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Flashcards in Antiobiotics Deck (62):
1

Penicillin G

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant

2) IV and IM. Inhibit PNC-binding proteins --> transpeptidase can't cross-link peptidoglycan --> Activates autolytic enzymes

3) Hypersensitivity rxns; Hemolytic anemia

4) Resistance: Beta-lactamases cleave Beta-lactam ring

2

Penicillin V

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant

2) PO. Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan--> Activates autolytic enzymes

3) Hypersensitivity rxns; Hemolytic anemia

4) Resistance: Beta-lactamases cleave Beta-lactam ring

3

Oxacillin

1) S. aureus (except MRSA; resistant d/t altered PCN-binding protein target site)

2) "Penicillinase-resistant PCNs". Penicillinase resistant b/c of bulkier R-group (sterically inhibits Beta-lactamase)

Narrow spectrum than PCN G/V

3) Hypersensitivity rxns; Interstitial nephritis

4

Nafcillin

1) S. aureus (except MRSA; resistant d/t altered PCN-binding protein target site. Nafcillin has Poor interaction w binding proteins****)

2) "Penicillinase-resistant PCNs". Penicillinase resistant b/c of bulkier R-group (sterically inhibits Beta-lactamase)

Narrow spectrum than PCN G/V

3) Hypersensitivity rxns; Interstitial nephritis

4) Use Naf for Staph

5

Dicloxacillin

1) S. aureus (except MRSA; resistant d/t altered PCN-binding protein target site)

2) "Penicillinase-resistant PCNs". Penicillinase resistant b/c of bulkier R-group (sterically inhibits Beta-lactamase)

Narrow spectrum than PCN G/V

3) Hypersensitivity rxns; Interstitial nephritis

6

Ampicillin

1) Extended-spectrum PCN: (HELPSS kill eneterococci) Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci) 

2) Same as PCN (bind transpeptidase), wider spectrum; also Penicillinase sensitive. 

-combine w Clavulonic acid to protect against Beta-lactamase.

3) Hypersensitivity rxs; Ampicillin* rash; Pseudomemranous colitis

4) Resistance: Beta-lactamases cleave Beta-lactam ring. Has greater oral bioavailability than PCN

AMinoPenicillins are AMP-ed up penicillin

7

Amoxicillin

1) Extended-spectrum PCN: (HELPSS kill eneterococci) Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci)

2) Same as PCN (bind transpeptidase), Wider spectrum; Penicillinase sensitive.

-combine w clavulonic acid to protect against Beta-lactamase.

3) Hypersensitivity rxs; Ampicillin* rash; Pseudomemranous colitis

4) Resistance: Beta-lactamases cleave Beta-lactam ring. Has greater oral bioavailability than PCN

AMinoPenicillins are AMP-ed up Penicillins

8

Ticarcillin

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase)

2) Antipseudomonals; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum

3) Hypersensitivity rxns

4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)--Takes Care of Pseudomonas

9

Piperacillin

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase)

2) Antipseudomonals; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum

3) Hypersensitivity rxns

4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)--Takes Care of Pseudomonas

10

Clavulonic Acid

1) Often added to PCN abxs to protect the abx from destruction by Beta-lactamase (penicillinase)

2) Beta-lactamase inhibitor

4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

11

Sulbactam

1) Often added to PCN abxs to protect the abx from destruction by Beta-lactamase (penicillinase)

2) Beta-lactamase inhibitor

4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

12

Tazobactam

1) Often added to PCN abxs to protect the abx from destruction by Beta-lactamase (penicillinase)

2) Beta-lactamase inhibitor

4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

13

Cefazolin

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae. **Cefazolin--used prior to surgery to prevent S. aureus wound infections.

2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ PCNs. Increased nephrotoxicity of Aminoglycosides, disulfuram rxn

4) Orgs covered by 1st Generation=PEcK--Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Orgs typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

14

Cephalexin

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae. **Cefazolin--used prior to surgery to prevent S. aureus wound infections.

