Antibiotic

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Antibiotic
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2014-06-19 20:38:15
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Antibiotics
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  1. Name all classes of cell wall agents
    • Penicillins
    • Cephalosporins
    • Cabapenems
    • Monobactams
    • Cyclic Glycopeptide
    • Cell membrane agents
    • Cell membrane agents
  2. Which classes are B-lactams?
    • Penicillins
    • Cephalosporins
    • Cabapenems
    • Monobactams
  3. Name DNA synthesis inhibitor classes
    • Fluorquinolones
    • Nitroimidazole
    • Rifamycins
    • Folicacid inhibitors
  4. What are antibiotic bactericidal?
    • DNA synthesis inhibitors
    • Cell wall agent
  5. What are static antibiotics?
    All protein inhibitors are static antibiotics except Aminoglycosides which are bactericidal.
  6. Protein inhibitors classes
    • Tetracyclines
    • Glycylcycline 
    • Aminoglycosides
    • Macrolides
    • Lincosamide
    • Streptogrammin
    • Oxazolidinone
    • Nitrofuran
  7. Subclass of Penicillins
    • Natural penicillins
    • Penicillinase-resistant Penicillins
    • Amino-penicillins
    • Extended-spectrumPenicillins
    • B-lactamase inhibitors
  8. Unique about natural penicillins
    T. palladium (syphilis)
  9. Unique about Penicillinase-resistant penicillins
    MSSA (drug of choice)
  10. Unique about amino-penicillins
    Enterococcus sp. (drug of choice)
  11. Unique about extended-spectrum penicillins
    Pseudomonas aeruginosa
  12. Unique about B- lactamase inhibitors
    • Pseudomonas aeruginosa
    • Anaerobic
  13. What do natural penicillins cover?
    • Strep sp.
    • Mouth anaerobes
    • T. palladium (syphilis)
  14. Natural penicillins
    • Penicillin VK (Veetids)
    • Penicillin G sodium (Pfizerpen)
    • Penicillin G procaine (Wycillin)
    • Penicillin G benzathine (Bicillin LA)
  15. Penicillinase-Resistant Penicillins
    • Nafcillin (Nafcil)
    • Oxacillin (Bactocil)
    • Dicloxacillin (Dynapen)
  16. Amino-penicillins
    • Amoxicillin (Amoxil)
    • Ampicillin (Principen)
  17. What  do amino-penicillins cover?
    • Extended spectrum compared to
    • the penicillinase-resistant penicillins
    •         
    • Gram +  
    • Streptococcus sp.  
    • Enterococcus sp. (drug of choice) 
    • Listeria sp.
    • Anaerobes       
    • Gram –
    • E. coli
    • H. influenzae  
    • Proteus sp.
  18. What does extended-spectrum penicillins cover?
    • Gram +
    • Strep sp.
    • Enterococcus sp.          
    • Gram –
    • E. coli
    • H. influenzae  
    • Proteus sp.  
    • Enterobacteriaceae   
    • P. aeruginosa
    • Acinetobacter sp.
  19. What are B-lactamase inhibitors?
    • Amoxicillin/Clavulanic Acid
    • (Augmentin)

    Ampicillin/Sulbactam (Unasyn)

    • Piperacillin/Tazobactam
    • (Zosyn)

    Ticarcillin/Clavulanate (Timentin)
  20. What are B-lactamase inhibitors cover?
    • Increased Gram (-)
    • coverage
    •        
    • Increased
    • anaerobic coverage
  21. Amoxicillin/Clavulanic acid
    Augmetin

