Antimicrobials
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Created by:
m_s_c on March 24, 2012
Subjects:
usmle, microbiology, pharmacology
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48 terms
Terms | Definitions |
|---|---|
 Penicillin | Block cell wall synthesis Gram positives tox: allergy, hemolytic anemia |
| Methicillin, nafcillion, oxacillin, dicloxacillin | Penicillinase resistant "Use NAF for STAPH" Staph MET a NAsty Ox Only a matter of time - CLOX are oral S. aureus (not MRSA) tox: Allergic, Methicillin-interstitial nephritis |
| Ampicillin, amoxicillin | AMPed up Penicillins amOxicillin Oral Amp HELPSS kill enterococci H. influenza, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella tox: Hyper, Ampicillin rash, Pseudomembranous colitis Resis: Beta lactamases cleave ring |
| Ticarcillin, carbenicillin, pipercillin | Anti-pseudomonas Bond brings: Ticks, Car, and Pipe bomb to kill Pseudomonas TCP: Takes Care of Psedomonas tox: hsr |
| Beta lactamase inhibitors | the helper CAST Clavulanic Acid, Sulbactam, Tazobactam amox+clavulanate ticar+ clavulanate ampi+ sulbactam piper+tazobactam |
| Cephalosporins | Orgs not covered are LAME: Listeria, Atypicals (chlamydia, mycoplasma), MRSA, Enterococci Inhibit cell wall synthesis, less susceptible to penicillinases tox: hsr, vit K def, inc. nephrotoxicity of aminoglycosides, disulfiram-like rxn w/ ethanol, cross-hsr w/ penicillins Renal excretion |
| 1st Gen Cephalosporins | Gram Pos. PEcK: Proteus mirabilis, E. coli, Klebsiella pneumoniae PH in name: cephalothin, cephapirin, cephradine, cephalexin, cefazolin, cefadroxil |
| 2nd Gen cephalosporins | Gram pos cocci HEN PEcKS: H. influenzae, Enterobacter aerogens, Neisseria, Proteus mirabilis, E. Coli, Klebsiella pneumo, Serratia marcescens MMT side chain (cefamandole, cefmetazole, cefotetan) vit K, alcohol FAMily of FURry FOXes I MET drinks TEa ceFAMandole, ceFAclor, ceFURoxime, ceFOXitin, cefMETazole, cefoTEtan, cefonicid, loracarbef, cefdinir |
| 3rd gen cephalosporins | Ceftriaxone- meningitis and gonorrhea Ceftazidime- pseudomonas Serious gram neg infxns MMT side chain: cefoperazone (vit K & alc) |
| 4th gen cephalosporins | Cefepime- PINED for the 4th gen Inc act against pseudomonas and gram Pos. |
| Aztreonam | Inhibits cell wall synthesis IV or IM, Renal excrete Gram neg rods only (penicillin allergies) *magic bullet for gram negs tox: occ GI upset |
| Carbepenams Imipenam/ Cilastatin, Meropenam | Inhibits cell wall synth Gram pos cocci, gram neg rods, anaerobes "I'm a pen crossing out all bacteria" Limit to life-threatening/ resistant orgs tox: GI distress, skin rash, CNS toxicity (seizures) - renal excretion Meropenam: red risk of seizures |
| Vancomycin | Inhibits cell wall mucopeptide formation (D-ala D-ala) Gram pos- S. aureus, enterococci, C. diff tox: NOT many probs Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing "red man" syndrome (use antihistamines) Resistance: D-ala to D-lac |
| Protein synthesis inhibitors | CLEan TAG 50s: Chloramphenicol, Clindamycin, Linezolid, Erythromycin 30s: Tetracyclines, AminoGlycosides A |
| Aminoglycosides | Mean GNATS canNOT kill anaerobes Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin tox: Nephrotoxicity, Ototoxicity, Teratogen moa: inh initiation complex use: gram neg rod- synergy w/beta lactam neomycin- bowel surgery IV or IM (not oral) res: transferase enzymes inactivate |
