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PHARM 2 > antimicrobials > Flashcards

antimicrobials Flashcards

1
Q

complications of antibiotic therapy

A

1) hypersensitivity
2) Direct toxicity
3) superinfection

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2
Q

beta lactam abx

A

PCN, cephalosporins, carbapenems, monobactams

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3
Q

beta-lactamases

A

bacterial enzymes: penicillinases, cephalosporinases that hydrolyze beta lactam ring

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4
Q

PCNs MOA

A

inhibit last step in PGN synthesis via PBP binding

PBPs = inactivate bacterial enzymes

autolysin production

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5
Q

PCNs are inactive against

A

mycoplasma
protozoa
fungi
viruses

organisms without PGN cell walls

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6
Q

PCN G use

A 
syphillis
strep
pneumococci
gram positives, 
some gram negatives - 
NOT STAPH

most anaerobes - not bacteroides

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7
Q

DOC for syphillis and rheumatic fever prophylaxis

A

PCN G benzathine

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8
Q

PCN G vs V, which is more stable? oral?

A

PCN V more acid stable and oral

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9
Q

DOC for strep throat

A

PCN V

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10
Q

antistaphylococcal PCNs

A 
b-lactamase resistant
methicillin
nafcillin
oxacillin
dicloxacillin
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11
Q

1st line tx for staphylococci endocarditis in pt w/o artificial heart valves

A 
antistaphylococcal PCNs
methicillin
nafcillin
oxacillin
dicloxacillin
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12
Q

extended spectrum pcn

A

ampicillin

amoxicillin

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13
Q

which PCN has higher oral bioavailability

A

amoxicillin

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14
Q

extended spec PCN use

A

OM, strep throat, PNA, skin infections, UTI, URI

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15
Q

prophylaxis for dental or respiratory tract procedures

A

amoxicillin

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16
Q

combination tx for enterococci and listerial infections

A

ampicillin + aminoglycoside

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17
Q

prophylactic tx for dog, cat and human bites

A

amoxicillin + clauvinic acid

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18
Q

antipseudomonal PCN

A

carbenicillin
ticarcillin
piperacillin

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19
Q

antipseudomonal PCN use

A

gram neg and gram pos

PSEUDOMONAS

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20
Q

injectable tx of gram -

A

antipseudomonal PCNs: carbenicillin, ticarcillin, piperacillin

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21
Q

PCN AE***

A

GI distrubance: diarrhea

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22
Q

PCN + aminoglycoside

A

synergistic effect: PCN facilitate movement of aminoglycosides into cell wall

  • DONT place in same infusion fluid
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23
Q

empiric tx for infective endocarditis

A

PCN + aminoglycoside

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24
Q

PCN resistance mechanisms (4)

A

1) inactivation by b-lactamase
2) modified PBP target
3) impaired penetration of drug to target PBP
4) inc efflux

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25
Q

PCN distribution

A

therapeutic levels everywhere EXCEPT prostate and eye

also - poor CNS penetration

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26
Q

PCN excretion

A

kidney - be careful in kidney failure

exception: nafcillin = excreted in bile

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27
Q

nafcillin excretion

A

bile

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28
Q

oxacillin excretion

A

renal and biliary excretion

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29
Q

dicloxacillin excretion

A

renal and biliary excretion

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30
Q

PCN hypersensitivity AE

A

penicilioc acid = major antigenic determinant

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31
Q

which PCN cause maculopapular rash

A

ampicillin

amoxicillin

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32
Q

beta lactamase inhibitors (3)

A

clavulanic acid
sulbactam
tazobactam

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33
Q

cephalosporins 1st-3rd generation

A

gram +

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34
Q

cephalosporins 4th generation

A

gram + and gram -

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35
Q

cephalosporins 5th generation

A

only one activate against MRSA. works against gram + and -; not effective against pseudomonas

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36
Q

1st generation cephalosproin drugs

A

cefazolin
cephalexin

can substitute PCN G
resistance to staph penicillinase

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37
Q

DOC for surgical prophylaxis**

A

cefazolin: 1st generation cephalosporin

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38
Q

2nd generation cephalosporin drugs

A

cefaclor
cefoxitin
cefotetan
cefamandaole

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39
Q

2nd generation cephalosporin use

A

gram negative - greater against h.flu, enterobac

sinusitis, otitis, lower resp tract infections

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40
Q

DOC prophylaxis and therapy of abdominal and pelvic cavity infections

A

cefotetan

cefoxitin

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41
Q

3rd generation cephalosporin drugs

A 
ceftriaxone
cefoperazone
cefotaxime
ceftazidime
cefixime
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42
Q

