1
NR565 Week 5 Study Outline
Many questions are written to assess your clinical application of the material from the textbook, in real-world
scenarios.
Chapter 24: Drugs used in treating infectious diseases (p. 692-760) SEE DRUG CHART BELOW
Know the following for each drug class (penicillins, cephalosporins, fluoroquinolones, lincosamides, macrolides,
sulfonamides, trimethoprim, nitrofurantoin, lipoglycopeptides):
• • Spectrum of coverage for various organisms
• • Pharmacodynamics
• • Pharmacokinetics
• • Pharmacotherapeutics
• • Clinical indications & dosing
• • ADRs
• • Monitoring
• • Patient education
Antimicrobial resistance
Treatment of Group A and Group B beta streptococci
Cross sensitivity with cephalosporins
Category Bacteriocidal or What do they Pharmacokineti Pregnancy Adverse Effe
Bacteriostatic Treat? cs Category? Safe in
(Indications) pediatrics?
Safe in Lactation?
Penicillins Bacteriocidal; Pcn - Treat aerobic Absorption – - Catergory B - Hypese
(PCN and Amoxicillin) inhibits synthesis and gram positive. from GI tract, - Safe in y
of bacterial cell Red Book depends on lactation - Superin
wall recommends agent, ph of - Safe in n
Used in tx bact. URI, penicillin for stomach/intesti pediatrics - GI
pharyngitis strep, otitis Group ne, presence of - Does not disturub
media, sinusitis, pna, STI, A beta streptococci food; high cross BBB s
wound infx & for Group doses can cause unless - Rash
B beta streptococci GI inflammatio (maculo
due to low upset/diarrhea n lar)
resistance - Change
Distribution – renal
Aminopcn – treat varies in function
gram posivite protein - Candida
,2
anaerobes and binding, well infectio
gram negative distributed, - Seizures
(MSSA, strep, inflammation ability
H.flu, E.coli, enhance - Decreas
Klebsiella, distribution, oral
Neisseria crosses contrapc
meningitides); placenta/breast ves
amoxicillin, milk effectiv
ampicillin; - Interstit
combined with Metabolism – nephriti
betalactamase minimal metab
inhib except for * Severe, type I
nafcillin/oxacill allergic reaction
Pcnase-resistant – in to cephalospori
(pcnase staph, carbapenems, o
strep, MSSA); not Excretion – beta-lactamase
effective against primarily inhibitors may
MRSA; cloxacillin, unchanged in contraindicate u
dicloxacillin, urine, caution penicillins.
methicillin, in renal
nafcillin, oxacillin insufficiency
(increase half
Antipseudomonal – life)
gramneg bacilli
(pseudo
aeruginosa,
enterbacter,
morganella);
piperacillin,
ticarcillin
Cephalosporins – 1st Bactericidal First gram pos Absorption In pregnancy d/t - GI
Generation and limited gram oral, GI tract, increase fluid distuban
(Cephalexin) & Increase in gram neg; doesn’t enter rate of shorter half life, (C.diff)
2nd Generation neg up the CSF, staph aureus, absorption lower serum levels - Alterati
(Cefuroxime) generations and strep, pna/resp infx delayed by and larger Vd blood
3rd Generation decreases in gram (cephalexin, food, IM – clotting
(ceftriaxone) & pos. cefazolin) absorbed by Lactation safe - Combin
4th Generation muscle with alc
(cefepime) Treat surgical Second gram + Pediatrics in (disulfir
prophylaxis, resp and H. flu, more Distribution neonates immature rxn –
1st – narrow spectrum tract infx, strep potent, broader widely renal fx causes flushing
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to increased half life dizzines
tis, CAP, skin, gonorrhea, resp most tissue, and accumulation; n/v, coa
soft tissues, infx (cefaclor variation in kids – varies by problem
bones/joints, UTI (CAP), protein drug - Nephrot
(2nd line for kids), cefziroxine) binding, ty
STI penetration - Superin
Third some CSF varies by n
gram + and -, not generation - Renal/h
active against c dysfun
MRSA, effective Metabolism extends
against hepatic halflife
pseudomonas, less metabolism – - Anaphy
freq dosing, insignificant rxn to p
crosses BBB with don’t gi
inflammation Excretion cephalo
,3
(ceftriaxone, excreted by - Probene
