Also, REMEMBER!!!!

* Sulfonamides compete for albumin with:

  • Bilirrubin: given in 2°,3°T, high risk or indirect hyperBb and kernicterus in premies
  • Warfarin: increases toxicity: bleeding

Beta-lactamase (penicinillase) Suceptible:

  • Natural Penicillins (G, V, F, K)
  • Aminopenicillins (Amoxicillin, Ampicillin)
  • Antipseudomonal Penicillins (Ticarcillin, Piperacillin)

Beta-lactamase (penicinillase) Resistant:

  • Oxacillin, Nafcillin, Dicloxacillin
  • 3°G, 4°G Cephalosporins
  • Carbapenems 
  • Monobactams
  • Beta-lactamase inhibitors

* Penicillins enhanced with:

  • Clavulanic acid & Sulbactam (both are suicide inhibitors, they inhibit beta-lactamase)
  • Aminoglycosides (against enterococcus and psedomonas)

Aminoglycosides enhanced with Aztreonam

* Penicillins: renal clearance EXCEPT Oxacillin & Nafcillin (bile)

* Cephalosporines: renal clearance EXCEPT Cefoperazone & Cefrtriaxone (bile)

* Both inhibited by Probenecid during tubular secretion.

* 2°G Cephalosporines: none cross BBB except Cefuroxime

* 3°G Cephalosporines: all cross BBB except Cefoperazone bc is highly highly lipid soluble, so is protein bound in plasma, therefore it doesn’t cross BBB.

* Cephalosporines are "LAME“ bc they  do not cover this organisms 

  • L  isteria monocytogenes
  • A  typicals (Mycoplasma, Chlamydia)
  • RSA (except Ceftaroline, 5°G)
  •  nterococci

* Disulfiram-like effect: Cefotetan Cefoperazone (mnemonic)

* Cefoperanzone: all the exceptions!!!

  • All 3°G cephalosporins cross the BBB except Cefoperazone.
  • All cephalosporins are renal cleared, except Cefoperazone.
  • Disulfiram-like effect

* Against Pseudomonas:

  • 3°G Cef taz idime (taz taz taz taz)
  • 4°G Cefepime, Cefpirome (not available in the USA)
  • Antipseudomonal penicillins
  • Aminoglycosides (synergy with beta-lactams)
  • Aztreonam (pseudomonal sepsis)

* Covers MRSA: Ceftaroline (rhymes w/ Caroline, Caroline the 5°G Ceph), Vancomycin, Daptomycin, Linezolid, Tigecycline.

Covers VRSA: Linezolid, Dalfopristin/Quinupristin

* Aminoglycosides: decrease release of ACh in synapse and act as a Neuromuscular blocker, this is why it enhances effects of muscle relaxants.

* DEMECLOCYCLINE: tetracycline that’s not used as an AB, it is used as tx of SIADH to cause Nephrogenic Diabetes Insipidus (inhibits the V2 receptor in collecting ducts)

* Phototoxicity: Q ue S T  ion?

  • uinolones
  • Sulfonamides
  • T etracyclines

* p450 inhibitors: Cloramphenicol, Macrolides (except Azithromycin), Sulfonamides

* Macrolides SE: Motilin stimulation, QT prolongation, reversible deafness, eosinophilia, cholestatic hepatitis

Bactericidal: beta-lactams (penicillins, cephalosporins, monobactams, carbapenems), aminoglycosides, fluorquinolones, metronidazole.

* Baceriostatic: tetracyclins, streptogramins, chloramphenicol, lincosamides, oxazolidonones, macrolides, sulfonamides, DHFR inhibitors.

Pseudomembranous colitis: Ampicillin, Amoxicillin, Clindamycin, Lincomycin.

