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PHAR 152 (Therapeutics 1 - Dr. Y. Shevchuk)) > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillin MOA?

A

Primary: PBP Binding & Peptidoglycan synthesis inhibition
Secondary: Activation of autolytic enzymes in the bacterial cell wall

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2
Q

Penicillin resistance development mechanisms?

A

-Beta Lactamase production
-Lack of PBP’s or altered PBP’s (Pneumococci & Enterococci)
-Drug efflux
-Bacteria that don’t synthesize Peptidoglycans

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3
Q

What species of bacteria are capable of producing Beta Lactamases?

A

-Staph
-Haemophilus
-Gonococci
-Other Gram Negative species

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4
Q

What leads to Penicillin inactivation?

A

Destruction of the Beta Lactam ring

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5
Q

Penicillin G is highly active against ____ ________ & ________.

A

GP Bacteria ; Spirochetes (Syphilis inducers)

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6
Q

What Penicillin G products, if not administered intramuscularly, are fatal to a patient?

A

Procaine & Benzathine

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7
Q

What must you take note of with Aqueous Penicillin G products?

A

Their associated monovalent salts (ie. Na+, K+)… Some patients have intolerances to certain salts.

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8
Q

What Penicillin product is used instead of Penicillin G because of its relative acid stability?

A

Penicillin V (oral formulation)

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9
Q

What is Penicillin the DOC for (what bacterial species)?

A

-Streptococci
-Pneumococci
-Meningococci
-Spirochetes
-Clostridia
-Anaerobic GP Rods
-Actinomyces
-Enterococci

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10
Q

The primary use of Methicillin, Cloxacillin, Nafcillin, Flucloxacillin, & Dicloxacillin is to treat what bacterial species?

A

Staph Aureus

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11
Q

T or F: Methicillin, Cloxacillin, Nafcillin, Flucloxacillin, & Dicloxacillin have more GP activity than Penicillin.

A

False… Less GP activity (only active against Staph Aureus).

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12
Q

What should Methicillin products NOT be used for?

A

MRSA

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13
Q

What is Cloxacillin specifically a DOC for?

A

MSSA (Methicillin Susceptible Staph Aureus)

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14
Q

What advantage do Methicillin drugs have over Penicillin?

A

Relative Beta Lactamase resistance

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15
Q

T or F: Aminopenicillins such as Amoxicillin & Ampicillin have relative Beta Lactamase resistance.

A

False… Are DESTROYED by Beta Lactamases.

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16
Q

Which Aminopenicillin drug is used IV? Orally?

A

IV: Ampicillin
Oral: Amoxicillin

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17
Q

What disadvantage does Ampicillin have?

A

Poor bioavailability (although it’s more acid stable than Natural Penicillins)

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18
Q

Amoxicillin is often found in combination drug products with what Beta Lactamase Inhibitor?

A

Clavulanic Acid

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19
Q

Aminopenicillins are a DOC for what organisms?

A

-Streptococci
-Enterococci
-Neisseria
-Non Beta Lactamase producing H. Influenzae / E. coli / P. mirabilis / Salmonella

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20
Q

T or F: Aminopenicillins are active against both GP & GN organisms.

A

True (although GN spectrum is limited)

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21
Q

What varieties of Beta Lactamases were discussed in class?

A

ESBL’s (Extended Spectrum Beta Lactamases)
NDM-Like (New Delhi Metallo Beta Lactamases)

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22
Q

What species of bacteria contain ESBL’s? NDM-Like Beta Lactamases?

A

ESBL: E. coli / K. pneumoniae
NDM-Like: A. baumannii

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23
Q

What advantage does the Ureidopenicillin class of drugs (ie. Piperacillin) have over Aminopenicillins or Natural Penicillin?

A

Increased GN activity

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24
Q

Piperacillin is active against what bacterial species?

A

P. Aeruginosa

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25
Q

In what formulation is Piperacillin available as?

A

IV only

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26
Q

What other drug is Piperacillin commonly seen with?

A

Tazobactam (Beta Lactamase Inhibitor)

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27
Q

T or F: Penicillins have a wide distribution & are good to use in CNS infections such as Meningitis.

A

True!

