midterm nr568
1. - Things to know about each
of the major antibiotic drug
classes
2. Classification of Antimicro- 1. Classification by Susceptible Organism
bial Drugs Antibacterial Drugs
• There are two main classifi- • Narrow Spectrum-Gram+ cocci/bacilli,
cation schemes Gram- aerobes, M. tuberculosis
• Broad Spectrum-Gram+ cocci and gram-
bacilli
Antiviral Drugs
• Drugs for HIV infection
• Drugs for influenza
• Other antiviral drugs-acycolvir
Antifungal Drugs-amphotericin B; Azoles
2. Classification by Mechanism of Action
• Inhibitors of cell wall synthesis
• Drugs that disrupt the cell membrane
• Bactericidal inhibitors of protein synthesis
• Bacteriostatic inhibitors of protein synthe-
sis
• Drugs that interfere with synthesis or in-
tegrity of bacterial DNA and RNA
• Antimetabolites
• Drugs that suppress viral replication
3. List the 10 classes of Antibi- ÏAminoglycosides-gentamicin, streptomycin
otics name examples Ï Cephalosporins-Cephalexin (Keflex)
HINT (acronym): Ï Tetracyclines-tetra/doxyclycline
Abx Can Terminate Protein Ï Penicillins-PCN G/V, amoxicillin
Synthesis For Microbial Cells Ï Sulfonamides-trimethoprim/sulfamethoxa-
Like Germs zole
Ï Fluoroquinolones-ciprofloxacin
Ï Macrolides-erythromycin, Azithromycin
Ï Carbapenems-imipenem, meropenem
, midterm nr568
Ï Lincosamides-Clindamycin
Ï Glycopeptides-Vancomycin
4. Other ways to organize class- • they have a ²-lactam ring in their structure,
es of Drugs the penicillins are known as ²-lactam antibi-
What is Beta Lactams? otic
• The ²-lactam family also includes the
cephalosporins, carbapenems, and aztreon-
am
• All of the ²-lactam antibiotics share the
same mechanism of action: disruption of the
bacterial cell wall
• they are bactericidal; bacteria must be
actively growing for them to work
5. Other ways to organize class- 1. Tetracycline
es of Drugs 2. Macrolide
- Bacteriostatic Inhibitors of 3. Clindamycin
Protein Synthesis include
6. Other ways to organize class- aminoglycosides,
es of Drugs beta-lactams,
- Bactericidal antibiotics di- fluoroquinolones,
rectly kill bacteria and in- metronidazole,
clude most antimycobacterial agents,
streptogramins,
vancomycin.
7. Other ways to organize class- Sulfonamides, Trimethoprim & Nitrofuran-
es of Drugs toin
What are Antimetabolites?
8. Broad spectrum vs narrow Broad-spectrum
spectrum - Broad-spectrum penicillins: ampicillin and
others
- Extended-spectrum penicillins: piperacillin
and others
- Cephalosporins (third generation)
- Tetracyclines: tetracycline and others
- Carbapenems: imipenem and others
, midterm nr568
- Trimethoprim
- Sulfonamides: sulfisoxazole and others
- Fluoroquinolones: ciprofloxacin and others
narrow-spectrum
- Penicillin G and V
- Penicillinase-resistant penicillins: oxacillin
and nafcillin
- Vancomycin
- Erythromycin
- Clindamycin
- Aminoglycosides: gentamicin and others
- Cephalosporins (first and second genera-
tions)
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
9. - Understand broad spectrum Broad-Spectrum:
vs narrow spectrum agents 1. gram- and gram + organisms
Broad-Spectrum: 2. H. influenzae, E. coli, Proteus mirabilis,
1. Targets wider number of enterococci, N. gonorrhoeae
bacteria types. Acts on both 3. empiric; infection with multiple types of
2. Commonly used against bacteria is suspected.
3. Commonly used for (blank) 4. native bacteria and the development of
therapy; when the pathogen antimicrobial resistance
is unknown or Narrow-Spectrum:
4. A major con is disruption of 1. bacteria type
Narrow-Spectrum: 2. is known
1. Effective against a specific
2. Used when infecting
pathogens
10. - Understand empiric treat- 1. when cultures are not available or results
ment and when to use: are not back yet
1. It is used when 2a. NP's knowledge of the patient's history,
2. is initiated based on two typical pathogens, gram stain results, and
main things: 2b. local susceptibility reports on which abx
, midterm nr568
3. Can be used in severe ill- work best in certain geographic locations.
nesses when 3. Critically ill pts need immediate empiric
4. What is the protocol for antibiotics
these pts 4. after first set of cultures is obtained, do not
5. IV vs. PO? wait for results. Give empiric (broad-spec-
6. Bactericidal vs. Bacterio- trum) abx
static 5. IV-for Critical or severe infections
PO for Mild/moderate or pts; Switch from IV
to PO once the patient is stable
6. Bactericidal antibiotics directly kill bacte-
ria
preferred for immunocompromised patients
such as those with diabetes, HIV, cancer or
overwhelming infections
11. What types of infections are community-acquired, mostly viral, upper
usually viral and do not war- respiratory tract infections;
rant antibacterial agents? - these infections are usually viral patients
are exposed to all the risks of abx but have
no chance of receiving benefits
12. Penicillins-Examples 1. Penicillin G, Penicillin V
1. Narrow-spectrum PCNs 2. Nafcillin, Oxacillin, Dicloxacillin
(penicillinase sensitive) 3. Ampicillin, Amoxicillin
2. Narrow-spectrum peni- 4. piperacillin
cillins: (penicillinase-resis-
tant)
3. Broad-spectrum penicillins
(aminopenicillins)
4. Extended-Spectrum Peni-
cillins (Antipseudomonal
Penicillins)
13. Indications for use of PCNs 1. streptococcal pharyngitis, N. Meningi-
1. Penicillin G, Penicillin V tis/gonorrhoeae; active against most gram
(Narrow/PCN-ase S) +/- cocci and spirochetes-T. pallidum
2. Nafcillin, Oxacillin, Di- 2. use for all PCN-ase R Staph infections ie:
cloxacillin (Narrow/PCN-ase S. aureus and S. epidermidis, NOT MRSA
R) 3. Amoxicillin-1st line for ENT/Skin/UTIs ie:
1. - Things to know about each
of the major antibiotic drug
classes
2. Classification of Antimicro- 1. Classification by Susceptible Organism
bial Drugs Antibacterial Drugs
• There are two main classifi- • Narrow Spectrum-Gram+ cocci/bacilli,
cation schemes Gram- aerobes, M. tuberculosis
• Broad Spectrum-Gram+ cocci and gram-
bacilli
Antiviral Drugs
• Drugs for HIV infection
• Drugs for influenza
• Other antiviral drugs-acycolvir
Antifungal Drugs-amphotericin B; Azoles
2. Classification by Mechanism of Action
• Inhibitors of cell wall synthesis
• Drugs that disrupt the cell membrane
• Bactericidal inhibitors of protein synthesis
• Bacteriostatic inhibitors of protein synthe-
sis
• Drugs that interfere with synthesis or in-
tegrity of bacterial DNA and RNA
• Antimetabolites
• Drugs that suppress viral replication
3. List the 10 classes of Antibi- ÏAminoglycosides-gentamicin, streptomycin
otics name examples Ï Cephalosporins-Cephalexin (Keflex)
HINT (acronym): Ï Tetracyclines-tetra/doxyclycline
Abx Can Terminate Protein Ï Penicillins-PCN G/V, amoxicillin
Synthesis For Microbial Cells Ï Sulfonamides-trimethoprim/sulfamethoxa-
Like Germs zole
Ï Fluoroquinolones-ciprofloxacin
Ï Macrolides-erythromycin, Azithromycin
Ï Carbapenems-imipenem, meropenem
, midterm nr568
Ï Lincosamides-Clindamycin
Ï Glycopeptides-Vancomycin
4. Other ways to organize class- • they have a ²-lactam ring in their structure,
es of Drugs the penicillins are known as ²-lactam antibi-
What is Beta Lactams? otic
• The ²-lactam family also includes the
cephalosporins, carbapenems, and aztreon-
am
• All of the ²-lactam antibiotics share the
same mechanism of action: disruption of the
bacterial cell wall
• they are bactericidal; bacteria must be
actively growing for them to work
5. Other ways to organize class- 1. Tetracycline
es of Drugs 2. Macrolide
- Bacteriostatic Inhibitors of 3. Clindamycin
Protein Synthesis include
6. Other ways to organize class- aminoglycosides,
es of Drugs beta-lactams,
- Bactericidal antibiotics di- fluoroquinolones,
rectly kill bacteria and in- metronidazole,
clude most antimycobacterial agents,
streptogramins,
vancomycin.
