Antimicrobials Flashcards
class of abx that wors by weakening the organisms cell wall, causing excessive amount of water to be taken up, and rupturing the cell wall, thus disrupting cell wall synthesis and promoting its discretion
Cillins
Coverage of ______:
Gm+
Cillins
\_\_\_\_\_\_ treat: Respiratory GU tract Skin, soft tissue, joints Intra Abdominal infections Prophylactically bacterial endocarditis prevention prior to dental procedure or dental surgery.
Cillins
SE of \_\_\_\_\_\_: nausea, vomiting, diarrhea, abdominal pain, stomach upset, skin rash, hives, itching
Cillins
Interactions of ______:
Oral contraceptives: ↓effectiveness (rare)
Cillins
Interactions of ______:
Methotrexate→ ↑ methotrexate level
Warfarin→ slight ↑ bleed risk
Penicillin
Interactions of ______:
Atenolol: choose different ABT
Allopurinol: avoid
Ampicillin
______ causes rash when used to treat strep throat and mono
Amoxicillin
Contrainidications of ________:
Any person who has a history of type 1 allergic reaction to these drugs
Caution in patients with allergy to cephalosporin
Cillins
Pregnancy/Lactation Considerations for _______:
- Safe in pregnancy and lactation
- Few studies, use only when clearly indicated
- Lacation: low concentrations in milk, may cause diarrhea, candidiasis, or allergic response in infants
Cillins
Pediatric Considerations for _________:
Safety for children < 12 yo not established for carbenicillin and piperacillin-tazobactam
PCN dose adjustments may be required for infants
Cillins
______ are completely safe for use in the elderly.
Penicillins
Class of Abx?
Cefadroxil
Cefazolin
Cephalexin
1st Generation Cephalosporins
Class of Abx that Interfere with cell wall synthesis
Cephalosporins
Coverage of ______:
Gm+ (Strep and Staph but NOT MRSA)
***Enterococcus are resistant
1st Generation Cephalosporins
Coverage of ______:
- Gr+ (but less than 1st gen) & Gm-
- Anaerobes
2nd Generation Cephalosporins
Class of Abx? Cefaclor Cefotetan Cefoxitin Cefproil Cefuroxime Loracarbef
2nd Generation Cephalosporins
Class of Abx? Cefdinir Cefixime Cefotaxime Cefpodoxime Ceftazodine Cefitibuten Ceftriaxone
3rd Generation Cephalosporins
Class of Abx?
Cefepime
4th Generation Cephalosporins
Coverage of ______ + _________:
Gr+ & Gm-
Pseudomonas
3rd Generation Cephalosporins
4th Generation Cephalosporins
SE of _______:
If a patient has a true allergy to PCN, they are more likely to have allergic reaction, particularly 1st generation
Cephalosporins
Interactions of ______:
Probenecid: ↑ and prolong abx plasma levels
Loop diuretics: ↑ nephrotoxicity
Warfarin: ↑ bleed risk
Cephalosporins
Interactions of ______:
ETOH: avoid
Antigoagulants: choose different abx class
Cefotetan <2nd Generation Cephalosporin>
Interaction of ______ (3 drugs):
Antacids: space admin at least 2hr
Cefaclor <2nd Generation Cephalosporin>
Cefdinir + Cefpodoxime <3rd Generation Cephalosporins>
Interaction of ______ :
Iron:space admin at least 2hr
Cefdinir <3rd Generation Cephalosporin>
Contrainidications of ________:
Type 1 Allergy to PCN
Cephalosporins
Contrainidications of ________:
Patients w/ renal impairment
1st Generation Cephalosporins
Contrainidications of ________:
Patients w/ hepatic impairment
Ceftriaxone <2nd Generation Cephalosporin>
Pregnancy/Lactation Considerations for _______:
Safe during pregnancy
Category B, all cross placenta; low presence in breast milk
1st Generation Cephalosporins
Pregnancy/Lactation Considerations for _______:
Reaches therapeutic levels in cord blood
Cefotetan <2nd Generation Cephalosporin>
Pregnancy/Lactation Considerations for _______ (3 drug classes):
Safe
2nd Generation Cephalosporins
