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Pharmacotherapeutics > Antibiotics > Flashcards

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
Q

drug combo for beta-lactamases

ampicillin + sublactam

A

Unasyn

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26
Q

drug combo for beta-lactamases

pipercillin + tazobactam

A

Zosyn

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27
Q

t/f: drug combos with beta lactamase inhibitors are commonly used

A

true, broader spectrum

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28
Q

how are cephalosporins classified

A

by generation: 1-5
increasing generation =
- increasing activity against gram negative bacteria and anaerobes
- increased resistance to beta lactamases
- increased ability to cross BBB

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29
Q

What is the most widely used group of abx?

A

Cephalosporins – low toxicity

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30
Q

ceph SE

allergic reaction

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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31
Q

PCN SE

GI distress

A

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
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32
Q

ceph SE

tissue irritation

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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33
Q

ceph SE

GI distress

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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34
Q

ceph SE

photosensitivity

A 
no
✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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35
Q

ceph SE

rash

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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36
Q

ceph SE

hepatotoxicity

A

no

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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37
Q

ceph SE

nephrotoxicity

A

no

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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38
Q

ceph SE

ototoxicity

A

no

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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39
Q

ceph SE

photosensitivity

A

no

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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40
Q

ceph SE

superinfections

A

yes

✔︎ allergic reaction
✔︎ tissue irritation: pain at injection site
✔︎ rash
✔︎ GI distress
✔︎ secondary infections
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
✘ photosensitivity
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41
Q

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
A

rash

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42
Q

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
A
  • neurotoxicity with high blood levels
  • nerve dysfunction with nerve injection
  • gangrene/necrosis with arterial injection
  • hyperkalemia with Potassium PCN G
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43
Q

PCN G preparation with special consideration

A

Potassium PCN G: hyperkalemia risk

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44
Q

Cefotetan special considerations

A

✔︎ increased bleeding risk
✔︎ intolerance to alcohol
✘ eliminated by liver
✘ don’t mix with Lactated Ringers

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45
Q

ceftriaxone special considerations

A 
opposite of cefazolin
✔︎ increased bleeding risk
✘ intolerance to alcohol
✔︎ eliminated by liver
✔︎ don't mix with Lactated Ringers
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46
Q

cefazolin special considerations

A 
Opposite of ceftriaxone
✘ increased bleeding risk
✔︎ intolerance to alcohol
✘ eliminated by liver
✘ don't mix with Lactated Ringers
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47
Q

Increased bleeding risk?

cefotetan, ceftriaxone, cefazolin

A

✔︎ cefotetan
✔︎ ceftriaxone
✘ cefazolin

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48
Q

Intolerance to alcohol? cefotetan, ceftriaxone, cefazolin

A

✔︎ cefotetan
✘ ceftriaxone
✔︎ cefazolin

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49
Q

Don’t mix with Lactated Ringers? cefotetan, ceftriaxone, cefazolin

A

✘ cefotetan
✔︎ ceftriaxone
✘ cefazolin

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50
Q

Eliminated by liver?cefotetan, ceftriaxone, cefazolin

A

✘ cefotetan
✔︎ ceftriaxone
✘ cefazolin

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51
Q

Carbapenem prototype

A

Imipenum/Cliastatin: Primaxin

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52
Q

Why are imipenum/cilastatin together?

A

cilastatin prevents destruction of imipenem by renal enzymes

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53
Q

drug-drug interaction for carbapenem

A

valproate acid (seizure medication) – can cause lower levels of valproate acid and thus seizures

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54
Q

carbapenem AE

A

GI distress, allergy

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55
Q

Is vancomycin effective against gram + or gram -?

A

Gram positive

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56
Q

Is vancomycin used for serious or minor infections?

A

serious

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57
Q

Vancomycin can cause which toxicities?

A

Renal and otic

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58
Q

Vancomycin is used in which route, except which case?

A

IV except PO for c. diff

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59
Q

Vancomycin is the drug of choice for which important infections?

A

MRSA and sometimes c. diff PO (or flagyl)

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60
Q

tests for renal toxicity

A

BUN, creatinine, GFR

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61
Q

t/f: we monitor trough levels for vancomycin

A

True

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62
Q

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
A
  • red man syndrome

- thrombophlebitis (irritating to veins)

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63
Q

How to avoid red man syndrome

A

infuse SLOWLY over at least 60 minutes

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64
Q

screening for MRSA carriers

A

nasal swab with PCR

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65
Q

treatment for MRSA carriers

A

intranasal application of Bactroban or retapamulin

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66
Q

What do all these drugs have in common?

Tetracyclines, macrolides, aminoglycosides,

A

Inhibit protein synthesis

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67
Q 
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
A

yellow-brown discoloration of teeth (under 8 and or fetal passed through placenta)

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68
Q

tetracycline SE

GI distress

A

Yes, AND absorption decreased if given with food.

✔︎ GI distress
✔︎ secondary infections (c. diff)
✔︎ yellow-brown discoloration of teeth
✔︎ photosensitivity
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
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69
Q

tetracycline SE

Secondary infections

A

Yes

✔︎ GI distress
✔︎ secondary infections (c. diff)
✔︎ yellow-brown discoloration of teeth
✔︎ photosensitivity
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
70
Q

tetracycline SE

photosensitivities

A

Yes

✔︎ GI distress
✔︎ secondary infections (c. diff)
✔︎ yellow-brown discoloration of teeth
✔︎ photosensitivity
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
71
Q

tetracycline SE

organ toxicity

A

No

✔︎ GI distress
✔︎ secondary infections (c. diff)
✔︎ yellow-brown discoloration of teeth
✔︎ photosensitivity
✘ hepatotoxicity
✘ nephrotoxicity
✘ ototoxicity
72
Q

tetracycline SE

Which four minerals decrease tetracycline absorption by 50%?

A

calcium, iron, magnesium, aluminum

73
Q

tetracycline SE

t/f: Advise patients to use yogurt to avoid candidiasis with tetracyclines

A

false: calcium can bind to tetracyclines and inhibit absorption

74
Q

t/f: tetracyclines should be taken on an empty stomach

A

true. Can cause GI distress, but food impairs absorption

75
Q

t/f: tetracyclines are used for STIs

A

true: chlamydia, syphilis, gonorrhea

76
Q

macrolide mechanism of action

A

inhibition of protein synthesis

77
Q

vancomycin mechanism of action

A

disrupt cell wall synthesis

78
Q

penicillin mechanism of action

A

disrupt cell wall

79
Q

cephalosporin mechanism of action

A

disrupt cell wall

80
Q

carbapenem mechanism of action

A

disrupt cell wall

81
Q

tetracycline mechanism of action

A

inhibition of protein synthesis

82
Q

Drug class of erythromycin, clarithromycin, azithromycin

A

macrolides

83
Q 
Which of these are macrolides?
erythromycin
vancomycin
clarithromycin
azithromycin
karamycin
A

-[i/y]thromycin
erythromycin, clarithromycin, azithromycin
(and dirithromycin)

84
Q

-ithromycin ending

85
Q

why is a Z pack popular

A

3-4 days of dosing lasts in the body for over a week – compliance is easy

86
Q

erythromycin GI upset is different because…

A

it increases the motility of the GI tract – can be used with diabetic gastroparesis, passing feeding tubes

87
Q

macrolide SE

GI distress

A

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
Q

macrolide SE

drug-drug interactions

A

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
Q

Is erythromycin commonly used?

A

No, too many drug-drug interactions. Given continuously when used.

