Antibiotics Flashcards
1
Q
Penicillin MOA?
A
Primary: PBP Binding & Peptidoglycan synthesis inhibition
Secondary: Activation of autolytic enzymes in the bacterial cell wall
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
3
Q
What species of bacteria are capable of producing Beta Lactamases?
A
-Staph
-Haemophilus
-Gonococci
-Other Gram Negative species
4
Q
What leads to Penicillin inactivation?
A
Destruction of the Beta Lactam ring
5
Q
Penicillin G is highly active against ____ ________ & ________.
A
GP Bacteria ; Spirochetes (Syphilis inducers)
6
Q
What Penicillin G products, if not administered intramuscularly, are fatal to a patient?
A
Procaine & Benzathine
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.
8
Q
What Penicillin product is used instead of Penicillin G because of its relative acid stability?
A
Penicillin V (oral formulation)
9
Q
What is Penicillin the DOC for (what bacterial species)?
A
-Streptococci
-Pneumococci
-Meningococci
-Spirochetes
-Clostridia
-Anaerobic GP Rods
-Actinomyces
-Enterococci
10
Q
The primary use of Methicillin, Cloxacillin, Nafcillin, Flucloxacillin, & Dicloxacillin is to treat what bacterial species?
A
Staph Aureus
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).
12
Q
What should Methicillin products NOT be used for?
A
MRSA
13
Q
What is Cloxacillin specifically a DOC for?
A
MSSA (Methicillin Susceptible Staph Aureus)
14
Q
What advantage do Methicillin drugs have over Penicillin?
A
Relative Beta Lactamase resistance
15
Q
T or F: Aminopenicillins such as Amoxicillin & Ampicillin have relative Beta Lactamase resistance.
A
False… Are DESTROYED by Beta Lactamases.
16
Q
Which Aminopenicillin drug is used IV? Orally?
A
IV: Ampicillin
Oral: Amoxicillin
17
Q
What disadvantage does Ampicillin have?
A
Poor bioavailability (although it’s more acid stable than Natural Penicillins)
18
Q
Amoxicillin is often found in combination drug products with what Beta Lactamase Inhibitor?
A
Clavulanic Acid
19
Q
Aminopenicillins are a DOC for what organisms?
A
-Streptococci
-Enterococci
-Neisseria
-Non Beta Lactamase producing H. Influenzae / E. coli / P. mirabilis / Salmonella
20
Q
T or F: Aminopenicillins are active against both GP & GN organisms.
A
True (although GN spectrum is limited)
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)
22
Q
What species of bacteria contain ESBL’s? NDM-Like Beta Lactamases?
A
ESBL: E. coli / K. pneumoniae
NDM-Like: A. baumannii
23
Q
What advantage does the Ureidopenicillin class of drugs (ie. Piperacillin) have over Aminopenicillins or Natural Penicillin?
A
Increased GN activity
24
Q
Piperacillin is active against what bacterial species?
A
P. Aeruginosa
25
In what formulation is Piperacillin available as?
IV only
26
What other drug is Piperacillin commonly seen with?
Tazobactam (Beta Lactamase Inhibitor)
27
T or F: Penicillins have a wide distribution & are good to use in CNS infections such as Meningitis.
True!
28
Penicillins demonstrate ______ ______ pharmacodynamics.
Concentration Independent
29
i) What do "Concentration Independent" pharmacodynamics infer?
ii) What type of administration tactics are ideal for drugs with these PD characteristics?
i) That kill rates won't improve once concentration thresholds are met.
ii) Continual IV Infusion
30
All Penicillins should be taken on an empty stomach... With the exception of what?
Amoxicillin
31
Are Penicillins safe for pregnant women to take?
Yep
32
What particularly important drug-drug interaction is demonstrated with Penicillins?
Oral Contraception... Cases of women becoming pregnant on Penicillins b/c of Estrogen destruction.
33
S/E's of Penicillins (although generally well-tolerated & really safe)?
