13 AntibioticsAntiRetroviralsAIDS PDF

+
Microbiology Pharmacology
Shan Nanji
+ Aminoglycosides 2
“amI-NOt-glycosides”
MOA: Bacteriocidal
n  Block _____________________
n  Inhibit Formation Of Initiation Complex
And Cause _____________________
n  Of mRNA
n  _____________________
n  The letter “A” ;the first letter of the alphabet!
Shan Nanji - NanjiMD@gmail.com

+ Aminoglycosides 3
n RESISTANCE:
n  Transferase Enzymes
Inactivate the Drug by:
1)  Acetylation
2)  Phosphorylation
3)  Adenylation

+ 4
Aminoglycosides
S/E:
n  _____________________ Especially with
Cephalosporins
n  Ototoxicty– Especially when used with
_____________________
n  Teratogen
Clinical Use:
n  SevereGram (-) Rod Infections
n  Synergistic with B-lactam Antibiotics
n  Must Monitor Peak and Trough

+ 5
Aminoglycosides
n  Gentamycin n  ________________

n  Marketed the longest n  Best for
n  Most S/E n  TB
n  Tularemia
n  Neomycin n  Amikacin

n  Used in Bowel Surgery n  Hepatic metabolism, Renal
Excretion

+ 6
Tetracyclines “+-etracyclins”
MOA: Bacteriostatic
n  Bind to 30s
n  _____________________
n  Limited CNS Penetration
n  DO NOT take with Milk, Antacids, or an Iron Containing Prep
n  RESISTANCE:
n  Decrease Uptake Into Cells or
n  Increased Efflux Out of Cells by
Plasmid Encoded Transport Pumps

+ 7
MOA: Bacteriostatic
n  Bind to 30s

n  Prevent Attachment of Aminoacyl-tRNA
n  Limited CNS Penetration
n  DO NOT take with:
n  Milk
n  Antacids
n  Iron Containing Prep

+ 8
n RESISTANCE:
n  Decrease Uptake Into Cells Or
n  Increased Efflux Out Of Cells By Plasmid

Encoded Transport Pumps

+ 9
Clinical Use:
n  _____________________
n  Mycoplasma Pneumoniae
n  Accumulates_____________________
n  Rickettsia
n  Chlamydia

+ 10
S/E:
n  GI Distress
n  Discoloration of Teeth
n  Inhibition of Bone Growth in Children
n  Photosensitivity
n  C/I in Pregnancy

+ 11
n  Thirty S subunit
n  _____________________
n  _____________________
n  Terrible vision

n  _____________________ (resistance)

+ 12
n  Doxycycline
n  Hepatic Excretion
n  _____________________
n  ADH Antagonist
n  Can be Used a Diuretic in SIADH
n  Minocycline
n  Effective against acne
n  “Mi–NO like acne on my woman!”

+ 13
Penicillin
MOA:
1.  Bind Penicillin-Binding Proteins
2.  Block Transpeptidase Cross Linking of Peptidoglycan
3.  Activate Autolytic Enzymes
n  RESISTANCE:
n  Beta Lactamases Cleave Beta Lactam Ring

+ 14
Penicillin
Clinical Use:
n  Mostly for Gram (+) organisms
n  S.Pneumo
n  S.Pyogenes
n  Actinomyces
Syphilis
n 
n  Bacteriocidal for:
n  Gram (+) Cocci
n  Gram (+) Rods
n  Gram (–) Cocci
n  Sphirocetes

+ 15
Penicillin
S/E:
n  Hypersensitivity reactions
n  Hemolytic anemia

+ 16
Penicillin
n Penicillin G
n  IV Form
n Penicillin V
n  Oral

+ 17
Penicillinase Resistant Penicillins
MOA:
n  Same As Penicillins
n  But Narrow Spectrum
n  Penicillinase Resistant
n  Due To Bulkier R-group
1.  Bind Penicillin-Binding Proteins

+ 18
Penicillinase Resistant Penicillins
Clinical Use:
n  S.Aureus
n  Except MRSA
n  Resistance Due To Altered Penicillin
Binding Protein Target Site
S/E:
n  Hypersensitivity Reactions
n  Methicillin – Interstitial Nephritis

+ 19
Penicillinase-Resistant Penicillins
n Methicillin
n  Interstitial Nephritis
n Nafcillin
n Dicloxacillin

