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Pharmacology > Exam 4 - Sulfonamides, Aminoglycosides & Misc. > Flashcards

Exam 4 - Sulfonamides, Aminoglycosides & Misc. Flashcards

1
Q

How do sulfonamides work?

A

Broad spectrum antibiotics
Suppress bacterial growth by inhibiting folic acid

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2
Q

Primary use of sulfonamides

A

Urinary tract infections
(E. Coli)

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3
Q

Other uses of sulfonamides

A

Nocardiosis
Chlamydia trachomatis
Conjunction therapy for toxoplasmosis/malaria
Ulcerative colitis

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4
Q

Adverse effects of sulfonamides

A

Hypersensitivity reactions: Stevens-Johnson Syndrome
Hematologic effects
Kernicterus
Renal damage from crystalluria

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5
Q

Drug interactions with sulfonamides

A

Metabolism-related interactions
Cross-hypersensitivity

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6
Q

A topical creams used to suppress colonization in patients with second- and third-degree burns

A

Silver sulfadiazine
Mafenide

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7
Q

Between silver sulfadiazine and mafenide, which is painful and which is not?

A

Silver = pain free when applied
Mafenide = frequently painful when applied

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8
Q

Side effect of mafenide

A

Can cause acidosis

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9
Q

How does trimethoprim work?

A

Suppresses bacterial growth by inhibiting folic acid

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10
Q

*Primary use of trimethoprim

A

*Acute and uncomplicated urinary tract infections

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11
Q

Bacteria that trimethoprim can be used against

A

E. Coli
Proteus mirabilis
Kiebsiella pneumoniae
Enterobacter
Coagulase-negative staphylococcus

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12
Q

Adverse effects of trimethoprim

A

Hematologic effects
Hyperkalemia
Contraindicated for use in pregnancy and lactation

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13
Q

What is trimethoprim frequently combined with?

A

Sulfamethoxazole

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14
Q

Brand names of trimethoprim-sulfamethoxazole

A

Bacteria
Septra

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15
Q

How does trimethoprim-sulfamethoxazole work?

A

Inhibits sequential steps in bacterial folic acid synthesis, making it much more powerful than TMZ or SMZ alone

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16
Q

Uses of trimethoprim-sulfamethoxazole

A

*UTIs
*Otitis media
Bronchitis
Shigellosis
Pneumonia
GI infection

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17
Q

Patient teaching for trimethoprim-sulfamethoxazole

A

Important to drink a lot of water to flush renals
(8-10 glasses of water per day)

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18
Q

Adverse effects of bacteria and septra

A

GI issues: nausea and vomiting
Rash
Hyperkalemia
Hypersensitivity reactions (Stevens-Johnson syndrome)
- Blood dyscrasias
- Kernicterus
- Renal damage: crystalluria
Contraindicated during 1st and 3rd trimesters of pregnancy

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19
Q

What is crystalluria?

A

Bacteria and septra get caught in the renal area due to how it breaks down in the system
This is why it’s important to tell pts to drink a lot of water

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20
Q

What are aminoglycosides?

A

*Narrow spectrum antibiotics *that are Bactericidal
*Used for aerobic gram-negative bacilli

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21
Q

Most commonly used aminoglycosides

A

*Gentamicin
*Tobramycin
*Amikacin

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22
Q

What are aminoglycosides typically prescribed with?

A

With beta lactam antibiotics to fight severe infection
*Need to be given in separate tubes

23
Q

How can aminoglycosides be administered?

A

*IV or *IM
(Not absorbed from the GI tract)

24
Q

Main reasons you need to be careful when administering aminoglycosides

A

*can cause serious injury to inner ear and kidney

25
Q

Adverse effects of aminoglycosides

A

*Nephrotoxicity
*Ototoxicity
Hypersensitivity reactions
Neuromuscular blockade
Blood dyscrasias
Vary rare but can cause paralysis or deadly respiratory depression

26
Q

How do you monitor for nephrotoxicity when administering aminoglycosides?

A

Look at creatinine and BUN levels
If high, know drug is damaging kidneys

27
Q

How do you monitor for Ototoxicity when administering aminoglycosides?

A

Take total cumulative and *trough levels.
Watch for ear issues in pt like vertigo

28
Q

Beneficial drug interactions with aminoglycosides

A

Penicillins
Cephalosporins and vancomycin
(All used to enhance bacterial kill)

29
Q

Adverse drug reactions with aminoglycosides

A

Ototoxic drugs
Nephrotoxic drugs
Skeletal muscle relaxants

30
Q

Important things involved with dosing of aminoglycosides

A

Single large dose given each day or 2-3 smaller doses per day

Monitoring of serum levels is common to monitor plasma levels (peak and trough levels)

31
Q

When should *peak and *trough levels be taken?

