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Fluoroquinolones
(drugs, use, MOA, MOR, adverse reactions)
- Drugs: CIPROFLOXACIN (broad spect, gram -), LEVOFLOXACIN (broad spect, gram + and -)
- Use: Give oral or IV but antacids decrease oral availability. Ear and eye drops agianst pseudomonas (-), staph (+) and strept (+). Levo also good for atypical respiratory bugs (mycoplasma and legionella)
- MOA: Inhibit DNA gyrase (topo II) and topo IV. Bactericidal
- MOR: 1. target modificaton 2.altered uptake/efflux 3. plasmid mediated modification by quinolone transacetylase
- Adverse Reactions: Arthropathy (no pregnant, children, joint paint in elderly). QT interval prolongation (contra for antiarrythmic drugs or those that induce bradycardia)
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Rifampin
(use, MOA, MOR, adverse reactions)
- Use: First line drug for mycobacterium tuberculosis. Give Oral or IV with great CNS and intracellular dist
- MOA: Inhibit RNA polymerase (bactericidal)
- MOR: target site mutation in rpoB subunit
- Adverse Reactions: liver problems, induce cyt p450 enzymes (bad or HIV meds), turns body fluid orange
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Metronidazole
(use, MOA, MOR, adverse reactions)
- Use: Gaurdia, Trichomonas, Anaerobes, Protozoa. Also bismuth and amoxicillin for triple therapy against H. Pylori.
- MOA: Produce DNA toxic metabolites via pyruvate:ferredoxin oxireductase interference (bastericidal)
- MOR: unknown
- Adverse Reactions: Renal retention of lithium and ergot derivatives (NO ALCOHOL!!!)
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Sulfonamides
(drugs, use, MOA, MOR, adverse reactions)
- Drugs: SULFAMETHOXAZOLE, SULFADIAZINE, DAPSONE (leprosy, pneumo. carinii). ALL broad sprectrum against gram + and -.
- Use: synergistic with trimethoprim "TMP-SMX" (Bactrim) for UTIs, Nocardia, Chlamydia. Give PO or IV. Topical cream with silver ions
- MOA: PABA analog blocks folic acid synthesis (dihyropteroate synthetase inhibitor)
- MOR: target site mutation, upregulates new genes, altered uptake/efflux via plamid and chromosomes
- Adverse Reactions: Allergic reactions, Prophylaxis in HIV but can cause neutropenia and dermatitis, Not for patients who are pregnant, with folic acid deficiency or G6P deficiency
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Trimethoprime
(Use, MOA, MOR, adverse reactions)
- Use: synergistic with sulfonamide "TMP-SMX" (Bactrim) for UTIs, Shigella, Salmonella, Pneumo carinii
- MOA: DHF acid analog blocks folic acid synthesis (DHF acid reductase inhibitor)
- MOR: target site mutation, up-regulation of new genes, altered uptake/efflux
- Adverse Reactions: Allergic reactions, Prophylaxis in HIV but can cause neutropenia and dermatitis, Not for patients who are pregnant, with folic acid deficiency or G6P deficiency
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Penicillin G/V
(class, use, MOA, MOR, adverse reactions)
- class: natural penicillin
- Use: Oral or IV, crosses BBB, broad spectrum against gram + and - however decreased usage due to resistance
- MOA: Binds transpeptidases to prevent cross linking and inhibits cell wall synthesis (bactericidal
- MOR: mutated transpeptidases, beta-lactamases, altered uptake
- Adverse Reactions: Allergic reactions, Hemolytic anemia
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Nafcillin
(class, use, MOA, MOR, adverse reactions)
- Class: artificial penicillinase resistant penicillin
- Use: Oral or IV, crosses BBB, STAPH Aureus
- MOA: Binds transpeptidases to prevent cross linking and inhibits cell wall synthesis (bactericidal)
- MOR: mutation of transpeptidases, beta-lactamases, altered uptake
- Adverse Reactions: Allergic reactions, hemolytic anemia
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Dicloxacillin
(class, use, MOA, MOR, adverse reactions)
- Class: artifical penicillinase resistant penicillin
- Use: Oral or IV, crosses BBB, same as other penicillins
- MOA: Binds transpeptidases to prevent cross linking and inhibits cell wall synthesis (bactericidal)
- MOR: mutation of transpeptidases, beta-lactamses, altered uptake
- Adverse reactions: hypersensitivity
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Ampicillin
