Antibiotic Classes and Drugs Flashcards

Question

VIR

Answer 1

Vancomycin-infusion reaction Infusion related rxn w/ erythematous or urticarial rxn, flushing, tachycardia, and hypotension. From the release of histamine and is not an allergic reactions. Management: Stop infusion and wait for SE to subside. Restart are 1gm/hr and adjust rate as tolerated. May administer diphenhydramine prior to infusion

Answer 2

A lipoglycopeptide, similar to vanco, but only has a once daily dosing. BBW for pregnancy. Good for complicated SSTI, and nosocomial pneumonia IV only; adjust for renal dysfuntion More frequent ADR to Vanco; Nausea and taste changes. Redman syndrome; infuse overs 60 min, can cause nephrotoxicity, GI upset, metallic taste.

Answer 3

2nd gen lipoglycopeptides, IV only Approved for Tx of SSTI Oritavancin is a one time dose for SSTI Dalbavancin - ones weekly dosing

Answer 4

Works by inserting itself into the Cytoplasmic membrane leading to ION leakage and cell death! Coverage is similar to vancomycin, but covers VRE as well Use for SSTI, Bacteremia, endocarditis. Cannot be used in meningitis as it does not distribute into the CNS Cannot be used in pneumonia as surfactant destroys it. Adjust for Renal Dysfunction. ADR: Common injection site reaction, fever, chills, D/N/V Srs rhabdomyolysis. D/C immediately if muscle pain/cramps + elevation of CPK >5 times upper limit of normal.

Answer 5

Includes Tetracyclines, Linezolid, Macrolides, and Aminoglycosides.

Answer 6

Prevents the binding of tRNA to MRNA-ribosome complex, thus inhibiting protein synthesis Common ADRs include photosensitivity, sunburn, N/V Can cause tooth discoloration (enamel agenesis), Abn bone growth (do not use in pregnancy or in children <8y/o) Vestibular toxicity with minocycline - dizziness, ataxia, n/v which resolves 24-48 hours after d/c Must monitor for hepatic toxicity with high doses or long-term use.

Answer 7

Tetracycline PO, doxycycline IV/PO, minocycline PO GM+ S. pneumoniae, S. Pyogenes, CA -MRSA GM- E. Coli, Klebsiella, H. influenzae Atypical - Chlaymidia pneumoniae, Mycopalsma pneumoniae, Legionella pneumoniae, chlamydia, trachomatis, Borrelia burgdorferi (lyme) Commonly used for: Respiratory infections CA -MRSA, SSTI, acne Doxycucline - anthrax, chlamydia, lyme, CA-MRSA Want to separate from foods containing Al, Mg, Ca, Fe by 1-2 hours Mino can be taken with or without food Tertra should be taken on an empty stomach Doxycycline - must be taken with food due to GI intolerance, but decreases absorption by 20%

Answer 8

IV derivative of minocycline good for MDR GNR (not PA), B fragilis, Strep/Staph (MRSA too!) Enterococcus (some VRE) and Aypicals Commonly used in SSTI, I-ABd infections, CAPs ADR n/v anemia BBW risk of death; only use when all other therapies are unsuitable

Answer 9

Approved for CAP, SSTI with no known cases of c diff associated diarrhea in clinical trials No known CYP450 drug interactions IV and PO

Answer 10

Approved for complicated I-Abd infections less incidence of n/v than tigecycline Worse than levofloxacin for UTIs IV only

Answer 11

Important to be aware of QTc prolongation CYP450 drug interactions inhibits translocation of step of protein synthesis CYP450 interactions: inhibits cyp3A4: erythromycin> clarithromycin>azithromycin Some GI intolerance w/ n/v/d abd pain (25% with erythromycin) CV: QT prolongation risk (same order as above) Food interactions: Clarithromycin with or w/o food Azithromycin ER suspension and erythromycin: 1 hour before or 2 hours after a meal Fidaxomicin: with or w/o food

Answer 12

Important to be aware of QTc prolongation CYP450 drug interactions inhibits translocation of step of protein synthesis CYP450 interactions: inhibits cyp3A4: erythromycin> clarithromycin>azithromycin Some GI intolerance w/ n/v/d abd pain (25% with erythromycin) CV: QT prolongation risk (same order as above) Food interactions: Clarithromycin with or w/o food Azithromycin ER suspension and erythromycin: 1 hour before or 2 hours after a meal Fidaxomicin: with or w/o food

Answer 13

erythromycin IV/PO, Clarithromycin PO, Azithromycin IV/PO Gm+ Strep Gm_ H. influenzae, N. gonorrhea Atypical - Chlaymidia pneumoniae, Mycopalsma pneumoniae, Legionella pneumoniae, chlamydia, trachomatis Common uses: Alternative for PCN allergic Pts CAPs Pharyngitis SSTI Otitis media Azithromycin - urethritis, MAC, COPD exacerbation prevention (anti inflammatory) Erythromycin Tx post op ileus and improves GI Motility. Fidaxomicin PO is for C. Diff

Answer 14

Lincosamide - associated with C. Diff colitis ADRs: N/D, dyspepsia less commonly -hepatotoxicity, skin rashes Higher incidence of C. Diff associated D vs other ABX Food Considerations: Take with food due to GI Upset. Full glass of water to decrease Esophageal ulceration.