3rd Generation Cephalosporins
4th Generation Cephalosporins
Pediatric Considerations for _________:
Not established for infants < 1 month old
Cefazolin <1st Generation Cephalosporin>
Cefaclor <2nd Generation Cephalosporin>
Cefotaxime <3rd Generation Cephalosporin>
Pediatric Considerations for _________:
Varies across generations… more than what’s listed here
Cephalosporins
Pediatric Considerations for _________:
Not established for infants < 2 months old
Cefpodoxime <3rd Generation Cephalosporin>
Pediatric Considerations for _________:
Not established for infants < 3 months old
Cefuroxime <2nd Generation Cephalosporin>
Class of Abx? Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin Gemifloxacin
Fluoroquinolones
Class of abx that interfere w/ synthesis and repair enzymes of bacterial DNA so that bacteria can’t reproduce
Fluoroquinolones
class of abx that, when taken PO, are not absorbed well, aren’t highly protein bound, minimally metabolized in the liver, and excreted primarily in urine
Fluoroquinolones
Coverage of _________:
~Narrow spectrum~
Mostly Gm-
Some Gr+
Newer drugs have ↑ activity against Staph, Enterococcus, Strep, DRSP
Atypical organisms: Chlamydia, Legionella, Mycoplasma
Fluoroquinolones
Coverage of ________ :
Anaerobic bacteria
Moxifloxacin (Fluoroquinolone)
SE of \_\_\_\_\_\_\_\_\_: *Tendon Rupture *Tendonitis Dizziness N/V/D Abdominal pain Altered taste Fever Chills Blurred vision Tinnitus Phototoxicity: ranging from mild erythema to severe bullous eruptions in sun- exposed areas Bacterial/fungal overgrowth Severe: diarrhea w/ blood, pus, mucus Rare: CV- Angina, Atrial Flutter, Cardiopulmonary Arrest, Cerebral Thrombosis, MI, Ventricular Ectopy Rare: Acute Renal Failure, Seizures
Fluoroquinolones
Most common SE of _________:
GI symptoms including altered taste
Fluoroquinolones
SE of \_\_\_\_\_\_\_\_\_\_: Acidosis Polyuria Urine retention Calculi
Cipro (Fluoroquinolone)
Interactions of ___________:
Antacids: ↓ GI absorption, ↓ serum levels
Antidiabetics: blood sugar changes
Some antiarrhythmics: risk of serious CV effects, fatal arrhythmias
Glucocorticoids: tendon rupture
Warfarin: ↑ anticoagulant effect
Fluoroquinolones
Interactions of \_\_\_\_\_\_\_\_\_\_\_: Caffeine Phenytoin Probenecid Theophylline
Cipro (Fluoroquinolone)
Interactions of ___________:
NSAIDS
Levofloxacin (Fluoroquinolone)
Interactions of ___________:
Rifampin
Moxifloxacin (Fluoroquinolone)
Interactions of ___________:
Caffeine
Cyclosporine
Nitrofurantoin
Norfloxacin (Fluoroquinolone)
Contraindications for __________:
Patients w/ myasthenia gravis: avoid (tendonitis, tendon rupture)
Patients w/ renal impairment, known or suspected CNS disorders, or predisposed to seizures
First sign of jaundice: Discontinue
Fluoroquinolones
Pregnancy/Lactation Considerations for ___________:
Category C: NOT recommended
No adequate, well-controlled studies
Only use if there is clear benefit that justifies risk to fetus
Lactation: Lower doses (only if no safer alternative)
Fluoroquinolones
Geriatric Considerations for ___________:
High risk for tendonitis and tendon rupture
Increased risk for adverse CNS reactions
Fluoroquinolones
Pediatric Considerations for _________:
Not recommended for children < 18 years old
Only use for complicated UTIs, Pyelonephritis, Post-Anthrax Exposure
Restricted to when there is no safe and effective alternative
Fluoroquinolones
class of abx that inhibit RNA- dependent protein synthesis by acting on small portion of ribosome. They reversibly bind to P site of 50s ribosome. They are distributed to most tissues and body fluids except CSF when meninges are inflamed
