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Clinical Pharmacology > Drugs for bacterial infections 2 > Flashcards

Drugs for bacterial infections 2 Flashcards

1
Q

What should you NOT compare on a C&S report?

A

the MIC of different classes of antibiotics

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2
Q

What are examples of tetracyclines?

A

tetracyclline, doxycycline, minocycline

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3
Q

are tetracyclines bacteriostatic or bactericidal?

A

bacteriostatic

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4
Q

What’s the MOA of tetracyclines?

A

inhibit protein synthesis w/ binding to 30S ribosomal subunit and blocking binding of aminoacyl transfer-RNA

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5
Q

What are ADRs of tetracyclines?

A

photosensitivity, GI intolerance, stain on developing teeth (<8yo), cannot take in pregnancy!

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6
Q

What do tetracyclines have a drug interaction with?

A

DI w/ polyvalent cations decreasing absorption – must take two hours before or after medications

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7
Q

When are tetracyclines reliable to use?

A

atypicals, plasmodium (malaria), rickettsia, spirochetes

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8
Q

When are tetracyclines moderate to use?

A

staph (MRSA), s pneumoniae

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9
Q

What can you not gram-stain b/c they lack a peptidoglycan layer?

A

atypicals

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10
Q

When are tetracyclines clinically utilized?

A

respiratory tract infections, SSTI, syphilis, PID (w/ cefoxitin), malaria prophylaxis, acne

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11
Q

When are tetracyclines your DOC?

A

tick-borne diseases, chlamydia

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12
Q

What are examples of macrolides?

A

erythromycin, clarithromcin, azithromycin

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13
Q

What’s the MOA of macrolides?

A

bacterioSTATIC
inhibit protein synthesis by binding to 50s ribosomal units, inhibiting translocation of peptidase chain

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14
Q

What do macrolides do that cause major DIs?

A

inhibit CYP450 clarithro and erythro only major DIs!

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15
Q

What are ADRs of macrolides?

A

GI effects (erythro is the worst), hepatic effects, Qtc prolongation

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16
Q

When are macrolides relibale?

A

atypicals, h. flu (NOT erythro), h. pylori (clarithro), mycobacterium avium

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17
Q

When are macrolides moderate?

A

s. pneumoniae, s. pyogenes

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18
Q

When are macrolides clinically utilized?

A

resp infections, atypical mycobacterial infections, traveler’s diarrhea (azi), SSTI if PCN allergic

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19
Q

When are macrolides your DOC?

A

chlamydia (azithromycin) H. pylori (clarithromycin –metallic taste)

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20
Q

What are examples of oxazolidinones?

A

linezolid and tedizolid

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21
Q

What’s the MOA of oxazolidinones?

A

bacterioSTATIC
inhibit protein synthesis by binding to 23S RNA of 50s subunit, preventing translation

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22
Q

How are oxazolidinones orally bioavailble?

A

100%

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23
Q

When should you be cautious with using oxazolidinones?

A

sympathomimmetics and SSRIs – weak MAO inhibitor and can cause serotonin syndrome

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24
Q

What are ADRs of oxazolidinones?

A

thrombocytopenia, peripheral and optic neuropathy, lactic acidosis

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25
Q

When are oxazolidinones reliable?

A

MSSA, MRSA, strep (resistant s. pneumoniae), enterococci (including VRE)
hospital based!

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26
Q

When are oxazolidinones moderate?

A

some atypicals

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27
Q

When are oxazolidinones clinically utilized?

A

infections caused by GPC (MRSA, VRE) like SSTIs, and hospital associated pneumonia

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28
Q

What’s clindamycin?

A

lincosamide

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29
Q

What’s the MOA of lincosamides?

A

inhibits protein synthesis by reversibly binding to 50S

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30
Q

What’s the oral bioavailability of lincosamides?

A

90%

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31
Q

What’s the eagle effect?

A

bacteria exposed to concentrations higher than optimal concentration survive more

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32
Q

What are ADRs of lincosamide?

A

GI intolerance (C. dif colitis)

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33
Q

When are lincosamides reliable?

A

many G+ anaerobes, plasmodium species (malaria)

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34
Q

When are lincosamides moderate?

A

s. aureus (MRSA) but not DOC, strep, G- anaerobes

35
Q

When are lincosamides clinically utilized?

A

SSTIs, infections of oral cavity, anaerobic intra-abdominal infections, acne (topically)

36
Q

What are folate antagonists?

A

sulfamethoxazole and trimethoprim
bactericidal combo!

37
Q

What’s the MOA of folate antagonists?

A

sulfa = structurally similar to PABA and block incorporation of PABA
tri = prevents reduction of dihydrofolate to tetra by inhibiting enzyme

38
Q

What’s folate antagonists bioavailability?

A

90-100%

39
Q

How should you always prescribe folate antagonists?

A

1:5 ratio of TMP and SMX

40
Q

What are ADRs of folate antagonists?

A

hypersensitivity, hematologic toxicity, hyperkalemia, obstructive uropathy

41
Q

When is there a DDI with folate antagonists?

A

warfarin! displaces warfarin from albumin - higher conc in blood

42
Q

When are folate antagonists clinically reliable?

A

h. flu, pneumocystis jirovecii, s. aureus (some MRSA), strenotrophomonas maltophilia

43
Q

When are folate antagonists moderate?

A

enteric GNRS, s. pneumoniae, shigella, nocardia

44
Q

When are folate antagonists clinically utilized?

A

UTIs, SSTIs, GI infections

45
Q

When are folate antagonists your DOC?

A

stenotrophomonas maltophilia, nocardia, pneumocystitis jiroveci pneumonia

46
Q

What’s the MOA of fluoroquinolones?

