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NAPLEX Prep > Aminoglycosides, Quinolones, Macrolides, Tetracyclines & Sulfonamides > Flashcards

Aminoglycosides, Quinolones, Macrolides, Tetracyclines & Sulfonamides Flashcards

1
Q

Gentamicin

A

Aminoglycoside

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2
Q

Tobramycin

A

Aminoglycoside
IV,IM, ophthalmic, inhaled

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3
Q

Amikacin

A

Aminoglycoside
IV, IM

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4
Q

Aminoglycoside activity

A
  • gram negative bacteria, including pseudomonas (mostly tobramycin)
  • gentamycin & streptomycin are used for synergy w/ b lactams or vancomycin for gram positive infections
  • amikacin is second line for Mycobacterial infections
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5
Q

Aminoglycosides Boxed Warnings

A
  • Nephrotoxicity
  • Ototoxicity
  • Neuromuscular blockade
  • Avoid with other neurotoxic/nephrotoxic drugs
  • Do not use in pregnancy
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6
Q

Aminoglycoside warnings

A

caution in:
- impaired renal function
- elderly patients
- patients on nephrotoxic drugs (amphotericin B, cisplatin, polymyxins, cyclosporine, loop diuretics, NSAIDs, radiocontrast dye, tacrolimus, vancomycin)

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7
Q

Aminoglycoside ADE

A

Nephrotoxicity
Hearing loss
Impaired balance

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8
Q

Aminoglycoside monitoring

A

monitor drug level & renal function

Traditional dosing:
- trough immediately before 4th dose
- peak 1hr after 4th dose starts

Extended interval dosing:
- random level

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9
Q

Aminoglycoside: dosing weight considerations

A

if underweight ( < IBW), use TBW for dosing

normal bodyweight, can use TBW or IBW depending on institution

if obese, use AdjBW

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10
Q

Aminoglycosides traditional IV dosing

A

Gentamycin & Tobramycin:
1-2.5 mg/kg/dose

Renal adjustments:
- CrCl > 60 -> Q8H
- CrCl 40-60 -> Q12H
- CrCl 20-40 -> Q24H
- CrCl < 20 -> 1x dose then per levels

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11
Q

Aminoglycosides: Extended interval dosing

A

Lower risk of nephrotoxicity & decreased cost
Has not been shown to be clinically superior to traditional though

Gentamycin & Tobramycin:
- 4-7 mg/kg/dose
- Q24H if renal function is normal

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12
Q

Gentamycin traditional dosing target concentrations

A

gram positive infections (synergy)
- peak 3-4 mcg/mL
- trough < 1 mcg/mL

gram negative infections
- peak 5-10 mcg/mL
- trough < 2 mcg/mL

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13
Q

Tobramycin traditional dosing target concentrations

A

peak: 5-10 mcg/mL
trough: < 2 mcg/mL

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14
Q

Amikacin traditional dosing target concentrations

A

peak: 20-30 mcg/mL
trough: < 5 mcg/mL

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15
Q

Quinolone general activity

A

broad spectrum activity against gram positive, negative, & atypical bacteria

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16
Q

Respiratory quinolones

A

Levofloxacin & Moxifloxacin

Enhanced coverage of S. pneumoniae & atypicals

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17
Q

Quinolones with best gram negative activity (inc pseudomonas)

A

Ciprofloxacin & Levofloxacin

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18
Q

Quinolones:
________ has enhanced gram positive and anaerobe activity

A

Moxifloxacin

can be used alone for polymicrobial infections (ex. intra-abdominal)

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19
Q

The only quinolone without high rates of MRSA resistance is _______

A

Delafloxacin

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20
Q

Cipro

A

Ciprofloxacin
Quinolone

tablet, suspension, injection, ointment, ophthalmic, otic

suspension NOT G tube or feeding tube compatible

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21
Q

Levaquin

A

Levofloxacin
Quinolone

Tablet, solution, injection, ophthalmic

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22
Q

Avelox

A

Moxifloxacin
Quinolone

Tablet, injection, ophthalmic

no renal adjustments

does not concentrate in urine -> do not use for UTI

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23
Q

Quinolone Boxed Warnings

A
  • Tendon inflammation and/or rupture
  • peripheral neuropathy
  • CNS effects inc seizure -> caution in pts with CNS disorders or drugs that lower seizure threshold
  • avoid in pts with myasthenia gravis
24
Q