Answer 15

Clindamycin IV/PO Gm+ SA (MSSA/CA-MRASA) Strep, Peptostreptococcus. Anaerobes Clostridium (not diff), bacteroides, Prevotella, Fusobacterium. Common uses: SSTI (CA-MRSA), Strept, Anaerobic infections, aspiration pneumonia. Alternative Pcn allergic Patients with otitis media, dental prophylaxis Can be used for CA-MRSA, but resistances can develop rapidly.

Answer 16

Linezolid and tedizolid; good for MRSA IV or PO ADRs with prolonged Tx >2 weeks: myelosuppression --> thrombocytopenia peripheral or optic neuropathy (which can be partially reversible) less risk with tedizolid v linezolid Increased risk of serotonin syndrome: hyper-reflexia, hallucinations, myoclonus, tachycardia, shivering use with caution with Pts on SSRIs, TCAs, or MAOIs avoid tyramine-rich foods such as wine, cheese, processed meat less risk with tedizolid v linezolid Increased risk of hypertension Oral formulation shows 100% bioavailability

Answer 17

IV or PO Gm +: SA (all) Strep, enterococcus faecium Used for resistant infections such as MRSA or Vancomycin resistant E. Faecium Used for SSTI, Bone and joint infections, bacteremia, Pneumonia BID dosing.

Answer 18

Approved For Acute bacterial skin and skin structure infections only. Once daily dosing. IV or PO Gm +: SA (all) Strep, enterococcus faecium Used for resistant infections such as MRSA or Vancomycin resistant E. Faecium

Answer 19

Use high-dose extended interval dosing if the Pt has good renal function. Have risk of ototoxicity and nephrotoxicity - usually when >5 day durations. More common in the elderly or in patients with impaired renal function. Vestibular and auditory toxicity is irreversible Traditional Dosing: Gentamicin/Tobramycin (2mg/kg q8): Goal is to peak at 6-10mg/dl, trough <2mg/dl Amikacin(5mg/kg q8): goal is to peak at 25-30mg/dl, trough undetectable High Dosing, extended interval (5-7mg/kg q24) Considered more effective and less likely to induce resistance and has a lower risk of nephrotoxicity. -

Answer 20

Genamicin IV, Tobramycin IV, Amikacin IV Gm+ synergy against SA, Strep, Enterococcus. Gm- Enteric GNR, Pseudomonas Rarely used alon, even for Gram (-) infections Synergy with cell-wall active agents against gram + organisms as in endocarditis. UTI, Pneumonia, Meningitis

Answer 21

Include Sulfonamides, Fluoroquinolones, Metronidazole

Answer 22

Bactrim has retained excellent activity against most pathogens, including CA-MRSA Considered bacteriostatic; analogues of PABA Sulfa allergy to non-sulfonamide drugs has minimal cross reactivity Increases serum creatine when initiating; thus nephrotoxicity can occur Dosed on trimethoprim component, and adjusted for renal function N/V/D, photosensitivity, rash SJS/TENS Blood dyscrasias, aplastic Anemia, Granulocytopenia, thrombocytopenia, hemolytic anemia (in Pt with g6pd deficiency)

Answer 23

Bacrtim IV/PO, Sulfisoxazole, Sulfadiazine, Sulfasalazine Gm+ Staph, S. pneumoniae, Anthrax, Clostridium tetani Gm- E. colio, Proteus, H. influenzae Atypicals - Chlamydia trachomatis Common uses: UTI toxoplasmosis (combo with pyrimethamine. Considered 1st line for CA-MRSA, PJP Tx and prophylaxis, and URI

Answer 24

Increased use of these has been associated with MRSA Inhibit DNA gyrase and topoisomerase, preventing the uncoiling and De-catenation of copied DNA from its parent Absortion is reduced when administered concomitantly with divalent or trivalent cations (Mg, Ca, Al, Fe, Zinc) Avoid use with medications that prolong QT interval (cipro is least likely to cause issues, moxifloaxacin is the most likely) GI intolerance, h/a, rash, photosensitivity, hypo/hyperglycemia BBW = tendonitis or tendon rupture

Answer 25

Cirprofloxacin, ofloxacin, norfloxacin - 2nd gen Gm- Enterobacteriaceae, H. influenzae, M. catarrhalis, Neisseria, Pseudomonas (cipro only) Cipro and ofloxacin cover atypicals Common Uses: Norfloxacin is for uncomplicated UTIs Cipro and ofloxacin - Complicated and uncomplicated UTIs, Gastroenteritis, prostatitis, STDs, skin infections Cirpo - anthrax Overall Gm- activity Cipro> levo=gati=moxi>sparfloxacin

Answer 26

Levo, Moxi, Gatifloxacin(ophthalmic only) - 3rd and 4th gen Gm+ S. pnuemoniae Gm- Enterobacteriaceae, H. influenzae, M. catarrhalis, Neisseria, Pseudomonas (levo) Atypicals Similar indications to 2nd gen plus CAP and URIs

Answer 27

Delafloxacin - 5th gen Similar to levo but also covers MRSA SSTI infections only

Answer 28

Anaerobic workhorse - Steals Ions to become a toxic free radical that destroys DNA ADR - Peripheral neuropathy, GI intolerance, Dry mouth, metallic taste. DO NOT drink alcohol during and 48 hrs s/p d/c - gives hangover reactions, with flushing, tachycardia, n/v, sob