Antimicrobials 2 Flashcards
11 Classes that Work by Inhibiting/Altering Protein Synthesis
Aminoglycosides
Lincosamides: clindamycin
Macrolides
Oxazolindinones
Streptogramins
Tetracyclines
Glycylcycline
Fluoroquinolones
Cycliclipopeptides
Sulfonamides
Metronidazole
3 Aminoglycoside drugs
gentamycin
amikacin
tobramycin
what does aminoglycosides work well on
gram neg bacteria
what are aminoglycosides used for
complicated infections:
UTIs/pyelonephritis, gynecological infections, peritonitis, endocarditis, PNA, osteomyelitis (DM related infections)
2 severe side effects of aminoglycosides
Nephrotoxicity - usually reversible
ototoxicity - usually permenant
how do we monitor aminoglycosides
therapeutically through peak and trough levels
MOA of aminoglycosides
inhibit bacterial ribosomes stopping transcription and translation
T/F aminoglycosides are used in pregnant women
FALSE
what is gentamycin not given with
Neuromuscular blockade
be careful, can cause PROFOUND respiratory distress [myasthenia gravis]
what CNS side effects are associated with gentamycin
confusion, depression, disorientation, numbness, and tingling
what damage is associated with gentamycin
cochlear damage
ototoxicity, high-frequency hearing loss, high-pitched tinnitus
routes for gentamycin
IV; intrathecal for meningitis
Also available in ophthalmic drops, and topical ointments
route of amikacin
IV
what is amikacin used for
infactions resistant to tobramycin and gentamycin
routes of tobramycin
Inhalation for pulmonary infections (esp. CF patients)
Topical and ophthalmic solutions available
Lincosamide drug
clindamycin
is clindamycin Bactericidal or bacteriostatic–
can be either depending on concentration
MOA for clindamycin
binds to ribosomes and inhibits protein synthesis
7 indications of clindamycin
chronic bone infections,
GU tract infections, intraabdominal infections, anaerobic pneumonia, septicemia,
serious skin infections; prophylaxis for endocarditis
route of clindamycin
PO/IV
clindamycin primary use
treating pseudomembranous colitits
nursing considerations of clindamycin
Monitor use with neuromuscular blockade medications
Very toxic- monitor levels
2 macrolide drugs
erythromycin
azithromycin
S/E of macrolides
YUCK DRUGS
GI side effect profile intense
MOA of macrolides
inhibit protein synthesis by binding to ribosomes
indications of macrolides
various infections of upper and lower respiratory infections,
skin infections,
soft tissue infections;
STIs
what can be treated with macrolides
Legionnaire’s,
Listeria,
mycoplasma pneumonia
T/ F macrolides are Bacteriostatic in general, bactericidal in high enough concentrations
True
what benefits does erythomycin have
Has hypomotility benefits for diabetic gastroparesis & increase gastric motility and emptying
routes of erthromycin
PO & IV–
IV is painful, oral absorption isn’t great
Topical and ophthalmic also available
does erthromycin cross the BBB
NO
should you take erythomycin on an empty stomach
NO
does erythromycin have a lot of drug-drug interactions
YES
T/F azithromycin differs structurally from other macrolides
TRUE
Do you take a Z-pack with food
No, decreases absorption
T/F z-packs have Very good tissue penetration & long duration of action
True
Oxazolidinones drug
linezolid
MOA of linezolid
inhibits protein synthesis through non-selective monoamine oxidase (MAO) inhibitors
what is linezolid indicated for
healthcare-associated pneumonias and infections
what do we use caution in with linezolid
Hypertension Untreated thyroid disease Severe cardiac disease Cerebrovascular disease Pheochromocytoma
A/E of linezolid
headache
nausea
vommiting
routes of linezolid
po/iv
what do we watch for in linezolid
Watch platelet count = thrombocytopenia
Can cause serotonin syndrome with use of SSRIs
Avoid foods high in tyramine: wines, smoked meats, aged cheese, soy sauce
what is the streptogramin drug
quinupristin/dafopristin
what are quinupristin/dafopristin
