CHAPTER 06- ANTIBIOTICS.txt

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CHAPTER 06- ANTIBIOTICS.txt
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  1. Antiseptic:
    kills and inhibits organisms on body
  2. Disinfectant
    kills an inhibits organisms on inanimate objects
  3. Sterilization:
    all organisms killed
  4. Common antiseptics in surgery:
    1) Iodophors (betadine) - good for GPCs, GNRs, and poor fungi

    2) Chlorhexidine gluconate (hibiclens)- good for GPCs, GNRs, and fungi
  5. Inhibit cell wall synthesis:
    • 1) penicillins
    • 2) cephalosporins
    • 3) carbapenems
    • 4) monobactams
    • 5) vancomycin
  6. Inhibitors of 30S ribosome and protein synthesis:
    • 1) tetracycline
    • 2) aminoglycosides (tobramycin, gentamycin)
    • 3) linezolid
  7. Inhibitors of the 50S ribosome and protein synthesis:
    • 1) erythromycin
    • 2) clidamycin
    • 3) chloramphenicol
    • 4) synercid
  8. Inhibitors of DNA helicase (DNA gyrase):
    quinolones (bid dosing)
  9. Inhibitors of RNA polymerase:
    rifampin
  10. Produces oxygen radicals that breakup DNA-
    metronidazole (flagyl)
  11. Sulfonamides
    • 1) PABA analogue
    • 2) inhibit purine synthesis
  12. Trimethoprim
    • 1) inhibits dihydrofolate reductase
    • 2) inhibits purine synthesis
  13. Bacteriostatic agents:
    • 1) clindamycin
    • 2) erythromycin
    • 3) tetracycline
    • 4) chloramphenicol
    • (all have reversible ribosomal binding)
    • 5) bactrim
  14. Bactericidal
    Aminoglycosides have irreversible binding to ribosome and are considered bactericidal
  15. PCN resistance:
    plasmids for beta-lactamase
  16. Whats the most common method for antibiotic resistance?
    Transfer of plasmids
  17. Methicillin-resistant S. aureus (MRSA)
    resistance to methicillin caused by mutation of cell wall-binding protein
  18. Vancomycin resistant enterococcus
    resistance develops from mutation in cell wall-binding protein
  19. Gentamycin resistance:
    resistance due to modifying enzymes leading to decrease in active transport
  20. Vancomycin drug levels
    • peak 20-40 ug/mL
    • trough 5-10ug/mL
  21. Gentamicin
    • peak 6-10ug/mL
    • trough <1ug/mL
  22. What do you do if the peak is too high?
    decrease amount of each dose
  23. What do you do if trough is too high
    decrease frequency of doses (increase time interval between doses)
  24. Penicillin
    • 1) GPC
    • 1- streptococci
    • 2- beta-hemolytic streptococcus
    • 3- neisseria meningitides (GPR)
    • 4- Clostridium perfringes (GPR)
    • 5- syphillis
    • 6- anthrax
    • 2) Not effective against staphylococcus or enterococcus
  25. Oxacillin/nafcillin:
    anti-staph penicillins (staph only)
  26. ampicillin/amoxicillin
    same as penicillin but also picks up enterococci
  27. Unasyn (ampicillin/sulbactam) and augmentin (amoxicillin/clavulanic acid)
    • 1) broad spectrum- pick up GPCs (staph and strep), GNRs, +/- anaerobic coverage
    • 2) Effective for enterococci
    • 3) not effective for :
    • 1- pseudomonas
    • 2- acinetobacter
    • 3- serratia
    • 4) sulbactam and clavulanic acid are beta-lactamase inhibitors
  28. Ticarcillin/piperacillin
    • 1) antipseudomonal penicillins
    • 2) GNRs-
    • 1- enterics
    • 2- psedomonas
    • 3- acinetobacter
    • 4- serratia
    • 3) Side effects:
    • 1- inhibits platelets
    • 2- high salt load
  29. Timentin (ticarcillin/clavulanic acid) and Zosyn (piperacillin/sulbactam)
    • 1) Broad spectrum- pick up GPCs (staph and strep), GNRs, anaerobes
    • 2) Effective for enterococci; effective for pseudomonas, acinetobacter, and serratia
    • 3) Side effects:
    • 1- inhibit platelets
    • 2) high salt load
  30. First generation cephalosporins:
    • 1) cefazolin, cephalexin
    • 2) GPCs- staph and strep