Ciprofloxacin contraindication

A

concurrent use with tizanidine

25
Quinolone warnings
- QT prolongation (M>L>C) - hypo & hyperglycemia - psychiatric disturbances - avoid quinolones in children and pregnancy/breastfeeding d/t musculoskeletal toxicity - photosensitivity
26
Quinolone DDI: Antacids & Cations
- antacids & cations can chelate and inhibit quinolone absorption -> separate admin
27
Quinolone DDI: Phosphate binders: Lanthanum, Sevelamer (Renvela, Renagel)
phosphate binders decrease serum concentration of quinolones separate quinolone admin by at least 2 hrs before & - 2 hrs after lanthanum - 6 hrs after sevelamer
28
Quinolone DDI: Warfarin
Quinolones increase the effects of warfarin
29
Quinolone DDI: Sulfonylureas, Insulin, & other hypoglycemic drugs
Quinolones inc hypoglycemic effects
30
Quinolone DDI: CV concern
caution with other QT prolonging drugs
31
Quinolone DDI: NSAIDs & Probenecid
increase quinolone levels
32
Quinolone DDI: Ciprofloxacin & Theophylline
cipro increases levels of theophylline
33
Levofloxacin IV:PO
1:1
34
Moxifloxacin IV:PO
1:1
35
Macrolide activity
good atypical coverage: - Legionella - Chlamydia - Mycoplasma and Mycobacterium avian complex azithromycin: better gram negative activity clarithromycin: better gram positive activity options for community acquired upper and lower respiratory infections & some STIs
36
Zithromax, Z-pak, Tri-pak
Azithromycin Macrolide tablet, suspension, injection, ophthalmic
37
Clarithromycin
Macrolide tablet, ER tablet, suspension
38
EES, Ery-Tab, Erythrocin
Erythromycin Macrolide capsule, tablet, suspension, injection, ophthalmic, topical
39
Macrolide CI
Clarithromycin & Erythromycin: do not use with simvastatin or lovastatin
40
Macrolide warnings
QT prolongation hepatotoxicity Clarithromycin: caution in pts with CAD (inc mortality)
41
Macrolide ADE
GI upset taste perversion ototoxicity (rare, reversible) SJS/TEN/DRESS (rare)
42
Z-Pak dosing
500mg day 1 250mg days 2-5
43
Tri-pak dosing
500mg daily x 3 days
44
Macrolide DDI
Clarithromycin & Erythromycin: strong CYP3A4 inhibitors -> CI w/ simva & lova, caution w/ warfarin All macrolides: caution with other QT prolonging drugs
45
Tetracycline activity
- Broad gram positive coverage (strep, staph, enterococcus) - Gram negative coverage inc resp flora (Moraxella, Haemophilus, atypicals)
46
Vibramycin
Doxycycline Class: Tetracyclines Cap, Tab, Suspension, Injection No renal adjustments broader indications than other tetracyclines: - CAP - tickborne/rickettsia diseases - spirochetes - STIs (chlamydia) - CA-MRSA skin infections
47
Minocin, Solodyn
Minocycline Class: Tetracyclines Cap, Tab, Injection
48
Tetracycline Warnings
- bone growth suppression & teeth discoloration (children < 8 years, pregnancy, & breastfeeding) - Photosensitivity - SJS/TEN/DRESS - Minocycline: DILE
49
Tetracyclines IV:PO ratio
1:1
50
Tetracyclines admin
take tablets and capsules with 8oz of water + doxycycline, sit upright for at least 30 min after dose (avoids esophageal irritation) avoid dairy products
51
Tetracyclines DDI
- antacids, sucralfate, bismuth subsalicylate and bile salts inhibit tetracycline absorption -> separate doses (tetracycline 1-2 hrs before or 4hrs after interacting drug) - Avoid dairy products 1 hr before or 2hrs after tetracycline
52
Sulfonamide activity
Staph (inc MRSA) Broad gram negative coverage - HPEK - Enterobacter - Shigella, Salmonella, Stenotrophomonas Opportunistic pathogens: - Pneumocystis - Toxoplasmosis Does not cover: - Pseudomonas - Enterococci - Atypicals - Anaerobes Unreliable strep coverage
53
Bactrim
Sulfamethoxazole/Trimethoprim Class: Sulfonamide Tablet, Suspension, Injection
54
Sulfonamide safety/ADE/monitoring
CI: sulfa allergy Warnings: - SJS/TEN, TTP - Hemolytic anemia (do not use with G6PD deficiency) ADE: - Photosensitivity - hyperkalemia - crystalluria (take with 8oz water)
55
SMX/TMP Single Strength (SS)
400mg SMX / 80mg TMP
56
SMX/TMP Double Strength (DS)
800mg SMX / 160mg TMP
57
Sulfonamide DDI
- significantly increased INR when used with warfarin - Inc risk of hyperkalemia with ACEs or ARBs

NAPLEX Prep (40 decks)

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