Antimicrobials 2 Flashcards
What are bacteriocidal antibiotics?
they kill bacteria dead
Give examples of bacteriocidal antibiotics
penicillin
cephalosporins
metronidazole
What are bacteriostatic antibiotics?
they make bacteria stop working
bacteria are then cleared by the immune system
Give examples of bacteriostatic antibiotics
macrolides
lincosamides
tetracyclines
fusidic acid
How is the in-vitro antimicrobial activity of drugs assessed?
determining minimum inhibitory concentration (MIC) and minumum bactericidal concentration (MBC)
What is the minimum inhibitory concentration?
the lowest concentration of a chemical that prevents visible growth (bacteriostatic)
What is the minimum bactericidal concentration?
lowest concentration of a chemical that results in death (bactericidal)
Practically, how is the antimicrobial activity of a chemical assessed?
overnight aerobic incubation of a standard size inoculum of bacteria in a low protein liquid medium at pH 7.2
Why may the antimicrobial activity of a chemical differ in vivo?
conditions in vivo will be different from incubation conditions thus antimicrobial activity will change
If a drugs has a MBC 4x greater than the MIC then the drug is classed as …
bactericidal
What are broad spectrum antibiotics?
they act against both gram positive and gram negative bacteria
When are broad spectrum antibiotics used?
prior to formal identification of the (specific) disease causing bacteria
Give examples of broad spectrum antibiotics
amoxicillin
co-amoxiclav
tetracyclines
What are narrow spectrum antibiotics?
they act against a specific family of bacteria
When are narrow spectrum antibiotics used?
best when used with culture sensitivity and testing
Give examples of narrow spectrum antibiotics
Macrolides
Clindamycin
What is pharmacokinetics?
This is what the body does to the drug
ADME
What does absorption refer to ?
bioavailability of the drug
What does distribution refer to ?
the process by which a drug diffuses from intravascular fluid space to extravascular fluid spaces
Elimination of the drug after administration usually occurs from …
liver or kidney
What is pharmacodynamics?
this is what the drug does to the body
Regarding pharmacodynamics, the antimicrobial effects of the drug at the site of infection is…
concentration dependent
time dependent
What are the clinical functions of pharmacodynamics?
-used to predict drug efficacy in patients
-provide a rational basis for determining the optimal dosing regimens
The pharmacodynamics of an antimicrobial drug relates its pharmacokinetics to the _________ of the antimicrobial effects at the site of action.
time course
What is the most common side effect of antibiotics ?
allergic reactions
How are allergic reactions to antibiotics typically avoided?
by avoiding the drug
What is an option for patients with an allergy to a specific antibiotic who have no other antibiotic options?
desensitisation
(may be possible)
What serious allergic reactions can arise from antibiotic use?
Stevens Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)
SJS and TEN can present as
serious skin and mucous membrane disorders
rashes, skin peeling and sores on mucous membranes
What antibiotics can be implicated in SJS and TEN?
penicillin
cephalosporins
Antibiotic associated colitis a side effect of antibiotic use due to …
disruption of the normal balance of the gut flora
eradication of the normal gut flora by antibiotic which results in an overgrowth of other microbes which include clostridium difficile
____% of patients may develop anti-biotic associated diarrhoea
5-25%
What kind of antibiotics are often implicated in antibiotic-associated colitis ?
broad spectrum antibiotics
Clindamycin (this is a narrow spectrum antibiotic)
cephalosporin
coamoxiclav
amoxicillin (to a lesser extent?)
What is pseudomembranous colitis ?
medical condition in which the colon gets inflamed in association with excessive intake of antibiotics
What are the symptoms of pseudomembranous colitis?
watery diarrhoea
abdominal pain along with cramping
fever
mucousy stools
nausea
dehydration
Another side effects of antibiotic induce/mediated flora change is _________.
opportunistic candidal infections which may occur in mouth or vagina
overgrowth of fungal species
Candida albicans may take over where there is limited competition from bacteria due to antibiotic treatment
What is the effect of antibacterial on typhoid vaccine?
antibacterials inactivate typhoid vaccine
Miconazole (antifungal) interacts with what drugs?
Alfacalcidol- miconazole reduces effects of alfacalcidol
Calcitriol- miconazole possibly reduces effects of calcitriol
ciclosporin- miconazole possibly inhibits metabolism of ciclosporin which increases its plasma concentration
Coumarins- miconazole enhances the anticoagulant effect of coumarins; avoid concomitant use if possible
(coumarins include warfarin)
Miconazole (antifungal) interacts with what drugs?