    β-lactamase Inhibitors
  22. Ampicillin/Sulbactam
    Unasyn

    β-lactamase Inhibitors
  23. Piperacillin/Tazobactam
    Zosyn

    β-lactamase Inhibitors
  24. Ticarcillin/Clavulanate
    Timentin

    β-lactamase Inhibitors
  25. Piperacillin
    Pipracil

    • Extended-Spectrum
    • Penicillins
  26. Amoxicillin
    Amoxil

    Amino-penicillins
  27. Ampicillin
    Principen

    Amino-penicillins
  28. Nafcillin
    Nafcil

    Penicillinase-Resistant Penicillins
  29. Oxacillin
    Bactocil

    Penicillinase-Resistant Penicillins
  30. Dicloxacillin
    Dynapen

    Penicillinase-Resistant Penicillins
  31. Penicillin VK
    Veetids

    Natural Penicillins
  32. Penicillin G sodium
    Pfizerpen

    Natural Penicillins
  33. Penicillin G procaine
    Wycillin

    Natural Penicillins
  34. Penicillin G benzathine
    Bicillin-LA 

    Natural Penicillins
  35. What is the bacteria coverage when we move from 1st to 3rd generation of cephalosporins?
    • As you move from 1st generation to 3rd
    • generation: 
    •      
    • Slightly decreased Gram + activity     .
    •    
    • Significantly increased Gram – activity

    Increased CNS penetration
  36. Unique about 1st generation cephalosporins
    MSSA (2nd line after Nafcillin or Oxacillin)
  37. Cefazolin
    Ancef

    1st generation cephalosporins
  38. Cephalexin
    Keflex

    1st generation cephalosporins
  39. Cefadroxil
    Duricef

    1st generation cephalosporins
  40. 1st generation cephalosporins
    Cefazolin (Ancef)

    Cephalexin (Keflex)

    Cefadroxil (Duricef)
  41. Coverage of 1st generation cephalosporins
    • Lowest Gm –
    • Highest Gm +
    • Lowest CNS penetration

    • Gm +     
    • Streptococcus sp.    
    • MSSA
  42. Unique about 2nd generation cephalosporin
    MSSA
  43. Coverage of 2nd generation cephalosporin
    • Gm +     
    • Streptococcus      
    • MSSA
    • Gm –     
    • E. coli       
    • H influenzae
    • P. mirabilis
  44. 2nd generation cephalosporin
    Cefotetan (Cefotan)

    Cefoxitin (Mefoxin)

    Cefprozil (Cefzil)

    Cefaclor (Raniclor)

    Cefuroxime (Ceftin, Zinacef)
  45. Cefotetan
    Cefotan

    2nd generation cephalosporin
  46. Cefoxitin
    Mefoxin

    2nd generation cephalosporin
  47. Cefprozil
    Cefzil

    2nd generation cephalosporin
  48. Cefaclor
    Raniclor

    2nd generation cephalosporin
  49. Cefuroxime
    Ceftin, Zinacef 

    2nd generation cephalosporin
  50. 3rd generation cephalosporin
    Cefdinir (Omnicef)

    Cefpodoxime (Vantin)     (anaerobic)

    Cefixime (Suprax)

    Cefditoren (Spectracef)

    Ceftibutin (Cedax)

    Ceftriaxone (Rocephin)

    Ceftazidime (Fortaz)   (anti-pseudomonal)

    Cefotaxime (Claforan)

    Ceftizoxime (Cefizox)
  51. Cefdinir
    Omnicef

    3rd generation cephalosporin
  52. Cefpodoxime
    Vantin (anaerobic)

    3rd generation cephalosporin
  53. Cefixime
    Suprax

    3rd generation cephalosporin
  54. Cefditoren
    Spectracef

    3rd generation cephalosporin
  55. Ceftibutin
    Cedax

    3rd generation cephalosporin
  56. Ceftriaxone
    Rocephin

    3rd generation cephalosporin
  57. Ceftazidime
    Fortaz (anti-speudomomal)

    3rd generation cephalosporin
  58. Cefotaxime
    Claforan

    3rd generation cephalosporin
  59. Ceftizoxime
    Cefizox

    3rd generation cephalosporin
  60. Bacteria coverage of 3rd generation cephalosporin.
    • Highest Gm –
    • Relatively good Gm + still
    • Highest CNS penetration

    • Increased Gm –         
    • Enterobacteriaceae
    • Ceftazidime—pseudomon.
  61. Unique about 3rd generation cephalosporin
    Cefpodoxime (Vantin)—Anaerobic

    Ceftazidime (Fortaz)—Anti-pseudomonal
  62. Unique about 4th generation cephalosporin
    MSSA
  63. 4th generation cephalosporin agent
    Cefepime (Maxipime)
  64. Cefepime
    Maxipime

