Antibiotics

Front 1

Bactericidal Abx

Back 1

Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinilones, Metronidazole

Front 2

Penicillin Mechanism of Action
Pen G = IV
Pen V = Oral

Back 2

MOA-
1)Binds Penicillin binding proteins
2)Blocks transpeptidase cross linking of cell wall
3)Activates autolytic enzymes

Front 3

Penicillin Use and Toxicity

Back 3

Uses- Bactericidal for Gram (+) cocci (Strep), rods (listeria, etc), gram (-) cocci (Neisseria) and spirochetes

Toxicity- Hypersensitivity reactions (Type I) and hemolytic anemia (Type 2)

Front 4

Methicillin, Naficillin, Dicloxacillin

Back 4

MOA- same as penicillin but resistant to B-lactamase

Uses- adds S.aureus coverage but no MRSA (has altered PBP, not penicillinase)

Toxicity- Hypersensitivity
Methicillin- Interstitial Nephritis

Front 5

Ampicillin, Amoxicillin
MOA

Back 5

MOA- same as Penicillin, still susceptible to B-lactamse (no S. aureus)

Can combine with clavulonic acid (B-lactamase inhibitor)
AmOxicillin better Oral

Front 6

Amoxicillin, Ampicillin
Use and Toxicity

Back 6

Use- Extended spectrum Penicillin for gram (+) and (-)
H. flu
E.colo
Listeria
Proteus
Salmonella
entercocci and strep

Toxicity- Rash, Pseudomembranous colitis

Front 7

Ticarcillin, Carbenicillin, and Piperacillin

Back 7

MOA- same as penicillin but with extended spectrum

Use- All Gram (+) except S.aureus
All Gram (-) rods and cocci

Front 8

Cephalosporins MOA and Toxicity

Back 8

MOA- B-lactam drugs that inhibit cell wall cross linking by binding PBP
Less susceptible to B-lactamases

Toxicity- Hypersensitivity (seen in ~5% pts allergic to penicillin)
Acts like disulfiram in EtOH metabolism causing nausea while drinking (esp Cefamandole)
Worsens aminoglycoside nephrotoxicity

Front 9

1st generation Cephalosporins

Back 9

Cefazolin, Cephalexin

Uses- Gram (+) plus PEcK
Proteus
E.coli
Klebsiella

Front 10

2nd generation Cephalosporins

Back 10

Cefoxitin, Cefaclor, Cefuroxime

Uses- Gram (+) plus HEN PEcKS
H.flu, Enterobacter, Nisseria, Proteus, E.coli,Klebsiella, Serratia

Front 11

3rd Generation Cephalosporins

Back 11

Ceftriaxone, Cefotaxime, Ceftazidime

Uses- serious gram (-) infxns resistant to other Penicillins, etc
Adds Pseudomonas
Meningitis, gonorrhea

Front 12

4th Generation Cephalosporins

Back 12

Cefepime, Cefpiramide

Best for Pseudomonas and Gram (+) coverage

Front 13

Aztreonam

Back 13

MOA- Bind PBP3 to block cross linking, and is resistant to B-lactamases
Acts in synergy with Aminoglycosides
No Cross reactivity with Penicillin allergy

Uses- Gram (-) rods
Klebsiella, Pseudomonas, Serratia
No Gram (+) activity
Use in pen allergic pts and pts with renal failure (no aminoglycosides)

Toxic- minor GI

Front 14

Imipenem/Cilastatin, Meropenum

Back 14

MOA- B-lactamase resistant carbapenum
Cilastatin inhibits renal dihydropeptidase to decrease inactivation

Use-Everything, esp Enterobacter

Toxicity- GI distress, Rash, Seizures at high levels

Front 15

Vancomycin

Back 15

MOA- Inhibits cell wall synthesis by binding D-Ala D-Ala precursor (resistance via change to D-Ala D-Lac)

Use- MRSA, C. difficile, Enterococcus

Toxicity- NOT many
Nephrotoxic
Ototoxic
Thrombophlebitis and Red Man Syndrome if infused too fast (block with Antihistamines--not an allergy)

Front 16

30S inhibitors are _____ and ______

50S inhibitors are _____, _____, ______, and _______

"buy AT 30, CELL at 50"

Back 16

Aminoglycosides and Tetracyclin

Chloramphenicol, Erythromycin, Lincomycin, and cLindomycin (CELL)

Front 17

Aminoglycosides (GNATS)

GNATS do NOT kill anaerobes

Back 17

Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin

Requires O2 for uptake --> ineffective against anaerobes

Front 18

Aminoglycosides MOA, Use, Toxicity

Back 18

MOA- blocks 30S initiation complex to cause misreading of mRNA --> bactericidal
No anaerobe activity

