Term
Penicillin (mech, spectrum, adverse, resisistance) |
|
Definition
Pen G (parenteral), Pen V (oral) - Mech: Inhibit transpepsidase enzyme: bacterial cell wall synthesis, excellent CNS penetr'n
- Spect: Strep species (DOC: Grp A Strep), T. Pallidum (Syphillus)
- Adverse: Hypersens'y rxn: allergic nephritis, seizures
- Resistance: Penicillinase (All S. Aureus), PBP alteration (MRSA)
|
|
|
Term
Aminopenicillins (Mech, spect, adverse, resistance) |
|
Definition
Ampicillin (parenteral), Amoxicillin (oral) - Mech: inhibit bacterial cell wall synthesis
- Spectrum: Strep Species (DOC for enterococci), H. Flu, Moraxella, E.Coli/Proteus (now 50% resistant)
- Adverse: PNC Hypersensitivity
- Resistance: B lactamase producing species
|
|
|
Term
Penicillinase Resistant Penicillins (Mech, Spect, Adverse, Resistance) |
|
Definition
Oxacillin (oral),Dicloxacillin (parenteral) - Mech: Inhibit bacterial cell wall synthesis
- Spectrum:Designed for non-MRSA Staph
- Adverse: Most frequent cause of allergic interstitial nephritis
- Resistance: MRSA precludes use of any PCN or cephalosporin (d/t PBP resistance!)
|
|
|
Term
Extended Spectrum PCNs (anti-pseudomonal) (Mech, Spect, Adverse, Resistance) |
|
Definition
Piperacillin - Mech: Inhibit cell wall synthesis
- Spectrum: Strep species, H. Flu/Moraxella, Gram Neg nosocomials: E. Coli, proteus, pseudomonas
- Adverse:diarrhea - d/t to coverage of gut anaerobes
- Resistance: penicillinase-sensitive, MRSA precludes use of any PCN or cephalosporin (d/t PBP resistance!)
|
|
|
Term
Beta Lactamase Inhibitor/PCN Combinations (Mech, Spect, Adverse, Resistance) |
|
Definition
Ampicillin/Sulbactam, piperacillin/tazobactam, amoxicillin/clavulonic acid (augmentin) - Mech: Suicide inhibitor of PCNase, no antibact activity unless paired w/ PCN
- Spectrum: S. Aureus, all H. Flu, gut anearobes
- Adverse: Diarrhea - d/t to coverage of gut anaerobes
- Resistance: MRSA precludes use of any PCN or cephalosporin (d/t PBP resistance!)
|
|
|
Term
1st Generation Cephalosporins (Mech, Spect, Adverse, Resistance) |
|
Definition
cefazolin (parenteral), Cephalexin (oral) Don't be FAZed by the PHirst generation. - Mech: Cell Wall Synthesis Inhibitor: transpeptidase inhibition
- Spectrum: Non-MRSA Staph, Strep, + Gram Neg coverage: E.Coli, Proteus, Klebsiella
- Adverse: NO CNS PENETRN - 8% X-allergenic
- Resistance: MRSA - PBP alteration = resistant to all Cephos and PCNs
|
|
|
Term
2nd Generation Cephalosporins (Mech, Spect, Adverse, Resistance) |
|
Definition
Cefuroximide (oral/parenteral) Your FAMily wears FUR while drinking TEA w/ a FOX - Mech: Cell wall synthesis: transpeptidase inhibition
- Spectrum: Pneumococcus, all H. Flu strains, Gram Neg: E. Coli, Proteus, Klebsiella, anaerobes
- Adverse:
- Resistance: MRSA precludes use of any PCN or cephalosporin (d/t PBP resistance!)
|
|
|
Term
3rd Generation Cephalosporins (Mech, spect,adverse, resistance) |
|
Definition
Ceftriaxone (parenteral - Staph coverage) Ceftazidime (parenteral - Psuedomonal coverage) - Mech: Cell wall synthesis, Excellent CNS penetrn
- Spectrum: Less Gram+, DOC:Pneumococcus, all anaerobes, expanded Gram Neg
- Resistance: MRSA - PBP alteration
- Use: ceftriaxone + vanco, empirical tx for bact'l meningitis (pneumococ, N. mening, SA)
|
|
|
Term
Carbapenems (Mech, Spect, Adverse, Resistance) |
|
Definition
Imipenem (parenteral only) 'gorillamycin' - Mech: Lactam ring - transpeptidase inhibitor
- Spectrum: Broadest of all antiB's (no MRSA acty)
- Adverse: Dose related seizures, X-allergenic, must couple w/ (long-lastin) cilastin to reduce rapid renal clearance
- Resistance: only MRSA escapes!
