9-14 Macrolides/Ketolides/Streptogramins/Lincosamides Flashcards
CLINDAMYCIN
A1: MOA
A2: How does this interfere with other abx
B: Bacteriostatic vs. BacteriCIDAL
C: [Mechanism of Resistance]
D: How is Clindamycin related to the [mEF gene] ?
CLINDAMYCIN
MOA:
*[REVERSIBLY Binds to 50s Ribosomal subunit —> Inhibits Protein Synthesis]*
A2: It binds to a site on the [50s Ribosomal subunit] that is close to the binding site for Synercid and Macrolides —> Competitive Inhibition
B:
-[Normally Bacteriostatic]… UNLESS IN HIGH CONCENTRATIONS —> BACTERICIDAL
C: [Mechanism of Resistance]
1. [ERm gene] alters [50s Ribosomal subunit] binding site
D: Bacteria have a [mEF gene] encoding for an [Active Efflux Pump] that pumps out Macrolides BUT NOT CLINDAMYCIN
CLINDAMYCIN
[Gram POSITIVE Aerobes] (5)
B: What class does this abx belong to?
CLINDAMYCIN
[Gram POSITIVE Aerobes]
“May Clindamycin Positively Guard Vaginas? “
- MSSA
- [CA-MRSA] (some)
- PSSP (Penicillin susceptible Strep Pneumoniae)
- [Group Strep A and B]
- [Virdans Strep]
B: Lincosamide
CLINDAMYCIN
AnAerobes: (3)
B: Clindamycin also treats what other uncategorized pathogens? (3)
CLINDAMYCIN
AnAerobes: “A [SAC of Clindamycin AnAerobes] May Prevent Toxoplasmosis”
- some Bacteroides species
- Actinomyces
- Clostridium Species (BUT NO C DIFF)
B: Clindamycin also treats
a. Malaria
b. [Pneumocystis Carinii]
c. [Toxoplasmosis Gondii]
A: Clindamycin Route of Administration (2)
A2: Which of these have better absorption?
B: Distribution
- CSF?
- [Tissue and Bone] ?
C1: ELIMINATION
C2: Is Clindamycin removed during hemodialysis?
A: Clindamycin is available IV and PO and BOTH HAVE [RAPID AND VERY EFFICIENT ABSORPTION]
B:
- Does NOT penetrate CSF well
- Does penetrate tissue and bone well
C1: HEPATIC ELIMINATION
C2: Clindamycin is NOT removed during hemodialysis
CLINDAMYCIN CLINICAL USES: (3)
CLINDAMYCIN CLINICAL USES:
A: Anaerobic Infections that are NOT in the CNS ([decubitus ulcer infection] or pulmonary)
B: [Skin and Soft Tissue] in pt [allergic to PCN] or with [CA-MRSA]
C: Alternative therapy for [BV/ Malaria and Toxoplasmosis]
A: Common Adverse Effects of Clindamycin (2)
B: RARE ADVERSE EFFECTS OF CLINDAMYCIN (3)
A: Common Adverse Effects of Clindamycin
- NVD
- Dyspepsia
B: RARE ADVERSE EFFECTS OF CLINDAMYCIN
(x) [Neutropenia / thrombocytopenia]
(x) Hepatotoxicity
(x) [C.Diff INDUCTION]
A: Name the MACROLIDES (3)
A2: Which one is least efficient?
B1: MOA
B2:-Bacteriostatic vs. BacteriCIDAL?
C:
State whether each are [Concentration or Time-Dependent]
A: MACROLIDES “MACE”
- Azithromycin
- Clarithromycin
- Erythromycin = oldest/narrow spectrum/poor tolerability
B: MOA= *[REVERSIBLY Binds to 50s Ribosomal subunit —> Inhibits Protein Synthesis]*
B2:-[Normally Bacteriostatic]… UNLESS IN HIGH CONCENTRATIONS —> BACTERICIDAL
C:
1. Azithromycin = Concentration - Dependent
- Clarithromycin = TIME-DEPENDENT
- Erythromycin= TIME-DEPENDENT
A: Which [Mechanism of Resistance] offers the HIGHEST RESISTANCE to [Macrolides / Clindamycin / [Synercid Streptogramin] ]]?