7. Other ways to organize class- Sulfonamides, Trimethoprim & Nitrofuran-
es of Drugs toin
What are Antimetabolites?
8. Broad spectrum vs narrow Broad-spectrum
spectrum - Broad-spectrum penicillins: ampicillin and
others
- Extended-spectrum penicillins: piperacillin
and others
- Cephalosporins (third generation)
- Tetracyclines: tetracycline and others
- Carbapenems: imipenem and others
, midterm nr568
- Trimethoprim
- Sulfonamides: sulfisoxazole and others
- Fluoroquinolones: ciprofloxacin and others
narrow-spectrum
- Penicillin G and V
- Penicillinase-resistant penicillins: oxacillin
and nafcillin
- Vancomycin
- Erythromycin
- Clindamycin
- Aminoglycosides: gentamicin and others
- Cephalosporins (first and second genera-
tions)
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
9. - Understand broad spectrum Broad-Spectrum:
vs narrow spectrum agents 1. gram- and gram + organisms
Broad-Spectrum: 2. H. influenzae, E. coli, Proteus mirabilis,
1. Targets wider number of enterococci, N. gonorrhoeae
bacteria types. Acts on both 3. empiric; infection with multiple types of
2. Commonly used against bacteria is suspected.
3. Commonly used for (blank) 4. native bacteria and the development of
therapy; when the pathogen antimicrobial resistance
is unknown or Narrow-Spectrum:
4. A major con is disruption of 1. bacteria type
Narrow-Spectrum: 2. is known
1. Effective against a specific
2. Used when infecting
pathogens
10. - Understand empiric treat- 1. when cultures are not available or results
ment and when to use: are not back yet
1. It is used when 2a. NP's knowledge of the patient's history,
2. is initiated based on two typical pathogens, gram stain results, and
main things: 2b. local susceptibility reports on which abx
, midterm nr568
3. Can be used in severe ill- work best in certain geographic locations.
nesses when 3. Critically ill pts need immediate empiric
4. What is the protocol for antibiotics
these pts 4. after first set of cultures is obtained, do not
5. IV vs. PO? wait for results. Give empiric (broad-spec-
6. Bactericidal vs. Bacterio- trum) abx
static 5. IV-for Critical or severe infections
PO for Mild/moderate or pts; Switch from IV
to PO once the patient is stable
6. Bactericidal antibiotics directly kill bacte-
ria
preferred for immunocompromised patients
such as those with diabetes, HIV, cancer or
overwhelming infections
11. What types of infections are community-acquired, mostly viral, upper
usually viral and do not war- respiratory tract infections;
rant antibacterial agents? - these infections are usually viral patients
are exposed to all the risks of abx but have
no chance of receiving benefits
12. Penicillins-Examples 1. Penicillin G, Penicillin V
1. Narrow-spectrum PCNs 2. Nafcillin, Oxacillin, Dicloxacillin
(penicillinase sensitive) 3. Ampicillin, Amoxicillin
2. Narrow-spectrum peni- 4. piperacillin
cillins: (penicillinase-resis-
tant)
3. Broad-spectrum penicillins
(aminopenicillins)
4. Extended-Spectrum Peni-
cillins (Antipseudomonal
Penicillins)
13. Indications for use of PCNs 1. streptococcal pharyngitis, N. Meningi-
1. Penicillin G, Penicillin V tis/gonorrhoeae; active against most gram
(Narrow/PCN-ase S) +/- cocci and spirochetes-T. pallidum
2. Nafcillin, Oxacillin, Di- 2. use for all PCN-ase R Staph infections ie:
cloxacillin (Narrow/PCN-ase S. aureus and S. epidermidis, NOT MRSA
R) 3. Amoxicillin-1st line for ENT/Skin/UTIs ie:
