CLASS: PENICILLINS: cillins
Class
Penicillin
MOA
BacterioCIDAL: Weaken the cell wall causing bact. to take up water and RUPTURE
Uses
-
BROAD spectrum: active against a variety of bacteria
Adverse
effects
-
-
Allergic rxn (common to be allergic to penicillin so ask if allergic and what was the rxn)- 0.4-7% ppl have rxn
Rxn can occur minutes to weeks later
**Most people have previously consumed penicillin so the rxn can happen on the first dose**
Can perform skin test by administering locally to see what happens (rash?)
Anaphylaxis- ABC’s and give epinephrine!!
If anaphylaxis to penicillin-> don’t give cephalosporin bc MOA is almost identical
If minor reaction, can consider giving cephalosporin
n/v
diarrhea
Drug
interactions
-
Aminoglycosides
Bacteriostatic abx (tetracyclines- suppress bact.)
Probenecid (delayed excretion from kidneys-> toxicity)
Warnings/
contraindicatio
ns
-
Bacterial resistance is high bc of high use -> #1 drug with resistance
Inability of penicillins to reach their target cell
Inactivation of penicillins by bact. Enzymes
Production of penicillin-binding proteins (PBP’s) that have a low affinity for penicillins
Dose/route
Penicillin G
Amoxicillin
Nafcilin
Amoxicillin/clavulanate
(augmentin) &
Piperacillin/tazobactam
(zosyn)
IM: stays in system for 30 days
PO
Absorption in GI is not good
so it is not usually given
PO-> usually given
IV
IM (rare)
Given IV
Common in
oncology
Kids
Pregnancy
breastfeeding moms
**Reduce dose for pt with
renal impairment**
s/e
Rash
diarrhea
Important
Increased activity against
some gram - bacilli
-
Well tolerated
Extends microbe spectrum
when combined with
penicillinase- sensitive abx
CLASS: CEPHALOSPORINS
Class
Cephalosporin
MOA
BacteriCIDAL: Disrupt the pathogens cell wall synthesis and causes cell lysis
Most effective against cells undergoing active growth and division
Uses
BROAD spectrum
Most widely used group of abx
Dose and
Route
Not absorbed well through the GI tract so usually given
IV
IM
Adverse
effects
Generally well tolerated
Hypersensitivity (rash)-> doesn't necessarily mean allergic
Anaphylaxis
BLEEDING TENDENCIES (interferes with vit K and prothrombin levels)
Thrombophlebitis may occur
Drug
interactions
-
Prevacid (proton pump inhibitor)
Drugs that promote bleeding**
Alcohol (should be avoided, but at least decreased)
Warnings/
contraindicatio
ns
-
Bact resistance is high because it is given often
Excreted by the kidneys-> reduce dose if pt has renal impairment
As you go down: increased ability to reach CSF (cross BBB) ; increased ability to tx resistant bact (MRSA) ; increasingly more active against gram - bact
1st generation
2nd generation
3rd generation
4th generation
5th generation
Cephalexin (keflex)
Cefoxitin
Cefotaxime & Ceftriaxone
(rocephin) & ceftazidime (Fortaz)
Cefepime
Ceftaroline
Prophylaxis against
infection in surgical pt
Rarely used for active infection
Very active against gram infections
Used to tx hospital associated
pneumonias- even those that are
resistance like pseudomonas
Infections associated with
MRSA
Crosses BBB
Skin infections
Able to penetrate CSF
**rarely used for active
infections**
Crosses BBB
IV
Crosses BBB
Ceftriaxone: given IM for
gonorrhea
Ceftazidime: most effective
against pseudomonas
aeruginosa (overgrowth of e.
Coli)
**can cause superinfection->
pseudomembranous colitis
s/s:
Bloody diarrhea
Abdominal pain
fever
VANCOMYCIN (not a class apparently)
MOA
Uses
Dose and
Route
BacteriCIDAL: Inhibits cell wall synthesis
-
Usually given IV bc erratic in GI
**if it is FOR a Gi prob or pt is going home, it will be PO
Adverse
effects
Warnings/
contraindicati
ons
Monitoring
Severe infections ONLY!!! STRONGGGGG!!!
