Antimicrobial Adverse Effects (Pre-Study) Flashcards
What is the Drug of Choice for Syphilis?
Penicillin G
What do you give Penicillin V for?
Oropharyngeal Infections
What are the most narrow spectrum Penicillins?
- what advantage do they have?
Oxacillin, Nafcillin
*These are Penicillinase Resistant
What limits the oral bioavailability of Penicillins?
Gastric Acid may hydrolize
Which penicillins can be given parenterally?
Ampicillin
Piperacillin
Ticaracillin
(Parent’s AParTment)
How are penicillins excreted?
Unchanged in the Urine
What two penicillins undergo hepatic elimination?
Nafcillin and Ampicillin
A patient with what complications is most likely to experience adverse effects of penicillin?
Renal Failure or anything reducing kidney filtration will increase the blood concentration of Penicllins
What group of Penicillins is most likely to cause Hepatic Damage?
- what are some other WEIRD symptoms to know?
Semisynthetic Penicllins (AOA - Amoxicillin, Oxacillin, Amoxicillin)
SYMPTOMS TO KNOW:
• Granulocytopenia or Agranulosis
• Muscle Irritability
• SIEZURES
**Remember all these are way more likely to occur in renally impaired patients
Should you rely on your oral contraceptive when taking Penicilllins?
- why not?
NO
Oral Contraceptives get Glucuronated and Sulfonated by Phase II metabolism, Microflora in the Intestines convert Phase II products of OCs back to the original OC that can be absorbed. This type of Enterohepatic cyclining is relied upon to prolong the effects of OCs.
**Penicllins and other drugs that hurt your microflora will render OCs less effective
Besides penicillins, what other drugs reduce the efficacy of oral contraceptives?
- RIFAMPIN (MOST Problematic)
- Penicillin
- SMX-TMX
- Tetracyclines
- Minocycline
How are most cephalosporins administered?
- how good is their penetration into body fluids and ECF?
IV/IM
*Good penetration, especially with concurrent inflammation
How are most Cephalosporins Excreted?
- what is the main exception?
- Renally (this is no surprise as a penicillin off-shoot)
EXCEPTION:
Ceftriaxone
Which of the Cephalosporins reach high enough concentrations in the CSF to treat meningitis?
- Ceftriaxone
- Cefotaxime
- Ceftazidime
- Cefepime
What instructions should you give to patients taking oral forms of:
- Penicillins
- Cephalosporins
Penicillins - take with H2O
Cephalosporins - take with Milk or Food
What is imipenem often co-formulated with and why?
Cilastin - this reduces renal toxicity
What is special about Aztreonam?
Its ß-lactamase Resistant
How is aztreonam administered?
IV or IM
How do you administer Imipenem and Meropenem?
- Toxicity?
- Distribution?
Given IV or IM (imipenem only)
- Renal Toxicity
- Readily Distributed
What are some side effects common to all of the ß-lactams?
- Possibilities of Allergic Reactions
- Serum Sickness (type III hypersensitivies)
What are some Weird Effects of Imipenem/Cilastin?
- Meropenem?
Imipenem/Cilastin:
• C. Diff.
• Seizure
*Meropenem is must less likely to produce seizures
Why would you give Vancomycin orally?
Treatment of C. Diff. infections
How is Fosfomycin excreted?
- how is this important for what it is often used to treat?
Fosfomycin:
- excreted Renally where it is concentrated in the Urine
- often used to treat UTIs
What rare and very adverse symptom to some people taking Daptomycin experience?
- patients taking what other medicine concurrently can make this more likely to happen?
- Daptomycin
- Statins (HMG-CoA reductase inhibitors) can increase the chances of the symptoms occurring (these people should be monitored)
What are the Broad Spectrum Protein Synthesis Inhibitors?
TETRACYCLINS
• Doxycycline
• Minocycline
• Tigecycline