used for
superbugs
why are quinupristin/dafopristin
given in combo
quinupristin/dalfopristin used in combination alone bacteriostatic, combination=bactericidal 16x the activity used alone
what must quinupristin/dafopristin be given IV with
D5W
what is the infections quinupristin/dafopristin are used for
Use for serious, life-threatening infections caused by VRE and complicated skin and skin structures, including MRSA
A/E of quinupristin/dafopristin
arthralgias, myalgias; painful/erythema/inflammation at IV site in 75%
3 Tetracycline drugs
tetracycline
doxycycline
minocycline
MOA of tetracyclines
bacteriostatic drugs that inhibit protein synthesis by binding to ribosomes
Some infections treated by tetracyclines
Rickettsia (rocky mountain spotted fever) Chlamydia and trichomonas Lyme disease Cholera Pelvic inflammatory disease Mycoplasma pneumonia Acne
contraindications of tetracyclines
Pregnant and nursing women,
children younger than 8
A/E for tetracyclines
discoloration of the permanent teeth and tooth enamel hypoplasia in fetuses and children, photosensitivity, many others
Is tetracycline bacteriostatic
yes, inhibits or retards the growth
A/E of tetracycline
N/V/D, headache, photosensitivity, dizziness
Rare: anaphylaxis and angioedema
Route of tetracycline
PO
where does tetracycline concentrate
bone
liver
tumor
spleen
teeth
what is doxycycline used for
Chlamydial and mycoplasmal infections
Prophylaxis for STIs
Acne and other non-dangerous skin infections
what is minocycline used for
Neisseria meningitides
Decreases symptoms of rheumatoid arthritis
Solodyn is an extended release (ER) formula - acne
what is the glycylcyline drug
tigecycline
what is tigecycline effective against
Treats complicated skin and skin structure infections MRSA, VRE, extended-spectrum beta lactamases
Peritonitis and other complicated abdominal infections
S/E of tigecycline
N/V
2 Fluoroquinolone drugs
ciprofloxacin
levofloxacin
MOA of fluroquinolones
destroy bacteria by altering their DNA
nterfere with the bacterial enzymes DNA gyrase and topoisomerase
Mostly gram-negative and some gram-positive coverage
T/F fluroquinolones have good oral absorption
TRUE
what does ciprofloxacin treat
Used to treat UTIs, some STIs, upper and lower respiratory tract infections, gonorrhea, and other infections
Also treats anthrax infection with Bacillus anthracis
route of cipro
po,iv,topical
A/E of cipro
arthropathy (joint disease), often irreversible
avoid in patients under 18 and over 60
t/f cipro hasMinimal penetration of the BBB/CSF
true
route of levofloxacin
po iv
100% bioavailabiilty orally
side effects of levofloxacin
CNS disorders that predispose to seizures, kidney failure, can cause prolongation of QT interval, photosensitivity
where does levofloxacin have more activity
More activity against pneumococcal and other ‘atypical’ respiratory infections
cyclic lipopeptide drug
daptomycin
MOA of daptomycin
Not completely understood; binds to gram + cells in calcium-dependent process, disrupts the cell membrane potent
route of daptomycin
IV once per day
What does daptomycin treat
MRSA, VRE bacteremia, right-sided endocarditis, complicated skin & skin structure infections
what are the sulfonamide drug
sulfamethoxale + trimethoprim (Bactrim)
MOA of sulfonamide
don’t actually destroy bacteria but inhibit their growth= bacteriostatic by preventing the synthesis of folic acid needed for DNA synthesis
indications of sulfonamide
uncomplicated UTIs, respiratory infections, salmonella, shigellosis
caution with sulfonamide
sulfa allergies
photosensivity
metronidazole is anti what?
Antiprotozoal & antibacterial
metronidazole is used to treat what
Crohn’s disease
Antibiotic-associated diarrhea
MOA of metronidazole
inhibits DNA synthesis, similar to fluroquinolones
Caution with metronidazole
do not take with alcohol
A/E of metronidazole
N/V
xerostomia
vaginal candidasis
activity of metronidazole
anaerobic only