MRSA
Staph epidermidis
SEVERE C. DIff
Meningitis (can cross CSF)
-
-
Ototoxicity (reversible)
Thrombophlebitis
Thrombocytopenia
Allergy
Red man syndrome
Should not happen if it is administered correctly
Should be given slowly over at least 1 or 2 hours
If given too fast or pt is renal impaired-> red man syndrome
Red
Itching (ants)
Hypotensive
Tachycardia
If person turns red- slow the dose and call provider to see if if it can be given over 3 hrs
Kidney toxicity
Monitor BUN, creatinine
Thrombocytopenia
Monitor platelets
Prior to dose- get blood level drawn and confirm it is in a safe therapeutic range
Too much- kidney damage
Too low- won't make a difference
CLASS: TETRACYCLINES
Class
Tetracyclines
MOA
BacteriostatiC: suppresses bact growth
Uses
-
BROAD spectrum abx (but more narrow than vancomycin)
Infectious diseases
Peptic ulcer disease
Periodontal disease
RA
Mycoplasma pneumoniae
H. pylori
Ricketts
Lyme
Anthrax
Rocky mt spotted fever
acne
Adverse
effects
-
GI irritation
Effects bone and teeth
Superinfection
Hepatotoxicity
Renal toxicity
Photosensitivity - WEAR SUNSCREEN!!
Drug
interactions
Absorption REDUCED by food- AVOID or SPREAD out
Ca (milk)
Iron
Zinc
Mg
Antacids
Aluminum
Warnings/
contraindicatio
ns
Resistance is increasing
Not for use in
Children <8
Pregnant women
Breast feeding women
Will cause teeth to turn brown bc it binds to Ca
Will also decrease bone strength
Pt counseling
Monitoring
CLASS: MACROLIDES
Erythromycin
Class
Macrolide (mycin)
MOA
BacterioSTATIC: Inhibition of protein synthesis
Sometimes bactericidal
Uses
BROAD spectrum
Used if pt is allergic to penicillin bc cant give cephalosporin either
Active against most gram + and some gram - bact.
-
Diphtheria
Corynebacterium diphtheria
Chlamydial infections
M. pneumoniae, group A strep pyogenes
DRUG OF CHOICE for whooping cough
Dose and
Route
Adverse
effects
Take on empty stomach with full glass of water
-
Upper gi pain
QT prolongation
Sudden cardiac death
Superinfections
Thrombophlebitis
Transient hearing loss
-
Seizure meds
Bipolar meds
Warfarin
Theophylline (asthma drug)
Drug
interactions
Anything on list
Warnings/
contraindicatio
ns
Safe and free from major
Pt counseling
Monitoring
Clindamycin
Class
Macrolide
MOA
BacterioSTATIC: Inhibition of protein synthesis
Sometimes bactericidal
Uses
Usually for wound infections
Usually NOT drug of choice
Active against most anaerobic bact (gram + and gram -)
Indicated for only certain anaerobic infections OUTSIDE the CNS
***ALT. for penicillin***
Dose and
Route
Take on empty stomach with full glass of water
Can be given topically (bact vaginosis)
Adverse
effects
-
CDAD (CDIFF)
Hepatic toxicity
Blood dyscrasias (agranulocytosis, leukopenia)
Diarrhea (can be bc infection OR bc the abx)
Hypersensitivity reactions
Drug
interactions
Warnings/
contraindicatio
ns
Pt counseling
Monitoring
Can PROMOTE severe C. Diff - associated diarrhea (can be fatal!!)