A

bactericidal!
MOA: Inhibit DNA gryase preventing DNA synthesis

47
Q

What’s the oral bioavailability of fluoroquinolones?

A

80-100%

48
Q

How are cipro/levo eliminated vs moxi?

A

renally versus hepatically

49
Q

What are ADRs for fluorquinolones?

A

GI, headache, photosenstivity
rare: glycemic changes, seizures, prolongation of QT interval, arthralgias, Achilles tendon rupture, CNS

50
Q

When are fluorquinolones contraindicated?

A

pregnant women and mostly children

51
Q

What are some DIs of fluoroquinolones?

A

polyvalent cation binding & inhibits warfarin metabolism

52
Q

When are fluoroquinolones reliable?

A

atypicals, enteric GNRs, H. flu, s. pneumoniae (NOT cipro)

53
Q

When are fluoroquinolones moderate?

A

pseudomonas (levo/cipro), MSSA, anaerobes (moxi)

54
Q

When are fluoroquinolones clinically utilized?

A

UTIs (NOT moxi), resp tract infections (NOT cipro), intra-abdominal infections w/ metronidazole, osteomyelitis

55
Q

When are fluoroquinolones your DOC?

A

complicated UTIs (cipro/levo), severe pneumonia (not cipro)

56
Q

What’s the MOA of metronidazole?

A

bactericidal!
disrupts DNA’s helical structure
90% orally available

57
Q

What are ADRs of metronidazole?

A

GI effects, metallic taste, headache, dark urine
rare: peripheral neuropathy (prolonged use), seizures, SJS

58
Q

What are DIs with metronidazole?

A

disulfuram-like reaction w/ EtOH; increases INR of warfarin

59
Q

When is metronidazole reliable?

A

G- and G+ anaerobes

60
Q

When is metronidazole moderate?

A

H. pylori

61
Q

When is metronidazole clinically utilized?

A

addition of anerobic coverage, vaginal trichomoniasis, GI infections from protozoa

62
Q

When is metronidazole your DOC?

A

mild-moderate C. dif

63
Q

What’s the MOA of nitrofurantoin?

A

static or cidal depending on concentration!
reduced by flavoproteins to active intermediatese that inactivate/damage ribosomal proteins

64
Q

In who can you not prescribe nitrofurantoin?

A

poor renal function patients (CrCl<50)

65
Q

What are ADRs of nitrofurantoin?

A

GI effects
rare: peripheral neuropahty and pulmonary fibrosis (long term)

66
Q

When is nitrofurantoin clinically good?

A

e. coli, staph saprophyticus

67
Q

When is nitrofurantoin moderate?

A

citrobacter, klebsiellla, enterococci

68
Q

When are nitrofurantoins clinically utilized?

A

uncomplicated UTIs

69
Q

When is nitrofurantoin your DOC?

A

uncomplicated UTis and uncomplicated UTIs in pregnancy

70
Q

What is can’t see, can’t pee, can’t climb a tree?

A

gonorrhea! can spread to their joints

71
Q

What is trichomoniasis vaginitis?

A

anaerobic protozoan trophozoite – STD with malodorous, yellow-green discharge, dyspareunia, strawberry cervix

72
Q

What’s the treatment for trichomoniasis vaginitis?

A

metronidazole

73
Q

What’s syphillis?

A

treponema pallidum, spirochete
PAINLESS chancre followed weeks later by malaise, fever, pharyngitis, LAD, can go for years and cause inflammatory reaction in every organ

74
Q

What’s the treatment for syphilis?

A

<1 year = benzathine PCN G
>1 year w/ no CNS ssxs = benzathine PCN G weekly x 3 weeks
neurosyphilis = IV every 4 hours 10-14 days

75
Q

What should you treat pharyngitis with if PCN allergy w/o anaphylaxis?

A

keflex

76
Q

What should you treat pharyngitis with for PCN allergy WITH anaphylaxis?

A

macrolide or clindamycin

77
Q

What’s important to ask when looking at pneumonia treatments?

A

community or hospital acquired?
outpatient or inpatient treatment?
healthy w/no risk for MRSA/pseudomonas?
comorbidities?
LOTS of bacteria that can cause pneumonia!

78
Q

How do you treat community acquired pneumonia outpatient in a healthy patient?

A

doxycycline, clarithromycin, azithromycin

79
Q

How do you treat community acquired pneumonia outpaitent w/ comorbidites?

A
  • macrolide
  • doxy AND beta-lactam (augmentin, cefuroxime, cefpodoxime)
  • fluoroquinolones (levaquin, moxifloxacin)
80
Q

What organisms commonly cause TSS?

A

staph aureus, coagulase-neg staph, strep, mycoplasma

81
Q

How do you treat TSS?

A

supportive!
staph = nafcillin or oxacillin AND clindamycin (MSSA), vancomycin AND clindamycin (MRSA)

strep = PCN G AND clindamycin, vancomycin AND clindamycin (PCN allergic), ceftriaxone AND clindamycin

82
Q

REVIEW: How do you treat hidradenitis suppurativa?

A

stage 1 = topical benzoyl peroxide or clindamycin
stage 2 = above + Doxycycline (oral abx)
stage 3 = derm referral

83
Q

REVIEW: how do you treat erysipelas?

A

IV dicloxacillin or 1st gen cephs
(I have penicillin on mine but she doesn’t have that on hers)

84
Q

Covering anaerobes : CAMP MUC

A

Clindamycin
Augmentin
Metronidazole
Piperacillin/tazobactam
Moxifloxacin
Unasyn
Carbapenems

Clinical Pharmacology (9 decks)

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