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Flashcards in antimicrobial therapy Deck (35):
1

pathogens

sterile fluids are CNS, urine, and blood

2

classes of abx

cell wall active agents: -bela lactase ( PCN, cephalosporins), Aztreonam, Vancomycin, carbapenems

protein synthesis inhibitors:
macrocodes, clinda, tetracyclines, linezolie

interfere with DNA synthesis: fluroquinolones, rifamycin

3

PCN class

MOA: Beta lactam-binds to PCN -binding protein to inhibit cell wall synthesis

spectrum: gram positive gram negative

AE: hypersensitivity, GI, hematologic, lowers seizure threshold

DI: OCs


PCN G- IM, IV

PCN VK:PO- best on empty stomach

antistaph PCN-staph and and fair streptococcal activity

amino PCN: ampicillin amoxicillin
- spectrum: enterococci, listeria, H. pylori

Extended spectrum- zosyn, mezlocillin, azlocillin
- spectrum: anti-pseduomasal coverage
indications: serious infections
Inpatient tx

4

beta lactate inhibitors

- combined with PCN
sublactam, clavuulanic
- activity for wide range of infections, respiratory tract, animal bits, skin infections

SE: diarrhea

5

cephalosporins

spectrum: broader are cephalosporin progresses
Gram + --> gram + and gram -
No Enterococcus spp or listeria

eliminated via renal
don't adjust cefriaxone

MOA: inhibit cell wall synthesis

SE: allergic rnn, cross reactivity with PCN

6

first gen cephalosporins

Reflex, Ancef

skin infections, strep, prepop prophylaxis

7

second generate

ceclor, cefprozil, caftan

- increases risk for bleeding
-avoid ETOH
- more gram negative, less gram positive

indication: URI, UTI, skin infection

8

third generation

ceftriaxone
-excellent CNS penetration
- use for meningitis
-ceftaz has pseudomas activity

Drug of choice: gonorrhea

9

fourth/fifth generation

cefepime- gram postive and gram negative


Teflaro- IV
-gram pos, gram neg, MRSA , and resistant to S. pneumonie

10

Aztreonam

use for pt who has anaphylactic rx to PCN

cover gram negative including pseudomonas

renally cleared

11

carbapenems

broadest class of abx

excellent for gram negative and gram positive
No MRSA, MRE
NO pseudomonas-ertapenems


indications: lower respiratory infections, intra-abdominal infections, bacterial sepsis
UTI
skin/skin structures, endocarditis

meropenem- CNS -related infections
ertapenem- Invanz IM

renal elimination

precipitates seizure activity

cross sensitivity with PCN

12

fluroquinolones

cipro, levaquin

MOA: bind and inhibitor DNA synthesis

good tissue penetration
good gram positive
gram negative( cipro)

indications: URI, skin infections, anthrax, traveler's diarrhea

AE: GI, CNS, cartilage toxicity ( no pets), tendon rupture, photosensitivity, QT prolongation( cipro least), rash, worsens MG

check drug interactions: warfarin, theophylline, drugs affecting blood glucose,

always separate calcium intake with abx

13

macrolides

erythromycin, clarithromycin, azithromycing

MOA: inhibits protein synthesis

-gram postive, some gram negative and atypical

indications: resp infections lyme, GI ulcers, MAC chlamydia, skin infections

AE: GI, ototoxicity, prolong QT, tate changes

DI: inhibit cytochrome P450

14

ketolides

ketek-telithromycin

MOA: protein synthesis inhibitor

spectrum: gram postive,gram negative,

AE: hepatic dysfunction( not used in pads), CI with MG
DI: inhibitor CYP 3A4

15

tetracyclines

cover H.pylori, spirochetes, community acquire MRSA

tetracycline, doxycycline ,minocycline

indications: acne, resp tract, lyme, ricettsia

AE: photosensitivity, deposition in teeth and bones ( dont use in peds and preggers)
DI: chelation with calcium supplements, OC, warfarin