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28
Q

Penicillins demonstrate ______ ______ pharmacodynamics.

A

Concentration Independent

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29
Q

i) What do “Concentration Independent” pharmacodynamics infer?

ii) What type of administration tactics are ideal for drugs with these PD characteristics?

A

i) That kill rates won’t improve once concentration thresholds are met.

ii) Continual IV Infusion

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30
Q

All Penicillins should be taken on an empty stomach… With the exception of what?

A

Amoxicillin

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31
Q

Are Penicillins safe for pregnant women to take?

A

Yep

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32
Q

What particularly important drug-drug interaction is demonstrated with Penicillins?

A

Oral Contraception… Cases of women becoming pregnant on Penicillins b/c of Estrogen destruction.

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33
Q

S/E’s of Penicillins (although generally well-tolerated & really safe)?

A

-Skin Rash
-Diarrhea / GI Distress
-Electrolyte Imbalances
-Serum Sickness (Fever & Joint Stiffness)
-Neutropenia & Thrombocytopenia (on extended 3-4wk therapy)

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34
Q

Penicillins & Cephalosporins are both _______-type drugs.

A

bactericidal

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35
Q

Cephalosporin resistance…?

A

-Lack of PBP or altered PBP affinity
-Beta Lactamase production
-Drug efflux
-Inability of drug to penetrate

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36
Q

What bacterial species do Cephalosporins demonstrate Beta Lactamase resistance to?

A

-S. Aureus
-Common GN’s

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37
Q

1st gen Cephalosporins?

A

Cephalexin, Cefadroxil (Oral) ; Cefazolin (IV / IM)

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38
Q

What conditions would 1st gen Cephalosporins be shitty to use for?

A

CNS infections (ie. Meningitis)

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39
Q

What is the spectrum of activity of 1st Gen Cephalosporins?

A

GP Cocci ; Some GN Bacilli such as E. Coli / Klebsiella / Proteus

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40
Q

What are 1st Gen Cephalosporins NOT active against?

A

Enterococci / MRSA

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41
Q

1st Gen Cephalosporins are only indicated as a DOC for what?

A

Surgical Prophylaxis

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42
Q

2nd Gen Cephalosporins… What are they?

A

Cefuroxime Axetil, Cefprozil (Oral) ; Cefuroxime, Cefoxitin, (IV / IM)

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43
Q

What do 2nd Gen Cephalosporins have greater coverage against (relative to 1st Gen)?

A

GN’s (especially Beta Lactamase producing Haemophilus)

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44
Q

What GN species do 2nd Gen Cephalosporins NOT have greater coverage against (relative to 1st Gen)?

A

P. Aeruginosa

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45
Q

Cephamycins are used to treat what sorts of infections?

A

Mixed Aerobic / Anaerobic Infections (ie. Diverticulitis ; Appendix Rupture ; Diabetes)

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46
Q

Cefoxitin (2nd Gen Cephalosporin) offers greater coverage against what (in comparison to Cephamycins): Anaerobic or Aerobic?

A

Anaerobic Coverage > Aerobic Coverage

-Cephamycin good for mixed infections.

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47
Q

3rd Gen Cephalosporins… What are they?

A

Cefotaxime, Ceftriaxone, Ceftazidime (IV / IM) ; Cefixime (Oral)

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48
Q

Ceftazidime is poor against what spectrum of bacteria? Should be reserved for what bacterial species?

A

Poor against GP ; Reserve for P. Aeruginosa

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49
Q

Cefotaxime & Ceftriaxone have a good spectrum against what bacteria? No coverage against what species?

A

Good against many GN bacteria ; No P. Aeruginosa coverage (reserve Ceftazidime for this).

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50
Q

Relative to 1st Gen Cephalosporins, how are 3rd Gen Cephalosporins against GP Cocci?

A

Decreased GPC activity (EXCEPT against S. Pneumoniae)

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51
Q

T or F: 3rd Gen Cephalosporins are able to penetrate the CNS.

A

True!

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52
Q

4th Gen Cephalosporins… What are they?

A

Cefepime, Ceftaroline, Ceftobiprole

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53
Q

Cefepime has enhanced activity against _______ & _______… Is somewhat active against __________.

