Antibiotics/Antivirals/Anti-fungals Condensed Version Flashcards
Sulfonamides MOA
inhibits synthesis of tetrahydrofolic acid
Sulfonamides bacteriostatic or bactericidal
bacteriostatic
Sulfonamide meds
Sulfamethoxazole, trimethoprim
Sulfonamide Use
UTIs - E. Coli
MRSA
Sulfonamide side effects
Photosensitivity, stevens-johnson syndrome, itching, rash, thrombocytopenia, neutropenia, renal damage
Sulfonamide implications
Decrease sun, increase water, teratogenic (moms, <2 months), monitor BS in DM patients
Penicillin bactericidal or bacteriostatic
bactericidal
Penicillin MOA
weaken bacterial cell wall
Penicillin meds
- Narrow (s): penicillin G/V
- Narrow (r): nafcillin
- Broad: ampicillin, amoxicillin
- Extended: piperacillin
Penicillin uses
skin, ear, urinary, STIs, pneumonia, meningitis
Penicillin side effects
Allergic reaction: anaphylaxis, rash itching, hives
Broad: rash/diarrhea
Penicillin implications
PO: empty stomach
IM: prescribed in units, aspirate
Keep epi/resp support for 30mins
Cephalosporins bacteriostatic or bactericidal
bactericidal
Cephalosporin MOA
weaken bacterial wall
Cephalosporin med
increase activity against gram (-) bacteria, resistance to beta-lactamases, and ability to reach CSF/cross BBB with each new generation
Ceph generations
- cefazolin
- cefotetan
- ceftriaxone
- cefepime
- ceftaroline
Cephalosporin use
meningitis, MRSA
Cephalosporin side effects
CEF the GIANT
Cephalosporin implications
- use cautiously with renal insufficiency
- rotate IVs to avoid thrombophlebitis
Vancomycin bactericidal or bacteriostatic
bactericidal
Vancomycin MOA
weakens cell wall
Vancomycin use
CDI, MRSA, alt/PCN, reserve for severe infections
Vancomycin side effects
Ototoxic, nephrotoxic, red person syndrome (flushing, rash, itching, tachycardia, hypotension)
Vancomycin implications
- infuse slowly
- 10-20mcg/mL range
- Avoid alcohol
Tetracyclines bacteriostatic or bactericidal
bacteriostatic
Tetracycline MOA
inhibit protein synthesis
Tetracycline meds
doxycycline, minocycline
Tetracycline use
Chlamydia, acne
Tetracycline side effects
GI, teeth stain, suppress bone growth, CDI superinfection, hepatotoxic, nephrotoxic, photosensitivity
Tetracycline implications
- no antacids or milk
- teratogenic (moms, <8 y/o)
- don’t give if renal insufficient
- Empty stomach, w/food for GI distress
- sunscreen
Macrolides bacteriostatic or bactericidal
bacteriostatic
Macrolides MOA
inhibit protein synthesis
Macrolides meds
erythromycin, azithromycin, clarithromycin
Macrolides use
Respiratory: pneumonia, sinus
Skin: chlamydia, ear
Alt/PCN
Macrolides side effects
QT prolongation, hepatotoxic, GI
Macrolides implications
- avoid antacids and antidysrhythmic drugs
- w/food for GI distress
Oxizolidinones bacteriostatic or bactericidal
bacteriostatic
Oxizolidinones meds
linezolid
Linezolid MOA
inhibit protein synthesis
Oxizolidinones use
VRE, MRSA
Oxizolidinones side effects
myelosuppression - decreased bone marrow activity
Oxizolidinones implications
- monitor CBC for myelosuppression
- avoid MAO inhibitors, tyramine, SSRIs
Clindamycin MOA
inhibits protein synthesis
Clindamycin use
MRSA, alt/PCN
Clindamycin side effects
CDI
Clindamycin implications
monitor liver, educate on CDI
Aminoglycosides bacteriostatic or bactericidal
bactericidal
Aminoglycosides MOA
inhibits protein synthesis
Aminoglycosides med
gentamycin
Aminoglycosides Use
serious aerobic gram (-) infections
Aminoglycoside side effects
ototoxic, nephrotoxic
Aminoglycosides implications
- monitor peaks and troughs
- daily IV preferred - decrease ototoxicity
Fluoroquinolones MOA
inhibit DNA/RNA
Fluoroquinolones meds
ciprofloxacin, levofloxacin
Fluoroquinolones Use
respiratory, UTI, GI infections
Fluoroquinolone side effects
photosensitivity, tendon rupture
Fluoroquinolones implications
- sunscreen
- no milk, antacids, cationic compounds
Metronidazole MOA
inhibits bacterial DNA gyrase
Metronidazole use
CDI, gardnerella vaginalis, H pylori
Metronidazole side effects
neurotoxic, metallic taste, hepatotoxic, urine discoloration
Metronidazole implication
no alcohol - disulfiram reaction
Isoniazid MOA
inhibit growth of mycobacteria
