Anti-Infectives 2 Flashcards by Claire watkins

What are the carbapenam examples?

Imipenem

Meropenem

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What does imipenem come with? What is the significance?

Cilastatin– decreases the nephrotoxicity but does not increase the spectrum of coverage

“guerillacillin”

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Spectrum of carbapenams?

Broad spectrum

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What is cilastatin?

Dihydropeptidase inhibitor

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Caution with what and carbapenams?

Cross-Sensitivity with PCN & cephalosporins

- Lowers seizure threshold (less likely with Meropenem)

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What class is Vancomycin?

Its owl

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What is the spectrum for vancomycin?

Gram positive

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Caution with Vancomycin?

Nephrotoxicity

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Why restricted use?

VERSA – and right now its our MRSA DOC so don’t want to build up resistance!

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Philicity of Vancomycin?

Hydrophilic, so limited to local action (good for C. Diff)

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What are the 3 macrolides??

Erythromycin
Clarithromycin
Azithromycin

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How do macrolides work?

Concentrate intracellularly

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Macrolide coverage?

Various gram positive and gram negative, plus atypicals

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What is an atypical bug? Examples?

Replicate intracellularly– legionella, mycobacterium, chlamydia

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Allergies with Macrolides?

Rare, usually only reports of GI upset

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What macrolide is best for H. flu?

Clarithromycin

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Side effect of clarithromycin?

Metallic taste, so take it with chocolate :)

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What is special with azithromycin?

Long half life, excellent tissue penetration

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How do you take a Z-PAK?

500 mg PO Day 1
250mg PO x 4 days

Gives you 3 weeks of therapeutic drug levels

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What should you give HIV patients?

CD4

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What does the pneumococcal vaccine cover?

Streptococcus pneumonias

Gram positive, most common CAP

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Tetracyclines coverage?

Gram negative
Gram positve
Weird bugs

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What are some weird bugs covered by tetracyclines?

Tick born diseases

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What are the tetracycline drugs?

Tetracycline
Doxycycline
Minocycline

Issue with tetracycline drugs?

High level of plasmid-mediated resistance

Avoid what with tetracycline drugs?

chelating agents-- MVI, antacid, milk, iron Space them 2 hours apart

Any cautions with tetracyclines?

Not in pregnant females or children under 8- binds calcium and streaks of yellow on teeth

What is side effect of tetracyclines?

photosensitivity

What is the issue with outdated tetracyclines?

Cause a fanconi-like syndrome (renal damage)

What is the most used tetracycline?

Doxycycline- most potent and well tolerated

What is DOC for Lyme disease?

Doxycycline

What is minocycline used for?

Anti-inflammatory Acne RA

What is the father of fluoroquinolones? What does it cover?

Ciprofloxacin Gram negative coverage, even Pseudomonas aeurogenosa PO! Bad Gram positive coverage

What is ciprofloxacin similar to?

Extended spectrum PCNs

What fluoroquinolones cover gram positive bugs?

Levofloxican Ofloxacin (they are isomers) Good for community acquired infections (strep pneumo)

How do fluoroquinolones work?

Bind to and inhibit DNA gyrase (similar to chemo!)

Norfloxacin concentrates where, and the significance of this?

Kidney only, so use to treat UTIs

Ofloxacin provides better Gram ___ coverage than ciprofloxacin but has limited ___ coverage.

Gram positive Pseudomonas aeuroginosa coverage

Avoid what 3 things with fluoroquinolone?

- chelating agents - pregnancy - children under 18

What is the a/e of fluoroquinolone?

Cartilage & soft tissue malformation Tendon ruptures! don't give to athletes

Cost of fluoroqinolones?

EXPENSIVE!

What is Bactrim?

Trimethoprim | Sulfamethoxazole

What does Bactrim interrupt?

PABA --> Folinic Acid Folinic acid is necessary to make DNA Works like Mehthotrexate

Bactrim coverage?

Gram positive, Gram negative NO COVERAGE of anaerobes or PA

Bactrim is similar to what drug class?

2nd generation cephalosporins | Macrolides (but they do atypical unlike Bactrim)

Bactrim is commonly used to treat what?

Uncomplicated UTIs

IV dosing of Bactrim is based on what?

Trimethoprim content

Bactrim and pregnancy?

C- do not use in kids under 2- kernicterus (mental retardation due to bilirubin displacement from SMX)

What is key about Bactrim?

Highly PPB, it displaces bilirubin

A/E of bilirubin?

Rash (watch for SJS) | Photosensitivity

What ABX for SJS propylaxis?

One that covers Staph & strep *** figure out answer

Metronidazole covers what? (3)

Anaerobic organisms Protozoas Trichomoniasis

What did metronidazole use to be DOC for?

C. diff

Best administration of metronidazole?

PO- excellent absorption

Avoid what with metronidazole??

ALL alcohol- it inhibits aldehyde dehydrogenase and causes accumulation of aceta aldehyde

What is the metronidazole and alcohol interaction called?

Disulfiram reaction- nausea/vomiting and flushing

What is the DOC for community acquired MRSA?

Bactrim -not as serious as nosocomial, just a skin/skin reaction

What are the 2 adverse effects of metronidazole?

metallic taste | brown urine discoloration

what was the original date rape drug?

cholorohydrate