A

Enterobacter ; Citrobacter ; P. Aeruginosa

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54
Q

Ceftaroline & Ceftobiprole have activity against ____, ___________, & __________.

A

MRSA ; Ampicillin Sensitive E. Faecalis ; Penicillin Resistant S. Pneumoniae

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55
Q

4th Gen Cephalosporins are almost exclusively in hospitals due to what?

A

Broad spectrum of coverage & $$$

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56
Q

S/E’s of Cephalosporins?

A

-Diarrhea
-Skin Rash
-Hypersensitivity
-Fever
-Granulocytopenia
-Hemolytic Anemia

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57
Q

Unique s/e of Ceftriaxone (3rd Gen Cephalosporin)?

A

Biliary Pseudolithiasis ; Drug Crystallization within the Gall Bladder (mimics Gall Stones) b/c of its unique elimination through the Biliary System rather than the Kidneys or the Liver.

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58
Q

Can we use Cephalosporins with pregnant women or kids?

A

Absolutely (safe drugs).

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59
Q

Because Ceftriaxone is eliminated through the Biliary System (rather than Renally or Hepatically), what might change with regards to its dosing regimen?

A

OD rather than TID that is commonly seen with other AB’s… Unique elimination system extends its half life greatly.

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60
Q

With what Carbapenem drug is Cilastatin commonly seen with?

A

Imipenem

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61
Q

What is Cilastatin’s role in the combo Imipenem drug?

A

Peptidase Inhibitor… Imipenem is inactivated by renal DHP’s!

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62
Q

Other Carbapenem drugs?

A

Meropenem & Ertapenem

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63
Q

Spectrum of activity of Carbapenem drugs?

A

GP, GN (including P. aeruginosa), & Anaerobes.

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64
Q

Advantages & Disadvantages of Ertapenem usage over Imipenem or Meropenem?

A

A: Long 1/2 life (OD dosing)

D: Poor Enterococcus & Pseudomonas activity.

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65
Q

T or F: Carbapenems have a broad spectrum of activity similar to that of 4th Gen Cephalosporins.

A

True!

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66
Q

Only commercially available Monobactam in Canada?

A

Aztreonam

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67
Q

Spectrum of activity of Aztreonam?

A

GN’s (including P. aeruginosa)

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68
Q

T or F: Aztreonam is active against ESBL or AmpC producers.

A

False.

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69
Q

Macrolide AB’s?

A

Erythromycin, Clarithromycin, Azithromycin

70
Q

MOA of Macrolide AB’s?

A

Attach to 23S rRNA on 50S of bacterial ribosome ; inhibition of protein synthesis.

71
Q

Are Macrolide AB’s considered Bactericidal or Bacteriostatic?

A

Bacteriostatic (generally).

72
Q

Macrolide resistance?

A

-rRNA Receptor Methylation (disables drug binding)
-Inactivating Enzymes
-Active Drug Efflux

73
Q

Macrolide spectrum of activity?

A

-GP’s (Pneumococci / Streptococci / Corynebacteria)

-Mycoplasma Pneumoniae

-Chlamydia Trachomatis

-Chlamydia Pneumophilia

-Bordatella Pertussis

-Campylobacter Jejuni

-Helicobacter Pylori

74
Q

What unique s/e does IV Erythromycin cause?

A

Severe Phlebitis… Requires IV site changes frequently.

75
Q

Adverse s/e’s of Erythromycin?

A

-GI (Dyspepsia, Nausea, Vomiting)

-Cholestatic Hepatitis (increased with Estolate & in pregnancy)

-QT Prolongation / Cardiac Arrythmias (particularly in combo with CYP3A Inhibitors)

76
Q

Clarithromycin & Azithromycin have enhanced activity against what organisms?

A

-L. pneumophilia
-C. trachomatis
-C. pneumoniae
-M. catarrhalis
-H. influenzae
-M. avium
-Some MRSA species

77
Q

T or F: Resistance to Erythromycin means resistance will also exist with Clarithromycin & Azithromycin.

A

True.

78
Q

Dosing frequencies for Erythromycin / Clarithromycin / Azithromycin?

