ANTIBIOTICS II Flashcards by Onecia Hannibal

lipoglycopeptides are analogues of

Vancomycin

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What are the lipoglycopeptides?

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

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What is their spectrum?

MRSA
Coag negative staph
Strep
Enterococcus

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What are the lipoglycopeptides used for?

skin and soft tissue infection w. MRSA

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What is the most important side effect of Telavancin?

nephrotoxicity - Daptomin

Metallic taste, nausea

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What is a pearl about the lipoglycopeptides?

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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Which of the three are you most concerned about resistance?

Dalbavancin and Oritavancin due to their long half lives

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mech of action of Daptomycin

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

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Spectrum of Daptomycin

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

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What are the side effects of Daptomycin?

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

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

Bind 30S subunit of bacterial ribosomes

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Spectrum of aminoglycosides

GRAM NEGATIVES, Pseudomonas

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what conditions are aminoglycosides used to treat?

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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what are the side effects of aminoglycosides?

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

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what is special about the aminoglycosides?

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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Tetracyclines include

doxycycline, minocycline and tetracycline

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MOA of tetracyclines

bind to 30S ribosomal subunit of bacterial ribosomes

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What is the spectrum of tetracyclines

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

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What conditions do you use tetracyclines for?

tick-borne illnesses, uncomplicated URI and community acquired infections

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What are the side effects of tetracyclines?

GI
PHOTOTOXICITY (sunburn)
discolored teeth
pill esophagitis

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what are some important drug interactions to watch out for?

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

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Glycylcyclines include

Tigecycline

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MOA of Tigecycline

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

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What is the spectrum of Tigecycline?

ATYPICALS, broad spectrum and some gram negative holes including Pseudomonas

When do you use Tigecycline?

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

what are the side effects of Tigecycline?

N/V, diarrhea

When do you NOT use Tigecycline?

bacteremia - due to large volume of distribution

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

Tigecycline

The Macrolides include

Azithromycin, Clarithromycin, Erythromycin

MOA of macrolides

reversibly bind to 50S of ribosome

What is the spectrum of the macrolides?

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

Where are Macrolides used?

respiratory tract infections and HIV patients

What are the side effects?

Macrolide pearls

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

Clindamycin MOA

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

Which antibiotic could be used to treat Malaria?

Clindamycin | --for oral infections

What are the side effects of clindamycin?

Pseudomembranous colitis (C, diff)

LECTURE 3: Linezolid and Tedizolid belong to which category?

Oxazolidinones: Tidezolid

uses of Linezolid?

- -gram positives only - alternate therapy - MRSA - -VRE bacteremia (or Daptomycin - alt to vanco

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

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

What are rare side effects of linezolid

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

who are the nucleic acid inhibtiors?

quinolones, metronizadole, rifampin

quinolones inclue

ciprofloxacin, levofloxacin or moxifloxacin

MOA of quinolones

inhibit DNA gyrase or topoisomerase IV

moxifloxacin and levofloxacin are termed what?

respiratory quinolones - activity against S. pneumo

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

ATYPICALS Gram negatives outpatient: Cipro and levofloxacin

which is the only quinolone to have ANEROBIC activity?

Moxifloxacin

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

UTIs and | bone/joint infections- Rifampin

What are some side effects of quinolones?

GI, CNS, QT prolongation and tendon rupture | C. dificile (NAP-1 strain)

Which antibiotic could exacerbate myasthenia gravis?

Quinolones

Metronidazole is used to treat what conditions

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

What are the side effects of metronidazole?

Metallic taste and Disulfaram raction w. alcohol | peripheral neuropathy, seizures

What are the bacterial antimetabolites?

Trimethoprim-Sulfamethoxazole (Bactrim)

What is the special coverage for TMP/Sulfa?

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

Clinical uses of bactrim?

prophylaxis of Pneuomocystis jirovecii pneumonia

What are the side effects of TPM/Sulfamethoxazole?

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

What are the drug interactions w. Bactrim?

Warfarin leads to increase in INR

What condition is Bactrim used to treat?

uncomplicated cystitis and PCP prophylaxis

treating pseudomonas while getting into the brain

ceftazidime cefipime meropenem