3rd generation cephalosporin use

A

gram negative cocci
h flu, neisseria, enterobacter - pseudomonas

less active against gram pos

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43
Q

which 3rd generations are useful for pneumococci

A

ceftriaxone

cefotaxime

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44
Q

DOC for gonorrhea

A

ceftriaxone

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45
Q

DOC for meningitis d/t ampicillin-resistant h.flu

A

ceftriaxone

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46
Q

DOC prophylaxis of meningitis of exposed individuals

A

ceftriaxone

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47
Q

which 3rd generation cephalosporin can help tx lyme’s (but is not DOC)

A

ceftriaxone

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48
Q

4th generation cephalosporin

A

cefipime - parenteral admin only

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49
Q

cefipime use

A

wide spectrum - only use as empiric therapy and you’re not sure

gram + like 1st generation and gram - of 3rd generation = enterbac, hemophilus, neisseria, e.coli, pneumococci, proteus, pseudo

UTIs, complicated intra-abdominal infections, febrile neutropenia

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50
Q

5th generation cephalosporin

A

ceftaroline

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51
Q

5th generation cephalosproin use

A

ONLY FOR MRSA - reserved drug - similar to 3rd generation

parenteral only

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52
Q

drug tx for skin/soft tissue infection due to MRSA (esp with gram - coinfection)

A

ceftaroline

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53
Q

which cephalosporins are not given parenterally

A

cephalexin
cefaclor
cefixime

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54
Q

which generatoin cephalosporin reaches adequeate levels in CSF

A

3rd generation - useful for meningitis

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55
Q

elimination of cephalosporins

A

kidneys

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56
Q

which cephalosporins are excreted in bile

A

ceftriaxone

cefoperazone

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57
Q

cephalosporins AE

A 
allergic reaction
pain at infection site (IM)
thrombophlebitis (IV)
superinfection: c. diff
kernicterus: pregnant
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58
Q

If pt has allergy to PCN, what should you remember about cephalosporin use

A

cross sensitivity with cephalosporin CAN occur

only okay if the PCN allergic reaction was very mild - but don’t risk it

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59
Q

which cephalosporins can cause hypoprothrombinemia and disulfiram like reactions?

A

cefamandole
cefoperazone
cefotetan

all contain methyl-thiotetrazole group

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60
Q

if woman is pregnant and has meningitis, is ceftriaxone safe?

A

YES - risk outweighs benefit
- even with possible kernicterus risk

  • but if pregnant mother has OM, choose ampicillin or another Abx
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61
Q

2 carbapenems

A

imipenem

meropenem

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62
Q

carbapenem use

A

empiric therapy - multiple infections - resists b-lactamases

very broad spectrum: pencillinase producing gram positive and negative, aerobes, anaerobes, pseudomonas

not active against carbapenemase producing organisms

not active against MRSA

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63
Q

DOC for enterobacter infections

A

carbapenems

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64
Q

DOC for extended spec B-lactamase producing gram negatives

A

carbapenems

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65
Q

Imipenem danger

A

can form nephrotoxic metabolite - combine with cilastatin prevents metabolism and toxicity = increased bioavailability

not needed for meropenem- not metabolized by same enzyme

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66
Q

carbapenem AE

A 
n/v/d
high imipenem = seizures
allergic reaction (with PCN cross reactive)
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67
Q

Monobactam drug

A

aztreonam

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68
Q

monobactam use

A

AEROBIC gram - rods only

(includes pseudomonas)

not active against gram positive or anaerobes

UTIs (for pt who’s infection hasn’t been tx properly with 1 or 2nd line)
lower resp tract infections
septicemia…

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69
Q

monobactam PK

A

IV, IM, inhalation for CF)

can penetrate CSF when inflamed (not normally)

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70
Q

monobactam excretion

A

urine

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71
Q

best route of administration in CF patients

A

inhalation

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72
Q

monobactam AE

A

IV: phlebitis/thrombophlebitis
skin rashes, inc serum aminotransferases
GI upset

little cross hypersensitivty with other b-lactam abx

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73
Q

vancomycin

A

bactericidal
bacterial glycoprotein
ONLY gram +: multi-drug resistant organisms
gram - organisms are resistant