16

glycycyclines

tygvacil
gram positive and gram negative but no pseudomonas

indications: second line agent for CAP or intra-abdominal infections

AE: n/v

17

ahminoglycosides

gentamicin, tobramycin
IV only

indications: generally gram negative and infections in hospital

AE: neprotoxicty, ototoxic, neuromuscular blockade

18

sulfonamides

Bacterium

DOC: UTI, PCP
CAP

AE: GI, hypersensitivity, bone marrow suppression, photosensitivity

DI: OC, warfarin, sulfonylureas

19

metronidazole ( flagyl and Tindzdazole

trichimonas
c.diff

AE: metallic tate, urine changes

DI: ETOH, warfarin

20

clindamycin

gram postive and anerobic
Community-acquired MRSA
PCN allergic pt

AE: GI, c.diff


21

fidaxomicin ( difcid)

recurrent C.diff

22

Rifampin

TB, meningicoccal

AD: organs-red body fluids, hepatotoxicity, GI, flu-like sxs

23

MRSA abx

vance, zyvox

24

vancomycin

IV- MRSA
oral - used for C.diff

AE: red man syndrome, thrombophlebitis, nephrotoxicity, toxicity

check trough -10- 20 mg/L , if not then they get resistant

25

zyvox -linezolid

oral/ IV
used for pneumonia
AE: myelosuppression until 2 weeks of tx,
inhibits MAO, SSRI

26

UTI managetment

macrobid- avoid if they have renal issues
bactrim

27

anti-vitals

acyclovir, famvir, valtrex

- goal is to tx first episodes

herpes zoster- varicella( speeds healing, dec. pain/ neuralgia)

severe infection: --> acyclovir

AI: GI headache

28

influenza tx

relenza and tamiflu- cover flu a and b

Amantadine and rimantadine- influenza A and prevention
AE: GI, CNS

29

CMV

gancilovir, fosacir, visited



manage counts

30

hep b management

interferon alpha
entecavir

goal: dec. hep b levels
and improve liver histories

Interferon ( SQ)
4mon-1 year
flu-like scans
bone marrow suppressions
psych symptoms

31

hep c tx

peg interferon and ribavarin

SE: ribavarin- hemolytic anemia, tetragenic
neutropenia

32

anti fungals

azoles, polyenes ( ampotericin- covers everything)
lamisil- use for dermatophyte infections

AE: ampho- nephrotoxit

azoles- hepatic, QT prolongation

terbinafine- liver enzymes

drugs interactions are common
ketokonzaole/ itraconazole- check on h2 blockers, needs acidic environment

rifampin- increased cleared for azoles

33

bug and drugs

MSSA
MRSA- vance

community -acquired MRSA- clinda, bacterium
complicated: vanc, dap

strep pyogenies: PCN V or G,
for PCN-allergic: clinda or macrolide

strep pneumo: PCN V or G or amox

moraxella ca- caftan
nester gone- ceftrizxone
n. meningi- pCN g
c.diff- metronidazole, recurrent vanco oral

e.coli/kelb- cefrixone

proteus mirablis- ampicillin

h.flu- URI: bacterium


h.pylori: PPI+ clarithro+ amor or flagyl

chlaymdia- macrolide
mycoplasma pneumonia: macrolides

34

drug interactions

macrocodes- inhibit cytochorne p50
rifampin- induces Cp50
fluroquin and tetracyclines- chelated by divalent cations
linezolid- MOA
ETOH- flagyl, cefotetan
oral contraceptives -amox, PCN

photosensitivity: bacterium, tetracycline

Rash: fluroquin

QT prolongation: fluroquinolones, macrolides,

Red man syndrome- vanco, slow down infusion

Nephrotoxic/ ototoxic: vanco and aminoglycodies

seizures: PCN, fluroqin

Mono: amor

bone marrow suppression: bacteria, linezolie
GI: multiple drugs ( clauvante)

taste: clarithromycin, metronidazole

tendonitis: fluroquinolodes

orange/red-rifampin

CI with peds: tetra, fluroquinolones, telithromycin, bacterium

35

anti fungal efficacy

gold standard: amphotericin B( renal issues)

aspergillosis: voriconazole, amphotericin

blastomycosis: itraconazole
amphoterecin, fluconazole

candidemia: fluconazole, amphotereicin, voriconazole

coccidiomycosis: itraconazole, fluconazole