci (e) thrombocytopenia, neutropenia esp in IC MAO inhibition (dietary and drug restriction) (f) often reserved for resistant infection |
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Sulfonamides
(a) mechanism of action (b) spectrum (c) mechanism of resistance (d) toxicity (e) notes |
(a) PABA antimetabolite inhibits bacterial dihydropteroate synthase curbing folate synthesis (bacteriostatic)
(b) G-, G+, chlamydia, Nocardia (c) Decreased accumulation of drugs, decreased affinity of drug or dihydropteroate synthase (d) Hypersensitivity, hemolytic anemia in G6PD, nephrotoxicity, Kernicterus in newborns, nephrotoxicity, photosensitivity, displace other drugs from albumin (e) combined with trimethoprim for increased efficacy |
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Trimethoprim
(a) mechanism of action (b) spectrum (c) mechanism of resistance (d) toxicity (e) notes |
(a) inhibits bacterial dihydrofolate reductase thus inhibiting folate synthesis
(b) H flu and M cat; used in combo for recurrent UTI's, Shigella, Salmonella, Pneumocystic jiroveci pneumonia (c) production of bacterial dihydrofolate reductase with decreased affinity for drug (d) megaloblastic anemia, leukopenia, granulocytopenia (e) adverse effects may be reduced by concurrent folinic acid; good for UTI's b/c it is excreted in urine unchanged |
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Fluoroquinolones
(a) examples (b) site/mechanism of action (c) mechanism of resistance (d) spectrum (e) toxicities (f) notes |
(a) ciprofloxacin, ofloxacin, levofloxacin
(b) interfere w/bacterial DNA topoisomerase II and IV (DNA gyrase) resulting in inhibition of DNA synthesis (c) G- rods, Neisseria, occasional G+ (G- rods of urinary and GI tracts incl Pseudomonas). (d) Decreased intracellular drug concentration through efflux pumps and altered porins; alteration of binding site (e) GI distress, skin rash, superinfection, headache, dizziness. Tendonitis and tendon rupture in adults; leg cramps and myalgias in kids (f) Contraindicated in pregnancy due to cartilage formation abnormalities in animal studies NOTE: do not take with antacids |
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Metronidazole
(a) mechanism of action (b) spectrum (c) mechanism of resistance (d) toxicity (e) notes |
(a) when reduced, interferes with nucleic acid synthesis (bacteriocidal)
(b) anaerobes (except actinomyces); also treats Giardia, Entameoba, Trichomonas, garnderlla vaginalis. Used w/bismuth and amoxicillin (or tetra) for H pylori (c) rare plasma mediated resistance (d) GI distress, disulfuram like rxn with alcohol, peripheral neuropathy, ataxia (e) strong metallic taste; DOC in pseudomembranous colitis |
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Polymyxins
(a) mechanism (b) clinical use (c) toxicity |
(a) bind to cell membranes of bacteria and disrupt their osmotic properties; cationic basic proteins that act like detergents
(b) resistant G- infection (c) neurotoxicity; acute renal tubular necrosis |
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Prophylaxis and treatment for TB
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Prophylaxis: isoniazid
Treatment: Rifampin, Isoniazid, Pyrazinamide, Ethambutol |
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Prophylaxis and treatment for M. avium intracellulare
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Prophylax with azithromycin
Treat with Azithromycin, rifampin, ethambutol, and streptomycin |
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Prophylaxis and treatment for M leprae
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No prophylaxis
Treat with dapsone, rifampin, and clofazimine |
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2nd line therapy for TB
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Cycloserine
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Side effect of ethambutol
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Optic neuropathy (red green color blindness)
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Isoniazid
(a) mechanism (b) clinical use (c) toxicity |
(a) decreases synthesis of mycolic acids
(b) MTB; used for solo prophylaxis of MTB (c) neurotoxicity (can be prevented with vitB6), hepatotoxicity |
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Rifampin
(a) mechanism (b) clinical use (c) toxicity |
(a) inhibits DNA dependent RNA polymerase
(b) MTB; delays resistance for dapsone when used for leprosy. Also used for meningococcal prophylaxis and chemoprophylaxis in contacts of children w/H fly type B (c) minor hepatotoxicity and drug interactions (increase P-450); orange body fluids |
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Mechanism of resistance for: penicillins/cephalosporins
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Beta lactamase cleavage of beta lactam ring or altered PBP in cases of MRSA or penicillin resistant S pneumo
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Mechanism of resistance for: aminoglycosides
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Modification via acetylation, adenylation, or phosphorylation
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Mechanism of resistance for: vancomycin
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Terminal D ala of cell wall replaced with D-lac which decreases affinity
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Mechanism of resistance for: chloramphenicol
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Modification via acetylation
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Mechanism of resistance for: macrolides
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Mehtylation of rRNA near erythromycin's ribosome binding site
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Mechanism of resistance for: tetracyline
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Decreased uptake or increased transport out of cell
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Mechanism of resistance for: sulfonamide
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Altered enzyme (bacterial dihydropteroate synthetase); decreased uptake or increased PABA snthesis
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Mechanism of resistance for: quinolones
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Altered gyrase or reduced uptake
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Non surgical antimicrobial prophylaxis: meningococcal infection
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Rifampin or minocycline
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Non surgical antimicrobial prophylaxis: gonorrhea
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Ceftriaxone
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Non surgical antimicrobial prophylaxis: syphilis
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Benzathine penicillin G
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Non surgical antimicrobial prophylaxis: history of recurrent UTI's
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TMP-SMX
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Non surgical antimicrobial prophylaxis: pneymocystic jiroveci
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TMP-SMX or aerosolized pentamidine
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Non surgical antimicrobial prophylaxis: endocarditis w/surgical or dental procedures
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Penicillins
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Treatment of MRSA
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Vanc
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Treatment of VRE
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Linezolid and stretogramins (quinupristin/dalfopristin)
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