    • 3) Not effective for enterococcus
    • 4) Does not penetrate CNS
    • 5) Ancef (cefazolin) has the longest half-life --> best for prophylaxis
    • 6) Side effects: can produce positive coombs test
  31. Second generation cephalosporins
    • 1) cefoxitin, cefotetan, cefuroxime
    • 2) GPCs, GNRs, +/- anaerobic coverage; lose some staph activity
    • 3) not effective for enteroccocus, pseudomonas, acinetobacter, or serratia
    • 4) effective only for community-aquired GNRs
    • 5) Cefotetan has the longest half-life--> best for prophylaxis
    • 6) Side effects: prolonged PT
  32. Third generation Cephalosporins
    • 1) ceftriaxone, ceftazidime, cefepime, cefotaxime
    • 2) GNRs, mostly, +/- anaerobic coverage
    • 3) Not effective for enterococcus; effective for pseudomonas, acinetobacter, and serratia
    • 4) Side effects:
    • 1- cholestatic jaundice (ceftriaxone)
    • 2) sludging in gallbladder (ceftriaxone)
  33. Monobactam
    • 1) aztreonam
    • 2) GNRs; picks up pseudomonas, acinetobacter, and seratia
  34. Carbapenems
    • 1) meropenem, imipenem
    • 2) Broad spectrum- GPCs, GNRs, and anaerobes
    • 3) not effective for MEPP:
    • MRSA
    • Enterococcus
    • Proteus
    • Pseudomonas (which can develop resistance)
    • 4) Cilastin- prevents renal hydrolysis of the drug and increases half-life
    • 5) Side effects: Carbapenems can cause seizures
  35. Bactrim:
    • 1) GNRs, +/- GPCs
    • 2) not effective for enterococcus, pseudomonas, acinetobacter, and serratia
    • 3) Side effects (numerous):
    • 1- teratogenic
    • 2- renal damage
    • 3- allergic reactions
    • 4) Stevens-Johnson syndrome (erythema multiforme)
    • 5) hemolysis in G6PD-deficient patients
  36. Quinolones
    • 1) ciprofloxacin, levofloxacin, trovafloxacin
    • 2) GPCs, mostly GNRs
    • 3) not effective for Enterococcus
    • 4) picks up pseudomonas, acinetobacter, and serratia
    • 6) 40% of MRSA sensitive
    • 7) same efficacy PO an IV
  37. Aminoglycosides
    • 1) gentamycin, tobramycin, amikacin
    • 2) GNRs
    • 3) good for pseudomonas, acinetobacter, and serratia
    • 4) not effective for anaerobes (need O2)
    • 5) resistance due to modifying enzymes leading to decreased active transport
    • 6) synergistic with ampicillin for enterococcus- beta-lactams (ampicillin/amoxicillin)
    • 7) Side effects:
    • 1- reversible nephrotoxicity
    • 2- irreversible ototoxicity
  38. Erythromycin
    • 1) macrolides
    • 2) GPCs
    • 3) best for community-acquired pneumonia and atypical pneumonias
    • 4) side effects:
    • 1- nausea (PO)
    • 2- cholestasis (IV)
    • 5) also binds motilin receptor and is prokinetic for bowel
  39. Vancomycin
    • 1) glycopeptides
    • 2) GPCs, enterococcus, clostidium difficile (with PO intake), MRSA
    • 3) binds cell wall proteins
    • 4) resistance develops from change in cell wall-binding sites
    • 5) Side effects:
    • 1- HTN
    • 2- redman syndrome (histamine release)
    • 3- nephrotoxicity
    • 4- ototoxicity
  40. Synercid
    • 1) streptogramin- quinupristin-dalfopristin
    • 2) GPCs; includes MRSA, VRE
  41. Linezolid
    • 1) oxazolidinones
    • 2) GPCs, includes MRSA and VRE
  42. Tetracycline
    • 1) GPCs, GNRs, syphillis
    • 2) Side effects: tooth discoloration in children
  43. Clindamycin
    • 1) anaerobes, some GPCs
    • 2)good for aspiration pneumonia
    • 3) can be used to treat C. perfringens
  44. Metronidazole
    • 1) anaerobes
    • 2) Side effects:
    • 1- disulfiram-like reaction
    • 2- peripheral neuropathy
  45. Name two antibiotic interactions:
    • 1) carbenicillin and ticarcillin can interfere with aminoglycosides
    • 2) tetracyclines can interfere with beta-lactams
    • 3) broad-spectrum antibiotics can lead to superinfection

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