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Unit 6 Pharm - MEEE > ANTIBIOTICS II > Flashcards

ANTIBIOTICS II Flashcards

1
Q

lipoglycopeptides are analogues of

A

Vancomycin

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2
Q

What are the lipoglycopeptides?

A

Dalbavancin, Telavancin and Oritavancin - they all have vanco in their names.

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3
Q

What is their spectrum?

A

MRSA
Coag negative staph
Strep
Enterococcus

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4
Q

What are the lipoglycopeptides used for?

A

skin and soft tissue infection w. MRSA

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5
Q

What is the most important side effect of Telavancin?

A

nephrotoxicity - Daptomin

Metallic taste, nausea

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6
Q

What is a pearl about the lipoglycopeptides?

A

more bactericidal than vancomycin

Their half life is very long (2oo h) - on the bad side you have low levels of the drug hanging around forever

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7
Q

Which of the three are you most concerned about resistance?

A

Dalbavancin and Oritavancin due to their long half lives

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8
Q

mech of action of Daptomycin

A

insertion into the gram-positive cell membrane causing depolarization and ultimate cell death

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9
Q

Spectrum of Daptomycin

A

GRAM POSITIVES: MSSA, MRSA, coag negative staph, enterococcus (VRE)- alternate to Vancomycin
—expensive

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10
Q

What are the side effects of Daptomycin?

A

myalgia that can result in rhabdomyolysis [or eosinophilic pneumonia]
===> not good for pulmonary infections

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11
Q

Mech of action of the aminoglycosides (gentamycin, amikacin, streptomycin)

A

Bind 30S subunit of bacterial ribosomes

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12
Q

Spectrum of aminoglycosides

A

GRAM NEGATIVES, Pseudomonas

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13
Q

what conditions are aminoglycosides used to treat?

A

GRAM NEGATIVE SEPSIS (from urinary source)

  • poor penetration into the brain, unless you send it directly into the CSF
  • must be used synergistically with a big drug.
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14
Q

what are the side effects of aminoglycosides?

A 
ototoxicity and renal dysfunction
NEUROMUSCULAR blockade (avoid in MS patients)
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15
Q

what is special about the aminoglycosides?

A

conc-dependent - Cmax: MIC ratio is 8-10x MIC to get results and extended interval dosing is less nephrotoxic than when given every 8h or every 12h

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16
Q

Tetracyclines include

A

doxycycline, minocycline and tetracycline

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17
Q

MOA of tetracyclines

A

bind to 30S ribosomal subunit of bacterial ribosomes

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18
Q

What is the spectrum of tetracyclines

A

ATYPICALS (Mycoplasma, Rickettsia…)
community acquired MRSA
Limited gram negatives

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19
Q

What conditions do you use tetracyclines for?

A

tick-borne illnesses, uncomplicated URI and community acquired infections

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20
Q

What are the side effects of tetracyclines?

A

GI
PHOTOTOXICITY (sunburn)
discolored teeth
pill esophagitis

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21
Q

what are some important drug interactions to watch out for?

A

chelates divalent cations (Ca, Mg, Fe) that reduces the availability of the drugs

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22
Q

Glycylcyclines include

A

Tigecycline

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23
Q

MOA of Tigecycline

A

binds to 30S ribosome with glycyl side chain prevents efflux that causes resistance with other tetracyclines

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24
Q

What is the spectrum of Tigecycline?

A

ATYPICALS, broad spectrum and some gram negative holes including Pseudomonas

25
Q

When do you use Tigecycline?

A

it is a “back-pocket” drug for multi-drug resistant infections or polymicrobial infections where a single agent is desired

  • –intra-abdominal infection
  • –multi-drug resistant carbapenem-resistant enterobacteriaceae (CRE) - but it ends up more in the tissue than in the blood
26
Q

what are the side effects of Tigecycline?

A

N/V, diarrhea

27
Q

When do you NOT use Tigecycline?

A

bacteremia - due to large volume of distribution

28
Q

Which antibiotic has a black box warning of its increased all cause mortality?

A

Tigecycline

29
Q

The Macrolides include

A

Azithromycin, Clarithromycin, Erythromycin

30
Q

MOA of macrolides

A

reversibly bind to 50S of ribosome

31
Q

What is the spectrum of the macrolides?

