Antibiotics Flashcards
Antibiotics that TREAT Gram -
FQs (CIPRO)
Antibiotics that TREAT Gram +
Macrolides
Clindamycin
Antibiotics that TREAT BOTH Gram -/+
PCN
Cephalosporins
Sulfa
Beta-lactam inhibitors
FQs
Tetracycline
LOCATION: Heart
strep (GM +)
s.epi (GM +)
LOCATION: Abdominal
e coli (GM-)
enterococcus (GM +)
anaerobes
GM -
LOCATION: Brain
strep (GM +)
staph (GM +)
N. meningitides
e coli (GM -)
LOCATION: Respiratory
strep (GM +)
moraxella
H. flu
mycoplasma
LOCATION: Skin
staph (GM +)
strep (GM +)
LOCATION: GU
e coli (GM -)
enterococcus (GM +)
PCN MOA (-cillins)
inhibit CELL WALL SYNTHESIS
PCN Pharmacokinetic Profile
SE: Allergic RXN, Diarrhea, GI upset, Bacterial overgrowth w/ prolonged repeated treatment
Interactions: BIRTH CONTROL
Med Admin: RENAL function, 10-14 days treatment
Education: SAFE PREGNANCY, EMPTY STOMACH
Beta-Lactam/Beta-Lactam Inhibitors MOA
Inhibit CELL WALL synthesis
Beta-Lactam inhibitor Pharmacokinetic profile
SE: GI EFFECTS N/V/D
Contraindications: PCN allergy
Education: EXPENSIVE
Cephalosporins MOA
inhibit CELL WALL SYNTHESIS
Cephalosporins Pharmacokinetic profile
SE: GI (Diarrhea, C diff); Allergy (skin rash)
RISK of pseudomembranous colitis
Hypersensitivity = PCN allergy
Med administration: RENAL function w/ high doses; watch RBC, BUN, UA w/ prolonged treatment
Education: mostly PO, IM dose painful; well absorbed in GI; SAFE PREGNANCY; take w/ food
Fluoroquinolones MOA (-oxacins)
Ciprofloxacin, Gatifloxacin, Levofloxacin
inhibit NUCLEIC ACID synthesis
Fluoroquinolones Pharmacokinetic profile (-oxacins)
SE: QT prolongation, dizziness
Contraindications: NO PREGNANCY; AVOID peds/older adults = tendon rupture; AVOID Peds = interfere w/ growth plates
Interactions: NO milk, antacids, calcium, magnesium, iron, zinc
Med admin: DEC RENAL function will influence half life
Education: EMPTY STOMACH
Tetracyclines MOA (-cyclines)
inhibit PROTEIN SYNTHESIS
Tetracyclines Pharmacokinetic profile
Bacteriostatic = severe acne, Lyme disease, Rocky Mtn spotted fever
Contraindications: NO PREGNANCY; Caution w/ RENAL impairment
Interactions: NO antacids, dairy, calcium, iron, anticoagulants, digoxin, insulin, lithium, birth control, PCN
Education: Binds w/ calcium & developing teeth
Sulfonamides MOA (sulfa) (TMP-SMX)
Bactrim, Septra
Inhibit METABOLIC PATHWAYS
Sulfonamides Pharmacokinetic profile
SE: GI UPSET/Allergic Rxn = 1st degree sx; SJS; photosensitivity
NO PREGNANCY
Interactions: warfarin INC INR, phenytoin, sulfa drugs
Education: DRINK 1L daily (avoid crystallization), AVOID SUN
Clindamycin Class
Lincosamides
Clindamycin MOA
Inhibit PROTEIN SYNTHESIS
Clindamycin Pharmacokinetic Profile
Alternative agent for MRSA
TX: Mouth, Skin, Vagina
SE: GI upset, metallic taste; DIARRHEA
Med admin: MONITOR LIVER & KIDNEY
SAFE PREGNANCY
Education: LARGE glass of water, good for skin/bone
Metronidazole MOA
Flagyl
Disrupts DNA & PROTEIN SYNTHESIS
Metronidazole Pharmacokinetic Profile
SE: GI, HA, Dizziness, dry mouth, fatigue, metallic bitter taste
