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PHARMACOLOGY - Pulmonary > Antimicrobial Adverse Effects (Lect) > Flashcards

Antimicrobial Adverse Effects (Lect) Flashcards

1
Q
A
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2
Q

Why do you see few drug

-drug interactions with the penicillins?

A

Metabolism of Penicillin occurs in the Kidney

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3
Q

What other ß-lactam drug are you somewhat likely to be allergic to if you are allergic to Penicillin?

A

Cephalosporins

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4
Q

Why do you suspect G.I. upset is a problem with penicillin?

  • what more serious problem can be caused?
A

Penicillin can disrupt the Microflora causing C. Diff infections

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5
Q

What are some weird effects of penicillin?

  • what patient population is this typically seen in?
A
  • Platelet function is inhibited (bleeding risk)
  • Blood Procrazia
  • Muscle membrane issues with Innervation
  • Interference with oral contraceptives

*Mostly this is seen in people with renal issues or those who are genetically predispositiond

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6
Q

Why do penicillins sometimes cause oral contraceptives to be ineffective?

A

**Rooted in Microflora DestructionTypically girl takes oral contraceptive and the following happens: 1. 1st pass metabolism occurs and Drug is pushed off into bile

  1. Bile is secreted into the colon and bacteria in the colon reverse the modifications that were made on the drug by the liver.
  2. Drug re-enters the blood and the effect of Birth contol is sustained
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7
Q

When is the major difference in areas accessible with penicillins and cephalosporins?

A

Penicillins can’t penetrate the BBB and Cephalosporins Can

  • This can cause issues
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8
Q

Why might cephalosporins cause an alcoholic to stop drinking for a day or two?

A

Can cause a Disulfuram (antidose) -like effect…This is a drug given to alcoholic so that Acetyladehyde accumulates and they vomit and get super hungover feeling

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9
Q

What are some weird effects you might see with Cephalosporins?

A
  • SIEZURES (from CNS penetration)
  • Serum Sickness Less distinctive effects:
  • Thrombotic Effects with drug at the injection site
  • GI distress if taken orally
  • Blood issues
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10
Q

What is the major difference between imipenem and meropenem?

A

Imipenem is known to cause CNS defects

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11
Q

Besides Red Man sydrome what other side effects make vancomycin unique?

A
  • Peripheral Neuropathy
  • Renal Elimination Issues
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12
Q

What drug is known to cause Rhabdomyolysis?

  • what indicates that this is happening?
A

Rhabdomyolysis results from DAPTOMYCIN (and other similar drugs) causing damage to the membrane of muscle tissue CAUSING ELEVATED CPK!

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13
Q

What are some classic adverse affects of Tetracycline?

A
  • Tooth Staining
  • Black Tongue (w/ tobacco use and bad hygiene)
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14
Q

Protein synthesis inhibitor is known to cause vertigo?

A

Minocycline

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15
Q

Rate the macrolides from greatest to least amount of Drug-Drug interactions?
- what causes these problems?

A

• Lots of drug-drug interactions because these work on CYP3A4 and bind SEMI-PERMINENTALLY

  1. Erythromycin and Telrithromycin (MOST)
  2. Clarithromycin
  3. Azithromycin (LEAST)
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16
Q

What are some adverse affects of macrolides?

A
  • Hearing Loss
  • QT prolongation (not terrible, but you don’t want to give with other drugs that elongate QT)
  • Photosensitivity
17
Q

What advese affect is common with both macrolides and tetracyclines?

A

Photosensistivity

18
Q

What is your main concern with synpristin and Dalfopristin?

A
  • Cyp Drug-Drug interactions
19
Q

What is your main concern with giving someone Clindamycin?

A
  • Hepatic Dysfunction can be caused by these drugs
20
Q

What drug is known to cause Gray Baby syndrome?
- why does it cause this?

A

Chloramphenicol - 90% is glucuronidated and Eliminated in the stool in normal people, in babies it accumulates in the liver causing SEVERE HEPATIC dysfunction

21
Q

What is another severe adverse affect of Chloramphenicol outside of gray baby syndrome?

A

* Serious Blood Dyscrasia **Aplastic Anemia**

22
Q

You are given a drug that causes Optic n. Neuropathy (loss of vision) and causes Serotonin Syndrome. What drug is this?

A

Linezolid Note: Serotinin syndrome may manifest as dilated pupils, muscle rigidity, confusion, or loss of coordination. (this is because it is an MAOI)

23
Q

What is the blackbox warning on aminoglycosides?
- what should you do to monitor these affects?

A
  • Neuro and Ototoxicity
  • Nephrotoxicity
  • Neuromuscular Blockage

• Measure Effects by:

  • Hearing Tests
  • Serum Creatinin
  • BUN
24
Q

What are the symptoms of a patient experiencing neuromuscular blockage as a result of taking aminoglycosides?

A
  • Muscle Paralysis b/c the Neuron can’t Innervate the Muscle
  • This can progress to RESPIRATORY paralysis
25
Q

What is a primary adverse reaction of TMX-SMX (Cotrimoxazole)?

A

Allergic Reactions, especially in people with HIV

26
Q

A patient goes on antibiotic therapy and a month later experiences tendonitis followed by tendon rupture. What drug do you suspect the patient was taking?
- what patients are especially susceptible to this adverse effect?

A

• Patient was most likely taking a Fluroquinolone like Ciprofloxacin

Vulnerable Populations
• Transplant Patients
• People on Coriticosteroids
• Older People

27
Q

What protein exists at the BBB and controls influx of drug into the CSF and brain?

A

P-gp (p-glycoprotein)

28
Q

What are some people who might have a compromised BBB?
- why?

A

Football Players/anyone with Chronic Inflammation

why?
• Inflammation inhibits p-gp
• less CSF so less outflow pushing the drug out of the CNS cavities

29
Q

Why can’t you just jack up the dose to get drug across the BBB?

A

You’ll get outside of the Therapeutic Window

30
Q

How does knowing that a works on the basis of concentration dependent killing, rather than time dependent killing change how you dose?

A

Concentration Dependent Killing:

  • One High Dose Periodically
  • Jacks up the Blood Conc. Killing the Bug
  • Can’t Keep conc. high for too long or you’ll kill pt.
  • Use wide intervals

Time Dependent Killing:
- Lots of small doses to keep the drug steady for long enough to kill the bug

PHARMACOLOGY - Pulmonary (30 decks)

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