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Pharm > Antimicrobials: Sulfas, Nitros, Oxals, and Lipos > Flashcards

Antimicrobials: Sulfas, Nitros, Oxals, and Lipos Flashcards

1
Q

tst

A
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2
Q

Nitroimidazoles: Metronidazole

MoA

A

enters the cell, then is reduced to free radicals which damage bacterial DNA.

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3
Q

Nitroimidazoles: Metronidazole

bacteriocidal or static?

A

cidal.

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4
Q

Nitroimidazoles: Metronidazole

dose adjustment

A

no need for hepatic or renal adjustment

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5
Q

Nitroimidazoles: Metronidazole and ANY form of alcohol

A

Disulfiram reaction due to effect on alcohol dehydrogenase, alcohol cannot be broken down.

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6
Q

Nitroimidazoles: Metronidazole and warfarin

A

increased INR

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7
Q

Nitroimidazoles: Metronidazole pt education

A

absolutely no alcohol, not even mouthwash with alcohol

also tastes horrible

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8
Q

Nitroimidazoles: Metronidazole coverage

A

ANAEROBES

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9
Q

Nitroimidazoles: Metronidazole

activity

A

not active against most gram pos or neg because it does not provide aerobic coverage

active against all anaerobes including c. diff

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10
Q

Nitroimidazoles: Metronidazole and h pylori

A

active against

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11
Q

Nitroimidazoles: Metronidazole AE (5)

A 
poor taste
GI disturbance
reversible neutropenia
dark urine
rash
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12
Q

fever of unknown origin: treatment (3)

A

cover MRSA - vanco
cover anaerobes - metronidazole
everything else, including psuedomonas - cefepime

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13
Q

Oxalinediones: linezolid

MoA

A

Binds to 50S ribosomal subunit, inhibits the early phase of protein synthesis.

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14
Q

Oxalinediones: linezolid

bacteriostatic or bacteriocidal?

A

bacteriostatic

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15
Q

Oxalinediones: linezolid was made to

A

combat increasing resistance against vancomycin

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16
Q

Oxalinediones: linezolid

activity

A

gram positive pathogens:

enterococci faecium and faecalis which are vanco sensitive and resistant organisms

staph: MRSA and MSSA
strep: including PCN resistant strains

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17
Q

Oxalinediones: linezolid

when may you expect to see it?

A

if you cannot use vanco because of allergy, resistance, or issues with levels

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18
Q

Oxalinediones: linezolid AEs

A

diarrhea/nausea
taste
inc LFT
thrombocytopenia

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19
Q

Oxalinediones: linezolid should be reserved for

A

patients who cannot be helped by vanco

otherwise it is a very expensive drug

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20
Q

lipopeptide drug

A

daptomycin

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21
Q

lipopeptide (daptomycin) MoA

A

binds to bacterial cell membranes causing rapid depolarization of membrane potential, leading to inhibition of protein/dna/rna synthesis and ultimately bacterial cell death

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22
Q

lipopeptide (daptomycin) is bacteriostatic or bacteriocidal?

A

bacteriocidal

23
Q

lipopeptide (daptomycin) gram positive activity:

A

streptococci
s epidermidis
enterococci (VRE*)
S aureus (MSSA, MRSA, GISA, GRSA)

24
Q

lipopeptide (daptomycin) is the first bacteriocidal drug against

A

gram positive organisms

25
Q

lipopeptide (daptomycin) distrubution

A

everywhere EXCEPT lungs

26
Q

why is lipopeptide (daptomycin) ineffective for pneumonia?

A

it cannot get through the surfactant in the lungs

27
Q

lipopeptide (daptomycin) adverse event and implication

A

increase in CK
get CK at baseline and then weekly as long as the patient is on the drug.
could become rhabdomyolysis

28
Q

lipopeptide (daptomycin) and renal insufficiency

A

dose reduce

29
Q

Sulfas, Nitros, Oxals, and Lipos

monitoring

A

C&S
CBC
RFT
dap: CK

30
Q

Sulfas and Linezolid

pregnancy/lactation

A

C

31
Q

metronidazole and daptomycin pregnancy category

A

B

32
Q

Daptomycin lactation consideration

A

excreted in milk

33
Q

daptomycin and MAOIs

A

myopathy

34
Q

dosing daptomycin: obesity

A

actual weight

35
Q

Sulfa drug

A

bactrim: trimethoprim/sulfamethoxazole

36
Q

MoA: bactrim (trimethoproim/sulfamethoxazole)

A

trimethoprim: folic acid antagonist, starves organism
sulfamethoxazole: inhibition of bacterial cell growth by inhibiting purine synthesis.

37
Q

distribution of sulfas (bactrim)

A

widely distributed, but CSF levels are just about 40%

38
Q

sulfas (bactrim) are one of the few PO drugs for

A

MRSA cellulitis

39
Q

patient/clinician education regarding sulfas (bactrim)

A

need to be adequately hydrated because crystalluria can form.

40
Q

drug interaction: sulfa (bactrim)

A

will increase activity of warfarin or phenytoin because it displaces it from protein binding sites. may need to dose them down.

41
Q

sulfas (bactrim) and electrolytes

A

can cause hyperkalemia as it can block the excretion of potassium

42
Q

sulfas (bactrim) and renal function

A

likely to bump up creatinine- check BMP

avoid in dialysis patients

43
Q

Sulfas (Bactrim) activity: gram neg aerobes

A

good

44
Q

sulfas (bactrim) activity for gram pos aerobes

A

good

45
Q

sulfas (bactrim) and MRSA

A

moderate activity against MRSA

46
Q

Sulfas (bactirm) and anaerobes

A

no coverage

47
Q

PCP pneumonia and sulfas (bactrim)

A

effective against this opportunistic infection.

48
Q

sulfas (bactrim) in HIV patients

A

prophylaxis for PCP and toxoplasmosis.
3x a week
not enough to elicit resistance

49
Q

sulfas (bactrim) GI AE

A

GI intolerance

50
Q

Sulfas (bactrim) and hypersensitivity

A

stevens-johnsons syndrome

51
Q

Sulfas (bactrim) AEs: lab values (4)

A

anemia
neutropenia
hyperkalemia
elevated serum creat

52
Q

If a patient tells you they have a bactrim allergy

A

do not give, especially if it was a skin reaction.

53
Q

t 1/2 of sulfas (bactrim)

A

9-11 hours

dose 2x/day

54
Q

dose adjustment for sulfas (bactrim)

A

CrCl < 15mL/min

Pharm (31 decks)

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