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What is the mechanism of action of Beta-Lactams?
Inhibition of bacterial cell wall synthesis
What are the mechanisms of resistance in Beta-Lactams (3)?
  • Beta-lactamases
  • Alteration in access to binding site
  • Alteration in penicillin binding proteins (PBP)

For Penicillin V PO and Penicillin G IV describe Spectrum (2), Common indications (2).
Spectrum
  • Streptococci
  • Gram(+) anaerobes
Indications
  • Dental infections
  • Endocarditis (IV)
For Amoxicillin PO and Ampicillin IV, indicate Spectrum (5) and Indications (4)
Spectrum

SHLEP
  • Streptococci spp
  • Hemophilus influenzae
  • Listeria monocytogenes
  • Enterococcus spp
  • Proteus spp
Indications
  • Otitis media
  • Community-acquired pneumonia (CAP)
  • Entercoccal UTI
  • Entercoccal endocarditis
For Cloxacillin PO/IV, indicate Spectrum (1) and Indications (3)
Spectrum
  • Methicillin-susceptible S. aureus (MSSA)
Indications
  • Bacteremia
  • Endocarditis
  • Bone/joint infections

For Amoxicillin/Clavulanate PO, indicate Spectrum (6) and Indications (2)
Spectrum
  • Gram (+)
  • Gram (-) enterobacteraciae
  • MSSA (S. aureus)
  • Anaerobes
  • Proteus spp
  • Hemophilus influenzae

Indications
  • Polymicrobial infections
  • Bite wounds
  • Diabetic foot ulcers

For Piperacillin/Tazobactam IV, indicate Spectrum (6) and Indications (4)
Spectrum
  • Gram (+)
  • Gram (-) enterobacteraciae
  • MSSA
  • Anaerobes
  • Entercocci faecalis
  • Pseudomonas
Indications
  • Febrile neutropenia
  • Intraabdominal
  • Polymicrobial infections
  • Sepsis unknown source
For Ticarcillin/Clavulanate IV, indicate Spectrum (1)
Identical to Piperacillin/Tazobactam IV, except add Stenotrophomonas.
For Cephalexin PO (1st gen.), what is the Spectrum (2) and Indications (1)?
Spectrum
  • S. aureus (MSSA)
  • Beta hemolytic Streptococci
Indications
  • Skin and soft tissues infections (SSTI)
For Cefazolin IV (1st gen.), what is the Spectrum (5) and the Indications (3)?
Spectrum
  • S. aureus (MSSA)
  • Streptococci spp.
  • E. coli
  • Proteus
  • Klebsiella
Indications
  • Skin and soft tissue (SSTI)
  • Bone/joint
  • Surgical prophylaxis
For Cefuroxime IV, Cefuroxine axetil PO, Cefprozil PO (2nd gen.), what is the Spectrum (3) and the Indications (1)?
Spectrum

McSpy
  • S. pneumoniae
  • H. influenzae
  • M. cattarrhalis
Indications
  • Community-acquired respiratory infections
For Cefotaxime IV (3rd gen.), what is the Spectrum (5) and the Indications (4)?
Spectrum

McSpy + Strep + Gram(-)Ent
  • Streptococci
  • Penicillin I/R S. pneumoniae
  • Gram(-) Enterobacteraciae
  • H. influenzae
  • M. cattarrhalis
Indications
  • Urosepsis
  • Endocarditis
  • Skin/soft tissue (SSTI)
  • Meningitis
For Cetriaxone IV (3rd gen.), what is the Spectrum (6) and the Indications (5)?
Spectrum

Same as Cefotaxime IV, except add gonorrhea:
  • Streptococci
  • Penicillin I/R S. pneumoniae
  • Gram(-) Enterobacteraciae
  • H. influenzae
  • M. cattarrhalis
  • N. gonorrheae
Indications

Same as Cefotaxime IV, except add gonorrhea:
  • Urosepsis
  • Endocarditis
  • Skin/soft tissue (SSTI)
  • Meningitis
  • Gonorrhea (IM)
For Cefixime PO (3rd gen.), what is the Spectrum (5) and the Indications (2)?
Spectrum

Same as Ceftriaxone IV, except remove penicillin I/R S. pneumoniae:
  • Streptococci
  • Gram(-) Enterobacteraciae
  • H. influenzae
  • M. cattarrhalis
  • N. gonorrheae
Indications
  • UTI
  • Gonorrhea
For Ceftazidime IV (3rd gen.), what is the Spectrum (1) and the Indications (1)?
Spectrum

