Antibiotics Flashcards
Learn antibiotics (35 cards)
What are the Beta lactam antibiotics (drug classes)?
Penicillin, Aminopenicillins, Semisynthetic Penicillinase-Resistant Penicillins (Anti-Staph), Extended Spectrum Penicillins (Anti-Pseudomonas), Combo (Penicillin + beta Lactamase Inhibitor), 1G Cephalosporins, 2G Cephalosporins, 3G Cephalosporins, Carbapenems, Monobactams
Penicillin: info
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
ex: Penicillin G or Penicillin VK
Mxn of action: binds Penicillin Binding Proteins (PBPs), inhibiting transpeptidase’s cell wall synthesis
Mxn of resistance: beta lactamase, alter porins, efflux pumps, alter PBP
Gram+ coverage: strep, sensitive staph
Gram- coverage: spiros, meningoc.
CSF: with high doses; needs inflam. to cross BBB
Pharmacology: IV/IM
Primary indications: group A strep, primary syphilis, sensitive s. aureus and s. pneum
Side effects/toxicity: allergy (IgE), c. diff
Aminopenicillins: Info
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
ex: Ampicillin, Amoxicillin
Mxn of action: -NH3 = increase penetration of porins vs. penicillin
Mxn of resistance: beta lactamase
Gram+ coverage: strep, enterococ
Gram- coverage: broad
CSF: with high doses; needs inflam. to cross BBB
Pharmacology: Oral/IV
Primary indications: Grp A Strep, enterococc, broad gram neg
Semisynthetic Penicillinase-resistant penicillins (anti-staph)
ex: (methicillin), nafcillin, oxacillin, (di)cloxacillin
Mxn of action: bulky side chains resist penicillinase, so can kill staph aureus
Mxn of resistance: bulkiness prevents entry into gram neg porins
Gram+ coverage: staph aur
CSF: with high doses; needs inflam. to cross BBB
Notable resistants: MRSA
Pharmacology: IV, Oral ((Di)cloxacillin), Biliary (Nafcillin)
Primary indications: staph (IE, Cellulitis, Sepsis)
Side effects/toxicity: Meth-Renal
Extended spectrum penicillins (anti-pseudomonas)
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
Ex: Piperacillin, Ticarcillin, Carbenicillin
Mxn of action: charged side chains = increased porin permeability, PBP binding
Mxn of resistance: penicillinase sensitive
Gram- coverage: p. aeruginosa
Anaerobic
CSF: with high doses; needs inflam. to cross BBB
Pharmacology: Oral/IV
Primary indications: P. Aeruginosa
Side effects/toxicity: platelet dysfunction, decreased K+
Combo (Penicillin + beta lactamase inhibitor)
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
ex: Augmentin, timentin, unasyn, zosyn
Mxn of action: amox + clavulanate; ticarcillin + clavulanate; amp. + sulfbactam; piper. + tazobactam (all inhibit beta lactamases)
Mxn of resistance: alter porins, efflux pumps, alter PBP
Gram+ coverage: staph aur.
Gram- coverage: p.aerug, hem. infl.
Anaerobic: B. frag
CSF: with high doses; needs inflam. to cross BBB
Pharmacology: Oral/IV
Primary indications: otitis media from PCN-resistant S. pneumo, nosocomial (aka HAI)
Side effects/toxicity: diarrhea, interstitial nephritis
1G Cephalosporins (beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin)
ex: cefazolin, cephalexin, (cephalothin)
Mxn of action: binds PBP’s, inhibiting transpeptidase’s cell wall synthesis; penicillinase resistant
Mxn of resistance: permeability, beta lactamase, alter PBP, efflux pumps
Gram+ coverage: strep, staph aur.
Gram- coverage: e.coli, klebsiella
Notable resistants: Enterococ
Pharmacology: Oral
Primary indications: surgical prophylaxis (skin infection)
Side effects/toxicity: Allergy (IgE) + c. diff. superinfection
2G Cephalosporins (beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin)
ex: cefoxitin, cefuroxime, cefotetan
mxn of action: binds PBP’s, inhibiting transpeptidase’s cell wall synthesis; penicillinase resistant
mxn of resistance: permeability, alter PBP, efflux pumps
Gram+ coverage: strep, staph aur.
