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natural penicillins
Pen V oral, Pen G IV (Pen G Benzathine/Procaine = long-acting IM)
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aminopenicillins
amoxicillin (Amoxil) oral, ampicillin oral/IV
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aminopenicillin + b-lactamase inhibitors
amoxicillin-clavulanate (Augmentin) oral, ampicillin-sulbactam (Unasyn) IV
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narrow spectrum penicillins
dicloxacillin oral, nafcillin IV(only), oxacillin IV
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extended spectrum penicillin
piperacillin IV
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extended spectrum penicillin + b lactamase inhibitors
piperacillin-tazobactam (Zosyn) IV(only), ticarcillin-clavulanate (Timentin) IV(only)
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probenecid
benificial interaction c penicillins -- compete for same transporter in kidney
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amoxicillin dosing
Amoxil 500-875 BID, max 4g/d
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amoxicillin-clavulanate dosing
Augmentin 500-875/125 BID
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pen VK dosing
500 BID-TID x 10d
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-
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hospital acquired pneumonia (likely MDR)
piperacillin-tazobactam (Zosyn)
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1st generation cephalosporins
cePHALexin (Keflex), ceFADroxil (Duricef), ceFAZolin
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2nd generation cephalosporins
cefAClor (Ceclor), cefPROzil (Cefzil), ceFURoxime, ceFOXitin, ceFOtetan
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3rd generation cephalosporins
cefDINir (Omnicef), cefTRIazone (Rocephin), all the other cefs
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4th generation cephalosporins
cefepime
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5th generation cephalosporins
ceftaroline
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cephalosporin MOA
b-lactams, mess with cell wall PBPs. moltiple modifiable sites, so more resistant to cleavage by b-lactamases.
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penicillin MOA
b-lactams, mess with cell wall PBPs.
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cephalosporin c CNS penetration
3rd generation
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cephalosporin c long half life (ODD)
ceftriaxone (Rocephin)
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cephalosporin interaction
cefotetan+ethanol (disulfiram-like rxn)
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cephalexin dosing
Keflex 1G 1000-4000/d div BID-QID
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cefdinir dosing
Omnicef 3G
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carbapenems
meropenem (Merrem), ertapenem (Invanz), doripenem (Doribax), imipenem-cilastatin (Primaxin - cilastin inhibits breakdown if imipenem in kidney)
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carbapenems MOA
b-lactams, mess with cell wall PBPs. parenteral only.
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drug-resistant UTI
doripenem
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glycopeptide
vancomycin (Vancocin)
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vancomycin MOA
inhibits peptidoglycan synthesis by attatching to end of peptidoglycan and being bulky
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vancomycin kinetics
poorly absorbed orally, so route based on where the infection is (GI vs outside)
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vancomycin SE
neutropenia, hearing loss (especially c aminoglycosides), nephrotoxicity, red man syndrome (c rapid infusion)
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fluoroquinolones
ciprofloxacin (Cipro), levofloxacin (Levaquin), moxiflixacin (Avelox), gemifloxacin (Factive), norfloxacin (Noroxin), ofloxacin (Floxin)
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fluoroquinolones MOA
target DNA and replication by inhibiting DNA gyrase (topoisomerase)
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parenteral/oral fluoroquinolones
Cipro, Levaquin, Avelox. all others oral only. Avelox only one not excreeted renally.
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fluoroquinolones interactions
fluoroquinolone+cations (chelation)
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fluoroquinolones SE
achilles tendon rupture, QT prolongation
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ciprofloxacin dosing
Cipro 250-750 BID
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levofloxacin
Levaquin 500-750 PO/IV qd x 5-7d
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complicated UTI
ciprofloxacin
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respiratory fluoroquinolones
Levaquin, Avelox, Factive
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aminoglycosides
oral = neomycin, paromomycin, tobramycin inhaled (Tobi). parenteral = streptomycin, gentamicin, tobramycin, amikacin ,kanamycin
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aminoglycosides MOA
protein synthesis inhibitors, also attack/put holes in outer bacterial membrane (they are polar molecules).
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aminoglycosides SE
ototoxicity, nephrotoxicity (accumulation in tubules)
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lincosamides
clindamycin (Cleocin)
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clindamycin MOA
inhibit protein synthesis (bacteriostatic). also because toxins are often proteins, lincosamides are helpful in toxin-producing infections (necrotizing fasciitis, toxic shock syndrome)
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tetracyclines and glycylcyclines
tetracycline, doxycycline (Vibramycin), minocycline (Minocin), demeclocycline
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tetracyclines MOA
inhibit protein synthesis (bacteriostatic).
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tetracyclines contraindications
PREGNANCY
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tetracyclines interactions
TCA+cations (chelation)
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tetracycline SE
photosensitivity, teeth mottling (core ring is a chelator of calcium, causing discoloration and Ca deposition in growing bones, so avoid in kids). minocycline also hyperpigmentation.
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doxycycline dosing
Vibramycin 100 BID day 1, qd day 2+
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TCA uses
acne/rosacea, malaria/Lyme prophylaxis, atypipcal infections, magic mouthwash
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SIADH
demeclocycline (inhibits binding of ADH to its receptor)
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macrolides
erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin)
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macrolides MOA
inhibit protein synthesis, bacteriostatic. they are delivered to the site of infection by macrophages.
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macrolides kinetics
erythromycin is unsable in gastric acid (enteric coating or parenteral). azithromycin given for 5 days, stays in system for 10 (no CNS).
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erythromycin indication
also for gastroparesis
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macrolides interactions
erythromycin/clarithromycin are CYP3A4 inhibitors
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macrolides SE
GI (particularly erythromycin), QT prolongation, liver impairment
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azithromycin dosing
Zithromax 500 x1 day 1, 250 qd day 2-5
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oxazolidinones
linezolid (Zyvox)
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linezolid MOA
inhibits protein synthesis (bacteriostatic)
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linezolid interactions
linezolid is a weak MAOI...
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linezolid SE
thrombocytopenia, anemia, leukopenia. serotonin syndrome, neuropathies. hyperlactatemia, metabolic acidosis.
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sulfonamides and folate synthesis inhibitors
trimethoprim-sulfamethoxazole (Bactrim, Septra), sulfisoxazole-erythromycin, sulfadiazine
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sulfonamides MOA
bacteria are unable to absorb folate like humans. sulfonamides competitively inhibit PABA, the first reaction in the folate synthesis pathway. trimethoprim blocks the last step in the pathway.
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sulfonamides SE
stevens-johnson syndrome, kernicterus (bilirubin-induced brain dysfunction -- contraindicated in pts <2 months)
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imidazoles
metronidazole (Flagyl)
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metronidazole MOA
anaerobic bacteria naturally reduce the prodrug metronidazole to its active form via an enzyme called ferredoxin. once reduced, it is postulated to lead to toxic products that result in DNA breakage and subsequent cell death.
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imidazole interactions
metronidazole+ethanol (inhibits aldehyde dehydrogenase, resulting in buildup of toxic metabolites)
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metronidazole SE
metallic taste, furring of the tongue
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