2020 week 4

4 penicillin groups

Extended spectrum penicillins, penicillin G and V, penicillinase resistant penicillins, amoxicillin,

Penicillin affects cellularly

Inhibits cell wall synthesis, bactericidal agent binds to penicillin binding proteins on cell wall so they can't attach (can’t get past gram - membrane around wall)

Penicillin type of antibiotic

Beta lactam antibiotic

Oral penicillin

Less serious allergy reaction, BUT blood levels rise slower and are less predictable, degraded by gastric acid

Penicillin pharmacokinetics

Throughout body except CSF, bone, abscesses (crosses placenta and milk), liver metabolized, tubular secretion by kidney

Penicillin Resistance

Penicillin's producing staphylococci, clavulanic acid inhibits, gram - cell membranes prevent reaching PBP'S

Penicillin adverse allergy

Arose hi

•Anaphylactic reactions

●Rash

●Oral lesions

●serum sickness (delayed)

•Eosinophilia

●Hemolytic anemia

●Interstitial nephritis

Penicillin adverse toxicity

Crazy red heads bite people giving

●Convulsions

●Renal damage

●Hemolytic anemia

●Bone marrow depression

●Penicillinase-resistance

●GI irritation

●Sterile abscesses

●Thrombophlebitis

Penicillin uses

Dental infections, anoxic on for prophylaxis, aerobic and anaerobic

Penicillin G and V

Sodium salts, potassium salts, procaine salts, benzathine salts

Penicillinase resistant penicillins

Only used against penicillinase producing staphylococci (ex, oaxcillin, cloxacillin, nafecillin, dicloxacillin, methicillin)

Ampicillins

Penicillinase susceptible agents (ex. Ampicillin, amoxicillin)

Amoxicillin advantages

Makes higher blood levels, better absorbed, less frequent dosing, absorption not food impaired

Extended spectrum penicillins

Wider spectrum of action than G, available perenterally for systemic infection (ex. Ticarcllin, piperacillin)

Cephalosporins

Structurally related to pen, gram + and -, 50-240 min ½ life, inhibit cell wall synthesis

Cephalosporin pharmacokinetics

Excreted by glomerular filtration and tubular secretion

Cephalosporin adverse

Good nurses save lives helping all

●Gastrointestinal

●Nephrotoxicity

●Superinfection

●Local reaction

●Hemostasis and disulfiram-like reaction

●Allergy

Macrolides

Interferes with 50s protein synthesis, bacteriostatic, gram +, some dental infections, mainly aerobes (ex. Erythromycin, clarithromycn, azithromycn)

erythromycin adverse

Gross cats ignore instructions

●GI

●Cholestatic jaundice

•Inhibit hepatic metabolism of some drugs

●Increases serum concentrations of some drugs -> toxicity

azithromycin and clarithromycin names

Zithromax/Z Pak

Biaxin

azithromycin and clarithromycin adverse

Gross enzymes make drugs

Tetracyclines

Broad spectrum, 1st isolated from streptomyces

Tetracyclines pharmacokinetics

Secreted in saliva and milk concentrated by liver and excreted into intestines via bile, stored in dentin and enamel of unerrupted, concentrated in gingival crevicular fluid, cross placenta

Tetracycline mechanism

Bacteriostatic, 30s protein inhibition, broad spectrum, + and -

Tetracycline adverse

Giant dogs yawn calmly

•GI effects

●Diarrhea

●Yellowish-brown discoloration of tongue

●Candidiasis

Hungry nurses have super powerful cranky attitude

•Hepatotoxicity

●Nephrotoxicity

●Hematologic effects

●Superinfection: Candida albicans

●Photosensitivity

●CNS side effects (monocyline)

●Allergenicity is low

Tetracycline uses

Chalmydia, ricketts, acne, pulmonary infection, travelers diarrhea, periodontal conditions (bc GCF concentrated)

Clindamycin (cleocin)

Bacteriostatic, gram + anaerobes some -, from lincomycin, mainly

Clindamycin pharmacokinetics

distributed throughout body tissues (not CSF) including bone, crosses placenta, peak 45 mins

Clindamycin adverse

Good germs protect some bodies against microbes

GI effects

●Glossitis and stomatitis

●Pseudomembranous colitis (PMC)

●Superinfection

●blood elements affected

•anaphylaxis

•morbilliform (measles like rash)

Clindamycin uses

Infection caused by anaerobic organism, some staphylococcus infections when pt allergic to penicillin

Metronidazole (flagyl)

Also anti inflammatory, exceptional against most obligate anaerobes

Metronidazole adverse

NAAG

Neuro (CNS)

Alcohol causing disulfiram like reaction (renal toxicity)

Abnormal taste (metallic)

GI side effects (nausea, diarrhea)

Metronidazole uses

Anaerobic spectrum

The PAGE

Trichomonas

Pylori (in case of penicillin allergy in triple therapy)

Anaerobes (Bacteroides, C difficile)

Gardinerella vaginalis, Giardia

Entamoeba