Antibiotics Cont. Flashcards
Class: Sulfonamides
- Broad-spectrum antibiotics
- Suppress bacterial growth by INHIBITING TETRAHYDROFOLIC ACID, a derivative of folic acid or folate
-DOC: UTI
(90% of UTIs from E. coli
*Other uses: nocardiosis, C. trachomatis, conjugation therapy for toxoplasmosis/malaria, ulcerative colitis
Sulfonamides Cont.
- A/E:
- hypersensitivity reactions (Stevens-Johnson syndrome)
- hematologic effects
- kernicterus
- renal damage from crystalluria
- Microbial resistance
- many bacterial species developed resistance (gonococci, meningococci, streptococci, shigella)
-Do not give to: Pt’s more than 32 weeks pregnant and infants less than 2 months old
Silver Sulfadiazine (Silvadene)
- Use: to suppress bacterial colonization in patients with 2nd and 3rd degree BURNS
- Application usually pain free
- Systemic absorption
- Blue-green or blue-gray discoloration of the skin (AVOID ON FACE)
Trimethoprim/sulfamethoxazole (BACTRIM)
- Inhibits sequential steps in bacterial folic acid synthesis, making it much more powerful than TMP or SMZ alone
- Allergies!!!
- DOC: Acute UTI (7-day therapy)
Other uses: Bronchitis, shigellosis, pneumonia caused by P. jiroveci, Pneumocystis Pneumonia (PCP), GI infection
Trimethoprim/sulfamethoxale (BACTRIM) Cont.
a/e:
- GI (n/v)
- Rash
- Hyperkalemia
- Hypersensitivity reactions (Stevens-Johnson syndrome)
- Kernicterus (stop drug when excessive bilirubin)
- Blood dyscrasias
- Renal damage: crystalluria
Which drugs are used for UTIs?
TMP/SMZ (Bactrim)
Nitrofurantoin
Nitrofurantoin (Macrodantin)
- Urinary tract antiseptics
- Low concentrations: Bacteriostatic
- High concentrations: Bactericidal
Uses: Lower UTIs (bladder/urethra), prophylaxis, recurrent lower UTIs
Nitrofurantoin (macrodantin) cont.
a/e:
- GI effects
- Pulmonary rxns
- Hematologic effects
- Peripheral neuropathy*
- Hepatotoxicity
- Birth defects
- Brown discoloration of urine is normal a/e*
GIVE WITH FOOD
Acute Cystitis
- Lower UTI that occurs most in women of child-bearing age
- s/s on ppt*
DOC:
- Uncomplicated: TMP/SMZ or Nitrofurantoin
- Resistance exceeds 20%: Fluroquinolones (ciprofloxacin, norfloxacin)
- Adherence is a concern: single-dose fosfomycin
Acute Uncomplicated Pyelonephritis
- Infection of kidneys
- Common in young children, older adults, women of child-bearing age
- s/s on ppt*
-Mild to moderate infection:
TMP/SMZ, trimethoprim alone, ciprofloxacin, levofloxacin
-Severe infection: hospitalization and IV antibiotics
Acute Bacterial Prostatis
- Inflammation of the prostate caused by local bacterial infection
- s/s on ppt.
- responds well to antimicrobial therapy. Drug selection and route depends of organism and severity
Class: Fluoroquinolones
“BIG GUNS” - saved for last
- Broad-spectrum agents with multiple applications
- Disrupt DNA replication and cell division
- s/e: generally mild but can cause TENDON RUPTURE (low risk)
- usually affects achilles tendon
- avoid in pt younger than 18
- Risk to those older than 60 who take glucocorticoids, undergone kidney, heart, or lung transplant
Ciprofloxacin (Cipro)
- Gram-negative and some gram-positive organisms
- Inhibits bacterial DNA gyrase and topoisomerase II
- DOC: Anthrax
- Infection uses: respiratory, severe UTIs, GI, bones, joints, skin, and soft tissue
- Bacterial resistance: S. aureus, Serratia marcescens, Campylobacter jejuni, Pseudomonas aeruginosa, & Neisseria gonorrhoeae
Ciprofloxacin cont.