Use- Severe Gram(-) infxns, act in synergy with B-lactams
Req'd for Enterobacter
Neomycin used before bowel sx

Toxicity- Nephrotoxic (in combo with cephalosporins), Ototoxic (combo with loop duiretics), and Teratogenic

Front 19

Tetracyclines

1)MOA
2)absorption

Back 19

1) BLocks aminoacyl-tRNA from binding ribosome-->bacteriostatic
2) inhibited by cations --> can't take w/ antacids, milk, iron, etc

Front 20

Tetracyclines

1)uses
2)Toxicity

Back 20

1) VACUUM THe BedRoom
Vibrio, Acne, Chlamydia,Ureaplasma, Urealyticum, Mycoplasma,Tularemia,H.pylori,Borrelia (Lyme), Rickettsia

2) Tooth discoloration, GI distress, bone growth inhibition, photosensity, Teratogenic

Front 21

Demeclocycline

1) MOA
2) Use

Back 21

1) ADH antagonist even though it's an ABx

2) Used to trt SIADH

Front 22

Macrolides (ACE)

1) MOA
2) Use

Back 22

Azithromycin, Clarithromycin, Erythromycin

1) blocks 23S RNA subunit of 50S ribosome to prevent translocation of growing peptide into P site

2)Atypical Pneumonia - Mycoplasma, Legionella, Psitticosis,
STDs- Chlamydia, Neisseria
Trt of Strep if Pen allergy
Simple Gram (-)like E.coli, H.flu

Front 23

1)Macrolides Toxicity

2) 2 drugs increased while on this Abx (inhibits p450)

Back 23

1)MC is GI disturbance
Skin Rash, Change in taste (clarithromycin), Eosinophilia, Tosades de Pointes (w/ 3rd antihistamine and Cisapride)

2)Blood thinners, theophylline

Front 24

Chloramphenicol

Back 24

MOA- Bacterostatic via blocking 50S pepidyltransferase (blocks addition of amino acid onto growing peptide)

Use- Meningitis if other therapies fail

Toxicity- Anemia, Aplastic Anemia, gray baby syndrome

Front 25

Clindamycin

Back 25

MOA- Bacterostatic via 50S

Use- Anaerobic infxns (Bacteroides, Clostridium, mouth bacteria), and Staph?Strep

Toxicity- Pseudomembranous colitis, fever, diarrhea

Front 26

Sulfonamides (SMX)
1) MOA
2) Use
3) Toxicity

Back 26

1)Inhibits PABA --> Dihydrofolate (dihydropteroate synthase)

2) Gram (+) and Gram (-), simple UTI's

3) Hypersensitivity, hemolysis if G6PD deficient, nephrotoxic, kernicterus

Front 27

Trimethoprim

TMP-SMX

Back 27

1) MOA- inhibits Dihydrofolate--> THF to prevent DNA synthesis

2) used in combo with SMX to trt recurrent UTIs, Shigella, Salmonella, PCP

3) Toxic- megaloblastic anemia, granulocytopenia, leukopenia

Front 28

Quinolones
(all end in -oxacin)

Quinolones hurt your bones

Back 28

1) MOA- inhibits DNA gyrase and is bactericidal

2)Use- gram (-) UTI and GI infxns, Pseudomonas, Neisseria, Gram (+)

3) Toxic- GI upset, headache, cartilage damage (teratogenic), tendonitis, myaglia

Front 29

Metronidazole

Back 29

MOA- toxic metabolites in cell wall --> cidal

Uses- Protozoa (Giardia, Entamoeba, Trichomonas
Triple Therapy for Ulcers
Anaerobes

Toxic- acts like disulfiram for EtOH use, metallic taste

Front 30

Polymyxins

Back 30

MOA- binds cell membranes like a detergent and disrupts them (mixes up membrane)

Use- Resistant Gram (-) infxns

Toxic- Neurotoxic, Acute Tubular Necrosis

Front 31

Penicillin/Cephalosporin Resistance

Back 31

B-lactamase cleaves the ring

Front 32

Aminoglycoside Resistance

Back 32

Modification via acetylation, adenylation, or phosphorylation

Front 33

Vancomycin Resistance

Back 33

Terminal D-Ala in cell wall is changed to D-Lac to decrease affinity

Front 34

Chloramphenicol Resistance

Back 34

Modified by acetylation

Front 35

Macrolide Resistance

Back 35

Methylation of RNA near the 50S binding site

Front 36

Tetracycline Resistance

Back 36

blocked uptake or increase efflux out of the cell

Front 37

Sulfonamides Resistance

Back 37

Altered Dihydropteroate synthase enzyme, or increased PABA synthesis to overwhelm the drug