1. Penicillin
1.1. From fungus Penicillim
1.2. beta-lactam ring structure attacks cell wall
1.2.1. beta-lactamase/penicillinase = resistance
1.2.2. weakens cell wall, water enters
1.3. Oxacillin and cloxacillian are penicillinase-resistant penicillins
1.4. Most effective against gram +, few have gram - bacteria
1.5. Most narrow spectrum
1.6. Widely distro
1.7. Rapidly excreted thru kidneys
1.7.1. Need a lower dose with pt. with impaired renal function
1.8. Most have short half lives (30min)
1.9. Allergy most common side effect
1.10. Superinfection can occur: antibiotic-ass. pseuodomembranous colitis
1.10.1. Clostridium difficile
1.11. With most, take a full glass of water 1h before or 2h after meals (increase ab)
1.11.1. Oral penicillin G is inactivated with acidic fruit juice
1.12. Penicillin G Potassium
1.12.1. inactivated by penicillinase
1.12.2. streptococci, pneumococci, staphylococci, gonorrhea and syphilis
1.12.3. Not well absorbed orally
1.12.3.1. given IM or Iv
1.12.4. 60% protein bound
1.12.5. anaphylaxis is most serious side effect
1.12.6. may decrease effectiveness of oral contraceptives
2. Destroys Cell Walls
3. Cephalosporins
3.1. beta-lactam ring structure attacks cell wall
3.1.1. inhibit cell wall synthesis
3.2. allergy most common adverse side effect
3.3. sometimes prescribed for pt. who are allergic to penicillin
3.3.1. 5-10% of pt. have hypersensitivity to both
3.4. Almost all eliminated by kidneys
3.5. cause pain at IM sites
3.6. thrombophlebitis can occur when given IV
3.7. 4 generations
3.7.1. Gen 1
3.7.1.1. beta-lactamase ring
3.7.2. Gen 2
3.7.2.1. more resistant
3.7.2.2. broader spectrum
3.7.3. Gen 3
3.7.3.1. longer duration of action
3.7.3.2. broader spectrum
3.7.3.3. resistant to beta-lactamase
3.7.3.4. Can enter CSF
3.7.4. Gen 4
3.7.4.1. more organisms with resistance to previous gen
3.7.4.2. Can enter CSF
3.8. for gram - and pt. with hypersensitivity to penicillin
3.9. careful with NSAIDS, cephalosporins increase platelet inhibition
3.10. superinfection can occur: pseudomembranous colitis
3.10.1. cultured dairy can help suppress superinfections
3.11. avoid alcohol use
3.11.1. produces disulfiram-like state
3.12. Cefotaxime (Claforan)
3.12.1. Gen 3
3.12.2. broad spectrum against gram -
3.12.3. serious infections of lower resp tract, CNS, genitourinary system, bones, and joints, blood infections
3.12.4. not ab thru GI
3.12.4.1. IV or IM
3.12.5. wide distro, partly met by liver, 50% excreted unchnaged by kidneys
3.12.6. interacts with probenecid
3.12.6.1. decreased renal elimination of the drug
4. Tetrocyclines
4.1. extracted from Strptomyces soil microorg
4.2. selectively inhibit bac protein synthesis
4.2.1. bind to 30S bac ribo
4.2.1.1. aa can't be added to polypeptide chain
4.2.1.2. means they can't attack human protein synthesis, high concentration had toxic effects
4.3. broadest spectrum of any antibiotic
4.3.1. gram - and +
4.4. large number of resistant bac strains
4.4.1. prevent tetracyclines from building up in cell
4.4.2. Ribo changes shape
4.5. Rocky Mountain spotted fever, typhus, cholera, Lyme disease, ulcers, chlamydial infections
4.6. take on empty stomach to increase ab
4.6.1. iron and milk supplements big no
4.6.2. food and dairy decrease ab by 50%
4.6.3. magnesium-containing laxatives and antacids also a no
4.7. Superinfection can occur: pseudomembranous colitis
4.7.1. Clostridium difficile
4.7.2. Candida albicans
4.7.2.1. oral and perineal hygiene important
4.8. Can cause hepototoxicity
4.8.1. careful with liver disease
4.9. can cause photosensitivity
4.10. decreases effectiveness of oral contraceptives
4.11. do not save, toxic effects after expiration date
4.12. take at least 2h before/after taking lipid lower drugs
4.13. Tetracycline
4.13.1. given orally
4.13.2. short half life
4.13.2.1. need to be given often
4.13.3. mostly ab
4.13.4. widely distro
4.13.5. excreted unchanged in urine
4.13.6. take with full glass of water to decrease esophageal and GI irritation
4.13.7. admin antacids 1-3h before/after
4.13.8. admin antilipidemic agents 2h before
4.13.9. can cause superinfections
5. Inhibits protein synthesis
6. Macrolides
6.1. inhibit bacterial protein synthesis
6.1.1. bind to 50S ribo subunit
6.1.1.1. preventing movement of ribo along mRNA
6.1.1.2. can't effect human protein synthesis
6.1.1.3. resistance by pumping out of cell or changing subunit shape
6.2. can be bactericidal or bacteriostatic depending on dose or target org
6.2.1. usually bacteriostatic
6.3. whopping cough, legionnaires disease, streptococcus, H. influenzae, Mycoplasma pneumoniae and Chlamydia
6.4. newer macrolides have longer half-lives and cause less GI irritation
6.5. considered one of the safest antibiotic cases
6.6. should be taken on empty stomach
6.6.1. food decreases ab
6.6.2. have enteric coating
