1. Antibiotic
   1. penicillin G
      1. Penicillin G benzathine
         1. penecillin vk
            1. Antistaphylococcal penicillins Methicillin (discontinued) Nafcillin Oxacillin Cloxacillin Dicloxacillin Fluxacillin
            2. Extended-spectrum Penicillins > aminopenicillin > ampicillin
            3. Extended-spectrum Penicillins > aminopenicillin > amoxicillin
            4. Extended-spectrum Penicillins > carboxypenicillin > ticarcillin
            5. Extended-spectrum Penicillins > urdylpenicillin > piperacillin
            6. first generation > cephalxine
            7. first generation >cefazoline
            8. 2nd generation > cefaclor
            9. 2nd generation > cefauroxime
            10. 3rd generation > cefotaxime
            11. 3rd generation > ceftrixone
            12. 3rd generation > ceftazidime
            13. 4th generation > cefepime
            14. 5th generation > ceftaroline
            15. Monobactams > aztreonam
            16. Carbapenem> Imipenem
            17. vancomycin
            18. 2nd gen > Cephamycins > Cefoxitin, cefotetan, cefametazole
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2. spectrum, bacteria
   1. narrow spectrum, Gram p+ , does not pass gram N- well
      1. narrow spectrum, gram positive
         1. narrow spectrum, gram positive
            1. Active against MSSA Enterococci and MRSA strains are resistant
            2. These extended agents retain spectrum of activity of Penicillin G, Differ in having greater activity against gram-negative bacteria.
            3. the extended agents retain spectrum of activity of Penicillin G, Differ in having greater activity against gram-negative bacteria.
            4. These extended agents retain spectrum of activity of Penicillin G, Differ in having greater activity against gram-negative bacteria.
            5. These extended agents retain spectrum of activity of Penicillin G, Differ in having greater activity against gram-negative bacteria.
            6. spectrum similar to the extended spectrum penicillins (amoxicillin )
            7. narrow spectrum (similar to antistaph )
            8. negative aerobic primarily positive aerobic as well
            9. negative aerobic primarily positive aerobic as well
            10. Expanded gram negative coverage
            11. Expanded gram negative coverage
            12. Expanded gram negative coverage
            13. Has activity against gram-positive and gram-negative, especially against P. aeruginosa; and gram-negative organisms with multiple-drug resistance patterns
            14. It has a broad gram-negative spectrum activity
            15. only gram negative aerobic no activity against gram positive bacteria or anaerobes.
            16. gram positive cocci, gram negative rods and anaerobes
            17. gram- positive bacteria. No activity against gram-negative organisms.
            18. active against anaerobes
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3. DOC, disease
   1. 1.diphtheriae ( crystalline penicillin G) 2.Penicillin G is commonly used as the drug of choice for prophylactic antibiotic during labor to prevent group B Streptococcus (GBS) infection in newborns
      1. syphilis (sexually transmitted infection)
         1. it is replaced by amoxicillin clinically
            1. 1.certain Staphylococcus infections 2. clean surgical sites ( brain ) as a prophylaxis
            2. the gram-positive bacillus Listeria monocytogenes, enterococcaal species
            3. prophylactically by dentists in high-risk patients for the prevention of bacterial endocarditis.
