NURP 424 - Pharm Exam 3 Study Guide.

Exam 3

Week 10: Bacterial, Viral, Fungal, and Protozoal Infections (19)

Antibiotics (13)

48-72 hours until start feeling better

Empiric- evidence based guidelines
Prophylactic- prevent infection
Definitive- culture

Penicillin, cephalosporins, vancomycin
MOA: prevent cell wall synthesis

Penicillin V, Penicillin G Benzathine
 Aerobic, gram positive organisms, S. pneumoniae, group A beta-hemolytic
streptococci
 Syphilis  Penicillin G
Amoxicillin, Amoxicillin/Clavulanic Acid
 Gram positive organisms, S. pneumoniae, group A beta-hemolytic streptococci,
greater activity against gram negative bacteria
 Endocarditis, H. pylori, Lyme disease treatment

Contraindications- hx hypersensitivity reaction (Stevens Johnsons syndrome), caution in
renal impairment

ADR: N/V/D, candidiasis, C. difficile, maculopapular rash

Cefazolin, Cephalexin (Keflex)
Gram positive cocci, S. aureus, S. epidermis, most streptococci

2nd generation cephalosporins
Cefuroxime, Cefprozil, Cefaclor
Gram positive cocci, methicillin sensitive S. aureus, S. epidermis, E. Coli, H. influenzae

3rd generation
Ceftriaxone, Cefdinir, Cefpodoxime
Gram positive cocci, N. gonorrhoeae, H. flu, complicated UTI (pregnancy, male UTI,
kidney involvement)

Cross-sensitivity/ cross-resistance If patient has anaphylaxis reaction to penicillins,
avoid cephalosporins (very similar chemical structure- contain structurally similar side
chains and beta lactam ring)

Glycopeptides (Vancomycin)
Gram positive (Cdiff)

, Oral very little systemic involvement. Peak/trough not necessary to monitor

Lincosamides (Clindamycin)
 Bind to 50S subunit of bacterial ribosome, suppresses protein synthesis
 Gram +
 Methicillin resistant S. aureus (MRSA)
 Strep pharyngitis, PID
 Take with full glass of water, Sit/stand for 30 min after
 Call clinic if diarrhea develops

Macrolides (Azithromycin, Erythromycin, Clarithromycin)
 Bind to 50S subunit of bacterial ribosome, suppresses protein synthesis
 Broad spectrum gram + and gram –
 S. pneumoniae, MSSA, H. flu, pertussis, Chlamydia (treatment of choice)
 Topically for acne
 Risk of QT prolongation (Torsades de pointes)
 Erythromycin and Azithromycin  first choice in pregnancy

Doxycycline, Tetracycline
 Inhibit protein synthesis by reversibly binding to 30S subunit of bacterial
ribosome
 Broad spectrum for gram + and – bacteria
 SUNSCREEN
 Avoid in pregnancy discoloration of teeth in neonates
 Caution in renal and hepatic impairment
 Avoid in children younger than 8 bone health
 Take with food, but NOT dairy
 Take with full glass of water, Sit/stand for 30 min after

Fluoroquinolones (Levofloxacin, Ciprofloxacin)
 Affects DNA Gyrase
 Cipro- complicated UTI, travelers diarrhea, anthrax
 Levofloxacin- complicated infections COPD exacerbation, prostatitis,
complicated UTI
 BBW- Tendon rupture, tendonitis (rare) report new onset of pain
 Avoid in myasthenia gravis, renal and hepatic impairment

Sulfonamides, Trimethoprim
 Prevents folic acid synthesis, which is important for some bacteria to survive
 Gram + and gram –
 Avoid in sulfa allergy, G6PD, caution in folate deficiency

Nitrofurantoin
 Gram + cocci, gram – bacilli
 Really only used for uncomplicated UTI
 Concentrates in kidneys and urine
 Avoid if CrCl less than 30 mL/min, caution if less than 60***