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Pharm > Antimicrobials: Macrolides and Lincosamides > Flashcards

Antimicrobials: Macrolides and Lincosamides Flashcards

1
Q

macrolides drugs (3)

A

erythromycin
clarithromycin
azithromycin

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2
Q

macrolide activity

A

good against gram positives and gram negative aerobes

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3
Q

which macrolide is the best for gram pos?

A

erythromycin

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4
Q

which macrolide is the worst for gram pos?

A

azithromycin

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5
Q

which macrolide is the best for gram negative?

A

azithromycin

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6
Q

which macrolide is the worst for gram negative?

A

erythromycin

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7
Q

main use for clarithromycin

A

h pylori

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8
Q

clarithromycin dosing is different from azithromycin, how?

A

it is dosed more frequently, typically 2x/day

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9
Q

macrolide and gram negative aerobes

A

no efficacy

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10
Q

macrolide are very useful in the setting of

A

pneumonia, especially the atypical pathogens of pneumonia

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11
Q

atypical pathogens of pneumonia

A

legionella pneumophila
mycoplasma pneumoniae
chlamoydophila pmneumoniae

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12
Q

macrolide have activity against these organisms

A 
strep pneumo and other strep spp
h influenzae
m cat
legionella pneumoniae
mycoplasma pneumoniae
chlamydophila pneumoniae
chalmidia trachomatis
ureaplasma urealyticum
borrelia burgdorfei
h pylori (clari, azith)
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13
Q

erythromycin drug:drug interactions due to

A

metabolism through the CYP450 enzyme system

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14
Q

macrolides for MAC

A

clarithromycin

azithromycin

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15
Q

MAC prophylaxis

A

large dose of azithromycin 1x a week

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16
Q

azithromycin t 1/2

A

5 days

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17
Q

azithromycin vs fluoroquinolones

A

activity against atypical organisms may be superior in azithromycin

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18
Q

macrolides + EKG changes

A

QTc prolongation

*watch other QTc prolonging drugs

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19
Q

azithromycin course of therapy

A

only 5 days, has PAE.

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20
Q

erythromycin

dose related adverse events

A

GI: abdominal cramps, nausea, vomiting, diarrhea

thrombophlebitis if given IV

choelstatic hepatitis in rare cases

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21
Q

clarithromycin and azithromycin side effects

A

GI: less than erythromycin

tinnitus and dizziness (dose related)

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22
Q

erythromycin distribution

A

poor penetration into many body tissues/fluids

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23
Q

clarithromycin/azithromycin distribution

A

penetrates well into tissues, particularly sputum and lungs. achieves high concentration in alveolar macrophages.

24
Q

elimination of macrolides

A

excreted in bile, small amounts in urine

25
Q

t 1/2 of erythro and clarithro

A

short half lives

26
Q

azithromycin t 1/2

A

68 hours. long.

27
Q

dose adjustment in macrolides

A

hepatic impairment

renal impairment

28
Q

Lincosamides drug

A

clindamycin

29
Q

MoA Clindamycin, a lincosamide

A

binds to 50S ribosomal subunit, decreases protein synthesis.

30
Q

distribution of clindamycin, a lincosamide

A

concentrates in bone, bile, and most other tissues but does not penetrate well into the CSF.

31
Q

lincosamides are bacteriocidal or static?

A

static

32
Q

lincosamides are very against

A

staph & strep (mssa, mrsa, streptococcus) and b fragilis

head and neck flora/mouth flora/sometimes GI

33
Q

lincosamides and gram neg aerobes

A

no activity

34
Q

lincosamides and toxoplasmosis

A

good activity against it

35
Q

bone penetration of lincosamides

A

excellent

36
Q

when is lincosamide a go to drug?

A

when they’re on a staph/strep IV abx and there isn’t an easy conversion to a PO drug. clindamycin may be used in this instance.

37
Q

t 1/2 lincosamides

A

short, 2.4 hours

multi times a day dosing

38
Q

GI adverse events: lincosamidses, specifically clindamycin

A

GI intolerance/diarrhea/pseudomembranous colitis

39
Q

liver function and lincosamides

A

can cause LFTs and hepatotoxicity

40
Q

patient education for lincosamides

A

esophageal irritant

drink lots of water, no laying down

41
Q

hematologic side effect of lincosamide

A

rare: neutropenia/thrombocytopenia

42
Q

dose adjustment for lincosamides

A

not required for renal insufficiency

43
Q

higher doses of lincosamides may lead to

A

dose limiting GI toxicity

44
Q

lincosamide monitoring

A

C&S
CBC
RFT
bowel changes

45
Q

pregnancy/lactation considerations for lincosamides

A

C

excreted into breast milk

46
Q

pediatric considerations: lincosamides

A

diarrhea

47
Q

geriatric consideration for lincosamides

A

diarrhea

48
Q

renal impairment and lincosamides

A

no adjustment needed

49
Q

hepatic impairment and lincosamides

A

consider dose adjusting in severe hepatic dysfunction

50
Q

macrolides monitoring

A

C&S
CBC
RFT
LFT for long term use

51
Q

Pregnancy/lactation considerations for macrolides

A

category B/C

excreted into breastmilk at low concs

52
Q

pediatric considerations for macrolides

A

n/a

53
Q

geriatric considerations for macrolides

A

renal insufficiency

54
Q

renal impairment and macrolides

A

dose adjust for GFR <30

55
Q

hepatic impairment and macrolides

A

LFTs may increase

Pharm (31 decks)

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