90
Q

macrolide SE

toxicity

A

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
Q

macrolide SE

tissue irritation

A

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
Q

macrolide SE

secondary infections

A

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
Q

macrolide SE

allergic reactions

A

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
Q

macrolide SE

nephrotoxicity

A

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
Q

macrolide SE

photosensitivity

A

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
Q

clindamycin mechanism of action

A

inhibition of protein synthesis

97
Q

biggest risk of clindamycin

A

c. diff. If pt has diarrhea, stop clindamycin and tx c. diff

98
Q

c. diff symptoms

A
  • profuse, watery diarrhea
  • abdominal cramping
  • fever
  • leukocytosis
99
Q

t/f: c. diff can be killed with hand sanitizer

A

false. Wash hands with soap and water.

100
Q

CDAD

A

c. diff-associated diarrhea

101
Q

precautions for c.diff

102
Q

this severe side effect can come from rapid clindamycin IV infusion

A

cardiac arrest

103
Q

aminoglycosides mechanism of action

A

inhibition of protein synthesis: creates abnormal proteins and are bacteriocidal

104
Q

routes of administration for aminoglycosides

105
Q

toxicities for aminoglycosides

A

ototoxicity, nephrotoxicity

106
Q

what do aminoglycocides and vancomycin have in common?

A
  • Big guns: bacteriocidal
  • needs trough levels
  • ototoxicity
  • nephrotoxicity
  • mycin/micin ending
107
Q

aminoglycoside-related headaches can warn of…

A

vestibular toxicity (balance issues)

108
Q

aminoglycosides have these two forms of ototoxicity

A

tinnitus, vestibular toxicity

109
Q

aminoglycocide SE

ototoxicity is [permanent/reversible] and nephrotoxicity is [permanent/reversible]

A

ototoxicity is permanent and nephrotoxicity is reversible

110
Q

sulfonamides mechanism of action

A

inhibition of folate synthesis

111
Q

Sulfonamide prototype

A

TMP/SMX (trimethoprim/sulfamethoxazole) ratio 1:5

aka: Bactrim, Cotrim, Septra, co-trimoxazole

112
Q

GI distress

A

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
Q

rash

A

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
Q

hemolytic anemia

A

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
Q

bone marrow suppression

A

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
Q

crystalluria

A

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
Q

photophobia

A

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
Q

CNS effects

A

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
Q

toxicity of the liver, kidneys, ears

A

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
Q

what do cephalosporins, penicillins, and sulfonamides have in common?

A

not toxic to ears/kidneys/liver, cause allergic reactions

121
Q

What is Stevens-Johnson Syndrome?

A

Severe, 25% fatal hypersensitivity reaction, including systemic rash with sloughing skin.

122
Q

G6PD mutation can cause which symptom with sulfa drugs

A

hemolytic anemia (more common in Middle Eastern and African populations)

123
Q

sulfa SE

patients with alcohol use disorder or who are pregnant are more susceptible to which side effect

A

bone marrow suppression

124
Q

sulfa SE

Pregnancy side effects

A

Kernicterus risk and birth defects

125
Q

When patients say they have a sulfur allergy, what do they typically mean?

A

Sulfonamide allergy

126
Q

drug-drug interactions: sulfonamides

A

warfarin, dilantin

127
Q

sulfa drugs and Potassium PCN G have which risk in common

A

hyperkalemia

And allergy

128
Q

fluroquinolones mechanism of action

A

disrupt DNA replication/cell division

129
Q

fluroquinolones suffix

130
Q

prototype for fluroquinolones

A

ciprofloxacin

131
Q

t/f: oral availability of cipro is less than IV availability

A

false. same

132
Q

what do cipro, vancomycin, and flagyl have in common?

A

must be infused over 1 hour

133
Q

what do flagyl, cefotetan, and cefozolin have in common? (or do they…)

A

antabuse reaction. Except research isn’t supporting this reaction to flagyl.