Contraindications: NO blood dycrasias, seizure d/o, neurological issues
NO ETOH
Interactions: cimetidine, phenobarbital, phenytoin
Med admin: topical form (local irritation)
SAFE PREGNANCY
TAKE W/ FOOD
Nitrofurantoin DOC
Macrodantin
Nitrofurantoin MOA
protein synthesis, aerobic energy metabolism, DNA synthesis, RNA synthesis, and cell wall synthesis are inhibited
Nitrofurantoin Efficacy
BacterioCIDAL = HIGH con
BacterioSTATIC = LOW con
Nitrofurantoin Pharmacokinetic profile
SE: GI, SJS, HA, dizziness, may change urine color
NO ANTACIDS
DOC in PREGNANCY
Must complete 7 days of treatment
Antimycobacterials MOA
inhibition of the cell wall synthesis
Antimycobacterials Pharmacokinetic profile
Used to tx TB
Antivirals classes
Nucleoside analogues
Influenza
Antivirals (nucleoside analogues) MOA
Acyclovir, famciclovir, valacyclovir
Inhibit VIRAL CELL DNA SYNTHESIS
Antivirals (nucleoside analogues) Pharmacokinetic profile
SE: HA, N/V/D, skin rash
INC risk of serious adverse effects in IMMUNOCOMPROMISED individuals
Interactions: FEW (probenecid, cimetidine, theophylline, digoxin)
Med admin: RENAL impairment = dosage change, START at earliest sign infection; PATIENT SELF INITIATE TX
SAFE PREGNANCY; SAFE CHILDREN OVER AGE 2
TAKEN W/FULL GLASS WATER
Antivirals (influenza) MOA
Inhibit VIRAL CELL DNA SYNTHESIS
Antivirals (influenza) Pharmacokinetic profile
Amantadine/Rimantadine (DEATH OVERDOSE) vs Zanamivir/Oseltamivir (MORE FREQUENT)
TX influenza
med admin: must be taken within 2 days of exposure or onset of sx
Systemic Antifungals (-azoles) MOA
inhibit biosynthesis of ergosterol by interfering w/ the cytochrome P450
Systemic Antifungals Pharmacokinetic profile
AZOLES
long term therapy = pulse dosing
many drug interactions
Anti-fungal KETOCONAZOLE
Brand: Nizoral
Systemic - candidiasis, blastomycosis, histoplasmosis, dermatophytoses
BOX WARNING: hepatotoxicity, NEED LFTs before and during tx
DEC oral contraceptive effectiveness
monitor drug interactions
ADEs = pruritis and GI for oral, take with food
Pruritis, burning, drying, rash, hair loss with topical
separate oral from antacids
Anti-fungal
FLUCONAZOLE
Brand: Diflucan (PO, IV)
NO PREGNANCY
Candidiasis- vaginal, oropharyngeal, esophageal, urinary, systemic
**CAUTION renal/hepatic impairment
multiple drug interactions - CYP450
Drugs that INC gastric pH will DEC absorption
Rifampin, histamine 2 blockers, warfarin
Terbinafine, ETOH = liver toxicity
ADEs = GI
Anti-fungal
ITRACONAZOLE
Brand: Sporanox (capsules)
dermatophytoses, fungal keratitis, onchomycosis
oral and esophageal candidiasis
NO PREGNANCY
BOX WARNING: cardiovascular effects, no patients w/ LVD and HF
NO active liver disease
CHECK LFTs
ADEs = GI, edema, HA, HTN, abnormal LFT
NO grapefruit juice
Anti-fungal
TERBINAFINE
Brand: Lamisil
NO PREGNANCY
onychomycosis of nails
tineas - pedis, cruris, corporis, versicolor
RARE = SJS, liver failure, SLE exacerbation
PO NOT for liver/renal impairment
oral ADEs = HA, fever, rash, GI
Topical - burning, dryness, exfoliation, irritation
HYGIENE IMPORTANT
Blepharitis TREATMENT