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74
Q

vancomycin MOA

A

binds @ D-Ala-D-Ala terminus of nascent peptidoglycan pentapeptide

  • therefor inhibits bacterial cell wall synthesis and polymerization (NOT cross linking** like PCN)
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75
Q

development of vancomycin resistance

A

modified D-ala-D-ala binding site

plasmid mediated changes in drug permeability

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76
Q

enterococcal endocarditis tx

A

vancomycin + aminoglycoside

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77
Q

empirical infective endocarditis tx

A

aminoglycoside + vancomysin

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78
Q

tx gram + in pt severely allergic to b-lactams

A

vancomycin

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79
Q

tx b-lactam resistance gram + organisms (MRSA)

A

vancomycin

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80
Q

staphylococcal enterocolitis tx

A

vancomycin orally

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81
Q

antibiotic associated pseumembranous colitis tx

A

vancomycin orally

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82
Q

when is vancymycin used orally

A

for GI infections

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83
Q

vancomycin PK

A

SLOW IV infusion - if too quick –> red man syndrome

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84
Q

vancomycin excretion

A

kidneys

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85
Q

red man syndrome

A

fast vancomycin administration = massive histamine release - flushing to face and upper torso

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86
Q

vancomycin AE

A

fever/chills/phlebitis
red neck syndrome
otoxocitiy and nephrotoxicity with drug accumulation

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87
Q

daptomycin for PNA treatment

A

NO EFFECT: can’t reach cell membranes passing through surfactant

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88
Q

daptomycin

A

bactericidal
Gram positive organisms - MRSA, enterococci

inactive against gram negative

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89
Q

daptomycin MOA

A

binds cell membrane via calcium dependent insertion of lipid tail = K+ leaks out - depolarization = cell death

useful for multidrug resistant bacteria

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90
Q

daptomycin clinical app

A

severe infections with MRSA or VRE

tx complicated skin/structure infections d/t s. aureus

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91
Q

daptomycin administration

A

IV

if accumulate - renal insufficiency

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92
Q

daptomycin AE

A

inc creatine phosphokinases (MYOPATHY)- discontinue coadministration of statins

will c/o muscle pains

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93
Q

which Abx should not be used with statins

A

daptomycin

macrolides

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94
Q

Bacitracin MOA

A

interferes in late stage cell wall synthesis = effective against gram positive

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95
Q

bacitracin unique mechanism

A

NO cross resistance

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96
Q

Bacitracin AE

A

nephrotoxicity - mainly topical

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97
Q

Fosfomycin MOA

A

inhibits cytoplasmic enzyme enolpyruvate transferase in early stage cell wall synthesis (compare to bacitracin - late stage)

Gram + and Gram -

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98
Q

tx of uncomplicated lower UTI (not DOC)

A

fosfomycin

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99
Q

tetracycline

A

protein synthesis inhibitior

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100
Q

glycylcylines

A

protein synthesis inhibitior

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101
Q

aminoglycosides

A

protein synthesis inhibitior

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102
Q

macrolides

A

protein synthesis inhibitior

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103
Q

chloramphenicol

A

protein synthesis inhibitior

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104
Q

clindamycin

A

protein synthesis inhibitior

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105
Q

streptogramins

A

protein synthesis inhibitior

106
Q

linezolid

A

protein synthesis inhibitior

107
Q

mupirocin

A

protein synthesis inhibitior

108
Q

bacterial vs mammalian ribosome

A

bacterial - 70s
mammaliam - 80s

bacteriostatic

109
Q

tetracyclines (3)

A

doxycycline
minocycline
tetracycline

110
Q

tetracycline use

A

broad spectrum
bacteriostatic - (don’t want to use with PCN - b/c only attacks actively dividing cells)
aerobic and anaerobic gram + and -

111
Q

tetracycline MOA

A

binds 30S subunit = no attachment of aminoacyl tRNA

entry via passive diffusion/energy dependent transport

drug concentrated intracellularly

112
Q

tetracycline resistance

A

WIDESPREAD

1) imparied influx/inc efflux by active protein pump
2) proteins produced that interfere with ribosome binding
3) enzymatic inactivation