Macrolides
______ are acid sensitive so they must be buffered or have enteric coating for PO to prevent destruction by gastric acid
Macrolides
________ are absorbed in the duodenum.
Macrolides
Coverage of _______:
Broad spectrum against Gr(+) and some Gm(-)
PO: Gm(-)
Atypical and intracellular orgs commonly resistant to beta-lactams
Macrolides
_______ is the greatest coverage of the ______ class against Gm(-) and anaerobes
Azythromycin; Macrolides
SE of \_\_\_\_\_\_\_\_\_: ***Overall fewer Epigastric distress N/V/D, diarrhea esp w/ large doses rash fever eosinophilia anaphylaxis reversible hearing loss Fatal hepatotoxicity Potentially fatal exacerbations of myasthenia gravis Visual disturbances
Macrolides
SE of _______:
hepatitis
liver abnormalities
Erythromycin
Azithromycin
Telithromycin
(Macrolides)
SE of _______:
SJ syndrome
skin changes
Erythromycin (Macrolide)
Class of Abx? Erythromycin Azithromycin Fidaxomicin Telithromycin Clarithromycin
Macrolides
SE of _______:
Taste changes
Clarithromycin (Macrolide)
Interactions of \_\_\_\_\_\_\_\_\_: strong CYP450 inhibitors cyclosporine most statins rivaroxaban theophylline carbamazepine select benzos
Increased effect of:
colchicine
digoxin
warfarin
Causes dysrhythmia:
pimozide
tourette tx
Slows absorption:
Antacids with aluminum or magnesium
Macrolides
3 drugs in Macrolide class that have more drug interactions than the others
Erythromycin
Telithromycin
Clarithromycin
Contraindications of ________:
Patients at risk for torsades de pointes
Meds that prolong QT interval
Macrolides
Contraindications of ________:
Not appropriate for treatment of minor upper respiratory infections
Azithromycin
Contraindications of ________:
Pre-existing liver disease
Myasthenia gravis
Erythromycin
Pregnancy Considerations for Macrolides:
_______ + ________ are safe, Category B
Erythromycin
Azithromycin
Lactation Considerations for Macrolides:
(3) drugs are compatible with breastfeeding
Caution w/ other meds in class due to few studies
Erythromycin
Azithromycin
Clarithromycin
Pregnancy Considerations for Macrolides:
(2) drugs have adverse effects on fetal development, Category C
Telithromycin
Clarithromycin
Macrolide that is safe for infants and children
Erythromycin
Macrolide that is safe for children as young as 6 mos for otitis media, sinusitis, CA
and children > 2 yo for pharyngitis and tonsillitis
Azithromycin
Macrolide that is safe for children > 6 mo
Clarithromycin
Macrolide that safety is not established for children < 12 yo
Dirithromycin
Macrolide that safety is not established for children
Telithromycin
Geriatric Considerations for ________:
No specific dosage adjustments or precautions recommended w/ normal renal and hepatic function
*WIth impairment, treat as you would other patients w/ no additional precautions
Macrolides
Class of Abx? Minocycline Tetracycline Doxycycline Tigecycline Demeclocycline
Tetracyclines
Class of abx that inhibit growth or multiplication of bacteria by penetrating bacterial cell
(Bacteriostatic) Tetracyclines
Class of abx that work on highly susceptible organisms and high concentrations by binding primarily to subunit of the ribosome causing protein synthesis inhibition
Reversibly to 30S
(Bactericidal) Tetracyclines
Coverage of \_\_\_\_\_\_\_\_: Broad Gr+ and Gm- Also... aerobic anaerobic spirochetes mycoplasmas rickettsiae chlamydiae gonorrhea some protozoa MRSA
Tetracyclines
SE of \_\_\_\_\_\_\_: N/V/D photosensitivity abdominal distress/distention Teeth: discoloration, enamel hypoplasia Severe: hepatic and renal toxivity Decreased oral contraceptive effectiveness
Tetracyclines
SE of \_\_\_\_\_\_ (Tetracycline): lightheadedness dizziness vertigo vestibular reactions
Minocycline
SE of ______ (Tetracycline):
fatty infiltration of the liver
Tetracyclines
Interactions of _________:
Best to avoid calcium/iron or take >2 hours apart: Milk products- space 1-2 hrs after meals
Tetracyclines EXCEPT Minocycline and Doxycycline
Interactions of __________:
aluminum, magnesium, calcium (↓ PO absorption)
Oral contraceptives
Tetracyclines
Interactions of \_\_\_\_\_\_\_\_\_\_: iron salts bismuth zinc sulfate (space dosing) (All of these decrease absorption of 2 drugs in this class)
Tetracycline
Doxycycline
Interactions of \_\_\_\_\_\_\_\_\_\_: barbiturates carbamezepine phenytoin ETOH (All of these increase metabolism and decrease effect of 1 drug in this class)
Doxycycline (Tetracycline)
Contraindications of __________:
Pregnancy
Children up to 8 yo: binds to calcium in bones and teeth → yellow or brown discoloration and hypoplasia of tooth enamel
Premies: suppresses long bone growth
Caution in patients w/ renal and hepatic impairment
Tetracyclines
Pregnancy Considerations for ________:
!!Contraindicated!!
Cat X, should not be used in pregnancy
*Cross placenta w/concentration up to 60%
Tetracyclines
Lactation Considerations for __________:
Excreted in breastmilk
AAP consideres it compatible b/c serum concentrations below detectable level
Tetracyclines
Tetracycline that may affect breast milk production or composition
Minocycline
Only Tetracycline that is Cat D, not Cat X
Doxycycline
Pediatric Considerations for ___________:
Do not give to children < 8 yo
Do not give to premies (suppresses long bone growth)
Tetracyclines
In pediatric patients, the tetracycline less likely to harm but risks outweigh benefits for most indications
Doxycycline
Geriatric Considerations for _________:
None, safe to Rx
Tetracyclines
Class of Abx? Sulfadiazine Sulfamethoxazole Sulfamethoxazole/trimethoprim (Bactrim) Sulfisoxazole Sulfasalazine
Sulfanomides
Class of abx that acts by interfering with folic acid synthesis by preventing addition of para-aminobenzoic acid (PABA) into the folic acid molecule through competing for the enzyme dihydropteroate synthetase.
