Term
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Definition
1. Penicillin
2. cephalosporin
3. carbapenems & monobactams
4. Vancomycin
5. Vancomycin Alternatives: Linezolid, quinupristin/dalfopristin, daptomycin, telavancin
6. Fluroquinolones |
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Term
Penicillin CLassification |
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Definition
-narrow spectrum penicillin (natural penicillins)
-Penicilinase-Resistant penicillins
(Anti-staph penicillins)
-Extended spectrum penicillins
(Amino-penicillins, anti-pseudomonal penicillin, B-lactamase inhibitor combinations)
- |
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Term
Narrow Spectrum Penicillins (Natural Penicillins) |
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Definition
Penicillin G-IV, IM, PO
Penicillin V-PO |
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Term
Spectrum of activity of Penicillins |
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Definition
Gram + (Steptococcus, Enterococcus)
Gram - (Neisseria meningitidis)
Anaerobes (peptostreptococcis, clostridiium non-deficil)
Other (troponema pallidum, listeria) |
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Term
Common use of penicillins: |
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Definition
1. Step pharynitis
2. strep pneumoniae infections
3. endocarditis due to strept viridans
4. endocarditis prophylaxis
5. meningitis due to neisseria meningtidis
6. Syphilis=DOC
7. Lymes disease (carditis, meningitis, arthritis, high dose) |
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Term
benzathine pen
procaine pen
benzathine/procaine penicillin
Penicillin G potassium or sodium
Penicillin V potassium |
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Definition
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Term
Dose for strep pharyngitis |
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Definition
Penicillin V potassium PO 500 mg BID x 10days |
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Term
Methicillin
nafcillin
oxacillin
Dicloxacillin
cloxacillin |
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Definition
Penicillinase-resistance penicillins |
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Term
Spectrum of activity of penicillinase-resistant penicillins |
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Definition
G+ (MSSA, streptococcus, MSSE)
Anaerobes (Peptostreptococcus) |
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Term
Common uses of penicillinase resistant penicillin |
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Definition
1.Skin and skin structures infections due to stap areus (MSSA, or MSSE)
2.osteomyelitis dues to MSSA or MSSE
3.Infection of prosthetic joint due to MSSA or MSSE
4.Line infections due to staph
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Term
Nafcillin and oxacillin
dicloxacillin |
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Definition
Penicillinase Resistant penicillins |
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Term
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Definition
Extended Spectrum Penicillins
Amino-penicillins |
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Term
Spectrum of activity for amino-penicillins |
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Definition
G+ = streptococcus, enterococcus
G- = H.flu, Neisseria, proteus
Anaerobes = Peptostreptococcus, clostridium (non deficil)
Other = listeria, H.pylori |
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Term
Common use of Amino-penicillins |
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Definition
1.Upper respiratory tract infections
-otitis media (amoxicillin DOC)
-Strep pharyngitis (strep pyogenes)
2. enterococcus infection
3. UTI
4. Meningtits due to listeria monocytogenes
5. H. pylori (with PPI and other abx)
6. Lymes disease
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Term
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Definition
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Term
Amoxicillin/clavulanate (augmentin)
Ampicillin/sulbactam (Unasyn) |
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Definition
Amino-penicillin + B lactamase inhibitor |
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Term
Amino-penicillins + B lactamase inhibitor spectrum of activity |
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Definition
G+ = Staph, Strep, Enterococcus
G- = H.flu, neisseria, m.cat, E.coli, Klbsiella, proteus
anaerobes = peptostreptococcus, clostridium, B.fragilis
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Term
Common uses of Amino-Penicillins + b-lactamase inhibitor |
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Definition
Otitis media
Sinusitis
aspiration pneumonia
Bites (cat, dog, human)
Urinary tract infections
Anearobic infections (abscess) |
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Term
Amoxicillin/clavulanate (augmentin)
Ampicillin Ampicillin/sulbactam |
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Definition
Amino-Penicillins + B-lactamase inhibitor |
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Term
Ticarcillin
Piperacillin
Carbenicillin
Mezlocillin |
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Definition
Anti-pseudomonal penicillin |
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Term
Anti-pseudomonal penicillins spectrum of activity |
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Definition
G+ = Staph, Step, enterococcus
G- = h. flu, neisseria, m.cat, e.coli, klebsiella, proteus, pseudomonas
Anaerobes = peptostreptocuccus, clostridium, B. fragilis
Broadest spectrum |
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Term
Common uses of anti-pseudomonal penicillins + B-lactamase inhibitor |
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Definition
1. Ticacillin and piperacillin are rarely used w/out B-lactamase inhibitors
2. Empiric broad spectrum coverage +/- other antimicrobials
-Gi organisms: ruptured appy, gi surgery, diverticulitis
-nosocomial pneumonia (hospital aquired)
3. Pseudomonas infections
4. febrile neutropenia |
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Term
Zosyn (piperacillin/tozobactam)
timentin (ticarcillin/clavulanate) |
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Definition
Anti-pseudomonal penicillins + B-lactamase inhibitors |
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Term
Adverse effects: Penicillin |
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Definition
Generally well tolerated
Allergic rxn: rash, anaphylaxis, increased LFts, interstitial nephritis