A

E: QID
C: BID
A: OD

79
Q

T or F: Incidence of GI-related s/e’s are lower with Clarithromycin & Azithromycin (in comparison to Erythromycin).

A

True

80
Q

Does Azithromycin’s long 1/2 life warrant it as being the best Macrolide AB?

A

No… Good in theory, but OD dosing leads to long periods of sub-therapeutic drug concentrations (can lead to more resistance).

81
Q

Three Macrolide uses?

A

-URTI’s
-STI’s
-Acne

82
Q

Of the three discussed Macrolides, which is least concerning with regards to other drug-drug interactions?

A

Azithromycin… Lots with Erythromycin & Clarithromycin.

83
Q

What CYP enzymes do Erythromycin & Clarithromycin inhibit?

A

CYP3A4

84
Q

What categories of drugs may increase in toxicity if administered with Erythromycin or Clarithromycin?

A

-Antiarrythmics
-Antidepressants
-Benzodiazepines
-Anticonvulsants
-Statins

85
Q

What mechanistically similar drug to the Macrolides is commonly tied to AB-Associated C. difficile Diarrhea?

A

Clindamycin

86
Q

Clindamycin spectrum of activity?

A

-Anaerobes
-S. aureus (some MRSA & Streptococci)

87
Q

T or F: Clindamycin & mechanistically similar Macrolides are the DOC for many infections.

A

False… The four discussed drugs are reserved for those with Penicillin Allergies.

88
Q

Adverse s/e’s of Clindamycin?

A

-NVD
-Rash
-Elevated LFT’s
-Esophageal Irritation
-C. difficile Diarrhea

89
Q

Tetracycline AB’s?

A

Tetracycline, Minocycline, Doxycycline

90
Q

MOA of Tetracyclines?

A

Inhibit Aminoacyl-tRNA binding to 30S subunit of bacterial ribosomes ; Inhibit protein synthesis.

91
Q

Are Tetra AB’s Bacteriostatic or Bactericidal?

A

Bacteriostatic

92
Q

Tetra’s spectrum?

A

-GP’s & GN’s (high rates of E. coli & S. pneumoniae resistance)

93
Q

What species are Tetra’s a DOC against?

A

-Rickettsiae
-Bartonella
-Chlamydiae
-M. pneumoniae

94
Q

Adverse s/e’s of Tetra’s?

A

-NVD
-Rash
-Photosensitivity
-Yeast Overgrowth
-Bone / Tooth Deposition
-Hepatitits

95
Q

What unique s/e is tied to Minocycline?

A

Vestibular Toxicity & more Hypersensitivity rxn’s (doesn’t usually happen with Doxy or Tetracycline).

96
Q

Drug-Drug & Drug-Mineral Interactions of Tetra AB’s?

A

-Anticonvulsants (reduce Tetra levels ; Phenobarbitol / Phenytoin / Carbamazepine)

-Divalent / Trivalent Cations

-Warfarin (Increased INR & Bleeding)

97
Q

Tigecycline is a synthetic Tetracycline analogue… What category does it fall under?

A

Glycylcyclines

98
Q

Tigecycline spectrum of activity?

A

-MRSA
-S. pneumoniae & Enterococci
-Salmonella
-Shigella
-Acinetobacter & Anaerobes

99
Q

What formulations of Tigecycline are available?

A

IV or IM

100
Q

Vancomycin is classified as a _____, and is the DOC for ____.

A

glycopeptide ; MRSA

101
Q

MOA of Vancomycin?

A

Binding to D-Ala-D-Ala residues of PDG precursors & inhibits cell wall synthesis.

102
Q

Vancomycin resistance?

A

-VRE
-VISA
-S. aureus

103
Q

Vancomycin spectrum of activity?

A

GRAM POSITIVES!!!
-Enterococci
-PRSP
-MRSA
-Clostrioides
-Some Bacilli

104
Q

Oral Vancomycin is reserved for what type of infection?

A

C. difficile… Not orally absorbed. IV is for serious infections.

105
Q

Vancomycin s/e’s?

A

-Nephrotoxicity
-Ototoxicity
-Red Man Syndrome (due to lengthened infusions)
-Granulocytopenia

106
Q

Similar drugs to Vancomycin?