These drgus are antimetabolites that substitute for PABA, resulting in blockade of enzymes needed for biogenesis of purine bases, etc, needed for formation of RNA. The effect is bacteriostatic; bactericidal action is evident at the high concentrations found in urine.
Sulfanomides
Coverage of \_\_\_\_\_\_\_\_\_: Gr+ and Gr- Nocardia Actinomyces spp some protozoa such as coccidia and Toxoplasma spp
More active drugs in this class may include several species of: Streptococcus Staphylococcus Salmonella Pasteurella E. coli
Sulfanomides
Resistant to \_\_\_\_\_\_\_\_\_\_: Strains of Pseudomonas Klebsiella Proteus Clostridium Leptospira spp Rickettsiae Mycoplasmas Chlamydia.
Sulfanomides
SE of \_\_\_\_\_\_\_\_\_\_\_: **Severe hypoglycemia Weight gain **Dermatological reactions GI disturbances SIADH **Excessive water retention Hemolytic anemia **Agranulocytosis Leukopenia **Thrombocytopenia
Sulfanomides
Interactions for \_\_\_\_\_\_\_\_\_: Alcohol Androgens Anticoagulants Chloramphenicol Fluconazole Gemfibrozil Histamine 2 blockers Magnesium salts Methyldopa MAOIs NSAIDs (except diclofenac) Phenylbutazone Probenecid Salicylates Tricyclic antidepressants Urinary acidifiers Beta-adrenergic blockers Cholestyramine Diazoxide, hydantoins, rifampin, thiazide diuretics, urinary alkalinizers, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, nicotinic acid, sympathomimetics, and isoniazid
Sulfanomides
Contraindications for \_\_\_\_\_\_\_\_\_\_: Allergy to ANY drugs in this class or thiazide diuretics. Nursing or pregnant. Type 1 diabetes, DKA, diabetic coma. Liver or kidney disease. Uncontrolled infection. Burns and trauma. CHF
Sulfanomides
Pregnancy/Lactation Considerations for ________:
Do not Rx!
Class C: Teratogenic in animal studies - no human studies on pregnant women conducted
Several drugs penetrate breastmilk at dangerous levels
Sulfanomides
Pediatric Considerations for ________:
Potential for studies, but no data currently.
May cause severe hypoglycemia.
Sulfanomides
Geriatric Consideration for ___________:
May cause severe hypoglycemia.
Poor hepatic or renal function may cause complications.
Caution should be used in prescribing
Sulfanomides
Abx that inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome. It is bacteriostatic
CLINDAMYCIN (ANTIANAEROBIC AGENT)
Coverage of __________:
Active/effective against roughly ⅔ of B. fragilis and roughly 80% of isolates of Clostridium, Peptostreptococcus, and Fusobacterium
Spectrum includes BOTH aerobic & anaerobic bacteria, Pneumonocystis, malaria, and Toxoplasma
Clindamycin
SE of \_\_\_\_\_\_\_\_\_: Positive: inhibits synthesis of toxic shock syndrome toxins Negative: Allergic reactions Minor reversible elevation in AST/ALT Potential liver injury C.diff. Local phlebitis Serum sickness N/V headache dysrhythmias Reversible neutropenia thrombocytopenia eosinophilia
Clindamycin
Interactions of __________:
Kaolin
Muscle relaxants
St. John’s Wort
ANTIANAEROBIC AGENTS
Clindamycin and Metronidazole
Contraindications for __________:
History of hypersensitivity
Concomitant use: Erythromycin is not recommended.
Gastrointestinal: Use with caution in patients with a history of gastrointestinal disease, particularly colitis .
Hepatic disease
Allergic-type risk may be higher in patients with aspirin sensitivity
Caution in atopic individuals
ANTIANAEROBIC AGENTS
Clindamycin and Metronidazole
Pregnancy/Lactation Considerations for _________:
Pregnancy:
Class C - teratogenic.
Fetal risk cannot be ruled out.
Breastfeeding:
WHO: Avoid breastfeeding if possible. Monitor infant for side effects.
Micromedex: Infant risk cannot be ruled out.
ANTIANAEROBIC AGENTS
Clindamycin and Metronidazole
Pediatric Considerations for ________:
Do not administer the oral capsules to children who cannot swallow them whole
Capsules do not provide exact mg/kg doses
Consider using palmitate oral solution
ANTIANAEROBIC AGENTS
Clindamycin and Metronidazole
Geriatric Consideration for ___________:
no specific dosage adjustments appear to be necessary
ANTIANAEROBIC AGENTS
Clindamycin and Metronidazole
Abx that works by passive diffusion into cytoplasm of anaerobic bacteria, messing with cellular transport. It interacts with intracellular DNA resulting in the inhibition of DNA synthesis and degradation and ultimately bacterial death . Topical application exerts an antiinflammatory effect in the treatment of rosacea.