-Skin Rash
-Diarrhea / GI Distress
-Electrolyte Imbalances
-Serum Sickness (Fever & Joint Stiffness)
-Neutropenia & Thrombocytopenia (on extended 3-4wk therapy)
34
Penicillins & Cephalosporins are both _______-type drugs.
bactericidal
35
Cephalosporin resistance...?
-Lack of PBP or altered PBP affinity
-Beta Lactamase production
-Drug efflux
-Inability of drug to penetrate
36
What bacterial species do Cephalosporins demonstrate Beta Lactamase resistance to?
-S. Aureus
-Common GN's
37
1st gen Cephalosporins?
Cephalexin, Cefadroxil (Oral) ; Cefazolin (IV / IM)
38
What conditions would 1st gen Cephalosporins be shitty to use for?
CNS infections (ie. Meningitis)
39
What is the spectrum of activity of 1st Gen Cephalosporins?
GP Cocci ; Some GN Bacilli such as E. Coli / Klebsiella / Proteus
40
What are 1st Gen Cephalosporins NOT active against?
Enterococci / MRSA
41
1st Gen Cephalosporins are only indicated as a DOC for what?
Surgical Prophylaxis
42
2nd Gen Cephalosporins... What are they?
Cefuroxime Axetil, Cefprozil (Oral) ; Cefuroxime, Cefoxitin, (IV / IM)
43
What do 2nd Gen Cephalosporins have greater coverage against (relative to 1st Gen)?
GN's (especially Beta Lactamase producing Haemophilus)
44
What GN species do 2nd Gen Cephalosporins NOT have greater coverage against (relative to 1st Gen)?
P. Aeruginosa
45
Cephamycins are used to treat what sorts of infections?
Mixed Aerobic / Anaerobic Infections (ie. Diverticulitis ; Appendix Rupture ; Diabetes)
46
Cefoxitin (2nd Gen Cephalosporin) offers greater coverage against what (in comparison to Cephamycins): Anaerobic or Aerobic?
Anaerobic Coverage > Aerobic Coverage
-Cephamycin good for mixed infections.
47
3rd Gen Cephalosporins... What are they?
Cefotaxime, Ceftriaxone, Ceftazidime (IV / IM) ; Cefixime (Oral)
48
Ceftazidime is poor against what spectrum of bacteria? Should be reserved for what bacterial species?
Poor against GP ; Reserve for P. Aeruginosa
49
Cefotaxime & Ceftriaxone have a good spectrum against what bacteria? No coverage against what species?
Good against many GN bacteria ; No P. Aeruginosa coverage (reserve Ceftazidime for this).
50
Relative to 1st Gen Cephalosporins, how are 3rd Gen Cephalosporins against GP Cocci?
Decreased GPC activity (EXCEPT against S. Pneumoniae)
51
T or F: 3rd Gen Cephalosporins are able to penetrate the CNS.
True!
52
4th Gen Cephalosporins... What are they?
Cefepime, Ceftaroline, Ceftobiprole
53
Cefepime has enhanced activity against _______ & _______... Is somewhat active against __________.
Enterobacter ; Citrobacter ; P. Aeruginosa
54
Ceftaroline & Ceftobiprole have activity against ____, ___________, & __________.
MRSA ; Ampicillin Sensitive E. Faecalis ; Penicillin Resistant S. Pneumoniae
55
4th Gen Cephalosporins are almost exclusively in hospitals due to what?
Broad spectrum of coverage & $$$
56
S/E's of Cephalosporins?
-Diarrhea
-Skin Rash
-Hypersensitivity
-Fever
-Granulocytopenia
-Hemolytic Anemia
57
Unique s/e of Ceftriaxone (3rd Gen Cephalosporin)?
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.
58
Can we use Cephalosporins with pregnant women or kids?
Absolutely (safe drugs).
59
Because Ceftriaxone is eliminated through the Biliary System (rather than Renally or Hepatically), what might change with regards to its dosing regimen?
OD rather than TID that is commonly seen with other AB's... Unique elimination system extends its half life greatly.
