Chapter 47 Medications Flashcards
Antibiotics for CAP
Amoxicillin (Amoxil, Trimox)
Amoxicillin/clavulanate (Augmentin)
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Ceftriaxone (Rocephin)
Cefuroxime (Zinacef)
Cefpodoxime (Vantin)
Doxycycline (Vibramycin)
Erythromycin (E-Mycin, Ery-Tab)
Erythromycin Estolate (Ilosone)
Erythromycin Ethylsuccinate (E.E.S., EryPed)
Gemifloxacin (Factive)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Ofloxacin (Floxin)
Sparfloxacin (Zagam)
Amoxicillin (Amoxil, Trimox)
Class: Penicillin
MOA (Mechanism of Action): Inhibits bacterial cell wall synthesis via binding to penicillin-binding proteins (PBPs).
Indications: Community-acquired pneumonia, otitis media, sinusitis, infections caused by susceptible organisms.
Side Effects: GI upset, rash, allergic reactions (including anaphylaxis in rare cases).
Contraindications: Hypersensitivity to penicillins, cephalosporins, or beta-lactams.
Pharmacodynamics: Time-dependent killing, (Killing effect is related to the time the drug concentration stays above the minimum inhibitory concentration)
Pharmacokinetics: Absorption not affected by food; excreted unchanged in urine.
Amoxicillin/clavulanate (Augmentin)
Class: Penicillin
MOA: Amoxicillin as above; clavulanate inhibits beta-lactamases.
Indications: As above, especially in mixed infections.
Side Effects: GI upset, rash, rare cases of hepatic dysfunction.
Contraindications: Hepatic dysfunction, Hypersensitivity to penicillins, cephalosporins, or beta-lactams.
Pharmacodynamics: Time-dependent killing, (Killing effect is related to the time the drug concentration stays above the minimum inhibitory concentration)
Pharmacokinetics: As above; clavulanate is eliminated via renal excretion.
Azithromycin (Zithromax)
Class: Macrolide
MOA: Binds to the 50S ribosomal subunit, inhibiting protein synthesis.
Indications: Community-acquired pneumonia, acute bacterial sinusitis, acute bacterial exacerbations of chronic obstructive pulmonary disease.
Side Effects: GI upset, headache, QT prolongation.
Contraindications: Hepatic dysfunction, Hypersensitivity to macrolides.
Pharmacodynamics: Concentration-dependent killing, (higher drug concentration, the greater rate and extent of bacterial killing)
Pharmacokinetics: Extensively distributed into tissues; excreted via bile.
Clarithromycin (Biaxin)
Class: Macrolide
MOA: Similar to azithromycin.
Indications: Community-acquired pneumonia, pharyngitis/tonsillitis, acute bacterial sinusitis.
Side Effects: GI upset, taste disturbances, QT prolongation.
Contraindications: Hepatic dysfunction, Hypersensitivity to macrolides.
Pharmacodynamics: Concentration-dependent killing.
Pharmacokinetics: Extensively metabolized by liver; excreted in urine and bile.
Ceftriaxone (Rocephin)
Class: Cephalosporin
MOA: Binds to penicillin-binding proteins, inhibiting bacterial cell wall synthesis.
Indications: Severe community-acquired pneumonia, meningitis, gonorrhea.
Side Effects: GI upset, rash, rare cases of biliary sludging.
Contraindications: Neonates <28 days risk of bilirubin encephalopathy.
Hypersensitivity to cephalosporins.
Pharmacodynamics: Time-dependent killing.
Pharmacokinetics: Excreted primarily unchanged in bile.
Cefuroxime (Zinacef)
Class: Cephalosporin
MOA: Similar to ceftriaxone.
Indications: Community-acquired pneumonia, otitis media, sinusitis.
Side Effects: GI upset, rash, rarely
Clostridium difficile-associated diarrhea.
Contraindications: Hypersensitivity to cephalosporins.
Pharmacodynamics: Time-dependent killing.
Pharmacokinetics: Excreted unchanged in urine.
Cefpodoxime (Vantin)
Class: Cephalosporin
MOA: is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
Indications: Treatment of community-acquired pneumonia caused by susceptible organisms.