2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ PCNs. Increased nephrotoxicity of Aminoglycosides, disulfuram rxn

4) Orgs covered by 1st Generation=PEcK--Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Orgs typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

15

Cefoxitin

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens

2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. Disulfuram like rxns 

4) Orgs covered by 2nd Generation=HEN PEcKS--Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

16

Cefaclor

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens

2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. Disulfuram like rxns

4) Orgs covered by 2nd Generation=HEN PEcKS--Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

17

Cefuroxime

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens

2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. Disulfuram like rxns

4) Orgs covered by 2nd Generation=HEN PEcKS--Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

18

Ceftriaxone

1) Serious GRAM NEGATIVE** infections resistant to other Beta-lactams; **Ceftriaxone--MENINGITIS & GONORRHEA, LYME

2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.

4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

19

Cefotaxime

1) Serious GRAM NEGATIVE infections* resistant to other Beta-lactams

2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.

4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

20

Ceftazidime

1) Serious GRAM NEGATIVE infections resistant to other Beta-lactams; **Ceftazidime--PSEUDOMONAS.

2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.

4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

21

Cefepime

1) Increase activity against Pseudomonas & gram-positive orgs** 

2) Beta-lactam, 4th Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.

4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

22

Ceftaroline

1) **Only Cephalosporin that covers MRSA

2) Beta-lactam, **Newest Generation Cephalosporin; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal

3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.

4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

23

Aztreonam

1) GRAM NEGATIVE RODS ONLY--No activity against gram-positives or anaerobes. For penicllin-allergic pts & those w/ renal insufficiency who cannot tolerate aminoglycosides

2) a Monobactam thats resistant to Beta-lactamases. Prevents peptidoglycan cross-linking by binding to PBP3**. Synergistic w/ Aminoglycosides. No cross-allergenicity w/ Penicillins.

3) Usually nontoxic; Occasional GI upset

24

Meropenem

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to LIFE-THREATENING INFXNS, or after other drugs have failed.

2) a Carbapenem/Beta-lactam rs thats highly resistant to Beta-lactamase 

3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma levels

4) **Meropenem, however, has a reduced risk of seizures & is stable to dehydropeptidase I. 

25

Imipenem (w/ Cilastatin)

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to LIFE-THREATENING INFXNS, or after other drugs have failed.

2) a Carbapenem/Beta-lactam rs thats highly resistant to Beta-lactamase

3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma levels

4) Always administered w Cilastatin (inhibits renal dehydropeptidase I) to decr inactivation of drug in renal tubules

"Cilastatin keeps Imipenem lastin!"

26

Vancomycin

1) Gram-positive only--serious, amultidrug-resistant orgs, including MRSA*, enterococci*, & C. difficile** (oral dose for pseudomembranous colitis)

2) Antimicrobial; Inhib cell wall peptidoglycan SYNTHESIS by binding D-ala D-ala** portion of cell wall precursors. Bactericidal.

3) Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing--"Red Man Syndrome" (can largely prevent by pretreatment w/ antihistamines & slow infusion rate). Well tolerated in general (--does NOT have many problems)

4) Resistance: Occurs w/ amino acid change of D-ala D-ala to D-ala D-lac*. ["Pay back 2 D-alas (dollars) for VANdalizing (VANcomycin)]

27

Streptomycin

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. AEROBES**

2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex/30S & cause misreading of mRNA. block translocation. Req O2 for uptake*

3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.

4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

4) Aminoglycoside Rxs & ADES: "MEAN"=(aMINoglycosides) GNATS caNNOT kill anaerobes--Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

28

Tobramycin

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. AEROBES**

2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex/30S & cause misreading of mRNA. block translocation. Req O2 for uptake*

3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.

4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

4) Aminoglycoside Rxs & ADES: "MEAN"=(aMINoglycosides) GNATS caNNOT kill anaerobes--Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

29

Amikacin

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. AEROBES**

2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex/30S & cause misreading of mRNA. block translocation. Req O2 for uptake*

3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.

4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

4) Aminoglycoside Rxs & ADES: "MEAN"=(aMINoglycosides) GNATS caNNOT kill anaerobes--Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

30

Neomycin

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. AEROBES**. NEOMYCIN FOR BOWEL SURGERY

2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex/30S & cause misreading of mRNA. block translocation. Req O2 for uptake*

3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.