A

*Peak levels should be taken 30 mins after giving IM injection or after a 30 minute IV infusion
And 1 hour after an hour long infusion

*Trough levels depends on the dosing schedule
Ex: once daily doses: draw single sample 1 hour before next dose (value should be very low - close to zero)

32
Q

In general, what is Gentamicin (Garamycin) used for?

A

To treat serious infections caused by aerobic gram-negative bacilli

33
Q

Types of bacteria Gentamicin (Garamycin) is used for

A

*Pseudomonas aeruginosa (affects intubated pts in hospital, hard to kill)
*E. Coli (hard to kill)
Klebsiella
Serratia
Proteus mirabilis

34
Q

Adverse effects of Gentamicin (Garamycin)

A

Nephrotoxicity
Ototoxicity

35
Q

Examples of other aminoglycosides

A

Tobramycin (Nebcin)
Amikacin (Amikin)
Neomycin
Kanamycin (Kantrex)
Streptomycin
Paromomycin (Humatin)

36
Q

What are fluoroquinolones?

A

Broad spectrum agents with multiple applications

37
Q

How do fluoroquinolones work?

A

Disrupt DNA replication and cell division

38
Q

How are fluoroquinolones administered?

A

Orally
IV

39
Q

Side effects of fluoroquinolones

A

Generally mild, but can cause *Tendon rupture (low risk)
Usually affects Achilles tendon

40
Q

Which patients are fluoroquinolones contraindicated for?

A

Younger than 18
*Older than 60
Those taking glucocorticoids
Those who have undergone kidney, heart, or lung transplantation

41
Q

Prototype of Fluoroquinolones

A

Ciprofloxacin (Citroen)

42
Q

What type of bacteria (in general) is Ciprofloxacin (Ciprofloxacin) used for?

A

Gram negative and some gram positive

43
Q

Uses of Ciprofloxacin (Ciprofloxacin)

A

Drug of choice for anthrax
Respiratory infections
UTI (if pt is allergic to sulfa drugs)
GI infections
Bone, joint, skin, and soft tissue infections

44
Q

Bacteria that are resistant to Ciprofloxacin

A

Staphylococcus aureus
Serratia marcescens
Campylobacter jejuni
Pseudomonas aeruginosa
Neisseria gonorrhoeae

45
Q

Adverse effects of Ciprofloxacin

A

GI: nausea/vomiting, diarrhea, abdominal pain
CNS: dizziness, headache, restlessness, confusion, rarely seizures
*Tendon rupture (Black Box Warning)
*Phototoxicity
Candida infections: pharynx and vagina
Increased risk of C diff infection (CDI)

46
Q

Adverse effects if Ciprofloxacin is given to older adults

A

Confusion
Somnolence
Psychosis
Visual disturbances
Can exacerbate myasthenia gravis

47
Q

Drug and food interactions with Ciprofloxacin

A

Cationic compounds reduce absorption:
- Aluminum antacids
- Magnesium antacids
- Iron salts, Zinc salts, Sucralfate
- Milk and dairy products

Elevation of drug levels:
- Theophylline (used for asthma)
- Warfarin (anticoagulant)
- Tinidazole (antifungal)

48
Q

Other types of fluoroquinolones

A

Oflaxacin
Moxifloxacin
Norfloxacin
Levofloxacin
Genifloxacin

49
Q

What is metronidazole (Flagyl) used for?

A

Protozoan infections
Infections caused by obligate anaerobes
H. Pylori
C diff infection
Prophylaxis for pts having abdominal or colorectal surgery

50
Q

Adverse effects of Flagyl

A

Neurotoxicity
Allergy
Superinfections

51
Q

How does daptomycin (Cubicin) work?

A

Cylic lipopeptides active against gram positive bacteria

52
Q

Uses of Daptomycin (Cubicin)

A

Bloodstream infections caused by staph aureus (MRSA) and other skin infections caused by staph

Streptococcus

53
Q

Adverse effects of Daptomycin (Cubicin)

A

GI related
Headache
Rash
Myopathy (muscle pain/weakness)

54
Q

How can you determine if a pt is having myopathy?

A

Can draw CPK lab work that would indicate if there’s been muscle injury

Pharmacology (16 decks)

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