- Use: Limited, use in ICU w/ polymicrobial infxn
|
|
|
Term
Monobactams (Mech, Spect, Adverse, Resistance) |
|
Definition
Aztreonam (parenteral only) - Mech: Cell wall synthesis inhibition
- Spect: Only Gram negs (inc. pseudomonas), NO gram + act'y (=aminglyco w/o nephrotox)
- Adverse: no x-allergenicity
- Resistance: MRSA - PBP alteration
- Use: Gram Neg infxn w/ renal insufficiency
|
|
|
Term
Glycopeptide (Mech, Spect, Adverse, Resistance, Use) |
|
Definition
Vancomycin (IV only) - Mech: Binds terminal alanine on cell wall precursor = inhibits synthesis
- Spectrum: Only gram+ aerobes/anaerobes
- Adverse:'red man' syndrome: erythema, flushing, dose-dependent nephro/oto toxicity
- Resistance: Oh shit, VRSA
- Use: MRSA/coagulase neg Staph infxns
|
|
|
Term
Phosphonic Acid Derivative (mech, spectrum, adverse, resistance) |
|
Definition
Fosfomycin - Mech: Inactivates cell wall synthesis enzyme
- Spectrum: Broad Spec - E. coli, enterococcus
- Adverse: NO X-allergenicity w/ PCN
- Resistance: None, may be good vs. MRSA
- Use: Currently, vs. gram neg UTI, but may have potential vs. MRSA, resistant pneumococcus
|
|
|
Term
Cyclic Lipopeptide (Mech, Spectr, Adverse, Resist) |
|
Definition
Daptomycin - Mech: Punches holes in Grm+ cell wall (need DAP Cmpnd to patch walls)
- Spectrum: Only Grm+ cocci (VRSA, VRenterococc)
- Adverse: Risk of rhabdomyolisis
|
|
|
Term
Fluoroquinolones (Mech, Spect, Adverse, Resistance) |
|
Definition
Ciprofloxacin, levofloxacin - Mech: Inhibit bacterial DNA gyrase
- Spectrum: Gram neg enterobacteriaceae, Pneumococcus
- Adverse: Dose-dependent CNS toxicity (confusion, hallucination, seizures) + arrythmias (QT widening, Vent Tachy)
- Use: UTIs w/ bacts resistant to Sulfonamides or PCN
|
|
|
Term
Nitroimidazoles (Mech, Spect, Adverse) |
|
Definition
Metronidazole - Mech: In anaerobic condns, caused free radical damage to fungal/bacterial DNA
- Spectrum: Very effective vs. anaerobic bacts and protozoa (giardia, trichomonas, ameobas), H. Pylori, C. Dificile
- Adverse: NO alcohol, toxic to fetus
|
|
|
Term
Aminoglycosides (Mech, Spect, Adverse, Use) |
|
Definition
Strepto-, Genta-, Tobra-mycin, Amikacin - Mech: Inhibit protein synth at 30 S ribosome- only bacteriocidal protn synth inhibitors (prolonged cell kill after dosing)
- Spectrum: Very effective vs. Gram Negs, no activ'y vs. anaerobes(O2 req'd for uptake)
- Adverse: Nephrotoxicity (+ renal accumulat'n), ototoxic (multiple forms w/in class), CNS effects
- Use: D/t dose-dependent toxicities, use for initial TX of severe gram neg infxn and change to less toxic AntiB
|
|
|
Term
Tetracyclines (mech. spect, adverse, resist) |
|
Definition
Doxycycline - Mech: Inhibition of 30S Ribosome subunit (blocks entry of tRNA to active site)
- Spectrum: Broad spect, but resistance limits use. Very Effective vs. intracell infxn (mycoplasma, chlam, rickettsia)
- Adverse: Photosensitivit, hepatotoxic, discolored fetal teeth (no pregs)
- Resistance:SA, pneumococcus, enterobacteria
|
|
|
Term
Clindamycin (Mech, Spect, Adverse, Resist) |
|
Definition