A

Teicoplanin, Daptomycin

107
Q

Major s/e of Daptomycin administration?

A

Myopathy

108
Q

Aminoglycoside AB’s?

A

Streptomycin, Gentamicin, Tobramycin, Amikacin

109
Q

MOA of Aminoglycoside AB’s?

A

Inhibition of bacterial protein synthesis ; Inhibit 30S ribosomal subunit.

110
Q

Aminoglycoside resistance?

A

-Mutation / Methylation of 16s rRNA binding site
-Enzymatic destruction of drug
-Lack of drug molecule permeability
-Active drug efflux

111
Q

Major downside of Aminoglycoside AB’s?

A

-Only a spectrum of activity against Aerobic GN’s!!! Require something that destroys bacterial cell walls to have any GP spectrum of activity.

112
Q

Aminoglycosides demonstrate synergistic effects with what AB’s?

A

Penicillins… Against Enterococci & Streptococci.

113
Q

What is Streptomycin normally reserved for?

A

Tuberculosis (M. tuberculosis infection)

114
Q

Formulations available for Aminoglycosides?

A

IV & IM (not orally absorbed)

115
Q

T or F: Aminoglycosides are great agents for Meningitis because of their enhanced tissue penetrance.

A

FALSE (!!!)… Penetrate tissues relatively poorly.

116
Q

Primary toxicity demonstrated with Aminoglycosides?

A

Nephrotoxicity… Requirement of dose adjustments with those who have renal dysfunction.

117
Q

Other adverse s/e’s with Aminoglycosides?

A

-Ototoxicity

-Neuromuscular Blockade

-Allergies (rare)

-Drug Interactions with other Nephrotoxic / Ototoxic / NM Blocking Agents.

118
Q

What AB class (because of being well absorbed orally & having broad spectrum coverage) is largely misused in community Pharmacy?

A

Fluoroquinolones

119
Q

Fluoroquinolone drugs?

A

Ciprofloxacin, Levofloxacin, Moxifloxacin

120
Q

How do Fluoroquinolones work?

A

Inhibit DNA Gyrase / Topoisomerase II & IV

121
Q

BS or BC: Fluoroquinolones?

A

Bactericidal (Concentration-Dependent Killing)

122
Q

Fluoroquinolone resistance?

A

-A / B Subunit alteration of DNA Gyrase
-ParC / ParE mutation of Topo IV
-Outer Membrane Permeability changes
-Efflux Pumps

123
Q

Fluoroquinolone spectrum of activity?

A

-GN’s (Haemophilus, Neisseriae, Chlamydiae)
-P. aeruginosa (Cipro best)
-S. pneumoniae (Levo & has better GP spectrum)
-Anaerobes (Moxi)

124
Q

Of the Fluoroquinolones (Ciprofloxacin, Levofloxacin, Moxifloxacin), which one is best for P. aeruginosa infection?

A

Ciprofloxacin

125
Q

Although UTI’s are a condition that Fluoroquinolones can be used to treat, which one is a poor choice because of its inability to get into the urine?

A

Moxifloxacin

126
Q

Uses for Fluoroquinolones?

A

-UTI’s
-STI’s
-LRTI’s
-Enteritis / Travelers Diarrhea
-Resistant Mycobacterial Infections

127
Q

T or F: Fluoroquinolones possess excellent oral bioavailability.

A

True

128
Q

Formulation types for Fluoroquinolones?

A

-IV or Orally (Parenteral use not as common)

129
Q

How are Fluoroquinolones eliminated?

A

Cipro / Levo: Renal Pathways
Moxi: Biliary Pathways

130
Q

S/E’s of Fluoro’s?

A

-NVD
-Insomnia / Headaches / Dizziness
-CNS Effects (ie. Seizures)
-Skin Rash
-Impaired Liver Function
-Prolonged QTc Interval
-Hypo/Hyperglycemia
-C. difficile Infection
-Peripheral Neuropathy

131
Q

Other unique Fluoro s/e?

A

Tendinitis / Tendon Rupture (young & old more susceptible)

132
Q

Other unique Fluoro s/e?

