Pharmacology Review - Antimicrobials

1. 1st gen cephalosporin: G+ cocci, PEcK (Proteus

mirabilis, E. coli, Klebsiella pneumoniae)
2. 2nd gen cephalosporin: G+ cocci, HEN PEcKS
(Haemophilus influenze, Enterobacter aerogenes,
Neisseria species, Proteus mirabilis, E. coli, Klebsiella
pneumoniae, Serratia marcescens
3. 30S protein synthesis inhibitors: Aminoglycosides and
tetracyclines
4. 3rd Generation cephalosporin: serious G- infections
resistant to other Beta lactams; meningitis (most
penetrate BBB)
5. 4th gen cephalosporin: increased activity against
pseudomonas G+ organisms
6. 50S protein synthesis inhibitors: CELL /
Chloramphenicol, Erythromycin, Lincomycin,
cLindamycin // all are bacteriostatic
7. Aminoglycosides: (streptomycin, gentamicin, tobramycin,
amikacin) / bactericidal
8. Aminoglygosides: Mechanism of Action: Block protein
synthesis at 30s ribosomal subunit
9. Amphotericin B: Mechanism of Action: disrupt fungal cell
membranes
10. Ampicillin: Mechanism of Action: Blocks cell wall
synthesis by inhibition of petidoglycan cross-linking
11. Ampicillin, Amoxicillin: Same mechanism of action as
penicillin. Wider spectrum; penicillinase sensitive
12. Ampicillin, amoxicillin (clinical use): ampicillin /
amoxicillin HELPS kill enterococci (Haemophilus
influenzae, Escherichia coli, Listeria monocytogenes,
Proteus mirabilis, Salmonella, enterococci)
13. Ampicillin, amoxicillin (toxicity): Hypersensitivity
reactions; ampicillin rash; pseudomembranous colitis

14. Aztreonam: A monobactam resistant to Beta lactamases.

Inhibits cell wall synthesis - synergistic w/
aminoglycosides / no cross-alergenicity w/ penicillins
15. Aztreonam: Mechanism of Action: Blocks cell wall
synthesis by inhibition of peptidoglycan cross-linking
16. Aztreonam (clinical use): G- rods (klebsiella species,
Pseudomonas species, Serratia species) // no activity
against anaerobes. // used for penicillin-allergic
patients and those w/ renal insufficiency who can't
tolerate aminoglycosides / usually nontoxic - can cause
GI upset
17. Bacitracin: Mechanism of Action: Block peptidoglycan
synthesis
18. Carbenicillin, Piperacillin, ticarcillin: Same mechanism
of action as penicillin; extended spectrum pseudomonas species and G- rods; susceptible to
penicillinase; use w/ clavulanic acid; can cause
hypersensitivity reaction
19. Cephalosporin toxicity: hypersensitivity, increased
nephrotoxicity of aminoglycosides, disulfiram-like
reactions w/ ethanol
20. Cephalosporins: Mechanism of Action: Blocks cell wall
synthesis by inhibition of peptidoglycan cross-linking
21. Cephalosporins (mechanism of action): beta lactam
drugs that inhibit cell wall synthesis but are less
susceptible to penicillinases; bactericidal
22. Chloramphenicol: Mechanism of Action: Block Protein
synthesis at 50s ribosomal subunit
23. Clindamycin: Mechanism of Action: Block Protein
synthesis at 50s ribosomal subunit
24. DOC for enterobacter: imipenem / cilastatin

25. Erythromycin/Macrolides: Mechanism of Action: Block

Protein synthesis at 50s ribosomal subunit
26. fluconazole (azoles): Mechanism of Action: disrupt fungal
cell membranes
27. Gonorrhea: Ceftriaxone (3rd Gen ceph)
28. Imipenem: Mechanism of Action: Blocks cell wall
synthesis by inhibition of peptidoglycan cross-linking
29. Imipenem / cilastatin: Broad-spectrum, beta
lactamase-resistant / always given w/ cilastatin (inhibits
renal dihydropeptidase 1 --> decrease imipenem
inactivation in renal tubules)
30. Imipenem / Cilastatin (clinical use): G+ cocci, G- rods,
and anaerobes
31. Imipenem / cilastatin (toxicity: GI distress, skin rash, and
CNS toxicity (seizures) at high plasma levels
32. Lincomycin: Mechanism of Action: Block Protein
synthesis at 50s ribosomal subunit
33. methicilin, nafcillin, dicloxacillin (toxicity):
hypersensitivity reactions
34. Methicillin (toxicity): interstitial nephritis
35. Methicillin, nafcillin, dicloxacillin: same mechanism of
action as penicillin. Narrow spectrum; Penicillinase
resistant due to bulkier R group
36. Methicillin, nafcillin, dicloxacillin: clinical use --> treat
staph aureus
37. Nystatin: Mechanism of Action: disrupt fungal cell
membranes
38. Penicillin: 2 forms G (IV form) // Penicillin V (oral)
39. Penicillin: Mechanism of Action: Blocks cell wall synthesis
by inhibition of peptidoglycan cross-linking
40. Penicillin (clinical use): bactericidal for G+ cocci, G+
rods, G- cooci, and spirochetes. Not penicillinase
resistant
41. Penicillin (mechanism of action): 1. Binds
penicillin-binding proteins 2. Blocks transpeptidase
cross-linking of cell wall 3. Activates autolytic enzymes

42. Penicillin (toxicity: hypersensitivity reactions, hemolytic

anemia
43. Pentamidine: Mechanism of Action: unknown mechanism
of action
44. Piperacillin: Mechanism of Action: Blocks cell wall
synthesis by inhibition of peptidoglycan cross-linking
45. Polymyxins: Mechanism of Action: Disrupt
bacterial/fungal cell membranes
46. Pseudomonas: ceftazidime (3rd gen ceph)
47. Quinolones: Mechanism of Action: Block DNA
topoisomerases
48. remember: amOxicillin has greater Oral bioavailability
than ampicillin
49. Rifampin: Mechanism of Action: Block mRNA synthesis
50. Streptogramins (quinupristin,dalfopristin): Mechanism
of Action: Block Protein synthesis at 50s ribosomal
subunit
51. Tetracyclines: bacteriostatic
52. Tetracyclines: Mechanism of Action: Block protein
synthesis at 30s ribosomal subunit
53. Ticarcillin: Mechanism of Action: Blocks cell wall
synthesis by inhibition of peptidoglycan cross-linking
54. Vancomycin: Mechanism of Action: Block peptidoglycan
synthesis
55. Vancomycin (clinical use): used for serious, G+
multidrug-resistant organisms. including staph aureus
and Clostridium difficile (pseudomembranous colitits)
56. Vancomycin (mechanism of action): inhibits cell wall
mucopeptide formation by binding D-ala D-ala portion
of cell wall precursors / Bactericidal / resistance occurs
w/ amino acid change of D-ala D-ala to D-ala D-lac
57. Vancomycin tocicity: NOT - Nephrotoxicity, Ototoxicity,
and Thrombophlebitis, diffuse flushing -->"red man
syndrome" (can prevent w/ pretreatment w/
antihistamines and slow infusion rate)

58. What can you combine w/ ampicillin or amoxicillin to

enhance spectrum: clavulanic acid (penicillinase
inhibitor)