QT prolongation: macrolides, sometimes fluoroquinolones

List of Medical Documentaries

History of Medicine
Ancient Egypt: Medicine and History (History Channel, “Where Did it Come From?)
Forbidden Knowledge: Ancient Medical Secrets (Discovery)
Getting Better: 200 Years of Medicine (New England Journal of Medicine)
Human Anatomy and Medicine (Discovery)
Lost Tomb of Imhotep (Ancient Egypt Documentary)

Frontline: The Trouble with Antibiotics (PBS)
Rise of the Superbugs (Dailymotion)
Origin of AIDS: The Polio Vaccine (CBC: Witness)

Business of Medicine
The Business of Being Born (Barranca Productions)

Siddhartha Mukherjee - The Emperor of All Maladies: A Biography of Cancer, Lecture (Harvard Book Store)
Pain, Pus and Poison - Pus, The Search for Modern Medicine (BBC; @medicine-nerd)

Global Medical Missions
Médicins sans Frontières: From Action to Words (MSF)
Living in Emergency: Stories of Doctors without Borders (MSF Australia)

Health Care
Escape Fire: The Fight to Rescue American Healthcare (Lionsgate; @stayingmedicallyinspired)

Human Behavior
Pleasure and Pain Documentary with Michael Mosley (BBC)

Pioneering Physicians
Present and Unaccounted for: Black Women in Medicine (URU, The Right to Be, Inc.)

Pain, Pus and Poison - Pain, The Search for Modern Medicine (BBC; @medicine-nerd)

Medical Dramas
Boston Med, Season 1 (ABC)
Emergency Room: Life + Death at Vancouver General Hospital (Knowledge Network)
Hopkins (ABC)
NY Med, Season 1 (ABC)
NY Med, Season 2 Episode 1, 2, 34, 5, 6, 7, and 8 (ABC)

Medical Education
Doctors’ Diaries: Part 1 and Part 2 (PBS NOVA)
"I am a Medical Student” - The Motivations and Interests of 5 Future Physicians (Mauch Scott)

Science Documentary: Stem Cells (UCL)

Surgery & Surgical Procedures
Surgery’s Dirty Secrets (BBC)
The Lobotomist, Walter J. Freeman: Part 1 and Part 2 (PBS)
Extracting a Deadly Brain Tumor (University of Miami School of Medicine; @medicine-nerd)
The Human Face (BBC)

Pain, Pus and Poison - Poison, The Search for Modern Medicine (BBC)
The Venom Cure (PBS; @medicine-nerd)

War & Medicine
Nuremberg: Nazis on Trial (Parts 1-3) (BBC)
Battlefield Medicine (History Channel)
Modern Marvels: Battlefield Medicine (History Channel)
Surgeons at War: Combat Surgery in World War II (Unknown)
Frontline Medicine (BBC)

Please note: This list is updated regularly. If you have any documentary suggestions, please share!


Preparing the meat that we raised together as a family.
July 11th 2016
Atlanta, Georgia

This is our fourth year of running our backyard rabbitry. Our rabbits are cared for and loved. We have a great admiration and respect for the animal. Before we butcher our rabbits my children have learned to say, “Thank you for being here for us and for making us stronger, we will not waste your meat, you are now a part of us.” The children do not have any problems with the harvesting of the rabbits they help raise. They are excited and feel like they are contributing to the family. We believe this makes them more confident growing into the people they will become and more respectful to the environment they are growing within. There is something that has changed within us since we began raising our own meat. There is an understanding that is gained by being responsible for the lives that we end so we can continue. We are tighter as a family because we shoulder the reality of understanding how much dies to keep us alive. Past experience in sharing these particular endeavors that we engage in as a family lead me to believe that many of you reading this may find it unsettling, to say the least. We only ask that you try to understand that we are choosing not to participate in factory farmed meats. The meat that we harvest and eat in our house has been loved or, if hunted, has lived a real life.

We hope our latest family blog post finds you doing well and in the present moment with an open mind.

Most respectfully,


This year's Longitude Prize is focused on the growing problem of antibiotic resistant bacteria. They’ve put together a nice image, shown here, which showcases what they term ‘the ten most dangerous antibiotic resistant bacteria’. You can read more detail on each of them here:

The prize offers a £10 million prize fund for the development of a cheap, accurate, and easy to use bacterial infection test kit, which will allow doctors to prescribe the correct antibiotics at the correct time for patients, to try to help minimise the development of antibiotic resistance.

