Antimicrobial Review Flashcards
Exam 4
These are broad spectrum not usually used to treat gram (-) UTIs.
Tetracyclines
List 3/6 other usefulness for tetracyclines
chlamydia, mycoplasma, rickettsia, cholera, anthrax, acne vulgaris
Top 3 tetracycline drugs
TCN, doxycycline, minocycline
What are the common doses for doxy- and mono cycyline
100 mg 2x/day for 10 days
What reduces the oral absorption of tetracycylines?
dairy products, antacids
Does TCN have an anti-inflammatory action?
Yes
T/F, doxycycline levels are affected by renal disease
F
Who are tetracyclines contraindicated in?
pregnant women, children <8
What are the adverse effects of tetracycline?
photo-sensitivity, Gastric/GI upset
This is considered a glycylcyclines reserved for resistant staph and strep infections.
Tigecycline
What are the adverse effects of tigecycline?
more nausea and vomitting
These are used in serious gram negative infections, like septic shock, with a gram positive abx.
aminoglycosides
Since aminoglycosides are poorly absorbed in the GI tract, how are they given?
parenteral
Top 4 aminoglycosides
amikacin, gentamicin, tobramycin, neomycin
What are the toxicities of aminoglycosides?
ototoxic, nephrotoxic, toxicity increased by loop diuretics
These abx have good gram (+) coverage and are safe in pregnancies and peds.
Macrolides
What abx is similar to tetracyclines?
macrolides
What are the other useful tx of macrolides?
chlamydia, legionella, mycoplasma, treponema, helicobacter, diphtheria
What is the most commonly used macrolides?
Azithromycin
This group of abx has a broader spectrum of action, less bacterial resistance
ketolides
This is the current choice of ketolides
telithromycin
What are the macrolide toxicities?
GI upset (motilin-lie effects), and drug interactions, liver toxicity, ototoxicity
This drug classes main indication is c diff and acts against bacterial transcription
macrolide derivative - Fidaxomicin
Since lincomycin is too toxic, this drug is given and is especially good against anaerobes
clindamycin
What does clindamycin not work against?
c diff
Besides c diff, what are the other risks of clindamycin?
liver fx impairment, neutropenia
What are the abx who have the greatest risk for c diff?
clindamycin, amoxicillin, ampicillin, cephalosporin, fluoros
Choramphemicol is a broad spectrum abx seldomly used and its greatest risk are?
bone marrow suppression, aplastic anemia, neonatal toxicity, drug interactions
This abx is a part of the new class of bacteriostatic againt gram (+) aerobes and anaerobes given oral and IV for vancy resistant organisms.
Linezolid
These are bacteriocidal for most organisms IV use only for vancy resistant. Cause arthralgia, myalgia, and hyperbili
quinupristin, dalfopristin
These inhibit nucleic acids
fluoros
This is a second generation fluoro used alot for gram (-), atypical coverage, and some (+) coverage
cipro
This is a commonly used 3rd generation agent; has better gram (+) coverage
levofloxacin
This is a 4th generation fluoro with better gram (+) and anaerobic coverage but less useful against atypicals
moxifloxacin
Why do we avoid fluoros in <18 and pregnancy?
damage cartilage, preg is tech class C
What tendon issue is common in fluoro use? and who does it effect
achilles tendon damage/rupture; >60 y/o and corticosteroid use
What is a black box warning regarding CNS adverse effects of fluoros?
increase symptoms of MS; can also cause insomina and lower seizure threshold
What is the FDA recommendation for using fluoros?
don’t use them to treat minor infections
These abx inhibit folate biosynthesis/inhibit metabolism?
sulfonamides, trimethoprim, co-trimoxazole
What is the generic term for sulfonamide analogs?
PABA
This is the most commonly utilized sulfa drug; used for UTIs, prostatic infections, alt adjunct
cotrimoxazole
What percentage of ppl have a sulfa class allergic reaction?
5%
When are sulfonamides contraindicated?
< 2 mos old, late pregnancy, concurrent use with methenamide
What 3 “other” abx help with UTIs?
methenamine, nitrofurantoin, nitrofurantoin monohydrate
What abx is useful in uncomplicated cystitis?
methenamine
When do you avoid using methenamine?
liver & kidney probs, with sulfa drugs, upper UTI
This “other abx” has a limited spectrum of action, discolors urine (makes it really brown), and cause rare complications.
nitrofuratoin
What are the big two mycobacterium that cause TB?
mycobacterium TB, mycobacterium bovis
To tx leprosy, what do you use?
dapsone
What are the adverse effects of dapsone?
hemolysis, peripheral neuropathy
When can TB affect every organ system?
in the late stages
Conversion of latent TB becomes active TB happens in these immunosuppressed states?
corticosteroid therapy, chemo, immunosuppression therapy
What is the popular TB tx 6 month regimen?
intensive phase: 1-2 mos consolidation phase (3-6 mos)
What are the INH toxicities?
peripheral neuritis, hepatitis/liver tox, drug interactions
This TB tx is well tolerated can cause nausea and rash and interactis wit CYP induction drugs ESPECIALLY ORAL CONTRACEPTION
rifampin
When this drug is combined with Rifampin, there is a significant risk of liver tox!
pyrazinamide
What two fluoros are used to tx TB?
moxifloxacin, gatifloxacin
