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Antibiotics Flashcards

1
Q

What do these drugs have in common?

penicillins, carbapenems, cephalasporins, vancomycin

A

they disrupt the cell wall, are bactericidal

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2
Q

When do drugs that weaken the cell wall work on the bacterial cells?

A

During cell growth and division

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3
Q

Why do drugs that weaken the cell wall not affect human cells?

A

human cells don’t have a cell wall

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4
Q

prototypical drug

penicillins

A

Penicillin G

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5
Q

How is Penicillin G administered?

A

Only given IM or IV. Some forms given as repositories.

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6
Q

repository

A

drug given as an injection but absorbed slowly over time, maintaining consistent and low levels

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7
Q

Penicillin lethal adverse effect

A

Allergy

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8
Q

Cross sensitivity with penicillin

A

cephalosporins

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9
Q

time frame of an allergic reaction

immediate

A

20-30 minutes

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10
Q

time frame of an allergic reaction

accelerated

A

1-72 hours

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11
Q

time frame of an allergic reaction

late

A

days to weeks

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12
Q

treatment for allergic reaction (anaphylactic)

A

epinephrine

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13
Q

can you give a patient with mild penicillin allergy cephalosporins?

A

Probably, PO. Avoided with a severe penicillin allergy.

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14
Q

can PCN skin test precipitate an allergic reaction?

A

yes, testing blood for IgG antibiodies is safer

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15
Q

Can patients be desensitized to PCN?

A

yes – small dose of penicillin every 60 minutes, with antihistamine support

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16
Q

Penicillin side effects

injection injuries

A

yes

✔︎ allergic reaction
✔︎ injection injury: pain at injection site, nerve injection, arterial injection (gangrene, necrosis)
✔︎ neurotoxicity
✔︎ Potassium PCN G: risk of hyperkalemia
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
✘ secondary infections
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17
Q

PCN side effects

oto/nephro/hepatotoxicity

A

no

✔︎ allergic reaction
✔︎ injection injury: pain at injection site, nerve injection, arterial injection (gangrene, necrosis)
✔︎ neurotoxicity
✔︎ Potassium PCN G: risk of hyperkalemia
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
✘ secondary infections
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18
Q

PCN side effects

hyperkalemia

A

yes

✔︎ allergic reaction
✔︎ injection injury: pain at injection site, nerve injection, arterial injection (gangrene, necrosis)
✔︎ neurotoxicity
✔︎ Potassium PCN G: risk of hyperkalemia
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
✘ secondary infections
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19
Q

PCN side effects

photosensitivity

A

no

✔︎ allergic reaction
✔︎ injection injury: pain at injection site, nerve injection, arterial injection (gangrene, necrosis)
✔︎ neurotoxicity
✔︎ Potassium PCN G: risk of hyperkalemia
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
✘ secondary infections
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20
Q

PCN side effects

allergic reaction

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ neurotoxicity
✔︎ Potassium PCN G: risk of hyperkalemia
✔︎ injury from injection site: nerve injection, arterial injection (gangrene, necrosis)
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
✘ secondary infections
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21
Q

beta lactamases

A

enzyme made by bacteria that breaks down the beta lactam ring present in all penicillins (PCN doesn’t work)

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22
Q

beta lactams

A

PCNs, cephalasporins, monobactams, carbapenems (not vancomycin)