warm compresses for 5-10 minutes 3-4x day
apply ERYTHROMYCIN OPHTHALMIC OINTMENT until sx clear + 7 more days
Ointment is preferred treatment d/t increased contact w/ ocular tissue
Azithromycin 1% solution for 4 wks may be used
Conjunctivitis TREATMENT (bacterial, viral, allergic)
BACTERIAL - erythromycin ointment, fluoroquinolones
VIRAL - simple (sulfacetamide 10% solution, or broad spectrum); herpes keratitis (antiviral agents - ganciclovir, trifluridine, vidarabine)
ALLERGIC -
Chronic Bronchitis TREATMENT
sulfonamides
amoxicillin
Community Acquired Pneumonia CAUSES
strep pneumoniae
Community Acquired Pneumonia MICROORGANISMS
STREP PNEUMONIAE (PNEUMOCOCCUS)
Common = haemaphilus influenzae, moraxella catarrhalis
viruses
**most cases causative organism is never identified»_space; EMPIRIC COVERAGE
Community Acquired Pneumonia TREATMENT
Healthy outpatient = MACROLIDE (AZITHROMYCIN) or doxycycline
Outpatient w/ comorbidity = RESP FQ (2nd gen or higher) or BETA-LACTAM (amoxicillin or augmentin) + MACROLIDE
FQ: NO CIPRO (1st gen)
Pregnancy = tx as healthy outpatient. ERYTHROMYCIN or AZITHROMYCIN 1ST CHOICE
STI: SYPHILIS
DOC: BENZATHINE PCN (bicillin-LA)
Pregnancy DOC: BENZATHINE PCN
PCN allergy: desensitize and give BENZATHINE PCN
DOSES:
Primary/Secondary syphilis:
Adults: 2.4 million units IM single dose
infants/children: 50,000 units/kg IM single dose
LATE LATENT: same dose, but given 3 times, 1 wk apart (ADULT total 7.2 million units, CHILDREN total 150,000 units/kg)
STI: GONORRHEA
develops resistance to antimicrobials easily
DOC: CEPHALOSPORINS
RECOMMENDED TX: cephalosporins + azithromycin or doxycycline
DOSAGE: Ceftriaxone 250mg IM single dose + Azithromycin 1g orally single dose
STI: CHLAMYDIA
DOSAGE: AZITHROMYCIN 1mg orally single dose OR DOXYCYCLINE 100mg BID x7 days
PREGNANCY: AZITHROMYCIN 1g orally single dose
INFANTS/CHILDREN:
weight >45kg and age <8 yrs: azithromycin 1g PO single dose
Age >8 yrs: azithromycin 1g PO single dose OR doxycycline 100mg PO BID x7 days
STI: HERPES
USE ANTIVIRALS
FIRST EPISODE: ACYCLOVIR 400mg PO TID x7-10 days OR VALACYCLOVIR 1g PO BID x7-10 days
RECURRENT HERPES: ACYCLOVIR 400mg PO TID x5 days
PREGNANCY: start at 36 wks; ACYCLOVIR 400mg PO TID OR VALACYCLOVIR 500mg PO BID
Vaginitis: BACTERIAL VAGINOSIS
fried egg cells w/ pepper
DOC: METRONIDAZOLE 500mg PO BID x7 days; Clindamycin cream 2% 5g vaginally x7 days; Metronidazole gel 0.75% one applicator vaginally x5 days
PREGNANCY: METRONIDAZOLE 500mg BID x7 days
pregnancy ONLY PO MEDS
Vaginitis: TRICHOMONIASIS
protozoan infection
DOC: METRONIDAZOLE 2g PO single dose OR tinidazole 2g PO single dose OR metronidazole 500mg BID x7 days
TREAT PARTNERS
PREGNANCY: use METRONIDAZOLE (risk of preterm labor, PROM, LBW)
Vaginitis: VULVOVAGINAL CANDIDIASIS
recent hx antibiotic use
chronic infections: screen for DM
DOC: FLUCONAZOLE 150mg PO single dose
PREGNANCY: ONLY TOPICAL CREAM
CAUTION: AZOLE DRUG INTERACTIONS
Otitis TYPES
Serous Otitis - chronic, viral
Otitis Media - bacterial
Otitis externa
Otitis CAUSES