    4th generation cephalosporin
  65. Bacteria coverage of 4th generation cephalosporin
    • Good Gm + activity (Strep, MSSA)
    • Excellent Gm – activity
  66. Anti-MRSA Cephalosporin agent
    Ceftaroline (Teflaro)
  67. Ceftaroline
    Teflaro

    Anti-MRSA Cephalosporin
  68. Bacteria coverage of Anti-MRSA Cephalosporin

    Ceftaroline (Teflaro)
    • ONLY β-lactam that covers MRSA
    • Gm +       
    • MSSA      
    • MRSA      
    • Streptococcus sp.

    • Gm –   (limited)       
    • E. Coli      
    • Klebsiella sp.
    • H. influenzae
  69. Unique about ONLY β-lactam that coverage of Anti-MRSA cephalosporin.
    MRSA  (ONLY β-lactam)

    MSSA
  70. Cabapenems agents
    • Big brothers
    • Imipenem/Cilastatin (Primaxin)
    • Meropenem (Merrem)
    • Doripenem (Doribax)

    Little brother

    Ertapenem (Ivanz)

    -->doesn’t have same spectrum
  71. Bacteria coverage of Cabapenems
    Very broad spectrum agents With coverage against most Gm+, Gm - , and anaerobes

    (ertapenem does NOT cover p. aeruginosa or A.baumannii)
  72. Unique about cabapenems
    Pseudomonas aeruginosa

    A. baumannii
  73. Imipenem/Cilastatin
    Primaxin

    Cabapenems
  74. Meropenem
    Merrem

    Cabapenems
  75. Doripenem
    Doribax

    Cabapenems
  76. Ertapenam
    Ivanz

    Cabapenems

    Doesn't cover p.aeruginosa orA. baumannii
  77. Monobactams
    Aztreonam (Azactam)
  78. Bacteria coverage of monobactams
    Gram (–) ONLY

    Including Pseudomonas

    (NOT acinetobacter sp.)
  79. Aztreonam
    Azatam

    Monobactams
  80. Unique about monobactam
    • MSSA   (drug of
    • choice)

    Pseudomonas
  81. Cyclic Glycopeptide agent
    Daptomycin (Cubicin)
  82. Bacteria coverage of cyclic glycopeptide
    • Gram + ONLY      
    • MRSA
    • VRE
  83. Daptomycin
    Cubicin

    Cyclic glycopeptide
  84. Cell membrane agents
    • Colistin, Polymixini E
    • (Coly-Mycin M)

    Polymixin B (Poly-Rx)
  85. Colistin, Polymixin E
    Coly-Mycin M
  86. Polymixin B
    Poly-Rx
  87. Bacteria coverage of Cell Membrane Agents
    Gram – only

    NEVER used empirically

    Only see when multi-drug resistant (>3 drugs failed) P.aeruginosa and                  A. bauannii
  88. Flouroquinolones agents
    Ciprofloxacin (Cipro)

    Levofloxacin (Levaquin)

    Moxifloxacin (Avelox)

    Gemifloxacin (Factive)

    Ofloxacin (Floxin)
  89. flouroquinolones spectrum
    • Respiratory Fluoroquinolones
    • (strep, Gm–, enterobacteriacea)       
    • Levofloxacin       
    • Moxifloxacin      
    • Gemifloxacin

    • Anti-Pseudomonal Fluoroquinolones
    • (Gm – plus pseudomonas)      
    • Levofloxacin        
    • Ciprofloxacin

    Good Anaerobic coverage
  90. Unique about fluoroquinolones
    Anaerobic (RTI)
  91. What are respiratory fluoroquinolones?
    Levofloxacin (Levaquin)

    Moxifloxacin (Avelox)

    Gemifloxacin (Factive)
  92. What are anti-pseudomonas fluoroquinolones?
    • Levofloxacin (Levaquin)
    • Ciprofloxacin (Cipro)
  93. Nitroimidazole agents
    Metronidazole (Flagyl)
  94. Metronidazole
    Flagyl
  95. Nitroimidazole spectrum
    • Anaerobes ONLY    
    • Good for B.fragilils