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23
Q

drug combo for beta-lactamases

amoxicillin + clavulanate

A

augmentin

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24
Q

drug combo for beta-lactamases

ticarcillin+clavulanate

A

Timentin

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25
# drug combo for beta-lactamases ampicillin + sublactam
Unasyn
26
# drug combo for beta-lactamases pipercillin + tazobactam
Zosyn
27
t/f: drug combos with beta lactamase inhibitors are commonly used
true, broader spectrum
28
how are cephalosporins classified
by generation: 1-5 increasing generation = - increasing activity against gram negative bacteria and anaerobes - increased resistance to beta lactamases - increased ability to cross BBB
29
What is the most widely used group of abx?
Cephalosporins -- low toxicity
30
# ceph SE allergic reaction
yes ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
31
# PCN SE GI distress
no -- because always given parenterally ``` ✔︎ neurotoxicity ✔︎ Potassium PCN G: risk of hyperkalemia ✔︎ injury from injection site: nerve injection, arterial injection (gangrene, necrosis) ✘ GI distress ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ✘ secondary infections ```
32
# ceph SE tissue irritation
yes ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
33
# ceph SE GI distress
yes ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
34
# ceph SE photosensitivity
``` no ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
35
# ceph SE rash
yes ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
36
# ceph SE hepatotoxicity
no ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
37
# ceph SE nephrotoxicity
no ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
38
# ceph SE ototoxicity
no ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
39
# ceph SE photosensitivity
no ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
40
# ceph SE superinfections
yes ``` ✔︎ allergic reaction ✔︎ tissue irritation: pain at injection site ✔︎ rash ✔︎ GI distress ✔︎ secondary infections ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ✘ photosensitivity ```
41
# ceph SE ``` Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
rash
42
# PCN SE ``` Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
- neurotoxicity with high blood levels - nerve dysfunction with nerve injection - gangrene/necrosis with arterial injection - hyperkalemia with Potassium PCN G
43
PCN G preparation with special consideration
Potassium PCN G: hyperkalemia risk
44
Cefotetan special considerations
✔︎ increased bleeding risk ✔︎ intolerance to alcohol ✘ eliminated by liver ✘ don't mix with Lactated Ringers
45
ceftriaxone special considerations
``` opposite of cefazolin ✔︎ increased bleeding risk ✘ intolerance to alcohol ✔︎ eliminated by liver ✔︎ don't mix with Lactated Ringers ```
46
cefazolin special considerations
``` Opposite of ceftriaxone ✘ increased bleeding risk ✔︎ intolerance to alcohol ✘ eliminated by liver ✘ don't mix with Lactated Ringers ```
47
Increased bleeding risk? | cefotetan, ceftriaxone, cefazolin
✔︎ cefotetan ✔︎ ceftriaxone ✘ cefazolin
48
Intolerance to alcohol? cefotetan, ceftriaxone, cefazolin
✔︎ cefotetan ✘ ceftriaxone ✔︎ cefazolin
49
Don't mix with Lactated Ringers? cefotetan, ceftriaxone, cefazolin
✘ cefotetan ✔︎ ceftriaxone ✘ cefazolin
50
Eliminated by liver?cefotetan, ceftriaxone, cefazolin
✘ cefotetan ✔︎ ceftriaxone ✘ cefazolin
51
Carbapenem prototype
Imipenum/Cliastatin: Primaxin
52
Why are imipenum/cilastatin together?
cilastatin prevents destruction of imipenem by renal enzymes
53
drug-drug interaction for carbapenem
valproate acid (seizure medication) -- can cause lower levels of valproate acid and thus seizures
54
carbapenem AE
GI distress, allergy
55
Is vancomycin effective against gram + or gram -?
Gram positive
56
Is vancomycin used for serious or minor infections?
serious
57
Vancomycin can cause which toxicities?
Renal and otic
58
Vancomycin is used in which route, except which case?
IV except PO for c. diff
59
Vancomycin is the drug of choice for which important infections?
MRSA and sometimes c. diff PO (or flagyl)
60
tests for renal toxicity
BUN, creatinine, GFR
61
t/f: we monitor trough levels for vancomycin
True
62