Pseudomonas aeruginosa

Indications

Combine with aminoglycosides for severe Pseudomonas infections 

For Cefepime IV (4th gen.), what is the Spectrum (5) and the Indications (3)?
Spectrum
  • Gram(+)
  • Penicillin I/R S. pneumoniae
  • S. aureus (MSSA)
  • Gram(-) enterobacteraciae
  • Pseudomonas aeruginosa
Indications
  • Combine with aminoglycosides for Pseudomonas infections
  • Febrile neutropenia
  • Polymicrobial infections 
Name the Cephalosporins (10)
  • Cephalexin PO
  • Cefazolin IV
  • Cefuroxime IV
  • Cefuroxime axetil PO
  • Cefprozil PO
  • Cefotaxime IV
  • Ceftriaxone IV
  • Cefixime PO
  • Ceftazidime IV
  • Cefepime IV

Name the Carbapenems (3)
  • Ertapenem IV
  • Meropenem IV
  • Imipenem IV

For Ertapenem IV, describe the Spectrum (5) and the Indications (1)
Spectrum
  • Gram(+)
  • S. aureus (MSSA)
  • Gram(-) enterobacteraciae
  • ESBL/AmpC producers
  • Anaerobes
Indications
  • Outpatient prescription for polymicrobial infections or multidrug resistance organisms

For Meropenem IV, describe the Spectrum (6) and the Indications (2)
Spectrum

Same as ertapenem IV, except add Pseudomonas:
  • Gram(+)
  • S. aureus (MSSA)
  • Gram(-) enterobacteraciae
  • ESBL/AmpC producers
  • Anaerobes
  • Pseudomonas
Indications
  • Post-trauma neurosurfical meningitis
  • Polymicrobial infections (suspected multidrug resistance)
For Imipenem IV, describe the Spectrum (7) and the Indications (2)
Spectrum

Same as ertapenem IV, except add Pseudomonas and Entercoccus faecalis:
  • Gram(+)
  • S. aureus (MSSA)
  • Gram(-) enterobacteraciae
  • ESBL/AmpC producers
  • Anaerobes
  • Pseudomonas
  • Enterococcus faecalis
Indications
  • Intraabdominal
  • Polymicrobial infections (with suspected multidrug resistance)

What is the mechanism of action of Cephalosporins?
Inhibit cell wall synthesis by binding to penicillin binding proteins (PBPs)
What is the mechanism of action for Glycopeptides (e.g. Vancomycin)?

Mechanism: Inhibition of bacterial cell wall synthesis

Works at an earlier stage than beta-lactams
What is the mechanism of action for Lipopeptides (e.g. Daptomycin)?
Mechanism: Disruption of cell wall membrane
  • Calcium dependent
  • Cell membrane depolarization
  • Disrupts RNA, DNA, protein synthesis (leading to cell death)
What is the mechanism of resistance for Vancomycin?
Vancomycin binds to D-ala-D-ala to prevent polymerization of cell wall.

Genes such as VanA, VanB, VanC, VanD encode for pentapeptides terminating in D-ala-D-lac, which prevents Vancomycin from functioning.

VanA gene may have been acquired in S. aureus by VanA gene from VRE (Vancomycin-resistance entercocci)
What is the Spectrum (6) and Indications (7) for Vancomycin IV?
Spectrum
  • Gram(+)
  • Gram(+) anaerobes
  • Enterococci
  • Penicillin I/R Streptococci
  • MRSA
  • CNS (S. epidermidis)
Indications
  • Bacteremia
  • Endocarditis
  • Bone/joint
  • SSTI
  • Pneumonia
  • CNS (S. epidermidis)
  • Surgical prophylaxis for MRSA/Allergy
What is the Spectrum (1) and Indications (1) for Vancomycin PO?
Spectrum
  • C. difficile
Indications
  • C. difficile
What is the Spectrum (1) and Indications (4) for Daptomycin IV?
Spectrum

Same as Vancomycin IV, except works for Vancomycin-resistance organisms
  • Gram(+)
  • Gram(+) anaerobes
  • Enterococci
  • Penicillin I/R Streptococci
  • MRSA
  • CNS (S. epidermidis)
Indications
  • Bacteremia
  • Endocarditis
  • Bone/joint
  • SSTI
What are the 2 aminoglycosides? What is their main indication and how are they commonly used?
  • Gentamicin
  • Tobramycin
Main indication: UTIs for gram(-) enterobacteriaceae, and Pseudomonas