Amox/Amp: Maculopapular rash with mono infection, CLLL, allopurinol= not true allergy
diarrhea
seizures with high doses
neutropenia, thrombocytopnia
thrombophlebitis
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Term
clinical issues of penicillins |
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Definition
1. Dose changed for renal dysfunction
2. strep pneumo more resistant to pen
3. time above MIC is critical to penicillins success
-frequent doses
-continues infusion pen have to be used |
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Term
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Definition
Bind to PSPs and interfere with cell wall synthesis- similar to PEN |
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Term
Mechanism of resistance of cephalosporins: |
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Definition
-B-lactamase production
(Cephs are more stable with b-lactamse)
-PEn binding protein alteration |
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Term
Cephalosporin Classification: |
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Definition
Separated into 3 generations
1st generation = G+ best (G-worst) no anaerobes
3rd generation = G- best (G+worst)
All cephalosporins dont work against MRSA and enterococcus |
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Term
Cephalexin (keflex)
Cefazolin (ancef, kefzol)
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Definition
1st generation cephalosporins |
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Term
Common use of 1st cephalosporin |
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Definition
Skin and skin structure infections
bone infections
surgical prophylaxis
uncomplicated UTI (EKP)
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Term
cefuroxime (ceftin)
cefoxitin (mefoxin) |
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Definition
2nd generation cephalosporins
Spectrum of activity in the middle
g+ g- anaerobes |
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Term
Common uses of 2nd generation cephalosporins |
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Definition
Respiratory tract infections
otitis media
UTI, cystitis, pyelonephritis
cefoxitin & cefotetan only-GI, GU, GYN, procedures, and tx pelvic inflammatory disease w/doxycycline |
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Term
PO: Cefpodoxime (vantin)
cefdinir (omnicef)
Iv: Ceftriaxone (rocephin), cefotamime (claforan), cefizoxime (cefizox), ceftazidime (fortaz), cefipime (maxipime)
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Definition
3rd generation cephalosporin
Spectrum activity G+ G- |
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Term
Common use of 3rd generation cephalosporins |
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Definition
PO agents
-respiratory tract infections
UTI
IV agents
Empiric tx of serious infections
Meningitis DOC w/ vancomycin
W/aminoglycoside for pseudomonas
febrile neutopenia |
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Term
Adverse effects: Cephalosporins |
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Definition
1.Generally well tolerated
2.hypersensitivity
-cross reactivity with penicillin
-do not use with hives to penicillin
3.diarrhea
4. neutropenia, throbocytopenia
5. platelet dysfunction
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Term
DOC for N. gonorrhea
Useful in otitis media
Need double coverage for pseudomonas |
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Definition
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Term
imipenem + cilastatin (primaxin)
meropenem (merrem)
doripenem (doribax)
ertapenem (invanz)
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Definition
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Term
Mechanism of resistance with carbapenems |
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Definition
generally stable in the presence of most types of b-lactamase
pseudomonas has shown altered permeability to imipenem
antagonism has been seen when imipenem is use with other b-lactams due to inc B-lactamase production |
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Term
Spectrum of activity for carbapenems |
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Definition
G+ G- (good) Anaerobes (good) |
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Term
Common Uses of carbapenems and monbactams |
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Definition
- Serious nosocomial infections (hospital acquired)
-serious polymicrobial infections
-intra-abdominal infections (hospital acquireD)
-pseudomonoas infections
-febrile neutropenia |
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Term
The other carbapenem
+spectrum of activity |
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Definition
Ertapenem
Similar to imipenem but no psuedomonas or enterococcis coverage |
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Term
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Definition
intra-abdominal infections
Skin and skin structures infections
UTI, pyelonephritis |
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Term
Adverse effects of Carbapenems
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Definition
Allergy - rash
Seizures-do not use with hx of seizures of meningitis
GI problems |
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Term
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Definition
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Term
Monobactams: mechanisms of action |
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Definition
Similar to other B-lactams
binds to PBPs and therefore inhibits call wall formation |
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Term
Spectrum of activity of monobactams |
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Definition
considered a g-specialist
good activity against G- aerobes including pseudomonas |
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Term
Common uses of monobactams |
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Definition
G- sepsis
urinary tract infection
G- osteomyelitis
G- pneumonia
intra-abdominal infections
CF (inhaled) |
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Term
vancomycin spectrum of activity |
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Definition
G+ very active Staph, MRSA, MRSE -DOC; Strep, Enterococcus |
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Term
Mechanism of action of vancomycin |
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Definition