            4. gram-negative bacilli, including Pseudomonas aeruginosa (common cause of healthcare-associated infections )
            5. gram-negative bacilli, including Pseudomonas aeruginosa + klibsella pneumonia
            6. It is the drug of choice for surgical prophylaxis , altervative to antistyphlococcual AB, can be used in clean surgical sites ( brain ) as a prophylaxis
            7. treats : 1. Gonorrhea 2. streptopneumococci ( meningitis ) 3.meningiococci ( meningitis ) 4. H influenza ( meningitis ) but not Listeria monocytogens meningitis + when we suspect meningitis after physical examination it is used as an empirical therapy cause it is dangerous to wait for he results we add ampicillin for extreme ages cause it may be Listeria
            8. treats : 1. Gonorrhea 2. streptopneumococci ( meningitis ) 3.meningiococci ( meningitis ) 4. H influenza ( meningitis ) but not Listeria monocytogens meningitis + when we suspect meningitis after physical examination it is used as an empirical therapy cause it is dangerous to wait for he results we add ampicillin for extreme ages cause it may be Listeria
            9. combined with aminglycoside to treat meningitis caused by P aeurginosa we add ampicillin for extreme ages cause it may be Listeria
            10. 1.combined with aminoglycosides to treat psuedomonus areuginosa 2.active against bacteria with multidrug resistance
            11. methicillin resistance styphalococcus aures ( MRSA ) especially pneumonial infections
            12. It is considered an alternative to 3rd generation alternative to aminoglycosides
            13. The drug of choice for enterobacter infections
            14. The combination of vancomycin and Aminoglycoside as GENTAMYCIN is synergistic against 1. Sepsis or endocarditis caused by MRSA 2. MSSA in patients who are allergic to penicillins or cephalosporins ( last option ) 3. antibiotic-associated enterocolitis caused by Clostridium difficile ( when we give so many antibiotics we kill the flora which will cause C.diff to grow freely and cause "antibiotic pseudomembranous colitis " distinct by yellowish membrane 4. Vancomycin in combination with gentamicin is an alternative regimen for treatment of enterococcal endocarditis in a patient with serious penicillin allergy.
            15. prophylaxis of rich flora sites Surgery in vagina for example(Rich in microflora) we use the one of anaerobic activity
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4. mechanism
   1. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
      1. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
         1. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            1. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            2. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            3. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            4. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            5. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            6. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            7. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            8. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            9. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            10. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            11. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            12. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            13. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            14. inhibit transpeptidase enzyme that catalyze formation of the cross-linkages between peptidoglycan chains of the cell wall
            15. Inhibits the cell wall synthesis by binding to PBP3(transpeptidase).
            16. Inhibits the cell wall synthesis by binding to PBP3(transpeptidase).
            17. Inhibits bacterial cell wall synthesis (transglycosylase)
            18. cephalosporins must be administered parentally because of their poor oral absorption.
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5. charactersitics
   1. weak , penicillinase sensitive acid labile , Widely distributed, Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
      1. used for prolonged actions, even if the patient is sensitive for penicillin (we make desensitization…) Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
         1. resist acid degredation, absorbed in the upper respiratory tract Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
            1. Penicillinase-resistant Penicillins (B LACTAMASE RESISTANT) , Nafcillin (by biliary secretion), oxacillin and dicloxacillin (by both kidney and biliary) so no need for dose adjustment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
            2. water soluble less excreted from the intestine ( may cause diarrhoea used as an empirical therapy for listeria ampicillin is inactivated by b-lactamase , need to be protected by b-lactamase inhibitor (ampicillin-sulbactam) penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic) Rapid renal excretion ( dose adjusment in renal failure
            3. They are inactivated by β -lactamases so they need to be protected by beta lactamase inhibitor Amoxicillin-clavulanic acid more excreted by GI tract better oral absorbstion Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
            4. They are inactivated by β -lactamases so they need to be protected by beta lactamase inhibitor ticarcillin-clavulanic acid used in combination with an aminoglycoside for a Pseudomonal infection Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
