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What is the MOA of penicillins?
- Inhibit cell wall synthesis
- Bacterialcidal
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Which class of penicillins can be used for anaerobes?
- Natural penicllin
- Penicillin G and V
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What penicillins can be used for psuedo?
Pipercilin, ticarcillin, mezlocillin
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What are the penicillins with a beta lactamase inhibitor?
- Timentin- ticarcillin/clavulanic acid= 3.1 gm IV q4-6
- Zosyn- pipercillin/tazobactam= 3.375 gm IV q8
- Unasyn- ampicillin/sulbactam= 1.5-3.0 gm IV q6
- Augmentin- amoxicillin/clavulanic acid= 875 mg PO bid
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Which penicillin can increase BP by increasing Na?
Ticarcillin
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What is the MOA of cephalosporins?
- Inhibit cell wall synthesis
- Bacterialcidal
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What is the spectrum of activity?
- 1st- gram + and little gram - (PESS)
- 2nd- more gram - and gram + (-) are HeN PECK
- 3rd- More gram - including psuedo
- 4th- greatest gram - (Cefipime= Maxipime)
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What is the cross reactivity with penicillins?
- Some say 1-5%
- Presby 5-15%
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This is the gorillacillin and is also a beta lactam?
Imipenem/cilastatin (Primaxin)
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Is Aztreonam a beta lactam?
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What is the MOA of quinolones?
- Inhibit DNA gyrase
- bacterial cidal
-
What is the only quinolone that may cover CA MRSA?
- Cipro 250-500 mg PO
- 200-400mg IV
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What are the contras of quinolones?
- Don't take with milk or calcium, vitamin D
- Caution with tendons and bone
- Don't give to kids it can damage the cartilage
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What is the MOA of AMG?
- Binds 30S bacterial ribosome inhibits protein synthesis
- Tobramycin, Gentamycin, Amikacin
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When do you check troughs and peaks of AMGs?
Check after 3rd dose
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What are the ADRs of AMGs?
- ototoxcity
- nephrotoxcity
- neuromusclar blockage
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What is the MOA of Sulfonamide-Trimethoprim Sulfamethoxazole?
- Bactrim
- Sulfamethoxazole- inhibits folic acid production
- Trimethoprim- inhibits bacterial dihydrofolate reductase
- bacteriostatic
-
What is the dosing of Bactrim?
- Trimethoprim= 160mg
- Sulfamethoxazole= 800mg
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ADRs of bactrim?
- Hemolytic anemia
- Contra with oral hypoglycemics and G6PD deficiency
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What is the MOA of Macrolids?
- Bind 50s bacterial ribosome inhbitis protein synthesis
- bacteriostatic
- Mainly gram positive staph and strept
-
What are teh drugs?
- Erythromycin= 250-500 mg PO QD
- Azithromycin (Zpack)= 500mg 1st day 250 mg qd for 4 days
- Clarithromycin= 250 mg po bid
- Dirythromycin
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What is the MOA of vanco?
- Inhibit cell wall synthesis
- bactericidal
- 1gram IV q12hr
- 125 mg PO qd for Cdiff
-
What are the peaks and troughs of Vanco?
- Peak= 15-30 mg/ml (30min after 3rd dose)
- Trough= <10 mg/ml (30 min before 4th dose)
- (Presby says after 5th dose)
-
Spectrum of Vanco?
- MRSA (HA)
- Staph, strept
- + anaerobes (Clostridium and Cornybacterium)
- Not active against gram -
-
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What is the MOA of Clindamycin?
- Inhibits translation of 50s bacterial ribosome
- bacteriostatic
-
ADRs of clinda?
- PSUEDOMEMBRANOUS COLITS!!!!
- C. diff
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What abx can stain bones and teeth?
- Tetras
- Minocycline= 100mg PO q12-14
- Doxycycline= 100mg po q12-24
- tetracycline= 250-500mg PO qid
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This abx is used for TB and changes body fluids orange?
Rifampin
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This is used for ANAEROBES gram -?
- Flagyl (Metronidazole) use in C.diff
- 500mg PO tid
-
What drug can cause a metal taste?
Flagyl
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When do you want to surgical prophylax a pt?
- >2 hr surgery
- Implants
- trauma
- immunocompromise
- SBE risks
-
What are the common abx for prophylaxis?
- Ancef (Cefazolin) 1 gram IV
- Clindamycin 600mg IV
- Vancomycin 1 gram IV
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What are the HA MRSA abx?
- VCSZ
- Vanco
- Cubicin
- Synercid
- Zyvox (Linezolid)
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What are the abx for CA MRSA?
- M BCD
- Minocycline
- Bactrim
- Cipro
- Doxy
-
What are the abx that are PO for MRSA?
- Linezolid
- Mino
- Cipro
- Bactrim
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What are teh Psuedomonas abx?
- A Man Can't Fire Pelo Z
- Atreonam
- Maxipime
- Cipro
- Fortaz
- Pipercillin
- Zosyn
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What are the Broad Spectrum abx?
- D TAAZ
- Doripenem
- Timentin
- Augmentin
- Alveox
- Zosyn
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Your pt gets C. diff what do you do?
- Stop abx
- NO ANTIDIARRHEAL MEDS!!!!!!! (They allow toxins to collected)
- Fluid and electrolyte balance
- ABX: Metronidazole 500 mg q8
- or Vanco 125 mg PO q6
-
What are your Polyenes for fungal meds and what is the MOA?
- Nystatin
- Amphotericin B
- MOA: binds ergosterol (hole in membrane)
- fungistatic
-
What is the MOA of Azoles?
Inhibit ergosterol also and increase intracellular peroxide levels
-
Azoles may interact with what major meds?
- Increase warfarin, cyclosporin, theophyline, oral hypoglycemics, rifampin
- Inhibits phenytoin metabolism
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Which azole is good for yeast infections?
Clotrimazole
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What meds and allylamines?
- Terbinafine and Naftifine
- MOA: Inhibits squalene epoxidase
- FUNGICIDAL
-
Does of Lamisil?
- Onychomycosis: 250 mg/day for 12 weeks
- Tinea pedis: 250mg/day for 2-6 weeks
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What do you look for in a liver function test for Lamisil?
- ALP, ALK levels and
- Kidney Cr<50ml/min
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What med increases clearnace of Lamisil?
Rifampin
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What med decreases clearance of lamisil?
Cimetidine
-
What fungistatic med inhibits cell mitosis?
Griseofulvin
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What other fungal drug inhibits squalene epoxidase?
Tolnaftate
-
What is whitfields ointment?
Benzoic acid and salicyclic acid that causes desquamation of epidermis containing fungal organisms
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