+ 20
Aminopenicillins
MOA:
n  SAME AS PENICILLINS
n  BUT WIDER SPECTRUM
n  ALSO COMBINED WITH CLAVULANIC ACID

n  TO PROTECT AGAISNT B-LACTAMASE
1.  Bind Penicillin Binding Proteins

2.  Block Transpeptidase Cross Linking Of Peptidoglycan

+ 21
Aminopenicillins
Clinical Use:
n  Extended Spectrum Penicillins
n  H-Influenza
n  E.Coli
n  Listeria Monocytogenes
n  Proteus Mirabilis
n  Salmonella
n  Shigella
n  Enterococci

+ 22
Aminopenicillins
S/E:
n  Ampicillin – Rash
n  Pseudomembranous Colitis

+ 23
Aminopenicillins
n Ampicillin
n Amoxicillin
n  amOxicillin = greater O-ral bioavailability

+ 24
Anti-Pseudomonals
MOA:
n  Same as Penicillins but Extended Spectrum
1.  Bind Penicillin Binding Proteins

+ 25
Anti-Pseudomonals
Clinical Use:
n  Pseudomonas And Gram (-) Rods
n  Susceptible To Penicillinase
n  Use With Clavalunic Acid
S/E:

+ 26
Anti-Pseudomonals
n Ticarcillin
n Carbenicillin
n Piperacillin
“TCP – Takes Care of Pseudomonas!”

+ 27
Penicillins and Related Drugs

n Penicillins
n  Penicillin G – IV
n  Penicillin V – Oral
n  _____________________
n  Methicillin – Interstitial Nephritis
n  Nafcillin
n  Dicloxacillin

+ 28
Penicillins and Related Drugs

n Aminopenicillins
n  Ampicillin
n  Amoxicillin – Best oral bioavailability
n Anti-Pseudomonals
n  Ticarcillin
n  Carbenicillin
n  Piperacillin

+ 29
Beta-Lactamase Inhibitors
n  Added With Penicillins

n  To Protect Destruction By B-lactamase
n  AKA Penicillinase!
n  Clavulanic Acid
n  Sul_____________________
n  Tazo_____________________

+ 30
Cephalosporins
MOA:
1.  Beta-lactam Drugs that Inhibit Cell Wall Synthesis

n  But are Less Susceptible to Penicillinase

+ 31
Cephalosporins
S/E:
n  _____________________
n  Cross Hypersensitivity with _____________________
n  in 5-10% of Patients
n  Increase ____________________ of Aminoglycosides
n  Disulfram-like Reactions with Ethanol

n  (if Cephalosporin has a Methylthiotetrazole group –
Cefamandole)

+ 32
Cepaholosporins
n First Generation – PEcK

n  E.Coli
n  Klebsiella Pneumoniae
n Cefazo_____
n Cepha_____in
“Jeremy LIN drives a LEXus”

+ 33
Cepaholosporins
n Second Generation– HEN PEcKS

n  H.influenza
n  Enterobacter Aerogenes
n  Neissera Spp.

n  E.Coli
n  Klebsiella Pneumoniae
n  Serratia Marcescens

+ 34
Cepaholosporins
n Second Generation– HEN PEcKS
n Ce____lor – “CeFAKlor”
n Ce____itin
n Ce____oxime
“Two Make Her Happy Buy Some

FA(K)e FOX FUR”

+ 35
Cephalosporins
n Third Generation
n  Serious Gram (-) infections resistant to other B-lactams
n Cef___axone
n  Meningitis
n  Gonorrhea
n Cefo___ime
n Cef___idime
n  Pseudomonas

+ 36
Cephalosporins
n Fourth Generation
n  Increase activity against Pseudomonas and
Gram (+) Organisms
n Cefepime

+ 37
Chloramphenicol
n MOA:
n  Blocks Peptide Bond Formation at 50s
n  Resistance:
n  Plasma Encoded Acetyltransferase that
Inactivates Drug

+ 38
Chloramphenicol
n Clinical Use:
n  MENingitis
n  ChloraMphENicol
n  S/E:
n  Dose Dependent ______________
n  Dose Independent ______________
n  ______________

+ 39
Clindamycin
n MOA:
n  Blocks peptide bond formation at 50s

+ 40
Clindamycin
n  Anaerobic infections
n  Aspiration Pneumonia
n  Lung abcess
n S/E:
n  ______________
n  Fever
n  Diarrhea

+ 41
Macrolides “mac-RO-SLIDES”
MOA: Bacteriostatic
n  Block Translocation At 50s

n  Inhibit Protein Synthesis
RESISTANCE:
n  Methylation of the rRNA Binding Site
n  At the 23s of the 50s Subunit