134
Q

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
A
  • tendon rupture
  • CNS in elderly
  • dysrhythmias if on anti-dysrhythmias
135
Q

fluroquinolone SE

GI upset

A

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
Q

fluroquinolone SE

CNS effects

A

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
Q

fluroquinolone SE

SE of concern for elderly

A

tendon rupture, CNS effects

138
Q

fluroquinolone SE

photosensitivity

A

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
Q

fluroquinolone SE

superinfections

A

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
Q

fluroquinolone SE

nephro/oto/hepatotoxicity

A

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
Q

fluroquinolone SE

Risk of tendon rupture related to COPD

A

COPD pts are often elderly and on steroids

142
Q

drug-food interactions in common between cipro and tetracycline?

A

Al, Mg, Iron, Ca

cipro: also zinc

143
Q

Unlike tetracycline, Al, Mg, Fe, Ca, Zn decrease cipro absorption by:

A

90% (and zinc is included)

144
Q

drug-drug interactions with cipro

A

sucralfate, theophylline, warfarin, tinidazole

145
Q

Metronidazole mechanism of action

A

(flagyl) inhibition of nucleic acid synthesis

146
Q

Flagyl mechanism of action

A

(metronidazole) inhibition of nucleic acid synthesis

147
Q

Flagyl is only active against [aerobic/anaerobic] bacteria

148
Q

drug of choice for c. diff

149
Q

flagyl SE

GI upset

A

Yes

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
150
Q

flagyl SE

secondary infections

A

Yes - candidiasis

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
151
Q

flagyl SE

dark reddish-brown urine

A

Yes

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
152
Q

flagyl SE

metallic taste

A

Yes

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
153
Q

flagyl SE

alcohol intolerance

A

Maybe???

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
154
Q

flagyl SE

nephro/oto/hepatotoxicity

A

No

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
155
Q

flagyl SE

allergy

A

No

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
156
Q

flagyl SE

tissue sensitivity

A

No

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
157
Q

flagyl SE

photosensitivity

A

No

✔︎ GI upset
✔︎ secondary infections
✔︎ dark reddish-brown urine
✔︎ metallic taste
❓ no alcohol - antabuse reaction
✘ nephro/oto/hepatotoxicity
✘ allergy
✘ photosensitivity
✘ tissue sensitivity
158
Q

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
A
  • reddish brown urine
  • metallic taste
  • maybe antabuse reaction
159
Q

would it be better to give vancomycin with cefatriaxone or gentamicin?

A

Cefatriaxone. Vancomycin is nephrotoxic, and cefatriaxone is excreted through the liver. Like vanc, gentamicin is also nephrotoxic.

160
Q

what do these drugs have in common

vancomycin, flagyl, gentamicin, cipro

A

big guns! bacteriocidal

161
Q

What do these drugs have in common?

vancomycin, gentamicin

A

big guns!, nephro/ototoxic, trough values

162
Q

what side effect do these drugs have in common?

penicillins, cephalosporins, sulfonamides

163
Q

what side effect do these drugs have in common?

tetracycline, tmp/smx, cipro

A

photosensitivity

164
Q

what side effect do these drugs have in common?

penicillin, tmp/smx, cipro

A

CNS effects

165
Q

what side effect do these drugs have in common?

cephalosporins, vancomycin, sulfa drugs

166
Q

What drug interaction do these have in common?

erythromycin, tmp/smx, cipro

167
Q

t/f: it would be appropriate to give an immunocompromised patient a bacteriostatic drug

A

false: bacteriostatic drugs rely on the host’s immune system to clean up the mess.

168
Q

Which drug would you choose for an anaerobic bacteria? cipro or flagyl

A

flagyl selects for anaerobic bacteria

169
Q

Which drug would you choose for MRSA? vancomycin or gentamicin

A

vancomycin

170
Q

Which drug would you use in combination with cilastatin? Imipenum or penicillin G

A

imipenum (Primaxin)

171
Q

Which drug would you use in combination with clavulanate? amoxicillin or meropenem

A

amoxicillin (Augmentin)

172
Q

Contraindicated population for these drugs: tmp/smx, tetracyclines

A

gestating parents

Pharmacotherapeutics (20 decks)

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