ABX overview Flashcards by Sarah Hoffman

bacteriocidal ABX MOA + examples

disrupt cell wall production (B-lactams, monobactams, glycopeptides)
inhibit DNA synthesis (FQ, metronidazole)
destabilize cell membranes (cyclic lipopeptides)
destabilize cell wall + membranes (lipoglycopeptides)

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bacteriostatic ABX MOA + examples

inhibit protein synthesis
- 50S - macrolides, lincosamines, oxazolidinones, pleuromutilins
- 30S - AG, TTC, glycylcyclines
inhibit folic acid synthesis - TMP-SMX

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B-lactamases mechanism of ABX resistance

drug inactivation by enzymes

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3 mechanisms of ABX resistance

decrease intracellular [drug], drug inactivation by enzymes (B-lactamases, aminoglycosides), ABX target modification

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list bacteriocidal ABX

*B-lactams
monobactams
glycopeptides
lipoglycopeptides 
cyclic lipopeptides
aminoglycosides
*fluoroquinolones 
nitroimidizoles

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list bacteriostatic ABX

*tetracyclines 
glycylcyclines
*macrolides
lincosamides 
oxazolidinones
pleuromutilins
sulfonamides

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concentration-dependent killing drugs

Aminoglycosides
Fluoroquinolones
glycopeptides/lipoglycopeptides

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time-dependent killing drugs

B-lactams

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ABX against intracellular organisms

FQ, macrolides

TTC, TMP-SMX, clindamycin, rifampin

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anti-anaerobic ABX

clindamycin, metronidazole, Augmentin (PO), Unasyn (IV), Zosyn (IV), carbapenems

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bioequivalent ABX

*FQ
*TTCs
*Metronidazole
Rifampin
TMP-SMX
linezolid

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renal excretion

(most)
B-lactams, monobactams, glycopeptides, cyclic lipopeptides/lipoglycopeptides, AGs, FQs, TTC/Glycylcyclines, oxazolidinones

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hepatic excretion

ceftriaxone, all macrolides, metronidazole

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oral contraceptives and ABX

recommend back-up birth control while on ALL ABX

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ABX that increase INR

metronidazole, TMP-SMX

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ABX that decrease INR

rifampin

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ABX that cause dysrhythmia

macrolides

fluoroquinolones

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ABX associated with ototoxicity

aminoglycosides, vancomycin, minocycline

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what ABX can induce seizures

PCNs, CPHs, carbapenems

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what ABX is linked to psychosis + cognitive impairment in pts being treated for H. pylori

clarithromycin

what ABX may induce insomnia, confusion, hallucinations, other CNS effects

FQ (levofloxacin&raquo_space;)

what ABX may induce encephalopathy

metronidazole

ABX associated with nephrotoxicity

aminoglycosides (gentamycin)
vancomycin
PCNs (nafcillin > piperacillin) + FQs (ciprofloxacin)

ABX associated with hepatotoxicity

amoxicillin/clavulanate (Augmentin)
TMP-SMX (Bactrim
INH > RIF = PZA

ABX that cause chemical phlebitis

*nafcillin cefepime vancomycin clindamycin

what ABX should you recommend that pt does not drink alcohol while on AND WHY

(usually) Metronidazole - no ETOH while on ABX and for 2-3 days after last dose causes disulfram-like reactions

red man/neck syndrome

rapid vancomycin infusion | *not an allergy!

red lobster syndrome

rifampin - red/orange discoloration of urine, tears, sweat

discolored teeth

TTCs

loss of red/green color perception

ethambutol

yellow baby syndrome

sulfonamides

ABX that can cause hyperkalemia

Trimethoprim | increased risk with ACEi/ARB/spironolactone

ABX that can cause hypokalemia

PCNs (nafcillin >)

ABX that cause C. diff

``` Clindamycin (highest incidence) oral aminopenicillins (amoxicillin & amox/clav) oral cephalosporins (cephalexin) ```

what ABX, when given with an EBV infection, can cause a maculopapular rash

aminopenicillin

ABX to avoid in pregnancy

Fluoroquinolones Aminoglycosides Sulfonamides Tetracyclines

what two ABX have the highest percent of cross-reactivity

aminopenicillins (amoxicillin, ampicillin) and CPHs

combos of penicillins and cephalosproins with identical R1 side chain

ampicillin -- cephalexin | amoxicillin -- cefprozil

pts with h/o IgE-mediated rxn to PCN management

treated with non-B-lactam ABX or referred to an allergist for skin testing

pts with h/o severe non-IgE mediated rxn to PCN management

should NOT receive PCNs or CPHs in any form | skin testing/desensitization are CONTRAINDICATED

someone has a MP rash to a penicillin... what can they try

CPH, carbapenems, aztreonam

someone anaphylaxes to PCN, what can they try

aztreonam or "non-B-lactam ABX" | cant use PCN, CPH, carbapenems

sulfa reaction characteristics

7-14 days after | fever +/- MP rash

3 classes of sulfa drugs

1. sulfonylarylamines (sulfamethoxazole), HIV PIs (darunavir) 2. nonsulfonylarylamines - carbonic anhydrase anhibitors, cox-2 inhibitors, loops/thiazides, sulfonylureas, Tamsulosin, -triptans 3. sulfonamide-moiety containing drugs - AEDS (topiramate), HCV PIs

anti-MSSA ABX (oral and IV) gold + silver standard

oral - dicloxacillin, cephalexin | IV - nafcillin, cefazolin

anti-MRSA ABX (oral and IV)

oral - linezolid/tedizolid, minocycline/doxycycline, TMP-SMX, clindamycin IV - vancomycin

anti-pseudomonal ABX (oral and IV) gold + silver

oral - ciprofloxacin & levofloxacin | IV - pip/tazo, aztreonam, ceftazidime/ceftolazone/cefepime, cipro or levo, tobramycin, doripenem

anti-VRE ABX

oral - linezolid/tedizolid | IV - linezolid/tedizolid, daptomycin, tigecycline, telavancin/oritavancin

anti-anaerobic ABX (oral and IV) gold + silver

oral - metronidazole or amox/clav, (silver) clindamycin | IV - b-lactam/b-lactamase inhibitor combo (pip/tazo), carbapenems, metronidazole, (silver) clindamycin