113
Q

tetracycline clinical app

A

severe acne and rosacea

empiric therapy for CAP

respiratory tract, sinuses, middle ear, UT, intestinal infections

syphillis

114
Q

severe acne and rosacea tx

A

tetracycline

115
Q

syphillis tx for pt allergic to PCN

A

tetracyclines

116
Q

empiric therapy for community acquired PNA

A

tetracycline

117
Q

DOC for chlamydia

A

tetracycline

118
Q

DOC for mycoplasma pneumoniae

A

tetracycline

119
Q

DOC for lyme disease

A

tetracycline

120
Q

DOC for cholera

A

tetracycline

121
Q

DOC for anthrax prophylaxis

A

tetracycline

122
Q

DOC for ricketssia: RMSF, typhus

A

tetracycline

123
Q

Tetracycline combo tx for

A 
h. pylori
malaria prophylaxis and tx
plague
tularemia
brucellosis
124
Q

tetracycline PK

A

variable oral absorption - dec by divalent/trivalent cations

125
Q

which tetracycline is preferred for parenteral admin, STDs, prostatitis

A

doxycycline

126
Q

which tetracycline reaches high concentrations in all secretions - spec for tx of meningitis

A

minocycline - eradicate meningococcal carrrier

127
Q

tetracycline excretion

A

urine - except doxy in bile

128
Q

doxycycline excretion

A

bile

129
Q

tetracycline and pregnancy

A

TERATOGENIC

category D

130
Q

tetracycline AE

A

discoloration/hypoplasia of teeth
stunting growth (avoid in pregnant female and kids under 8)
photosensitization

hepatotoxicity
exacerbate renal dysfunction

131
Q

glycylcyclines

A

tigecycline

broad spec against multidrug resistant: gram pos, some gram neg and anaerobics

132
Q

Glycylcyclines clinical app

A

complicated skin, soft tisue and intraabd infections

133
Q

glycylcyclines AE

A

Black box warning = inc mortality risk - FDA recommend alternative antimicrobial use

similar AE as tetracyclines
contraindicated in pregnancy and children under 8

134
Q

glycylcyclines PK

A

IV only

biliary and fecal elimination

135
Q

Only protein synthesis inhibitor that is bactericidal

A

aminoglycoside

136
Q

amikacin

A

aminoglycoside

137
Q

gentamicin

A

aminoglycoside

138
Q

tobramycin

A

aminoglycoside

139
Q

streptomycin

A

aminoglycoside

140
Q

neomycin

A

aminoglycoside

141
Q

aminoglycosides MOA

A

passive diffuse across Gram - membranes

active transp (O2 dependent) across cytoplasmic membrane = AEROBIC GRAM NEG only

bind 30s = mRNA misreading, inhibits translocation

serious toxicities - replaced by other abx

142
Q

aminoglycosides resistance

A

1) plasmid associated syntehsis of enzymes that modify/inactivate drug
2) decreased accumulation of drug
3) 30s receptor protein may be deleted

143
Q

aminoglycoside clinical pp

A

in combo

empiric therapy of speticemia, nocosomial respiratory tract infections, complicated UTIs, endocarditis

144
Q

DOC for empiric therapy of infective endocarditis

A

PCN/vancomycin + aminoglycoside

145
Q

DOC for plague/Y. pestis

A

streptomycin

146
Q

Aminoglycoisdes admin

A

parenteral admin only
1x daily

high levels accum in renal cortex and inner ear

except neomycin = dopical

147
Q

aminoglycoside excretion

A

urine

dec dose in renal insufficiency

148
Q

aminoglycoside AE

A

time and concentration dep
ototoxicity
nephrotoxicity - contraindicated in MG
NM blockade

pregnancy - category D

149
Q

aminoglycosides PD

A

postAb effect + concentration dependent killing - ONCE DAILY DOSING

doesn’t matter if concentration falls below MIC - already gets greatest killing at peak

150
Q

time dependent drugs

A

PCN
cephalosporins

concentration dep: aminoglycosides

151
Q

Oral neomycin

A

adjunt for hepatic encephalopathy tx

152
Q

Alt tx options for hepatic encephalopathy

A

lactulose
oral vanco
oral metro
rifaximin

153
Q

Lactulose

A

nonasorbable disaccharide

154
Q

lactulose MOA

A

degraded by intestinal bacteria –> lactic acid + other organic acids

gut becomes acidic
NH3 –> NH4 - trapped in colon = dec ammonia concentrations

osmotically active laxative
prebiotic (supresses urase producing organisms)