A

Tendinitis / Tendon Rupture (young & old more susceptible)

133
Q

Patient subtypes at higher risk of tendon rupture / tendonitis due to Fluoroquinolone usage?

A

-Concurrent use of steroids
- >60yrs of age
-Females

134
Q

Drug Interactions with Fluroquinolones?

A

-Di & Trivalent Cations
-QTc Prolonging Agents
-CYP1A2 Metabolized Drugs (ie. Clozapine, Duloxetine, Methotrexate, Quinapril, Rasagiline, Ropinirole, Varenicline)
-Warfarin (increased INR)

135
Q

Reserve Fluoroquinolones for what patient cases?

A

-Organismal Resistance
-Situations where DOC’s can’t be used
-Children < 18yrs

136
Q

Sulfamethoxazole MOA?

A

Competitive Inhibition of DHF Acid Synthesis

137
Q

Trimethoprim MOA?

A

Binds to DHF Reductase & inhibits DHF Acid — Tetrahydrofolic Acid reduction.

138
Q

TMP/SMX spectrum of activity?

A

WIDE GN / GP SPECTRUM
-Chlamydiae
-Nocardiae
-Protozoa
-Staph (including MRSA)
-S. pneumonia (but NOT Group A Strep)
-S. maltophilia
-Moraxella
-H. influenzae
-Enterobacteriaciae
-Brucella
-P. jirovecii

139
Q

Uses of TMP/SMX drug therapies?

A

-UTI’s
-MRSA-related skin & soft tissue infections
-Pneumocystitis Jirovecii Pneumonia (PJP)

140
Q

TMP/SMX s/e’s?

A

-Skin Rash
-Hypersensitivity
-Headaches
-NVD
-Bone Marrow Suppression
-Hyperkalemia / Hyponatremia
-Photosensitivity

141
Q

TMP/SMX Drug-Drug Interactions?

A

-Carvedilol / Digoxin / Phenytoin (acts as a CYP2C9 Inhibitor & CYP3A4 Substrate)
-Warfarin (increased INR & bleeding)
-Hypoglycemic Agents (increased risk)
-Drugs that increase K+ levels

142
Q

What trimesters of pregnancy is TMP/SMX therapies contraindicated in?

A

1st & 3rd

143
Q

MOA of Metronidazole?

A

Possibly inhibition of nucleic acid synthesis & DNA disruption

144
Q

Metronidazole spectrum of activity?

A

-Anaerobes (including C. difficile)
-Protozoa sp. (Trichomonas, Giardia)

Resistance to Propionibacterium!!!

145
Q

Benefit of Metronidazole?

A

Excellent oral bioavailability… Also available IV.

146
Q

Metronidazole s/e’s?

A

-NVD / GI Distress
-Metallic Taste
-Headache
-Dark Urine
-Peripheral Neuropathy
-Insomnia
-Stomatitis

147
Q

Unique s/e of Metronidazole?

A

Disulfiram-like rxn with alcohol… Makes pt. feel extremely ill (even with vaginal use).

148
Q

Drug-Drug Interactions with Metronidazole?

A

-Alcohol
-Warfarin (increased INR & bleeding)

149
Q

Linezolid MOA?

A

Inhibits bacterial protein synthesis

150
Q

Bacteriostatic or Bactericidal: Linezolid?

A

Bacteriostatic (but Bactericidal against Streptoccci).

151
Q

Linezolid spectrum of activity?

A

-Streptococci
-Enterococci (including VRE)
-Staphylococci (including MRSA)

152
Q

What cases do we reserve Linezolid for?

A

Multi-Drug Resistant Organisms

153
Q

What drug is Linezolid an alternative therapy for?

A

Vancomycin

154
Q

Downside of Linezolid therapies?

A

Extremely expensive

155
Q

Linezolid formulations available?

A

IV & Oral

156
Q

Linezolid s/e’s?

A

-NVD
-Headache
-Rash
-Myelosuppression
-Increased need for Liver Function Tests (LFT’s)
-Optic / Peripheral Neuropathy
-Lactic Acidosis
-Decreased Seizure Threshold

157
Q

Drug-Drug Interactions of Linezolid?