Side Effects: Common: GI upset (nausea, diarrhea). Other: Rash, allergic reactions.
Contraindications: Hypersensitivity to cephalosporins.
Pharmacodynamics: Spectrum: Active against gram-positive and gram-negative bacteria. Bactericidal activity.
Pharmacokinetics: Oral bioavailability: 50-65%. Protein binding: 22-33%. Metabolism: Minimal hepatic. Excretion: Primarily renal.
Doxycycline (Vibramycin)
Class: Tetracycline
MOA: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit.
Indications: Atypical pneumonia (e.g., caused by Mycoplasma pneumoniae), acne, chlamydia.
Side Effects: GI upset, photosensitivity, tooth discoloration (in children).
Contraindications: Hypersensitivity to tetracyclines, pregnancy, child < 8 permanent tooth discoloration
.
Pharmacodynamics: Time-dependent killing.
Pharmacokinetics: Absorption reduced by food and dairy; excreted in urine and feces.
Erythromycin (E-Mycin, Ery-Tab)
Class: Macrolide
MOA: Similar to azithromycin.
Indications: Atypical pneumonia, Legionnaires’ disease, chlamydia.
Side Effects: GI upset, QT prolongation, rare hepatotoxicity.
Contraindications: Hypersensitivity to macrolides.
Pharmacodynamics: Concentration-dependent killing.
Pharmacokinetics: Metabolized by liver; excreted in bile.
Erythromycin Estolate (Ilosone)
Class: Macrolide
MOA: Erythromycin is a macrolide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit.
Indications: Treatment of community-acquired pneumonia caused by susceptible organisms.
Side Effects: Common: GI upset (take with food to decrease), abdominal cramping, diarrhea.
Other: Rash, allergic reactions.
Contraindications: Hypersensitivity to macrolides.
Pharmacodynamics: Spectrum: Active against gram-positive bacteria. Bacteriostatic activity.
Pharmacokinetics: Oral bioavailability: Variable. Protein binding: 70-90%. Metabolism: Hepatic (CYP3A4). Excretion: Bile.
Erythromycin Ethylsuccinate (E.E.S., EryPed)
Class: Macrolide
MOA: Same as Erythromycin Estolate.
Indications: Same as Erythromycin Estolate.
Side Effects: Common: GI upset (take with food to decrease), abdominal cramping, diarrhea. Other: Rash, allergic reactions.
Contraindications: Hypersensitivity to macrolides.
Pharmacodynamics: Spectrum: Active against gram-positive bacteria. Bacteriostatic activity.
Pharmacokinetics: Oral bioavailability: Variable. Protein binding: 70-90%. Metabolism: Hepatic (CYP3A4). Excretion: Bile.
Gemifloxacin (Factive)
Class: Quinolones (Fluoroquinolone)
MOA: Inhibits DNA synthesis by inhibiting DNA gyrase and topoisomerase IV.
Indications: Community-acquired pneumonia.
Side Effects: GI upset, headache, QT prolongation.
Contraindications: Hypersensitivity to quinolones, history of tendon disorders.
Pharmacodynamics: Concentration-dependent killing.
Pharmacokinetics: Extensively metabolized by liver; excreted in urine.
Levofloxacin (Levaquin)
Class: Quinolones (Fluoroquinolone)
MOA: Similar to gemifloxacin.
Indications: Community-acquired pneumonia, chronic bronchitis, sinusitis.
Side Effects: GI upset, headache, QT prolongation.
Contraindications: Hypersensitivity to quinolones, history of tendon disorders.
Pharmacodynamics: Concentration-dependent killing.
Pharmacokinetics: Excreted largely unchanged in urine.
Ofloxacin (Floxin)
Class: Quinolones (Fluoroquinolone)
MOA: Similar to gemifloxacin.
Indications: Community-acquired pneumonia, bronchitis, prostatitis.
Side Effects: GI upset, headache, QT prolongation.
Contraindications: Hypersensitivity to quinolones, history of tendon disorders.
Pharmacodynamics: Concentration-dependent killing.
Pharmacokinetics: Excreted in urine and feces.