Alfacalcidol- miconazole reduces effects of alfacalcidol
Calcitriol- miconazole possibly reduces effects of calcitriol
ciclosporin- miconazole possibly inhibits metabolism of ciclosporin which increases its plasma concentration
Coumarins- miconazole enhances the anticoagulant effect of coumarins; avoid concomitant use if possible
(coumarins include warfarin)
MHRA (Medicines and healthcare products regulatory agency) employs the use of _________ and __________ to monitor adverse effects observed due to drugs/medication
Yellow card schemes
Medical alerts
In 2012, a medical alert for the potential reminder of hypersensitivity for which drug was announced by the MHRA?
chlorhexidine
In 2016, a medical alert for the potential reminder of serious interaction with warfarin for which drug was issued by the MHRA?
topical miconazole, including oral gel
What is the Yellow Card scheme used for ?
used to report suspected side effects or adverse drug reactions to any medicines, vaccines and even medical devices
medical devices e.g. implants
What are components of a typical bacterial cell?
cell wall
plasma membrane
chromosome
cytoplasm
ribosome
Whats is the MOA of penicillin?
beta-lactams present in penicilln interfere with the crosslinking of peptidoglycan protein in the bacterial cell wall
(bacterial cell wall- peptidoglycan crosslinks present)
Penicillin (beta lactam) binds to the transpeptidase enzyme which is responsible for peptidoglycan cross-links
this weakens the strength of the cell wall
Penicillin have a ______ dependent bactericidal action
time dependent
What adverse drug reaction is associated with penicillin?
allergy
What is a contraindication of penicillin use ?
methotrexate (immunomodulatory) - dihydrofolate reductase enzyme inhibitor
probencid (kidney disease)
What is the purpose of a beta-lactam ring
disrupt peptidoglycan cell wall- prevent cross-links from forming
What enzyme is responsible for the formation of the peptidoglycan crosslinks?
bacterial DD-transpeptidase enzyme
What is a requirement for penicillin to work?
the bacteria must be growing for it to work
Briefly compare the bioavailability of oral dose amoxicillin and penicillin V
amoxicillin has a greater oral bioavailability (74-92%) compared to penicillin v
How is penicillin G administered and why is this?
Penicillin G is administered intravenously
it is not acid stable thus cannot be delivered orally
Amoxicillin is equally well absorbed with food or in the fasting state. True or false
True
When is co-amoxiclav better taken (for better absorption)?
it is better taken at the start of a meal
When is penicillin V better taken (for better absorption)?
it is better absorbed in the fasting state
Is penicillin able to cross the BBB?
no it is not because it is poorly lipid soluble
How is penicillin eliminated after drug administration?
excreted unchanged by tubular secretion in the kidneys
Penicillin excretion/elimination can be blocked by…
probencid (used in kidney disease)
Penicillin excretion/elimination can be blocked by…
probencid (used in kidney disease)
Why is a dose reduction of penicillin necessary for patient with kidney disease on probencid?
this is because probencid can block tubular excretion of penicillin
Amoxicilling is a __________ spectrum antibiotic which can be used to treat … (name the conditions)
broad
Dental abscesses
otitis media
bronchitis
pneumonia
urinary tract infections
gonorrheoa
Phenomethylpenicillin (Pen V) is a _______ spectrum antibiotic for use as amoxicillin. How is it dosed?
narrow spectrum
dosed QDS (4x daily) on an empty stomach
What is the benefit of co-amoxiclav?
(as amoxicillin)
reduced resistance due to clavulanic acid which inhibits beta-lactamase enzyme
((beta-lactamase enzyme developed to increase resistance to beta-lactam which interferes with cell wall synthesis)
Co amoxiclav side effects can include …
pseudomembranous colitis?
risk of c. difficle
When should co-amoxiclav be used?
after consultation with secondary care
When antibiotics are under the antibiotic class “penicillins”
penicillin
amoxicillin
coamoxiclav
What are the most common side effects of penicillins?
rash
diarrhoea
abdominal pain
nausea/vomiting
drug fever
hypersensitivity
allergic reactions
When should you contact a health care provider immediately when using penicillins?
bloody stool
anaphylaxis
severe skin reaction
fever
What is the MOA of metronidazole (broad spectrum antibiotic)?
inhibits DNA synthesis once converted into an active form by anaerobic bacteria
Metronidazole is active against… (name the microorganisms)
anaerbobic bacteria
Protozoa
Metronidazole has _________ dependent bactericidal action
dose/concentration dependent
What adverse reactions are associated with metronidazole?
