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Pharmacology Block 3
Penicillin
Gram Positive
Spirochetes
Bind PBPs
Block Transpeptidase Cross-linking of Cell Wall
Activate Autolytic Enzymes
Bactericidal
Hypersensitivity Reactions
Hemolytic Anemia
Beta-lactamase Sensitive
2 mins
Ampicillin and Amoxicillin
Mechanism
Aminopenicillin
Broad Spectrum Penicillin
Indications
Gram-Positive and Some Gram-Negative Infections
Side Effects
Rash
Diarrhea
Considerations
No Effect Against Staph Aureus
Often combined with Beta Lactamase Inhibitor
Allergic Reaction
2 mins
Antipseudomonal Penicillins
Drugs
Ticarcillin
Carbenicillin
Piperacillin
Mechanism of Action
Same Mechanism as Penicillin
Indications
Extended Spectrum
Pseudomonas and Gram-Negative Rods
Considerations
Combine with Beta Lactamase Inhibitor
Clavulanic Acid
Tazobactam
Hypersensitivity Reactions
2 mins
Cephalosporins Overview
Mechanism of Action
Beta lactam drug
Inhibits cell wall synthesis
Bactericidal
Side Effects
Hypersensitivity reactions
Vitamin K Deficiency
Disulfiram like reaction with Alcohol
Increased Nephrotoxicity of Aminoglycosides
1 min
1st Generation Cephalosporin
Drug Names
Cefazolin
Cephalexin
Indications (PEcK Mnemonic)
Proteus mirabilis
E. coli
Klebsiella
Gram-Positive Cocci
1 min
2nd Generation Cephalosporin
Drug Names
Cefoxitin
Cefaclor
Cefuroxime
Indications (PEcK HENS Mnemonic)
Proteus mirabilis
E. coli
Klebsiella
Gram-Positive Cocci
Haemophilus influenzae
Enterobacter
Neisseria
Serratia marcescens
2 mins
3rd Generation Cephalosporin
Drug Names
Cefotaxime
Ceftriaxone
Cefdinir
Ceftazidime
Pseudomonas
Indications
Serious Gram-Negative Bacteria Resistant to Other Beta-Lactams
1 min
Aztreonam
Monobactam
Resistant to beta lactamases
Binds to penicillin binding protein (PBP)
Inhibit cell wall synthesis
No Activity on Gram-Positives or Anaerobes
Gram-Negative Rods
Non allergenic to penicillin
Synergistic with aminoglycosides
2 mins
Imipenem
Mechanism
Resistant to Beta-Lactamases
Broad Spectrum
Indications
Anaerobes
Gram-Negative Rods
Gram-Positive Cocci
Must Administer with Cilastatin
Cilastatin is Inhibitor of Renal Dehydropeptidase I
Side Effects
Diarrhea
Skin Rash
Seizures
Considerations
Meropenem
Stable to Dehydropeptidase I
Reduced Risk of Seizures (Non-Seizure Causing)
2 mins
Vancomycin Side Effects & Toxicity
Side Effects
Thrombophlebitis
Nephrotoxicity
Ototoxicity
Diffuse Flushing Called Red Man Syndrome
Prevent with Antihistamine
Prevent with Slow Infusion
2 mins
Vancomycin Mechanism
Bacteriostatic and Bactericidal
Gram-Positive
Inhibits Cell Wall Mucopeptide
Binds to D-ala D-ala
Resistance with Change to D-ala D-lac
Staphylococcus aureus
Orally for Clostridium difficile
Enterococci
2 mins
Tetracycline Toxicities
Inhibition of Bone Growth in Children
Teratogen
Discoloration of Teeth
Photosensitivity
GI Distress
2 mins
Tetracycline Mechanism
Binds to 30 S to Prevent Attachment of Aminoacyl tRNA
Limited CNS Penetration
Divalent Cations Inhibit Absorption
Must Not Take with Milk, Antacids, Iron
1 min
Tetracycline Drug Names and Indications
Drug Names
Demeclocycline
Minocycline
Doxycycline
Fecally Eliminated
Can be Used in Renal Failure
Indications
Antidiuretic Hormone Antagonist
Chlamydia
Rickettsia
Borrelia burgdorferi
Helicobacter Pylori
Mycoplasma Pneumonia
3 mins
Macrolides
Mechanism of Action
Bacteriostatic
Bind to 23S rRNA of 50S Subunit
Inhibit Protein Synthesis by Blocking Translocation
Macrolides
Erythromycin
Azithromycin
Clarithromycin
Indications
Gram-Positive Cocci
Atypical Pneumonia
Chlamydia
Considerations
Resistance by Methylation of 23S rRNA Binding
2 mins
Macrolides Side Effects
Side Effects
Diarrhea
Prolonged QT Interval
P450 Inhibitor
Cholestatic Hepatitis
Skin Rash
Eosinophilia
3 mins
Clindamycin
Mechanism
Bacteriostatic
Binds 50S Ribosomal Subunit
Indications
Gram-Positive Infections
Anaerobic Infections
Side Effects
Rash
Pseudomembranous Colitis
C. Difficile (Associated Diarrhea)
Arrhythmias
Blood Dyscrasias
Considerations
Monitor for Diarrhea
3 mins
Aminoglycosides
Drug Names
Gentamicin
Neomycin for Bowel Surgery Prep
Amikacin
Tobramycin
Streptomycin
Mechanism of Action
Bactericidal
Inhibit Formation of Initiation Complex
Cause Misreading of mRNA
Require O2 for Uptake
Resistance
Resistance by Transferase Enzymes
Acetylation
Phosphorylation
Adenylation
Indications
Gram-Negative Rod Infections
Synergistic with B-Lactam Antibiotics
Side Effects
Nephrotoxicity Especially When Used with Cephalosporins
Ototoxicity Especially When Used with Loop Diuretics
Teratogen
5 mins
Neomycin Sulfate
Mechanism
Aminoglycoside Antibiotic
Indications
Topical Infection
Intestinal Surgery Prophylaxis
Side Effects
Ototoxicity
Nephrotoxicity
Rash
Blood Dyscrasias
Considerations
GI Superinfection
2 mins
Sulfonamides Mechanisms
Bacteriostatic
Gram-Positive
Gram-Negative
Nocardia
Chlamydia
PABA antimetabolites
Inhibit dihydropteroate synthase
Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
1 min
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