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Pharmacology > Antibiotics Cont. > Flashcards

Antibiotics Cont. Flashcards

1
Q

Class: Sulfonamides

A
  • 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

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2
Q

Sulfonamides Cont.

A
  • 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

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3
Q

Silver Sulfadiazine (Silvadene)

A
  • 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)
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4
Q

Trimethoprim/sulfamethoxazole (BACTRIM)

A
  • 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

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5
Q

Trimethoprim/sulfamethoxale (BACTRIM) Cont.

A

a/e:

  • GI (n/v)
  • Rash
  • Hyperkalemia
  • Hypersensitivity reactions (Stevens-Johnson syndrome)
  • Kernicterus (stop drug when excessive bilirubin)
  • Blood dyscrasias
  • Renal damage: crystalluria
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6
Q

Which drugs are used for UTIs?

A

TMP/SMZ (Bactrim)

Nitrofurantoin

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7
Q

Nitrofurantoin (Macrodantin)

A
  • Urinary tract antiseptics
  • Low concentrations: Bacteriostatic
  • High concentrations: Bactericidal

Uses: Lower UTIs (bladder/urethra), prophylaxis, recurrent lower UTIs

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8
Q

Nitrofurantoin (macrodantin) cont.

A

a/e:

  • GI effects
  • Pulmonary rxns
  • Hematologic effects
  • Peripheral neuropathy*
  • Hepatotoxicity
  • Birth defects
  • Brown discoloration of urine is normal a/e*

GIVE WITH FOOD

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9
Q

Acute Cystitis

A
  • 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
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10
Q

Acute Uncomplicated Pyelonephritis

A
  • 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

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11
Q

Acute Bacterial Prostatis

A
  • 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
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12
Q

Class: Fluoroquinolones

“BIG GUNS” - saved for last

A
  • 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
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13
Q

Ciprofloxacin (Cipro)

A
  • 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
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14
Q

Ciprofloxacin cont.

A

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)
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15
Q

Ciprofloxacin Cont…..

A

-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)
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16
Q

Metronidazole (Flagyl)

own class?

A

-Bactericidal

  • Uses:
  • Protozoal infections
  • Infections caused by obligate anaerobes
  • H. pylori
  • **C. diff (severe C. diff = vancomycin)

A/E:

  • Neurotoxicity
  • Allergy
  • superinfections
17
Q

Amphotericin B (Abelcet)

own class?

A
  • 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
18
Q

Class: Azoles

A
  • Broad-spectrum antifungal drugs

- lower toxicity and can be given by mouth

19
Q

Itraconazole (Sporanox)

A
  • 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
20
Q

Ketoconazole (Nizoral)

A

-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

21
Q

Fluconazole (Diflucan)

A
  • 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)
22
Q

Clotrimazole

A

-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
23
Q

Class: Nystatin (Mycostatin)

A
  • 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)

Pharmacology (17 decks)

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