60
With what Carbapenem drug is Cilastatin commonly seen with?
Imipenem
61
What is Cilastatin's role in the combo Imipenem drug?
Peptidase Inhibitor... Imipenem is inactivated by renal DHP's!
62
Other Carbapenem drugs?
Meropenem & Ertapenem
63
Spectrum of activity of Carbapenem drugs?
GP, GN (including P. aeruginosa), & Anaerobes.
64
Advantages & Disadvantages of Ertapenem usage over Imipenem or Meropenem?
A: Long 1/2 life (OD dosing)
D: Poor Enterococcus & Pseudomonas activity.
65
T or F: Carbapenems have a broad spectrum of activity similar to that of 4th Gen Cephalosporins.
True!
66
Only commercially available Monobactam in Canada?
Aztreonam
67
Spectrum of activity of Aztreonam?
GN's (including P. aeruginosa)
68
T or F: Aztreonam is active against ESBL or AmpC producers.
False.
69
Macrolide AB's?
Erythromycin, Clarithromycin, Azithromycin
70
MOA of Macrolide AB's?
Attach to 23S rRNA on 50S of bacterial ribosome ; inhibition of protein synthesis.
71
Are Macrolide AB's considered Bactericidal or Bacteriostatic?
Bacteriostatic (generally).
72
Macrolide resistance?
-rRNA Receptor Methylation (disables drug binding)
-Inactivating Enzymes
-Active Drug Efflux
73
Macrolide spectrum of activity?
-GP's (Pneumococci / Streptococci / Corynebacteria)
-Mycoplasma Pneumoniae
-Chlamydia Trachomatis
-Chlamydia Pneumophilia
-Bordatella Pertussis
-Campylobacter Jejuni
-Helicobacter Pylori
74
What unique s/e does IV Erythromycin cause?
Severe Phlebitis... Requires IV site changes frequently.
75
Adverse s/e's of Erythromycin?
-GI (Dyspepsia, Nausea, Vomiting)
-Cholestatic Hepatitis (increased with Estolate & in pregnancy)
-QT Prolongation / Cardiac Arrythmias (particularly in combo with CYP3A Inhibitors)
76
Clarithromycin & Azithromycin have enhanced activity against what organisms?
-L. pneumophilia
-C. trachomatis
-C. pneumoniae
-M. catarrhalis
-H. influenzae
-M. avium
-Some MRSA species
77
T or F: Resistance to Erythromycin means resistance will also exist with Clarithromycin & Azithromycin.
True.
78
Dosing frequencies for Erythromycin / Clarithromycin / Azithromycin?
E: QID
C: BID
A: OD
79
T or F: Incidence of GI-related s/e's are lower with Clarithromycin & Azithromycin (in comparison to Erythromycin).
True
80
Does Azithromycin's long 1/2 life warrant it as being the best Macrolide AB?
No... Good in theory, but OD dosing leads to long periods of sub-therapeutic drug concentrations (can lead to more resistance).
81
Three Macrolide uses?
-URTI's
-STI's
-Acne
82
Of the three discussed Macrolides, which is least concerning with regards to other drug-drug interactions?
Azithromycin... Lots with Erythromycin & Clarithromycin.
83
What CYP enzymes do Erythromycin & Clarithromycin inhibit?
CYP3A4
84
What categories of drugs may increase in toxicity if administered with Erythromycin or Clarithromycin?
-Antiarrythmics
-Antidepressants
-Benzodiazepines
-Anticonvulsants
-Statins
85
What mechanistically similar drug to the Macrolides is commonly tied to AB-Associated C. difficile Diarrhea?
Clindamycin
86
Clindamycin spectrum of activity?
-Anaerobes
-S. aureus (some MRSA & Streptococci)
87
T or F: Clindamycin & mechanistically similar Macrolides are the DOC for many infections.
False... The four discussed drugs are reserved for those with Penicillin Allergies.
88
Adverse s/e's of Clindamycin?
