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Pharmacology PaxFlan > Anti-Ribosomal ABX > Flashcards

Anti-Ribosomal ABX Flashcards

1
Q

why would ID use macrolides & FQ

A
  • pt can’t tolerate B-lactams
  • killing for a specific microbe
  • specific pk/pd properties
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2
Q

azithromycin kills…

A

mycoplasma

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3
Q

ciprofloxacin kills…

A

salmonella

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4
Q

anti-ribosomal antibiotics

A
  • tetracyclines
  • macrolides
  • lincosamides
  • oxazolidinones
  • aminoglycosides
  • pleuromutilins
    (50S = MOP-L, 30S = GTA)
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5
Q

tetracyclines

A

tetracycline
minocycline
doxycycline

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6
Q

tetracycline MOA

A

30S ribosomal inhibition

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7
Q

can’t combine tetracyclines with…? and why

A

isotretinoin (acutane)

can = pseudotumor cerebri

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8
Q

multivalent cations + tetracycline

A

multivalent cations (Ca, Fe, Mg) may decrease absorption of tetracyclines

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9
Q

pharmacology of tetracycline

A

split excretion

bacteriostatic

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10
Q

what is the tetracycline “salt” that we use

A

generic doxycycline hyclate

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11
Q

tetracycline is slightly protective against

A

CDI

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12
Q

ADRs of tetracyclines

A
  • nausea, photosensitivity
  • contraindicated in pregnant women / children <8 y.o
  • hyperpigmentation
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13
Q

microbial coverage of TTC

A
  • s. pneumo, M. cat, H. influenza (CAP “typicals”)
  • chlamydiaphila, legionella, mycoplasma (CAP “atypicals”)
  • rickettsia, ehrlichia/anaplasma, B. burgdorferi
  • pasturella
  • S. aureus
  • chlamydia trachomatis
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14
Q

doxy treatment indications

A
  • URTI*
  • CAP
  • NGU
  • tick-borne diseases* (lyme, rickettsial, ehrlichiosis) (for cutaneous lyme manifestations)
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15
Q

minocycline treatment indications

A

mostly acne

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16
Q

1st gen synthetic tetracyclines

A

tigecycline

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17
Q

2nd gen synthetic tetracyclines

A

omadacycline

eravacycline

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18
Q

pharmacology of synthetic tetracyclines

A

split excretion

bacteriostatic

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19
Q

when should tigecycline be used and why

A

when there are no suitable alternative options d/t higher reported mortality

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20
Q

ADRs of synthetic tetracyclines

A
  • nausea, photosensitivity
  • do not use in pregnancy, children <8 y.o
  • fairly well tolerated
  • do not use in pts with hx of serious allergic rxn to TTC
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21
Q

synthetic TTC microbial coverage

A

broad spectrum - G+, G-, atypical, anaerobic pathogens

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22
Q

synthetic TTCs do not cover…

A

pseudomonas aeruginosa

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23
Q

synthetic TTC treatment indications

A

nosocomial infections (B-lactams still&raquo_space;)

