Flashcards in Allman - AG, Vanc, Linezolid, Dapt, Tig, Tele Deck (25):
Aminoglycoside Mechanism of action
- Binds to outer membrane of cell resulting in a rearrangement of LPS
- Taken up into the cell (energy dependent)
- Irreversibly trapped in bacterial cytoplasm
- Bind to 30S and 50S ribosomal subunits --> decreased protein synthesis and increased misreading of mRNA
After exposure to inhibitory concentrations of AMGs, continued killing continues.
Concentration dependent killing
Poorly absorbed from GI tract --> no oral form for a systemic infection
Lung concentrations only 25-50% of those IN SERUM (poor)
CSF = 20% with inflammation
Unchanged; ALL RENAL
Types of AMGs (4)
Which AMG is used ORALLY to wipe out gut flora?
2 most common adverse effects with AMGs?
Ototoxicity - 8th Cranial Nerve (peaks)
Nephrotoxicity -- (troughs)
AMG spectrum of activity
*ONLY synergy with gram positive organisms
*All Gram neg through SPACE
What type of AMG is reserved for TB and only available from the manufacturer?
AMG hartford nomogram dosing?
What is the benefit of individualizing dosages?
Vancomycin mechanism of action
Inhibits the biosynthesis of peptidoglycan polymers during cell wall formation
Bactericidal for multiplying organisms
Vancomycin spectrum of activity
All Gram + except VRE
*Good for MRSA when penicillin allergy present.
*Closely monitored by CDC to prevent resistance
Poorly absorbed in GI tract; Must by give via IV except for C Diff
CSF ONLY with inflammation
Unchanged; ALL RENAL
Vancomycin Adverse Effects
Red Man/Red Neck Syndrome
- Individually static, together tidal
- Both bind 50S (diff sites)
- GRAM +
- Infusion requires PICC Line or Central Line
- 23 S Ribosome
- Oral is 100% bioavailable (oral = IV)
- RESISTANT GRAM + (VRE, VISA)
*** Drug-Drug Interaction: SSRI bc Linezolid is an MAOI and together they cause a serotonin storm.
- Kitchen Sink
- Polymyxin E
- Great Gram - coverage (SPACE)
- last resort antibiotic for resistant bugs
- resistant UTIs
- MDR pathogens (MRSA, VRE, ESBL, SPACE)
- 1 dose (3 grams)
- GI upset
- skin infections
- NOT for bacteremia (doesn't get into blood well)
- tier 3 drug: high mortality?
- CRE (carbapenem resistant enterobacteria)
- Excellent Gram + coverage
- MRSA, VRE
- skin and soft tissue infections
- INACTIVATED BY LUNG SURFACTANT (NOT good for pneumonia)
- Side effect = rhabdomyolysis