Metronidazole (ANTIANAEROBIC AGENT)
Coverage of __________:
Limited spectrum of activity that encompasses various protozoans
most Gm- and Gr+ anaerobic bacteria
Metronidazole
SE of \_\_\_\_\_\_\_\_\_: >Common: Gastrointestinal: Abdominal discomfort Abnormal taste Diarrhea Nausea Jarisch Herxheimer reaction Dizziness Headache Candidiasis >Serious: Dermatologic: Stevens-Johnson syndrome Epidermal necrolysis CNS damage, Liver damage, Kidney damage, Eye & ear damage.
Metronidazole
Abx that inhibits bacterial wall synthesis causing ↑ susceptibility to lysis; also damages cell membrane
Glycopeptides (Vancomycin and Telavancin)
Coverage of __________:
Gr+
Vanco: staph (slow), strep, pneumococci
Telav: S.aureus, MRSA, enterococcus, strep
Glycopeptides (Vancomycin and Telavancin)
SE of ________:
Nephrotoxicity
High IV rate: red man syndrome (slower push ↓ risk)
Glycopeptides
SE of \_\_\_\_\_\_\_\_\_: ototoxic(rare) reversible neutropenia eosinophilia thrombocytopenia Oral: rash
Vancomycin
SE of __________:
QT prolongation
GI disturbance
hypersensitivity
Telavancin
Interactions of __________:
drugs with nephro or ototoxic effects (aminoglycosides)
Vancomycin
Interactions of __________:
drugs affecting renal function (ACE inhibitors, loop diuretics, NSAIDS)
Telavancin
Contraindications for ____________:
PO not appropriate for systemic infect
Also avoid IM admin
Inflammatory GI mucosa disorders
Glycopeptides (Vancomycin and Telavancin)
Contraindications for ____________:
Impaired renal fxn
Vancomycin
Pregnancy Considerations for _________:
PO: Category B
IV: Category C
Vancomycin
Pregnancy Considerations for _________:
Category C- no data so avoid use
Telavancin
Lactation Considerations for _________:
Caution with nursing mothers- little data
Glycopeptides (Vancomycin and Telavancin)
Pediatric Considerations for ________:
confined to serious infections usually only used when hospitalized
Vancomycin
Pediatric Considerations for ________:
not studied or approved for <18yo
Telavancin
Geriatric Consideration for ___________:
Use Caution
Vancomycin
Abx used in combination therapy both to achieve additive or synergistic antibacterial efficacy and to reduce the risk of development of resistance. Also used as a prophylaxis for close contacts of people suspected with infection.
Rifampin
1st line drug for Tuberculosis; interferes with lipid & nucleic acid biosynthesis
Isoniazid (INH)
Abx used for UTI’s which works by inhibiting rotein synthesis, aerobic energy metabolism, DNA/RNA synthesis, and cell wall synthesis
Bacteriostatic in low concentrations
Bacteriocidal in high concentrations
Nitrofurantoin
Coverage of ___________:
activity with Mycobacterium
Rifampin
Coverage of ___________:
Bactericidal against susceptible mycobacteria. Bactericidal to both extracellular and intracellular organisms
Isoniazid (INH)
Coverage of ___________:
Gr+ cocci
Gm- bacilli
Nitrofurantoin
SE of \_\_\_\_\_\_\_\_: anorexia N/V/D flatulence abdominal pain Transient elevation of liver enzymes
Rifampin
SE of \_\_\_\_\_\_\_\_: Hepatitis peripheral neuropathy photosensitivity convulsions allergic skin rashes toxic encephalopathy
Isoniazid (INH)
SE ________:
Acute/Chronic pulmonary reactions:
pulmonary fibrosis
sudden onset of chest pain, dyspnea, fever, cough
Dark colored urine
Peripheral neuropathy that can be irreversible
Nitrofurantoin
Interactions of ________:
Antacids: decreases abx levels
Warfarin: Suboptimal anticoagulation
Rifampin
Interactions of ________:
ETOH/Rifampin: increased risk of hepatic injury
PO hypoglycemics: decreased levels of hypoglycemics
Isoniazid (INH)
Interactions of \_\_\_\_\_\_\_\_: Anticholinergics Magnesium salt Probenecid High doses decrases renal clearance
Nitrofurantoin
Contraindications for _________:
Do not use as monotherapy
Rifampin
Contraindications for \_\_\_\_\_\_\_\_\_: Hemodialysis: on dialysis days administer the dose after dialysis Precautions: HIV patients pregnant patients with hepatic impairment >35 years old severe renal dysfunction
Isoniazid (INH)
Contraindications for _________:
Cannot use in patients with CCr < 60 mL/min.