            5. They are inactivated by β -lactamases so they need to be protected by beta lactamase inhibitor Piperacillin-tazobactam Usually an antipseudomonal penicillins are used in combination with an aminoglycoside for a Pseudomonal infection Rapid renal excretion ( dose adjusment in renal failure penecillins Can not penetrate BBB , unless we have active acute inflammation(not chronic)
            6. absorbed similar to amoxicillin cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            7. penetrates well into most tissues. cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            8. More stable, wider spectrum , more towards gram negative cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            9. More stable, wider spectrum , more towards gram negative the only 2nd generation AB that penetrates well the BBB , but cant cure meningitis cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            10. Active against B-lactamase producing strains Able to cross the BBB and treat meningitis cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            11. Active against B-lactamase producing strains Able to cross the BBB and treat meningitis excreted through the bile into the feces. crosses placenta cross allergenicity with penecillin 3%-5%
            12. Active against B-lactamase producing strains Able to cross the BBB and treat meningitis cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            13. more resistant to hydrolysis by β-lactamases cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            14. cross placenta , eliminated renally Adjust dose in case of renal failure cross allergenicity with penecillin 3%-5%
            15. It resists β-lactamases Eliminated renally No cross-allerginicity with penicillin mono=one b lactam ring , no fused one no cross allergenicity with penicillins
            16. It has low susceptibility to β-lactamses carbapenem: all ring members are carbons Mixed with cliastatin: dehydropeptidase 1 inhibitor ,which convert it rapidly to its metabolite , which is toxic, causing nephrotoxicity ---just mixing it to make the drug safer partial cross allergenicity with penecillin
            17. non b lactam Glycopetide big structure Bactericidal against most gram-positive organisms (except enterococci). Poorly absorbed from GIT. Widely distributed in body tissues, thus not removed by hemodialysis So no need to adjust the dose in case of hemodialysis but It is very important to adjust the dose in renal dysfunction .
            18. Cephamycins are not cephalosporins , just structurally related . Functionally related .
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6. adminstraition
   1. not orally ( acide labile )
      1. intramuscular
         1. oral formulation , Absorption of most oral penicillins (except Amoxicillin) is impaired by food. AB should be administered at least 1-2 hours before or after a meal.
            1. Absorption of most oral penicillins (except Amoxicillin) is impaired by food. AB should be administered at least 1-2 hours before or after a meal.
            2. Absorption of most oral penicillins (except Amoxicillin) is impaired by food. AB should be administered at least 1-2 hours before or after a meal.
            3. Absorption of Amoxicillin is not impaired by food.
            4. Absorption of most oral penicillins (except Amoxicillin) is impaired by food. AB should be administered at least 1-2 hours before or after a meal.
            5. Absorption of most oral penicillins (except Amoxicillin) is impaired by food. AB should be administered at least 1-2 hours before or after a meal.
            6. cephalosporins must be administered parentally because of their poor oral absorption.
            7. The only antibiotic in 1st generation the is given parenterally, no oral
            8. cephalosporins must be administered parentally because of their poor oral absorption.
            9. cephalosporins must be administered parentally because of their poor oral absorption.
            10. cephalosporins must be administered parentally because of their poor oral absorption.
            11. cephalosporins must be administered parentally because of their poor oral absorption.
            12. cephalosporins must be administered parentally because of their poor oral absorption.
            13. cephalosporins must be administered parentally because of their poor oral absorption.
            14. cephalosporins must be administered parentally because of their poor oral absorption.
            15. give IV
            16. parenterally
            17. Absorption in GI is difficult , so not active orally Local infections –can be given orally (Administered orally only for the treatment of antibiotic-associated enterocolitis caused by Clostridium difficile.) Highly water soluble , limited absorption, coclea of the ear and kidneys– concentrated causing Ototoxicity and nephrotoxicity
            18. cephalosporins must be administered parentally because of their poor oral absorption.
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7. adverse effect
   1. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks.
      1. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks.
         1. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks.
            1. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks.
            2. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks. 6. enterocolitis caused by Clostridium difficile.
            3. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks. 6.enterocolitis caused by Clostridium difficile.
            4. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks.
