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 E
Bacteriostatic Treat? cs Category? Safe in
(Indications) pediatrics?
Safe in Lactation?
Penicillins Bacteriocidal; Pcn - Treat aerobic Absorption – - Catergory B - Hyp
(PCN and Amoxicillin) inhibits synthesis and gram positive. from GI tract, - Safe in y
of bacterial cell Red Book depends on lactation - Sup
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 distu
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 (ma
due to low upset/diarrhea n lar)
resistance - Cha
Distribution – rena
Aminopcn – treat varies in func
gram posivite protein - Can
, anaerobes and binding, well infe
gram negative distributed, - Seiz
(MSSA, strep, inflammation abili
H.flu, E.coli, enhance - Dec
Klebsiella, distribution, oral
Neisseria crosses cont
meningitides); placenta/breast ves
amoxicillin, milk effec
ampicillin; - Inte
combined with Metabolism – neph
betalactamase minimal metab
inhib except for * Severe, ty
nafcillin/oxacill allergic reac
Pcnase-resistant – in to cephalosp
(pcnase staph, carbapenem
strep, MSSA); not Excretion – beta-lactama
effective against primarily inhibitors m
MRSA; cloxacillin, unchanged in contraindica
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 distu
(Cephalexin) & Increase in gram neg; doesn’t enter rate of shorter half life, (C.d
2nd Generation neg up the CSF, staph aureus, absorption lower serum levels - Alte
(Cefuroxime) generations and strep, pna/resp infx delayed by and larger Vd bloo
3rd Generation decreases in gram (cephalexin, food, IM – clott
(ceftriaxone) & pos. cefazolin) absorbed by Lactation safe - Com
4th Generation muscle with
(cefepime) Treat surgical Second gram + Pediatrics in (disu
prophylaxis, resp and H. flu, more Distribution neonates immature rxn
1st – narrow spectrum tract infx, strep potent, broader widely renal fx causes flush
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to increased half life dizz
tis, CAP, skin, gonorrhea, resp most tissue, and accumulation; n/v,
soft tissues, infx (cefaclor variation in kids – varies by prob
bones/joints, UTI (CAP), protein drug - Nep
(2nd line for kids), cefziroxine) binding, ty
STI penetration - Sup
Third some CSF varies by n
gram + and -, not generation - Ren
active against c dy
MRSA, effective Metabolism exte
against hepatic half
pseudomonas, less metabolism – - Ana
freq dosing, insignificant rxn
crosses BBB with don’
inflammation Excretion ceph
, (ceftriaxone, excreted by - Prob
omnicef (CAM) kidney in
conc
Fourth broad n of
spectrum of - Loo
activity, good for diur
organisms that in
developed risk
resistance to earlier neph
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 - Irrit
spectrum (Vancocin)) disrupts from GI tract, (oral) tissu
(telavancin (Vibativ)- used to membrance barrier IV rapidly - Category C bloo
tx HAP or CAP when vanc function; affects absorbed; (parenteral) intim
fails) RNA synthesis vanc:52-56% - Must do - Red
protein bound; pregnancy synd
Vanc: C.diff, and telavancin: test prior to (fac
staph enterocolitis 90% protein telavancin torso
bound use min
Telavancin: Lactation infu
complicated skin Distribution – - Excreted in Adverse Eff
infections widely breast milk - Nep
distributed; Pediatrics - Tran
penetrates CSF - Hospitalized otot
patients - Hyp
Metabolism – only with vity
primarily given serious - Phle
IV; bypasses illness injec
first pass
Excretion –
oral vanc
(feces); Iv vanc
(renally via
glomerular
filtration);
telavancin
(primarily
urine)
Macrolides Bactericidal or Inhibits gram + Absorption – Cautions - GI u
(Erythromycin, bacteriostatic and few gram - well absorbed - Prolongs (esp
Clarithromycin, depending on in duodenum QT eryt
Azithromycin, dirithromycin, concentration; - Liver )
telithromycin) reversibly binds Distribution – impairment - Seve
to 50S ribosome distribute - Clarithromy expl
unit, preventing readily to body cin: wate
protein synthesis tissues, enters - CrCl diar
of bacteria; CSF when <30ml/min - Acu
alkaline – meninges are requires chol
inactivated by inflamed dosage to be hepa
, acid; halved - Rash
Metabolism – Pregnancy eosi
metabolized in - Erythromyci - Met
liver, n: cat B Inte
erythromycin, - Clarithromy esp
heavily cin: cat C eryt
metabolized by - Azithromyci - Prol
CYP3A4 n: cat B QT
Lactation synd
Excretion – - Safe mali
excreted in Pediatrics arrth
feces and urine, - Safe over
caution with age 6 Interactions
clarithromycin months - Colc
increased - War
renal excretion - Digo
incr
effec
Lincosamides Bacteriostatic in First line tx in Absorption – Cautions - GI s
(clindamycin - Cleocin) usual doses; MRSA, primarily good oral - Asthma - Dizz
suppresses gram +, some absorption - Severe vert
protein synthesis anaerobic allergies - C.di
– binds to 50S pathogens Distribution – - Severe serio
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: - Pho
synthesize increased activity IV and oral can cause - Skin
bacterial DNA) against gram +; similar serum increase - Sup
only moxifloxacin concentration half-life n
has activity against with - Mus
anaerobic bacteria; Distribution – majority of etal
PO and IV widely drug - Ren
formulations; distributed; excreted - Diab
resistance already high tissue, unchanged - Seri
occurring from urinary in urine effec
inappropriate use prostate, sinus - CrCl dysr
and lung <50mL/min:
penetration; adjust
variable protein dosage
binding; - Cautious in
moderately patients
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 E
Bacteriostatic Treat? cs Category? Safe in
(Indications) pediatrics?