(class, use, MOA, MOR, adverse reactions)
- Class: artificial pencillin; Use: Oral or IV, crosses BBB, HELPS kill enterococci (Haemophilus influenza, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci)
- MOA: Binds transpeptidases to prevent cell wall synthesis (bactericidal)
- MOR: mutation of transpeptidases, beta-lactamases, altered uptake
- Adverse reactions: hypersensitivity, rash
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Amoxicillin
(class, use, MOA, MOR, adverse reactions)
- Class: artificial penicillin
- Use: Oral or IV, crosses BBB, HELPS kill enterococci (Haemophilus influenza, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci)
- MOA: Binds transpeptidases to prevent cell wall synthesis (bactericidal)
- MOR: mutation of transpeptidases, beta-lactamases, altered uptake
- Adverse reactions: hypersensitivity
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Amoxicillin/Clavulanate
(class, use, MOA, MOR, adverse reactions)
- Class: art. penicillin plus beta-lactamase inhibitor
- Use: Oral when IV is not possible. Everything else is same as plain amoxicillin but clavulunate prevents resistance by inhibiting beta-lactamases
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Ampicillin/Sulbactam
(class, use, MOA, MOR, adverse reactions)
- Class: art. penicillin plus beta-lactamase inhibitor
- Use: Everything is same as ampicillin but sulbactam prevents resistance by inhibiting beta-lactamases
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Piperacillin/Tazobactam
(class, use, MOA, MOR, adverse reactions)
- Class: art. penicillin plus beta-lactamase inhibitor
- Use: IV only!! Pseudomonas. Similar to other pencillins but inhibits beta-lactamases
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Cephalexin
(class, use, MOA, adverse reactions)
- Class: Cephalosporin (1st gen.)
- Use: PEaK (gram + cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae)
- MOA: beta-lactam that inhibits cell wall synthesis but less susceptible to penicillinases (bastericidal)
- Adverse Reactions: 5-10% PCN allergy cross hypersensitivity
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Ceftazidime
(class, use, MOA, adverse reactions)
- Class: Cephalosporin (3rd gen.)
- Use: Pseudomonas, meningitis, serious gram neg. infections resistant to other beta-lactams
- MOA: beta-lactam that inhibits cell wall sythesis but less susceptible to penicillinases (bactericida)
- Adverse Reactions: 5-10% PCN allergy cross hypersensitivity
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Cefotaxime
(class, use, MOA, adverse reactions)
- Class: Cephalosporin (3rd gen.)
- Use: serious gram - infections resistant to other beta-lactams, pseudomonas
- MOA: beta-lactam that inhibits cell wall synthesis but less susceptible to penicillinase (bactericidal)
- Adverse Reactions: 5-10% PCB allergy cross hypersensitivity
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Ceftriaxone
(class, use, MOA, adverse reactions)
- Class: Cephalosporin (3rd gen.)
- Use: serious gram - infections resistant to other beta-lactams, pseudomonas
- MOA: beta-lactam that inhibits cell wall synthesis but less susceptible to penicillinase (bactericidal)
- Adverse Reactions: 5-10% PCB allergy cross hypersensitivity
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Imipenem/Cilastatin
(class, use, MOA, adverse reactions)
- Class: Carbapenem
- Use: broad spectrum use with gram + cocci, gram - rods, and anaerobes. Enterobacter
- MOA: beta-lactam inhibits cell wall synthesis by binding transpeptidases and blocking cross-linking. Cilastatin inhibits dihydropeptidase I to increase t1/2 life (normally inactivates in renal tubule in presence of dihydropeptidase I). Resistant to beta-lactamase
- Adverse Reactions: PCN allergy cross-hypersensitivity, GI distress, skin rash, CNS toxicity at high plasma levels
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Aztreonam
(class, use, MOA, adverse reactions)
- Class: Monobactem
- Use: For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides. Gram negative rods only (pseudomonas, klebsiella, serratia)
- MOA: Inhibits cell wall synthesis by binding PBP3 and preventing cross-linking. Resistant to beta-lactamse.
