Exam 4 - Sulfonamides, Aminoglycosides & Misc. Flashcards
How do sulfonamides work?
Broad spectrum antibiotics
Suppress bacterial growth by inhibiting folic acid
Primary use of sulfonamides
Urinary tract infections
(E. Coli)
Other uses of sulfonamides
Nocardiosis
Chlamydia trachomatis
Conjunction therapy for toxoplasmosis/malaria
Ulcerative colitis
Adverse effects of sulfonamides
Hypersensitivity reactions: Stevens-Johnson Syndrome
Hematologic effects
Kernicterus
Renal damage from crystalluria
Drug interactions with sulfonamides
Metabolism-related interactions
Cross-hypersensitivity
A topical creams used to suppress colonization in patients with second- and third-degree burns
Silver sulfadiazine
Mafenide
Between silver sulfadiazine and mafenide, which is painful and which is not?
Silver = pain free when applied
Mafenide = frequently painful when applied
Side effect of mafenide
Can cause acidosis
How does trimethoprim work?
Suppresses bacterial growth by inhibiting folic acid
*Primary use of trimethoprim
*Acute and uncomplicated urinary tract infections
Bacteria that trimethoprim can be used against
E. Coli
Proteus mirabilis
Kiebsiella pneumoniae
Enterobacter
Coagulase-negative staphylococcus
Adverse effects of trimethoprim
Hematologic effects
Hyperkalemia
Contraindicated for use in pregnancy and lactation
What is trimethoprim frequently combined with?
Sulfamethoxazole
Brand names of trimethoprim-sulfamethoxazole
Bacteria
Septra
How does trimethoprim-sulfamethoxazole work?
Inhibits sequential steps in bacterial folic acid synthesis, making it much more powerful than TMZ or SMZ alone
Uses of trimethoprim-sulfamethoxazole
*UTIs
*Otitis media
Bronchitis
Shigellosis
Pneumonia
GI infection
Patient teaching for trimethoprim-sulfamethoxazole
Important to drink a lot of water to flush renals
(8-10 glasses of water per day)
Adverse effects of bacteria and septra
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
What is crystalluria?
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
What are aminoglycosides?
*Narrow spectrum antibiotics *that are Bactericidal
*Used for aerobic gram-negative bacilli
Most commonly used aminoglycosides
*Gentamicin
*Tobramycin
*Amikacin
What are aminoglycosides typically prescribed with?
With beta lactam antibiotics to fight severe infection
*Need to be given in separate tubes
How can aminoglycosides be administered?
*IV or *IM
(Not absorbed from the GI tract)
Main reasons you need to be careful when administering aminoglycosides
*can cause serious injury to inner ear and kidney
Adverse effects of aminoglycosides
*Nephrotoxicity
*Ototoxicity
Hypersensitivity reactions
Neuromuscular blockade
Blood dyscrasias
Vary rare but can cause paralysis or deadly respiratory depression
How do you monitor for nephrotoxicity when administering aminoglycosides?
Look at creatinine and BUN levels
If high, know drug is damaging kidneys
How do you monitor for Ototoxicity when administering aminoglycosides?
Take total cumulative and *trough levels.
Watch for ear issues in pt like vertigo
Beneficial drug interactions with aminoglycosides
Penicillins
Cephalosporins and vancomycin
(All used to enhance bacterial kill)
Adverse drug reactions with aminoglycosides
Ototoxic drugs
Nephrotoxic drugs
Skeletal muscle relaxants
Important things involved with dosing of aminoglycosides
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)
When should *peak and *trough levels be taken?
*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)
In general, what is Gentamicin (Garamycin) used for?
To treat serious infections caused by aerobic gram-negative bacilli
Types of bacteria Gentamicin (Garamycin) is used for
*Pseudomonas aeruginosa (affects intubated pts in hospital, hard to kill)
*E. Coli (hard to kill)
Klebsiella
Serratia
Proteus mirabilis
Adverse effects of Gentamicin (Garamycin)
Nephrotoxicity
Ototoxicity
Examples of other aminoglycosides
Tobramycin (Nebcin)
Amikacin (Amikin)
Neomycin
Kanamycin (Kantrex)
Streptomycin
Paromomycin (Humatin)
What are fluoroquinolones?
Broad spectrum agents with multiple applications
How do fluoroquinolones work?
Disrupt DNA replication and cell division
How are fluoroquinolones administered?
Orally
IV
Side effects of fluoroquinolones
Generally mild, but can cause *Tendon rupture (low risk)
Usually affects Achilles tendon
Which patients are fluoroquinolones contraindicated for?
Younger than 18
*Older than 60
Those taking glucocorticoids
Those who have undergone kidney, heart, or lung transplantation
Prototype of Fluoroquinolones
Ciprofloxacin (Citroen)
What type of bacteria (in general) is Ciprofloxacin (Ciprofloxacin) used for?
Gram negative and some gram positive
Uses of Ciprofloxacin (Ciprofloxacin)
Drug of choice for anthrax
Respiratory infections
UTI (if pt is allergic to sulfa drugs)
GI infections
Bone, joint, skin, and soft tissue infections
Bacteria that are resistant to Ciprofloxacin
Staphylococcus aureus
Serratia marcescens
Campylobacter jejuni
Pseudomonas aeruginosa
Neisseria gonorrhoeae
Adverse effects of Ciprofloxacin
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)
Adverse effects if Ciprofloxacin is given to older adults
Confusion
Somnolence
Psychosis
Visual disturbances
Can exacerbate myasthenia gravis
Drug and food interactions with Ciprofloxacin
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)
Other types of fluoroquinolones
Oflaxacin
Moxifloxacin
Norfloxacin
Levofloxacin
Genifloxacin
What is metronidazole (Flagyl) used for?
Protozoan infections
Infections caused by obligate anaerobes
H. Pylori
C diff infection
Prophylaxis for pts having abdominal or colorectal surgery
Adverse effects of Flagyl
Neurotoxicity
Allergy
Superinfections
How does daptomycin (Cubicin) work?
Cylic lipopeptides active against gram positive bacteria
Uses of Daptomycin (Cubicin)
Bloodstream infections caused by staph aureus (MRSA) and other skin infections caused by staph
Streptococcus
Adverse effects of Daptomycin (Cubicin)
GI related
Headache
Rash
Myopathy (muscle pain/weakness)
How can you determine if a pt is having myopathy?
Can draw CPK lab work that would indicate if there’s been muscle injury