Linezolid (zyvox) (no class apparently)
Class
No class
MOA
BacterioSTATIC: inhibits protein synthesis
Uses
Active against multi resistant, gram + pathogens (VRE & MRSA)
Dose and
Route
Can be given long term: > 5 mo
Optic neuropathy (reversible)
Peripheral neuropathy (reversible)
Adverse
effects
Drug
interactions
Warnings/
contraindicatio
ns
Pt counseling
Monitoring
-
Diarrhea
n/v
HA
Myelosuppression (reversible)
Low blood cells -> do CBC BEFORE
ANEMIA
Usually well tolerated and just have n/v AND DIARRHEA
-
Monoamine oxidase inhibitors (MAOI’s)
AMINOGLYCOSIDES
Class
aminoglycoside
MOA
Inhibit protein synthesis
BacterioCIDAL
NARROW spectrum
Uses
Aerobic gram - bacilli
Dose and
Route
Not absorbed in GI so usually don’t give PO unless issue is in the GI
Usually IV
Reduce dose for renal impairment
Adverse
effects
Can cause serious injury to inner ear and kidney (damage to renal tubules)
**NOT REVERSIBLE**
Nephrotoxicity
Ototoxicity
Hypersensitivity
Neuromuscular blockade
Blood dyscrasia (RARE)
Drug
interactions
MANY DRUG INTERACTIONS
Warnings/
contraindicatio
ns
Check trough levels
Microbial resistance
Other ototoxic drugs (vancomycin)
Other nephrotoxic drugs
Any skeletal muscle relaxants
Monitoring
CALCIUM GLUCONATE = ANTIDOTE
Gentamicin - one that is usually given if pt needs aminoglycoside
***no resistance issue***
Amikacin (Amikin)
***no resistance issue**
Used for serious aerobic gram - bacilli
- Pseudomonas aeroginosa
- E.coli
- Klebsiella
- Serratia
- Proteus miribilis
Active against the broadest spectrum of gram - bacilli
(still narrow spectrum)
DOC when gentamicin is resistant in hospital
UTI’S!!!
Acute cystitis: lower uti that occurs most
in women of clid bearing age
Acute uncomplicated pyelonephritis: infection
of the kidneys (upper uti)
- Common in young children, older
adults, women of child bearing age
Acute bact prostatitis: inflammation of
the prostate caused by local bact
infection
s/s
s/s
s/s
DOC
-
Dysuria
Urinary urgency and frequency
Subprapubic discomfort
Pyuria (WBC/pus in urine)
Bacteriuria
Can be undx bc asymptomatic
uncomplicated : Bactrim or
nitrofurantoin
Resistance exceeds 20%:
fluoroquinolones (ciprofloxacin,
norfloxacin)
Adherence is a concern: single
dose fosfomycin
-
Fever
Chills
Flank pain
Dysuria
Urinary frequency and urgency
Pyuria
Bacteriuria
-
Mild to moderate: Bactrim
Trimethoprim alone,
Ciprofloxacin : severe
Levofloxacin
Severe infection: hospitalization and IV
abx
-
High fever
Chills
Malaise
Myalgia
Localized pain
Various uti symptoms
Responds well to antimicrobial therapy
if drug can penetrate deep enough
- Drug selection and route
depend on organism and
severity
E Coli: IV agent (fluoroquinoloneciprofloxacin followed by oral agent
doxycycline of fluoroquinolone)
Vancomycin sensitive e faecalis: iv
ampicillin/sulbactam then PO
amoxicillin, levofloxacin, doxycycline8
CLASS: SULFONAMIDES
Class
Sulfonamide
MOA
BacterioSTATIC: suppress bact growth by inhibiting tetrahydrofolic acid, a derivative of folic acid or folate
Uses
BROAD spectrum
DOC for UTI’s -> hits E.coli
-
Nocardiosis
Chlamydia trachomatis
Conjugation therapy for toxoplasmosis/malaria
Ulcerative colitis
Dose and
Route
Excreted through Kidneys -> want this tho bc then it will pass through urinary tract to help tx UTIs
Adverse
effects
Only 3% are hypersensitive
Stevens-johnsons syndrome
Hematologic effects
Kernicterus
Renal damage from crystalluria
More common in african americans and mediterranean populations
Warnings/
contraindicatio
ns
A lot of resistance (especially gonococci, meningococci, streptococci, shigella)
May be acquired by spontaneous mutation or by transfer of plasmids that code for abx resistance (R factors)
Kernicterus: Bilirubin in the brain
Don't give to babies <2mo
Don't give to breast feeding moms
Don't give to pregnant women after 32 weeks
Pt counseling
Monitoring
Silver Sulfadiazine (silvadene)
Trimethoprim/sulfamethoxazole (Bactrim)
Used for 2nd and 3rd degree burns
- App is usually pain free
- Systemic abs.