155
Q

erthryomycin

A

macrolide

156
Q

clarithromycin

A

macrolide

157
Q

azithromycin

A

macrolide

158
Q

telithromycin

A

macrolide

159
Q

macrolides function

A

tx gram positive infection

bacteriostatic - bactericidal at high concentrations

160
Q

macrolides MOA

A

reversible binding to 23S rRNA of 50S = stops translocation

similar binding site to that of clindamycin and chloramphenicol

161
Q

macrolides resistance

A

1) dec membrane permeability or active efflux
2) production of esterase - hydrolyzing drugs
3) modification of ribosomal bidning site**

cross resistance b/c erythrromcyin, azithromycin, clarithromycin - partially with clindamycin and streptogramins

162
Q

macrolides with broader spectrum

A

azithromycin
clarithromycin
telithromycin

163
Q

DOC mycoplasma pneumoniae

A

macrolides - erythromycin AND tetracycline

If pregnant female - go for erythromycin

164
Q

DOC pertussis

A

macrolides - erythromycin

165
Q

macrolide clinical app

A

empiric therapy of CAP with b-lactam if an inpatient

upper respiratory tract, soft tissue infections

substitute for PCN allergy

166
Q

which macrolides have long t 1/2

A

clarithromycin
azithromycin
telithromycin
- better oral absorption = longer half life

(compared to erythromycin)

167
Q

which macrolides have greater tissue penetration

A

azithromycin

telithromycin

168
Q

macrolides AE

A

GI irritation = activate motilin!!!**

hepatic abnormalities: erythromycin, azithromycin

QT prolongation - only contraindicated in people with CAD, prolonged QT

169
Q

which macrloides inhibit CYP P450

A

erythromycin
clarithromycin
telithromycin

170
Q

macrolides contraindications

A

statins

telithromycin = lots of toxicity, dont use if minor. can cause fatal hepatotoxicity, exacerbations of MG, visual disturbances

171
Q

tetracyclines contraindicated with

A

beta lactams
TC: static
lactam: cidal

172
Q

CAP empirical tx

A

macrolide (bacteriostatic) + b lactam (bactericidal)

macrolides = coverage for atypicals
beta-lactams = good coverage over s. pneumoniae

GOOD coverage for most likely agents

173
Q

chloramphenicol

A

protein synthesis inhibitor

174
Q

chloramphenicol use

A

broad spec: aerobic and anaerobic - gram + and negative

TOXICITY limits use only to life threatening infections with no alternatives.

active against many VREs.

topical tx of eye infections

bacteriostatic

175
Q

chloramphenicol MOA

A

reversible binding to 50S ribosomal subunit = inhibits peptidyltransferase

176
Q

chloramphenicol toxicity

A

can also inhibit protein synthesis in mitochondrial ribosomes = BM toxicity

**aplastic anemia can occur

177
Q

chloramphenicol resistance

A

presence of factor that codes for chloramphenicol acetyltransferase

changes in membrane permeability

178
Q

chloramphenicol PK

A

inhibits hepatic oxidases: 3A4, 2C9

179
Q

chloramphenicol AE

A

BM depression = dose related reversible depression

gray baby syndrome = cyanosis - restricted in newborns

180
Q

clindamycin

A

MOA same as macrolides - binding 50s

bacteriostatic

GRAM POS ANAEROBIC - and bacteroides and gram + aerobes

“anaeroboic infections above diaphragm”

181
Q

anaerobic infections below diaphgragm

A

metronidazole

182
Q

clindamycin resistance

A

1) mutated ribosomal receptor site
2) modified receptor
3) enzymatic inactivation

most gram - aerobes and enterococci are
intrinsically resistant with macrolides and chloramphenicol

183
Q

clindamycin use

A

anaerobic infections: bacteroides, abscesses, abd infections

complicated skin and soft tissue infections: strep, staph, some MRSA

184
Q

clindamycin + primaquine

A

PCP tx alternative

185
Q

clindamycin + pyrimethamine

A

toxoplasmosis of brain tx alternative

186
Q

prophylaxis of endocarditis in valvular pt allergic PCN

A

clindamycin (s. viridans is covered)