-NVD
-Rash
-Elevated LFT's
-Esophageal Irritation
-C. difficile Diarrhea
89
Tetracycline AB's?
Tetracycline, Minocycline, Doxycycline
90
MOA of Tetracyclines?
Inhibit Aminoacyl-tRNA binding to 30S subunit of bacterial ribosomes ; Inhibit protein synthesis.
91
Are Tetra AB's Bacteriostatic or Bactericidal?
Bacteriostatic
92
Tetra's spectrum?
-GP's & GN's (high rates of E. coli & S. pneumoniae resistance)
93
What species are Tetra's a DOC against?
-Rickettsiae
-Bartonella
-Chlamydiae
-M. pneumoniae
94
Adverse s/e's of Tetra's?
-NVD
-Rash
-Photosensitivity
-Yeast Overgrowth
-Bone / Tooth Deposition
-Hepatitits
95
What unique s/e is tied to Minocycline?
Vestibular Toxicity & more Hypersensitivity rxn's (doesn't usually happen with Doxy or Tetracycline).
96
Drug-Drug & Drug-Mineral Interactions of Tetra AB's?
-Anticonvulsants (reduce Tetra levels ; Phenobarbitol / Phenytoin / Carbamazepine)
-Divalent / Trivalent Cations
-Warfarin (Increased INR & Bleeding)
97
Tigecycline is a synthetic Tetracycline analogue... What category does it fall under?
Glycylcyclines
98
Tigecycline spectrum of activity?
-MRSA
-S. pneumoniae & Enterococci
-Salmonella
-Shigella
-Acinetobacter & Anaerobes
99
What formulations of Tigecycline are available?
IV or IM
100
Vancomycin is classified as a _____, and is the DOC for ____.
glycopeptide ; MRSA
101
MOA of Vancomycin?
Binding to D-Ala-D-Ala residues of PDG precursors & inhibits cell wall synthesis.
102
Vancomycin resistance?
-VRE
-VISA
-S. aureus
103
Vancomycin spectrum of activity?
GRAM POSITIVES!!!
-Enterococci
-PRSP
-MRSA
-Clostrioides
-Some Bacilli
104
Oral Vancomycin is reserved for what type of infection?
C. difficile... Not orally absorbed. IV is for serious infections.
105
Vancomycin s/e's?
-Nephrotoxicity
-Ototoxicity
-Red Man Syndrome (due to lengthened infusions)
-Granulocytopenia
106
Similar drugs to Vancomycin?
Teicoplanin, Daptomycin
107
Major s/e of Daptomycin administration?
Myopathy
108
Aminoglycoside AB's?
Streptomycin, Gentamicin, Tobramycin, Amikacin
109
MOA of Aminoglycoside AB's?
Inhibition of bacterial protein synthesis ; Inhibit 30S ribosomal subunit.
110
Aminoglycoside resistance?
-Mutation / Methylation of 16s rRNA binding site
-Enzymatic destruction of drug
-Lack of drug molecule permeability
-Active drug efflux
111
Major downside of Aminoglycoside AB's?
-Only a spectrum of activity against Aerobic GN's!!! Require something that destroys bacterial cell walls to have any GP spectrum of activity.
112
Aminoglycosides demonstrate synergistic effects with what AB's?
Penicillins... Against Enterococci & Streptococci.
113
What is Streptomycin normally reserved for?
Tuberculosis (M. tuberculosis infection)
114
Formulations available for Aminoglycosides?
IV & IM (not orally absorbed)
115
T or F: Aminoglycosides are great agents for Meningitis because of their enhanced tissue penetrance.
FALSE (!!!)... Penetrate tissues relatively poorly.
116
Primary toxicity demonstrated with Aminoglycosides?
Nephrotoxicity... Requirement of dose adjustments with those who have renal dysfunction.
117
Other adverse s/e's with Aminoglycosides?
-Ototoxicity
-Neuromuscular Blockade
-Allergies (rare)
-Drug Interactions with other Nephrotoxic / Ototoxic / NM Blocking Agents.