4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

4) Aminoglycoside Rxs & ADES: "MEAN"=(aMINoglycosides) GNATS caNNOT kill anaerobes--Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

31

Gentamicin

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. AEROBES**

2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex/30S & cause misreading of mRNA. block translocation. Req O2 for uptake*

3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.

4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

4) Aminoglycoside Rxs & ADES: "MEAN"=(aMINoglycosides) GNATS caNNOT kill anaerobes--Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

32

Minocycline

1) Borrelia burgdorferi (LYME**), MYCOPLASMA PNEUMONIAE. Drug's ability to accumulate INTRACELLULARLY makes it very effective against Rickettsia & Chlamydia.

2) Tetracycline; BacterioSTATIC**. Bind to 30S & prevents attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib Rx absorption in the gut

3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.

4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

33

Demeclocycline

1) rarely used as an antibiotic, is used as ADH ANTAGONIST, use as DIURETIC in SIADH

2) Tetracycline; BacterioSTATIC**. Bind to 30S & prevents attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib Rx absorption in the gut

3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.

4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

34

Doxycycline

1) Borrelia burgdorferi (LYME**), MYCOPLASMA PNEUMONIAE. Drug's ability to accumulate INTRACELLULARLY makes it very effective against Rickettsia & Chlamydia.

2) Tetracycline; BacterioSTATIC**. Bind to 30S & prevents attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib Rx absorption in the gut

3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.

4) Doxy is FECALLY ELIMINATED, can be used in pts w renal failure

Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

 

35

Tetracycline

1) Borrelia burgdorferi (LYME**), MYCOPLASMA PNEUMONIAE. Drug's ability to accumulate INTRACELLULARLY makes it very effective against Rickettsia & Chlamydia.

2) Tetracycline; BacterioSTATIC**. Bind to 30S & prevents attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib Rx absorption in the gut

3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.

4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

36

Erythromycin

1) ATYPICAL pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)

2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. BacterioSTATIC**.

3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.

4) Resistance: Methylation of 23S rRNA binding site.

37

Clarithromycin

1) ATYPICAL pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)

2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. BacterioSTATIC**.

3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.

4) Resistance: Methylation of 23S rRNA binding site.

38

Azithromycin

1) ATYPICAL pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)

2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. BacterioSTATIC**.

3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.

4) Resistance: Methylation of 23S rRNA binding site.

39

Chloramphenicol

1) MENINGITIS (Haemophius influenzae, Neisseria meningitidis, Streptococcus pneumoniae). Conservative use d/t toxicities but often still used in developing countries b/c of low cost

2) Protein Synthesis Inhib; Blocks peptidyltransfease at 50s ribosomal subunit. BacterioSTATIC

3) Anemia (dose dep)*, Aplastic aneima (dose indep), Gray baby syndrome (in premature infants b/c lack liver UDP-glucuronyl transferase) = 

4) Resistance: Plasmid-encoded acetyltransferase that inactivates drug

40

Clindamycin

1) ANAEROBE infections (e.g., Bacteroides fragilis, Clostridium perfringens) in aspiration pneumonia or lung abscesses. Also oroal infections w/ mouth anaerobes.

2) Protein Synthesis Inhib; Block peptide transfer at 50s ribosomal subunit. Bacteriostatic.

3) Pseudomembranous colitis (C. dificile overgrowth), fever, diarrhea.

4) Clindamycin tx anaerobes ABOVE the diaphragm vs Metronidazole (which tx anaerobes BELOW the diaphragm)

41

Sulfadiazine

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.

2) Sulfonamides; PABA antimetabolites that inhib dihydropteroate synthase. Bacteriostatic.

3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)

4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

42

Sulfisoxazole

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.

2) Sulfonamides; PABA antimetabolites that inhib dihydropteroate synthase. Bacteriostatic.

3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)

4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

43

Sulfamethoxazole (SMX)

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.

2) Sulfonamides; PABA antimetabolites that inhib dihydropteroate synthase. Bacteriostatic.

