Term
|
Definition
| Pen VK (oral); pen G (IV), pen G procaine or benzathine (IV/IM) |
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Term
|
Definition
| gram-positive (except Staph), non-bacteroides anaerobes, +/- gram-negatives |
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Term
|
Definition
| strep. infections (otitis media, pharyngitis, meningitis and skin infections); STDs (syphilis +/- gonorrhea)- pen G procaine and pen G benzathine increase compliance- big syringes IM ceftriaxone and 1 g Azithro; increasing incidence of pen-resistant S. pneumoniae (PRSP)- pen-producing N. gonorrhea (PPNG)- 50% of gonorrhea |
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Term
|
Definition
| will enhance PCN blood levels (20 min half life) |
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Term
| Penicillinase resistsant PCNs (or anti-staphylococcal PCNs) |
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Definition
| dicloxacillin (oral); nafcillin = oxcillin (IV) |
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Term
| anti-staphylococcal PCNs Indications |
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Definition
| primary is Staph infections (cellulitis, sepsis, pneumonia +/- UTIs), empiric therapy for bacterial endocarditis |
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Term
| anti-staph PCNs Acitivity |
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Definition
| enhanced to cover Staph (PCNase producing)- especially in drug users |
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Term
|
Definition
| amoxicillin (PO), ampicillin (IV) |
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|
Term
| amino-penicillins activity |
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Definition
| broader coverage against gram - bugs (e. coli, klebsiella and haemophilus) but like the natural they are inactivated by PCNases (no good against Staph)- wimpy gram - |
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Term
| amino-penicillins indications |
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Definition
| upper resp. tract infections like otitis media and sinusitis, pharyngitis; amoxicillin extensively used for pediatric infections, especially respiratory |
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|
Term
| has an increased tendency to cause diarrhea |
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Definition
|
|
Term
| hepatically eliminated and doesn't require renal adjustment |
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Definition
|
|
Term
| preferred over ampicillin for oral therapy (40% H. flu (+) beta lactamase) |
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Definition
|
|
Term
| help stabilize b-lactamase enzymes (Augmentin and Unasyn) |
|
Definition
| beta-lactamase inhibitor combos |
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|
Term
| can overcome some strains of PRSP |
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Definition
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Term
|
Definition
| Hospital acquired gram -; Piperacillin > mezlocillin> ticarcillin > carbenicillin; single agents mostly obsolete- replaced by piperacillin/tazobactam (Zosyn) |
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|
Term
| antispeudomonal PCNs indications |
|
Definition
| serious gram negative infections (sepsis, pneumonia, abdominal infections, osteomyelitis); hospital acquired infections, especially Pseudomonas |
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|
Term
| Anti-Pseudomonal Reactions |
|
Definition
| sodium content of Ticar/Carbenicillin may cause a problem in CHF patients |
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Term
|
Definition
| inhibition of cell wall synthesis which results in membrane lysis |
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Term
|
Definition
| inhibition of cell wall synthesis which results in membrane lysis |
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|
Term
|
Definition
| in general, as you move from 1st to 3rd generation you gain greater gram negative coverage at the expensve of gram positive coverage; exception: 4th generation- cefipine |
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|
Term
| cephalosporins adverse reactions |
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Definition
| generally well tolerated; about 10% of pts allergic to PC are cross-reactive to cephs; the ones with 3 methyl thiotetrazole componenet may predispose pts to bleeding abnormalities or cause a disulfiram reaction |
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|
Term
| cephalosporins: except for cefoperazone |
|
Definition
| are renally eliminated: may need to adjust in renal dysfunction |
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|
Term
| only parenteral agent used for the 1st gen cephs |
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Definition
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|
Term