| Tetracyclines | Dems stop bloating Demeclocycline- ADH antagonist (SIADH) tetracyclin, doxycycline, minocycline bind 30s, inhibit aminoacyl-tRNA RICK Cleans his BLEhMp use: rickettsia, chlamydia, Borrelia & Leptospira, M. pneumoniae, E. histolytica tox: GI distress, Photoxic Dermatitis, renal (Fanconi) & hepatotox Teratogen: Ca chelator efx bones and teeth dark |
| Macrolides | erhythromycin, azithromycin, clarithromycin Inhibit protein synth 50s subunit clin: Atyp pneumo (Myco, Legion, Chlam), URIs, STDs, gram+ cocci, Neisseria tox: prolonged QT, GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rash, Inc conc of anticoags & theophyllines resis: methylation of 23S rRNA binding |
| Chloramphenicol | Blocks 50s. bacterial static CHLORox turns SHiNs gray Meningitis "SHiN" (S. pneumo, H. influenza, N. meningitidis) tox: anemia, aplastic anemia, gray baby (40% fatal) res: acetyltransferase inact. drug |
| Clindamycin | blocks 50s, bacteriostatic Anaerobic (bacteroides, C. perfringens) in aspiration pneumonia or lung abscess "Clean above METRO below" tox: Pseudomembranous colitis (C. dif), fever, diarrhea |
| Sulfonamides | Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine moa: PABA, inh Dihydropteroate Synthetase clin: gram+, gram-, Norcardia, Chlamydia tox: hsr, Hemolysis if G6PD, Tubulointersitial nephritis, photosens, kernicterus (infants), displace rx albumin res: Altered enzyme, dec uptake, in PABA |
| TMP SMX | Trimethoprim/Sulfamethoxazole (Bactrim) TMP Smx Tree: resp tree: S. pneumo, H. influenzae (otitis media, sinusitis, bronchitis, pnumo) Mouth: GI tract, gram negs cause diarrhea, Shigella, Salmonella, E. coli Pee: GU tract, UTIs, prostatitis, urethritis by Enterics, N. gonorrhoeae, Chlamydia Syndrome: AIDS, prevent PCP w/CD4<200 |
| Trimethoprim | Inh bacterial Dihydrofolate Reductase TMP= Treats Marrow Poorly tox: megaloblastic anemia, leukopenia, granulocytopenia [treat w/ folinic acid] |
| Fluoroquinolones | Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin fluoroquinoLONES hurt BONE attachment Inh DNA Gyrase, not with antacids Gram-neg rods of GI and GU (inc Pseudomonas), Neisseria, some gram pos tox: GI sx, skin rash, cartilage, achilles tendonitis, headache, dizzy res: mutation DNA gyrase |
| Metronidazole | GET GAP on the Metro Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (bacteroides, C diff) H. Pylori moa: free radical toxic metabolites tox: rxn w/alcohol, headache, metal taste |
| Antimycobacterial drugs | TB treatment RIPE-Rifampin, Isoniazid, Pyrazinamide, Ethambutol Prophylaxis: M.Tuberculosis: Isoniazid M. avium-intercellulare: Azithromycin |
| Isoniazid (INH) | INH- Injures Neurons and Hepatocytes moa: dec synth mycolic acids tox: neurotox, hepatotox, lupus Pyroxidine(B6) can prevent tox |
| Rifampin | 4 Rs: RNA polymerase inh Revs up microsomal P-450 Red/orange body fluids Rapid resistance (if used alone) use: TB, meningococcal prophylaxis H. Influenza type B tox: minor hepatotox, inc P-450 |
| Pyrazinamide | Inh mycolic acid blocking Pyrazanamide TB tox: hyperuricemia, hepatotox |
| Ethambutol | Dec carb polymerization of cell wall, blocks arabinosyltransferase tox: Optic neuropathy (red-green color blindness) |
| Antimicrobial prophylaxis | Meningitis - Ciprofloxacin, rifampin, minocycline Gonorrhea- Ceftriaxone Syphilis- benzathine penicillin G recurrent UTIs: TMP-SMX Endocarditis w/procedures- penicillins |
