ABX HY Review Expanded

Cefotetan

2nd generation cephalosporin Contains Methylthiotetrazol (NMTT) which may cause bleeding 2/2 hypoprothrombinemia and a disulfiram-like Rxn w/ EtOH

Cefuroxime

2nd generation cephalosporin

Clindamycin

NOT A MACROLIDE (different spectrum of activity but same everything else) Used for anaerobes above the diaphragm

Cefazolin

1st generation cephalosporin

Sulfacetamide

Sulfonamide Typically used as eye drop/topical for conjunctivitis (pink eye)

Trimethoprim MOA + AE

"Other" nucleic acid syn inhibitor Blocks dihydrofolate reductase Renally cleared AE: Megaloblastic Anemia

Cephalosporin AE

Dose dependent Nephrotoxicity Thrombophlebitis when given IV

Delafloxacin

Fluoroquinolone

Amoxicilin

Penicillin B-Lactam Broad spectrum

Clavulanate

B-Lactamase inhibitor

Ampicilin

Penicillin B-Lactam Broad spectrum

Ceftaroline

5th generation cephalosporin

Which Classes of ABX cause photosensitivity?

• Sulfonamides (Bactrim) - Fluoroquinolones - Tetracyclines

Sulfamethoxazole

Sulfonamide

Ofloxacin

Fluoroquinolone Crosses BBB

Cefoxitin

2nd generation cephalosporin

Doripenem

Carbapenem

Cefpodoxime

3rd generation cephalosporin

Linezolid characteristics + adverse effects

"Other" Protein synthesis inhibitor Binds 23s of 50s ribosome to inhibit formation of complex Bacteriostatic AE: Potential serotonergic activity Myelosupression - causes "-penias"

What is a superinfection?

Opportunistic infection after using a broad-spectrum ABX

Telithromycin

Macrolide

Ceftriaxone

3rd generation cephalosporin Hepatically cleared Cannot use in very young (biliary sludge build up)

Cefdinir

3rd generation cephalosporin

Mafenide

Sulfonamide Typically for burns

Tazobactam

B-Lactamase inhibitor

Minocycline

Tetracycline

Clarithromycin

Macrolide

Levofloxacin

Fluoroquinolone

Tetracylcine AE

Accumulates in liver, bone, teeth and can cause deformity, teeth browning, dysplasia ***Teterogenic ***Photosensitivity Occ C.Diff

Amikacin

Aminoglycoside

Metronidazole characteristics + MoA + AE + Uses/Tx

Prodrug -> anaerobic pathogens donate e- to activate Reduction of Nitro group forms labile intermediate which inhibits DNA synthesis Bacteriocidal ***Used for anaerobes below the diaphram AE: Neurotoxicitiy Disulfiram effect (hypersensitivity to EtOH) Li+ toxicity

Fluoroquinolones MoA

Blocks Topoisomerase II (DNA gyrase) and IV Bacteriocidal, concentration dependent Renally cleared (blocked by probenecid)

Methicilin

Penicillin B-Lactam Penicillinase resistant

Vaborbactam

B-Lactamase inhibitor

Tetracycline MoA

Binds 30s Ribosome to block tRNA attachment Bacteriostatic Biliary and Renally cleared Absorption blocked by Cations(+)

Vancomycin

"other" cell wall inhibitor ****Only G(+) orgs Large molecular wt = must be given IV (PO for CDiff)

Aztreonam main use is in what kind of patients

PCN allergic

Neomycin (Neosporin)

Aminoglycoside

Quinupristin/Dalfopristin (Synercid)

Streptogramin Binds 50s Ribosome ***Bactericidal AE: Hyberbilirubinemia, Plebitis ***Strong inhibitor of Cytrocrome CYP3A4

Aztreonam only treats

gram (-)

Cefoperazone

4th gen ceph

Rifampin MoA / Tx

RNA Polymerase Tx for TB

Sulbactam

B-Lactamase inhibitor

Chloramphenicol characteristics + adverse effects

"Other" Protein synthesis inhibitor Binds 50s Ribosome to block peptide bond formation Bacteriostatic Hepatically Cleared AE: Supression of bone marrow -> anemia, Leukopenia "Gray baby syndrome" - 2/2 inability to conjugate drug ***Aplastic anemia

RNA Polymerase MoA

Inhibits RNA polymerase Bacteriocidal

B-Lactam MOR

• Lack cell wall - Have impermeable cell walls - Produce B-Lactamase - Have PBPs w/ low affinity

Sulfonamides AE

Hemolytic/Aplastic anemia Teterogen (Kernicterus - brain dmg from high lvls of bilirubin) Photosensitivity Moderate/strong Cytocrome 2C8/9 system (Warfarin interaction)

Fosfomycin Tx MOA

"other" cell wall inhibitor Tx uncomplicated UTIs Inhibits Enolpyruvate Transferase which blocks cell wall syn

Cefprozil

2nd gen cephalosporin

In a patient with a penicillin allergy, list: What reaction is caused? Treat with what instead?