            5. 1. Hypersensitivity reactions are the most common including: anaphylactic shock (very rare) Urticaria fever joint swelling angioneurotic edema : edematous episodes of cutaneous and mucosal tissues such as lips, eyes, oral cavity, larynx, and gastrointestinal system (GIS) pruritus skin rashes. 2. Diarrhea: disruption of the normal balance of intestinal flora 3. Nephritis: methicillin 4. Neurotoxicity 5. Hematologic toxicities: - Decreased coagulation (piperacillin, ticarcillin, and nafcillin) - Cytopenias: treatment for longer than 2 weeks. 6. enterocolitis caused by Clostridium difficile.
            6. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            7. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            8. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            9. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection 2. enterocolitis caused by Clostridium difficile.
            10. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            11. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection 2, enterocolitis caused by Clostridium difficile.
            12. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            13. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            14. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
            15. AD.E: GI upset, superinfection, vertigo, rarely hepatotoxicity
            16. GI distress, skin rash and at very high plasma levels  CNS toxicity (confusion, encephalopathy and seizures). Partial cross allergenicity with penicillins. (20-30%)
            17. It is irritating to tissues phlebitis at site of injection. Chills and fever may occur. Ototoxicity and nephrotoxicity are rare with current preparations. However, coadministration with aminoglycosides will increase this toxicity. Red man or red neck syndrome: infusion related flushing due to histamine release.
            18. Allergy Identical to penicillins- cross allergenicity 3-5 % Toxicity Severe pain (IM) Thrombophlebitis (IV) Renal toxicity Hypoprothrombinemia (some cephalosporins) Disulfiram like reaction Stevens-Johnson syndrome Superinfection
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8. mnemonics
   1. vk: very acidic , keep resisting acid
      1. nafcillin ( nafci : نفسية ) the only one undergoes biliary secretion
      2. a(p)micillin is an em(p)irical therapy for (lis)teria the (less) excectred bacteria from intestine , if it will stay longer in the intestine then it is perfect to cure enterococcal bac
      3. (p)e(p)iracillin 2p's treats (p)suedomonus areginosa and klibsella (p)neumonia
      4. special mnemonic: if your name is (hal)a, cap(hal)exine , you are always in the first place ( 1st G )
      5. cefa(zol)ine , zol زول = واحد بالسوداني 1st generation
      6. cefa(clor) , (chlor)ide molecule is written Cl(2) , 2nd generation
      7. the only sec gen that penetrate BBB and still can not treat meningitis the pure example of " خالف تُعرف " a sentence of 2 words = 2nd gen
      8. third gen are the family of 3 cefotaxi(me) = me ceftrix(one) = one cute child ceftazi(dime) = di me, my other half + (cefo)tax(i)(m)(e) = (cefo) (i)s (m)eningitis (e)mpirical therapy
      9. third gen are the family of 3 cefotaxi(me) = me ceftrix(one) = one cute child ceftazi(dime) = di me, my other half cef(tri)xone : tri = third gen ceftrix(on)e : g(on)orrhea
      10. third gen are the family of 3 cefotaxi(me) = me ceftrix(one) = one cute child ceftazi(dime) = di me, my other half areuginosa is pronounced ( areuginoza ) : ceft(a)(z)id(i)(m)e treats psuedomonus (a)reugino(z)a caused (m)eningitis
      11. Four pieces of apple (pi)e all 4th gen AB have pi cefe(pi)me
      12. all 5th gen AB have (rol) rola 2005
      13. "IMI(P)(EN)EM" (P)otent Against (E)verything given (p)arenetrally to treat (en)terococci
      14. vancomycin v : (v)ery water soluble a : (a)lternative to penicillin and cephalosporins (a)llergic patients n: nephroitis c : Clostridium difficile o : otoitis m : MSSA , MRSA y : yellow membrane c : cause pseudomembranous (c)olitis (i)(n) : (i)mpossible for (n)egative bacteria
      15. Cefoxitin : 2 i = 2nd generation Cefo(teta)n : 2 t + we are the sec generation to our teta = sec gen Cefametazole : meta is the sec step of cell division
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