Chapter 23 Deck 2 Flashcards
Fluoroquinolones phamacodynamic
interfere with the bacterial enzymes required for the synthesis of bacterail DNA. Noted for extensive gram-negative activity
Fluoroquinolones not recommended for
children younger than 18
Result of overprescribing of Fluroquinolones
Can no longer be used for gonorrhea, resistant to TB
Fluroquinolones are narrow or broard
narrow
Fluroquinolones are best taken on
an empty stomach. They are well absorbed in the GI tract
Fluoquinolones ADR
Black Box warning to avoid when less toxic alternatives available
Tendon rupture:
Older adults at higher risk
Can have delayed onset, 120 days to months after administration
Fluroquinolones should be avoided in
pregnancy
Fluorquinolnes ADRs continued
GI: pseudomembranous colitis
Central nervous system (CNS): sleep disorders, dizziness, acidosis
Renal/hepatic failure
Cardiovascular: angina, atrial flutter
Increased risk of aortic aneurysm or dissection
Should be avoided in pregnancy
Not prescribed for children younger than 18 years of age
Fluoroquinolones uses? Are they first line? why?
No longer first line because of resistance and ADRs
Complicated UTI, pyelonephritis infections, chronic bacterial prostatitis
Pneumonia/chronic bronchitis exacerbation
PCN-resistant S. pneumoniae, skin infections, bone/joint infections, complicated intraabdominal, infectious diarrhea
Prlonged use of Fluoroquinolnes monitor
ECG in at risx patients before giveing moxifloxacin
avoid what with Fluroquinolnes
alcohol use
Fluroquinolnes patient education
Food delays absorption. Many drug interactions occur. Take with full glass of water. Drugs may cause dizziness. If tendon tenderness occurs, stop medication and notify provider.
Fluoroquinolone drug names
ciprofloxacin, ofloxacin, gemifloxacin, levofloxacin, moxifloxacin and delafloxacin.
The most popular brand name drugs in the class are: Cipro and Cipro XR (ciprofloxacin) Avelox (moxifloxacin)
Lincosamide Drug name
clindamycin
lincosamide pharmacodynamics
inhibits protein synthesis (50S) ribosoal unit
lincosamide use
No gram-negative activity
Gram-positive activity: Corynebacterium acnes, Gardnerella vaginalis, some MRSA
Lincosamide pharmacokinetics
oral dosing completely absorbed; not affected by gastric acid
Lincosamide ADr
Black Box warning for severe colitis; dermatological: rash, burning, itching, erythema; transient eosinophelia, neutropenia, thrombocytopenia
Lincosamide Clinical use and dosing
First-line therapy for MRSA in some areas
Infections in PCN-allergic patients
Drug-resistant Streptococcus pneumoneae infections
Dental infections
Lincosamide rational drug selction
Considered second-line therapy; narrow spectrum of aerobic activity
**First-line therapy in special populations (pregnant women and children)
Clindamycin has a
broad spectrum for infections in the mouth
Clindamycin monitoring
Monitoring
Stop medication if significant diarrhea occurs.
Patient education
Finishing therapy
ADRs: diarrhea
recomendation when taking an antibiotic
take a probiotic for about 30 days
Macrolides and Azalides drug names
erythromycin, azytrhomycin respectivley
Erythromycin (macrolines) is inactived by
acid. comes in an enteric coated form
Macrolide pharmacodynamics
Inhibits RNA-dependent protein synthesis
macrolines increase in
alkaline media
What is useptibale to macrolides
Atypical and intracellular organisms commonly resistant to beta-lactam antibiotics are often susceptible
Macrolides are well absorbed from teh
duodenum
Macrolides taken with statins may increase the risk of
myopathy (mucles fibers do not function poperly)
Macrolides exhibit what? this leads to?
Exhibit enterohepatic recycling, which can lead to buildup in the system and can cause n/v; tissue levels are higher than serum levels
Macrolides are safe in
pregnancy
Azithromycin may cause
QT prolonged interval and torsades de points
Macrolides ADR
ADRs
Dose-related GI: n/v, abdominal pain, cramping, diarrhea
Skin: urticaria, bullous eruptions, eczema, Stevens-Johnson syndrome
Drug interactions
Inhibitors of CYP3A4
Stephen Johnson Syndrome
A rare, serious disorder of the skin and mucous membranes.
A medical emergency, this is often a reaction to medication or an infection.
Flu-like symptoms appear first. A painful rash that spreads and blisters follows.
Emergency treatment aims to eliminate the underlying cause and control symptoms and complications.
ETOH and Macrolides will cause an increased risk of
prolonged QT
macrolides clinical use and dosing
Clinical use and dosing
Drug of choice for community-acquired pneumonia (mycoplasma)
Chlamydia
Pertussis
Helicobacter Pylori infections (clarithromycin)
chronic bronchitis
Macrolides Drug Selection
Often as alternatives for patients with PCN allergies
Increasing resistance
Not appropriate for treating AOM or sinusitis
Macrolides Monitoring
Monitoring For altered response to concurrent medications metabolized by CYP3A4 or CYP2C9 Hepatic/renal impairment Hearing loss Patient education ADRs Drug interactions
Fidaxomicin name and class
Dificid 18 ring macrolide
Fadaxomicin pharmcodynamics
active against C. diff, rare resistance
contraindications for fadaxomicin
safe in pregnancy
not established for safety in persons younger than 18
Fidaxomicin drug interactions
rifampin, rifaximin
clincial use for fidaxomicin
C. Diff Only.