# vancomycin SE ``` Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
- red man syndrome | - thrombophlebitis (irritating to veins)
63
How to avoid red man syndrome
infuse SLOWLY over at least 60 minutes
64
screening for MRSA carriers
nasal swab with PCR
65
treatment for MRSA carriers
intranasal application of Bactroban or retapamulin
66
What do all these drugs have in common? | Tetracyclines, macrolides, aminoglycosides,
Inhibit protein synthesis
67
``` Tetracycline Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
yellow-brown discoloration of teeth (under 8 and or fetal passed through placenta)
68
# tetracycline SE GI distress
Yes, AND absorption decreased if given with food. ``` ✔︎ GI distress ✔︎ secondary infections (c. diff) ✔︎ yellow-brown discoloration of teeth ✔︎ photosensitivity ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ```
69
# tetracycline SE Secondary infections
Yes ``` ✔︎ GI distress ✔︎ secondary infections (c. diff) ✔︎ yellow-brown discoloration of teeth ✔︎ photosensitivity ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ```
70
# tetracycline SE photosensitivities
Yes ``` ✔︎ GI distress ✔︎ secondary infections (c. diff) ✔︎ yellow-brown discoloration of teeth ✔︎ photosensitivity ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ```
71
# tetracycline SE organ toxicity
No ``` ✔︎ GI distress ✔︎ secondary infections (c. diff) ✔︎ yellow-brown discoloration of teeth ✔︎ photosensitivity ✘ hepatotoxicity ✘ nephrotoxicity ✘ ototoxicity ```
72
# tetracycline SE Which four minerals decrease tetracycline absorption by 50%?
calcium, iron, magnesium, aluminum
73
# tetracycline SE t/f: Advise patients to use yogurt to avoid candidiasis with tetracyclines
false: calcium can bind to tetracyclines and inhibit absorption
74
t/f: tetracyclines should be taken on an empty stomach
true. Can cause GI distress, but food impairs absorption
75
t/f: tetracyclines are used for STIs
true: chlamydia, syphilis, gonorrhea
76
macrolide mechanism of action
inhibition of protein synthesis
77
vancomycin mechanism of action
disrupt cell wall synthesis
78
penicillin mechanism of action
disrupt cell wall
79
cephalosporin mechanism of action
disrupt cell wall
80
carbapenem mechanism of action
disrupt cell wall
81
tetracycline mechanism of action
inhibition of protein synthesis
82
Drug class of erythromycin, clarithromycin, azithromycin
macrolides
83
``` Which of these are macrolides? erythromycin vancomycin clarithromycin azithromycin karamycin ```
-[i/y]thromycin erythromycin, clarithromycin, azithromycin (and dirithromycin)
84
-ithromycin ending
macrolide
85
why is a Z pack popular
3-4 days of dosing lasts in the body for over a week -- compliance is easy
86
erythromycin GI upset is different because...
it increases the motility of the GI tract -- can be used with diabetic gastroparesis, passing feeding tubes
87
# macrolide SE GI distress
yes - increases motility ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
88
# macrolide SE drug-drug interactions
yes Erithromycin - interacts with CYP 3A4 -- calcium channel blockers, antifungals, HIV protease inhibitors - toxic levels of theophilline, carbamazepine, warfarin ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
89
Is erythromycin commonly used?
No, too many drug-drug interactions. Given continuously when used.
90
# macrolide SE toxicity
yes: drug-drug for Erithromycin, and hepato- or oto-toxicity ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity
91
# macrolide SE tissue irritation
yes, thrombophlebitis ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
92
# macrolide SE secondary infections
yes, candidiasis and c. diff ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
93
# macrolide SE allergic reactions
no ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
94
# macrolide SE nephrotoxicity
no ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
95
# macrolide SE photosensitivity
no ``` ✔︎ GI distress: when given orally ✔︎ drug-drug interactions ✔︎ hepatotoxicity: pregnancy and cholestatic hepatitis ✔︎ ototoxicity: greater than 4 gm/day ✔︎ tissue irritation: thrombophlebitis when given IV ✔︎ secondary infections ✘ allergic reaction ✘ nephrotoxicity ✘ photosensitivity ```
96
clindamycin mechanism of action
inhibition of protein synthesis
97
biggest risk of clindamycin
c. diff. If pt has diarrhea, stop clindamycin and tx c. diff
