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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
Q

macrolide MOA

A

50S ribosomal inhibition

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26
Q

interactions with all macrolides

A

raise INR

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27
Q

erythromycin/clarithromycin interactions

A
  • potent inhibitor of 3A4

- do not use with other QTC-prolonging drugs

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28
Q

azithromycin interactions

A
  • do not use with other QTC-prolonging drugs
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29
Q

pharmacology of macrolides

A

hepatic excretion

bacteriostatic

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30
Q

potency of macrolide agents

A

clarithro > azithro > erythro

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31
Q

class effect ADR of macrolides

A

cardiac rhythm disturbance

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32
Q

erythromycin ADR

A
  • its products activate motilin receptors = uncoordinated peristalsis = *N/V/D
  • used as a prokinetic agent (off-label) in DM gastroparesis
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33
Q

Azithromycin microbial coverage

A
  • s. pyogenes
  • S. pneumo, H. influenzae, M. cat
  • chlamydia sp., legionella, mycoplasma, Bordetella pertussis
  • shigella, campylobacter
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34
Q

clarithromycin coverage/indications

A

same as azithromycin for coverage

but mostly for H. pylori in primary care

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35
Q

Azithromycin treatment indications

A
  • URTIs
  • *CAP
  • *NGU
  • *some “enteritis” (shigella in kids, campylobacter)
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36
Q

Macrolides are…

A

JUNK/DEAD & should rarely be used in primary care

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37
Q

when would you decide to use a macrolide

A
  • true b-lactam allergy + no other options
  • NGU
  • leginoalla & mycoplasma
  • H. pylori
  • cholera, shigella, campy infections
  • pertussis
38
Q

unique macrolide

A

fidaxomicin

39
Q

fidaxomicin MOA

A

inhibits RNA polymerase

40
Q

fidaxomicin pharmacology

A

bacteriocidal against Clostridia

41
Q

fidaxomicin ADRs

A
  • N/V
  • abdominal pain/GI hemorrhage
  • bone marrow suppression
42
Q

fidaxomicin indications

A

C. difficile

43
Q

lincosamides

A

clindamycin

44
Q

clindamycin MOA

A

inhibits 50S ribosome

45
Q

clindamycin pharmacology

A
  • hepatic excretion
  • bacteriostatic
  • minimal drug interactions
46
Q

clindamycin coverage

A
  • most anaerobes (above the diaphragm!)

- S. aureus, S. pyogenes, viridans strep in those with serious PCN allergies

47
Q

clindamycin treatment indications

A
  • 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
Q

oxazolidinones

A

linezolid

tedizolid

49
Q

oxazolidinones MOA

A

binds ribosomal 50S subunit

50
Q

oxazolidinones pharmacology

A

split excretion
bacteriostatic
high bioavailability
no dose adjustments

51
Q

oxazolidinones interactions

A
  • do not combine with levodopa (its an MAOI)

- concomitant serotonergic drugs –> serotonin syndrome (line>ted)

52
Q

oxazolidinones ADRs

A
  • *reversible thrombocytopenia (lin>ted)
  • *reversible inhibitor of monamine oxidase –> watch dietary tyramine (lin>ted)
  • *peripheral neuropathy
  • *“serotonin syndrome” (lin >ted)
53
Q

oxazolidinones treatment indications

A

MRSA/VRE infections (gold standard for oral MRSA coverage)

54
Q

aminoglycosides

A

gentamycin, tobramycin, amikacin

streptomycin, neomycin, kanamycin, paromomycin, spectinomycin, plazomicin

55
Q

aminoglycoside MOA

A

inhibits 30S ribosome

56
Q

aminoglycoside pharmacology

A

renal excretion
bactericidal
concentration-dependent killing

57
Q

aminoglycoside interaction

A

additive nephrotoxicity with other nephrotoxic drugs

58
Q

coverage of aminoglycoside

A

narrow - anaerobic GNB

59
Q

aminoglycoside ADRs

A
  • nephrotoxicity (reversible)

- ototoxicity; vestibular & cochlear (reversible?)