Isoniazid use
active and latent TB
Isoniazid side effects
hepatotoxic, peripheral neuropathy (treat with pyridoxine, vitamin B), optic neuritis, anemia
Isoniazid implications
- monitor liver enzymes
- no alcohol
Rifampin MOA
destroys DNA/RNA
Rifampin Use
TB, MRSA
Rifampin side effects
hepatotoxic, red/orange body fluids
Rifampin implications
- contraindicated w/liver disease
- minimize alcohol
- monitor liver
- drug interaction w/birth control
Pyrazinamide MOA
inhibits growth of mycobacteria
Pyrazinamide use
TB
Pyrazinamide side effects
hepatotoxic, hyperuricemia
Pyrazinamide implications
- monitor liver
- liver and kidney tests frequently
Ethambutol MOA
inhibit growth of mycobacterium
Ethambutol use
TB and resistant TB
Ethambutol side effects
optic neuritis, hyperuricemia, not hepatotoxic
Ethambutol implications
educate on optic neuritis
monitor hyperuricemia
Amphotericin B MOA
increase cell membrane permeability
Amphotericin B use
systemic mycoses, IV only, not absorbed well through intestine
Amphotericin B side effects
nephrotoxic, hypokalemia, hypomagnesemia, highly toxic, infusion reaction (fever, chills, nausea, headache)
Amphotericin B implications
- monitor urine output
- 1000mL normal saline day of meds
- pretreat with diphenhydramine and acetaminophen
- infuse slowly over 2-4 hrs
- IV only
- monitor potassium levels
Itraconazole/fluconazole MOA
inhibits fungal cytochrome
Itraconazole/fluconazole route
PO, topical, alt for ampho-b
Itraconazole/fluconazole use
systemic mycoses + superficial fungal infections
Itraconazole/fluconazole side effects
Decreased HR, hepatotoxic, drugs that decrease gastric acidity reduce PO absorption
Itraconazole/fluconazole implications
- educate on GI effects + drug interactions
- monitor liver + HR
AZT/Zidovudine MOA
early termination of DNA strand
AZT/Zidovudine use
HIV/AIDS - choice of drugs
AZT/Zidovudine side effects
Severe anemia, neutropenia, liver damage, lactic acidosis w/hepatomegaly
AZT/Zidovudine implications
monitor liver + CBC
Lopinavir/ritonavir, fosamprenavir MOA
cleaves bonds in polyprotein to keep virus immature and noninfectious
Lopinavir/ritonavir, fosamprenavir use
HIV
Lopinavir/ritonavir, fosamprenavir side effects
Hyperglycemia, DM, lipodystrophy, hyperlipidemia
Lopinavir/ritonavir, fosamprenavir implications
- high fat meals can increase toxicity
- monitor liver, lipids, glucose
- take on empty stomach at night
Efavirenz MOA
direct inhibition
Efavirenz use
HIV
Efavirenz side effects
CNS: insomnia, depression, HA, impaired consciousness
Hepatotoxic
Teratogenic
Efavirenz implications
- do not take if pregnant/trying
- empty stomach at night
- monitor liver
- high fat meals can increase toxicity
Raltegravir MOA
prevent integration into DNA
Raltegravir use
HIV and resistant HIV
Raltegravir side effects
hepatotoxic, elevation in serum amylase + lipase (pancreatic issues)
Raltegravir implications
- take w/wo food
- monitor liver + pancreas
Acyclovir MOA
inhibit replication by suppressing DNA
Acyclovir use
HSV: type 1 (mouth) type 2 (genital)
VZV
Acyclovir side effects
IV: reversible nephrotoxicity, hepatotoxic
PO: GI distress, vertigo, HA
Topical: stinging
Acyclovir implications
- monitor renal lab levels
- no cure, just diminish symptoms and decrease length of illness
- use condoms
Valacyclovir route
PO only
Influenza vaccine side effects
- injection site redness/pain
- Fever, malaise, mylagia 1-2 days
- LAIV: runny nose, congestion
- Risk for Guillain-Barre syndrome
Influenza vaccine implications
- protection 1-2 wks post vaccine
- Defer if febrile illness
- do not give LAIV to immunocomporomised
- 6 months + should be vaccinated annually
- 6mo-8years should have 2 vaccines, 1 month apart if they have never been vaccinated
- precaution: pt. with hypersensitivty/anaphylatic reaction to eggs
Influenza medication routes
PO: oseltamivir, amantadine, rimantadine
Inhalation: zanamivir
Influenza medications use
Oseltamivir+zanamivir: flu A+B, prophylaxis
Influenza meds side effects
GI distress, neuropsychiatric effects in young, cough, sore throat
Influenza med implications
Start no later than 2 days after symptoms begin