98
c. diff symptoms
- profuse, watery diarrhea - abdominal cramping - fever - leukocytosis
99
t/f: c. diff can be killed with hand sanitizer
false. Wash hands with soap and water.
100
CDAD
c. diff-associated diarrhea
101
precautions for c.diff
contact
102
this severe side effect can come from rapid clindamycin IV infusion
cardiac arrest
103
aminoglycosides mechanism of action
inhibition of protein synthesis: creates abnormal proteins and are bacteriocidal
104
routes of administration for aminoglycosides
IV or IM
105
toxicities for aminoglycosides
ototoxicity, nephrotoxicity
106
what do aminoglycocides and vancomycin have in common?
- Big guns: bacteriocidal - needs trough levels - ototoxicity - nephrotoxicity - mycin/micin ending
107
aminoglycoside-related headaches can warn of...
vestibular toxicity (balance issues)
108
aminoglycosides have these two forms of ototoxicity
tinnitus, vestibular toxicity
109
# aminoglycocide SE ototoxicity is [permanent/reversible] and nephrotoxicity is [permanent/reversible]
ototoxicity is permanent and nephrotoxicity is reversible
110
sulfonamides mechanism of action
inhibition of folate synthesis
111
Sulfonamide prototype
TMP/SMX (trimethoprim/sulfamethoxazole) ratio 1:5 aka: Bactrim, Cotrim, Septra, co-trimoxazole
112
GI distress
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
113
rash
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
114
hemolytic anemia
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
115
bone marrow suppression
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
116
crystalluria
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
117
photophobia
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
118
CNS effects
yes ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
119
toxicity of the liver, kidneys, ears
no ``` ✔︎ GI distress: n/v ✔︎ rash ✔︎ blood dyscrasias: hemolytic anemia and bone marrow suppression ✔︎ crystalluria (increase hydration ✔︎ photophobia ✔︎ CNS effects ✔︎ secondary infections ✔︎ allergic reaction ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ```
120
what do cephalosporins, penicillins, and sulfonamides have in common?
not toxic to ears/kidneys/liver, cause allergic reactions
121
What is Stevens-Johnson Syndrome?
Severe, 25% fatal hypersensitivity reaction, including systemic rash with sloughing skin.
122
G6PD mutation can cause which symptom with sulfa drugs
hemolytic anemia (more common in Middle Eastern and African populations)
123
# sulfa SE patients with alcohol use disorder or who are pregnant are more susceptible to which side effect
bone marrow suppression
124
# sulfa SE Pregnancy side effects
Kernicterus risk and birth defects
125
When patients say they have a sulfur allergy, what do they typically mean?
Sulfonamide allergy
126
drug-drug interactions: sulfonamides
warfarin, dilantin
127
sulfa drugs and Potassium PCN G have which risk in common
hyperkalemia | And allergy
128
fluroquinolones mechanism of action
disrupt DNA replication/cell division
129
fluroquinolones suffix
oxacin
130
prototype for fluroquinolones
ciprofloxacin
131
t/f: oral availability of cipro is less than IV availability
false. same
132
what do cipro, vancomycin, and flagyl have in common?
must be infused over 1 hour
133
what do flagyl, cefotetan, and cefozolin have in common? (or do they...)
antabuse reaction. Except research isn't supporting this reaction to flagyl.
134
# fluroquinolone SE ``` Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
- tendon rupture - CNS in elderly - dysrhythmias if on anti-dysrhythmias
135
# fluroquinolone SE GI upset
yes ``` ✔︎ GI upset ✔︎ CNS effects (elderly) ✔︎ tendon rupture -- elderly, steroid use, kids under 18 ✔︎ photosensitivity ✔︎ dysrhythmias if on anti-dysrhythmic ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ✘ allergy ```
136
# fluroquinolone SE CNS effects
yes (elderly) ``` ✔︎ GI upset ✔︎ CNS effects (elderly) ✔︎ tendon rupture -- elderly, steroid use, kids under 18 ✔︎ photosensitivity ✔︎ dysrhythmias if on anti-dysrhythmic ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ✘ allergy ```
137
# fluroquinolone SE SE of concern for elderly
tendon rupture, CNS effects
138