    Usually added to therapy to cover anaerobes
  96. Unique about Metronidazole (Flagyl)
    Anaerobes ONLY (B. fragilis)
  97. Rifamycins agents
    Rifampin (Rifadin)
  98. Rifamycins spectrum
    • Wide spectrum agent
    • Commonly used for:       
    • Staphylococcus 
    •      +Dissolves
    •      +protective layer on bacteria      
    • Mycobacterium
    • Neisseria sp. (meningitis prophylaxis)
  99. Unique about rifampin
    Staphylococcus

    Mycobacterium

    Neisseria sp. (meningitis prophylaxis)
  100. Folic acid inhibitors agent
    Sulfamethoxazole-Trimethoprim  (Bactrim, Septra)
  101. Folic acid inhibitors spectrum
    • Gm +     
    • Staphylococcus sp. (incl. MRSA)       
    • Streptococcus sp. (NOT against grp A)

    • Gm –
    • Variable activity against enterobacteriaceae
    • DRUG OF CHOICE for Stenotrophomonas maltophilia
  102. Unique about Folic acid inhibitors
    • Stenotrophomonas maltophilia—(drug of choice)
    • MRSA
  103. Tetrcycline agents
    Tetracycline

    Doxycycline (Vibramycin)

    Minocycline (Minocin)
  104. Ciprofloxacin
    Cipro

    Fluoroquinolones
  105. Levofloxacin
    Levaquin

    Fluoroquinolones
  106. Moxifloxacin
    Avelox

    Fluoroquinolones
  107. Gemifloxacin
    Factive

    Fluoroquinolones
  108. Ofloxacin
    Floxin

    Fluoroquinolones
  109. Metronidazole
    Flagyl

    Nitroimidazole
  110. Rifampin
    Rifadin

    Rifamycins
  111. Sulfamethaxozole-trimethoprim
    Bactrim, Septra
  112. Tetracycline
    Tetracycline

    Tetracyclines
  113. Doxycycline
    Vibramycin

    Tetracyclines
  114. Minocycline
    Minocin

    Tetracyclines
  115. Tetracyclines spectrum
    • Gm + 
    • Staphylococcus sp.(including MRSA)     
    • Streptococcus sp.(variable group A)
    • Gm –      
    • Variable enterobacteriaceae
    • Anaerobes (NOT bacterioides sp.)
    • Atypicals
  116. Unique about Tetracyclines
    Anaerobes

    Atypicals

    MRSA
  117. Glycylcycline agents
    Tigecycline (Tygacil)
  118. Tigecycline
    Tygacil

    Glycylcycline
  119. Spectrum of Glycylcycline
    Very BROAD spectrum

    • Main hole in coverage is:      
    • Pseudomonas       
    • Proteus
    • Provedentia
  120. Aminoglycosides agents
    • Gentamicin (Garamycin)
    • Tobramycin (TOBI)
    • Amikacin (Amikin)
    • Streptomycin
    • Kanamycin (Kantrex)
    • Neomycin (Neo-Fradin)
  121. Gentamicin
    Garamycin

    Aminoglycosides
  122. Tobramycin
    TOBI

    Aminoglycosides
  123. Amikacin
    Amikin

    Aminoglycosides
  124. Streptomycin
    Streptomycin

    Aminoglycosides
  125. Kanamycin
    Kantrex

    Aminoglycosides
  126. Neomycin
    Neo-Fradin

    Aminoglycosides
  127. What are gram (-) and (+) coverage of tobramycin and gentamycin?
    Tobramycin (more for Gm –s) and Gentamicin (more for gram +s)
  128. Mechanism of action of aminoglycoside
    Bactericidal agents that inhibit normal bacterial protein synthesis by binding to the 30S and 50S ribosomal subunit.
  129. Vancomycin
    Vancocin