| stand alone 2nd gen: no anaerobic activity like other 2nd gen cephs, available an oral form (Ceftin) for step down therapy after IV |
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Definition
|
|
Term
| 3rd gen ceph with the longest half life of all cephs (dosed once daily) |
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Definition
|
|
Term
| efficient at crossing the blood brain barrier into the CSF (meningitis) |
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Definition
|
|
Term
| tend to be the primary workhorses of the 3rd gen cephs |
|
Definition
| ceftriaxone and cefotaxime |
|
|
Term
| preferred cephalosporin for Pseudomonas infections |
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Definition
|
|
Term
| 1st generation cephalosporins |
|
Definition
| Anti-staph PCN- Cefazoline only real 1st gen |
|
|
Term
|
Definition
| primarily gram positive (including Staph) but not enterococci. also active against wimpy gram - bugs (e. coli, klebsiella, proteus) |
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|
Term
| 1st gen cephs indications: |
|
Definition
| widely used for surgical prophylaxis; cellulitis and other skin infections, susceptible gram + infections, strep infections (OM, pharyngitis, meningitis, skin infections) |
|
|
Term
| 2nd gen cephs (kind of forgotten)Activity |
|
Definition
| increased against gram negative bugs (Haemophilus, enterocbacter, Neisseria and anaerobes) |
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|
Term
| 2nd gen cephs indications |
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Definition
| 2 primary types: those with anaerobic activity (most of the agents)- replaced by Zosyn; those without anaerobic activity (cefuroxime), but good activity for respiratory infections - few that are available IV and oral, replaced by levofloxacin; Outside of surgical prophylaxis these agents are not used very often |
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|
Term
| 3rd generation cephs- Anti PS PCN |
|
Definition
| most active against stubborn gram negative organisms such as Pseudomonas, Serratia, Providencia, Citrobacter, Acinetobacter |
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|
Term
| 3rd gen cephs indications |
|
Definition
| 1. cefotaxime or cceftriaxone and 2. ceftrazidime. double therapy; primarily used in hospital-acquired infections involving gram - bugs; serious gram - infections such a sepsis, pneumonia, meningitis; infections caused by organisms resistant to 1st and 2nd gen; empiric therapy until cultures are known; ceftriaxone IM as a single dose for treating STDs |
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|
Term
| 4th generation cephalosporins- cefepime- similar to Zosyn |
|
Definition
| touted as having the same activity of 3rd gen cephs without losing the gram + activity typically seen with the 1st gen cephs |
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|
Term
|
Definition
|
|
Term
| patients who are allergic to beta lactams shouldn't be with these |
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Definition
|
|
Term
|
Definition
| inhibition of cell wall synthesis |
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|
Term
|
Definition
| Imipenem/Cilastatin (Primaxin); Meropenem (Merrem); Ertapenem (invanze)- all are IV |
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|
Term
|
Definition
| the BROADEST SPECTRUM abx currently available. Active against anerobes, gram + cocci (including enterococcus) and gram - organisms (including pseudomonas) --- covers a lot of things but not very deep |
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Term
|
Definition
| excellent for empiric coverage pending culture results- then need to fine tune therapy; used in situations where several bacteria are involved in the infection; used in severe infections resistant to other agents |
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|
Term
| carbapenems adverse reactions |
|
Definition
| pseudomembraneous colitis and superinfection are common problems because it can kill good bacteria also; seizures (beta lactam like abx) may also occur with large doses and prolonged treatment |
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|
Term
| carbapenem 1:1 combination to avoid inactivation by renal dipeptidases |
|
Definition
| with cilastatin (enzyme inhibitor) |
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Term
|
Definition
| bactericidal agents that inhibit DNA gyrase. New MOA |
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Term
|
Definition
| ciprofloxacin, levofloxacin, moxifloxacin (most IV and oral) |
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|
Term
|
Definition
| older agents have good activity against gram negative bugs and are fairly active against gram positive bugs (exception: cipro has poor coverage against strep pneumoniae); newer agents have enhanced gram + activity but cover gram - to a lesser extent |
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|
Term
| referred to as the pneumococcal quinolones |
