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Antibiotics - Coggle Diagram

- - - - Gentamycin
      - Neomycin
        
        Bowel surgery
      - Tobramycin
    - - misreading of genetic code
    - - dont affect eukaryotes
        
        different ribosomes
    - - Streptomycin
        
        Tuberculosis
    - - Vancomycin and gentamycin
        
        endocarditis
        
        enterococci
      - ampicillin and gentamycin
        
        meningitis
        
        listeria
      - Pip/Tazo with tobramycin
        
        CF patients
        
        pseudomonas
    - - Drug modifying enzymes
    - - Nephrotoxicity
        
        ATN
      - Ototoxicity
        
        affect CNVIII
      - Neuromuscular blockage
      - Pregnancy Class D
    - - Peak level
      - Trough level
  - - - binds to P site
        
        block translocation
        
        block peptidyltransferase
    - - Most gram+ve
      - Some gram -ve
    - - Pneumonia
        
        Community acquired
        
        Strep. H Flu. Atypicals
      - Chlamydia infection
      - Arithromycin
        
        given in GI motility disorders
      - Clarithromycin
        
        triple therapy H. Pylori
    - - methylate 23s rRNA
        
        no binding
    - - NVD
      - Prolonged QT
      - Acute cholestatic hepatitis
        
        Azithromycin
      - Rash
      - P450 inhibitors
      - Erythromycin worst
  - - - ADH antagonist
      - SIADH
      - causes N-DI
    - - accumulates intracellularly
      - Zoonotic bacteria
      - intracellular bacteria
      - Acne vulgaris
        
        minocycline
    - - Ca, Mg
      - Milk
    - - decreased influx or increased efflux
    - - Rash
      - Photosensitivity
      - Discoloration of teeth
        
        children
      - Inhibition of bone growth
        
        children
      - Contraindicated in pregnancy
  - - - blocks peptidyl transferase
    - - toxicity
      - resistance
    - - broad
        
        used instead of doxycycline in pregnancy
        
        1/2 trimester
        
        used for meningitis
    - - Anemia
        
        Aplastic anemia
      - Grey Baby syndrome
        
        hepatic glucouronsyltransferase
  - - - preventing translocation
        
        similar to Macrolides
    - - Clostridium perfringens
      - Fusobacterium
      - Bacteroides
        
        resistance
        
        Metronidazole
        
        below the diaphragm
    - - anaerobe above diaphragm
        
        Aspiration pneumonia
        
        Lung abscess
        
        Oral infection
    - - C. Diff infection
      - antibiotic associated diarrhea
  - - - blocks initiation
    - - VRE
    - - MAOi
        
        Serotonin syndrome
      - Bone marrow suppression
        
        Thrombocytopenia
  - - - sequential protein synthesis block
    - - VRSA
      - VRE
- - - - Novofloxacin
        
        UTI
    - - Ciprofloxacin
        
        Enteric Gram -ve
        
        Most reliable pseudomonas coverage
        
        Gram +ve some
        
        Mycobacteria
        
        Agents of atypical pneumonia
        
        Mycoplasma
        
        Chlamydia
    - - Levofloxacin
        
        Gram +ve bacteria
        
        S. Pneumo
        
        Enterococci
        
        MRSA
      - Gemifloxacin, Moxifloxacin
        
        Newer drugs
  - - - Community acquired Pneumonia
    - - widest spectrum
  - - - Arthropathy
    - - newer fluoroquinolones
- - - - Dapsone
        
        M. leprae
        
        P. jirovecii
        
        Toxicity
        
        Methemoglobinemia
        
        Hemolysis G6PD deficiency
        
        Agranulocytosis
    - - Trimethoprim
        
        Toxicity
        
        Hyperkalemia
        
        Megaloblastic anemia
        
        Pancytopenia
        
        Leucovorin
      - Pyrimethamine
  - - - Bacteriocidal combination
        
        Most Gram + and Gram -
        
        Pseudomonas, anaerobics not included
        
        P. Jirovecii
        
        UTI
        
        Not in pregnancy
        
        Neural Tube defects
        
        Nocardia
        
        H. Influenza and M. Catarrhalis
    - - Silver cream
        
        Burn
    - - Toxoplasmosis
      - BMS
    - - IBD
  - - - linked to Arylamine
        
        more common in HIV
      - other sulfa drugs
        
        Furosemide
        
        Thiazide
        
        Probenecid
        
        Acetazolamide
        
        Sulfasalazine
        
        Sulfonylurea
        
        Same as penicillin
    - - Drug interaction with UV light
      - common with Tetracycline, Amiodarone
    - - Bilirubin
        
        Kernicterus
        
        Permanent neurologic impairment
      - Warfarin
        
        raise PT
  - - - Sulfasoxazole
    - - Sulfamethoxazole
    - - Sulfadoxine
- - - - mimics D-ala-D-ala binding
    - - inhibits renal secretion
        
        boosting its levels
    - - Modified PBP
        
        S. Pneumo
      - Reduced bacterial cell penetration
        
        Porins
        
        Gram -ve bacteria
      - Beta-lactamase enzymes
        
        Degrade
        
        Pen G V
        
        Some Cephs
        
        Gram -ve bacteria
        
        Periplasm
        
        S. Aureus
        
        secretion
        
        more production
        
        lactamase inhibitors
        
        Clavulanic acid
        
        Tazobactam
        
        Increase spectrum of activity
        
        Usage
        
        Ampicillin/ Sulbactam (Unasyn)
        
