Antibiotics

1. Antibiotics Slackers Facts by Mike Ori

2. Disclaimer The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes. The document can mostly be used forward and backward. I tried to mark questionable stuff with (?). If you want it to look pretty, steal some crayons and go to town. Finally… If you’re a gunner, buck up and do your own work.

3. What are the types of beta lactam antibiotics

4. Penicillins Cephalosporins Carbapenems Monobactams

5. Name the classes of penicillins

6. Standard Antistaphylococcal Amino Antipseudomonal

7. What are the anti-staph penicillins and their routes

8. Nafcillin - IV Dicloxacillin - PO

9. What are the standard penicillins and routes

10. Penicillin V – PO Penicillin G - IV

11. Which bacteria are exquisitely sensitive to standard penicillins

12. Group A strep (pyogenes)

13. Amino penicillins names and routes

14. Ampicillin – PO,IV Amoxicillin – PO

15. What is typically coadministered with the aminopenicillins

16. Beta lactamase inhibitors Amoxicillin – clavulanate Ampicillin - sulbactam

17. What is the CSF action of aminopenicillins

18. Can reach CSF if the meninges are inflamed

19. What side effect can happen when giving aminopenicillins to pt with infectious mononucleosis, chronic lymphocitic leukemia, allopurinol

20. Rash Lowest incidence with allopurinol, others are very high.

21. Cephalosporins names, generation, routes, and gram positive/negative effectiveness

22. Susceptibility by generation. General trend is down with gram positives and up with gram negatives.

23. Which generation reaches effective levels in the CSF

24. Third gen

25. Your patient has an allergy to penicillin G can you administer cephalosporins

26. Maybe. Contraindicated if the pt experienced an IgE mediated rash. Caution with other penicillin type reaction.

27. Carbapenems names, routes, and spectrum

28. Imipenem, IV Broadest range of all available antibiotics. Excellent penetration through porins into gram negative periplasmic space

29. What is cilastin

30. A drug coadministered with imipenem to inhibit kidney ezymes that breakdown imipenem into nephrotoxic metabolites

31. Imipenem ADR

32. Seizures

33. Monbactam names, routes, spectrum

34. Aztreonam, IV gram negatives including P aeruginosa. Ineffective against gram positives or anaerobes

35. Glycopeptides name, route, spectrum

36. Vancomycin, IV, Gram positives only

37. Vanco has poor oral availability so why do the dosing instructions include oral administration?

38. Vanco is useful for treatment of gram positive anaerobic infections of the GI tract such as C. difficile infections.

39. Describe the ADR from rapid infusion of vancomycin

40. Rapid infusion results in histamine release that cause flushing of the skin of the neck and upper trunk that can result in hypotension. AKA red man or red neck syndome

41. List the protein inhibitory antibiotic classes and their action

42. Aminoglycosides – 30s Macrolides – 50s Lincosamides – 50s Tetracyclines – 30s Chloramphenicol – 50s Streptogramins– 50s Oxazolidinones – ribosome assembly

43. Aminoglycoside names, routes, spectrum

44. Gentamicin, IV Tobramycin, IV Both are effective against aerobic gram negative and mycobacterium

45. Aminoglycoside toxicity characteristics

46. Nephrotoxic and ototoxic above an patient variable threshold in time dependent manner

47. Aminoglycoside dosing characteristics

48. Concentration dependent killing with significant post antibiotic effect allows for once daily dosing. Note: This contrasts to most others that are both time and concentration dependent.

49. Why are aminoglycosides ineffective against anaerobic bacteria?

50. Entry into the cell is mediated by oxygen dependent transport.