    Glycopeptide
  130. Mechanism of action of vancomycin
    Inhibits cell wall synthesis. Blocks peptidoglycan synthesis by binding to a portion of the bacterial cell wall (slowly bactericidal agent)
  131. Spectrum of action/indications of vancomycin
    • Gram-positive ONLY (Gold standard agent
    • for MRSA; no other MRSA agents have found to be superior to vanc in well-designed trials)
    • Treatment for patients with infections caused by staphylococcal, streptococcal, and
    • enterococcous (NOT VRE) species
    • Common indications (wide variety): 
    • endocarditis, osteomyelitis, respiratory tract infections (severe Community Acquired Pneumonia, Hospital Acquired Pneumonia, Ventilator Acquired Pneumonia,
    • Health-Care Associated Pneumonia), septicemia, surgical prophylaxis in
    • penicillin allergic patients, skin & skin structure infections and C. difficile associated diarrhea (oral formulation ONLY)
  132. Macrolides agents
    Erythromycin (Erythrocin)

    Azithromycin (Zithromax)

    Clarithromycin (Biaxin)

    Fidaxomycin (Dificid)
  133. Erythromycin
    Erythrocin

    Macrolides
  134. Azithromycin
    Zithromax

    Macrolides
  135. Clarithromycin
    Biaxin
  136. Macrolide spectrum
    • Gm +       
    • Streptococcus sp.       
    • Listeria
    • Gm –      
    • H. influenzae      
    • Moraxella
    • Atypicals
  137. Unique about macrolides
    Atypical

    Moraxella

    Listeria
  138. Fidaxomycin
    Dificid

    Macrolides
  139. What is that drug that to macrolides family and ONLY used for difficile and shouldn't be used for systemic infections?
    Fidaxomycin (Dificid)
  140. Lincosamide agents
    Clindamycin (Cleocin)
  141. Clindamycin
    Cleocin

    Lincosamide
  142. Mechanism of action of Clindamycin or lincosamide agent.
    Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism
  143. Lincosamide spectrum
    • Gm +      
    • Strep sp.      
    • Staph sp.  (including MRSA)

    Anaerobes (NOT B. fragilis)
  144. Unique about clindamycin (Cleocin)
    • MRSA
    • Anearobes
  145. Streptogrammin agents
    Quinupristin-Dalfopristin (Synercid)
  146. Quinupristin-Dalfopristin
    Synercid

    Streptogrammin
  147. Spectrum of Streptogrammin or Quinupristin-Dalfopristin (Synercid)
    Gram + ONLY

    (including MRSA)
  148. Unique about Quinupristin-Dalfopristin
    MRSA
  149. MOA of Quinupristin-Dalfopristin (synercid)
    Quinupristin/dalfopristin inhibits bacterial protein synthesis by binding to different sites on the 50S bacterial ribosomal subunit thereby inhibiting protein synthesis
  150. Oxazolidinone agents
    Linezolid (Zyvox)
  151. Linezolid
    Zyvox

    Oxazolidinone
  152. Spectrum of Oxazolidinone or Linezolid (Zyvox)
    Gram (+) ONLY (Including MRSA & VRE)
  153. Unique about Linezolid (Zyvox)
    • MRSA
    • VRE
  154. MOA of Linezolid (Zyvox)
    Inhibits bacterial protein synthesis by binding to bacterial 23S ribosomal RNA of the 50S subunit. This prevents the formation of a functional 70S initiation complex that is essential for the bacterial translation process. Linezolid is bacteriostatic against enterococci and staphylococci and bactericidal against most strains of streptococci.
  155. MOA of Nitrofrantoin (Macrobid)
    Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates that inactivate or alter bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis. Nitrofurantoin is bactericidal in urine at therapeutic doses. The broad-based nature of this mode of action may explain the lack of acquired bacterial resistance to nitrofurantoin, as the necessary multiple and simultaneous mutations of the target macromolecules would likely be lethal to the bacteria.
  156. Nitrofurantoin
    Macrobid

    Miscellaneous
  157. Unique about Nitrofurantoin (Macrobid)
    ONLY active in urine, so treats UTIs  (E. coli)
  158. Spectrum of Nitrofurantoin (Macrobid)
    Gm  +

