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antimicrobials2 4-15-06


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Imipenem/cilastatin What is imipenem?
broad spectrum beta-lactamase-resistant carbapenem
Imipenem What do you always administer it with and why?
cilastatin -- it decreases inactivation of imipenem in renal tubules
Imipenem/cilastatin What do you use it for?
Gram pos cocci, gram neg rods and anaerobes (broad spectrum), drug o' choice for Enterobacter

the girl from Ipanema was a Broad, y era Enterita
Imipenem/cilastatin What bug is it the drug of choice for?
Imipenem/cilastatin What are its side-effects
GI distress, skin rash, seizures at high conc.

kid with skin problems getting nervous (upset stomach, shaking) when talking to girl from Ipanema
Vancomycin Is it bactericidal or bacteriastatic and why?
Bactericidal because it blocks cross linkage and elongation of peptidoglycan by binding D-ala D-ala protion of cell wall.
Vancomycin How does resistance to Vanco occur?
D-ala D-ala is replaced with D-ala D-lactate which vanco does not block
Vancomycin What is it used for?
Used for serious infection that is resistant to other drugs (e.g. gram pos multi-drug resistant organisms like S. aureus and C. difficile, methicillin resistant staph (MRSA))
Vancomycin What are the important toxicities of vanco?
generally NOT many problems except, Nephrotoxicity, Ototoxicity and Thrombophlebitis

*also red man syndrome, give with histamine to prevent
Vancomycin What can happen with rapid infusion of vanco?
Red man's syndrome. Diffuse flushing which can be controlled by pretreatment with anti-histamines and with slow infusion rate
Protein Synthesis Inhibitors Which drugs target bacterial protein synthesis by blocking the 30S unit vs 50S unit?
Buy AT 30, CELL at 50
Protein Synthesis Inhibitors What does AT stand for?
A = Aminoglycosides (streptomycin, gentamicin, tobramycin an damikacin. And T = Tetracyclines
Protein Synthesis Inhibitors What does CELL stand for?
C = Chloramphenicol, E= Erythromycin, L= Lincomycin and L= cLindamycin
Which of the Protein Synthesis Inhibitors are bactericidal?
Only the aminoglycosides are, the rest are bacteriostatic
Aminoglycosides Name some aminoglycosides?
Gentamicin, neomycin, amikacin, tobramycin and streptomycin

mean GNATS
Aminoglycosides How do these drugs work?
They inhibit formation of the initiation complex in mRNA translation
Aminoglycosides Why are they ineffective against anaerobes?
They require oxygen for uptake into bacteria
Aminoglycosides When would you use aminoglycosides?
against severe gram-negative rod infections
Aminoglycosides What drugs can you use aminoglycosides with for synergy?
the drugs that inhibit cell wall synthesis (e.g. penicillin and cephalosporins -- the beta-lactam antibiotics). Presumably this allows the drug to get in with out reliance on oxygen transport
Aminoglycosides What drug in this class is commonly used for bowel surgery?
Aminoglycosides What are the major toxicities?
Nephrotoxicity (esp w/ cephalosporins), Ototoxicity (esp w/ loop diuretics), Teratogen

mean GNATS canNOT kill anaerobes
Tetracyclines Name some tetracylcines
Tetracycline, doxycycline, demeclocycline, minocycline
Tetracyclines How does it work?
Blocks t-RNA attachment to 30S subunit
Tetracyclines Which tetracycline can you use in patients with renal failure and why?
Can use doxycycline because its elimination is fecal
Tetracyclines Should you take these drugs with a glass of milk?
NO, because it intereferes with absorption in the gut as does antacids and iron-containing preparations, or any divalent cations
Tetracyclines What are tetracyclines used for?
Toby, VACUUM THe Bed Room-- Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H pylori, Borrelia burgdorferi, Rickettsia
Tetracyclines What are the common toxicities
GI distress, teeth discoloration, inhibition of bone growth in children, Fanconi's syndrome and photosensitivity. Contraindicated in pregnancy
Macrolides Name some macrolides?
Erythromycin, azithromycin, Clarithromycin

EaZy was a Crip Mac
Macrolides How do these drugs work?
bind to 23S rRNA of 50S and inhibit translocation, bacteriostatic
Macrolides What are they used for?
URIs, pneumonias, STDs -- streptococcal in patients that are allergic to PNC --- Mycoplasm, Legionella, Chlamydia, Neisseria.

Eryc's Nipple's at the Mid Clavicular Line
Macrolides Pneumonic for macrolide use?
Eryc's Nipple is at his Mid Clavicular Line (Eryc is brand name for erythromycin, and eazy e's real name). Neisseria, Mycoplasm, Chlamydia, Legionella.
Macrolides What are the major toxicities?
GI discomfort, acute Cholestatic hepatitis, Eosinophilia, skin rashes
increases serum theophylines and oral anticoagulants

the Mac eazy E was a Gangsta Crip with bad Skin
Macrolides What is the most common cause for non-compliance to macrolides?
GI discomfort
Chloramphenicol How does this drug work?
inhibits 50S peptidyltransferase
Chloramphenicol Main use?
Meningitis (H. influenzae, N. meningitides, S. pneumo). Used conservatively b/c of toxicity
Chloramphenicol What are the main toxicities?
Anemia and aplastic anemia (both dose dependent), gray baby syndrome (in premes b/c they lack UDP-glucoronyl transferase)
Clindamycin How does it work?
blocks peptide bond formation at 50S

with CLINdamycin, the amino acids don't CLINk together
Clindamycin When do you use it?
Anaerobic infections (e.g. Bacteroides fragilis and C.perfringens)
Clindamycin Toxicities?
Pseudomembranous colitis, fever, diarrhea
Sulfonamides Name some sulfonamides
Sulfamethoxazole (SMX), sulfisoxazole, triple sulfa and sulfadiazine
Sulfonamides How does it work?
Inhibits bacterial folic acid synthesis from PABA by blocking dihydropteroate synthase.
Sulfonamides What are its uses?
Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas and SMX for simple UTIs
Sulfonamides Toxicities?
hypersensitivity rxn, hemolysis if G6PD deficient, nephorotoxicity (tubulointerstitial nephritis), kernicterus in infants, displace other drugs from albumin (e.g. warfarin)

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