Exam 3 - Fluoroquinalones, Antifolates, and Other Antibiotics Flashcards
UTI and prostate infection
Pneumocytis jiroveci
CA-MRSA
Gram -, enterobacteriaceae
Trimethoprim-sulfamethaxazole (TMP-SMX)
UTIs in sulfa-allergic patients (prevention and treatment)
Trimethoprim
2C9 inhibitor (significant interaction w/ Warfarin)
Trimethoprim-sulfamethoxazole
Adverse effects of sulfa drugs
- Megaloblastic anemia
- Photosensitivity
- Hyperkalemia
Adverse effects: crystalluria, Steven-Johnson Synrome (life threatening skin condition)
TMP-SMX
Drug interaction of sulfonamides w/ phenytoin
increased plasma levels leading to toxicity
Inhibits bacterial DNA-type II topoisomerase (DNA gyrase), inhibits resealing of DNA
Fluroquinolones - primary target for gram negative
Inhibits DNA-type IV topoisomerase which stops bacterial cell dividion
Fluoroquinolone - primary target for gram positive
Fluoroquinolones spectrum
ALL EFFECTIVE AGAINST:
GRAM NEGATIVE - H. influenzae, M. Catarrhalis, Enterobacteriaceae
ATYPICAL
Gram positive - S. pneuomoniae (except Ciprofloxacin)
ACID FAST BACILLI
ANAEROBES (ABDOMINAL INFECTIONS)
Fluoroquinolones pharmacokinetics
- concentration dependent killing, postantibiotic effect
- RENALLY ELIMINATED (EXCEPT MOXIFLOXACIN)
- Inhibits CYP 450
- Avoid drugs that prolong QT interval
Fluoroquinolones
Increase Warfarin levels
Fluoroquionolones adverse effects
Potentiates effect of sulfonylureas - blood sugar in diabetics, stimulates pancreas to make insulin
Fluoroquionolones adverse effects
Antacids, iron, zinc, sucralfate, calcium inhibit the absorption of ….
Fluoroquionolones adverse effects
Ciprofloxacin
EXCEPTION OF FLUROQUINOLONES: NO ACTIVITY AGAINST S. PNEUMONIA
Activity against PSEUDOMONAS
Fluroquinolones that have activity against Pseudomonas
Ciprofloxacin
Levofloxacin
Moxifloxacin
ANAEROBES
NOT RENALLY ELIMINATED - NOT USED FOR UTI
Nitrofurantioin spectrum
Gram positive - Staphylococcus saprophyticus (UTI pathogen)
Gram negative - E. coli, Klebsiella, Citrobacter (UTI pathogens)
Agent used only for the treatment and prevention of UTI; may cause pulmonary fibrosis
Nitrofurantoin
Do not use w/ CrCl less than 50 ml/min, may build up and cause accumulation
RAPIDLY RENALLY EXCRETED
Nitrofurantoin
N&V Pulmonary fibrosis Acute pnesumonitis Neuropathies HEMOLYTIC ANEMIA (RBCs GET BROKEN DOWN)
Nitrofurantoin
Spectrum:
MRSA
Vancomycin-sensitive enterococci
Daptomycin
CPK elevations (myopathy, rhabdomyolosis) *caution w/ statins
Daptomycin
Nonabsorbed, oral antibiotic (stays in the gut)
Rifaximin
Reduce ammonia-producing enteric bacteria
Rifaximin
Indicated for Traveler’s diarrhea
Rifaximin
Indicated for prevention of hepatic encephalopathy (worsening brain function occurs when liver is no longer able to remove toxic substances in the blood)
- recurrence in patients w/ advanced liver disease
Rifaximin