- Mech: blocks peptide bond form'n at 50s ribosomal subunit
- Spectrum: Only gram +'s (some acty vs. MRSA) all anaerobes (except C. Dif - bact'l overgrowth)
- Adverse: Notorious for Antibiotic-assoc'd diarrhea, pseudomembranous colitis
- Use: Aspiration pneumonia, bowel perforation (anaerobes), PCN alternative w/ allergies
|
|
|
Term
Macrolides (Mech, Spect, Adverse, Resist) |
|
Definition
Clarythromycin, azythromycin - Mech: Block ejection of 'used codon' at 50s ribo
- Spect:Strep/Staph (inc MRSA) + mycoplasma, H. flu, chlamydia
- Adverse: GI symptoms (diarrhea, N/V), cytochrome oxidase interaction (erythro, claryth)
- Use: Alternative to PCN (no allergies) in skin/oral infxn, sinusitis (H. Flu), pneumonia (Pneumo, H.Flu), cervisitis (chlamydia)
|
|
|
Term
Linezolid (Mech, Spect, Adverse, Resist) |
|
Definition
Godzilla lizard - Mech: bind 50s ribosome, inhibit translation
- Spect: Resistant gram+'s (daptomycin alternative vs. VRSA, VR enterococcus)
- $2000/ course
|
|
|
Term
Antimetabolites: PABA antagonist, DHFR inhibitor |
|
Definition
PABA antag: Sulfamethoxazole (SMX), Dapsone DHFR inhibitors: Trimethoprim (TMP), pyrimethamine (also TB tx) Combo: TMP/SMX (bactrim) - Mech: Inhibit folate metabolism
- Spect: Strep/Staph (some MRSA), Grm Negs (except pseudomonas, serratia), Parasites (pneumocystis, toxoplasm
- Adverse: Hypersensitivity Rxn (rash, hepatitis), bone marrow suppression (agranulocytosis) hemolytic anemia (w/G6PD def'y)
- Use:cystitis/urethritis, ENT infxn, bronchitis
|
|
|
Term
|
Definition
Pyroxidine (Vit B6) Analog= isoniazid (monotherapy for TB prophylaxis) - Mech: inhibit mycolic acid synth (mycobact cell wall)
- Toxicity: Centilob hepatitic (jaundice, ALT,AST), neurotoxic (periph+optic neuritis,)
- Use: prevent CNS symptoms w/ Vit B6
|
|
|
Term
|
Definition
Rifampin - Mech: Inhibits DNA-dependent RNA polymerase (bacterial transcription)
- Toxic: Elev'd AST,ALT( in pts w/ liver disease), flu-like hypersensitivity, thromboCP, interstitial nephritis (w/ intermittent dosing)
|
|
|
Term
|
Definition
Pyrazinammide - Mech: Pyroxidine analog: inhibits mycolic acid synthesis for mycobact cell wall
- Adverse: centrilobular hepatitis (elev'd AST, ALT) Incrsd serum uric acid and gout
|
|
|
Term
|
Definition
Steptomycin - Mech: aminoglycoside - 30s ribosome inhibition
- Adverse: Nephro/CNS toxicity + damage to CrN VII (w/ prolonged use)
|
|
|
Term
|
Definition
Ethambutal - Mech: disrupts mycolic acid metabolism: cell wall
- Adverse: Gout & Dose dependent optic neuritis (color blindness) - no use w/ isoniazid (d/t overlapping toxicities)
|
|
|
Term
Purine Analogs (anti-virals) |
|
Definition
Valcyclovir (prodrug to acyclovir), Sorivudine - Mech: Nucleoside analog: prodrug activated by thymidine kinase, incorporated into bacterial DNA=chain termination
- Adverse: well-tolerated, CNS symptoms if overdosed in renal failure
- Use: HSV+++, VZV+, CMV in HIV+++
- Sorivudine: more activity vs. VZV
|
|
|
Term
|
Definition
Gangciclovir Mech: incorporated in bact'l DNA =chain term'n Adverse: dose dependent neutropenia, thromboCP, CNS effects