TSK: She just came in for “eye infection”

Cranquis: So did anything happen to your eye before it turned red and itchy?

40-something female patient: NO IT’S NOT INJURED, IT’S JUST INFECTED.

Cranquis: Ok. Have you been around anyone with pink eye lately?


Cranquis glances at the chart – ‘ALLERGY: Cats’


Patient lifts shirt to reveal hives on torso

Cranquis glances at the chart – ‘ALLERGY: Bactrim’

Cranquis: Were the antibiotics called Bactrim?


First new antibiotic in 30 years discovered in major breakthrough

The first new antibiotic to be discovered in nearly 30 years has been hailed as a ‘paradigm shift’ in the fight against the growing resistance to drugs.

Teixobactin has been found to treat many common bacterial infections such as tuberculosis, septicaemia and C. diff, and could be available within five years.

But more importantly it could pave the way for a new generation of antibiotics because of the way it was discovered.

Scientists have always believed that the soil was teeming with new and potent antibiotics because bacteria have developed novel ways to fight off other microbes.

But 99 per cent of microbes will not grow in laboratory conditions leaving researchers frustrated that they could not get to the life-saving natural drugs.

Now a team from Northeastern University in Boston, Massachusetts, have discovered a way of using an electronic chip to grow the microbes in the soil and then isolate their antibiotic chemical compounds.

They discovered that one compound, Teixobactin, is highly effective against common bacterial infections Clostridium difficile, Mycobacterium tuberculous and Staphylococcus aureus.

Professor Kim Lewis, Director of the Antimicrobial Discovery Centre said: “Apart from the immediate implementation, there is also I think a paradigm shift in our minds because we have been operating on the basis that resistance development is inevitable and that we have to focus on introducing drugs faster than resistance

“Teixobactin shows how we can adopt an alternative strategy and develop compounds to which bacteria are not resistant.”



Beta-lactams are a wide range of antibiotics, the first of which to be discovered was penicillin, which Alexander Fleming identified in 1928. All beta-lactam antibiotics contain a beta-lactam ring; they include penicillins, such as amoxicillin, and cephalosporins. They work by interfering with the synthesis of peptidoglycan, an important component of the bacterial cell wall, and are mostly used against gram-positive bacteria. Bacteria can, however, develop resistance to beta-lactams via several routes, including the production of enzymes that break down the beta-lactam ring. In the NHS, penicillins are the most commonly prescribed antibiotics, with amoxicillin being the most common in the class.


Prontosil, a sulfonamide, was the first commercially available antibiotic, developed in 1932. A significant number of sulfonamide antibiotics were subsequently developed, defined as broad-spectrum antibiotics capable of acting on both Gram-positive and Gram-negative bacteria. Unlike the beta-lactams, they do not act by directly killing the bacteria, but by inhibiting bacterial synthesis of the B vitamin folate, thus preventing growth and reproduction of the bacteria. In the present day, sulfonamides are rarely used, partially due to the development of bacterial resistance, but also due to concern about unwanted effects such as hepatotoxicity.


Aminoglycosides inhibit the synthesis of proteins in bacteria, eventually leading to cell death. They are only effective against certain Gram-negative bacteria, as well as some Gram-positive bacteria, but are not absorbed during digestion, so must be injected. In the treatment of tuberculosis, streptomycin was the first drug found to be effective; however, due to issues with toxicity of aminoglycosides, their present day use is limited.


Tetracyclines are broad-spectrum antibiotics, active against both Gram-positive and Gram-negative bacteria. Like the sulfonamides, they inhibit protein synthesis, inhibiting growth and reproduction of bacteria. Their use is decreasing to increasing instances of bacterial resistance; however, they still find use in treatment of acne, urinary tract, and respiratory tract infections, as well as chlamydia infections. They must be taken in isolation, often two hours before or after eating, as they can easily bind with food, reducing their absorption.