60
Q

gentamycin treatment indications

A

“severe infections” with GNB

synergistic w cell-wall agents for enterococci - used for endocarditis

61
Q

tobramycin treatment indications

A

GNB (pseudomonas) - severe infections

62
Q

pleuromutilins

A

lefamulin

63
Q

lefamulin MOA

A

binds to part of 50S subunit –> inhibits bacterial protein synthesis

64
Q

lefamulin pharmacology

A

hepatic excretion

bacteriostatic

65
Q

lefamulin ADRs

A

n/v

qt prolongation

66
Q

lefamulin microbial coverage

A
  • 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
Q

lefamulin treatment indications

A

CAP

68
Q

Fluroquinolones

A

ciprofloxacin
levofloxacin
moxifloxacin
delafloxacin

69
Q

non-respiratory FQs

A

ciprofloxacin

70
Q

respiratory FQs

A

levofloxacin

moxifloxacin

71
Q

anti-MRSA FQ

A

delafloxacin

72
Q

FQ MOA

A

inhibit bacterial DNA topoisomerases to prevent DNA replication

73
Q

FQ interactions

A

multivalent cations decrease absorption

74
Q

cipro, levo, moxi CYP interactions

A

not with other QT prolonging agents

may raise INR

75
Q

FQ pharmacology

A

split excretion
time & concentration dependent killing
bactericidal

76
Q

FQ ADRs

A
  • tendinopathy - BBB
  • arthropathy
  • *anaphylaxis & AIN
  • CNS toxicity (HA, anxiety, dizziness; peripheral neuropathy)
  • photosensitivity
  • QT prolongation
  • ** dysglycemia (one of the most important); hypoglycemia&raquo_space; hyper
  • hepatotoxicity
77
Q

who is FQ tendinopathy more common in

A

elderly and pts on steroids

78
Q

ciprofloxacin coverage

A

anaerobic GNB (pseudomonas)

79
Q

ciprofloxacin treatment indications

A

“diaphragm to pelvis”

  • upper & lower UTI
  • treatment of enteric infections/ traveler’s diarrhea
80
Q

levo & moxi coverage

A
  • higher activity for s. pneumo & “atypical” respiratory/genital pathogens
  • most aerobic GNB
81
Q

levo & moxi treatment indications

A
  • upper & lower UTI
  • URI/LRTI
  • enteric infections/traveler’s diarrhea
82
Q

delafloxacin treatment indications

A
  • SSTIs
83
Q

delafloxacin coverage

A
  • MRSA
  • drug-resistant gonorrhea
    +/- pseudomonal coverage
84
Q

when should you use FQ

A

when you are desparate

85
Q

what is cipro commonly used for and what should you use instead

A
  • commonly used for uncomplicated cystitis
  • *reserve for pyelo & prostatitis
  • use TMP-SMX, cephalexin, fosfomycin, nitrofurantoin for uncomplicated cystitis
86
Q

nitroimidazoles

A
  • metronidazole (flagyl)
  • tinidazole
  • secnidazole
87
Q

nitroimidazole MOA

A

interacts w DNA to cause loss of helical DNA structure & strand breakage = inhibition of protein synthesis

88
Q

nitroimidazole pharmacology

A

split excretion

bactericidal

89
Q

nitroimidazole ADRs

A
  • metallic taste

- disulfram-like rxn (avoid ETOH)

90
Q

metronidazole microbial coverage

A
  • most anaerobes (“below diaphragm”) + C. diff

- various protozoa (trichomonas, giardia, Entamoeba)

91
Q

metronidazole treatment indications

A
  • bacterial vaginosis
  • CDI
  • giardiasis & trichomoniasis
  • intrabdominal abscess (ruptured diverticulum)

Pharmacology PaxFlan (12 decks)

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