6.6.3. do not take with fruit juice
6.7. met by liver and excreted in bile
6.7.1. decrease hepatic met of other drugs
6.7.1.1. drug-drug interactions
6.7.1.2. pot. toxicity
6.7.2. not given to pt. with hepatic disease
6.8. careful with taking other med and supplements
6.9. Erythromycin (Eryc)
6.9.1. inactivated by stomach acid therefore enteric coated
6.9.2. effective against most gram +
6.9.3. given to ppl who are allergic or penicillin-resistant infections
6.9.4. widely distro
6.9.5. partly met by liver
6.9.6. mostly excreted in bile, small amount in urine
6.9.7. short half life
6.9.8. admin with glass of water on empty stomach
7. Aminoglycosides
7.1. mostly restricted to TB treatment b/c of high resistance
7.2. aerobic gram - bac, mycobacteria, protozoans,
7.3. inhib protein synth
7.3.1. cause synth of abnormal protein
7.4. polar compound
7.4.1. oral dose is not absorbed
7.4.1.1. given orally for parasitic infections and sterilize bowls for surgery
7.4.2. parenterally given
7.4.3. can't enter human cells
7.4.4. can cross placenta
7.4.4.1. causes hearing loss
7.4.5. build up in renal tissue
7.4.5.1. nephrotoxicity
7.5. bac resistance happens quickly
7.5.1. degrades antinbiotic
7.5.2. mut ribo
7.5.3. give one large dose/day = greater bacteriocidal effect
7.5.4. given with penicillin
7.6. excreted through kidneys
7.6.1. binds to tissue tightly, can take up to 20 days to clear
7.6.1.1. post-antibiotic effect
7.6.2. builds up in renal tissue
7.6.2.1. nephrotoxicity
7.6.2.1.1. drug builds up, more toxic effects
7.7. can cause damage to hearing and balance
7.7.1. cumulative damage
7.8. inhib release of acetylcholine at synapses
7.8.1. when given other drugs that effect acetylcholine release = apnea, prolonged m. paralysis
7.9. Gentamicin (Garamycin)
7.9.1. urinary, respiratory, neurological or Gi infections
7.9.2. IM or IV
7.9.2.1. well ab
7.9.3. widely distributed
7.9.4. excreted in urine mostly
7.9.4.1. unchanged
7.9.4.2. careful with kidney disease
7.9.5. half life 2 to 4h
8. Fluoroquinolones
8.1. 4 gen
8.2. all gen against gram -, later gen gram + too
8.3. affect DNA synthesis
8.3.1. inhib DNA gyrase and topoisomerase IV
8.4. mostly used as alt to other antibiotics
8.5. well ab orally
8.5.1. some can be taken with food
8.5.2. multvit or supplements + NO
8.5.3. antacids and ferrous sulfate decrease ab
8.6. given once or twice a day
8.7. adverse effects
8.7.1. dysrhythmias
8.7.2. liver failure
8.7.2.1. careful with pt with liver dysfunction
8.7.3. CNS effects (dizziness, headache, sleep disturbances)
8.7.4. affects cartilage dev
8.7.4.1. careful with children
8.7.4.2. don't give to preg women
8.7.4.3. refrain from physical exercise
8.7.5. photo phobia can occur
8.8. use to treat against bio terrorism bac
8.8.1. Bacillus anthracis, Yersinia pestis, Francisella tularensis, Brucella melitensis
8.9. serum levels btw PO admin and IV admin are the same
8.9.1. easy transition from IV to PO treatment
8.10. careful with pt. with epilepsy, cerebral arteriosclerosis or alchholisum
8.11. excreted by the kidneys
8.11.1. careful with pt. with renal dysfunction
8.11.2. encourage pt. to drink water
8.12. interact with warfarin
8.12.1. increase anti coagulation effects
8.13. Ciprofloxacin (cipro)
8.13.1. 2nd gen
8.13.2. inhib DNA gyrase
8.13.2.1. affects DNA repair and mexico
8.13.3. more effective against gram -
8.13.4. rapidly ab orally
8.13.4.1. can also be IV
8.13.5. widely distro
8.13.6. met by liver
8.13.7. 50% excreted unchanged in urine
8.13.8. half life of 4h
8.13.9. GI side effects
8.13.9.1. can be taken with food
9. inhib DNA synthesis
10. Sulfonamides
10.1. wide spectrum for gram + and gram -
10.2. inhib folic acid
10.3. used in combination with other antibio for treating UTI
10.4. classified by how ab and excreted
10.4.1. sulfsoxazole and sulfamethoxazole
10.4.1.1. rapid ab and excretion
10.4.2. sulfasalazine
10.4.2.1. poor ab
10.4.2.1.1. stays in alimentary canal to treat infections
10.4.3. sulfadiazine
10.4.3.1. topical
10.5. careful with hematological disorders
10.6. careful with renal crystalluria
10.7. preg , lactating, child younger then 2 is a NONO
10.7.1. cause jaundice
10.8. risk of Stevens-Johnson syndrome
10.8.1. connected with hypersensitivity to sulfonamides
10.8.2. skin abnormality
10.9. void exposure to direct sunlight
10.10. take oral does with full glass of water
10.11. increase fluid intake
10.12. Trimethoprim-Sulfamethoxazole
10.12.1. Combination used to treat UTI
10.12.2. both inhib bac met of folic acid
10.12.3. well ab orally
10.12.3.1. admin with glass of water
10.12.4. partly met by liver
10.12.5. less then 40% excreted in urine unchanged
10.12.6. half life is 6-12h
10.12.7. common adverse effect
10.12.7.1. skin rash
10.12.7.2. nausea/vomiting
10.12.7.3. careful of pt. with renal disorders
10.12.7.4. check blood work periodically