|
Definition
| gatifloxacin, moxifloxacin, gemifloxacin |
|
|
Term
| referred to as the respiratory quinolones |
|
Definition
| levofloxacin, moxifloxicin |
|
|
Term
|
Definition
| treating pneumonia, bone and joint infections, prostatitis, cellulitis, UTI's and infectious diarrhea; newer agents target CAP; follow up oral therapy for infections requiring prolonged antimicrobial therapy; become popular agents for empiric therapy |
|
|
Term
| one of the few studied drugs used for the treatment of anthrax |
|
Definition
|
|
Term
| Quinolones Adverse Reactions |
|
Definition
| generally well tolerated; mild SE include GI complaints, CNS problems, glucose control; some have been limited due to phototoxicity, hepatotoxicity, cardiovascular side effects |
|
|
Term
| not approved for use in pediatric patients- used for cystic fibrosis |
|
Definition
|
|
Term
| Macrolides: Old- Erythromycin |
|
Definition
| Inhibition of protein synthesis |
|
|
Term
|
Definition
| Erythromycin (PO and IV), Clarithromycin (Biaxin oral), Azithromycin (Zithromax oral and IV) |
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|
Term
|
Definition
| used primarily for gram + cocci and bacilli, particularly in community acquired infections that may involve "atypical" bacteria. Little activity against hospital acquired gram - |
|
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Term
|
Definition
| community acquired respiratory infections (atypical organizms: Mycoplasma, Chlamydia, Legionella) |
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|
Term
|
Definition
| 1000 mg dose x 1 for STDs |
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|
Term
|
Definition
| for MAC infections in HIV |
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|
Term
| Macrolides Adverse Reactions |
|
Definition
| biggest problem with erythromycin is GI disturbances (nausea, vomiting, diarrhea); IV erythromycin can cause severe pain-- thrombophlebitis; clarith (1 g doses) can cause metallic taste |
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|
Term
| can interfere with metabolism of many drugs; common alternative of penicillin allergy |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| astemizole/terfenadine/cisapride |
|
|
Term
|
Definition
| longer half-life and better GI profile |
|
|
Term
| Aminoglycosides: Gram - IV |
|
Definition
| Bactericidal agents that inhibit protein synthesis |
|
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Term
|
Definition
| gentamicin, tobramycin, amikacin, streptomycin (IV agents); neomycin (oral) |
|
|
Term
|
Definition
| excellent activity against gram - organisms, including pseudomonas (tobra > gent). Limited usefulness for gram + but gent is frequently used for synergistic activity vs. Enterococcus |
|
|
Term
| Aminoglycoside Indication |
|
Definition
| frequently used for hospital-acquired gram - infections involving the more stubborn gram - rods; pneumonias, sepsis, UTI/pyelonephritis, meningitis, osteomyelitis; neomycin (oral) is used to prep the bowels for surgical procedures (Selective decontamination) |
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|
Term
| Aminoglycosides Adverse Reactions |
|
Definition
| most feared ADR is nephrotoxicity and oto/vestibular toxicity |
|
|
Term
| primary agents; amikacin is usually reserved for refractory/resistant infections |
|
Definition
| gentamicin and tobramycin |
|
|
Term
| need for pharmacokinetic monitoring for optimal effect and reduced toxicity; nephrotoxicity is reversible upon discontinuing therapy, oto/vestibular is irreversible; once daily dosing approach- short txt courses/still need to monitor |
|
Definition
|
|
Term
|
Definition
| inhibition of cell wall synthesis (at a step prior to beta-lactams), also believed to have additional mechanisms (direct effect on membrane and inhibition of RNA synthesis) |
|
|
Term
|
Definition
| limited to ONLY gram + organisms, including MRSA; reserved for serious resistant gram + infections; infections in pts with life-threatening penicillin allergies (anaphylaxis); second line agent for C diff. |
|
|
Term
| Vancomycin Adverse Reactions |
|
Definition
| potential for nephro and ototoxicity exists (espc if used w/ aminoglycosides); phlebitis and Red Mans Syndrome- purity and rate-related ADR |
|
|
Term
| pharmacokinetically monitored agent- 10-15 mg/kg w/ trough of 5-10 mg/L; daily dosing due to long half life- NOT the pharmacodynamic principles used for gent |
|
Definition
|
|
Term
|
Definition
| incorporates both PK data and microbiology data (MIC) |
|
|
Term
| Concentration-dependent killing: Peak looks at y axis |
|
Definition
| more is better. Bacterial kill is related to dose. Higher the cmax (peak) = better kill. Aminoglycosides- once daily (extended dosing) |
|
|
Term
| Concentration independent (Time-dependent) killing: looks at x axis |
|
Definition
| key issue is time that the concentration is above the MIC (T>MIC) - beta lactams |
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