B: Do Macrolides have any cross-resistance?
A: [ERm gene] alters [50s Ribosomal subunit] binding site
B: Cross-resistance occurs between ALL macrolides
MACROLIDES
A: [Gram POSITIVE Aerobe] (6)
B: Between the 3, rank most efficient to least efficient for [Gram POSITIVE Aerobes]
MACROLIDES
[Gram POSITIVE Aerobes]
“The CEA, Macrolides Cover Gram Positive Bacterial Virdans “
1. MSSA (Target)
- Cornyebacterium SPECIES
- Group Strep
- PssP
- Bacillus SPECIES
- Virdans Strep
B: Clarithro > Erythro > azithro
MACROLIDES
A: [Gram negative Aerobe] (2)
A2: What bacteria do MACROLIDES have NO activity against?
B: Between the 3, rank most efficient to least efficient for [Gram negative Aerobes]
MACROLIDES
A1: [Gram negative Aerobes]
- [Haemophilus Influenzae] – NOT ERYTHRO
- Neisseria SPECIES
A2: NO ACTIVITY AGAINST Enterobacteriaceae Family
B: AZITHRO > Clarithro > erythro “negative ACE”
MACROLIDES
A: AnAerobes
B: Atypical Bacteria: (3)
C: Which 2 Macrolides are used to treat [MAC in immunocompromised pts] ?
C2: Which of the two is for [MAC prophylaxis]?
MACROLIDES
A: AnAerobes = [upper airway AnAerobes]
B: Atypical Bacteria:
1) Legionella
2) Mycoplasma
3) Chlamydia SPECIES
**MAC (mycobacterium avium complex] in immunocompromised pt
C: Azithro and Clarithromycin
C2: Azithro for [MAC Prophylaxis]
MACROLIDES
A: CSF Penetration?
B:
- ______ is METABOLIZED BY CYP450 and excreted in _____. Why is this Macrolide a potential problem?
- What other Macrolide impedes the CYP450 system?
MACROLIDES
A: [ALL MACROLIDES HAVE Minimal CSF Penetration]
B:
1. Erythromycin is METABOLIZED BY CYP450 and excreted in Bile —> Potential Drug interactions
2: Clarithromycin INHIBITS CYP450
MACROLIDES CLINICAL USES: (5)
MACROLIDES CLINICAL USES:
- *Macrolide’s Clinical Uses Sound Real
1. MAC** (Azithro and Clarithromycin)
- [CA-PNA] (alone for outpatient) (with CefTriaxone for inpatient)
- [UNCOMPLICATED Skin infections]
- STD
- [Respiratory Tract infections] (especially in PCN allergic pt)
Which Alternative [Abx Class] is used for
- [Bacterial Endocarditis Prophylaxis]
- [Rheumatic Fever Prophylaxis]
- [Group A URI]
…in PCN Allergic Pts?
MACROLIDES
“MACE”
MACROLIDES
A: Common Adverse Effects (2)
B: RARE ADVERSE EFFECTS (4)
(x) Thrombophlebitis occurs with _____ or _____. How do you reconcile this?
(x) [_______ Hepatitis]
(x) _______ QTc (if baseline QTc is close to ____–>DO NOT USE MACROLIDE)
C: What DRUG is ABSOLUTELY CONTRAINDICATED with Macrolides?
MACROLIDES
” Crazy Dermatologist Try To Prescribe Nothing! “
A: Common Adverse Effects
- NVD
- Dyspepsia
B: RARE ADVERSE EFFECTS
(x) Thrombophlebitis (with IV Azithro or IV Erythro) : Tx= Dilute dose and slow administration
(x) [Cholestatic Hepatitis]
(x) Prolonged QTc (if baseline QTc is close to 500–>DO NOT USE MACROLIDE)
(x) [Transient reversible tinnitus]
C: COLCHICINE
“Crows always run away from COLEslaw!”