  • normally PCN or IV ampicillin
187
Q

clindamycin AE

A

fatal c. diff superinfection

188
Q

quinupristin

A

streptogramin

189
Q

dalfopristin

A

streptogramin

190
Q

streptogramins

A

give both together - synergistic effect is bactericidal, alone is bacteristatic

191
Q

streptogramin MOA

A

bind 50s

resistance is uncommon = needs two different mutations b/c of both drugs used

192
Q

streptogramin use

A

gram pos cocci and multi drug resistant bacteria

RESTRICTED USE: drug resistant staph or VRE

193
Q

streptogramin PK

A

CYP3A4 inhibitor

194
Q

Linezolid

A

bacteriostatic - cidal for strep and clostridium perfringes

- good for multi drug resistant bacteria

195
Q

linezolid MOA

A

inhibits formation of 70s initation complex

**UNIQUE SITE to 23S on 50S subunit - thats why it works on drug resistant drugs

196
Q

linezolid resistance

A

dec binding to drug site

no cross resistance with other drug class

**could occur very rapidly with a single course of tx

197
Q

linezolid use

A

advantage: ORAL - 100% bioavailable

most gram positive, some activity against m. tuberculosis

198
Q

linezolid PK

A

weak reversible inhibitor of MAO - lots of interactions; serotonin syndrome

oral!!! 100% bioavailability

199
Q

linezolid AE

A

long term:
reversible myelosuppression
optic/peripheral neuropathy
lactic acidosis

200
Q

linezolid contraindications

A

reversible MAOI = interaction with adrenergic and serotinergic drugs

–> serotonin syndrome (ex used in clicker: amitrytiline)

201
Q

fidaxomicin

A

narrow spectrum macrocyclic Abx = ORPHAN DRUG

active against gram + aerobes and anerobes - esp CLOSTRIDIA

not active against gram -

202
Q

fidaxomicin MOA

A

bind RNA polymerase: inhibits bacterial protein synthesis

203
Q

Fidaxomicin use

A

C. diff

**advantage: prevents reoccurence!!!
despite high price, saves money in long run that using vanco or metronidazole

204
Q

fidaxomicin PK

A

systemic absorption = negligible

fecal concentration = high

205
Q

mupirocin

A

topic and nasal tx of MRSA

monoxycarbolic acid class of abx

gram + cocci (MRSI and most strep - not enterococci)

206
Q

only topical agent against MRSA

A

mupirocin

207
Q

mupirocin MOA

A

binds bacterial isoleucyl transfer RNA synthetase = inhibit protein synthesis

208
Q

mupirocin use

A

nasal MRSA
impetigo, secondary skin infection via s. aureus or s. pyogenes

HIGH rate of resistance

209
Q

drugs that affect nucleic acid synthesis

A

fluoroquinolones
sulfonamides
trimethoprim

210
Q

nalidixic acid/quinolone

A

1st generation fluroquinolones

211
Q

ciprofloxacin

A

2nd generation fluroquinolones

212
Q

levofloxacin

A

3rd generation fluroquinolones

synergistic with beta lactams

213
Q

gemifloxacin

A

4th generation fluroquinolones

214
Q

moxifloxacin

A

4th generation fluroquinolones

215
Q

fluoroquinoles MOA

A

broad spec

enters bacterium via porins = inhibits DNA replication vai topoisomeriase II (DNA gyrase) and IV interference

216
Q

fluorquinolones resistance

A

chromosomal mutations: encode subunits of DNA gyrase and topo IV
regulate expression of efflux pumps

cross resistance b/w drugs

217
Q

Lower generations of fluoroquinolones

A

gram -

218
Q

higher generation of fluoroquinolones

A

gram +

219
Q

which generation fluoroquinlones is good against s. pneumoniae

A

3rd = levofloxacin

220
Q

first line traveller’s diarrhea

A

ciprofloxacin

221
Q

alternative ceftriaxone and rifampin for meningitis prophylaxis

A

2nd gen fluoroquinolone = ciprofloxacin

222
Q

suspect CAP in admitted pt

A

fluroquinolones: 3rd and 4th generation

reserved for aggressive tx: when 1st lines failed, comorbidities

223
Q

fluoroquinolones PK

A

iron, zinc, calcium interfere with absorption = don’t give with antacids or milk

adjust doses in renal dysfunction

224
Q

fluoroquinolones AE

A

photosensitivity (like with tetracyclines)

  • ** Black box warning: CT problems = rupture of tendons - contraindicated in pregnant, nursing, under 18
  • stop if c/o tendon pain

peripheral neuropathy
QT prolongation: moxifloxacin, gemifloxacin, levofloxacin
risk of superinfections: c.diff, candida, streptococci