Another broad-spectrum antibiotic, chloramphenicol also acts by inhibiting protein synthesis, and thus growth and reproduction of bacteria. However, it is also bactericidal against a limited number of bacteria. Due to the possibility of serious toxic effects, in developed countries it is generally only used in cases where infections are deemed to be life-threatening, although it is also occasionally used in the treatment of eye infections. Despite this, it is a much more common antibiotic in developing countries due to its low cost and availability, and is recommended by the World Health Organisation as an effective first line treatment for meningitis in those countries with a low income.


Much like the beta-lactams, the macrolides are mainly effective against Gram-positive bacteria; however, they act in a bacteriostatic manner, preventing growth and reproduction by inhibiting protein synthesis. Their effectiveness is marginally broader than that of penicillins, and they have been shown to be effective against several species of bacteria that penicillins are not. Whilst some bacterial species have developed resistance to macrolides, they are still the second most commonly prescribed antibiotics in the NHS, with erythromycin being the most commonly prescribed in the class.


Glycopeptides include the drug vancomycin – commonly used as a ‘drug of last resort’, when other antibiotics have failed. Whilst this used to be the last line of defence against infections, particularly MRSA, the more recent development of newer antibiotics in other classes has provided other options. Nonetheless, there remain strict guidelines on the circumstances in which vancomycin can be used to treat infections, in order to delay the development of resistance. The bacteria against which glycopeptides are active are otherwise somewhat limited, and in most they inhibit growth and reproduction rather than killing bacteria directly.


Oxazolidinones are active against Gram-positive bacteria, and act by inhibiting protein synthesis, and hence growth and reproduction. Linezolid, approved for use in 2000, was the first marketed antibiotic in the class, although the compound cycloserine has been used as a second line tuberculosis treatment since 1956. Whilst linezolid is expensive, resistance seems to be developing relatively slowly since its introduction.


This class of antibiotics are effective against Gram-positive bacteria, as well as some Gram-negative bacteria. They inhibit the production of RNA, which has important biological roles inside the cells of the bacteria, and as such leads to the death of the bacterial cells. A subclass of antibiotics, rifamycins, are used to treat tuberculosis and leprosy. Uncommonly, ansamycins can also demonstrate anti-viral activity.


Quinolones are bactericidal compounds that interfere with the replication and transcription of DNA in bacteria cells. They are broad-spectrum antibiotics, and are widely used for urinary tract infections, as well as other hospital-acquired infections where resistance to older classes of antibiotics is suspected. Additionally, their use for veterinary purposes is widespread; a use that has been criticised in some quarters for hastening the development of resistance. Resistance to quinolones can be particularly rapid in its development; in the US, they were the most commonly prescribed antibiotics in 2002, and their prescription for unrecommended conditions or viral infections is also thought to be a significant contributor to the development of resistance.


Streptogramins are unusual in that they are usually administered as a combination of two antibiotic drugs from the different groups within the class: streptogramin A and streptogramin B. On their own, these compounds only show growth-inhibiting activity, but combined they have a synergistic effect and are capable of directly killing bacteria cells, by inhibiting the synthesis of proteins. They are often used to treat resistant infections, although resistance to the streptogramins themselves has also developed.


Discovered in 1987, lipopeptides are the most recent class of antibiotics, and are bactericidal against Gram-positive bacteria. Daptomycin is the most commonly used member of the class; it has a unique mechanism of action, disrupting several aspects of cell membrane function in bacteria. This unique mechanism of action also seems to be advantageous in that, currently, incidences of resistance to the drug seem to be rare – though they have been reported. It is given via injection, and commonly used to treat infections in the skin and tissue.

Antibiotic Resistance

Bacterial resistance to antibiotics is on the rise, to the extent that it has been made the focus of this year’s Longitude Prize. The prize is offering a £10 million prize fund for the development of a cheap and easy to use bacterial infection test kit, in the hope that this will allow doctors to prescribe the correct antibiotics at the correct time for patients, and also prevent the prescribing of antibiotics in the cases of viral infections. It’s hoped both of these measures will help slow the development of antibiotic resistance in bacteria.

SOURCE : CompoundChem