A

ATYPLICALS - w. beta lactam for URI
Strep (big problem w. resistance)
gram negatives (respiratory pathogens)

32
Q

Where are Macrolides used?

A

respiratory tract infections and HIV patients

33
Q

What are the side effects?

A

GI

34
Q

Macrolide pearls

A

erythromycin and clarithromycin are strong inhibitors of CYP 3A which increase conc of 3A substrates such as must statins

35
Q

Clindamycin MOA

A

binds 50S ribosome and is used for ANEROBES (B. fragilis),
gram positives
Toxoplasma
Plasmosium falciparum

36
Q

Which antibiotic could be used to treat Malaria?

A

Clindamycin

–for oral infections

37
Q

What are the side effects of clindamycin?

A

Pseudomembranous colitis (C, diff)

38
Q

LECTURE 3: Linezolid and Tedizolid belong to which category?

A

Oxazolidinones: Tidezolid

39
Q

uses of Linezolid?

A
  • -gram positives only - alternate therapy - MRSA
  • -VRE bacteremia (or Daptomycin
  • alt to vanco
40
Q

Are there any drug interactions that we should be worried about with Linezolid?

A

REVERSIBLE inhibitor of MAOIs - has resulted in serotonin syndrome w. patients receiving other serotonergic agents. Just monitor it

41
Q

What are rare side effects of linezolid

A

thrombocytopenia
peripheral neuropathy (w. long term use-weeks)
-optic neuropathy
-lactic acidosis
-black hairy tongue
***reversible myelosuppression (thrombocytopenia)

42
Q

who are the nucleic acid inhibtiors?

A

quinolones, metronizadole, rifampin

43
Q

quinolones inclue

A

ciprofloxacin, levofloxacin or moxifloxacin

44
Q

MOA of quinolones

A

inhibit DNA gyrase or topoisomerase IV

45
Q

moxifloxacin and levofloxacin are termed what?

A

respiratory quinolones - activity against S. pneumo

46
Q

in addition to S. pneumo, what is the spectrum of the quinolones?

A

ATYPICALS
Gram negatives
outpatient: Cipro and levofloxacin

47
Q

which is the only quinolone to have ANEROBIC activity?

A

Moxifloxacin

48
Q

In addition to resp tract infections, what other conditions are quinolones used to treat?

A

UTIs and

bone/joint infections- Rifampin

49
Q

What are some side effects of quinolones?

A

GI, CNS, QT prolongation and tendon rupture

C. dificile (NAP-1 strain)

50
Q

Which antibiotic could exacerbate myasthenia gravis?

A

Quinolones

51
Q

Metronidazole is used to treat what conditions

A

C. dificile but they are not good for actinomycetes (penicllin)
Trichomoniasis

52
Q

What are the side effects of metronidazole?

A

Metallic taste and Disulfaram raction w. alcohol

peripheral neuropathy, seizures

53
Q

What are the bacterial antimetabolites?

A

Trimethoprim-Sulfamethoxazole (Bactrim)

54
Q

What is the special coverage for TMP/Sulfa?

A

Drug of choice of Stenotrophomonas
Toxoplasmosis, nocardia, pneumocystis (immunosuppressed)
LISTERIA (ampicillin if not allergic)

55
Q

Clinical uses of bactrim?

A

prophylaxis of Pneuomocystis jirovecii pneumonia

56
Q

What are the side effects of TPM/Sulfamethoxazole?

A
  1. stevens-johnsons syndrome, toxic epidermolysis necrosis
  2. bone marrow suppression (agranulocytosis)
  3. kidneys - pseudo renal failure - acute interstitial nephritis from sulfamethazole
  4. Hyperkalemia - TPM essentially acts as K+ sparing diuretic
57
Q

What are the drug interactions w. Bactrim?

A

Warfarin leads to increase in INR

58
Q

What condition is Bactrim used to treat?

A

uncomplicated cystitis and PCP prophylaxis

59
Q

treating pseudomonas while getting into the brain

A

ceftazidime
cefipime
meropenem

Unit 6 Pharm - MEEE (12 decks)

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