Fluoroquinalones, Other ABX Flashcards
Are fluoroquinalones bacteriostatic or icidal?
Bactericidal
Are Fluoroquinalones concentration or time dependent?
Concentration dependent
What is fluoroquinolone’s MOA?
They inhibit protein synthesis by binding to DNA gyrase, inhibiting the relaxation of the supercoiled DNA, promoting breaking of the DNA strands
Which fluoroquinolones cover pseudomonas?
Cipro, high dose levo, norfloxacin, and ofloxacin
What is fluoroquinolones’ relationship with atypicals?
They provide good atypical coverage, ex. Mycoplasma pneumonia
- provide good intracellular penetration to atypicals
What are the general uses for fluoroquinolones?
CAP, nosocomial pneumonia, acute sinusitis, complicated and uncomplicated UTIs (except not gemifloxacin and moxifloxacin), prostatitis, some soft tissue infections and osteo, Crohn’s, campylobacter, legionella, brucella, salmonella, mycobacterium
- cipro, levo, and ofloxacin for eyes
- ofloxacin for ears
Is cipro a good choice for strep pneumonia?
No, cipro is generally not great for gram +
Where are cipro’s SE?
GI, QT prolong, tendon rupture, increased seizure frequ, renal dose required
- CYP1A2 inhibitor
Which fluoroquinolone is good for MRSA
Only Delafloxacin
Which fluoroquinolones are not good for peds?
Norfloxacin, ofloxacin, moxifloxacin, and levo
Which fluoroquinolone does not require renal dosing?
Moxifloxacin
What pregnancy and lactation category are fluoroquinolones?
Category C, L3
General Fluoroquinolone SE
QT prolong (mostly with other meds or if you have prolongation syndrome
- seizure risk, mostly related to taking cipro with NSAID and used off label
- tendon rupture if organ transplant and taking steroids, and over 60y
Which fluoroquinolone is good for CF?
Cipro
What are the mechanisms of resistance to fluoroquinolones?
- change the structure of the DNA gyrase
- reduced abx uptake by the bacteria
Which fluoroquinolone eye drop does not have a preservative?
Moxifloxacin
Which otic solution is not sterile?
Cipro 0.2% and hydrocortisone suspension, don’t use if tympanic membrane is ruptured
Which otic solution is appropriate for acute otitis media externa from pseudomonas?
Cipro
Do bi and tri valent cations interact with fluoroquinolones?
Yes, Ca, Fe AL, and Mg interact with them, reducing the bioavailability of abx
What drug class is Daptomycin?
Cyclic Lipopeptide, a concentration dependent bactericidal against Gram +
What is Daptomycin mainly used for?
Gram + MRSA of skin/soft tissue infections
- also vanc sensitive enterococcus, s. Aureus endocarditis
Can Daptomycin be used for CAP
No. Broken down by surfactant
What are the SE of Daptomycin?
Increased CK and myopathy, caution with statins, fibrates, colchicine
What is the MOA of Trimethoprim/Sulfamethoxazole (TMP/SMX [Bactrim])?
Inhibits folic acid synthesis causing cell div to stop or slow, can cause bone marrow suppression and anemias dt cross over to effects on human cells
What is TMP/SMX prescribed for?
Drug of choice for PJP/PCP*
Only drug for ventilator associated Stenotrophomonas maltophilia*
-otitis media, UTIs, travelers diarrhea, shigella, cholera, prostatitis, nocardiosis
- Gram +: CA S. Aureus (MRSA), S. Epidermidis, S. Pneumoniae, S. pyogenes, s. Viridans
- Gram -: H. Influenzae, enterobacteriaceae, salmonella, shigella
- poor strep coverage
What are the TMP/SMX SE?
-increased bili/kernicterus (avoid in last trimester and breastfeeding)
- sulfa allergy (SJS)
- Major inhibitor of CYP2C9 (will increase effects of warfarin)
- renal dosing
- avoid in G6PD
- crystalluria
- hyperkalemia (dt K sparing)
- bone marrow suppression (TMP=Treats Marrow Poorly)
What type of drug is Dapsone?
Bacteriostatic, Sulfone, similar in action to sulfonamides
What is Dapsone used for?
Leprosy and alternative for PJP
What are the SE for Dapsone?
Anemia and increased bili if G6PD, N/V, HAs, neuropathy
What is the MOA of Nitrofurantoin (Macrobid, macrodantin)
Bactericidal, interferes will cell wall synthesis
What is nitrofurantoin (macrobid) prescribed for?
Gram + and gram - UTIs
What are the SE of nitrofurantoin (macrobid?)
Hemolytic anemia with G6PD(don’t give near term), caution with folate def, pulm tox with prolonged use, CNS effects, brownish urine, peripheral neuropathy, false + urine glucose, avoid with renal impairment since it needs to make to the urine for UTI treatment
Fluuroquinalones are the ________ line treatment for chlamydia and epididymitis, the ______ line therapy for traveler’s diarrhea, and no longer recommended for __________.
First line treatment for chlamydia and epididymitis
Second line therapy for diarrhea
No longer rec for gonorrthea
Which drug is a first line treatment for typhoid fever?
Cipro
Linezoilid is what type of abx?
Oxazolidinones
What is Linezolid used for?
Most effective against Gram +:
-also includes gram - and anaeorbic
- main ones are group A and B strep, S. Pneumoniae, E. Faecalis, E. Faecium, S. Aureus (both MSSA and MRSA), S. Epidermis is, C. Perfringens, Peptostreptococcus, Corynebacterium jeikeium, L. Monocytogenes, Enterococcus including VRE
What are the contraindications and SE for Linezolid?
Contra: concomitant use with MAOI, SSRIs, tricyclics, QT prolonging meds
- an cause serotonin syndrome, myelosupression, lactic acidosis, neuropathy, with long term use
What is Linezolid typically used for?
Group A and B strep, , esp MRSA pneumonia as alternative to vanc, Vanc resistant Enterococcus faecium (VRE)
Sulfonamides, TMP-SMZ, trimethoprim, nitrofurantoin, and fosfomycin can be used for what?
UTIs specifically cystitis
-TMP-SMZ can also be used for community acquired MRSA
Sulfanimides should be used cautiously in pts with which deficiency?
G6PD def and folate def
Use cautiously w renal impairment
Can also cause kernicterus, crystalluria unless urine alkaline and not enough water, TEN/SJS, hepatitis, photosens, increased K-, neuropathy, CNS changes, aseptic meningitis, increased QT
-Preg D
Trimethoprim should be used cautiously in pts with which deficiency?
Folate, renal impairment, pregnancy category C, although TMP-SMZ is Category D