Bacteria:
GM + STREP
GM - HAEMOPHILIUS INFLUENZA, MORAXELLA CATARAHALIS
Otitis PATHO
Viral URTI »_space; microbes refluxed into middle ear»_space; dark warn moist place»_space; bacteria enters (squatter)»_space; bacterial infection (AOM)
AOM Observational therapy
LOW RISK CASES: watchful waiting, pain management, no longer than 48-72 hrs
AOM TREATMENT
Based on severity
FIRST LINE: AMOXICILLIN OR ERYTHROMYCIN (IF PCN ALLERGY)
If resistance suspected = broad spectrum beta-lactam resistant CEPHALOSPORIN or combo (amoxicillin/clavulanate, TMP-SMX)
No response within 48 hrs = change antibiotic therapy
Rhinosinusitis TREATMENT
first line = amoxicillin/clavulanate
treat 5-7 days in adults, 10-14 days in children
other therapy: RECOMMEND
saline irrigation (Nettie pots)
INTRANASAL CORTICOSTEROIDS
First vs Second line therapy RHINOSINUSITIS
FIRST LINE = AMOXICILLIN/CLAVULANATE; PCN allergy: doxycycline or resp FQ
SECOND LINE = RESP FQ (NOT CIPRO = 1st gen) use 2nd gen or higher
Complicated UTI
recurrent UTI
pregnancy
pediatric patient to age 18
co-morbidities
post-menopausal
recent hospital discharge or resident of LTC
Men
s/sx of pyelonephritis
Uncomplicated UTI
healthy woman, NOT pregnant
UTI DOC
UNCOMPLICATED UTI:
DOC: NITROFURANTOIN 100mg BID x5 days
TMP-SMX DS 1 BID x3 days (increasing resistance)
Other: FQs 3 day regimen
COMPLICATED UTI: SAME AS ABOVE, tx 7-14 days
DOC: NITROFURATOIN 100mg BID x7 days
NO SULFA/FQs
test for cure: urine culture/sensitivity 1 wk after tx
URINARY ANALGESIC DRUGS
primary ingredient in these products is phenazopyridine
Brands: Azo-standard, Prodium, Pyridium, Uricalm, Urogesic
patient can take phenazopyridine 200mg x3 day for 2 days as a urinary analgesic added to treatment regimen
Pharmacokinetics vs pharmacodynamics in PEDs
PHARMACOKINETICS –
PHARMACODYNAMICS –
Developmental aspects of PED med administration
BREASTFED INFANTS – drug excretion in breastmilk
INFANTS– teaching parents how to administer meds; discuss reason for med, dose, how to draw up med, length of tx, potential adverse effects; dosing meds for parental convenience INC compliance
TODDLERS/PRESCHOOLERS – discuss med admin w/ parent before prescribing; chewable formulation if possible; prescribe a once or twice daily med if possible
SCHOOL-AGE – include child in decision making process; let child choose formulation; be sure child can swallow pills; teaching should be aimed at both child and parent
ADOLESCENTS – administer own meds; compliance rates vary
Factors that influence + outcomes in medication adherence in PED patients
SPECIFIC FACTORS – long-term med regimens, number of meds prescribed, med interval, palatability, cost, family issues
IMPROVE COMPLIANCE – med concentration (liquid form), written vs oral instructions, self-monitoring calendars, telephone/email reminders, mobile phone med adherence apps, med admin at school, contracts/reinforcement programs
CHILDHOOD OBESITY – no guidelines; monitor patient closely for adverse effect if dosed by weight, efficacy if dosed by age