omnicef (CAM) kidney incre
concent
Fourth broad n of cep
spectrum of - Loop
activity, good for diuretic
organisms that increa
developed risk for
resistance to earlier nephrot
generation y
cephalos, strep,
staph, doesn’t
penetrate CSF
(cefepime,
maxipime)
Glycopeptides Bacteriocidal Inhibits cell wall Absorption – Pregnancy Side effect
(Vancomycin – narrow gram positive synthesis and poor absorption - Category B - Irritatin
spectrum (Vancocin)) disrupts from GI tract, (oral) tissue an
(telavancin (Vibativ)- used to membrance barrier IV rapidly - Category C blood v
tx HAP or CAP when vanc function; affects absorbed; (parenteral) intima
fails) RNA synthesis vanc:52-56% - Must do - Red ma
protein bound; pregnancy syndrom
Vanc: C.diff, and telavancin: test prior to (face, ne
staph enterocolitis 90% protein telavancin torso 10
bound use mins aft
Telavancin: Lactation infusing
complicated skin Distribution – - Excreted in Adverse Effects
infections widely breast milk - Nephrot
distributed; Pediatrics - Transien
penetrates CSF - Hospitalized ototoxic
patients - Hyperse
Metabolism – only with vity
primarily given serious - Phlebiti
IV; bypasses illness injectio
first pass
Excretion –
oral vanc
(feces); Iv vanc
(renally via
glomerular
filtration);
telavancin
(primarily
urine)
Macrolides Bactericidal or Inhibits gram + Absorption – Cautions - GI upse
(Erythromycin, bacteriostatic and few gram - well absorbed - Prolongs (esp. wi
Clarithromycin, depending on in duodenum QT erythro
Azithromycin, dirithromycin, concentration; - Liver )
telithromycin) reversibly binds Distribution – impairment - Severe
to 50S ribosome distribute - Clarithromy explosiv
unit, preventing readily to body cin: watery
protein synthesis tissues, enters - CrCl diarrhea
of bacteria; CSF when <30ml/min - Acute
alkaline – meninges are requires choleste
inactivated by inflamed dosage to be hepatitis
, 4
acid; halved - Rash, fe
Metabolism – Pregnancy eosinop
metabolized in - Erythromyci - Metab.
liver, n: cat B Interacti
erythromycin, - Clarithromy esp with
heavily cin: cat C erythro
metabolized by - Azithromyci - Prolong
CYP3A4 n: cat B QT
Lactation syndrom
Excretion – - Safe maligna
excreted in Pediatrics arrthym
feces and urine, - Safe over
caution with age 6 Interactions
clarithromycin months - Colchic
increased - Warfari
renal excretion - Digoxin
increase
effect
Lincosamides Bacteriostatic in First line tx in Absorption – Cautions - GI symp
(clindamycin - Cleocin) usual doses; MRSA, primarily good oral - Asthma - Dizzine
suppresses gram +, some absorption - Severe vertigo,
protein synthesis anaerobic allergies - C.diff (
– binds to 50S pathogens Distribution – - Severe serious
subunit of the highly protein renal/liver
bacterial bound impairment
ribosome Pregnancy
Metabolism – - Category B
metabolized in - Okay for 3rd
liver trimester
Lactation
Excretion – - Present in
excreted in bile breast milk
and urine – weigh
risk/benefit
Pediatrics
- Severe infx
only
Quinolones Bactericidal for Broad spectrum; Absorption – Cautions - GI
(Levofloxacin, DNA gyrase extensive gram -; well absorbed - Renal - CNS
Ciprofloxacin, Moxifloxacin) (needed to later generations after PO admin, dysfunction: - Phototo
synthesize increased activity IV and oral can cause - Skin
bacterial DNA) against gram +; similar serum increase - Superin
only moxifloxacin concentration half-life n
has activity against with - Muscul
anaerobic bacteria; Distribution – majority of etal
PO and IV widely drug - Renal
formulations; distributed; excreted - Diabetic
resistance already high tissue, unchanged - Serious
occurring from urinary in urine effect:
inappropriate use prostate, sinus - CrCl dysrhyt
and lung <50mL/min:
penetration; adjust
variable protein dosage
binding; - Cautious in
moderately patients
NR565 Week 5 Study Outline
Many questions are written to assess your clinical application of the material from the textbook, in real-world
scenarios.
