Antibiotic Pharm
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- What are the 6 bactericidal cell wall lysers?
- "BIC PEN VANQUISHES" - Bacitracin, Isoniazid, Cycloserine, PENicillins and cephalosporins VANcomycin
- What are the 2 bacteriostatic anti-folic acid synthesis drugs?
- "TRIM PRIM SULFA" - TRIMethoPRIM SULFAmethoxadole
- What are the 3 classes of drugs?
- replacement therapy, magic bullets/cruise missiles, poisons & stimulants
- What are the 2 penicillinase fighters?
- clavulanic acid and sulbactam
- What are the drugs augmentin and timentin?
- augmentin=amoxicillin + clavanulate; timentin=ticarcillin + clavulanate
- What is unasyn?
- "USA": Unasyn=Sulbactam + Ampicillin
- What are the 2 cocci that produce penicillinase?
- staphylococcus and gonococcus
- What is cilastatin
- used in combination with imipenem; inhibits renal dihydropeptidase to reduce renal excretion and renal damage
- What is probenecid?
- blocks renal ampicillin loss; rarely used, competes with penicillin and cephalosporin for organic ion transport system
- What are the 3 "generations" of penicillins according to Youel?
- 1. basic penicillins; 2. penicillinase resistant penicillins; 3. broad spectrum penicillins
- What are the characteristics of the basic penicillins?
- 1. beta lactamase sensitive; 2. relatively narrow spectrum; 3. inexpensive
- Basic penicillins are the DOC for what bugs?
- streptococcus pyogenes, s. pneumoniae, spirochetes
- What makes aminopenicillins different?
- They can slip through the outer membrane of some gram - bacilli such as E. coli and Proteus
- What is the DOC for beta-hemolytic streptococcal pharyngitis?
- penicillin VK
- What is the DOC for subacute bacterial endocarditis caused by s. viridans?
- penicillin G aqueous
- What is the DOC to prevent the recurrence of rheumatic fever?
- penicillin G benzathine
- What are the characteristics of the penicillinase resistant drugs?
- 1. extremely narrow spectrum; 2. work well primarily against penicillinase-secreting staphylococci; 3. expensive
- What toxicity is caused by methicillin?
- allergic nephritis
- How do the penicillinase-resistant drugs work?
- attachment of bulky group to block beta-lactamase grip
- List the penicillinase-resistant drugs.
- methicillin, nafcillin, oxacillin, cloxacillin, dicloxacillin
- How is Methicillin administered?
- intraMuscular
- How is DiclOxicillin given?
- Definitely Oral
- What are the characteristics of the broad spectrum penicillins?
- 1. extended spectrum; 2. beta-lactamase sensitive; 3. expensive; 4. work against most gram - rods, including the slime monster pseudomonas.
- What are the broad spectrum penicillins?
- CAMP TIC: Carbenicillin, Azlocillin, Mezlocillin, Piperacillin, TICarcillin
- What is the problem with carbenicillin?
- leads to renal potassium loss, causing hypokalemic alkalosis
- Which valve does streptococcus viridans like to vegetate?
- mitral valve
- What can you get from penicillin allergies?
- "SNEAR": Serum sickness, Nephrotoxicity, Exfoliative dermatitis, hemolytic Anemia, maculopapular Rash
- How are penicillins and cephalosporins different?
- cephalosporins are more likely to kill staphylococci
- How are cephalosporins and penicillins similar?
- bacteriocidal, attack a microscopic part of cells that mammalian cells lack
- What do 1st generation cephalosporins cover?
- most effective against strep, gram +
- What do 2nd generation cephalosporins cover?
- G+ and some G- rods
- What do 3rd generation cephalosporins cover?
- most gram - rods, less effective against staph aureus and streptococcus than 1st and 2nd generation cephalosporins
- What generation cephalosporins is good for bacteroides?
- 2nd generation cephalosporins
- How do you treat pelvic inflammatory disease?
- ceftriaxone to kill neisseria gonorrhea and doxycycline for chlamydia
- What are the 6 first generation cephalosporins?
- "unFAZed, the RAD sLOTH reads, rights, and takes aspirin": cefazolin, cephradine, cephalothin, cephalexin, cephadroxil, cephapirin.
- What are the 7 2nd generation cephalosporins?
- "I MET a MAN FOND of FOX FUR with a TEA TAN FACE": cefmetazole, cefamandole, cefonicid, cefoxitin, cefuroxime, cefotetan, cefaclor
- What are the 7 3rd generation cephalosporins?