Safe in Lactation?
Penicillins Bacteriocidal; Pcn - Treat aerobic Absorption – - Catergory B - Hyp
(PCN and Amoxicillin) inhibits synthesis and gram positive. from GI tract, - Safe in y
of bacterial cell Red Book depends on lactation - Sup
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 distu
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 (ma
due to low upset/diarrhea n lar)
resistance - Cha
Distribution – rena
Aminopcn – treat varies in func
gram posivite protein - Can
, anaerobes and binding, well infe
gram negative distributed, - Seiz
(MSSA, strep, inflammation abili
H.flu, E.coli, enhance - Dec
Klebsiella, distribution, oral
Neisseria crosses cont
meningitides); placenta/breast ves
amoxicillin, milk effec
ampicillin; - Inte
combined with Metabolism – neph
betalactamase minimal metab
inhib except for * Severe, ty
nafcillin/oxacill allergic reac
Pcnase-resistant – in to cephalosp
(pcnase staph, carbapenem
strep, MSSA); not Excretion – beta-lactama
effective against primarily inhibitors m
MRSA; cloxacillin, unchanged in contraindica
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 distu
(Cephalexin) & Increase in gram neg; doesn’t enter rate of shorter half life, (C.d
2nd Generation neg up the CSF, staph aureus, absorption lower serum levels - Alte
(Cefuroxime) generations and strep, pna/resp infx delayed by and larger Vd bloo
3rd Generation decreases in gram (cephalexin, food, IM – clott
(ceftriaxone) & pos. cefazolin) absorbed by Lactation safe - Com
4th Generation muscle with
(cefepime) Treat surgical Second gram + Pediatrics in (disu
prophylaxis, resp and H. flu, more Distribution neonates immature rxn
1st – narrow spectrum tract infx, strep potent, broader widely renal fx causes flush
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to increased half life dizz
tis, CAP, skin, gonorrhea, resp most tissue, and accumulation; n/v,
soft tissues, infx (cefaclor variation in kids – varies by prob
bones/joints, UTI (CAP), protein drug - Nep
(2nd line for kids), cefziroxine) binding, ty
STI penetration - Sup
Third some CSF varies by n
gram + and -, not generation - Ren
active against c dy
MRSA, effective Metabolism exte
against hepatic half
pseudomonas, less metabolism – - Ana
freq dosing, insignificant rxn
crosses BBB with don’
inflammation Excretion ceph
, (ceftriaxone, excreted by - Prob
omnicef (CAM) kidney in
conc
Fourth broad n of
spectrum of - Loo
activity, good for diur
organisms that in
developed risk
resistance to earlier neph
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 - Irrit
spectrum (Vancocin)) disrupts from GI tract, (oral) tissu
(telavancin (Vibativ)- used to membrance barrier IV rapidly - Category C bloo
tx HAP or CAP when vanc function; affects absorbed; (parenteral) intim
fails) RNA synthesis vanc:52-56% - Must do - Red
protein bound; pregnancy synd
Vanc: C.diff, and telavancin: test prior to (fac
staph enterocolitis 90% protein telavancin torso
bound use min
Telavancin: Lactation infu
complicated skin Distribution – - Excreted in Adverse Eff
infections widely breast milk - Nep
distributed; Pediatrics - Tran
penetrates CSF - Hospitalized otot
patients - Hyp
Metabolism – only with vity
primarily given serious - Phle
IV; bypasses illness injec
first pass
Excretion –
oral vanc
(feces); Iv vanc
(renally via
glomerular
filtration);
telavancin
(primarily
urine)
Macrolides Bactericidal or Inhibits gram + Absorption – Cautions - GI u
(Erythromycin, bacteriostatic and few gram - well absorbed - Prolongs (esp
Clarithromycin, depending on in duodenum QT eryt
Azithromycin, dirithromycin, concentration; - Liver )
telithromycin) reversibly binds Distribution – impairment - Seve
to 50S ribosome distribute - Clarithromy expl
unit, preventing readily to body cin: wate
protein synthesis tissues, enters - CrCl diar
of bacteria; CSF when <30ml/min - Acu
alkaline – meninges are requires chol
inactivated by inflamed dosage to be hepa
, acid; halved - Rash
Metabolism – Pregnancy eosi
metabolized in - Erythromyci - Met
liver, n: cat B Inte
erythromycin, - Clarithromy esp
heavily cin: cat C eryt
metabolized by - Azithromyci - Prol
CYP3A4 n: cat B QT
Lactation synd
Excretion – - Safe mali
excreted in Pediatrics arrth
feces and urine, - Safe over
caution with age 6 Interactions
clarithromycin months - Colc
increased - War
renal excretion - Digo
incr
effec
Lincosamides Bacteriostatic in First line tx in Absorption – Cautions - GI s
(clindamycin - Cleocin) usual doses; MRSA, primarily good oral - Asthma - Dizz
suppresses gram +, some absorption - Severe vert
protein synthesis anaerobic allergies - C.di
– binds to 50S pathogens Distribution – - Severe serio
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: - Pho
synthesize increased activity IV and oral can cause - Skin
bacterial DNA) against gram +; similar serum increase - Sup
only moxifloxacin concentration half-life n
has activity against with - Mus
anaerobic bacteria; Distribution – majority of etal
PO and IV widely drug - Ren
formulations; distributed; excreted - Diab
resistance already high tissue, unchanged - Seri
occurring from urinary in urine effec
inappropriate use prostate, sinus - CrCl dysr
and lung <50mL/min:
penetration; adjust
variable protein dosage
binding; - Cautious in
moderately patients