Severe anaphylaxis reaction Avoid b-lactams, treat with monobactams (aztreonam) Dependent on infection, clindamycin or macrolides can be used

What generations of cephalosporins cannot be used for patients with penicillin allergies?

Avoid 1st/2nd gen cephs. Can use aztreonam, macrolide, or 3rd gen+ ceph

Which Classes of ABX cause QT/QRS prolongation? (Increase chance of arrythmia)

• Fluoroquinolones - Macrolides

Gemifloxacin

Fluoroquinolone

Fluoroquinolone AE

***Prolonged QTc -> Cardiac arrythmia ***Tendonitis/Tendon rupture Photosensitivity

Colistin , MOA, AE

"other" cell wall inhibitor "Salvage therapy" = Last line MoA: Cationic detergent AE: Acute tubular necrosis, neural disturbances

Tobramycin

Aminoglycoside

B-Lactam MOA

Binds to PBPs, blocks transpeptidation reaction for cross linking (bacteriostatic) Activates Autolysin (Murein Hydrolase) -> Bacteriocidial Time Dependent

Beta – lactams do not cover for what type of organisms

atypical

Cloxacilin

Penicillin B-Lactam

Carbapenem AE

Seizures in renal failure pts Super infections (C. Diff)

Which classes of ABX are concentration dependent killing (1x daily dose)

• Aminoglycosides - Fluoroquinolones - Amoxicillin

Macrolide MoA

Binds 50s Ribosome and prevents continuation of translation Bacteriostatic (Cidal in high [ ] against susceptible orgs) Biliary excretion

Tetracycline

Tetracycline (wowwwww)

Vancomycin only treats

gram (+)

Gentamicin

Aminoglycoside

Ceftazidime

3rd generation cephalosporin

Piperacilin

Penicillin B-Lactam Broad spectrum

Vancomycin AE

"Red man syndrome" - Flushing, hypotension Nephro/Oto Toxicity (uncommon)

Aminoglycoside MoA

30s Ribosome blocking initiation - binds irreversibly Concentration dependent Bacteriocidial *Synergism with B-Lactam Renally cleared +Placental xfer

Cephalexin

1st generation cephalosporin

Nafcilin

Penicillin B-Lactam Biliary Excretion

Sulfadiazine

Sulfonamide

Aminoglycoside AE

Nephro/Oto toxicity (>5 days use)

Penicilin G & V

Penicillin B-Lactam Hydrolyzed by Penicillinase PCN G only IM as IV can induce cardiopulmonary arrest

Moxifloxacin

Fluoroquinolone

Which 3 classes of ABX inhibit the cytochrome system?

• Sulfamethoxazole trimethoprim (Bactrim) - Macrolides (except azithromycin) - Metronidazole

Cefoporazone is similar to which other ABX? In what way?

Cefotetan, both have methylthiotetrazole (NMTT) group. This causes bleeding disorders (hypoprothrombinemia) -- fixed by Vit. K + Disulfram like rxns w/ alcohol

Which 3 ABX cannot be used in pregnancy?

• Sulfonamides (Inhibit DNA and folate synthesis) - Fluoroquinolones - Tetracycline (Incorporate themselves into bone)

Doxycycline

Tetracycline

Fosmomycin AE

N/V/D Vaginitis

Penicillin AE

Anaphylaxis!!!! Cross sensitizing w/ all other B-Lactams (other than Aztreonam)

Aminoglycosides are ineffective against what type of organisms?

anaerobic

Ciprofloxacin

Fluoroquinolone

Which 3 classes of ABX have efflux pumps as resistance mechanisms?

• Macrolides - Tetracyclines - Fluoroquinolones

Imipenem/Cilastatin (Primaxin)

Carbapenems Cilastatin prevents renal hydrolysis

Fidaxomicin (Dificid) MoA + Tx

RNA Polymerase Tx Cdiff (co first line w/ oral Vanc)

How do you treat a patient with B-lactamase producing infection?

You combine a B-lactam with b-lactamase inhibitor Example: Amoxicillin + clavulnate

Avibactam

B-Lactamase inhibitor

Ertapenem

Carbapenem

Daptomycin

"other" cell wall inhibitor Tx Vancomycin resistant bugs MOA: Depolarizes cell membrane ***Pulm surfactants inactivate drug -> cannot use in resp infections

Sulfonamides MoA

Blocks Dihydropteroate synthase (folate synthesis) ***Competes with PABA Bacteriostatic alone, -cidal with Trimethoprim (Bactrim) Renally cleared

Cefepime

4th generation cephalosporin

Macrolide AE

Dose dependent N/V/D, abd cramp Acute hepatitis ***Inhibition of cytocrome P450 ***QTc prolongation

Tigecycline

NOT A Tetracycline (Extended spectrum of activity, same everything else)

How is penicillin excreted?

Tubular secretion (kidney) This is why probenecid can block excretion

Azithromycin

Macrolide

Meropenem

Carbapenem

Erythromycin

Macrolide

Which class of ABX is time-dependent killing?

Beta-Lactams

Ticarcilin

Penicillin B-Lactam Broad spectrum