Anti-microbial drugs special considerations*** Flashcards
Which antimicrobial drug is assoc with hypersensitivity adn hemolytic anemia
Penicillin G, V
What is the primary cause of resistance of penicllin?
penicillinase in bacteria ( a type of beta-lactamase) cleaves beta-lactam ring
Which anti-microbial drug has its toxicity:
Hypersensitivity, rash, pseudomembranous colitis
Ampicillin, amoxicillin, (aminopenicllins, penicillinase-sensitive penicillins)
Which anti-microbial drug has its toxicity:
hypersensitivity rxn, and interstital nephritis
Dicloxacillin, Oxacillin, Nafcillin
penicillinase resistant-penicllinase)
Which anti-microbial has its toxicity:
hypersensitiivty rxn
Ticarcillin, piperacillin
(anti-pseudomonals)
Which anti-microbial drug has a toxicity:
- inc nephrotoxicity of aminoglycosides
- low cross reactivity with penicillins
- vit K def
- Hypersensitivity
cephalosporins (gen I, II, III, IV, V)
- 1st gen: cefazolin, cephalexin
- 2nd gen: cefoxitin, cefaclor, cefuroxime
- 3rd gen: ceftriaxone, cefotaxime, ceftazidime
- 4th gen: cefepime
- 5th gen: ceftaroline
What is aztreonam used for?
What is the toxicity of aztreonam?
- a monobactam, G- rods only (resistant to beta-lactamase)
- usually nontoxic, GI
which anti-microbial has toxicity:
GI distress, skin rash, CNS toxicity (seizures), at high plasma levels.
Carabpenems
What are carbapenems used for?
Wide spectrum, G+ cocci, G- rods and anaerobes
Imipenenem (class: carbapenems)
- What is its MOA
- What is it always admin w/_ _ (define moa) and why?
- broad spectrum beta-lactamase (resistant carbapenem)
-
Cilastatin
- MOA: inhibitor of renal dehydropeptidase I
- dec inactivation of drug in renal tubules
‘With imipenem, the killin’ is lastin’ with cilastatin’
Which anti-microbial drug is assoc w/ the following toxicity:
Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing
how do you deal with diffuse flushing (aka red man syndrome)
- Vancomycin
- pretreatment w/antihistamines adn slow infusion rate
What is the mechanism of resistance:
Vancomycin
- Occurs in bacteria via amino acid modification of D-ala D-ala to D-ala D-lac.
Pay back 2 D-alas (dollars) for vandalizing (vancomycin)
Whichi antimicrobial is assoc w/the following toxicity:
(Name class and give ex)
- Nephrotoxicity (especially when used with cephalosporins)
- Neuromuscular blockade
- Ototoxicity (especially when used with loop diuretics
- Teratogen
aminoglycosides
- Tobramycin
- Amikacin
- Neomycin
- Gentamycin
- Streptomycin
Which antimicrobial is assoc w/the following toxicity:
- Discoloration of teeth
- Contraindicated in pregnancy
- Photosensitivity
- Inhibition of bone growth in children
- GI distress
Tetracycline
DC PIG
- Tetracycline
- Doxycycline
- minocycline
Tetracyclines
mechanism of resistance is what?
- Dec uptake of inc efflux of bacterial cells by plasmid encoded transport pumps!!!
Which antimicrobial is assoc w/the following toxicity:
- Motility issues
- Arrhythmia caused by prolonged QT
- acute Cholestatic hepatitis
- Rash
- eOsinophilia
Macrolides
- Azithromycin
- Clarithromycin
- Erythromycin
Macrolides
- define the MOA
- define the MOR
- MOA
- inhibits protein synthesis
- by blocking translocation (macroslides)
- bind to the 23S rRNA of the 50S ribosomal subunit.
- Bacterostatic
- inhibits protein synthesis
- MOR
- methylation of 23S rRNA-binding site prevents binding of drug
Which antimicrobial is assoc w/ the following toxicity:
- Anemia (dose-dependent)
- aplastic anemia (dose-dependent)
- gray baby syndrome (define what it is)
- Chloramphenicol
- Gray baby syndrome: in premature infants b/c they lack liver UDP-glucoronyl transferase.
Which antimicrobial is assoc w/ the following toxicity:
- pseudomembrane colitis (C. difficle overgrowth)
- fever
- diarrhea
Clindamycin
Chloramphenicol
- define the MOA
- define the MOR
- MOA: blocks peptidyltransferase at 50 S ribosomal subunit
- MOR: plasmid encoded acetyltransferase inactivates the drug.
Which antimicrobial is assoc w/ the following toxicity:
- Hypersensitivity rxns
- Hemolysis of G6PD def
- Nephrotoxicity (tubulointerstitial nephritis)
- Photosensitivity
- Kernicterus in infants
- Displace other drugs from albumin (e.g. warfarin)
Sulfonamides
- SMX (sulfamethoxazole)
- Sulfisoxazole
- Sulfadiazine
Sulfonamides
- define the MOA
- define the MOR
-
MOA: inhibit folate syntehsts
- neg on Dihydropteroate synthase
- no PABA–> Dihydropteroic acid
- MOR: Altered enzyme (bacterial dihydropteroate synthase) dec uptake, or inc PABA synthesis.
Which antimicrobial is assoc w/ the following toxicity:
- Megalobasltic anemia
- leukopenia
- granulocytopenia (how may it be aleviated?)
- Trimethoprim
- supplemental folinic acid
Which antimicrobial is assoc w/ the following toxicity:
- GI stress, superinfections, skin rashes, headache, dizziness
- Less commonly, can cause tendonitis, tendon rupture, leg cramps, and myalgias
- Contraindicated in preganat women, nursing mothres, and children under 18 yo due to possible damage to cartilage.
- Some may cause prolonged QT interval
- May cause tendone rupture in people >60 yo and in patients taking prednisone.
Flurorquinolones
- oxacin and nalidixic acid (quinolone)
- Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, sparfloxacin, moxifloxacin, gemifloxacin, enoxacine
Fluoroquinolones
- Define the MOA
- Define the MOR
- MOA: Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV.
- Bactericidal
- must not be taken with antiacids
- MOR: Chromosome-encoded mutation in DNA gyrase, plasmid mediated resistance, efflux pumps
Which antimicrobial is assoc w/ the following toxicity:
- Disulfiram-like rx (**define it) **w/alcohol
- headache
- metallic taste
- Metronidazole
- Disulfiram-like rx (severe flushing, tachycardia, hypotension)
Which antimicrobial is assoc w/ the following toxicity:
Neurotoxicity, hepatotoxicity
what can be given to prevent neurotoxicity and other diseases?
- Isoniazid (INH)
- Pyridoxine (vit B6) can prevent neurotoxicity
- can prevent other diseases assoc with drug such as lupus.
Which antimicrobial is assoc w/ the following toxicity:
- Minor hepatotoxicity and drug interactions (p450)
- Orange body fluids (nonhazardous se)
Which drug is favored over with in pts w/HIV infection due to less cytochrome P-450 stimulation?
Rifamycins (Rifampin, Rifabutin)
- Rifabutin is favored over rifampin
Which antimicrobial is assoc w/ the following toxicity:
Hyperuricemia, hepatotoxicity
Pyrazinamide
Which antimicrobial is assoc w/ the following toxicity:
optic neuropathy (red-green color blindness)
Ethambutol