Di-sulfiram reaction where there is an acute sensitivity to alcohol
- immediate feeling of a hangover
should NOT be taken with alcohol.
What are the contraindications for metronidazole?
interacts with coumarin anticoagulants like warfarin
What is the clinical use of metronidazole?
dental abscess and NUG (necrotising ulcerative gingivitis)
also used to treat pseudomembranous colitis (C.difficile)
Briefly describe bioavailability of metronidazole?
excellent bioavailability after oral administration
food has no effect on bioavailability of metronidazole
Briefly describe distribution of metronidazole
lipid soluble drug thus has wide distribution throughout the body
When is the peak serum concentration of metronidazole reached?
after one hour of administration
How is metronidazole eliminated from the body?
eliminated unchanged in the urine
Disulfiram reaction associated with metronidazole is more unpleasant than serious. What must you warn you patients of?
NO alcohol
When it occurs- tachycardia and flushing can occur
Disulfiram reaction can occur up to _______ after stopping metronidazole
up to 72 hours after stopping metronidazole
What is the effect of metronidazole on warfarin (coumarin)?
the anticoagulant effects of warfarin increases
this has cause bleeding in some cases
What should you do if metronidazole is prescribed to a patient on warfarin?
monitor INR (international normalised ratio)
What are the most common side effects of metronidazole?
nausea/vomiting
dizziness
headache
vaginal candidiasis
metallic taste
Combined use of alcohol and metronidazoe may lead to…
cramps
nausea/vomiting
flushing
headache
red-brown urine discoloration
What is the MOA of macrolides (bacteriostatic)?
they inhibit protein synthesis by acting on bacterial ribosomes
Macrolides have the same site of action as ___________ antibiotics. Considering this, how should they be administered?
clindamycin
they should not be administered concurrently as they will compete for the same site of action
What are adverse reactions associated with macrolides?
GI disturbances are common and unpleasant
Macrolides have a __________ post anti-biotic effect
prolonged
What are the clinical uses of macrolides?
used if a patient is allergic to penicillin and metronidazole
What are the members of the macrolide class of antibiotics ?
erythromycin
clarithromycin
azithromycin
What macrolide commonly has resistance against it?
erythromycin
Describe the bioavailability of macrolide antibiotics
Erythromycin and azithromycin have low bioavailability (40%); this is even lower in the presence of food
clarithromycin has good bioavailability, can be administered with or without food
Oral administration of erythromycin and azithromycin antibiotics must be done in a ________ state. Why is this ?
fasting state
this is because their bioavailability is even lower in the presence of food
What macrolides have a wide distribution?
erythromycin
clarithromycin
Briefly describe the distribution of azithromycin
sequestered within tissues by macrophages
not as widely distributed as the others
How are macrolides eliminated after administration?
erythromycin and azithromycin are excreted by the liver
Macrolides are contraindicated for use with what drug ?
domperidone (anti-sickness molecule)
Avoid using macrolide antibiotics with the following drugs…
salmeterol
simvastatin
What are the most common side effects of macrolide antibiotics?
abdominal pain
diarrhoea
anorexia
nausea/vomiting
Taste alteration is a common side effect of what macrolide antibiotic?
clarithromycin =
Macrolides have a high rate of GI side effects. What instructions are given to minimise these side effects?
do not crush, chew, break or open enteric coat or delayed release pill
What is the MOA of lincosamides?
they inhibit protein synthesis by acting on bacterial ribosomes
(same site of action on bacterial ribosomes as macrolides thus they will compete if give concurrently)
Lincosamides has a ___________ post antibiotic effect
prolonged
What adverse reactions are associated with lincosamides?
mild diarrhoea (common)
pseudomembranous colitis (rare but fatal)
What are the clinical uses of lincosamides?
effective at penetrating poorly vascularised bone and connective tissue; diabetics ? bone infections?