- Adverse Reactions: Few. No cross sensitivity with penicillin or cephalosporin
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Vancomycin
(class, use, MOA, MOR, adverse reactions)
- Class: Glycopeptidase; Use: MRSA!!!!! Against gram + organisms resistant to beta-lactams
- MOA: Binds D-alanine to prevent crosslinking and inhibit cell wall synthesis (bactericidal)
- MOR: Transposon- bacterial enzymes use D-serine or D-lactate to make cell wall
- Adverse Reactions: Rapid IV administration can cause Red Man Syndrome (histamine mediated), nephortoxicity with aminoglycosides
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Bacitracin
(class, use, MOA, adverse reactions)
- Class: Polypeptide
- Use: Topical with neomycin and polymyxin B neosporin
- MOA: Blocks lipid carrier (inhibits dephosphorylation) used for cell wall components (bactericidal)
- Adverse Reactions: Few, allergy
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Tetracyline
(drugs, use, MOA, MOR, adverse reactions)
- Drugs: TETRACYCLINE, DOXYCYCLINE (adm. less frequently than tetra, good for patients with renal failure cause fecal elimination), TIGECYCLINE (not affected by resistance mechanism)
- Use: Broad spectrum including protozoa
- MOA: blocks protein synthesis by inhibiting 30S ribosome (bacteriostatic)
- MOR: (not for Tigecycline) Efflux pumping, ribosome binding protein
- Adverse reactions: Anatogonistic with Beta-lactams. Discoloration of teeth (not for children or prenant), nausea, photosensitivity, rash (sun exposure). Can not with milk, antacids or iron containing cus divalent cation inhbits absorption in gut.
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Macrolides
(drugs, use, MOA, MOR, Adverse reactions)
- Drugs: ERYTHROMYCIN (seldom used due to QT prolongation and more nausea), AZITHROMYCIN (children and preganant women, long half life so take less frequently), CLARITHROMYCIN (extended release version available)
- Use: broad spectrum including respiratory pathogens. Used in patients with penicillin allergy
- MOA: block protein synthesis by binding 50S ribosome
- MOR: methylation of ribosome, efflux pumping
- Adverse reactions: Erythromycin can cause QT prolongation
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Clindamycin
(class, use, MOA, MOR, Adverse reactions)
- Class: Lincosamides
- Use: IV, PO or topical gram + and anaerobes (protozoa). Not for gram - (can not cross outer membrane)
- MOA: binds 50S ribosome to block protein synthesis
- MOR: ribsome RNA methylation, altered proteins, and adenylatio
- Adverse Reactions: Allergy
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Linezolid
(class, use, MOA, MOR, Adverse reactions)
- Class: oxazolidinone
- Use: give IV or PO for gram positives, multiple resistant staph and entercocci
- MOA: binds 50S ribosomes
- MOR: mutation of 23s rRNA
- Adverse Reactions: Thrombocytopenia with long term use, Contra with SSRI
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Chloramphenicol
(use, MOA, MOR, Adverse reactions)
- Use: seldom used today but broad spectrum IV or PO
- MOA: binds 50S ribosome
- MOR: acetylation, efflux pumping
- Adverse reactions: aplastic anemia, bone marrow suppression, gray syndrome, dose adjustment with liver problems
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Quinupristin-Dalfopristin
(class, use, MOA, MOR, Adverse reactions)
- Class: streptogramins
- Use: IV admin. for drug resistant enterococci (gram +)
- MOA: binds 50s ribosome
- MOR: efflux pumping or methylation only if one of the two are given
- Adverse Reactions: Athralgias, Myalgias
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Mupirocin
(use, MOA, MOR, Adverse Reactions)
- Use: Topical drug resistant gram + (S aureus)
- MOA: blocks protein synthesis of bacterial ribosomes by inhibiting isoleucine tRNA synthetase
- MOR: target site mutation
- Adverse reactions: unclear
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Polymyxins
(use, MOA)
- Use: topical use for gram negatives. Also IV or IM
- MOA: distrupts bacterial membrane by charge alteration
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Daptomycin
(use, MOA, Adverse reactions)
- Use: IV admin for drug resistant gram +
- MOA: cyclic lipopeptide that disrupts membrane by pore formation
- Adverse reactions: elevated liver function tests, muscle weaknes, and pain with increased CPK
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Nitrofurantoin
(Use, MOA, MOR, Adverse reactions)
- Use: PO admin for uncomplicated UTIs (concentrated in the urine)
- MOA: unclear, mimics radiation damage, enzymatic reduction for activity
- MOR: altered levels of reduction enzyme
- Adverse Reactions: turns urine brown, lung problem with prolonged use
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Aminoglycosides
- Drugs: streptomycin, gentamicin, tobramycin; Post-ABX effect: persistent suppression after drug removal, Conc-dep killing: high conc better killing
- Use: IV or MI against gram negatives (not for anaerobes)
- MOA: binds 30S ribosome and also distrupts bridges between LPS
- MOR: Modifying enzymes, efflux pumping, and altered ribosome binding
- Adverse reactions: nephrotoxicity and ototoxicity FUCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCKKKKKKKK!!! I'm not making anymore cards ever again!
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