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Flashcards in Antibiotics Deck (37):
1

Beta-lactams

Penicillins (natural, antistaphylococcal, extended-spec, and antipseudomonal)
Cephalosporins (1-5)
Carbapenems
Monobactams

2

Cell-wall synthesis inhibitors

beta-lactams (PBPs = no synthesis of stable cell wall), vanco (transglycosylase = prevent binding of peptidoglycans, bacitracin (interferes with transport across cell)
Bactericidal, time-dependent

3

Cell membrane disruption

polymyxin, daptomycin

4

Classes that inhibit protein synthesis

Tetracyclines (30S), macrolides (50S), and aminoglycosides (30S - bactericidal)

5

Classes that inhibit nucleic acid synthesis

RNA polymerase inhibitor - rifampin
DNA replication inhibitor - Fluoroquniolones (cirpfloxacin)

6

Classes that inhibit folic acid synthesis

Trimethoprim and sulfonamides (sulfamethoxazole)

7

Streptococcus treatments

Penicillin V
Amoxicillin
Cephalexin
Amoxicillin+clavulanic acid

Allergy to beta-lactam: azithromycin, clarithromycin, clindamycin

8

MSSA treatments

Nafcillin
Oxacillin
Dicloxacillin
Cephalexin
Amoxicillin+clauvulanic acid
3rd gen cephalosporins for severe infections

Allergy to beta-lactams: azithromycin, clarithromycin, clindamycin

9

MRSA treatments

Ceftaroline (moderate)
Vanco (severe)
Dapto (severe)
SMX/TMP (mild-moderate)
Doxy (moderate)
Minocycline (moderate)
Clindamycin (moderate)
Linezolid (severe)

10

Extended spectrum penicillins treat these gram-

Haemophilus influenzae
Heliobacter pylori
Escherichia coli
Listeria monocytogenes
Proteus mirabilis
Salmonells
Shigells
Enterococci
(HHELPSSE)

11

Superinfection

-Broad-spectrum antibiotics (frequent: extended-spec penicillins, cephalosporins, clindamycin, fluoroquinolones; occasionally: TMP/SMX, macrolides)
-organisms: Clostridium difficile (pseudomembranous colitis), Staphylococcus aureus (entercolitis), candida albicans (vagina and mouth infections)

12

Activity of cephalosporins moving from 1st to 4th gen

Increasing activity against g-, beta-lactamase, pseudomonas, anaerboes; increasing ability to cross BBB

13

1st gen cephalosporins

-Cephalexin, cefazolin
-g+ (staph and strep, PEcK - proteus mirabilis, E.coli, and Klebsiella pneumoniae
-UTI
-SSTI caused by staph and strep like cellulitis or abscess

14

Vancomycin use

MRSA, Enterocolitis, C. diff, enterococci

15

Vanco adverse effects

Nephrotoxicity
Ototoxicity
Thrombophlebitis
Red man syndrome - histamine release (pre-treat with anti-histamine and slow infusion rate)

16

Vanco resistance

D-ala-D-ala to D-ala-D-lactate

17

Dapto clinical use

Staph aureus (including MRSA), enterococcus faecalis and faecium, strep pyogenes (GAS)

18

Dapto major side effects

Myopathy (elevated CK)

19

Spectrum of polymyxins

g- (mostly aerobes - pseudomonas)

20

Clinical use of polymyxins

Significant toxicity with systemic use so topical; systemic use limited to serious infections

21

Side effects of polymyxin

Nephrotoxicity and neurotoxicity

22

SMX and TMP MOA

p-Aminobenzoic acid converted to dihydropteroic acid via dihydropteroate synthase (inhibited by sulfonamides); dihydropteroic acid converted to dihydrofolate via dihydrofolate reductase (inhibited by trimethoprim)

23

SMX/TMP clinical use

-MSSA and mild-moderate MRSA
-UTI
-respiratory tract infections (H. influenzeae, strep pneumoniae - increased resistance)
-enterocolitis (shigella)
-traveler's diarrhea (E. coli and shigella)
-otitis media

24

SMX side effects

Allergies (fever, nausea, vomiting, diarrhea, rash, dermatitis, Steven Johnson syndrome); hematological disorders (megaloblastic anemia, leukopenia, granulocytopenia, thrombocytopenia, hemolytic anemia in pt with G6PD deficiency)

25

Side effect unique to SMX

kernicterus in newborns (drug displaces bilirubin from albumin>>free bilirubin deposist in basal ganglia and subthalamic nuclei>>encephalopathy

26

Tetracyclines MOA

Bind to 30S of bacterial ribosome, blocking access of aminoacyl-tRNA to mRNA-ribosome complex

27

Clinical use of tetracyclines

MRSA, anthrax, mycoplasma pneumonia, chlamydia, rickettsiae, Lyme, GI

28

Tetracyclines side effects

GI distress, photosensitivity, discoloration of teeth in children, inhibition of bone growth in children (tetracycline binds to Ca)

29

Macrolides MOA

Binds to 50S to inhibit peptide transfer

30

Macrolides clinical use

Substitute for penicillins, strep and staph (not MRSA), more on g-

31

Major side effects of macrolides

MACRO
gi Motility
Arrythmia
acute Cholestatis hepatitis
Rash
eosinOphilia

32

Clindamycin MOA

50S subunit

33

Clindamycin clinical use

strep and staph; anaerobic infections

34

Side effects of clindamycin

Fever, diarrhea, superinfection: pseudomembranous colitis

35

Linezolid MOA

50S

36

Clinical use of linezolid

broad g+
MRSA
VRE

37

Side effects of linezolid

bone marrow suppression (thrombocytopenia, anemia, neutropenia), optic and peripheral neuropathy, serotonin syndrome when administered with SSRIs