Pharm test 4

• Types of Antibiotics


  • Penicillins
  • Cephalosporins
  • Monobactams
  • Carbapenems
  • Vancomycin
  • Tetracyclines
  • Macrolides
  • Aminoglycosides
  • Fluoroquinolones
  • Sulfonamides
  • Urinary Tract Antiseptics
• Antibacterials


  • Penicillins
  • Cephalosporins
  • Monobactams
  • Carbapenems
  • Vancomycin
  • Tetracyclines
  • Macrolides
  • Aminoglycosides
  • Fluoroquinolones
  • Sulfonamides
  • Urinary Tract Antiseptics
• Antibiotics that affect the cell wall (Bactericidal)

  • amoxicillin (Amoxil) - Penicillin
  • cephalexin (Keflex) - Cephalosporin
  • aztreonam (Azactam) - Monobactam
  • imipenem (Primaxin) - Carbapenem
  • vancomycin (Vancocin)
• amoxicillin (Amoxil)/amoxicillin-clavulanic acid (Augmentin)

  • Penicillins – "cillin"
  • Broad spectrum
  • Beta-lactam
  • Treats non-penicillinase producing bacteria
  • Uses: ear & throat infxs, UTIs
  • ADR: allergy, GI, superinfx
  • Reduces efficacy of OCP
• cephalexin (Keflex) – First Generation

  • Cephalosporin – "cephs/cefs"
  • Broad spectrum
  • Similar structure & uses to PCN – beta-lactam
  • Categorized by "generations" 1-5
  • Later generations are more effective
  • ADR: allergy, GI, superinfx, thrombophlebitis
  • disulfiram reaction, hemorrhage (cefotetan)
  • Cross sensitivity with PCN allergy
  • Monitor PT/INR, aPTT, BUN/Creatinine
• aztreonam (Azactam)


  • Monobactam
  • Narrow spectrum: effective against gram- aerobic
  • Uses: respiratory, abdominal, & gyn infxs & UTIs
  • One beta-lactam ring
  • ADR: allergy/rash, GI, superinfx, thrombophlebitis
  • Admin: IV, IM, inhalation only
  • Not absorbed by GI tract
• imipenem (Primaxin)


  • Carbapenem
  • Broad spectrum
  • Treats serious, high risk infxs
  • Reserved for MDR organisms
  • ADR: allergy, GI, superinfx, thrombophlebitis
  • Monitor AST, BUN/Creatinine, LDH, bilirubin
• vancomycin (Vancocin)


  • Uses: gram+, MRSA, C. diff, & PCN allergy
  • Given PO for C.diff
  • ADR: nephrotoxicity, Red Man Syndrome, ototoxicity, thrombophlebitis
  • Infuse slowly, designated IV line
  • Monitor VS, trough levels, BUN/Creatinine
• Antibacterials that affect protein synthesis

  • tetracycline
  • erythromycin - Macrolide
  • gentamicin - Aminoglycoside
• tetracycline – "cycline"


  • Broad-spectrum & bacteriostatic
  • Uses: Rickettsial infxs, syphilis, cholera, anthrax
  • ADR: GI, teeth discoloration/bone growth suppression, photosensitivity, hepatotoxicity, superinfx
  • Avoid in children <8
  • Monitor liver fx
  • Ca impairs absorption
  • Decreases efficacy of OCP
• erythromycin


  • Macrolide
  • Broad-spectrum
  • Mostly bacteriostatic, but bactericidal in high doses
  • Uses: Legionnaire's, pertussis, diphtheria
  • ADR: GI, ventricular dysrhythmias, ototoxicity, superinfx
  • CYP3A4 inhibitors increase blood levels
  • Caution in pts with prolonged QT
• gentamicin


  • Aminoglycoside
  • Narrow-spectrum: most effective against gram- bacilli
  • Bactericidal
  • Uses: E.coli, klebsiella, pseudomonas infxs, eye infx
  • ADR: ototoxicity, nephrotoxicity
  • Monitor peak/trough levels, I&Os, BUN/Creatinine, urinalysis
• Antibacterials that inhibit DNA replication and cell division

  • Fluroquinolones
• ciprofloxacin (Cipro)


