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Flashcards in Overview of Antimicrobials Deck (18)
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1

MOA - disrupt cell wall production

1. B-lactam: PCN, Cephalosporins, Carbapenems (workhorses)
2. Monobactams (Aztreonam)
3. Glycopeptides (Vanco)

2

MOA - inhibit DNA synthesis

1. FQ
2. Metronidazole

3

MOA - destabilize cell membranes (ice pick puncturing balloon)

1. cyclic lipopeptides

4

MOA - destabilize cell wall & cell membrane

1. lipoglycopeptides

5

MOA - inhibit protein synthesis

50S ribosome
1. macrolides (Azithro)
2. lincosamides (Clindamycin)
3. oxazolidinones (Linezolid)
4. pleuromutilins

30S ribosome
1. aminoglycosides (AG)* - Genta, Tobra
2. tetracyclines (TTC) - Doxy
3. glycylcyclines

6

MOA - inhibit folic acid synthesis

1. TMP-SMX

7

3 general mechanisms of Abx resistance

1. decrease intracellular [drug]
2. drug inactivation by enzymes (Beta lactamases)
3. abx target modification - decreased affinity for PBP (old key, new deadbolt), DNA topoisomerase mod, rRNA methylation

8

Bolded bactericidal vs. bacteriostatic

When is bactericidal preferred?

Bactericidal: b-lactam, FQ

Bacteriostatic: TTC, macrolides

-cidal agents preferred if host is compromised or host defense do not operate well

9

What is concentration-dependent killing?

Increased drug concentration increases bactericidal effects.

Large, infrequent doses enhance efficacy and minimize toxicity. Think of a tsunami.

e.g. AG, FQ, glycopeptides, lipoglycopeptides

10

What is post-antibiotic effect?

Short exposure to abx prevent microbe from growing even after abx has been removed.

11

What is time-dependent killing?

Drug is effective as long as concentration is > MIC.

Small frequent doses or continuous infusion.

e.g. b-lactam

12

Abx active against intracellular organisms

1. FQ
2. Macrolides

13

Anti-anaerobic abx

1. Clindamycin
2. Metronidazole
3. PO Amox/Clav
4. IV ampicillin/sulbactam & pip/taz
5. all carbapenems

14

"Bioequivalent" Abx

1. FQ
2. TTC
3. Metronidazole

15

Abx renal excretion

1. b-lactam (most)
2. monobactam
3. glycopeptide
4. cyclic lipopeptides/lipoglycopeptides
5. AGs
6. FQs (split excretion)
7. TTC/glycylcyclines (split excretion)
8. Oxazolidinones (split excretion)

16

Abx hepatic excretion (memorize these so you don't have to know renal)

1. Ceftriaxone*
2. Nafcillin
3. Clindamycin
4. All Macrolides*
5. Rifampin
6. Metronidazole*

MUST KNOW THE STARRED

17

What anti-anaerobic abx would you use if above the diaphragm, such as the oropharynx?

Clindamycin

18

What anti-anaerobic abx would you use if below the diaphragm, such as in the colon?

Metronidazole