What are the members of the lincosamide class of antibiotics?
clindamycin
What is the clinical use of clindamycin?
currently being questioned whether it is appropriate as a pre-surgery dose before implants
Clindamycin is ________ absorbed
rapidly
Briefly describe the distribution of clindamycin
widely distributed throughout the body
may be actively transported into and out of host cells
How is clindamycin eliminated after administration?
excreted mainly by the liver
What are the most common side effects of clindamycin?
pseudomembranous colitis (may be severe)
diarrhoea
nausea/vomiting
rash
hypersensitivity
jaundice
When should a healthcare provider be consulted immediately with use of clindamycin?
if severe diarrhoea during treatment or for up to 8 weeks after treatment
may be pseudomembranous colitis
What is the mechanism of action of tetracycline antibiotics?
inhibits protein synthesis by binding to bacterial ribosomes
immunomodulatory, they can penetrate macrophages as well
has a different site of action to macrolides and lincosamides
Tetracyclines have bacteriostatic action and have _________ post antibiotic effect
prolonged
What are the adverse reactions associated with tetracycline use?
chelate calcium ions so are deposited in bones and teeth
Tetracyclines should not be prescribed to …
pregnant/nursing mothers
children under 9 years old
What are the clinical uses of doxycyline (tetracycline member)
oro-antral communication
some advocate long courses for periodontitis
acne and rosacaea
Tetracyclines and oxytetracyclines are in the DPF but not included in various guidelines. True or false
true
Briefly describe absorption of tetracyclines
oral dose is rapidly absorbed
absorption of tetracyclines is reduced by the chelation with aluminium, magnesium and calcium ion
Briefly describe the distribution of tetracyclines
wide distribution throughout the body
Briefly state how tetracycline is eliminated after administration
excreted from the kidneys primarily by glomerular filtration
List the members of the antibiotic class “tetracyclines”
tetracycline
doxcycycline
What are the most common side effects of tetracycline?
nausea/vomiting
diarrhoea
anorexia
abdominal pain
tooth discoloration in children <8 years old
liver toxicity
What additional warnings come with tetracyclines and why?
avoid prolonged sunlight exposure, use sunscreen, wear protective clothing
Tetracyclines may cause the skin to be more sensitive to sunlight
This is because tetracycline chelates calcium which affects vitamin D absorption ????
What is the MOA of cepalosporins ?
Similar to penicillin
betalactam ?
prevents crosslinks of peptidoglycan from forming
What antibiotic has the highest levels of resistance in the UK?
cephalosporins
Cephalexin and cephradine are both in the DPF but there are no dental indications in the current UK guidelines. True or false
True
Briefly describe the absorption of cephalosporins
The are acid stable so they can be absorbed orally
they have high bioavailability (80-95%)
food can lower the bioavailability of cephaosporins but not those in the DPF
How are cephalosporins eliminated after administration?
they are excreted from the kidneys primarily by glomerular filtration
List the members of the antibiotic class of cephalosporins
cephhalexin
cephradine
What are the common side effects of cephalosporins ?
rash
diarrhoea
nausea/vomiting (rare)
hypersensitivity (allergic) reactions
serum sickness vaginal candidiasis
What is a concern for patients with a penicillin allergy for prescription of cephalosporins?
cross-sensitivity may occur in patients with documented penicillin allergy
keep in mind when prescribing cephalosporins
What is the MOA of fusidic acid?
inhibits protein synthesis
Fusidic acid is a ___________ spectrum antibiotic
narrow
What are the clinical uses of fusidic acid?
good against staphylococcus aureus
topical sodium fusidate cream can be used for angular chelitis (if antifungal has not worked)
Chlorhexidine is a ___________ which means that there are 2 positive charges at its polar ends
bisguanide
Chlorhexidine is highly active against _______ and ________ but not _______________.
bacteria and candida
but not M.tuberculosis
0.4% solution of chlorhexidine can be used for…
hibiscrub- surgical scrub
0.2% aqueous solution of chlorhexidine can be used for…
anti-plaque mouthwash
2% chlorhexidine can be used for…
denture disinfectant
What is the effect of fluoride on bacterial metabolism?
fluoride inhibits enolase enzyme of glycolysis
thus it inhibits bacterial metabolism
Enolase
What is the problem with under-dosage of antibiotics?
if the concentrations are not sufficient to kill them, the bacteria may develop resistance
Who discovered penicillin and where? (Briefly state how)
Alexander Fleming
1928
Mould juice inhibited staphlycoccus
In 2017, WHO released a list of antibiotic resistant “priority bacteria”; this lists includes bacteria that pose the greatest threat to human health. What is the purpose of this list ?
