ch 73 Flashcards
Bacteriostatic inhibitors of protein synthesis
key note
Tetracyclines Macrolides Clindamycin Linezolid (Zyvox) Tedizolid (sivextro)
cannot give to immune compromised pts. Wont work
Tetracyclines are a ______-spectrum antibiotics
Broad
-cline
Tetracyclines
Tetracycline
doxycycline
minocycline
demeclocycline
eravacycline
omadacycline
sarecycline
Tetracyclines are active against a wide variety of _______ and ______
gram positive and gram negative
Organism sensitive to tetracyclines are
Rickettsia spirochetes Brucella chlamydia mycoplasma H.Pylori Borrelia burgdorferi Bacillus anthracis Vibrio cholerae
Tetracyclines are 1st line for
rickettsial disease (Rocky mountain spotted fever) Typhus fever Q fever infections caused by chlamydia trachomatis (trachoma, lymphogranuloma venereum, cervicitis Brucellosis cholera Mycoplasma pneumoniae lyme disease anthrax gastric infections with H. Pylori
what 2 tetracyclines are used for Periodontal disease
doxycycline - orally and topically
minocycline - topical
oral doxycycline benefit in periodontal disease
inhibits collagenase (destroys connective tissue in gums)
topical therapy for periodonal disease does what
adjuncts to scaling and root planing to reduce pocket depth and bleeding
drug interactions with tetracyclines
Calcium supplements milk products (due to calcium) iron supplements magnesium containing laxatives most antacids due to containing mag, aluminum or both
take 1 hour prior or 2 hours after
can increase digoxin or warfarin levels through increasing absorption in GI tract and increased INR by altering vit K producing flora in gut
does tetracyclines penetrate to CSF
no
adverse effects of tetracyclines
GI - epigastric burning, cramps, n/v/d - giving with food helps but can decrease absorption
esophageal ulceration - avoid dosing at bedtime
diarrhea - risk of c.diff - concern after 1 week
yellow or brown discoloration in teeth when taken by pregnant woman after 4th month gestation - stains deciduous teeth of infant - not perm teeth
if take 4months to 8 years - discolors perm teeth
in pregnancy - suppress growth of long bones in premature infants - reversible with d/c treatment
superinfection - c-diff or candida albicans in mouth pharynx vagina and bowel - symptoms vaginal, anal itching, inflammatory lesions, black furry tongue -> d/c tetracycline if possible or antifungal if not possible
can cause fatty infiltration of the liver - manifests as lethargy and jaundice
pregnant and postpartum or history of kidney disease are higher risk of hepatotoxicity
renal tox
increased sensitivity to sun - sunburn
which tetracyclines will food not decrease absorption
minocycline - no change
Doxycycline - some change
if a pt has renal impairment, which tetracyclines would be used
doxycycline
minocycline
eliminated primarily by liver
what 2 tetracyclines are the most dangerous in renal disease
tetracycline
demeclocycline
accumulate to toxic levels
can you give tetracyclines to pregnant woman
no
can you give tetracyclines to breastfeeding woman
no - teeth of infant
tetracyclines and older adults
can interact with drugs including digoxin
Macrolides are ____ spectrum
broad
-mycin except clindamycin
Macrolides
Azithromycin
Clarithromycin
Erythromycin
Salmonella drug of choice
Ceftriaxone
Drug of choice for whooping cough
macrolides
drug of choice for Corynebacterium Diphtheriae / acute diphtheria
Erythromycin
shared drug of choice for chlamydial infections such as urethritis , cervicitis with tetracyclines
Macrolides (Erythromycin)
shared first line with tetracyclines for Mycobacterium pneumoniae
Macrolides (-mycin)
what erythromycin base does food not decrease absorption and which 2 is affected
Erythromycin ethylsuccinate - not effected
Erythromycin base - is affected
Erythromycin stearate - affected
which erythromycin is approved for IV use
erythromycin lactobionate
can erythromycin cross placenta
yes but BBB is poor
metabolism of erythromycin/ drug interactions
CYP3A4 - increases chance of cardiac death
CCB - verapamil, diltiazem
Azole antifungal drugs - ketoconazole, itraconazole
HIV protease inhibitors - ritonavir, saquinavir
nefazodone - antidepressant
don’t combine with - monitor for tox
theophylline
carbamazepine
warfarin
clindamycin and chloramphenicol -antagonizing antibacterial effects
Adverse effects erythromycin
QT prolongation
GI - epigastric pain, n/v/d
what bacteria that is sensitive to Clindamycin
Bacteroides fragilis - resistance can be a problem with this one
Fusobacterium species
clostridium perfringes
anaerobic streptococci
what drug is good at targeting necrotic tissue
clindamycin
Drug of choice for group a strep and gas gangrene (caused by c.perfringens)
Clindamycin
adverse effects clindamycin
Clostridium difficile associated diarrhea (CDAD)
antibiotics for oxazolidinone class
Linezolid (Zyvox)
Tedizolid (Sivextro)
what abx is activity against multi drug resistant gram positive pathogens including Vancomycin resistant Enterococci (VRE) and HC-MRSA, Hospital acquired pneumonia both methicillin susceptible and resistant strains or S.pneumoniae (pennicillin-sucsceptible strains only) complicated skin infetions by S aureaus or S pyogenes
saved for VRE or MRSA
Linezolid (zyvox)
adverse effects of Linezolid (zyvox)
diarrhea
nausea
headache
reversible myelosuppression - manifests as anemia, leukopenia, thrombocytopenia, pancytopenia
CBC counts weekly
special caution needed with preexisting myelosuppression if it worsens or new develops then d/c
neuropathy - reverses with d/c
only give tetracyclines if there is ____with the abscess
cellulitis
drug interactions Linezolid (zyvox) and Tedizolid
is a MAO - hypertensive crisis if combined with sympathomimetics (ephedrine, pseudoephedrine, methylphenidate, cocaine) or foods with tyramine (wine and cheese)
Combining with SSRI can increase risk for serotonin syndrome because of MAO increases serotonin syndrome. Pt using SSRI cannot take this med (examples - Proxetine - paxil, duloxetine -cymbalta)
effective in treatment of MRSA, and bacterial skin and soft tissue infections caused by Staph and Strep (new drug class)
Tedizolid
adverse effects of Tedizolid
n/v/d dizziness headache neuropathy myelosuppression
How do you avoid esophageal ulceration in tetracyclines
do not take at night
what class is used topically and orally for severe acne
topically and orally for severe acne vulgaris
Doxycycline is _____ for staph __for strep
good for staph
bad for strep
first choice Chlmydia
Azithromycin 1 gram by mouth 1 time to cure
H pylori treated with
macrolides
mycobacterium pneumonia treated with
macrolides
what drug will you use for anaerobic infections outside of the CNS
Clindamycin
CDAD can happen ________ after clindamycin withdrawal
4-6 weeks