225
Q

which fluoroquinolones can cause QT prolongation

A

moxifloxacin, gemifloxacin, levofloxacin

226
Q

what drug can cause tendon ruptures

A

fluoroquinolones - black blox warning

227
Q

fluoroquinolones interactions

A

inc toxicity with theophyllin, NSAIDs, corticosteroids

3rd/4th gen can inc levels of warfarin, caffeine, cyclosporine

228
Q

sulfonamides

A

sulfamethoxazole
sulfadiazine
sulfasalazine

229
Q

tx chlamydia in pregnant female

A

azithromycin

230
Q

sulfonamides use

A

bacteriostatic against gram + and negative

231
Q

sulfonamides MOA

A

inhibit bacterial folic acid synthesis

PABA analog - comp inhibitor of dihydropteroate synthase. inc p-aminobenzoic acid (accumulates)

232
Q

sulfonamide resistance

A

plasmid transfer/mutations:

  • alterated dihydropteroate synthase
  • dec cellular permeability
  • enhanced PABA
  • dec intracellualr drug accum
233
Q

sulfonamide clincial app

A

topical agents = ocular/burns

oral: UTIs
sulfasalazine: oral - UC, enteritis, IBD

234
Q

sulfonamide PK

A

can accumulate in renal failure

acetylated in liver = kidney damage

235
Q

sulfonamides AE

A

crystaluria: nephrotoxic
HS rxn
hematopoeitic disturb = G6PD def
kernicterus (contraindic in babies <2 mo)

236
Q

sulfonamides interaction

A

inc plasma levels with:
warfarin
phenytoin
MTX

237
Q

sulfonamide contraindication

A

babies < 2 mo

drugs that compete with bilirubin for binding sites on albumin

238
Q

trimethoprim

A

bacteriostatic against gram + and negative

239
Q

trimethoprim MOA

A

inhibitor of bacterial dihydrofolate reducatse = inhibits purine, pyrimidine, aa synthesis

accumulate dihydrofolic acid
no THF made

240
Q

trimethoprim use

A

UTI

bacterial prostatitis, vaginitis

241
Q

trimethoprim excretion

A

kidney

242
Q

trimethoprim AE

A

antifolate - COMPLETELY CONTRAINDICATED IN PREGNANCY

243
Q

cotrimoxazole

A

TMP-MTX combination

bactericidal

244
Q

cotrimoxazole MOA

A

synergistic - inhib THF synthesis

245
Q

DOC for uncomplicated UTIs

A

cotrimoxazole*******

246
Q

DOC for PCP

A

cotrimoxazole

247
Q

DOC for cardiosis

A

cotrimoxazole

248
Q

toxoplasmosis tx alternative

A

cotrimoxazole

249
Q

h. flu and m.catarrhalis URI, OM, sinus infections tx

A

cotrimoxazole

250
Q

cotrimoxazole AE

A

dermatological
hemolytic anemia in G6PD**
AIDS pt = higher incidence of all the AE - specifically dermatological (rashes)

CONTRAINDICATED IN PREGNANCY (1st trim)

251
Q

metronidazole

A

antimicrobial
amebicide
antiprotozoal

active against anaerobic bacteria: bacteroides, clostridium

bactericidal

252
Q

metronidazole MOA

A

anaerobic vital for optimal activity
= reductive bioactivity of nitro group by ferredoxin. forms cytotoxic productions that interfere with nucleic acid synthesis

253
Q

metronidazole clincial app

A 
c. diff
anerobic/mix intra abd
vaginitis
brain abscess
h. pylori
254
Q

DOC c. diff

A

metronidazole

255
Q

metronidazole elimination

A

hepatic

256
Q

metronidazole AE

A

leukopenia, ataxia
opp fungal infection
peripheral neuropathy with prolonged use
disulfiram like effect with alcohol (anything with azole group)

not advised in 1st trimester

257
Q

nitrofurantoin

A

urinary antiseptic: bacteriostatic and cidal

gram pos and gram - activity

258
Q

nitrofurantoin MOA

A

reduction by bacteria in urine = metabolites damage bacterial DNA

259
Q

nitrofurantoin AE

A

anorexia, n/v

neuropathies, hemolytic anemia in G6PD

260
Q

nitrofurantoin contraindication

A

renal insufficiency
pregnant 38-42 weeks (at term) – used regularly in other stages of pregnancy
infants : b/c of possible G6PD deficiency

261
Q

1st line of UTI in pregnant female (NOT AT TERM)

A

nitrofurantoin

262
Q

PCNs resistance

A

via PBP mutations

PHARM 2 (18 decks)

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