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Bloc G - Infection > Apr26 M1-Antimicrobial antibiotics > Flashcards

Apr26 M1-Antimicrobial antibiotics Flashcards

1
Q

aminoglycosides coverage (3) + do they cross the BBB

A 
-gram negative only. (including pseudomonas)
EXCEPT Salmonella spp and Neisseria spp
-TB and TB mycobacteria for some
-giardia (protozoa) for paromomycin
*DON'T CROSS THE BBB*
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2
Q

other activities of aminoglycosides (2)

A
  • some have TB and non TB-mycobacteria activity

- paromomycin = anti-parasitic activity against giardia lamblia

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3
Q

paromomycin is what and does what

A
  • aminoglycosides Abx

- anti-parasitic activity against giardia lamblia

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4
Q

good and bad situations to use aminoglycosides

A

good for: UTIs and complicated infections

bad for: bacteremia (too slow acting)

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5
Q

aminoglycoside nephrotoxicity: why and charact

A
  • high trough (accumulated) levels, tubule toxicity
  • reversible
  • more toxic if with other nephrotoxic drugs
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6
Q

important irreversible SE of aminoglycosides and how to prevent it

A

hearing loss. prevent by stopping the Abx when have tinnitus (ringing in the ear), tinnitus is reversible

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7
Q

aminoglycosides how to determine the next dose given

A

measure the trough rate and adjust the next dose

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8
Q

other side effect of aminoglycosides than nephrotoxicity and vestibular, cochlear toxicity

A

muscular blockade. avoid them in pts with neuromuscular diseases:

  • botulism
  • DMD (Duschenne)
  • myasthenia gravis
  • etc
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9
Q

how to make sure tinnitus (and hearing loss) and nephrotoxicity are avoided while using aminoglycosides

A

monitor for a therapeutic drug level

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10
Q

how to recognize aminoglycosides by their name

A

end with cin (gentamicin, amikacin) or mycin (tobramycin, streptomycin, paromomycin) (but azythromycin and clarithromycin are macrolides, ketolides)

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11
Q

how to recognize fluoroquinolones by name

A

end with floxacin (gatifloxacin, grepafloxacin)

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12
Q

most important fluoroquinolones

A
  • Ciprofloxacin (po or IV) = Cipro
  • Levofloxacin (po or IV) = Levaquin
  • Moxifloxacin po (Avelox)
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13
Q

2 fluoroquinolones considered to be the respiratory ones

A
  • Levofloxacin (Levaquin)

- Moxifloxacin (Avelox)

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14
Q

fluoroquinolones how many generations and what they cover

A
  1. are BROAD SPECTRUM
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15
Q

FQs activity against S pneumoniae

A

gen 2,3,4 increasing. 4 is best

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16
Q

FQs activity against MSSA (and which one specifically)

A

moxifloxacin (gen 4) ONLY

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17
Q

moxifloxacin good and bad situations to use it

A

good for: community acquired pneumonia
bad for: UTIs
are broad spectrum so associated with c.diff

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18
Q

FQs enteric gram negative rods coverage

A

gen 2,3,4 are good. gen 1 is weak

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19
Q

FQs pseudomonas spp coverage

A

gen2,3,4 decreasing. gen 2 is the best

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20
Q

FQs atypical bacteria coverage

A

gen2,3,4 are good.

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21
Q

FQs anaerobes coverage

A

gen4 only

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22
Q

FQs: which cover enterococcus faecalis

A

gen4 only

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23
Q

fluoroquinolones: how much more bioavailability if give IV instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

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24
Q

sulfonamides coverage

A
  • broad spectrum (all bacteria requiring endogenous folic acid synthesis. bc sulfonamides block that)
  • anti-parasitic coverage (toxoplasma)
  • covers pneumocystis jeroveci
25
Q

sulfonamides exceptions: bacteria that are not covered

A
  • GAS (can’t give sulfonamides for skin infection)

- enterococcus spp

26
Q

do FQs cross the BB

A

no

27
Q

sulfonamides: how much more bioavailability if give IV instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

28
Q

sulfonamides: do they cross the BBB?