Inhibits bacterial cell wall synthesis at earlier step than the b-lactams |
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Term
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Definition
PEN, carbs, cephs, and slightly aztreonam |
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Term
Pharmacokinetics of vancomycin |
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Definition
1.Not absorbed from GI
2.Given IV for systemic infections
3.diffuses well into pleural, pericardial, synovial and ascitic fluids
4.therapeutic levels inCSF occur only with inflamed meninges and high doses
5.half-life 6hr with normal renal function upto 7.5 days with renal impairment
6. is not removed by conventional dialysis but is removed by high-flux methods of HD |
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Term
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Definition
DOC: HCA-MRSA
MRSE, and enterococci (for PNC-allergy)
serious infections caused by s.aureus, enterococcus, or strep intolerant of b-lactams
infections caused by g+ organisms
clostridiium defficile colitis if metronidazole fails
endocarditid prophylaxis- GU or GI procedures in PEN intolerant pts
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Term
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Definition
Neohrotixicity
ototoxicity
red man/neck syndrome |
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Term
VANC resistant enterococcus |
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Definition
VRE 15% OF ICU STRAINS
4 serotypes:
1. VanA type- High level resitence
2. VanB type- resistent to vanco
3. VanC type-low level resistance to vanco only
4. VanD type-similar to VanB
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Term
VANCO resistance prevention |
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Definition
Vanco is discouraged in:
-prophylaxis for infection or colonization of vasc catheters
-eradication of MRSA colonization or CA-MSRA
-primary tx for clostridium difficile colitis
-routine prophylaxis for very low birth weight infanst
-routine prophylaxis for peritoneal dialysis |
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Term
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Definition
1.Healthcare associated: Vanco =DOC or daptomysin
2. Community-associated MRSA = TMP/SMX, clindamycin, doxyclcline
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Term
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Definition
Linezolid, quinupristin/dalfopristin, daptomycin,telavancin |
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Term
Linezolid MOA, Spectrum of activity, and use |
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Definition
moa: protein synthesis inhibitor
Spectrum: Staph, strep, enterococcus, resistant organisms
Use: should be strictly reserved to serious infections due to organisms resistant to other therapies
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Term
QUINUPRISTIN/DALFOPRISTIN
info: |
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Definition
MOA: protein synthesis inhibitor combo
Spectrum: staph, step, enter, resistant organisms, VRE
Use: should be reserved for serious infections |
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Term
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Definition
MOA: inhibits bacterial cell wall synthesis
Spectrum: gram-positive bacteria, including MRSA
Use: strictly reserved to serious infections |
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Term
Strictly reserved for serious infections |
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Definition
1. Linezolid
2. Quinupristin/dalfopristin
3.telavancin |
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Term
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Definition
Inhibits topoisomerases II (supercoil DNA) and IV (separates daughter from parent)
Inhibition of topoisomerases results in rapid and lethal cessation of DNA replication |
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Term
Mechanism of resistance of fluroquinolones |
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Definition
Efflux pump
gene mutation
permeability |
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Term
ciprofloxacin (cipro)
ofloxacin (floxin)
norfloxacin (norflox) |
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Definition
Second generation Fluoroquinolones
g- best |
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Term
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Definition
Third generation fluoroquinolones |
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Term
Moxifloxacin (avelox)
Gemifloxacin (factive) |
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Definition
Fourth generation fluoroquinolones
g+ best |
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Term
Fluoroquinolones- spectrum |
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Definition
Other bacteria:
-chlamydia
-legionella
-mycoplasma
-mycobacterium TB, Avium
-H. Pylori: with combo |
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Term
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Definition
best psuedomonal activity of quinolones, poor s. pneumoniae
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Term
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Definition
Better S. pneumoniae than cipro, but ledd than 4th generation
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Term
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Definition
best respiratory quinolones |
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Term
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Definition
UTI (pyelonephritis, cystitis, prostatitis)
Osteomyelitis due to gram -
CAP
M. tuberculosis
complicated gram- and anaerobic abdominal and gyn infections |
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Term
Overuse of quinolones in: |
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Definition
acute exacerbations of chronic bronchitis
chronic sinusitis
travelers diarrhea |
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Term
Adverse effects of quinolones: |
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Definition
limited in children under 18 and avoided in pregnancy
=bone/joint erosion in young animals
-gi problems
-cns -dizzy, headache |
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Term
Drug interactions of quinolones |
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Definition
chelation (dec absorption)
theophylline (cipro)
warfarin
avoid with meds that prolong QT interval |
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