118
What AB class (***because of being well absorbed orally & having broad spectrum coverage***) is largely misused in community Pharmacy?
Fluoroquinolones
119
Fluoroquinolone drugs?
Ciprofloxacin, Levofloxacin, Moxifloxacin
120
How do Fluoroquinolones work?
Inhibit DNA Gyrase / Topoisomerase II & IV
121
BS or BC: Fluoroquinolones?
Bactericidal (Concentration-Dependent Killing)
122
Fluoroquinolone resistance?
-A / B Subunit alteration of DNA Gyrase
-ParC / ParE mutation of Topo IV
-Outer Membrane Permeability changes
-Efflux Pumps
123
Fluoroquinolone spectrum of activity?
-GN's (Haemophilus, Neisseriae, Chlamydiae)
-P. aeruginosa (Cipro best)
-S. pneumoniae (Levo & has better GP spectrum)
-Anaerobes (Moxi)
124
Of the Fluoroquinolones (Ciprofloxacin, Levofloxacin, Moxifloxacin), which one is best for P. aeruginosa infection?
Ciprofloxacin
125
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?
Moxifloxacin
126
Uses for Fluoroquinolones?
-UTI's
-STI's
-LRTI's
-Enteritis / Travelers Diarrhea
-Resistant Mycobacterial Infections
127
T or F: Fluoroquinolones possess excellent oral bioavailability.
True
128
Formulation types for Fluoroquinolones?
-IV or Orally (Parenteral use not as common)
129
How are Fluoroquinolones eliminated?
Cipro / Levo: Renal Pathways
Moxi: Biliary Pathways
130
S/E's of Fluoro's?
-NVD
-Insomnia / Headaches / Dizziness
-CNS Effects (ie. Seizures)
-Skin Rash
-Impaired Liver Function
-Prolonged QTc Interval
-Hypo/Hyperglycemia
-C. difficile Infection
-Peripheral Neuropathy
131
Other unique Fluoro s/e?
Tendinitis / Tendon Rupture (young & old more susceptible)
132
Other unique Fluoro s/e?
Tendinitis / Tendon Rupture (young & old more susceptible)
133
Patient subtypes at higher risk of tendon rupture / tendonitis due to Fluoroquinolone usage?
-Concurrent use of steroids
- >60yrs of age
-Females
134
Drug Interactions with Fluroquinolones?
-Di & Trivalent Cations
-QTc Prolonging Agents
-CYP1A2 Metabolized Drugs (ie. Clozapine, Duloxetine, Methotrexate, Quinapril, Rasagiline, Ropinirole, Varenicline)
-Warfarin (increased INR)
135
Reserve Fluoroquinolones for what patient cases?
-Organismal Resistance
-Situations where DOC's can't be used
-Children < 18yrs
136
Sulfamethoxazole MOA?
Competitive Inhibition of DHF Acid Synthesis
137
Trimethoprim MOA?
Binds to DHF Reductase & inhibits DHF Acid --- Tetrahydrofolic Acid reduction.
138
TMP/SMX spectrum of activity?
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
Uses of TMP/SMX drug therapies?
-UTI's
-MRSA-related skin & soft tissue infections
-Pneumocystitis Jirovecii Pneumonia (PJP)
140
TMP/SMX s/e's?
-Skin Rash
-Hypersensitivity
-Headaches
-NVD
-Bone Marrow Suppression
-Hyperkalemia / Hyponatremia
-Photosensitivity
141
TMP/SMX Drug-Drug Interactions?
-Carvedilol / Digoxin / Phenytoin (acts as a CYP2C9 Inhibitor & CYP3A4 Substrate)
-Warfarin (increased INR & bleeding)
-Hypoglycemic Agents (increased risk)
-Drugs that increase K+ levels
142
What trimesters of pregnancy is TMP/SMX therapies contraindicated in?
1st & 3rd
143
MOA of Metronidazole?
