FA macrolides/monobactam/metronidazole Flashcards
macrolides examples?
azithromycin, clarithromycin, erythromycin
administration of macrolides?
p/os or i/v
macrolides static or cidic?
static
mechanism of macrolides?
bind to 23S ribosomal RNA molecule of the 50S subunit → blockage of translocation → inhibition of bacterial protein synthesis
macrolides Route of elimination?
biliary
macrolides for what pneumonia?
Atypical pneumonia caused by:
Mycoplasma pneumonia
Legionella pneumophila
Chlamydophila pneumoniae
macrolides for what STI?
STIs caused by Chlamydia
macrolides are replacement for what?
Gram-positive cocci especially for the treatment of streptococcal infection in patients who are allergic to penicillin)
special indication for claritromycin?
H. pylori (clarithromycin is the part of triple therapy?
what other m/os treated with macrolides?
Ureaplasma urealyticum;
bordetela pertussis;
Neisseria spp.:
Second-line prophylaxis for N. meningitidis
Dual therapy with ceftriaxone for N. gonorrhoeae (azithromycin)
Mycobacterium avium
Prophylaxis: azithromycin
Treatment: azithromycin, clarithromycin
adverse of macrolides?
Adverse effects Increased intestinal motility → GI upset QT-interval prolongation --> arrhythmia Acute cholestatic hepatitis Eosinophilia Rash Increased risk of hypertrophic pyloric stenosis (erythromycin and azithromycin) in infants up to 6 weeks of age.
macrolides actions on what enzyme?
INHIBIT P450
macrolides increase concentraton of what?
teophyline and oral anticoagulants (warfarin).
half life of macrolides?
All macrolides (except azithromycin) have a short half-life.
macrolides mechanism of resistance?
Methylation of the binding site of 23S rRNA prevents the macrolide from binding to rRNA.
macrolides in pregnant women?
contraindicated
Nitroimidazoles agent?
metronidazole
metronidazole administration?
p/os or i/v
metronidazole static or cidal?
cidal
metronidazole route of elimination?
renal
metronidazole BBB penetration?
good
metronidazole mechanism of action?
Creates free radicals within the bacterial cell → DNA-strand breaks → cell death (bactericidal and antiprotozoal effect)
metronidazole covers what protozoa?
Certain protozoa: Entamoeba histolytica, Giardia, Trichomonas
metronidazole what facultative anaerobes?
Gardnerella vaginalis
Helicobacter pylori in place of amoxicillin (e.g., in case of penicillin allergy) as part of a triple therapy regimen
metronidazole anaerobes?
C. difficile, Bacteroides spp.
metronidazole agains aerobes?
NOT EFFECTIVE
metronidazole - most prominent adverse?
Disulfiram-like reaction: a systemic reaction occurs when metronidazole is consumed with alcohol
Nitroimidazoles inhibit acetaldehyde dehydrogenase → accumulation of acetaldehyde → immediate hangover-like symptoms after ethanol intake
Symptoms include flushing, tachycardia, and hypotension.
what are adverse of metronidazole?
headache, disulfiram-like reaction, metatic taste, peripheral neuropathy, vestibular dysfunction
metronidazoles for infections in relation to ,,diaphragma”?
metronidazole for anaerobic infections BELOW diaphragm (clindamycin - above)
monobactams agent?
aztreonam
aztreonam administration?
i/v
aztreonam mechanism?
Specifically binds to PBP3: inhibits peptidoglycan cross-linkin
PBP3 - penicillin binding protein 3
clinical use of aztreonam for gram?
gram - only including nosocomial Pseudomonas, H. influenzae, and N. meningitidis
not active agains gram + or anaerobes
aztreonam in penicillin allergy?
Alternative for penicillin-allergic patients (no cross-sensitivity with penicillins)
aztreonam as alternative for what?
Can be used as an alternative to aminoglycosides for patients with renal insufficiency because it is synergistic with aminoglycosides
aztreonam broad spectrum in combination with what?
Broad-spectrum coverage in combination with vancomycin or clindamycin
aztreonam adverse?
Adverse effects: rare, usually nontoxic
GI upset
Injection reactions
Rash