    • Gm –
    • Some enterobactericeae  (E. coli, Citrobacter sp.)
  159. What are gram (+) resistance?
    • MRSA- Methicillin-resistant Staph. Aureus
    • VRE- Vancomycin-Resistant Enterococcus
  160. Antibiotics for MRSA
    • Drug of choice—gold standard
    • Vancomycin 
    •    
    • Commonly used for more serious infections  
    • Daptomycin 
    • Linezolid   

    • May be off market, but still can treat MRSA
    • Telavancin
    •        
    • Only β-lactam with MRSA activit
    • Ceftaroline
    •       
    • Oral options   
    • Clindamycin (Cleocin)
    • Tetracyclines (including tigecycline)  
    • Sulfamethoxazole-trimethoprim (Bactrim)
    • Quinupristin-dalfopristin (Synercid)
  161. What is drug of choice or gold standard to treat MRSA
    Vancomycin (Vancocin)
  162. What are the two common drugs used for more MRSA serious infections?
    • Daptomycin (Cubicin)
    • Linezolid (Zyvox)
  163. What drug can be still used to treat MRSA but may be off market?
    Telavancin (Vibativ)
  164. What is the ONLY B-lactam that cover MRSA?
    Ceftaroline (Teflaro)

    Anti-MRSA cephalosporin
  165. Oral options for MRSA
    • Clindamycin (Cleocin)
    • Tetracyclines (including tigecycline)
    • Sulfamethoxazole-Trimethoprim (Bactrim, spectra)
    • Quinupritin-dalfopristin (Synercid)
  166. VRE- vancomycin-resistant enteroccocus
    • Enterococcus faecium is most likely to be vancomycin resistant 
    • Enterococcus faetalis can also be vancomycin resistant, but not as common  
    • Not as toxic as staph
    • Problem is that we have so high resistance that we have few treatments available
  167. What are bacteria that resist to Vancomycin?
    • Enterococcus faecium (most likely to be vancomycin resistant)
    • Eterococcus faetalis  (can also be vancomycin resistant but not that common)
  168. Antibiotics that indication for VER
    • Drug of choice   
    • Ampicillin 

    • Commonly used 
    • Linezolid  
    • Daptomycin
    •       
    • For UTIs, can use:  
    • Nitrofurantoin  
    • Tetracyclines (ONLY use in UTIs VRE at this point)
  169. Drug of choice for VER
    Ampicillin 
  170. What are the two drugs commonly used in VRE?
    • Linezolid (zyvox)
    • Daptomycin (Cubicin)
  171. Antibotic(s) for UTI VRE
    Tetracyclines (ONLY used in UTIs VRE at this point)
  172. Gram (-) resistance
    • Resistance to 1st, 2nd, and 3rd generation cephalosporins      
    • NOT cefoxitin or cefotetan and the monobactams

    Most commonly seen with K. pneumoniae and E. coli

    Carbapenems are the treatment of choice
  173. Drug of choice for Extended spectrum B-lactamase (ESBLs)
    • Carbapenems are the treatment of choice
    • Big brothers
    • Imipenem/Cilastatin (Primaxin)
    • Meropenem (Merrem)
    • Doripenem (Doribax)

    • Little brother
    • Ertapenem (Ivanz)
    • -->doesn’t have same spectrum
  174. what are 3 drugs that don't get resistance by ESBL (Extended spectrum B-lactamase)?
    • Cefoxitin (Mefoxin)
    • Cefotetan (cefotan)
    • Monobactams - Aztreonam (Azactam, Cayston)
  175. What are two common seen ESBLs bacteria?
    • K. pneumoniae
    • E. coli
  176. How do we do empiric double-coverage for gram negative- Pseudomonas aeruginosa?
    • Pick 2 drugs:
    • Choode 1 drug from : Piperacillin, Ticaricillin;Ceftazidime,Cefepime;Imipenem-Cilastatin, Meropenem, Doripemem/Aztreonam
    • Choose 2 drug from: Ciprofloxacin, Levofloxacin;tobramycin, Gentamicin, Amikacin
  177. What are the two Penicillinase-Resistant penicillins ?
    • Oxacillin (Bactocil)
    • Nafcillin (Nafcil)
    • They don't require adjustment renal dysfunction because they undergo billiary excretion instead.
  178. Adverse effects of Penicillins (B-lactamase)
    • Hypersensitivity reactions
    • GI disturbances (oral)
    • CNS toxicity (particularly in renal dysfxn)
    • Nephrotoxicity
  179. Major drug interactions of Penicillin (B-lactam)
    Probenacid
  180. Adverse effects of first generation cephalosporin:
    Cefazolin (Ancef)
    Cephalexin (keflex)
    • Hypersensitivity reactions
    • ** cross reactivity of < 1% in pts w/PCN allergy 
    • GI effects
    • Pain at injection site   (esp.IM)
  181. what are drug interaction of a cephalosporins drug which contain MTT side chain?
    • Cefotetan (Cefotan)
    • Drug interactions: MTT side chain -->
    • disulfiram-like rxn and may increase effects of warfarin
  182. Adverse effects of carbapenems
    Hypersensitivity reactions (Approx. 1% cross-reactivity with PCNs)