A

no (can’t treat meningitis with Septra)

29
Q

sulfonamides: one common one

A

trimethoprim-sulfametoxazole (Septra) (TMP-SMX)

30
Q

best Abx for toxoplasma and pneumocystis jeroveci (can see jeroveci more in HIV)

A

sulfonamides (Septra)

31
Q

tetracyclines Abx spectrum

A
  • gram negative ENTERIC RODS
  • anaerobes
  • atypical bacteria
32
Q

tigecycline Abx spectrum

A
  • gram negative ENTERIC RODS (includes tetracycline resistant + multiresistant enterobacteriaceae)
  • gram posities (MRSA, VRE, penicillin-R strep pneumoniae)
  • anaerobes
  • atypicals
33
Q

cyclines (tetra and tige): how much more bioavailability if give IV instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

34
Q

how clindamycin (in the lincosamides category) works and type of activity (conc or time dependent)

A
  • inhibits protein synthesis

- time dependent bacteriostatic activity

35
Q

how resistance to clindamycin develops

A

similar to resistance to macrolides

  • modification of target site (target mutation)
  • efflux pump (pump)
36
Q

clindamycin coverage

A

gram positives and anaerobes

37
Q

clindamycin: how much more bioavailability if give IV or IM instead of po + preferred mode of administration

A

bioavailability is same for po and IV or IM.

so give orally if possible

38
Q

cyclines (tetra and tige): is it used for meningitis (does it cross the BBB)

A

no

39
Q

clindamycin does it cross the BBB

A

no

40
Q

main adverse reactions with clindamycin

A
  • moderate diarrhea, possibly (bc kills gut anaerobes)

- C.diff association (pseudomembranous colitis)

41
Q

metronidazole coverage

A
  • anaerobes (gram+ and gram-)
  • C.diff
  • parasites (giardia lamblia, entamoeba histolytica)
42
Q

metronidazole: how much more bioavailability if give IV or IM instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

43
Q

important limit to using rifamycins

A
  • induce RAPID resistance if used on their own

- always use with other Abx to buffer the resistance

44
Q

when can you use rifamycins alone

A
  • as prophylaxis for meningitis from N meningitidis and H influenzae (if someone was in contact, saliva)
  • to people known to be carriers (prophylaxis, reduce risk for others): will have yellow secretions, orange urine and tears
45
Q

when would you use rifamycins (rifampin or rifabutin)

A
  • TB and non-TB mycobacteria tx

- post exposure prophylaxis for meningitis from N meningitidis or H influenzae

46
Q

pharmaco key point with rifamycins

A

MAJOR drug interactions

-rifampin and rifabutin both metabolized by CYP-450 enzymes in liver

47
Q

adverse reactions of all rifamycins

A
  • mainly GI (nausea, increase in liver enzymes)

- skin rashes

48
Q

adverse reactions related to rifampin

A

orange-red colouration of body fluids (urine, tears). stains contact lenses
reversible

49
Q

rifabutin specific adverse reactions

A
  • bronze discolouration of skin

- violet-red colouration of urine

50
Q

specific things to follow in patient using rifamycins

A
  • monitor liver enzymes

- avoid alcohol and drugs to avoid liver toxicity

51
Q

nitrofurantoin when to use

A
  • ONLY for 1. non-complicated cystitis TREATMENT and 2. UTI PROPHYLAXIS
  • you only achieve therapeutic concentrations in the urine
52
Q

specific conditions where you would give an Abx like nitrofurantoin for UTI prophylaxis

A
  • babies with vesicoureteral reflux with urine splashing up ureters and kidneys (risk UTI)
  • honeymoon cystitis (used to UTIs after intercourse)
53
Q

Abx designed specifically for multiresistant gram positive cocci (MRSA, VRE, VISA, VRSA)

A
  • oxazolidinones (Linezolid)
  • streptogramins (Quinipristin, Dalfopristin) (Synercid)
  • daptomycin
  • Ceftaroline (5th generation ceph) (this one only for MRSA)
54
Q

Abx designed specifically for multiresistant gram negative rods

A
  • carbapenems
  • carbapenem + beta-lactamase inhibitors
  • tigecycline
55
Q

oxazolidinones (Linezolid): how much more bioavailability if give IV or IM instead of po + preferred mode of administration

A

bioavailability is same for po and IV.

so give orally if possible

56
Q

do oxazolidinones penetrate the BBB

A

yes. are very good for meningitis

57
Q

(important) adverse reactions with prolonged use of oxazolidinones (Linezolid)

A
  • thrombocytopenia (if >2 weeks of tx, is reversible)

- inhibition of monoamine oxidase (get serotonin syndrome).

58
Q

(important) how to avoid serotonin syndrome with use of oxazolidinones (Linezolid)

A
  • avoid SSRIs

- avoid or limit tyramine containing foods (cheeses, smoked and processed meats)

Bloc G - Infection (39 decks)

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