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?: Enterobacter
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?: Neomycin
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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