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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?
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?
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?
Which aminoglycoside is used to fight pseudomonas?
Which aminoglycoside is a primary anti-TB drug?
Which aminoglycoside is least likely to induce resistance?
Which aminoglycoside is most nephrotoxic?
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?
What is vancomycin?
analogue of aminoglycoside, ototoxic, nephrotoxic, not absorbed, bacteriocidal
When should vancomycin be used?
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

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