    Seizures (Particularly in patients with Hx of seizure d/o or renal dysfxn)
  183. Carbapenems' drug interactions
    May decrease valproic acid levels
  184. What B-lactam is safe to use in PCN-allergic patients?
    Monobactam- Aztreonam (Azactam)
  185. Adverse effects of Monobactam (B-lactam)
    Hypersensitivity reactions

    (NO reported cross-reactivity w/PCNs—safe to use in PCN-allergic patients)
  186. What are adverse effects of Cyclic Glycopeptide?
    Daptomycin (Cubicin)

    • Musculoskeletal adverse effects       
    • Monitor CK weekly         
    • Incidence may ↑ with statin use

    GI effects

    • Peripheral effects      
    • Paresthesias
    • Peripheral neuropathies
  187. What is Daptomycin's unique PK and why it shouldn't be use in pneumonia?
    Daptomycin (Cubicin) is inactivated by pulmonary surfactant. Therefore, it is NOT used in pneumonia.
  188. What are adverse effects of cell membrane agents?
    Colistin, polymixin  E (Coly-Mycin M)
    Polymixin B (Poly-Rx)
    Nephrotoxicity

    • Neurotoxicity     
    • Neuromuscular blockade      
    • Paresthesias around lips, tongue, and extremities

    Peripheral neuropathy
  189. Cell wall Membrane's drug interations
    Caution use with other nephrotoxic agents

    Caution with other neuromuscular blocking agents
  190. What is black box warning of fluoroquinolines?
    Tendonitis/Tendon Rupture
  191. Adverse effects of Flouroquinolones
    • GI effects
    • CNS effects   (more common in elderly)
    • Tendonitis/ Tendon Rupture
  192. Drug interactions of Fluoroquinolones
    Caution use with other nephrotoxic agents

    Caution with other neuromuscular blocking agents

    Absorption is ↓ with products containing Ca++, Mg++, Fe++, Al- or Zinc

    Use with corticosteroids may ↑ risk of tendon rupture

    May ↑ effects of warfarin
  193. What is the black box warning of Metronidazole (Flagyl)-Nitroimidazole?
    Potential carcinogen
  194. Adverse effects of Nitroimidazole-Metronidazole (Flagyl)
    GI effects

    CNS toxicity

    Metallic taste

    Potential Carcinogen
  195. What are adverse effects of Rifamycins-Rifampin (Rifadin)?
    GI effects

    Discolored body fluids (urine, sweat, tears)

    Hematologic effects (thrombocytopenia, leukopenia, glanulocytopenia)
  196. Drug interactions of Rifampin (Rifadin)
    • Strong inducer of:
    • CYP 3A4, 1A2, 2C9, 2C19
  197. Adverse effects of Folic acid inhibitors sulfamethoxozole/Trimethoprim (Bactrim, Spectra)
    • GI symptoms
    • Rash
    • (one of more common antibiotics to cause  SJS or TEN)
  198. Drug interactions of Sulfamethoxazole/Trimethoprim
    • Potent CYP 2C9 inhib.
    • May ↑ effects of warfarin, MTX, anti-diabetic agents
    • AVOID in patients with G6PD deficiency
  199. What antibiotic that we need to avoid in patients who have G6PD deficiency?
    Sulfamethoxazole/Trimethoprim-Bactrim, Spectra
  200. Drug interactions of Tetracyclines
    Absorption is ↓ with products containing Ca++, Mg++, Fe++, Al- or Zinc

    May ↓ effect of oral contraceptives

    May ↑ effect of warfarin
  201. Adverse effects of Tetracyclines
    Hypersensitivity rxns

    Photosensitivity

    Skin pigmentation changes

    Discoloration of teeth/bones (children, contraindicated in pregnant women and children up to 8 y.o.)

