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Group Pharm II > 40-ABX Quinolones, Antifolate Drugs, and Sulfonomides > Flashcards

40-ABX Quinolones, Antifolate Drugs, and Sulfonomides Flashcards

1
Q

What are the two categories of Antifolate drugs

A
  1. Sulfonamides- work by inhibiting the synthesis of dihydrofolate in some bacteria and parasites.2. Folate Reductase Inhibitors- block the action of dihydrofolate reductase and formation of tetrahydrofolate in various organisms (kills protozoa, bacteria and mammalian cells)
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2
Q

Examples of Antifolate drugs

A

SulfamethoxazoleTrimethoprimTrimethoprim-Sulfamethoxazole (SMZ/TMP) (Bactrim, Septra) Silver SulfadiazineSulfacetamide

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3
Q

Which is the main work horse drug of sulfonamides?

A

Bactrim- -tolerated well orally, widely distributed to tissue and cross the BBB-Hepatically metabolized and excreted in urine

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4
Q

What do you caution patients taking sulfonamides (since its excreted in urine)

A

without adequate hydration will cause crystalluria. Patients need to drink enough water. Can be given IV/orally but still need proper hydration

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5
Q

Name some of the drug classes often used to treat UTI and other infections

A

SulfonamidesTrimethoprimFluoroquinolones

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6
Q

Why do we give immunosuppressed patients bactrim?

A

To prevent PCP pneumonia. Drug of choice to treat PCP PNA

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7
Q

What is the dose ratio of SMZ/TMP

A
  • 5:1 ratio synergistically - Double Strength: (DS, 800mg/160mg) - Single Strength: (SS, 400mg/80mg) and we dose off TMP and not SMZ
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8
Q

What sulfa drug is used to treat burns

A

Silver Sulfadiazine

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9
Q

Which sulfa drug is used to treat ocular infections

A

Sulfacetamide (Blep10)

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10
Q

Give some of the ADR’s of Sulfonamides?

A

Skin rash that can progress to Steven Johnson’s, crystalluria, GI distress, Hepatitis, Hematopoietic toxicity, in G6PD they can cause hemolytic anemia, photosensitivity

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11
Q

Which bacteria is sulfonamides not active against?

A

Pseudomonas (Gram-negative aerobic gammaproteobacteria)But can be active against MRSA

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12
Q

Bactrim is Highly plasma protein bond, so what do you have to worry about?

A

ASA and Warfarin

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13
Q

Is Bactrim beneficial to CHF patients?

A

No, especially when given IV, it requires large volumes of fluid to dissolve the drug. not helpful for fluid restriction on CHF pts

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14
Q

What are some ADR’s of Bactrim?

A

Megaloblastic anemia with low folic acid, rash, photosensitivity

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15
Q

What patient populations do you have to worry about with bactrim?

A
  • Infants less than 2 months old- Pregnant women and nursing mothers- More skin rashes associated with HIV patients
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16
Q

What are fluoroquinolones and name a few?

A

These are broad spectrum tidal drugs e.g Ciprofloxacin, ofloxacin, levofloxacin

17
Q

What is Cipro active against

A

The original fluoroquinolone is primarily active against gram negative bacteria while new drugs like levofloxacin can cover both gram +ve and -ve bacteria

18
Q

Why is it necessary to dose fluoroquinolone on an empty stomach?

A

When take orally, they bind to Ca+, Fe and Mg, thus decreasing its availability or effectiveness

19
Q

Where are fluoroquinolones metabolized and excreted?

A

Hepatically metabolized and renally excreted

20
Q

Combination of Cipro and Ofloxacin is good for treating what?

A

Pseudomonas

21
Q

What is the main stay quinolone for anthrax?

A

Cipro- Also active against MAC, CAP and multi-drug resistant TB

22
Q

What are some of the ADR’s of Quinolones

A
  • Photosensitivity- Tendonitis and tendon rupture- Problems with long bone formation of children and should not be used in patients <18yrs- Alterations in serum glucose- seizures- QT prolongation- inhibit caffeine and theophylline metabolism
23
Q

What are some of the other antibacterial drugs in this class?

A

Nitrofurantoin, Daptomycin, Polymycin B, Rifaximin, Fidaxomicin

24
Q

What is the spectrum of Nitrofurantoin?

A

Orally given and rapidly excreted in urine and used for uncomplicated UTI in women. Should be taken with food to increase absorption and decrease GI distress

25
Q

What are some ADR’s with Nitrofurantoin?

A

Pulmonary fibrosis, Hepatitis and hematologic toxicity

26
Q

What is the spectrum of Daptomycin?

A

Cidal against most GPB. Active against MRSA and VRE.

27
Q

Why should Daptomycin not be used to treat PNA?

A

It binds to lung surfactant and does not work in the lung.

28
Q

What is the spectrum for Polymycin B?

A

Comes as cream or ointment and used for skin and ocular infections. It is however contraindicated if patient has open wound. it is also nephrotoxic

29
Q

What is the Spectrum of Rifaximin?

A
  • Non-absorbed oral ABX derived from Rifampin- Used to tx traveler’s diarrhea in pts >12yrs- Tx encephalopathy- can be used off label for IBD
30
Q

What are some of the ADR’s with Rifaximin?

A

Peripheral edema, headache, ascites and dizziness

31
Q

What is the Spectrum for Fidaxomicin?

A
  • New drug for C-dif- Oral Macrolide- third line tx option
32
Q

A woman being treated for UTI complains of heel pain and is found to have an inflamed Achilles tendon. Bacteria resistance to the agent causing this adverse effect may result from decreased binding to which cell constituent? A. membrane phospholipid B. RNA polymerase C. Folate Reductase D. topoisomerase E. divalent cations

A

D. Topoisomerase

33
Q

A man with a staphylococcal infection is placed on a drug that disrupts plasma membrane function. He should be monitored for which adverse reaction? A. muscle toxicity B. tendinopathy C. megaloblastic anemia D. Stevens- Johnson Syndrome E. Renal impairment

A

A. Muscle toxicity

34
Q

A man treated for Nocardia asteroids infection subsequently develops hemolytic anemia. Which condition will predispose the patient to this adverse effect? A. immonodeficiency B. folate deficiency C. G6PD D. Iron Deficiency E. methionine deficiency

A

C. G6PD

35
Q

A woman with traveler’s diarrhea is treated with an agent that is not absorbed from the gut. Which agent was most likely used for this condition? A. Cipro B. Rifaximin C. TMP/SMZ D. Daptomycin E. nitrofurantoin

A

B. Rifaximin

Group Pharm II (8 decks)

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