| HIV prophylaxis | CD4<200: TMP-SMX *PCP CD4<100: TMP-SMX *PCP, toxoplasmosis CD4<50: Azithromycin *mycobacterium avium |
| Treat resistant bacteria | MRSA- vancomycin VRE- linezolid, streptogamins (quinupristin/dalfopristin) |
| Empiric therapy community-acquired pneumonia | outpatient: Macrolides inpatient: Fluoroquinolones ICU setting: Beta-lactam + (fluoroquinolones OR azithromycin) |
| Amphotericin B | "tears" holes in the fungal membrane moa: binds Ergosterol, pores clin: Serious Systemic mycoses cryptococcus, blastomyces, coccidioides, aspergillus, histoplasma, candida, mucor tox: 1. Nephrotoxic 2. Acute febrile rxn 3. Anemia 4. Phlebitis at IV site |
| Nystatin | "tears" holes in the fungal membrane moa: binds Ergosterol, pores Only topical- too toxic for systemic clin: "swish and swallow" oral candida Topical diaper rash or vaginal |
| Azoles | Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole, Voriconazole moa: inh p450 to convert lanosterol to ergosterol use: Systemic mycoses. Fluconazole: Cryptococcal meningitis in AIDS, Candidal infxns Ketoconazole: blasto, coccidioides, histo, candida, hypercortisolism Clotrimazole & Miconazole: topical fungal tox: N&V, anorexia, Hepatotoxic, Inh P450 causes: gynecomastia, impotence, dec sex drive & sperm |
| Flucytosine | Inh DNA synth- cytosine deaminase clin: systemic fungal w/ Amp B tox: N&V, diarrhea, bone marrow supp. |
| Caspofungin | Inh cell wall synth- Inh beta glucan clin: Invasive aspergillosis, Candida tox: GI upset, flushing |
| Terbinafine | Inh enzyme squalene epoxidase clin: Dermatophytoses esp onychomycosis (nails) tox: abnormal LFTs, visual probs |
| Griseofulvin | Inh microtubule func, disrupts mitosis clin: oral for superficial infxns, inhibits dermtophytes (tinea, ringworms) tox: Teratogen, carcinogen, confusion, headaches, inc p450 and warfarin metab |
| Chloroquine | Blocks plasmodium heme polymerase clin: Plasmodium species Mefloquine, Quinine (resistant) w/ Pyrimethamine/Sulfonamide tox: Retinopathy, G6PD hemolysis |
| Antiprotozoan drugs | Pyrimethamine: Toxoplasmosis or P. falciparum Suramin/Metarsoprol: Trypanosoma brucei Nifurtimox: T. cruzi Sodium stibogluconate: Leishmaniasis |
| Protease inhibitors | NAVIR (never) TEASE a proTEASE Protease cleaves HIV mRNA into func parts Ritonavir: Inh P450, inc other drugs tox: hyperglycemia, GI probs, lipodystrophy |
| NRTIs | Inh nucleotide binding to reverse transcriptase and terminate DNA. Need thymidine kinase to activate. ZDV prophylaxis and during pregnancy tox: bone marrow supp, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia (ZDV) |
| nNRTIs | Inhibit reverse transcriptase tox: bone marrow supp, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia (ZDV) |
| Integrase inhibitors | Raltegravir moa: Inh HIV integration into host chromosome- reversibly inh integrase tox: hypercholesterolemia |
| Antibiotics to avoid in pregnancy | Countless SAFe Moms Take Really Good Care Clarithromycin- embryotoxic Sulfonamides- kernicterus Aminoglycosides- ototoxicity Fluoroquinolones- cartilage, damage Metronidazole- mutagenesis Tetracyclines: color teeth, inh bone growth Ribavirin- teratogenic Griseofulvin- teratogenic Chloramphenicol- "gray baby" |
| Cephalosporins w/ MMT side chains | I MET a PER of MAN with MOXi for TEa with a hangover cefMETazole, cefoPERazone, cefaMANadole, lataMOXef, cefMenOXime, MOXalactam, and cefoTEtan, |
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