ABX 1

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31 terms · welcome to hell

List the classes of PCNs

natural
anti-staph
amino pcns
augmented amino pcns
extended spectrum

PCN pharmacology

most renal excretion except for nafcillin
time-dependant killing
bacteriocidal
coverage: natural and anti-staphy = good G+
as generation inc. less G+ and more G-

PCN ADRs

hypersentivity rxn
drug fever
cytopenias
neurotoxicity
***Phlebitis, intersitial nephritis, and hypokalemia possible with nafcillin

PCN G

natural PCN, IV
covers: strep pharyngitis/cellulitis
various stages of syphilis

PCN V

natural PCN, PO
covers: strep pharyngitis/cellulitis
various stages of syphilis

Procaine PCN

natural pcn, IM, short acting
covers: strep pharyngitis/cellulitis
various stages of syphilis

Benzathine

natural pcn, IM, long acting
covers: strep pharyngitis/cellulitis
various stages of syphilis

nafcillin

anit-staph pcn, IV
tx: SSTIs (esp S. aureus)
-MSSA, S. pyogenes

dicloxacillin

anti-staph pcn, PO
tx: SSTIs (esp S. aureus)

ampicillin

aminoPCN, IV
TX: URTIs (pharyngitis, AOM, sinusitis)
endocardidits prophylaxis for dental procedures
lyme dx (kids <8)

amoxicillin

amino PCN, PO
X: URTIs (pharyngitis, AOM, sinusitis)
endocardidits prophylaxis for dental procedures
lyme dx (kids <8)

ampicillin/sulbactam

augmented amino PCN, IV
covers more bugs
TX: animal/human bite
-amoxicillin failure URTs
-dental infections

amoxicillin/clavulanate

augmented amino PCN, PO
covers more bugs
TX: animal/human bite
-amoxicillin failure URTs
-dental infections
**too much clavulanate=diarrhea!!

piperacillin/tazobactam

extended-spectrum PCN, IV
TX: mostly nosocomial infecitons
-most anaerobes
-GPC (like enterococci), GNB

Cephalosporins to know

cephalexin, cefazolin
cefuroxime
cefpodoxime, ceftriaxone
ceftazidime, cefepime
ceftaroline

Cephalosporine Pharmacology

MOA: arrest cell wall synthesis by binding to PBPs (B-lactam)
**bact. must be dividing for these to work
MOR: same as PCNs
most renal exretion (except ceftriaxone)
time-dependent killing
bacteriocidal
Coverage: 1st and 2nd gen. good G+; as inc gen. lose G+ and gain G- (except 5th gen.)
*NO CEPHALOSPORIN COVERS LISTERIA OR ENTEROCOCCI***

Cephalosporin ADRs

hypersentivity rxn (rash->immediate anaphylaxis)
-drug fever
-cytopenias
-serum sickness like rxn with cefaclor
**Ceftrixone &Neonates: biliary sludging (pseudocholelithiasis); may precipitate Ca-> goes to lungs (use cefotaxime instead, it is the preggers version)

cephazolin

1st gen. cefalosporin, IV
-GAS> MSSA
-some E. coli, Klebsiella, Proteus
TX:
*SSTIs
*Perioperative prophylaxis
strp phryngitis
lower UTI (cystitis)

cephalexin

1st gen. cefalosporin, PO
-GAS> MSSA
-some E. coli, Klebsiella, Proteus (alk. urine)
TX:
*SSTIs
strep phryngitis
lower UTI (cystitis)

cefuroxime

2nd gen CS, PO and IV *RESPIRATORY CEPHALOSPORIN
="augmentinish"
same as 1st GEN+ S. pneumoniae, M. cat, H. flu (the ones that make B-lactamases)
TX: *amoxicillin failure URTIs (AOM, sinusitis, AE-COPD)
-SSTIs
-Lower UTIs
*good against B-lactamase

ceftriaxone

3rd gen CS, IM, IV
PRESCRIBED A LOT
Covers: most wimpy GNB (e. coli, klebsiella, proteus, m. cat, H. flu)
some GPC (S. pneumo, most other strep)
TX: *CAP (with azithromycin)
*Meningitis
*Gonorrhe (with azithroymycin)
refractory AOM

cefpodoxime

3rd gen CS, PO
approved for single oral therapy for gonorrhea
*essentially the same coverage a cefuroxime:
TX: *amoxicillin failure URTIs (AOM, sinusitis, AE-COPD)
-SSTIs
-Lower UTIs

ceftazidime

4th gen CS, IV
-resistant GNB (Pseuomonas, Enterobacter, Serratia)
TX: mostly nosocomial infections (not MRSA)

cefepime

4th gen CS, IV
-resistant GNB (Pseuomonas, Enterobacter, Serratia)
-better S. pneumo and enterobacter coverage than ceftazidime
TX: mostly nosocomial infections (not MRSA)

ceftaroline

5th gen CS, IV
"ceftriaxone with MRSA activity"
*doesn't have strong GNB as expected
1st CS with any MRSA coverage
MOA: stong affinity for PBP2a and PBP2x (the modified PBP in MRSA and S. pneumoniae respectively)

aztreonam

monobactam, IV
MOA, MOR, phamacology, & ADRs same as other B-lactams
TX: resistant G- aerobes, mostly nosocomial infections (like pseudomonas)
Doesn't cover any G+ or anaerobes
-OK for use if anaphylactic rxn to PCNs (unless ceftazadime)
*typically used in those with lots of drug allergies

imipenem/meropenem/doripenem

pseudomonal carbapenems, IV
MOA, MOR, Pharm, & ADRs similar to other B lactams
TX: complicated infections, resistent: GNBs, MDR GNB, ESBL GNB, including pseudomonas
**doesn't cover MRSA, VRE, C. diff

ertapenem

non-pseudomonal carbapenem
MOA, MOR, Pharm, & ADRs similar to other B lactams
TX: complicated infections, resistent: GNBs, MDR GNB, ESBL GNB
**doesn't cover MRSA, VRE, C. diff

vancomycin

glycopeptide, IV, PO
MOA: inhibits cell wall synth
MOR: alterations in the binding site
Pharm: conc. dependent killing; no oral absorption of PO formula (*good for C. diff); bactericidal; renal excretion
TX: PO=CDI
IV= MRSA; MSSA, various strep, enterococci if PCN allergies
Dosing: troughs @ 10-20mcg/ml (15-20 if serious)
*15mg/kg for most (20 if life threatening); comes in 1 g vial so usually give 1000mg
-q12 if normal; q8 if young; q24-72 if AKI/CKD
-mesure trough before 4th dose--> adjust
ADRs: red man>>nephrotoxicity>>ototoxicity

daptomycin

cyclic lipopeptides, IV
MOA: destabilize cell membranes
PHARM: overlapping toxicity with statins/fibrates; renal excretion, conc. dependent bactericidal
ADRs: myopathy
TX: MRSA and VRE (can't use in resp infections cause surfactant absorbs it)

telavancin

lipoglycopeptide, IV; =IV vancomycin
MOA: dual; inhibits cell wall syn & cell membrane fcn
PHARM: conc. dependent killing
Black box waring: women need preg. test before
ADRs: *Foamy urine, taste disturbance, QTc prolongation, renal dysfcn
TX: cSSSI from susceptible G+ like MRSA
use as alternative to linezolid, daptomycin, tigecycline, or ceftaroline

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