It is intended to guide and promote research and development of new antibiotics in an effort to address global resistance to antimicrobial medicines
Give examples of “critical” WHO superbugs
-acinetobacter baumannii (chest and blood infections)
-pseudomonas geruginosa (chest and blood infections)
-enterobacteriaceae inlcuding klebsiella, E.coli, proteus, Serratia
Give examples of “high priority” WHO superbugs
-Enterococcus faecium
-Staphylococcus aureus
-Helicobacter pylori
-Campylobacter spp
-Salmonellae
-Neisseria gonorrhoeae
Enterobacter faecium is ___________ resistant
vancomycin
Staphlococcus aureus is ____________ resistant
methicillin (hence MRSA)
Vancomycin intermediate and resistant
Helicobacter pylori is _____________ resistant
clarithromycin
Campylobacter spp is _____________ resistant
fluroquinolone resistant
Neisseria gonorrhoeae is ___________ and ___________ resistant
cephalosporin
fluoroquinolone
Acinetobacter baumanni is ___________ resistant
carbapenem
Pseudomonas geruginosa is _____________ resistant
carbapenem
Enterobacteriaceae are ____________ resistant
carbapene, ESBL producing strains
List “medium priority” WHO superbugs
-streptococcus pneumoniae
-Haemphilus influenzae
-Shigella spp.
Streptociccus pneumoniae _____________ non-susceptible
penicillin
Haemophilus influenzae is ___________ resistant
ampicillin
Shigella spp are _________________ resistant
fluoroquinolone
The most vulnerable immuno-compromised patients include those undergoing treatment for… (name the treatments)
cancer
transplants
Antibiotics select for …
resistant bacteria
only bacteria that are resistant to that particular antibiotic will survive
Antibiotic resistance facilitates ____________. (Name the process)
natural selection
How is bacteria able to resist antibiotics?
Degradation- enzymes break them down
Alteration- enzymes deactivate the antibiotic
Efflux- protein pumps them out
New proteins in bacteria can confer resistance. How are new proteins developed in bacteria?
Mutations in genes give rise to new, structurally different proteins
Proteins can be acquired from another bacteria
What are the mechanisms by which bacteria can become resistant to antibiotics?
Mutation
Conjugation
Transformation
Transduction
Resistant genes are often expressed on __________ of DNA
plasmid
What is a plasmid ?
small ring of bacterial DNA
Name a single, important characteristic of plasmid DNA
they can move easily between bacteria
Briefly describe conjugation
this is where the plasmid passes directly from one bacterium to another
(direct contact between bacterial cells)
What are the three mechanisms of horizontal gene transfer ?
conjugation
transformation
transduction
Briefly describe transformation
DNA from dead bacteria can be taken up from the environment
the DNA taken up may include the resistant gene
Briefly describe transduction
certain viruses can pick up DNA from one bacteria and pass it to another
The process of transduction has been exploited by scientists as a laboratory technique referred to as … (name the technique)
targeted gene insertion
Resistant strains of bacteria do no usually cause problems for healthy people. True or false
True
cause problems for the immunocompromised
MRSA stands for …
methicillin resistant staphlococcus aureus
MRSA can be found on …
the skin and nose
MRSA can cause …
poor wound healing
septicaemia
endocarditis
What are some reasons why MRSA is associated with hospital care?
point of entry through skin
High density of at risk population (immunocompromised)
elderly and immunocompromised
Where is clostridium difficile found?
GI tract
What does Clostridium difficle cause?
colitis (inflammation of colon)
Clostridium difficile over-growth is associated with the use of which antibiotics?
4 C’s
Co-amoxiclav
clindamycin
cephalosporin
ciprofloxacin
What is CPE?
Carbapenamase producing enterobacteriaceae
(gives resistance to carbapenem antibiotic)
What is an obligate anaerobe?
unable to grow in contact with oxygen
Many pathogenic bacteria will not grow in culture at all. True or false
True
When should microbial culture be undertaken?
when resistance is suspected
Why is a microbial culture from the mouth problematic?
rich in microbial diversity
some bacteria grow more readily in culture than others - many pathogenic bacteria will not grow in culture
Many hospitals require microbial cultures before prescribing following antibiotics? (State the antibiotics)
co-amoxiclav
clindamycin (lincosamide)
cephalosporins
Give examples of specimens that can be collected for microbial cultures
pus sample aspirate
Nasal swab for MRSA testing before surgery
A clinical required form for microbial culture should contain :
clinical condition
recent/current treatment details
patient details
reason for test being requested
What must you consider when transporting specimens for microbial testing ?
timescale
transport medium- should be compatible with organism e.g. anaerobes
safe robust containers
appropriate labelling of specimen and clinical request form
What is the purpose of clinical MIC breakpoints ?