    Vertigo (minocycline)

    GI effects (more with tetracycline)
  202. Tetracyclines are contraindicated in what population?
    pregnant women and children up to 8 y.o.
  203. Which antibiotic(s) is not recommended in bacteriemia and why?
    Tigecycline (Tygacil) is not recommended for use in bacteriemia because it is rapidly distributed to periphery.
  204. Adverse effects of Glycylcyclines-Tigecycline (Tygacil)
    • GI effects (up to 30%)
    • Photosensitivity
  205. Tigecycline (Tygacil) drug interactions
    May ↓ effect of oral contraceptives

    May ↑ effect of warfarin
  206. Macrolides adverse effects
    GI effects (esp. erythromycin)

    Hypersensitivity rxns
  207. Macrolides' drug interactions
    • Clarithromycin and Erythromycin
    • Are major substrates and inhibitors of CYP 3A4       
    • May prolong QT interval
    • May ↑ effect of warfarin
  208. What is black box warning of Clindamycin (Cleocin)?
    Pseudo-membranous Colitis
  209. Adverse effects of clindamycin (Cleocin)
    GI effects

    Pseudomembranous colitis (BBW)
  210. Adverse effects of Streptogrammin-Quinupristin/Dalfopristin (Synercid)?
    GI effects

    Arthralgia/myalgia

    Hyperbilirubinemia
  211. Drug interaction of Streptogrammin-Quinupristin/Dalfopristin (Synercid)
    Potent CYP 3A4 inhibitor
  212. Adverse effects of Oxazolidinone-Linezolid (Zyvox)
    GI effects

    Myelosuppression (more common with therapy > 2 weeks)

    Neuropathies (peripheral and optic)
  213. Drug interaction of Oxazolidinone-Linezolid (Zyvox)
    Serotonergic agents (SSRIs) may ↑ risk for serotonin syndrome

    Reversible, non-selective MAOI
  214. Adverse effects of Nitrofurantoin-Macrobid, Macrodantin
    GI effects

    Pulmonary reactions
  215. Mechanism of action of B-lactam
    • Bind to penicillin binding proteins
    • (PBP) in the cell wall of susceptible bacteria

    • This ultimately causes interruption in cell wall
    • synthesis, resulting in bacterial cell lysis and death
  216. MOA of B-lactamase inhibitors
    • Prevents hydrolytic action on penicillin and
    • also binds directly to penicillin-binding proteins to increase antibacterial
    • activity
  217. MOA of Cyclic Glycopeptide- Daptomycin (Cubicin)
    Binds to components of the cell membrane causing rapid depolarization to inhibit DNA, RNA, and protein synthesis
  218. MOA of cell membrane agents
    Damages cell membrane, allowing leakage of cell contents
  219. MOA of Fluoroquinolones
    Inhibits bacterial DNA topoisomerase and gyrase, promoting DNA leakage
  220. MOA of Nitroimidazole- Metronidazole (Flagyl)
    Causes loss of DNA helical structure and strand breakage
  221. MOA of Rifamycins- Rifampin (Rifadin)
    • Inhibits the β subunit of DNA-dependent RNA
    • polymerase
  222. MOA of folic acid inhibitors- Sulfamethoxazole/trimethoprim (Bactrim, septra)
    Folate antagonist
  223. What are the only 3 class of antibiotics that are able to cover atypicals (Mycoplasma, Legionella sp., chlamydophilia sp.)?
    • Fluoroquinolones
    • Macrolides
    • Tetracyclines (doxycycline)

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