Chapter 24: Drugs used in treating infectious diseases (p. 692-760) SEE DRUG CHART BELOW
Know the following for each drug class (penicillins, cephalosporins, fluoroquinolones, lincosamides, macrolides,
sulfonamides, trimethoprim, nitrofurantoin, lipoglycopeptides):
• • Spectrum of coverage for various organisms
• • Pharmacodynamics
• • Pharmacokinetics
• • Pharmacotherapeutics
• • Clinical indications & dosing
• • ADRs
• • Monitoring
• • Patient education
Antimicrobial resistance
Treatment of Group A and Group B beta streptococci
Cross sensitivity with cephalosporins
Category Bacteriocidal or What do they Pharmacokineti Pregnancy Adverse Effe
Bacteriostatic Treat? cs Category? Safe in
(Indications) pediatrics?
Safe in Lactation?
Penicillins Bacteriocidal; Pcn - Treat aerobic Absorption – - Catergory B - Hypese
(PCN and Amoxicillin) inhibits synthesis and gram positive. from GI tract, - Safe in y
of bacterial cell Red Book depends on lactation - Superin
wall recommends agent, ph of - Safe in n
Used in tx bact. URI, penicillin for stomach/intesti pediatrics - GI
pharyngitis strep, otitis Group ne, presence of - Does not disturub
media, sinusitis, pna, STI, A beta streptococci food; high cross BBB s
wound infx & for Group doses can cause unless - Rash
B beta streptococci GI inflammatio (maculo
due to low upset/diarrhea n lar)
resistance - Change
Distribution – renal
Aminopcn – treat varies in function
gram posivite protein - Candida
,2
anaerobes and binding, well infectio
gram negative distributed, - Seizures
(MSSA, strep, inflammation ability
H.flu, E.coli, enhance - Decreas
Klebsiella, distribution, oral
Neisseria crosses contrapc
meningitides); placenta/breast ves
amoxicillin, milk effectiv
ampicillin; - Interstit
combined with Metabolism – nephriti
betalactamase minimal metab
inhib except for * Severe, type I
nafcillin/oxacill allergic reaction
Pcnase-resistant – in to cephalospori
(pcnase staph, carbapenems, o
strep, MSSA); not Excretion – beta-lactamase
effective against primarily inhibitors may
MRSA; cloxacillin, unchanged in contraindicate u
dicloxacillin, urine, caution penicillins.
methicillin, in renal
nafcillin, oxacillin insufficiency
(increase half
Antipseudomonal – life)
gramneg bacilli
(pseudo
aeruginosa,
enterbacter,
morganella);
piperacillin,
ticarcillin
Cephalosporins – 1st Bactericidal First gram pos Absorption In pregnancy d/t - GI
Generation and limited gram oral, GI tract, increase fluid distuban
(Cephalexin) & Increase in gram neg; doesn’t enter rate of shorter half life, (C.diff)
2nd Generation neg up the CSF, staph aureus, absorption lower serum levels - Alterati
(Cefuroxime) generations and strep, pna/resp infx delayed by and larger Vd blood
3rd Generation decreases in gram (cephalexin, food, IM – clotting
(ceftriaxone) & pos. cefazolin) absorbed by Lactation safe - Combin
4th Generation muscle with alc
(cefepime) Treat surgical Second gram + Pediatrics in (disulfir
prophylaxis, resp and H. flu, more Distribution neonates immature rxn –
1st – narrow spectrum tract infx, strep potent, broader widely renal fx causes flushing
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to increased half life dizzines
tis, CAP, skin, gonorrhea, resp most tissue, and accumulation; n/v, coa
soft tissues, infx (cefaclor variation in kids – varies by problem
bones/joints, UTI (CAP), protein drug - Nephrot
(2nd line for kids), cefziroxine) binding, ty
STI penetration - Superin
Third some CSF varies by n
gram + and -, not generation - Renal/h
active against c dysfun
MRSA, effective Metabolism extends
against hepatic halflife
pseudomonas, less metabolism – - Anaphy
freq dosing, insignificant rxn to p
crosses BBB with don’t gi
inflammation Excretion cephalo
,3
(ceftriaxone, excreted by - Probene