  • Fluoroquinolone – "floxacin"
  • Inhibits enzymes necessary for DNA replication and cell division
  • Bactericidal
  • Uses: severe UTIs, anthrax exposure
  • ADR: CNS, GI, Achilles tendon rupture, photosensitivity, seizures, IIH, SI, hepatotoxicity, anaphylaxis, C.diff
• Antibacterials that inhibit folic acid synthesis

  • trimethoprim+sulfamethoxazole (Bactrim) - Sulfonamide
  • nitrofurantoin (Macrodantin) - Urinary Tract Antiseptic
• trimethoprim+sulfamethoxazole (Bactrim)


  • Sulfonamide
  • Broad spectrum & bacteriostatic
  • Uses: UTIs, pneumocystis pneumonia, Shigella, bronchitis, otitis media
  • ADR: SJS, kernicterus, blood dyscrasias, superinfx, nephrolithiasis
  • Disulfiram-type reaction
  • 1200-1500 mL water/day
  • Decreases OCP efficacy
• nitrofurantoin (Macrodantin/Macrobid)


  • Urinary Tract Antiseptic
  • Broad-spectrum
  • Bactericidal or bacteriostatic
  • Uses: UTIs
  • No antibacterial action outside urinary tract
  • Acidic pH enhances action
  • ADR: GI, URI s/s, pulmonary distress, peripheral neuropathy, blood dyscrasias, brown urine, CNS effects, photosensitivity, stained teeth
  • Monitor CBC
• Antimycobacterial/Antitubercular


  • Isoniazid
  • Rifampin
  • Ethambutol
  • Pyrazinamide
• isoniazid (INH)


  • Antimycobacterial
  • Narrow spectrum for active & latent TB
  • Active TB: in combination with other drugs
  • Latent TB: 6-9 months monotherapy
  • Bacteriostatic, but bactericidal in high doses
  • ADR: GI, hepatotoxicity, peripheral neuropathy, CNS effects, DRESS
  • Monitor AST/ALT
  • Disulfiram-type reaction
• rifampin (Rifadin)


  • Antimycobacterial
  • Broad spectrum
  • Bacteriostatic & bactericidal
  • ADR: GI, hepatotoxicity, rash, red-orange discoloration of body fluids
  • Monitor AST/ALT
  • Give 1 hr AC or 2 hrs PC
• Antiprotozoals/Antiparasites


  • Metronidazole (Flagyl)
  • Chloroquine (Aralen)
• metronidazole (Flagyl)


  • Azole Antibiotic
  • Broad spectrum & bactericidal
  • Does not produce pharmacological action until inside anaerobic organism
  • Uses: C.diff & other intestinal infxs, STDs, H. Pylori
  • ADR: GI, metallic taste, CNS effects, peripheral neuropathy, seizures, dark urine
  • Disulfiram-type reaction with many drugs & ETOH
• chloroquine (Aralen)


  • Antimalarial - "quine"
  • Preferred drug for mild-moderate malaria
  • Prophylactic or given with primaquine to cure malaria
  • Other uses: amebiasis, RA, SLE
  • Pharmacologic action is unknown
  • ADR: visual symptoms, GI, HA
  • Give 1-2 weeks BEFORE travel and 4 weeks AFTER returning home
• Antifungals


  • amphotericin B - Polyene
  • ketaconazole - Azole
• amphotericin B (Fungizone)


  • Polyene Antibiotic
  • Primarily effective for Candida infx & systemic fungal infx
  • Fungistatic & fungicidal
  • IV form can be very toxic
  • ADR: infusion reactions, anemia, nephrotoxicity, hypokalemia
  • Monitor BUN/Creatinine, K, CBC/Hct, I&Os
• ketoconazole


  • Azole Antibiotic
  • Uses: cutaneous infections
  • Fewer toxic effects
  • Mostly used topically but can be given orally
  • ADR: topical = local irritation, systemic = GI, hepatotoxicity, CNS effects
  • Monitor AST/ALT
  • Give with food
  • Acidic beverage helps absorption
  • Give 2 hrs before all GI meds
• acyclovir (Zovirax)


  • Antiviral – "vir"
  • Bacteriostatic
  • Uses: herpes simplex & herpes zoster
  • ADR: Topical: local irritation, PO: GI, HA, vertigo, IV: nephrotoxicity, CNS toxicity, thrombophlebitis
  • Monitor BUN/Creatinine
  • Hydrate during infusion & 2 hrs after