Pharmacology 3

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Antibacterials

Ampicillin used to tx

urinary tract infections and gram negatives
given w/ sulbactam = Unasyn (IV)

Augmentin

amoxicillin and clavulanic acid
beta lactamase inhibitor

Timentin

Ticarcillin and clavulanic acid
beta lactamase inhibitor

Beta lactamase inhibitors

clavulanic acid, sulbactam and tazobactam

penicillinase resistant penicillins

oxacillin, methicillin, nafcillin, and dicloxacillin
used to determine resistance in lab

Piperacillin

Antipseudomonal penicillin
also ticarcillin

1st gen cephalosporin

cephalexin and cefazolin
cellulitis prophylaxis before surgery

2nd gen cephalosporins

cefuroxime, cefoxitin
S. pneum and H. influ

3rd gen cephalosporins

ceftriazone, cefotaxime
multidrug resistan gram - and nosocomial infections
these two penetrate BBB therefore meningitis

Imipenem

very broad spectrum beta lactam antibiotic
"nuclear bomb of antibiotics"

Aztreonam

very broad spectrum beta lactam antibiotic
no cross-allergenicity to penicillin
gram negative rods

erythromycin

second line for penicillin allergic pts
mycoplasma (atypical pneum), chlamydia, Lyme, Legionella pneum

Azithromycin

similar to erythromycin
"z pack" for upper respiratory tract infections

Macrolides

Erythromycin, azithromycin, clarithromycin
binds Bacterial 50s ribosomal subunit
bacteriostatic

clindamycin

Lincosamide antibiotic
anaerobes therefore good for penetrating abdominal trauma
also means it triggers C. Difficile

Vancomycin

Glycopeptide
kills all gram + (only +)
Bacteriocidal: complexes w/ D-Ala which inhibits transpeptidation (cell wall synthesis)
VRE (vanco resistant Enterococci)

probenecid

given as adjunct w/ penicillins to prevent renal tubular secretion.

Penicillin V

oral form of penicillin G (benzylpenicillin)
susceptible to penicillinases therefore used against
syphilis, group A strep (s pyogenes), and Neisseria meningitidis

4th generation Cephalosporin

Cefepime
extended spectrum. better gram - activit than 3rd, and added gram + spectrum
resistant to beta lactamase

Amoxicillin

similar to ampicillin but Oral absorption
otitis media, community pneumonia

Sulfanamides

bacteriostatic
inhibit folic acid synthesis

Sulfanamides

bacteriostatic. inhibit folic acid synthesis
Trimethoprim-sulfamethoxazole (Bactrim) and Nitrofurantoin

Trimethoprim-sulfamethoxazole

Inhibits two steps in folic acid synthesis. trimethoprim alone rapidly develops resistance. sulfonamides inhibits tetrahydropteroate sythetase and thrimethoprim inhibits dihydrofolate reductase
broad spec. tx pneumocyctis jiroveci

adverse effects of Trimeth-sulfamx

stevens-johnson syndrome (type III hypersens)
neonatal kernicterus (displaces bilirubin from protein binding)
precipitates hemolytic anemia in G6PD deficiency

Nitrofurantoin

Sulfanamide that concentrates in the urine.
second line against UTI's
can precipitate hemolytic anemia in G6PD def

Fluoroquinolones

bactericidal.
Ciprofloxacin and levofloxacin

Tetracyclines

bacteriostatic 30S inhibitor
chlamydia, rickettsiae, mycoplasma= Doxycycline
photosensitivity, yellow teeth

Chloramphenicol

bacteriostatic 50s inhibitor
anaerobes, rickettsiae, H influ, salmonella typhi
grey baby syndrome (slow eliminators)

Aminoglycosides

bacteriocidal 30s inhibitor (parenterally)
All the ~Mycins; streptomycin, gentomicin, tobramycin, neomycin
Gram - (tobramycin for pseud arg)
ototoxicity and nephrotox
often added w/ cell wall synthesis inhibitor for synergy

Metronidazole

anaerobes (c. diff) and bugs w/ flagella (thrichomonas, amebiasis, giardia)
metallic taste in mouth, disulfiram-like reaction

Linezolid

bacteriostatic,
gram + that are multidrug resistant (even MRSA)
"the new Vanco"

Quinupristin

Bacterialcidal against multidrug resistant gram + even MRSA
inhibits CYP3A4 (workhorse)

Tx for Staphylococcus Aureus

Penicillinase-resistant penicillins (dicloxacillin, nafcillin, oxacillin)
Vancomycin (IV)
Linezolid (PO)
Quinupristin -dalfopristin
Clindamycin (PO)
Trimethoprim-Sulfamethoxazole (PO)

Tx for Enterococcus

Vancomycin
for VRE: Linezolid or Penicillin +aminoglycoside

Pseudomonas Aeruginosa

Ceftrazidime
Ciprofloxacin (only PO option)
Aminoglycoside (tobramycin)
Piperacillin/ tazobactam
Imepenem

Bacteroides (anaerobe)

Metronidazole
clindamycin

Cipro

bactericidal.
inhibit bacterial DNA gyrase (topoisomerase II)
Aerobic gram - (pseud ar) and Neisseria
Achilles tendon rupture and prolonged QT

Mycoplasma

causes atypical pneum
Macrolide (erythromycin)
tetracycline

Clostridium defficile

causes pseudomembranous colitis
metronidazole
vancomycin orally

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