+ 42
Clinical Use:
n  Atypical Pneumonias
n  Mycoplasma
n  Chlamydia
n  Legionella
n  URI
n  STDs
n  Gram + Cocci
n  Streptococcal Infections In Patients Allergic To Penicillin
n  Also Neisseria

+ 43
S/E:
n  Prolonged ____________(Erythromycin)
n  GI Discomfort
n  ______________
n  Eosinophilia
n  Skin Rashes
n  Increases Serum Concentration of:
n  Theophyllines
n  Oral Anti-coagulants

+ 44
Flouroquinolones
MOA: Bacteriocidal
n  Inhibit DNA Gyrase

n  AKA ______________
n  Bacterial DNA Can Not Separate

n  Leads To Inhibition Of Cell Replication
RESISTANCE:
n  Chromosome encoded mutation in DNA Gyrase

+ 45
Flouroquinolones
n  Ciprofloxacin
n  Norfloxacin
n  Levofloxacin
n  Ofloxacin
n  Sparfloxacin
n  Moxifloxacin
n  Gatifloxacin
n  Enoxacin
n  Nalididixic Acid (quinolone)

+ 46
Flouroquinolones
Clinical Use:
n  Gram (-) Rods Of Urinary And GI Tracts (Pseudomonas),
Neisseria
n  Some Gram + Organisms

+ 47
Flouroquinolones
S/E:
n  GI Upset
n  Superinfections
n  Skin Rashes
n  Headache
n  Dizziness
n  C/I In Pregnant And Children
Causes Cartilage Damage
n 
n  ____________________________ in Adults

n  Leg Cramps and Myalgia's in Kids

+ 48
Metronidazole
MOA: Bacteriocidal and Anti-protozoal
n  Form Free Radicals

n  Non-enzymatically Reduced to React with
Reduced Ferredoxin, which is Generated by
Pyruvate Oxido-reductase.
n  Leads To Anaerobe Cell Death

+ 49
Metronidazole
Clinical Use:
n  GET GAP on the Metro!
n GET - Giardia, Entameoba, Trichomonas,
n GAP - Gardenerella, Anaerobes, H.Pylori
“Metro Systems Are Underground and Free!”

+ 50
Metronidazole
S/E:
n  Metallic Taste
n  Disulfiram Reaction With Alcohol
n  Inhibits Aldehyde Dehydrogenase

n  Therefore Ethanol CANNOT be Metabolized
n  Leads to Increase in Aldehyde
n  Flushing
n  Sweating
n  Nausea
n  Head Ache

n  Hypotension

+ 51
Aztreonam
MOA:
n  Binds to PBP3, Preventing Peptidoglycan Crosslinking
n  Clinical Use:

n  Gram (-) Rods Only
n  Patients with a Penicillin Allergy
n  Patients with Renal Insufficiency and isn’t Able to take

Aminoglycosides

+ 52
Imipenem+Cilastatin, Meropenem
MOA:
n  Β-Lactamase Resistant Carbapenem
n  Cilastatin
n  ____________________________

n  Gram (+) Cocci
n  Gram (-) Rods
n  Anaerobes
n  Note: Limited Use because of Side Effects

+ 53
Imipenem+Cilastatin, Meropenam
S/E:
n  CNS Toxicity
n  Seizures
n  GI Distress
n  Skin Rash

+ 54
Vancomycin
MOA:
n  Inhibits Cell Wall Peptidoglycan Formation
n  Binds ______________

n  Gram (+) Only
n  Resistant Organisms

n  Clostridium Dificile – Best Treatment (Oral Vancomycin)
n  MRSA
n  Enterococci
+ 55
Vancomycin
n S/E:
n Nephrotoxicity
n Ototoxicity
n Thrombophlebitis
n “Red Man Syndrome”
n Flushing

+ 56
Sulfonamides
- Sulfamethoxazole(SMX), Sulfisoxazole, Sulfadiazine
MOA:
n  Bacteriostatic
n  Inhibit Dihydropteroate Synthase
n  Through PABA Antimetabolites

n  Gram (+)
n  Gram (-)
n  Nocardia
n  Chlamydia
n  Simple UTI

+ 57
Sulfonamides
- Sulfamethoxazole(SMX), Sulfisoxazole, Sulfadiazine
n  S/E:
n  Nephrotoxicity
n  Photosensitivity
n  Kernicterus
n  Infants
n  Hemolysis
n  If G6PD Deficient
n  Resistance:
n  Altered Enzyme
n  Decreased Uptake
n  Increased PABA Synthesis