Nitrofurantoin
Pregnancy/Lactation Considerations for _________:
Category C- Probably safe, monitor infant for toxicity
Rifampin
Pregnancy/Lactation Considerations for _________:
Category B, safe but should not be used near term, in labor, or when lactating
Infants with G6PD (glucose-6-phosphate-dehydrogenase deficiency) should not nurse while mother is receiving drug
Nitrofurantoin
Pregnancy/Lactation Considerations for _________:
Category C- add pyridoxine for pregnant women
Isoniazid (INH)
Pediatric Considerations for __________:
Children: Should not wear contact lenses/risk of being stained
Teenage girls: should not use oral contraceptives they have ↓ effect when on this drug and menstruation might become irregular
Rifampin
Pediatric Considerations for __________:
can be used on children but need to watch liver
Isoniazid (INH)
Pediatric Considerations for __________:
Should not be given to infant <1 month old
Can cause hemolytic anemia in the newborn
Nitrofurantoin
Geriatric Considerations for __________:
Caution for patients w/ underlying renal dysfunction
Neurotoxicity
Rifampin
Geriatric Considerations for ___________:
Educate to look for s/s of clinical hepatitis(dark urine, yellow eyes or skin)
> 65 yrs old give pyridoxine 25 mg/day
Isoniazid (INH)
Geriatric Considerations for ___________:
Watch for acute pneumonitis and peripheral neuropathy
Nitrofurantoin
Abx that inhibits bacterial ribosomal protein synthesis by binding to 50s ribosomal subunit preventing the formation of a 70s initiation complex
Oxazolidinones
Coverage of ____________:
Bacteriostatic in Gr+
Most effective against Staphylococci & Enterococci
Bactericidal against other bacteria
In Vitro spectrum of activity includes scant amount of Gm- bacteria.
Oxazolidinones
SE of \_\_\_\_\_\_\_\_\_: Most common: diarrhea and nausea Myelosuppression can result and resolves with discontinuance Watch out for Serotonin Syndrome! IncreasedBP
Oxazolidinones
Interactions of __________:
Tyramine-rich food & beverages: balance and don’t eat in large quantities
Dopaminergics, vasopressors, & sympathomimetics can have increased effects when given w/ Lenezolid
Oxazolidinones
Contraindications of __________:
Use for >28 days can cause peripheral and optic neuropathy
MAOI’s- Concomitant use or within 2 weeks is contraindicated
Oxazolidinones
Pregnancy/Lactation Considerations for __________:
Category C,
No clear studies, so only prescribe for pregnancy if the potential benefit to the mom outweighs the risk to the fetus.
Excreted in breast milk or consider benefit in mom choosing to continue drug/or discontinue breastfeeding.
Oxazolidinones
Pediatric Considerations for _________:
Can use from birth on up,
Preterm infants and neonates require reduced dosing
Oxazolidinones
Geriatric Considerations for __________:
Increased risk for toxic neuropathies and excessive CNS stimulation
Oxazolidinones
4 atom ring within Penicillins, Cephalosporin, Carbapenems, & Monobactams.
Beta-Lactam
drug that has minimal antibacterial activity but irreversibly inactivates beta-lactamase enzymes produced by bacteria by binding to their active site & protecting the antibiotic from inactivation.
Beta-Lactamase Inhibitors
Coverage of ________:
Broad spectrum
Gr+ and Gm-
Beta-Lactam/Beta-Lactamase Inhibitors
These 3 bacterias are Gram +
All others are Gram -
Staph, Strep, or Enterococci
drugs that treat viral syndromes in immunocompromised like herpes simplex and cytomegalovirus
○ including: Acyclovir, cidofovir, famciclovir, ganciclovir, valacyclovir, valganciclovir, ribavarin
Nucleoside analogues
Clavulanate, Sulbactam, & Tazobactam are all in the class of …
Beta-Lactamase Inhibitors
Antiviral used to treat Hep C and RSV
Ribaviran
Antiviral drug that works by interfering with DNA synthesis and inhibiting viral replication (each type has a specific pathway to this)
● Most need to be metabolized to be effective (prodrug?)
