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amandanelson
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2011-04-09 15:05:31
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anti biotics
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  1. Anti-biotics that have beta-lactam rings
    Pennicillins, Cephalosporins, Carbapenems, Monobactams
  2. Anti-biotics that inhibit bacterial cell wall synthesis
    Penicillins, Cephalosporins, Carbapenems, Monobactams, Vancomycin, Telavancin, Fosfomycin
  3. Protein syntehsis inhibitor anti-biotics
    Tetracyclines, Macrolides, Lincosamides, Streptogramins, Aminoglycosides, Linezolids
  4. Cell membrane disrupters
    Polymyxin, Daptomycin
  5. Nucleic acid synthesis inhibitors
    Rifampin, Rifaximin, Fluoroquinolones, Metronidazole
  6. Folate synthesis inhibitors
    Sulfonamides, Trimethoprim
  7. Anti-mycobaterials (TB, leprosy)
    Isoniazid, Ethambutol
  8. Penicillin catagories
    • Natural penicillins
    • Aminopenicillins
    • Antipseudomonal penicillins
    • Antistaphylococcal pennicillins
  9. amoxicillin + clavulanate
    Augment
  10. ampicillin + sulbactam
    Unasyn
  11. piperacillin + tazobactam
    Zosyn
  12. natural penicillins
    • penicillin G (IV, IM)
    • penicillin V (oral, IM)

    • Gram +
    • interstitial nephritis
    • anaphylaxis
    • beta-lactamase inactivation
    • Take penicillin V (oral) on empty stomach
    • renal elim
    • high dose seizure
  13. MOA of penicillins
    irreversible suicide-inhibition of transpepitidase enzyme
  14. Aminopenicillins
    • ampicillin (IV, PO)
    • amoxicillin (PO)

    • Gram +, little more Gram -
    • beta lactamase inactivation
    • renal elamination
    • high dose seizure
  15. Anti-pseudomonal penicillins
    piperacillin (IV)

    • Gram +, even more Gram -
    • beta lactamase inhibition
    • renal elimination
    • high dose seizure
  16. Anti-staphylococcal penicillins
    • nafcillin (IV)
    • dicloxacillin (PO)

    • staphlococcus
    • poor activity against non-staph
    • not staphlococcal beta-lactamase vulnerable
    • hepatic elimination
    • Take dicloxacillin on empty stomach
  17. 1st generation cephalosporins
    • cephalexin (PO)
    • cefazolin (IV)

    Gram + >> Gram -

    • renal excretion
    • seizure
    • anaphylaxis
  18. 2nd generation cephalosporins
    • cefuroxime (IV, PO)
    • cefoxitin (IV)

    Gram - ~ Gram +

    • renal excretion
    • seizure
    • anaphylaxis
  19. 3rd generation cephalosporins
    • ceftriaxone (IV) (BILIARY)
    • ceftazidime (IV)
    • cefdinir (PO)
    • cefixime (PO)

    Gram - >> Gram +

    • renal excretion
    • seizure
    • anaphylaxis
  20. 4th generation cephalosporins
    cefepime (IV)

    broad spectrum

    • renal excretion
    • seizure
    • anaphylaxis
  21. 5th generation cephalosporins
    ceftaroline (IV)

    • broad spectrum
    • not susceptible to MRSA b-lactamases

    • renal excretion
    • seizure
    • anaphylaxis
  22. Carbapenems
    • ertapenem INVANZ
    • meropenem MERREM
    • imipenem/cilastatin PRIMAXIN

    • broad spectrum
    • not vulnerable to beta-lactamases
    • inhibit lactamases, but also induce them
    • poor chemical stability
    • inactivated by renal dehydropeptidase 1
  23. renal dehydropeptidase
    inactivates imipenem
  24. cilastatin
    renal dehydropeptidase inhibitor
  25. Monobactams
    aztreonam (IV, inh for CF)

    • Gram - only
    • not vulnerable to beta-lactamase
    • renal elimination
  26. MOA of vancomycin and telavancin
    • vancomycin (IV, PO - GI infect)
    • telavancin (IV)

    binds to terminus of growing peptidoglycan peptides

    • Gram +
    • not beta-lactamase inactivated (no b-lactam ring)
    • renal elimination
    • Maintain adequate hydration
  27. basic antibiotic counseling points
    • complete full therapy course
    • may decrease OC efficacy - use back up
    • GI upset
    • seizure - cephs
    • anaphylaxis - cephs
    • fatal colitis - cell wall inhibitors
  28. Name antibiotics eliminated hepatically
    • dicloxacillin - anti-staph penicillin
    • azithromycin, erythromycin - macrolides
    • clindamycin - lincosamides
    • quinupristin/dalfopristin - streptogamins
    • linezolids
    • rifampin, rifaximin - rifamycins
    • ciprofloxacin, moxifloxacin, levofloxacin - fluoroquinolones
    • metronidazole
    • isoniazid
    • doxycycline
  29. MOA of fosfomycin
    fosfomycin (PO)

    inhibits enolpyruvate transferase which blocks the formation of cell wall acetylmuramic acid (NAM)

    • broad spectrum
    • not beta-lactam susceptable (no b-lactam)
    • renal elimination
    • maintain adequate hydration
    • powder that must be dissolved in cold water and taken immediately
  30. what does transpeptidase do?
    cross links polypeptide chains in peptidoglycan cell walls for structure to keep the cell from lysing
  31. what makes MRSA resistant to anti-biotics
    methacillin resistant staph aureus has a MecA gene that encodes a form of transpeptidase that is poorly inhibited by beta-lactams
  32. beta-lactamase
    is a resistance form where the bacteria has produced an enzyme to break down drugs with a beta-lactam ring. the beta-lactamase can use water to regenerate itself and release the drug with an inactivated open beta lactam ring
  33. Name 3 beta-lactamase inhibitors
    • clavulanate
    • tazobactam
    • sulbactam
  34. Drugs INHIBIT enzymes. Enzymes INACTIVATE drugs.
    bacteria and drugs can be VULNERABLE or RESISTANT to each other.
  35. Classes of drugs that have beta-lactam rings
    • penicillins
    • cephalosporins
    • carbapenems
  36. MOA of folate synthesis inhibitors
    block dihydropteroate synthetase (sulfonamide) or dihydropteroate reductase (trimethoprim) which blocks the production of tetrahydrofolic acid, purines, and ultimately the production of DNA, and RNA
  37. MOA of rifamycins
    • rifampin
    • rifaximin

    binds and inhibits RNA polymerase
  38. MOA of fluoroquinolones
    Inhibits DNA gyrase and blocks mRNA production
  39. MOA of metronidazole
    breaks apart DNA
  40. MOA of polymyxin
    Cell membrane disrupter

    detergent disruption of OUTER then INNER membrane, causes cell lysis
  41. MOA of daptomycin
    calcium dependent detergent disruption of INNER membrane causing cell lysis
  42. Gram positive cocci
    • Staphlococcus aureus
    • Staphlococcus epidermidis

    Anaerobes: Peptococcus, Peptostreptococcus
  43. Gram positive diplococci (pairs)
    Streptococcus pneumoniae
  44. Gram positive cocci chains
    • Streptocuccus pyogenes
    • Group B Strept
    • Viridans Streptococcus
    • Enterococcus
  45. Gram positive bacilli
    • small: Listeria
    • Large and anaerobic: Clostridium
  46. Gram negative cocci
    • Neisseria meningititis
    • Neisseria gonorrhoeae
  47. Gram negative bacilli
    • Escherichia coli
    • Klebsiella
    • Proteus
    • Serratia
    • Pseudomonas
    • Acinetobacter
    • Citrobacter
    • Enterobacter

    Anaerobe: Bacteroides
  48. Gram negative coccobacilli (respiriatory GNB)
    • Haemophilus influenzae
    • Moraxella catarrhalis
  49. Coagulase positive Staphlococcus
    • MSSA Methacillin sensitive Staph aureus
    • MRSA Methicillin resistant Staph aureus
  50. Coagulase negative Staphlococcus
    • Staph epidermidis (plastic)
    • Staph saprophyticus
  51. "Enterics"
    • E. Coli
    • Klebsiella
    • Proteus
  52. SPACE
    • Serratia
    • Pseudomonas
    • Acinetobacter
    • Citrobacter
    • Enterobacter
  53. Name anti-biotic drug classes that inhibit synthsis of proteins
    • tetracyclines
    • macrolides
    • lincosamides
    • streptogramins
    • aminoglycosides
    • linezolid
  54. MOA of tetracyclines
    • tetracycline (PO, IV)
    • doxycycline (PO, IV)

    binds reversibly to 30S subunit of bacterial ribosome and blocks tRNA from docking -> inhibits protein synthesis

    • broad spectrum
    • avoid dairy, Fe, or Ca
    • photosensitivity
    • take with full glass of water
  55. MOA of macrolides
    • erythromycin (PO, IV)
    • azithromycin (PO, IV)

    binds to 50S subunit of bacterial ribosome and blocks formation of elongation complex -> inhibits protein synthesis

    • Gram +, Gram -
    • Take with food if GI upset
    • hepatic elimination
    • QT prolongation
    • inhibits CYP3A4
  56. MOA to lincosamides
    clindamycin (PO, IV)

    binds to bacterial ribosome 50S and blocks protein elongation

    • Gram +
    • diarrhea
    • take with full glass of water
    • hepatic elination
    • [severe fatal colitis]
  57. MOA of streptogramins
    • quinupristin (IV)
    • dalfopristin (IV)
    • quinupristin + dalfopristin SYNERCID

    dalfopristin increases binding of quinupristin to the bacterial 50S ribosomal subunit and blocks elongation

    • Gram +
    • myalgia and flu-like symptoms
    • hepatic elimination (t50 = 0.85hr)
  58. MOA of aminoglycosides
    • gentamicin
    • tobramycin
    • amikacin
    • neomycin

    • bind to ribosome and blocks proof reading -> incorporation of wrong AAs
    • must be activily transported into cells
    • Gram - (enteric)
    • HA, dizzines, tinnitis
    • Ototoxic (irrevers)
    • Neprhotoxic (revers)
    • Cell wall inhibitors increase penetration
  59. MOA of oxazolidinones
    linezolid (PO)

    binds to unique site on bacterial ribosome 50S and inhibits the formation of initiation complex -> inhibits protein synthesis

    • Gram +
    • hepatic elimination
    • lots of GI upset
    • Gently mix oral solution before admin
    • No MAOIs within 2 weeks
    • Avoid tyramine foods
    • Bone marrow suppression
    • Serotonin Syndrome
  60. MOA of polymyxins
    • polymixin B
    • polymixin E
    • (top, Otic, Opth, IM, IV)

    detergent disruption to OUTER then inner cell membrane -> causes lysis

    • Gram -
    • renal excretion
    • Opth - redness, itching
    • Otic - accumulation (use spariningly)
    • Muscle pain, [nephrotoxicity], [IM/IT/IV hospital use only], [pregnant]
  61. MOA of daptomycin
    daptomycin (IV)

    calcium-dependent detergent disruption to INNER cell membrane

    • Gram + only
    • renal elimination
    • rhabdomyolysis (CPK monitoring)
  62. MOA of rifamycins
    • rifampin (PO, IV)
    • rifaximin (unabsorbed PO form)

    inhibits bacterial RNA polymerase -> blocks RNA synthesis

    • Gram +, mycobacteria
    • hepatic elimination
    • take on empty stomach with full glass of water
    • avoid alcohol
    • Orange body fluids (stains contacts)
  63. MOA of fluoroquinolones
    • ciprofloxacin (PO, IV)
    • moxifloxacin (PO, IV)
    • levofloxacin (PO, IV)

    inhibits bacterial DNA gyrase/topoisomerase and prevents relaxation of supercoiled DNA -> blocks DNA replication and protein synthesis

    • Gram +, Gram - (broad spectrum)
    • hepatic, renal elimination
    • photosensitivity
    • hypo/hyperglycemia diabetics
    • QT prolongation
    • [Tendon inflammation/rupture]
    • damages growing cartilage
    • CNS effects
    • no dairy, Fe, Ca
  64. MOA of metronidazole
    metronizadole (PO, IV)

    fragments DNA and blocks DNA synthesis and protein synthesis

    • Gram -
    • hepatic elimination
    • N, HA, taste disturbance
    • alcohol within 3 days (disulfiram like reaction)
    • GI upset - take with food, milk
    • contact MD c numbness/tingling [peripheral neuropathy]
  65. MOA of sulfonamides
    sulfamethoxazole (PO, IV)

    • Broad spectrum, Gram +, Gram -
    • renal elimination -> active metabolites UTIs

    • Sulfa allergies
    • photosensitivity
    • maintain adequate hydration
    • jaundice, haemolytic anemia
  66. anti-biotic basic counseling points
    • GI upset
    • OC backup
    • complete whole therapy
  67. MOA of isoniazid
    isoniazid (PO)

    inhibits mycobacterial fatt acid synthesis, blocks cell wall synthesis

    mycobacteria

    • hepatic elimination
    • take on empty stomach 1-2 hours after meal
    • avoid tyramine foods
    • avoid alcohol, acetaminophne
    • peripheral neuropathy = take VitB6

    fatal hepatitis
  68. MOA of ethambutol
    ethambutol (PO)

    inhibits mycobacterial fatt acid synthesis, blocks cell wall synthesis

    mycobacteria

    renal elimination

    • take with food
    • dizziness, disorientation, drowsiness
    • optic neuritis = need eye exams
  69. MOA of pyrazinamide
    pyrazinamide (PO)

    MOA unknown

    TB active only

    • hepatic elimination
    • need regular medical followups
    • nausea, loss of appetite
    • hepatitis
    • gout exacerbations

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