# fluroquinolone SE photosensitivity
yes ``` ✔︎ GI upset ✔︎ CNS effects (elderly) ✔︎ tendon rupture -- elderly, steroid use, kids under 18 ✔︎ photosensitivity ✔︎ dysrhythmias if on anti-dysrhythmic ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ✘ allergy ```
139
# fluroquinolone SE superinfections
yes ``` ✔︎ GI upset ✔︎ CNS effects (elderly) ✔︎ tendon rupture -- elderly, steroid use, kids under 18 ✔︎ photosensitivity ✔︎ dysrhythmias if on anti-dysrhythmic ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ✘ allergy ```
140
# fluroquinolone SE nephro/oto/hepatotoxicity
no ``` ✔︎ GI upset ✔︎ CNS effects (elderly) ✔︎ tendon rupture -- elderly, steroid use, kids under 18 ✔︎ photosensitivity ✔︎ dysrhythmias if on anti-dysrhythmic ✔︎ secondary infections ✘ nephro/oto/hepatotoxicity ✘ allergy ```
141
# fluroquinolone SE Risk of tendon rupture related to COPD
COPD pts are often elderly and on steroids
142
drug-food interactions in common between cipro and tetracycline?
Al, Mg, Iron, Ca | cipro: also zinc
143
Unlike tetracycline, Al, Mg, Fe, Ca, Zn decrease cipro absorption by:
90% (and zinc is included)
144
drug-drug interactions with cipro
sucralfate, theophylline, warfarin, tinidazole
145
Metronidazole mechanism of action
(flagyl) inhibition of nucleic acid synthesis
146
Flagyl mechanism of action
(metronidazole) inhibition of nucleic acid synthesis
147
Flagyl is only active against [aerobic/anaerobic] bacteria
anaerobic
148
drug of choice for c. diff
flagyl
149
# flagyl SE GI upset
Yes ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
150
# flagyl SE secondary infections
Yes - candidiasis ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
151
# flagyl SE dark reddish-brown urine
Yes ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
152
# flagyl SE metallic taste
Yes ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
153
# flagyl SE alcohol intolerance
Maybe??? ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
154
# flagyl SE nephro/oto/hepatotoxicity
No ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
155
# flagyl SE allergy
No ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
156
# flagyl SE tissue sensitivity
No ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
157
# flagyl SE photosensitivity
No ``` ✔︎ GI upset ✔︎ secondary infections ✔︎ dark reddish-brown urine ✔︎ metallic taste ❓ no alcohol - antabuse reaction ✘ nephro/oto/hepatotoxicity ✘ allergy ✘ photosensitivity ✘ tissue sensitivity ```
158
# flagyl SE ``` Side effects/toxicities BEYOND most common for all abx --- Most common SE for all abx: - GI distress - allergy - secondary infection - tissue irritation - toxicity: nephro, hepato, oto - photosensitivity ```
- reddish brown urine - metallic taste - maybe antabuse reaction
159
would it be better to give vancomycin with cefatriaxone or gentamicin?
Cefatriaxone. Vancomycin is nephrotoxic, and cefatriaxone is excreted through the liver. Like vanc, gentamicin is also nephrotoxic.
160
# what do these drugs have in common vancomycin, flagyl, gentamicin, cipro
big guns! bacteriocidal
161
# What do these drugs have in common? vancomycin, gentamicin
big guns!, nephro/ototoxic, trough values
162
# what side effect do these drugs have in common? penicillins, cephalosporins, sulfonamides
allergy
163
# what side effect do these drugs have in common? tetracycline, tmp/smx, cipro
photosensitivity
164
# what side effect do these drugs have in common? penicillin, tmp/smx, cipro
CNS effects
165
# what side effect do these drugs have in common? cephalosporins, vancomycin, sulfa drugs
rash
166
# What drug interaction do these have in common? erythromycin, tmp/smx, cipro
warfarin
167
t/f: it would be appropriate to give an immunocompromised patient a bacteriostatic drug
false: bacteriostatic drugs rely on the host's immune system to clean up the mess.
168
Which drug would you choose for an anaerobic bacteria? cipro or flagyl
flagyl selects for anaerobic bacteria
169
Which drug would you choose for MRSA? vancomycin or gentamicin
vancomycin
170
Which drug would you use in combination with cilastatin? Imipenum or penicillin G
imipenum (Primaxin)
171
Which drug would you use in combination with clavulanate? amoxicillin or meropenem
amoxicillin (Augmentin)
172
Contraindicated population for these drugs: tmp/smx, tetracyclines
gestating parents

Pharmacotherapeutics (20 decks)

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