Nucleoside analogues
Coverage of _________:
Active against HSV-1 and 2, varicella zoster (VZV); somewhat against epstein barr (EBV), CMV and HSV-6
Acyclovir
__________ is converted to acyclovir after PO admin is active against same viruses as acyclovir
Valcyclovir
Coverage of _________:
Active against, HSV-1 and 2, VZV, EBV, hep B
Famciclovir
SE of \_\_\_\_\_\_\_\_\_\_\_\_: hypersensitivity skin rash thrombotic thrombocytopenic pupera hemolytic uremic syndrome (TTP/HUS) IV route: reversible kidney impairment PO: headache, N/V/D
Acyclovir and Valacyclovir
this drug has a higher incidence of side effects compared to PO acyclovir (especially TTP/HUS)
Valacyclovir
SE of ________:
nephrotoxicity in more than half of patients
Cidofovir
SE of _______:
granulocytopenia and thrombocytopenia
Ganciclovir
SE of _______(2):
headache, nausea, neuro effects, paresthesias
Famciclovir and Valcyclovir
SE of _______:
seizures, retinal detachment, neutropenia, bone marrow suppression
Valganciclovir
SE of _______:
Neuro: ataxia, dizziness, confusion, encephalopathy, tremor, and seizures
Nucleoside Analogues
Interactions of ________:
Very few…
Acyclovir + Famciclovir =Probenicid: ↑ serum, ↓ renal clearance, avoid concurrent use; nephrotoxic-monitor closely
Famciclovir= Cimetidine and Theophylline: not clinically significant
Digoxin: little significance, monitor dig levels closely
Nucleoside Analogues
Contraindications for ____________:
renal impairment: consider dose adjustment (dehydration)
Nucleoside Analogues
Pediatric Considerations for ___________:
Acyclovir: safest of these for children, oral approved >2yo
Famciclovir: no established safety and efficacy for <18yo
Valacyclovir: no safety/efficacy established for any age child
Nucleoside Analogues
Geriatric Considerations for _________:
Patients with renal impairment more likely to experience neuro side effects
Nucleoside Analogues
Pregnancy Considerations for _______:
Category B
Little info for famciclovir, so acyclovir or valacyclovir are preferred
Nucleoside Analogues
Lactations Considerations for _________:
Acyclovir: excreted in milk, concentrations are low, considered minimal risk
Others have little research available
Nucleoside Analogues
Antiviral that works by inhibition of neuraminidase (enzyme responsible for cleaving viral attachment to the host cell surface→ viral cirulation) which prevents release of the virus and halts infection
● Oseltamivir is a prodrug
Influenza Antivirals
Coverage for __________:
Amantadine and Rimantadine: approved for prevention and tx of resp infection caused by influenza A (CDC recommends against due to high resistance to influenza A)
Zanamivir (inhaled), Oseltamivir (Tamiflu), Peramivir: active against influenza A and B
Influenza Antivirals
SE of _______:
bronchitis, cough, shortness of breath
Zanamivir
SE of ________:
nause and vomiting
Oseltamivir (Tamiflu)
Rare SE of all _______:
severe skin reaction, neuropsychiatric events
Influenza Antivirals
Interactions of __________:
None reported
Some research suggests they may impair immune system if coadministered with live attenuated influenza vaccine (should space 2 weeks before or 48 hours after)
Influenza Antivirals
Pediatric Considerations for ________:
children < 12 yo: higher clearance → decreased drug exposure
Oseltamivir (Tamiflu)
Pregnancy Considerations for _________:
Category C- Limited research
Zanamivir crosses placenta in low levels
Influenza Antivirals
Lactation Considerations for ____________:
Olseltamivir: poorly excreted in milk, adverse effects not expected for infants
Zanamivir is inhaled and unlikely to pass to infant, but unknown by current research
Influenza Antivirals
Drugs that work by inhibiting Fungal CYP450
○ These systemic agents are different than topicals
○ This also is the source of the many drug interactions
● Terbinafine for onychomycosis: used off label for tinea apitus
● Hepatotoxicity- important to monitor liver funciton especially in those already impaired
● QT prolongation Risk
● Diabetics have increased risk for fungal infections
● Pregnancy/lactation: Diflucan is considered safe, but caution with higher doses which can cause congenital abnormalities
Antifungals
Drug to Drug Interactions of __________:
- **Caution in use with other QT prolongation drugs
- **Statins often contraindicated
Antifungals
cells that produce antibodies and mediate humoral immunity
B lymphocytes
cells that produce cell mediated immunity (particularly active against viruses)
T lymphocytes
live attenuated (best and longest immune response)
live vaccine
inactivated whole killed pathogen
whole killed vaccine
vaccines that work against toxins and require sufficient standing antibody titer and needs boosting
toxoid vaccine
vaccine that contains only part of the microorganism (less effective than whole, also less side effects)
recombinant vaccine
type of vaccine that is revaccination with same vaccine to replenish the immune response
booster
Tdap is recommended in pregnancy is between _______ weeks- but may safely be given at any time if needed due to wound management, pertussis outbreak or other extenuating circumstances.