- Mafenide: acidosis
- Causes blue/green skin discoloration (avoid face)
DOC for ACUTE UTI
- Inhibits sequential steps in bacterial folic acid synthesis,
making it much more powerful than TMP or SMZ alone
- Plasma drug levels
Used for
- Acute uti
- Otitis media
- Bronchitis
- Shigellosis
- Pneumonia caused by pneumocystis jiroveci (recurrence)
- Pneumocystitis
- Pneumonia
- Gi infection
a/e
- N/v
- Rash
- Hyperkalemia
- HA
- Depression
- Hallucinations
- Hypersensitivity (steven johnsons)
- Blood dyscrasias
- Kernicterus
- Renal damage: crystalluria
CLASS: NITROFURANTOIN (Macrodantin)
Class
???
MOA
Low concentrations: bacterioSTATIC
High concentrations: bacterioCIDAL
Uses
Urinary tract antiseptics
Lower UTI’s (bladder and urethra)
Prophylaxis
Recurrent lower UTI’s
Dose and
Route
Adverse
effects
-
Brown urine
Anorexia
n/v-> give with food
Pulmonary rxn
Chills
Fever
Cough
Agranulocytosis
Hematological effects
Peripheral neuropathy
Birth defects -> jaundice or hepatitis
Drug
interactions
Warnings/
contraindicatio
ns
Pt counseling
Monitoring
Liver toxicity
Not for pregnant women
Not for infants <1mo because causes anemia
CLASS: FLUOROQUINOLONES
Class
Floroquinolone
MOA
Disrupt DNA replication and cell division
Uses
BROAD spectrum agents with multiple applications
Bacteriocidal
Adverse
effects
Usually mild butttt can cause **tendon rupture!!**
Affects achilles tendon
Warnings/
contraindicatio
ns
-
Not for use in pt < 18 yo
Risk for those >60 yo
Risk for those on glucocorticoids
Risk for kidney, heart, lung transplant
CIPROFLOXACIN
Class
Floroquinolone
MOA
Inhibits bact DNA gyrase and topoisomerase II
Uses
Gram - and + bact
DOC for anthrax
Infections
Resp
UTI severe***
GI
Bones
Joints
Skin
Soft tissue
Dose and
Route
Adverse
effects
GI: n/v, diarrhea, abdominal pain
CNS: dizziness, HA, restlessness, confusion, seizures,
Tendon rupture
Phototoxicity
Candida infections (pharynx & vagina)
Increased risk for C diff infection
Older adults
Confusion, somnolence, psychosis, visual disturbances
Myasthenia gravis
Drug
interactions
Cationic compounds
Absorption reduced by:
Aluminum
Mg
Antacids
Iron salts
Zinc salts
Sucralfate
Milk and dairy (Ca)
Elevate drug levels
Theophylline (asthma)
Warfarin (anticoagulant)
Tinidazole (antifungal)
Warnings/
contraindicatio
ns
Bact resistant
S aureus
Serratia marcescens
Campylobacter jejuni
Pseudomonas aeruginosa
Neisseria gonorrhoeae
Pt counseling
Monitoring
-
CLASS: METRONIDAZOLE (Flagyl)
Class
Metronidazole
MOA
BacterioCIDAL
Uses
-
Protozoal infections
Infections caused by obligate anaerobes
H pylori
DOC for C diff
**Severe c diff= vancomycin
Dose and
Route
Adverse
effects
-
Neurotoxicity
Allergy
Superinfections
Drug
interactions
Warnings/
contraindicatio
ns
Pt counseling
Monitoring
NO ALCOHOL -> n/v -> death
ANTIFUGALSSSSSS
CLASS: AMPHOTERICIN B (ABELCET)
Class
Amphotericin
MOA
Binds to components of the fungal cell membrane, increasing permeability