Gram- coverage: e.coli, klebsiella, H. flu
Anaerobic: B. frag
Notable resistants: Enterococ
Pharmacology: Oral/IV
Primary indications: CAP (community acquired pneumonia), anaerobes, RTI
Side effects/toxicity: Allergy (IgE) + c. diff. superinfection
3G Cephalosporins (beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin)
ex: ceftriaxone, cefotaxmine, ceftazidime, cefipime (4G)
mxn of action: binds PBP’s, inhibiting transpeptidase’s cell wall synthesis; penicillinase resistant
mxn of resistance: permeability, alter PBP, efflux pumps
Gram+ coverage: strep, staph
Gram- coverage: e.coli, klebsiella, H. flu, p.aerug
CSF: N. men
Notable resistants: Enterococ
Pharmacology: IV
Primary indications: meningitis, gonorrhea, resistant CAP (community acquired pneumonia), CNS Lyme
Side effects/toxicity: Allergy (IgE) + c. diff. superinfection
Carbapenems
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
ex: imipenem, meropenem, ertapenem
mxn of action: no beta lactam ring, high affinity for PBP-2, porin permeable
mxn of resistance: alter porins
Notable resistants: enterococ
Pharmacology: IV/IM
Primary indications: very broad coverage
Side effects/toxicity: CNS? (Imipenem), allergy (IgE)
Monobactams
beta lactam antibiotics; all are cidal; all are renal secretion except nafcillin
ex: aztreonam
mxn of action: no beta lactam ring, high affinity for PBP on gram neg
mxn of resistance: efflux pumps
Gram- coverage: p.aeruginosa
Pharmacology: IV/IM
primary indications: tough gram negatives
side effects/toxicity: no penicillin rxn
Vancomycins
cell wall (cidal)
ex: vancomycin, telavancin (VRSA)
mxn of action: targets D-Ala-D-Ala, decreases carboxypeptidase, transpeptidase (telavancin also disrupts membranes)
mxn of resistance: alternative D-Ala-D-Lactate peptide (scary)
Gram+ coverage: enterococc, MRSA
Anaerobic: C. Diff
Pharmacology: oral/IV (oral for C. diff)
Primary indications: C. Diff, resistant s.pneumo, tough gram+ (Vancomycin-Resistant Enterococci/MRSA)
Side effects/Toxicity: red man, nephrotoxicity, ototoxicity, phlebitis
Macrolides
protein synthesis inhibitors (all static except AGs
ex: erythromycin, clarithromycin, azithromycin (Z-pack)
mxn of action: reversibly binds 50S, inhibiting formation
mxn of resistance: permeability, efflux pumps, erm gene –> methylase that can modify binding site on 50S
Gram+ coverage: strep, staph, pneumo, mycoplas
Gram- coverage: h.flu, h.ducreyi, campylo, legionella, chlamydia
Pharmacology: Oral/IV (biliary excretion)
primary indications: weird things: CAP (community acquired pneumonia), chancroid, chlamydia, pertussis, mycoplasma
side effects/toxicity: GI side effects, Long QT
Lincosamides (Clindamycin)
protein synthesis inhibitors (all static except AGs
ex: clindamycin
mxn of action: reversibly binds 50S, inhibiting formation
Mxn of resistance: permeability, efflux pumps, erm gene –> methylase that can modify binding site on 50S
Gram+ coverage: MRSA
Anaerobic: B. Frag
Pharmacology: Oral/IV
Primary indications: oral abscesses, penetrating trauma, TSS
Side effects/toxicity: C.Diff
Aminoglycosides (AGs)
protein synthesis inhibitors (all static except AGs
ex: streptomycin, gentamicin, tobramycin, neomycin
mxn of action: cidal! messes with 30S translation accuracy + disrupts gram- outer membrane
mxn of resistance: AG-modifying enzymes
Gram+ coverage: (strep), staph, enterococc
Gram- coverage: enterobac, pseudom
notable resistants: anaerobes
Pharmacology: IV
primary indications: adjunct for serious gram- infections, empiric
side effects/toxicity: nephrotoxicity, ototoxicity, neuromuscular blockade
Tetracyclines (T for Ticks)
protein synthesis inhibitors (all static except AGs
ex: tigecycline, tetracycline, minocycline, doxycycline (vector-borne)
mxn of action: prevents binding of tRNA on 30S
mxn of resistance: permeability, efflux pumps, farmers use them in food
Gram+ coverage: pneumo, mycoplas, MRSA
Gram- coverage: rickettsia, ehrlichia, legionella, chlamydia
Pharmacology: oral
primary indications: rickettsia, acne, syphilis, chlamydia
side effects/toxicity: GI, photosensitivity, yellow teeth (kids), teratogen
Chloramphenicol
protein synthesis inhibitors (all static except AGs
ex: chloramphenicol
mxn of action: binds 50S preventing attachment to mRNA
mxn of resistance: ribosomal modification
Gram- coverage: rickettsia
anaerobic: b.frag
CSF: !!!