27-36
type of abx that disrupt bacteria cell membranes
polymixins and polyenes
type of abx that inhibit bacteria cell wall synthesis
SO MANY (Ex: Penicillins and Cephalosporins)
type of abx that inhibit DNA and RNA synthesis
Quinolenes and Nalidixic Acids, Rifamycin
type of abx that inhibit protein synthesis (ribosomes)…meaning it is BACTERIOSTATIC
erythromycin, tetracyclines, streptomycin, gentamycin, chloraphenicol
type of abx that prevent folic acid metabolism (turning PABA to folate)
sulfanomides and trimetoprim
Enzymes that provide antibiotic resistance by breaking part of the molecular structure.
Beta Lactamase
Abx that are safe during pregnancy?
Penicillins
Macrolides
1st and 2nd Generation Cephalosporins
Abx that are UNsafe during pregnancy?
Tetracyclines
Fluoroquinolones
If you think that the microbe might be Beta-Lactamase resistant, you should Rx…
Extended Spectrum Penicillin (like Augmentin)
3rd Generation Cephalosporin
Which antimicrobials interact with Warfarin and increase INR?
Trimethoprim-sulfamethoxazole (TMP-SMX Bactrim) Erythromycin Fluconazole Ketoconazole Itraconazole Metronidazole
Trimethoprim-sulfamethoxazole (TMP-SMX Bactrim) is
associated with the serious adverse effect of __________… especially when with concurrent use of TMP-SMX with angiotensin converting inhibitors or angiotensin receptor blockers (increased risk of cardiac death)
hyperkalemia
TMP-SMX is more likely to increase hyperkalemia in ________ patients and in patients with __________
elderly; kidney disease
__________ increases risk of aortic aneurysm, decreased blood sugar and certain mental health side effects… especially in artherosclerotic vascular disease, HTN, Marfan’s syndrome and the elderly.
Levaquin (levofloxacin)
____________ has increased risk of tendon rupture in patients > 60 yo
Levaquin (levofloxacin)
absorption of tetracycline is reduced by consumption of ______
food
tetracyclines form _____ _______ with calcium, iron, magnesium, aluminum and zinc resulting in decreased absorption
insoluble chelates
Abx most likely to cause \_\_\_\_\_\_\_\_\_: Imipenem Ceftazidime Clindamycin Moxifloxacin
C.Diff
Treatment for 1st episode of ________:
Vancomycin 125mg QID x 10 days OR
Fidaxomicin 200mg BID x 10 days
C.Diff
It is recommended that abstinence from alcohol occurs during treatment with Flagyl (metrodianozole) and up to 48 hours after treatment ends due to risk of _______ reaction
Disulfiram
In the third trimester, the compounds in __________ compete for bilirubin-binding sites on fetal and neonatal albumin resulting in hyperbilirubinemia and kernicterus
This drug should be avoided in 1st and 3rd trimesters due to risk of cardiovascular defects and cleft palate
Sulfanomides
__________ should be avoided in pregnancy, UNLESS NO OTHER REASONABLE ALTERNATIVE IS AVAILABLE
Sulfanomides
___________has been one of the most commonly used sulfonamides for urinary tract infections but there is significant resistance due to its frequent use.
Trimethoprim/Sulfamethoxazole (Bactrim)
________ is recommended for only symptomatic BV in any trimester in pregnancy
Flagyl (Metronidazole)
________ and_____________ are considered safe while breastfeeding although they may cause GI disturbances or Candidiasis (thrush/diaper rash) in infant
Penicillins and Cephalosporins
Some sources consider ________ safe due to the low levels found in breast milk. However, other sources associate exposure with hypertrophic pyloric stenosis
macrolides
If a macrolide is indicated while breastfeeding, the safest choice is ___________.
Azythromycin
_________ are contraindicated in infants who have either hyperbilirubinemia or G6PD deficiency due to risk of hyperbilirubinemia and kernicterus
Sulfanomides
Use of ___________ is controversial during lactation, although Ciprofloxacin–one of the most commonly prescribed drugs in this class–is approved for use by the American Academy of Pediatrics.
fluoroquinolones
Drugs that have SE of __________:
Antibiotics-Azithromycin, Ciprofloxacin, Clarithromycin, Erythromycin, Levofloxacin, and Moxifloxacin
Antimalarial - Chloroquine
Antifungal -Fluconazole, Pentamidine
QT interval prolongation
HIV patients often have interactions with _______.
Sulfanomides
Patients with risk for low B6 (HIV, diabetes, pregnant and lactating) should take supplemental vitamin B6 when taking _______ because it competes with vitamin B6 in certain enzymatic reactions; if untreated, the client can develop symptoms of vitamin B6 deficiency.
Isoniazid (INH)
The most commonly seen protozoans are ________ and _________
trichomonads and giardia
__________ is used to treat protozoan infections and also used to treat other amoebas and anaerobic bacteria
Metronidazole (Flagyl)
a collection of data usually in the form of a table summarizing the percent of individual bacterial pathogens susceptible to different antimicrobial agents
antibiogram
