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
penicillin for stomach/intesti
,anaerobes and binding, well infe
gram negative distributed, - Seiz
(MSSA, strep, inflammation abili
H.flu, E.coli, enhance
Klebsiella, distribution, - Dec
Neisseria crosses oral
meningitides); placenta/breast cont
amoxicillin, milk ves
ampicillin; effe
combined with - Inte
betalactamase Metabolism –
neph
inhib minimal metab
except for
nafcillin/oxacill * Severe, ty
Pcnase-resistant – in allergic reac
(pcnase staph, to cephalosp
strep, MSSA); not carbapenem
effective against Excretion –
beta-lactam
MRSA; cloxacillin, primarily
inhibitors m
dicloxacillin, unchanged in
contraindica
methicillin, urine, caution
penicillins.
nafcillin, oxacillin in renal
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 increase fluid
oral, GI tract, distu
(Cephalexin) & neg; doesn’t enter shorter half life,
rate of lower serum levels (C.d
Increase in gram
2nd Generation CSF, staph aureus, and larger Vd
neg up the absorption - Alte
(Cefuroxime) strep, pna/resp infx
generations and delayed by bloo
3rd Generation (cephalexin,
decreases in gram food, IM – clott
(ceftriaxone) & cefazolin) Lactation safe
pos. absorbed by
4th Generation - Com
muscle
(cefepime) Pediatrics in with
Second gram + neonates immature (disu
Treat surgical Distribution
and H. flu, more renal fx causes rxn
prophylaxis, resp potent, broader widely
1st – narrow spectrum tract infx, strep increased half life flush
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to and accumulation; dizz
tis, CAP, skin, gonorrhea, resp most tissue, kids – varies by n/v,
soft tissues, infx (cefaclor variation in drug prob
bones/joints, UTI (CAP), protein
- Nep
(2nd line for kids), cefziroxine) binding,
ty
STI penetration
CSF varies by - Sup
Third some generation n
gram + and -, not - Ren
active against c dy
Metabolism
MRSA, effective exte
hepatic
against metabolism – half
pseudomonas, less
insignificant - Ana
freq dosing,
rxn
crosses BBB with
Excretion don’
inflammation
ceph
, (ceftriaxone, excreted by - Prob
omnicef (CAM) kidney i
conc
n of
Fourth broad
spectrum of - Loo
activity, good for diur
organisms that inc
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,
membrance barrier (oral) tissu
IV rapidly bloo
(telavancin (Vibativ)- used to function; affects - Category C
absorbed; intim
tx HAP or CAP when vanc RNA synthesis (parenteral)
vanc:52-56%
fails) - Red
protein bound; - Must do
telavancin: synd
Vanc: C.diff, and pregnancy
90% protein (fac
staph enterocolitis test prior to
bound torso
telavancin
min
use
infu
Telavancin:
complicated skin Distribution – Lactation
Adverse Eff
infections widely - Excreted in
distributed; - Nep
breast milk
penetrates CSF - Tran
Pediatrics
otot
- Hospitalized
Metabolism – - Hyp
patients
primarily given vity
only with
IV; bypasses serious - Phle
first pass illness injec
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 (esp
- Prolongs
Clarithromycin, depending on in duodenum QT eryt
concentration;
Azithromycin, dirithromycin, - Liver )
reversibly binds
telithromycin)
to 50S ribosome Distribution – impairment - Seve
unit, preventing distribute expl
- Clarithromy
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
penicillin for stomach/intesti
,anaerobes and binding, well infe
gram negative distributed, - Seiz
(MSSA, strep, inflammation abili
H.flu, E.coli, enhance
Klebsiella, distribution, - Dec
Neisseria crosses oral
meningitides); placenta/breast cont
amoxicillin, milk ves
ampicillin; effe
combined with - Inte
betalactamase Metabolism –
neph
inhib minimal metab
except for
nafcillin/oxacill * Severe, ty
Pcnase-resistant – in allergic reac
(pcnase staph, to cephalosp
strep, MSSA); not carbapenem
effective against Excretion –
beta-lactam
MRSA; cloxacillin, primarily
inhibitors m
dicloxacillin, unchanged in
contraindica
methicillin, urine, caution
penicillins.
nafcillin, oxacillin in renal
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 increase fluid
oral, GI tract, distu
(Cephalexin) & neg; doesn’t enter shorter half life,
rate of lower serum levels (C.d
Increase in gram
2nd Generation CSF, staph aureus, and larger Vd
neg up the absorption - Alte
(Cefuroxime) strep, pna/resp infx
generations and delayed by bloo
3rd Generation (cephalexin,
decreases in gram food, IM – clott
(ceftriaxone) & cefazolin) Lactation safe
pos. absorbed by
4th Generation - Com
muscle
(cefepime) Pediatrics in with
Second gram + neonates immature (disu
Treat surgical Distribution
and H. flu, more renal fx causes rxn
prophylaxis, resp potent, broader widely
1st – narrow spectrum tract infx, strep increased half life flush
5th – broad spectrum pharyngitis/sinusi spectrum, distributed to and accumulation; dizz
tis, CAP, skin, gonorrhea, resp most tissue, kids – varies by n/v,
soft tissues, infx (cefaclor variation in drug prob
bones/joints, UTI (CAP), protein
- Nep
(2nd line for kids), cefziroxine) binding,
ty
STI penetration
CSF varies by - Sup
Third some generation n
gram + and -, not - Ren
active against c dy
Metabolism
MRSA, effective exte
hepatic
against metabolism – half
pseudomonas, less
insignificant - Ana
freq dosing,
rxn
crosses BBB with
Excretion don’
inflammation
ceph
, (ceftriaxone, excreted by - Prob
omnicef (CAM) kidney i
conc
n of
Fourth broad
spectrum of - Loo
activity, good for diur
organisms that inc
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,
membrance barrier (oral) tissu
IV rapidly bloo
(telavancin (Vibativ)- used to function; affects - Category C
absorbed; intim
tx HAP or CAP when vanc RNA synthesis (parenteral)
vanc:52-56%
fails) - Red
protein bound; - Must do
telavancin: synd
Vanc: C.diff, and pregnancy
90% protein (fac
staph enterocolitis test prior to
bound torso
telavancin
min
use
infu
Telavancin:
complicated skin Distribution – Lactation
Adverse Eff
infections widely - Excreted in
distributed; - Nep
breast milk
penetrates CSF - Tran
Pediatrics
otot
- Hospitalized
Metabolism – - Hyp
patients
primarily given vity
only with
IV; bypasses serious - Phle
first pass illness injec
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 (esp
- Prolongs
Clarithromycin, depending on in duodenum QT eryt
concentration;
Azithromycin, dirithromycin, - Liver )
reversibly binds
telithromycin)
to 50S ribosome Distribution – impairment - Seve
unit, preventing distribute expl
- Clarithromy