Use: CMV in HIV (viral retinitis)
|
|
|
Term
|
Definition
Foscarnet - Mech: Pyrophosphate analog
- Use: Active vs. HSV, CMV, VZV (effective in aciclovir failures)
- Adverse: No oral absorption, dose-dependent renal toxicity/CNS toxicity
|
|
|
Term
|
Definition
- Immune modulator enhances native interferon activity
- Topical admin - causes skin irritation
2. Cidofovir - Cytosine Analog - also vs. other DNA viruses
- Topical admin available
|
|
|
Term
RNA viruses: Influenza A & B |
|
Definition
Oseltamavir (tamaflu) - lessens duration of disease and viral shedding - Mech: Neuraminidase inhibitor - prevents viral release from host cells
- Use: Prophylaxis for shut-ins and immunocomp'd
- Adverse: rare neuropsychiatric toxicity
|
|
|
Term
Nucleoside Reverse Transcriptase Inhibitors (NRTIs of HIV Chemotherapy) |
|
Definition
HAART: 2 NRTIs + 1nNRTI + Protease inhibitor Avoid overlapping toxicities Zidovudine (AZT) - granulocytopenia, N/V, Anemia Didanosine - Pancreatitis, peripheral neuritis Stavudine - Pancreatitis, peripheral neuropathy Lamivudine - HA, N/V Neutropenia, pancreatitis
Zany days start low. |
|
|
Term
non-Nucleoside Reverse Transcriptase Inhibitors (nNRTIs of HIV chemotherapy) |
|
Definition
Nevirapine, delavirdine, efavirenz - Use: nNRTIs of HAART or protease inhibitor replacement (in case of intolerance, failure)
- Adverse: All agents cause skin rashes, cytochrome p450 disturbance
|
|
|
Term
Protease Inhibitors HIV Chemotherapy |
|
Definition
Mech: Inhibit post-translnal modific'n of viral protns Saquinavir - well-tolerated, but low bioavailability d/t first pass metabolism Ritonavir-periph neuropathy, hepatotoxic, cytochrome inhibitor; used concurrently to boost Saquinivir
Indinavir - resistance = resistant to saq,rito,too, nephrolithiasis (keep hydrated)
Adverse (all): lipodystrophy: hyperglycemia, hyperlipid, fat maldistribution (cushingoid) - Syndrome X |
|
|
Term
|
Definition
Amphoteracin B - Mech: perforates fungal cell membranes
- Use: Reserved for severe deep mycosis
- Adverse: Toxic shit - acute fever and chills, long-term nephrotox: Mg/K wasting, RTA, bone marrow suppression
Nystatin-I went to the NY STate fair, ate some CANDy, and got a yeast infxn.
- Use: superficial candida infxn - topical use
- Adverse: Toxic + No activity vs tinea
|
|
|
Term
Azole Antifungals (topical infxn) |
|
Definition
Imidazoles (miconazole, clortrimazole) - Mech: Inhibit ergosterol synthesis
- Use: DOC for topical dermatophyte (tinea) or candida infxn
|
|
|
Term
Azole Antifungals (deep infxn) |
|
Definition
Triazoles: fluconazole, otraconazole, voriconazole - Use: Onchomycosis (itra) candida vaginitis (fluco, vori)
- Adverse: hepatoxicity, drug interactions thru CYP isoform?
|
|
|
Term
|
Definition
Terbinafine, naftitine, tolnaftate - Use: limited to dermatophyte infxn. no activity vs. candida
- Adverse: rare hepatotoxicity
|
|
|
Term
|
Definition
Caspofungin - Use: Reserved for severe aspergillus or candida infxns
- Adverse: Less toxic than Ampoteracin B
|
|
|