Possibly inhibition of nucleic acid synthesis & DNA disruption
144
Metronidazole spectrum of activity?
-Anaerobes (including C. difficile)
-Protozoa sp. (Trichomonas, Giardia)
***Resistance to Propionibacterium!!!***
145
Benefit of Metronidazole?
Excellent oral bioavailability... Also available IV.
146
Metronidazole s/e's?
-NVD / GI Distress
-Metallic Taste
-Headache
-Dark Urine
-Peripheral Neuropathy
-Insomnia
-Stomatitis
147
Unique s/e of Metronidazole?
Disulfiram-like rxn with alcohol... Makes pt. feel extremely ill (even with vaginal use).
148
Drug-Drug Interactions with Metronidazole?
-Alcohol
-Warfarin (increased INR & bleeding)
149
Linezolid MOA?
Inhibits bacterial protein synthesis
150
Bacteriostatic or Bactericidal: Linezolid?
Bacteriostatic (but Bactericidal against Streptoccci).
151
Linezolid spectrum of activity?
-Streptococci
-Enterococci (including VRE)
-Staphylococci (including MRSA)
152
What cases do we reserve Linezolid for?
Multi-Drug Resistant Organisms
153
What drug is Linezolid an alternative therapy for?
Vancomycin
154
Downside of Linezolid therapies?
Extremely expensive
155
Linezolid formulations available?
IV & Oral
156
Linezolid s/e's?
-NVD
-Headache
-Rash
-Myelosuppression
-Increased need for Liver Function Tests (LFT's)
-Optic / Peripheral Neuropathy
-Lactic Acidosis
-Decreased Seizure Threshold
157
Drug-Drug Interactions of Linezolid?
-SSRI's / MAOI's (increased Serotonin Syndrome risk)
-Rifampin (decreases Linezolid levels)
158
What percentage of AB prescriptions in Canada are considered to be inappropriate?
30% all cases ; 50% for Respiratory Infections
159
Consequences of inappropriate AB prescribing?
-More severe illnesses & longer recovery
-May require hospitalization or prolong it
-More HCP visits
-Requirement to use more toxic AB's
-More deaths
160
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?
4 / 10
161
Role of a Pharmacist in promoting Anti-Microbial Stewardship?
-Determining if AB is needed in the 1st place
-Narrow >>> 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
Of a cohort of 10 000 patients, how many had true IgE-medicated penicillin allergies? Cephalosporin cross reactivity? True anaphylaxis?
i) < 100 / 10 000 (IgE-Medicated Allergy)
ii) 1-3 / 10 000 (Cephalosporin Cross Rxn)
iii) 1 / 10 000 (True Anaphylaxis)
163
Scenarios in which patients may be allergic to Beta Lactam AB's?
1) Beta Lactam Ring itself (pt. then allergic to all Beta Lactams)
2) Side Chains (allergy would then be drug specific)
164
Adverse Penicillin events?
-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
Severe Penicillin effects?
-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
Effects of true IgE mediated Penicillin allergy?
-Itchy Rash / Hives
-Angioedema / Hypotension / Bronchospasm
-Anaphylaxis (< 1hr after dose)
***LIFE-THREATENING SITUATION!!!***
167
How do we manage anaphylactic rxn's to Penicillin?
-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
What are some common reactive positions within Sulfa drugs that patients may be allergic to?
-Arylamine (N4 position)
-Nitrogen Containing Ring attached to N1 Nitrogen of Sulfonamide functional group
169
Rates of allergic rxn's to AB Sulfa's / Non-AB Sulfa's?
AB Sulfa's: 4.8%
Non-AB Sulfa's: 2%
170
Common drugs that contain Sulfonamide functional groups?
-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
Sulfa rxn types?
-Immediate IgE-Mediated Anaphylaxis (rare)
-Delayed Cutaneous Rxn's (more common)
172
Describe demonstrated cutaneous rxn's to Sulfa drugs.
-Fever followed by a Maculopapular or Morbilliform Rash that may also result in SJS or TENS.