pharmacology: oral/IV
primary indications: typhoid, meningitis, rickettsia in poor areas
side effects/toxicity: lots!!! aplastic anemia, grey baby
Oxazolidinones (Linezolid)
protein synthesis inhibitors (all static except AGs
ex: linezolid
mxn of action: decreased initiation complex @ 50S
mxn of resistance: ribosomal modification
Gram+ coverage: VRE Vancomycin-Resistant Enterococci, MRSA
pharmacology: oral/IV
primary indications: VRE, MRSA
side effects/toxicity: decreased platelets (plt), neuropathy
Streptogramins
protein synthesis inhibitors (all static except AGs
ex: pristinamycin, (quinupristin + dalfopristin)
mxn of action: decreased protein synthesis @ 50S
mxn of resistance: ribosomal modification (methylation of MLS-binding site)
Gram+ coverage: VRE (vancomycin-resistant enterococcus?), MRSA
pharmacology: IV
primary indications: VRE, MRSA, E. Faecium only!
side effects/toxicity: phlebitis, myalgias
Fluoroquinolones (Misc.-all cidal)
ex: ciprofloxacin, levofloxacin, moxifloxacin
mxn of action: blocks DNA replication, uncoiling, supercoiling
mxn of resistance: mutations in topoisomerase genes, efflux pumps
Gram- coverage: p. aeruginosa, enterobac
pharmacology: oral/IV
primary indications: CAP (community acquired pneumonia), STIs, TB, diarrhea
side effects/toxicity: allergy (IgE, GI side effects)
Trimethoprim-Sulfamethoxazole (TMP-SMZ) (Bactrim) (Misc.-all cidal)
ex: Bactrim, “sulfa drugs”
mxn of action: decrease folic acid synthesis by competitively inhibiting PABA in TH4 formation
mxn of resistance: permeability, increase intermediates in pathway
Gram+ coverage: staph, strep
Gram- coverage: e.coli, shigella, hemophil
pharmacology: oral/iv
primary indications: lots (UTIs, diarrhea, prostatitis)
side effects/toxicity: lots (fever, rash)
Metronidazole (Misc.-all cidal)
ex: metronidzole (flagyl)
mxn of action: free radical metabolites kill bacteria
mxn of resistance: rare-reduction of uptake
Anaerobic: b. frag, c. diff, t.vag
pharmacology: oral, IV, vaginal, rectal
primary indications: c. diff, anaerobes, parasites
side effects/toxicity: disulfiram effect w/ EtOH (aka Asian glow)
Daptomycin (Misc.-all cidal)
ex: daptomycin
mxn of action: lipopeptide, inserts into bacterial cell membrane
mxn of resistance: metabolic changes, change in surface charge
Gram+ coverage: VRE (Vancomycin-Resistant Enterococci), MRSA
Polymyxins (Misc.-all cidal)
ex: Colistin
mxn of action: lyses gram neg outer membrane (detergent)
Gram- coverage: P.Aeruginosa
Pharmacology: IV
Indications: multidrug resistant P.Aeruginosa
Side effects/toxicity: brain, kidneys