+ 58
Trimethoprim
- TMP
MOA:
n  Bacteriostatic
n  Inhibits Bacterial Dihydrofolate Reductase

n  As a Combination TMP-SMX
n  UTI
n  Shigella
n  Salmonella
n  Pneumocystis jirovecii Pneumonia

+ 59
Trimethoprim
- TMP
n  S/E:
n  Megaloblastic Anemia
n  Leukopenia
n  Granulocytopenia
n  Possible use of ______________ to Alleviate

+ 60
Rifampin
MOA:
n  Inhibits ______________
n  Rapid Resistance if Used By Itself

n  Mycobacterium Tuberculosis
n  Leprosy
n  Meningococcal Prophylaxis

+ 61
Rifampin
n S/E:
n  ORANGE, orange, ORANGE Body Fluids!
n  Hepatotoxicity

+ 62
Isoniazid (INH)
MOA:
n  Decrease Synthesis of Mycolic Acids
n  KatG (Bacterial Catalase-Peroxidase)
Needed to Activate Isoniazid
n  As Prophylaxis

+ 63
Isoniazid (INH)
n S/E:
n  Neurotoxicity
n  Giving Vitamin B6 (Pyridoxine) Can Prevent


+ 64
Pyrazinamide
MOA:
n  Unknown
n S/E:
n  Hyperuricemia

+ 65
Ethambutol
MOA:
n  Blocks Arabinosyltransferase
n  Decreases Carbohydrate Polymerization of Cell Wall
n S/E:
n  Optic Neuropathy
n  Red/Green Color Blindness

+ 66
Mycobacterium Tuberculosis
n  Treatment Regimen:
n  Rifampin
n  Isoniazid
n  Pyrazinamide
n  Ethambutol
n  Got M. TB…Use the RIPE Treatment!

+ 67
Amphotericin B (Antifungal)
MOA:
n  Binds ______________
n  Forms ______________
n  Cryptococcus
n  Blastomyces
n  Coccidioides
n  Histoplasma
n  Candida
n  Mucor
n  S/E:
n  Optic Neuropathy
n  ______________ Color Blindness

+ 68
Amphotericin B (Antifungal)
n S/E:
n  Fever
n  Chills
n  HypOtension
n  Arrhythmias
n  Anemia
n  IV Phlebitis
n  Reduced Toxicity with Liposomal Amphotericin B

+ 69
Nystatin (Antifungal)
MOA:
n  Binds Ergosterol
n  Forms Leaky Membrane Pores
n  Oral Candidiasis
n  Topical:
n  Diaper Rash
n  Vaginal Candidiasis

+ 70
Azoles (Antifungal)
MOA:
n  Inhibit Fungal Sterol Synthesis
n  By Inhibition of P-450
n  Cryptococcal Meningitis in AIDS
n  Blastomyces
n  Coccidioides
n  Histoplasma
n  Candida
n  S/E:
n  Inhibition of Testosterone Synthesis (Gynecomastia)
n  Liver Dysfunction (Inhibits P-450)

+ 71
Flucytosine (Antifungal)
MOA:
n  Inhibits DNA and RNA Synthesis
n  Converted to ______________ by ______________
n  Cryptococcal Meningitis
n  Combined with Amphotericin B
n S/E:
n  Bone Marrow Suppression

+ 72
Caspofungin, Micafungin
(Antifungals)
MOA:
n  Inhibit Cell Wall Synthesis
n  By Inhibition of β-glucan
n  Invasive Aspergillosis
n  Candida
n S/E:
n  GI Upset
n  Flushing
n  Histamine Released

+ 73
Terbinafine (Antifungals)
MOA:
n  Inhibits Fungal Squalene Epoxidase
n  Dermatophyte Infections
n S/E:
n  Abnormal Liver Function Tests (LFT’s)
n  Visual Disturbances

+ 74
Griseofulvin (Antifungals)
MOA:
n  Interferes with Microtubule Function during Mitosis
n  Superficial
Infections (Oral Treatment)
n  Dermatophyte Infections
n S/E:
n  Carcinogenic
n  Teratogenic
n  Confusion
n  Headaches
n  Induce P-450

+ 75
Chloroquine (Antiprotozoan)
MOA:
n  Blocks Detoxification of Heme
n  Heme Accumulates
n  Plasmodial Infections
n  EXCEPT P. Falciparum
n S/E:
n  Retinopathy