Often used in combination therapy
What is the mechanism of action for aminoglycosides?
Inhibits protein synthesis by binding to 30S ribosomal subunit
What are the mechanisms of resistance (4) for aminoglycosides?
  • Plasmid-mediated production of aminoglycoside-modifying enzymes
  • Alteration of 30S target
  • Alteration in cell wall permeability
  • Alteration in transport across cell membrane
What is the Spectrum (3) and Indications (3) for Gentamicin IV?
Spectrum
  • Gram(-) Enterobacteriaceae
  • Pseudomonas
  • Synergy vs Streptococci and Enterococci with beta-lactam or vancomycin
Indications
  • Drug-resistant UTI
  • Gram(-) sepsis (combo therapy)
  • Gram(+) bacteremia and endocarditis (combo therapy)
What is the Spectrum (2) and Indications (2) for Tobramycin IV?
Spectrum
  • Gram(-) Enterobacteriaceae
  • Pseduomonas (better than Gentamicin)
Indications
  • Drug-resistant UTIs
  • Pseudomonas (combo therapy)
Name 1 macrolide
Azithromycin
What is the mechanism of action for Azithromycin?
Inhibition of protein synthesis (binding to 23S ribosomal RNA in 50S ribosomal subunit)
What is the Spectrum (7) and Indications (4) for Azithromycin IV/PO?
Spectrum

MycMicMack + Chlams + Gonorrhea + Legionella
  • Mycoplasma
  • Moraxella catarrhalis
  • MAC (Mycobacterium avium complex)
     
  • Chlamydophila
  • Chlamydia trachomatis
  • Neisseria gonorrheae
     
  • Legionella 
Indications
  • MAC (combo therapy)
  • MAC prophylaxis in HIV patients
  • STI
  • Community-acquired pneumonia (combo therapy) 

Name 1 Lincosamide
Clindamycin
What is the mechanism of action for Clindamycin?
Inhibition of protein synthesis (binding to 50S ribosomal subunit)
What is the Spectrum (3) and Indications (6) for Clindamycin IV/PO?
Spectrum

SAM
  • Streptococci
  • Anaerobes
  • MRSA (S. aureus)
Indications
  • SSTI (skin and soft tissue)
  • Bone/joint
  • Abscesses
  • Dental infections (alternative)
  • Polymicrobial infections, in combination wtih Gram(-) agent
  • Necrotizing fasciitis (combo therapy)
Give 1 example of a Tetracycline and 1 example of a Glycylcycline?
  • Tetracycline (e.g. Doxycycline)
  • Glycylcyclines (e.g. Tigecycline) 

What is the mechanism of action for Tetracyclines and Glycylcylcines? Name 1 mechanism of resistance.
Mechanism of Action

  • Inhibition of protein synthesis (Binds 30S and 50S ribosomal subunits)


Mechanism of Resistance

  • Efflux pumps 

What is the Spectrum (10) and Indications (5) for Doxycycline PO?
Spectrum

MRSA + McSpHi + Weirds (VLP) + Mycoplasma + Chlams
  • MRSA (S. aureus)

  • Moraxella
  • S. pneumoniae
  • Haemophilus

  • Chlamydophilia
  • Chlamydia trachomatis

  • Vibrio
  • Legionella
  • Pasteurella

  • Mycoplasma
Indications

  • COPD
  • Community-acquired pneumonia
  • Bite wounds (alternative)
  • Chlamydial STIs
  • Purulent cellulitis (suspected MRSA)

Give the Spectrum (5) and Indications (3) for Tripmethoprim/sulfamethoxazole IV/PO?
Spectrum
  • Gram(-)
  • Pneumocystitis jiroveci (PCP pneumonia)
  • S. pneumoniae
  • S. aureus (MRSA)
  • Nocardia
Indications
  • PCP treatment/prophylaxis
  • Purulent cellulitis (suspected MRSA)
  • UTI (not first line)
What is the Spectrum (4) and Indictations (1) of Tigecycline IV?
Spectrum
  • Broad spectrum
  • Gram(+) including E. faecalis, MRSA
  • Gram(-) enterobacteriaceae
  • Anaerobes

Indications
  • Last-line option for polymicrobial multi-drug resistant organisms if susceptibility confirmed

Name 2 fluoroquinolones
  • Ciprofloxacin
  • Levofloxacin

Give the Spectrum (3) and Indications (1) for Nitrofurantoin PO?
Spectrum

EEK, a bladder infection!
  • E. coli
  • E. faecalis
  • Klebsiella
Indications
  • 1st line for cystitis 
What is the mechanism of action for fluoroquinolones?
Inhibit DNA gyrase and topoisomerase
Name 1 nitroimidazole
Metronidazole
What are 2 mechanisms of resistance for fluoroquinolones?
  • Chromosomal mediated alterations in targets, efflux pumps or cell-wall permeability
  • Plasmid-mediated inhibition of quinolone binding

What is the mechanism of action (1) and mechanism of resistance (2) of Metronidazole?
Mechanism of action
  • Inhibits DNA synthesis
Mechanism of resistance
  • Decreased cellular uptake
  • Decreased cellular reductase activity

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