Uses
BROAD spectrum antifungals
DOC for most systemic mycoses (internal infections)
Dose and
Route
May be given IV for 6wks to 4mo
Adverse
effects
Usually not given bc toxic infusion rxn (premedicate to avoid rxn, or stop infusion and fix problem)
Infusion rxn
Nephrotoxicity
hyPOkalemia (given w/ 1 L NS to protect the kidneys)
Hematologic effects (bone marrow suppression)
Drug
interactions
Warnings/
contraindicatio
ns
HIGHLY toxic-> should only be employed against infections that are progressive and potentially fatal
-
Don't give with other nephrotoxic drugs
Don't give with K sparing diuretics bc they harm the kidneys too
Pt counseling
Monitoring
***excretion from body can take 1 year!!!-> need to monitor whole time***
Monitor
BUN
Creatinine
-
CLASS: AZOLES
Class
Azole
Uses
BROAD spectrum antifungal
Use this before amphotericin B
Dose and
Route
Can be given PO (lower toxicity)
Drug
interactions
Interacts with alot of drugs
Antacids
inhibit/increases levels of other drugs
Itraconazole (sporanox)
Ketoconazole (nizoral)
Fluconazole (diflucan)
**#1 azole given**
Clotrimazole SKIN
Inhibits synthesis of ergosterol ->
increases permeability and leakage
of cellular components
Active against most fungi that
cause systemic mycosis and
superficial infections
Dermatophytes
Candida species
Inhibits synthesis of ergosterol ->
increases permeability and leakage of
cellular components
Dermatophytic infections and
candidiasis of the skin, mouth, throat
and vagina
Can be taken PO: Safer than
amphotericin B
a/e
Used for
Blastomycosis
Histoplasmosis
Meningitis caused by
cryptococcus neoformans
Coccidioides immitis
vaginal , oropharyngeal,
esophageal, disseminated
candida
a/e
DOC for
-
Blastomycosis
Histoplasmosis
Paracoccidioidomycosis
Sporotrichosis
a/e
GI n/v, diarrhea
Rash
HA
Abdominal pain
Edema
**cardiac suppression and liver
injury
Look at LFT
Look at ejection fraction
-
n/v (give drug with food)
Hepatotoxicity
Sex hormones impacted
Rash, itching
Dizziness
Fever
Chills
Constipation
Diarrhea
Photophobia
HA
**inhibits CYP3A4 and can
increase levels of other drugs
a/e
-
-
-
Topical administration
Stinging
Erythema
Edema
Urticaria
Pruritis
Peeling
Intravaginal
Burning
Lower ab. Cramps
Serious birth defects in 1st
trimester to face
**inhibits CYP3A4 and can increase
levels of other drugs -> wafarin,
phenytoin etc.
**try this one before Ketoconazole PO
bc of the toxicity rt po use
CLASS: POLYENE
NYSTATIN (Mycostatin)
Class
Polyene
MOA
Uses
DOC for intestinal candidiasis or oral, but can tx candida infections off the…
Skin
Mouth
Esophagus
Vagina
If in skin folds-> use powder to avoid adding more moisture
Dose and
Route
When giving PO have pt either swish and spit out or swish and swallow
**better to swallow so it coats whole oral cavity
Adverse
effects
Oral
GI problems n/v
Topical
Local irritation
Drug
interactions
Warnings/
contraindicatio
ns
-
Pt counseling
Monitoring
-