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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
Q

Quinolone warnings

A
  • QT prolongation (M>L>C)
  • hypo & hyperglycemia
  • psychiatric disturbances
  • avoid quinolones in children and pregnancy/breastfeeding d/t musculoskeletal toxicity
  • photosensitivity
26
Q

Quinolone DDI: Antacids & Cations

A
  • antacids & cations can chelate and inhibit quinolone absorption -> separate admin
27
Q

Quinolone DDI:
Phosphate binders: Lanthanum, Sevelamer (Renvela, Renagel)

A

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
Q

Quinolone DDI:
Warfarin

A

Quinolones increase the effects of warfarin

29
Q

Quinolone DDI:
Sulfonylureas, Insulin, & other hypoglycemic drugs

A

Quinolones inc hypoglycemic effects

30
Q

Quinolone DDI:
CV concern

A

caution with other QT prolonging drugs

31
Q

Quinolone DDI:
NSAIDs & Probenecid

A

increase quinolone levels

32
Q

Quinolone DDI:
Ciprofloxacin & Theophylline

A

cipro increases levels of theophylline

33
Q

Levofloxacin IV:PO

A

1:1

34
Q

Moxifloxacin IV:PO

A

1:1

35
Q

Macrolide activity

A

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
Q

Zithromax, Z-pak, Tri-pak

A

Azithromycin
Macrolide
tablet, suspension, injection, ophthalmic

37
Q

Clarithromycin

A

Macrolide
tablet, ER tablet, suspension

38
Q

EES, Ery-Tab, Erythrocin

A

Erythromycin
Macrolide
capsule, tablet, suspension, injection, ophthalmic, topical

39
Q

Macrolide CI

A

Clarithromycin & Erythromycin: do not use with simvastatin or lovastatin

40
Q

Macrolide warnings

A

QT prolongation
hepatotoxicity
Clarithromycin: caution in pts with CAD (inc mortality)

41
Q

Macrolide ADE

A

GI upset
taste perversion
ototoxicity (rare, reversible)
SJS/TEN/DRESS (rare)

42
Q

Z-Pak dosing

A

500mg day 1
250mg days 2-5

43
Q

Tri-pak dosing

A

500mg daily x 3 days

44
Q

Macrolide DDI

A

Clarithromycin & Erythromycin: strong CYP3A4 inhibitors -> CI w/ simva & lova, caution w/ warfarin

All macrolides: caution with other QT prolonging drugs

45
Q

Tetracycline activity

A
  • Broad gram positive coverage (strep, staph, enterococcus)
  • Gram negative coverage inc resp flora (Moraxella, Haemophilus, atypicals)
46
Q

Vibramycin

A

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
Q

Minocin, Solodyn

A

Minocycline
Class: Tetracyclines
Cap, Tab, Injection

48
Q

Tetracycline Warnings

A
  • bone growth suppression & teeth discoloration (children < 8 years, pregnancy, & breastfeeding)
  • Photosensitivity
  • SJS/TEN/DRESS
  • Minocycline: DILE
49
Q

Tetracyclines IV:PO ratio

A

1:1

50
Q

Tetracyclines admin

A

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
Q

Tetracyclines DDI

A
  • 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
Q

Sulfonamide activity

A

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
Q

Bactrim

A

Sulfamethoxazole/Trimethoprim
Class: Sulfonamide
Tablet, Suspension, Injection

54
Q

Sulfonamide safety/ADE/monitoring

A

CI: sulfa allergy
Warnings:
- SJS/TEN, TTP
- Hemolytic anemia (do not use with G6PD deficiency)
ADE:
- Photosensitivity
- hyperkalemia
- crystalluria (take with 8oz water)

55
Q

SMX/TMP Single Strength (SS)

A

400mg SMX / 80mg TMP

56
Q

SMX/TMP Double Strength (DS)

A

800mg SMX / 160mg TMP

57
Q

Sulfonamide DDI

A
  • significantly increased INR when used with warfarin
  • Inc risk of hyperkalemia with ACEs or ARBs

NAPLEX Prep (40 decks)

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