3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)

4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

44

Trimethoprim (TMP)

1) Used in combo w/ sulfonamides [trimethoprim-sulfamethoxazole (TMP-SMX)], causing sequential block of folate synth. This combination is used to tx: UTIs, Shigella, Salmonella, Pneumocystic jirovecii pneumonia (tx & prophylaxis)

2) Inhib bacterial dihydrofolate reductase. Bacteriostatic  (~Methotrexate)

3) Megaloblastic anemia, leukopenia, granulocytopenia. [May alleviate w/ supplemental folinic acid (=Leucovorin rescue)]

4) TMP--Treats Marrow Poorly

45

Ciprofloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal. 

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

46

Norfloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

47

Levofloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

48

Ofloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

49

Sparfloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

50

Moxifloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

51

Gatifloxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

52

Enoxacin

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

53

Nalidixic acid

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs

2) A QUINOLONE; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. BACTERIOCIDAL. Must not be taken w/ ANTACIDS.

3) GI upset, Super infections, Skin rashes, HA, Dizziness.tendonitis, tendon rupture (>60yrs or +prednisone), leg cramps, & myalgia, CI in pregnancy: cartilage damage.  Some may cause prolonged QT interal.

4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Don't take w antacids!!! (kinda like Tetracycline)

FluoroquinoLONES hurt attachments to your BONES, "-OXACIN"

54

Metronidazole

1) Txs Giardia**, Entamoeba, Trichomonas*, Gardnerella vaginalis, Anaerobes (Bacteroides, C. dificile). Used w/ proton pump inhib & Clarithromycin for "triple therapy" against H. Pylori* (GET GAP on the Metro w/ metronidazole!)

2) Forms free radical toxic metabolites in the bacterial cell that damage DNA. BacteriCIDAL, ANTIPROTOZOAL

3) Disulfuram-like rxn w/ alcohol; HA, Metallic taste

55

Isoniazid (INH)

1) Mycobacteriium tuberculosis; Only drug used as SOLO PROPHYLAXIS against TB

2) Antimicrobial; Decreases synth of mycolic acids. Bacterial catalase-peroxidases (KatG) needed to convert INH to active metabolite

3) LUPUS, Neurotox, sideroblastic anemia, hepatotox, def of B6. INHIBITS P450**

Give: Pyridoxine (vit B6) can prevent neurotoxicity, lupus (INH--Injures Neurons & Hepatocytes)

4) Different INH half-lives in fast vs slow acetylator

56

Rifampin

1) Mycobacterium tuburculosis; Delays resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis* and chemoprophylaxis in contacts of children w/ Haemophilus influenzae type B***

2) Antimicrobial; Inhib DNA-dep RNA polymerase

3) Minor hepatotoxicity & drug rxns (increased P-450); ORANGE BODY FLUIDS (nonhazardous)

4) 4 "R's"--RNA polymerase inhib, Revs up microsomal P-450, Red/orange body fluids, Rapid resistance if used alone

57

Rx for M. tuberculosis

-Prophylaxis: (PPD+ but CXR-) Isoniazid

Rx: Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE)

58

Rx for M. avium-intracellulare

Prophlyaxis: Azithromycin

Rx: Aazithromycin, Rifampin, ethambutol, streptomycin (ARES)

59

Rx for M. leprae

Prophylax: none

Rx: TB form: Long term Dapsone, Rifampin

Lepromatous form: Dapsone, Rifampin, Clofazimine

60

Pyrazinamide

1) Mycobacterium tuberculosis

2) Antimicrobial; Mech unknown--thought to acidify intracellular env via conversion to pyrazinoic acid. Effective in acidic pH of phagolysosomes, where TB engulfed by macs is found

3) Hyperuricemia, Hepatotoxicity

61

Ethambutol

1) Mycobacterium tuberculosis

2) Antimicrobial; Decreases carbohydrate polymerization of mycobacterum cell wall by blocking arabinosyltransferase

3) optic neuropathy (red-green color blindness)***

62

Linezolid

Blocks 50S binding to ribosomal complex - prevents protein synthesis

Uses: Vancomycin-resistant Etnerococci, and Methicillin-resistant S. aureus.

Linezolid is also a weak MAOinhibitor, so don't give w an SSRI (cuidado serotonin syndrome!)