        Amoxicillin/ Clavulanic acid (Augmentin)
    - - Natural penicillin
        
        Narrow spectrum
        
        GAS
        
        DOC
        
        Syphillis
        
        rarely
        
        N. meningitis
        
        S. pneumo
      - Anti-staph
        
        Oxacillin, nafcillin
        
        Methicillin
        
        Interstitial Nephritis
        
        Most S. aureus
        
        non-MRSA
        
        Used
        
        Skin
        
        cellulitis
        
        Impetigo
        
        Endocarditis
        
        Resistant to Beta-lactamases
      - Amino-pencillin
        
        Amoxicillin, Ampicillin
        
        Dosage
        
        Amox
        
        oral
        
        Amp
        
        IV
        
        Penetrate porin channel
        
        Coverage
        
        H. influenza
        
        Listeria
        
        E. Coli, Proteus, Salmonella, Shigella
        
        Usage
        
        Otitis Media
        
        Bacterial Sinusitis
        
        Meningitis
        
        newborn
        
        elderly
      - Anti-pseudomonal
        
        Piperacillin, Ticarcillin
        
        Greater porin channel penetration
        
        effective against P. aeruginosa
        
        Spectrum
        
        Broad
        
        Given with B-lactamase inhibitor
        
        Ticarcillin/Clavulanate (Timentin)
        
        Pipercaillin/Tazobactam (Zosyn)
        
        Most Gram +ve
        
        except MRSA
        
        Most anaerobic
        
        Most Gram -ve
        
        Pseudomonas
        
        Usage
        
        Hospitalised patients
        
        Pneumonia
    - - Hypersensitivity rx
        
        Acute
        
        Within 1 hr
        
        IgE
        
        Anaphylaxis
        
        Maculopapular rash
        
        days to weeks
        
        type IV
        
        Aminopenicillins
        
        more common with EBV
        
        Stevens Johnson syndrome
        
        Toxic Epidermal Necrolysis
        
        Interstitial Nephritis
        
        Type IV
        
        Drug acts as hapten
        
        Increased BUN
        
        Sterile pyuria
        
        Fever/ Oliguria
        
        Hemolytic anemia
        
        high doses
        
        Type II
        
        Direct Coombs Test +ve
        
        Serum sickness
        
        Type III
        
        Cross reactivity
      - C. Difficile infection
        
        Pseudomembranous collitis
        
        Usually assc.
        
        Clindamycin
      - Jarisch Herxheimer Rx
        
        Syphilis
        
        Febrile syndrome
        
        2 hrs after therapy
        
        not allergic rx
      - GI disturbance
  - - - Nephrotoxic metabolites
      - Given with cilastatin
      - Ertopenem
        
        not given with Pseudomonas
    - - GI effects
      - Skin rash
      - Neurotoxicity
        
        Seizures
        
        lower risk with meropenem
  - - - only in Gram -ve bacteria
    - - works against Pseudomonas
  - - - 1st
        
        Cefazolin, Cephalexin
        
        Gram +ve
        
        S. aureus
        
        not MRSA
        
        Not cover Listeria or enterococci
        
        Not Gram -ve
        
        Surgical skin infections
        
        Pre-op for prevention
      - 2nd
        
        .
        
        Increased anaerobic coverage
        
        Some resistance to B-lactamase
        
        more Gram -ve spectrum
        
        H. influenza, Enterobacter, Proteus
        
        treat amoxicllin resistant infections
        
        Cefuroxime, Cefotetan, Cefoxitin
        
        Cefuroxime
        
        Oral
        
        Otitis Media
        
        UTI
        
        Other two
        
        IV
        
        PID
        
        Pre-op for appendicitis
      - 3rd
        
        Ceftriaxone, Cefotaxime, Ceftazidime
        
        Ceftazidime
        
        covers Pseudomona
        
        Ceftriaxone
        
        CSF penetration
        
        Neisseria infection
        
        Ceftizoxime
        
        Bacteroides
        
        More gram -ve
        
        More B-lactamase resistant
      - 4th
        
        Cefipime
        
        Broad spectrum
        
        More gram -ve
        
        Resistant to some ESBL
      - 5th
        
        Ceftaroline
        
        Active against MRSA
        
        covers VRSA
        
        Some gram -ve
        
        not Pseudomonas
    - - Same hypersensitivity reactions as Penicillin
        
        some cross reactivity
      - Vit. K deficiency
        
        pt. on warfarin problematic
      - Hypoprothrombinemia
        
        NMTT
        
        Cefotetan
        
        Cefazolin
      - Nephrotoxicity
        
        with Aminoglycosides
      - Disulfiram reaction
- - - - D-ala-D-lac
        
        VRSA
    - - MRSA
      - C. difficile (oral)
    - - Nephrotoxicity
        
        dont give with Aminoglycosides
      - Ototoxicity
      - Red man syndrome
  - - - Below the diaphragm
    - - Cipro/Flagyl
        
        Diverticulitis
      - H. Pylori
      - Gardnerella Vaginalis
      - Anaerobic protozoa
        
        Trichomonas
        
        E. Histolytica
        
        Giardia
    - - Unpleasant taste
      - GI discomfort
      - Neuropathy
      - Disulfiram effect
  - - - Pregnancy
        
        avoid TMP-SMX
        
        Quinolones
      - Can trigger G6PD hemolysis