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24
Q

Macrolides

A

erythromycin
azithromycin
clarithromycin

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25
macrolide MOA
50S ribosomal inhibition
26
interactions with all macrolides
raise INR
27
erythromycin/clarithromycin interactions
- potent inhibitor of 3A4 | - do not use with other QTC-prolonging drugs
28
azithromycin interactions
- do not use with other QTC-prolonging drugs
29
pharmacology of macrolides
hepatic excretion | bacteriostatic
30
potency of macrolide agents
clarithro > azithro > erythro
31
class effect ADR of macrolides
cardiac rhythm disturbance
32
erythromycin ADR
- its products activate motilin receptors = uncoordinated peristalsis = *N/V/D - used as a prokinetic agent (off-label) in DM gastroparesis
33
Azithromycin microbial coverage
- s. pyogenes - S. pneumo, H. influenzae, M. cat - chlamydia sp., legionella, mycoplasma, Bordetella pertussis - shigella, campylobacter
34
clarithromycin coverage/indications
same as azithromycin for coverage | but *mostly for H. pylori in primary care*
35
Azithromycin treatment indications
- URTIs - *CAP - *NGU - *some "enteritis" (shigella in kids, campylobacter)
36
Macrolides are...
JUNK/DEAD & should rarely be used in primary care
37
when would you decide to use a macrolide
- true b-lactam allergy + no other options - NGU - leginoalla & mycoplasma - H. pylori - cholera, shigella, campy infections - pertussis
38
unique macrolide
fidaxomicin
39
fidaxomicin MOA
inhibits RNA polymerase
40
fidaxomicin pharmacology
bacteriocidal against Clostridia
41
fidaxomicin ADRs
- N/V - abdominal pain/GI hemorrhage - bone marrow suppression
42
fidaxomicin indications
C. difficile
43
lincosamides
clindamycin
44
clindamycin MOA
inhibits 50S ribosome
45
clindamycin pharmacology
- hepatic excretion - bacteriostatic - minimal drug interactions
46
clindamycin coverage
- most anaerobes (*above the diaphragm!*) | - S. aureus, S. pyogenes, viridans strep in those with serious PCN allergies
47
clindamycin treatment indications
- SSTIs ("eagle effect" - whatever the heck that means @pax) in pts with serious b-lactam allergy - streptococcal pharyngitis in pts with serious b-lactam allergy - anaerobic infections/abscesses (+ b-lactam or FQ)
48
oxazolidinones
linezolid | tedizolid
49
oxazolidinones MOA
binds ribosomal 50S subunit
50
oxazolidinones pharmacology
split excretion bacteriostatic high bioavailability no dose adjustments
51
oxazolidinones interactions
- do not combine with levodopa (its an MAOI) | - concomitant serotonergic drugs --> serotonin syndrome (line>ted)
52
oxazolidinones ADRs
- *reversible thrombocytopenia (lin>ted) - *reversible inhibitor of monamine oxidase --> watch dietary tyramine (lin>ted) - *peripheral neuropathy - *"serotonin syndrome" (lin >ted)
53
oxazolidinones treatment indications
MRSA/VRE infections (gold standard for oral MRSA coverage)
54
aminoglycosides
*gentamycin, tobramycin, amikacin* | streptomycin, neomycin, kanamycin, paromomycin, spectinomycin, plazomicin
55
aminoglycoside MOA
inhibits 30S ribosome
56
aminoglycoside pharmacology
renal excretion bactericidal concentration-dependent killing
57
aminoglycoside interaction
additive nephrotoxicity with other nephrotoxic drugs
58
coverage of aminoglycoside
narrow - anaerobic GNB
59
aminoglycoside ADRs
- nephrotoxicity (reversible) | - ototoxicity; vestibular & cochlear (reversible?)
60
gentamycin treatment indications
"severe infections" with GNB | synergistic w cell-wall agents for enterococci - used for endocarditis
61
tobramycin treatment indications
GNB (pseudomonas) - severe infections
62
pleuromutilins
lefamulin
63
lefamulin MOA
binds to part of 50S subunit --> inhibits bacterial protein synthesis
64
lefamulin pharmacology
hepatic excretion | bacteriostatic
65
lefamulin ADRs
n/v | qt prolongation
66
lefamulin microbial coverage
- respiratory microbes: s. pneumo, h. influenzae, M. cat, M. pneumoniae, C. pneumoniae, legionella pneumophilia, MSSA/MRSA - STI microbes: C. trachomatis, m. genitalium, n. gonorrhoeae
67
lefamulin treatment indications
CAP
68
Fluroquinolones
ciprofloxacin levofloxacin moxifloxacin delafloxacin
69
non-respiratory FQs
ciprofloxacin
70
respiratory FQs
levofloxacin | moxifloxacin
71
anti-MRSA FQ
delafloxacin
72
FQ MOA
inhibit bacterial DNA topoisomerases to prevent DNA replication
73
FQ interactions
multivalent cations decrease absorption
74
cipro, levo, moxi CYP interactions
not with other QT prolonging agents | may raise INR
75
FQ pharmacology
split excretion time & concentration dependent killing bactericidal
76
FQ ADRs
- tendinopathy - BBB - arthropathy - *anaphylaxis & AIN - CNS toxicity (HA, anxiety, dizziness; peripheral neuropathy) - photosensitivity - QT prolongation - ** dysglycemia (one of the most important); hypoglycemia >> hyper - hepatotoxicity
77
who is FQ tendinopathy more common in
elderly and pts on steroids
78
ciprofloxacin coverage
anaerobic GNB (pseudomonas)
79
ciprofloxacin treatment indications
"diaphragm to pelvis" - upper & lower UTI - treatment of enteric infections/ traveler's diarrhea
80
levo & moxi coverage
- higher activity for s. pneumo & "atypical" respiratory/genital pathogens - most aerobic GNB
81
levo & moxi treatment indications
- upper & lower UTI - URI/LRTI - enteric infections/traveler's diarrhea
82
delafloxacin treatment indications
- SSTIs
83
delafloxacin coverage
- MRSA - drug-resistant gonorrhea +/- pseudomonal coverage
84
when should you use FQ
when you are desparate
85
what is cipro commonly used for and what should you use instead
- commonly used for uncomplicated cystitis - *reserve for pyelo & prostatitis - use TMP-SMX, cephalexin, fosfomycin, nitrofurantoin for uncomplicated cystitis
86
nitroimidazoles
- metronidazole (flagyl) - tinidazole - secnidazole
87
nitroimidazole MOA
interacts w DNA to cause loss of helical DNA structure & strand breakage = inhibition of protein synthesis
88
nitroimidazole pharmacology
split excretion | bactericidal
89
nitroimidazole ADRs
- metallic taste | - disulfram-like rxn (avoid ETOH)
90
metronidazole microbial coverage
- most anaerobes ("below diaphragm") + C. diff | - various protozoa (trichomonas, giardia, Entamoeba)
91
metronidazole treatment indications
- bacterial vaginosis - CDI - giardiasis & trichomoniasis - intrabdominal abscess (ruptured diverticulum)

Pharmacology PaxFlan (12 decks)

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