Identify whether a bacterium is
-susceptible
-intermediate
-resistant
What agar is used for the disc diffusion method for staphylococci?
Mueller-Hinton agar
What agar is used for the disc diffusion method for streptococci?
mueller-hinton agar + 5% defibrinated horse blood
The MIC and zone diameter of inhibition (for disc diffusion method) are inversely related. What does this mean?
This means that the more susceptible the microorganism is, the lower the MIC and the larger the zone of inhibition
(less of antimicrobial concentration required to cause inhibition of growth)
Broth dilution tests involve…
broth dilutions with different concentrations of the antibiotic (hence dilutions)
What is the MBC ?
this is the lowest concentration of antibacterial agent that reduces the viability of the bacterial inoculum by >99.9%
There are genotypic methods that can be used to detect resistance genes. Give an example of this
DNA based assay
MRSA has MecA gener which confers resistance to methicillin and flucloxacillin
Give an advantage of genotypic methods of antimicrobial susceptibility testing
quicker
Give disadvantages of genotypic methods of antimicrobial susceptibility testing
expensive
thus not routinely used
Why are there only a few efficacious antivirals?
this is because it is difficult to interfere with viral activity without damaging the host cell
What is the only antiviral drug in the DPF?
aciclovir
When is the only time aciclovir is effective?
on an actively replicating virus
When is aciclovir ineffective?
in latent viruses in cells e.g. herpes labialis
What kind of patients benefit from active antiviral therapy?
immunocompromised patients
What is the mechanism of action of aciclovir ?
aciclovir triphosphate blocks herpes viral DNA polymerase
aciclovir is initially converted by viral thymidine kinase to aciclovir monophosphate
Aciclovir monophosphate is converted by host kinases to aciclovir monophosphate
What is the active form of aciclovir ?
aciclovir triphosphate
State the clinical use of aciclovir
primary and secondary herpes infections e.g. herpetic stomatitis and labialis
Ideally, aciclovir be started in the __________ phase of herpes infection.
prodromal phase
?What is the consequence of a later start of aciclovir in herpes infection?
will reduce discomfort, length and viral shedding period
What form of aciclovir is used to treat recurrent herpetic ulcers?
topical 5% cream
What form of aciclovir is used to treat severe herpetic stomatitis an herpes zoster ?
oral tablet/suspension
What forms of aciclovir can be used to treat primary gingivostomatitis ?
Topical 5% cream
oral tablet/suspension
Selective toxicity is difficult to achieve in antifungals. Why is this?
this is because both fungal and host cells are eukaryotic
What are the types of antifungals?
Azoles- miconazole, fluconazole
Polyenes- Nystatin
What is the MOA of azole antifungals ?
affect cell membrane synthesis
inhibit ergosterol synthesis
Aside from its anti-fungal function, miconazole is also bacteriostatic against what bacterial species?
Staphylococcus aureus
What is the clinical use of miconazole oromucosal gel?
angular cheilitis
What is the clinical use of fluconazole tablets?
prevention of candidal infections in HIV patienst
What is the dose of fluconazole tablets and why?
1x daily
this is because they have a long half-life
What is the MOA of polyene antifungals?
binds to the sterols in fungal cytoplasmic membrane
alters cell wall permeability- causes leakage of cell contents and death
What is the clinical use of nystatin?
used to prevent mucosal candidiasis
Nystatin is too toxic for systemic use. True or false
True
Nystatin is absorbed by the alimentary canal. True or false
False
What are drug interactions of fluconazole?
avoid use with clopidogrel
Possible interactions with - carbamazepine (anticonvulsant), citalopram (SSRI), diazepam (BZD), ibuprofen(NSAID), midazolam (BZD), simvastatin, warfarin
What are the drug interactions of miconazole?
avoid use with warfarin {[warfarin binds to albumin, miconazole competition for albumin binding increases free warfarin and increases risk of bleeding???}}
possible interactions with atorvastatin, carbamazepine, vitamin D substances
What are the interactions of Nystatin ?
no major interactions with commonly used drugs
What are the interactions with aciclovir?
no major interactions with commonly known drugs
Briefly describe absorption of fluconazole
rapidly absorbed
>90% bioavailability
How is fluconazole eliminated after administration?
excreted from kidneys primarily through glomerular filtration
80% excreted unchanged