a/e:
- Mild:
- GI: n/v, diarrhea, abdominal pain
- CNS: dizziness, headache, restlessness, confusion, rarely seizures
- Tendon rupture
- Phototoxicity (avoid sun and sun lamps)
- CANDIDA INFECTIONS: Pharynx and vagina
- Increased risk for C. diff infection
-Older adult patients:
- Confusion, somnolence, psychosis, visual disturbances
- MYASTHENIA GRAVIS (A weakness and rapid fatigue of muscles under voluntary control)
Ciprofloxacin Cont…..
-Drug and food interactions
- Cationic compounds
- Absorption reduced by:
Aluminum antacids, magnesium antacids, iron salts, zinc salts, sucralfate, MILK AND DAIRY PRODUCTS
-Elevation of drug levels:
- Theophylline (used for asthma)
- Warfarin (an anticoagulant)
- Tinidazole (an antifungal drug)
Metronidazole (Flagyl)
own class?
-Bactericidal
- Uses:
- Protozoal infections
- Infections caused by obligate anaerobes
- H. pylori
- **C. diff (severe C. diff = vancomycin)
A/E:
- Neurotoxicity
- Allergy
- superinfections
Amphotericin B (Abelcet)
own class?
- Broad-spectrum ANTIFUNGAL
- Binds to components of the fungal cell membrane, increasing permeability
- DOC for most systemic mycoses
- Highly toxic; therefore, should only be employed against infections that are progressive and potentially fatal
- a/e: infusion reactions, nephrotoxicity, hypokalemia, hematologic effects
- Monitor BUN, Creatinine every 3-4 days
- Do not give with potassium sparing diuretics
Class: Azoles
- Broad-spectrum antifungal drugs
- lower toxicity and can be given by mouth
Itraconazole (Sporanox)
- Inhibits the synthesis of ergosterol; the result is increased permeability and leakage of cellular components
- Safer than amphotericin B and can be taken orally
- DOC: blastomycosis, histoplasmosis, paracoccidioidomycosis, and sporotrichosis
- a/e: GI (n/v, diarrhea), rash, headache, abdominal pain, edema
- Serious a/e: cardiosuppression and LIVER INJURY
Ketoconazole (Nizoral)
-Active against most fungi that cause systemic mycoses, as well as fungi that cause superficial infections (dermatophytes and Candida species)
- a/e:
- n/v (give drug with food), hepatoxicity, effects on sex hormones, rash, itching, dizziness, fever, chills, constipation, diarrhea, photophobia, and headache
*Fatal hepatic necrosis
(most serious azole that affects the liver)
-Inhibits CYP3A4 and can increase levels of other drugs
Fluconazole (Diflucan)
- MOA: same as itraconazole
- Uses: blastomycosis, histoplasmosis, meningitis caused by cryptococcus neoformans and Coccidioides immitis; and vaginal, oropharyngeal, esophageal, and disseminated Candida infections.
- Can cause serious birth defects if taken in 1st trimester
- Can inhibit CYP3A4 and increase levels of other drugs (warfarin, phenytoin, cyclosporine, zidovudine, rifabutin, and sulfonylurea oral hypoglycemics)
Clotrimazole
-DOC: dermatophytic infections and candidiasis of the skin, mouth, and vagina
- a/e:
- Topical administration: stinging, erythema, edema, urticaria, pruritus, and peeling; however, the incidence is low
*Intravaginal administration: burning sensation and lower
abdominal cramps
- Oral: GI distress
- Try this topical cream before using ketoconazole PO because of the toxicity associated with oral use
Class: Nystatin (Mycostatin)
- Polyene antibiotic used only for CANDIDIASIS
- DOC: intestinal candidiasis, but can also treat candidal infections of the skin, mouth, esophagus, and vagina
- a/e
- Oral: GI disturbance (n/v, diarrhea)
- Topical: local irritation
(SWISH IN MOUTH AND SWALLOW DO NOT SPIT OUT)