+ 76
Antiprotozoan Therapy
n Pyrimethamine
n  Toxoplasmosis
n Suramin and Melarsoprol

n  Trypanosoma Brucei
n Nifurtimox
n  Trypanosoma Cruzi
n Sodium Stibogluconate
n  Leishmaniasis

+ 77
Antihelminthic Therapy
n Pyrimethamine
n PyrantelPamoate
n Ivermectin
n Diethylcarbamazine
n Praziquantel
n  Treats Flukes
n  Schistosoma

+ 78
Zanamivir, Oseltamivir
(AntiVirals)
MOA:
n  Inhibit Influenza Neuraminidase
n  Decreased Viral Release
n  Influenza A and B
n  Prevention and/or Treatment
n S/E:
n  Retinopathy

+ 79
Ribavirin (AntiVirals)
MOA:
n  Inhibit Synthesis of Guanine Nucleotides
n  Through Competitively Inhibiting IMP Dehydrogenase
n  RSV
n  Chronic Hepatitis C
n S/E:
n  Hemolytic Anemia
n  Extremely Teratogenic

+ 80
Acyclovir (Valacyclovir – Prodrug)

(AntiVirals)
MOA:
n  ____________________________ by Chain Termination
______________ Initiates Phosphorylation
n 
n  Cellular Enzymes Add Additional Phosphates
n  Guanosine Analog
n  _____ (Most Infections)
n  _____
n Resistance
n  Viral Thymidine Kinase Mutation

+ 81
Ganciclovir (AntiVirals)
MOA:
n  Inhibits Viral DNA Polymerase
n  ______________ causes Phosphorylation
n  Cellular Kinases Add Additional Phosphates
n  CMV
n  S/E:
n  Leukopenia
n  Neutropenia
n  Thrombocytopenia
n  Resistance
n  CMV DNA Polymerase Mutation
n  Absent Viral Kinase
+ 82
Foscarnet (AntiVirals)
MOA:
n  Binds to Pyrophosphate Binding Site of Enzyme
n  ______________
n  CMV Retinitis If Ganciclovir Fails
n S/E:
n Resistance
n  DNA Polymerase Mutation

+ 83
Cidofovir (AntiVirals)
MOA:
n  No Viral Kinase Phosphorylation Required
n  ______________
n  CMV Retinitis If Ganciclovir Fails
n  Acyclovir-Resistant HSV
n S/E:
n  To Reduce Nephrotoxicity:
n  Coadminister Probenecid and IV Saline
+ 84
AIDS - NRTI
MOA :
n  Comp/Rev. Inhibit nucleotide binding to reverse
transcriptase
n  Needs Thymidine Kinase to be active.
n  S/E :
(reversed with G-CSF and EPO)
n  Peripheral Neuropathy
n  Lactic Acidosis (nucleosides)
n  Rash (non-nucleosides)
n  Megaloblastic Anemia (ZDV)

+ 85
AIDS - NRTI
n  Abacavir
n  Tenofovir – Does NOT need to be phosphorylation
n  Zalcita_____
n  Emtricita___
n  Lamivu___
n  Zidovu___ – Used for general prophylaxis and
during pregnancy to reduce transmission risk.
n  Decreases vertical transmission. Blasts your BM
n  Stavu___
n  Didano___
n  Painful neuropathy and pancreatitis

+ 86
Protease Inhibitors
“-navir”
MOA:
n Inhibit pol gene
-> prevents maturation
n S/E:
n Hyperglycemia
n GI Intolerance
n Lipodystrophy

+ 87
Protease Inhibitors
n LopiNAVIR
n AtzaNAVIR
n FosampreNAVIR
n SaquiNAVIR
n ______
n  Can cause crystillization in the urine
n ______
n  Liver disease

+ 88
NNRTI
MOA:
n  Bind to Reverse Transcriptase at a Different Site
n  Do Not Need Thymidine Kinase to be Activated.
n S/E :
(reversed with G-CSF and EPO)
n  Peripheral Neuropathy
n  Lactic Acidosis (nucleosides)
n  Rash (non-nucleosides)
n  Megaloblastic Anemia (ZDV)

+ 89
NNRTI
n Ne___apine
n Efa___enz
n Dela___dine

+ 90
Integrase Inhibitor
n _________
MOA:
n  Inhibits HIV Genome Integration
into Host Cell Chromosome by
Reversibly Inhibiting HIV Integrase
n  S/E:
n  Hypercholesterolemia

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n The letter “A” ;the first letter of the alphabet!