- "TRY to pay your TAX, TAZ. TIZ not PERsonal or a MOCKery": ceftriaxone, cefotaxime, ceftazidime, ceftizoxime, cefperazone, moxalactam, imipenem-cilastin
- What are the 3 2nd generation cephalosporins good against anaerobes like bacteroides fragilis?
- "the FOX MET the anaerobe for TEA": cefotetan, cefoxitin, cefmetazole
- What is the disulfiram reaction and what drugs can cause it?
- nausea, vomiting, death when taken with alcohol; can occur with sulfas and cephalosporins
- When are sulfas contraindicated?
- pregnancy, newborns, and nursing mother
- What is the main action of the sulfa drugs?
- block folic acid synthetase; good because mammalian cells don't have or need folic acid synthetase
- What are bactrim and septra?
- 1-2 combo of folic acid synthesis blockers: sulfamethoxazole+trimethoprim
- How do sulfas cause kernicterus in newborns?
- sulfa displaces unconjugated bilirubin from serum albumin, the bilirubin can pass through the perinatal meninges and cause lasting damage to the development of the basal ganglia
- What are potential urinary complications with taking sulfas?
- crystaluria can occur if sulfa is given with acidic urine (pH<5.0)
- Which antibiotics inhibit protein synthesis by anti-ribosomal action?
- "I SAT (30S) on a big MACC! (50S)": Spectinomycin, Aminoglycosides, Tetracyclines, Macrolides, Azalides, Clindamycin/Lincomycin, Chloramphenicol
- What are the 8 aminoglycosides?
- gentamycin, tobramycin, streptomycin, amikacin, netilmicin, kanamycin, neomycin, paromycin
- What's the most widely used aminoglycoside?
- gentamycin
- Which aminoglycoside is used to fight pseudomonas?
- tobramycin
- Which aminoglycoside is a primary anti-TB drug?
- streptomycin
- Which aminoglycoside is least likely to induce resistance?
- amikacin
- Which aminoglycoside is most nephrotoxic?
- neomycin
- Which of the 30s anti-ribosomals are bacteriocidal, bacteriostatic?
-
spectinomycin, tetracycline: bacterioSTatic
aminoglycoside: bacteriocidal - What's the best use for aminoglycosides?
- gram negative bacilli, used in conjunction with cell wall lysers
- What are the main side effects of the aminoglycosides?
- ototoxicity, nephrotoxicity, neuromuscular block
- What are 4 key characteristics of aminoglycosides?
-
Aerobes only
Absorption is poor
Access to CNS is poor
Activity prolonged due to poor absorption
ie. use with aerobic bacteria, infection outside of CNS, good renal function - When should tetracyclines be used?
-
"tetra" = 4: BORes CRaM
BRUCe VIBrates
(Borrelia, Brucella, Vibrio cholerae, CRaM creatures) - When is spectinomycin used?
- used only against Neisseria gonorrhea
- Is there ototoxicity or nephrotoxicity associated with spectinomycin?
- NO!
- What is vancomycin?
- analogue of aminoglycoside, ototoxic, nephrotoxic, not absorbed, bacteriocidal
- When should vancomycin be used?
-
Rarely!
1. gram + septicemia, especially in penicillin resistant bug or penicillin allergic patient
2. pseudomembranous colitis - What toxicity is associated with vancomycin?
- red man syndrome: prostaglandin outpouring, profound flushing, pruritis, not dangerous
- What is the major macrolide? When is it used and what is the toxicity?
-
1. erythromycin
2. group A strep pharyngitis, non-enteric gram - rods except H. influenza
3. GI intolerance - What are the 2 azalides?
- azithromycin, clarithromycin
- The azalides are the DOC for what bugs?
-
azithromycin: same as erythromycin and includes anaerobes
clarithromycin: Helicobacter pylori, Mycobacterium avium - What is clindamycin/lincomycin used for?
- same as erythromycin (group A strep pharyngitis) AND bacteroides
- When is chloramphenicol used?
- kills most clinically important bacteria: gram +, gram -, anaerobes (incl. bacteroides)
- What are the toxic effects of chloramphenicol?
- bone marrow suppression, aplastic anemia, Gray Baby Syndrome
- Which antibiotics can be used to kill Pseudomonas aeruginosa?
- "PIC The FOX": piperacillin, imipenem, ciprofloxacin, tobramycin + piperacillin/ceftazidine, cefoxitin