omnicef (CAM) kidney incre
concent
Fourth broad n of cep
spectrum of - Loop
activity, good for diuretic
organisms that increa
developed risk for
resistance to earlier nephrot
generation y
cephalos, strep,
staph, doesn’t
penetrate CSF
(cefepime,
maxipime)
Glycopeptides Bacteriocidal Inhibits cell wall Absorption – Pregnancy Side effect
(Vancomycin – narrow gram positive synthesis and poor absorption - Category B - Irritatin
spectrum (Vancocin)) disrupts from GI tract, (oral) tissue an
(telavancin (Vibativ)- used to membrance barrier IV rapidly - Category C blood v
tx HAP or CAP when vanc function; affects absorbed; (parenteral) intima
fails) RNA synthesis vanc:52-56% - Must do - Red ma
protein bound; pregnancy syndrom
Vanc: C.diff, and telavancin: test prior to (face, ne
staph enterocolitis 90% protein telavancin torso 10
bound use mins aft
Telavancin: Lactation infusing
complicated skin Distribution – - Excreted in Adverse Effects
infections widely breast milk - Nephrot
distributed; Pediatrics - Transien
penetrates CSF - Hospitalized ototoxic
patients - Hyperse
Metabolism – only with vity
primarily given serious - Phlebiti
IV; bypasses illness injectio
first pass
Excretion –
oral vanc
(feces); Iv vanc
(renally via
glomerular
filtration);
telavancin
(primarily
urine)
Macrolides Bactericidal or Inhibits gram + Absorption – Cautions - GI upse
(Erythromycin, bacteriostatic and few gram - well absorbed - Prolongs (esp. wi
Clarithromycin, depending on in duodenum QT erythro
Azithromycin, dirithromycin, concentration; - Liver )
telithromycin) reversibly binds Distribution – impairment - Severe
to 50S ribosome distribute - Clarithromy explosiv
unit, preventing readily to body cin: watery
protein synthesis tissues, enters - CrCl diarrhea
of bacteria; CSF when <30ml/min - Acute
alkaline – meninges are requires choleste
inactivated by inflamed dosage to be hepatitis
, 4
acid; halved - Rash, fe
Metabolism – Pregnancy eosinop
metabolized in - Erythromyci - Metab.
liver, n: cat B Interacti
erythromycin, - Clarithromy esp with
heavily cin: cat C erythro
metabolized by - Azithromyci - Prolong
CYP3A4 n: cat B QT
Lactation syndrom
Excretion – - Safe maligna
excreted in Pediatrics arrthym
feces and urine, - Safe over
caution with age 6 Interactions
clarithromycin months - Colchic
increased - Warfari
renal excretion - Digoxin
increase
effect
Lincosamides Bacteriostatic in First line tx in Absorption – Cautions - GI symp
(clindamycin - Cleocin) usual doses; MRSA, primarily good oral - Asthma - Dizzine
suppresses gram +, some absorption - Severe vertigo,
protein synthesis anaerobic allergies - C.diff (
– binds to 50S pathogens Distribution – - Severe serious
subunit of the highly protein renal/liver
bacterial bound impairment
ribosome Pregnancy
Metabolism – - Category B
metabolized in - Okay for 3rd
liver trimester
Lactation
Excretion – - Present in
excreted in bile breast milk
and urine – weigh
risk/benefit
Pediatrics
- Severe infx
only
Quinolones Bactericidal for Broad spectrum; Absorption – Cautions - GI
(Levofloxacin, DNA gyrase extensive gram -; well absorbed - Renal - CNS
Ciprofloxacin, Moxifloxacin) (needed to later generations after PO admin, dysfunction: - Phototo
synthesize increased activity IV and oral can cause - Skin
bacterial DNA) against gram +; similar serum increase - Superin
only moxifloxacin concentration half-life n
has activity against with - Muscul
anaerobic bacteria; Distribution – majority of etal
PO and IV widely drug - Renal
formulations; distributed; excreted - Diabetic
resistance already high tissue, unchanged - Serious
occurring from urinary in urine effect:
inappropriate use prostate, sinus - CrCl dysrhyt
and lung <50mL/min:
penetration; adjust
variable protein dosage
binding; - Cautious in
moderately patients