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

n Must Monitor Peak and Trough

Shan Nanji - NanjiMD@gmail.com

n Gentamycin n ________________

n Neomycin n Amikacin

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

n Bind to 30s

Shan Nanji - NanjiMD@gmail.com

n Decrease Uptake Into Cells Or

n Increased Efflux Out Of Cells By Plasmid

Shan Nanji - NanjiMD@gmail.com

n Mycoplasma Pneumoniae

Shan Nanji - NanjiMD@gmail.com

n C/I in Pregnancy

Shan Nanji - NanjiMD@gmail.com

n Thirty S subunit

n Terrible vision

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Penicillinase Resistant Penicillins

Shan Nanji - NanjiMD@gmail.com

Penicillinase Resistant Penicillins

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

n ALSO COMBINED WITH CLAVULANIC ACID

1. Bind Penicillin Binding Proteins

Shan Nanji - NanjiMD@gmail.com

n Listeria Monocytogenes

n Proteus Mirabilis

Shan Nanji - NanjiMD@gmail.com

n Pseudomembranous Colitis

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

Shan Nanji - NanjiMD@gmail.com

n Use With Clavalunic Acid

Shan Nanji - NanjiMD@gmail.com

“TCP – Takes Care of Pseudomonas!”

Shan Nanji - NanjiMD@gmail.com

Penicillins and Related Drugs

n Penicillin V – Oral

Shan Nanji - NanjiMD@gmail.com

Penicillins and Related Drugs

n Amoxicillin – Best oral bioavailability

Shan Nanji - NanjiMD@gmail.com

n Added With Penicillins

n Clavulanic Acid

Shan Nanji - NanjiMD@gmail.com

1. Beta-lactam Drugs that Inhibit Cell Wall Synthesis

Shan Nanji - NanjiMD@gmail.com

n Disulfram-like Reactions with Ethanol

Shan Nanji - NanjiMD@gmail.com

n First Generation – PEcK

“Jeremy LIN drives a LEXus”

Shan Nanji - NanjiMD@gmail.com

n  The letter “A” ;the first letter of the alphabet!

n  Must Monitor Peak and Trough

n  Gentamycin n  ________________

n  Neomycin n  Amikacin

n  Bind to 30s

n  Decrease Uptake Into Cells Or

n  Increased Efflux Out Of Cells By Plasmid

n  Mycoplasma Pneumoniae

n  C/I in Pregnancy

n  Thirty S subunit

n  Terrible vision

n  ALSO COMBINED WITH CLAVULANIC ACID

1.  Bind Penicillin Binding Proteins

n  Listeria Monocytogenes

n  Proteus Mirabilis

n  Pseudomembranous Colitis

n  Use With Clavalunic Acid

n  Penicillin V – Oral

n  Amoxicillin – Best oral bioavailability

n  Added With Penicillins

n  Clavulanic Acid

1.  Beta-lactam Drugs that Inhibit Cell Wall Synthesis

n  Disulfram-like Reactions with Ethanol

n First Generation – PEcK

n Second Generation– HEN PEcKS

n  Proteus Mirabilis

n  Serratia Marcescens

n Second Generation– HEN PEcKS

n  Blocks Peptide Bond Formation at 50s

n  Blocks peptide bond formation at 50s

n  Aspiration Pneumonia

n  Lung abcess

n  Block Translocation At 50s

n  Skin Rashes

n  Increases Serum Concentration of:

n  Oral Anti-coagulants

n  Inhibit DNA Gyrase

n  Bacterial DNA Can Not Separate

n  ____________________________ in Adults

n  Form Free Radicals

n GET - Giardia, Entameoba, Trichomonas,

n GAP - Gardenerella, Anaerobes, H.Pylori

n  Inhibits Aldehyde Dehydrogenase

n  Head Ache

n  Clinical Use:

n  Patients with Renal Insufficiency and isn’t Able to take

n  Clinical Use:

n  Note: Limited Use because of Side Effects

n  Binds ______________

n  Clinical Use:

n  Resistant Organisms

n  Clinical Use:

n  Inhibits Bacterial Dihydrofolate Reductase

n  Clinical Use:

n  Clinical Use:

n  Giving Vitamin B6 (Pyridoxine) Can Prevent

n  Got M. TB…Use the RIPE Treatment!

n  Reduced Toxicity with Liposomal Amphotericin B