A

-SSRI’s / MAOI’s (increased Serotonin Syndrome risk)
-Rifampin (decreases Linezolid levels)

158
Q

What percentage of AB prescriptions in Canada are considered to be inappropriate?

A

30% all cases ; 50% for Respiratory Infections

159
Q

Consequences of inappropriate AB prescribing?

A

-More severe illnesses & longer recovery
-May require hospitalization or prolong it
-More HCP visits
-Requirement to use more toxic AB’s
-More deaths

160
Q

In a 2018 Canadian study, what fraction of deaths due to bacterial infections could have been prevented if 1st line AB’s worked against susceptible species?

A

4 / 10

161
Q

Role of a Pharmacist in promoting Anti-Microbial Stewardship?

A

-Determining if AB is needed in the 1st place
-Narrow&raquo_space;> Broad Spectrum
-No Infection = No AB Prescribing
-Vaccines!
-Hygiene practices
-Promoting safe sex
-Selecting shortest drug therapy duration
-Assessment of AB allergies (largely intolerances rather than true AB allergies)

162
Q

Of a cohort of 10 000 patients, how many had true IgE-medicated penicillin allergies? Cephalosporin cross reactivity? True anaphylaxis?

A

i) < 100 / 10 000 (IgE-Medicated Allergy)
ii) 1-3 / 10 000 (Cephalosporin Cross Rxn)
iii) 1 / 10 000 (True Anaphylaxis)

163
Q

Scenarios in which patients may be allergic to Beta Lactam AB’s?

A

1) Beta Lactam Ring itself (pt. then allergic to all Beta Lactams)
2) Side Chains (allergy would then be drug specific)

164
Q

Adverse Penicillin events?

A

-Diffuse, non-itchy rash (< 10% pt.’s on Pen)
-GI Upset & Headache

Usually begin after 2-5d therapy & last several days to 1wk! Not IgE mediated & these types of pt.’s we can safely give Penicillins & Cephalosporins.

165
Q

Severe Penicillin effects?

A

-SJS
-Toxic Epidermal Necrolysis (TENS)
-Interstitial Nephritis
-Hemolytic Anemia
-Serum Sickness

All Beta Lactams CI with these pt.’s (although not IgE mediated)… Skin Testing / Desensitization / Graded Challenges not recommended (could be harmful to pt.)!

166
Q

Effects of true IgE mediated Penicillin allergy?

A

-Itchy Rash / Hives
-Angioedema / Hypotension / Bronchospasm
-Anaphylaxis (< 1hr after dose)

LIFE-THREATENING SITUATION!!!

167
Q

How do we manage anaphylactic rxn’s to Penicillin?

A

-ABC’s (Airways / Breathing / Circulation)
-Epinephrine (0.3-0.5mg adults ; 0.01mg / kg kids) IM x 5-15mins [up to 3 injections]
-Oxygen / IV Fluids or Corticosteroids / Nebulized Salbutamol / Glucagon / DPH / Ranitidine

168
Q

What are some common reactive positions within Sulfa drugs that patients may be allergic to?

A

-Arylamine (N4 position)
-Nitrogen Containing Ring attached to N1 Nitrogen of Sulfonamide functional group

169
Q

Rates of allergic rxn’s to AB Sulfa’s / Non-AB Sulfa’s?

A

AB Sulfa’s: 4.8%
Non-AB Sulfa’s: 2%

170
Q

Common drugs that contain Sulfonamide functional groups?

A

-AB’s (ie. TMP/SMX)
-Thiazide / Loop Diuretics
-Oral Hypoglycemics
-COX-2 / Carbonic Anhydrase Inhibitors
-Anti-Virals (Amprenavir / Fosamprenavir / Darunavir)
-Probenecid / Tamsulosin / Triptans / Zonisamide

171
Q

Sulfa rxn types?

A

-Immediate IgE-Mediated Anaphylaxis (rare)
-Delayed Cutaneous Rxn’s (more common)

172
Q

Describe demonstrated cutaneous rxn’s to Sulfa drugs.

A

-Fever followed by a Maculopapular or Morbilliform Rash that may also result in SJS or TENS.

PHAR 152 (Therapeutics 1 - Dr. Y. Shevchuk)) (9 decks)

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