L34 - Drugs Flashcards by Logan Kolakowski

Adverse effect for aminoglycosides

Oto/nephrotoxicity
Irreversible
Neuromuscular blockade - avoid for MG patients

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Adverse event for tetracyclines

Bone/teeth

Photo-sensitivity (sunburn easily)

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Adverse events for ery/azithromycin

QT prolongation

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Adverse events for clindamycin

C.diff infection

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Adverse events for linezolid

BM suppression

Serotonin syndrome

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What drugs are your first choice for anaerobes (3)

Clindamycin
Metronidazole
Tigecycline

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GP only protein synthesis inhibitors (2)

Linezolid

Mupirocin

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Bacterial ribosome structure

30S + 50S = 70S

vs humans: 40S + 60S = 80S

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Are most protein synthesis inhibitors cidal or static

STATIC

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Common aminoglycosides (2)

Gentamicin
Amikacin

(Streptomycin)

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Mechanism of action for aminoglycosides

Binds 30S - X protein synthesis

Cidal or static - depends on [ ]

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Spectrum of action aminoglycosides

GN w/ pseudo
GP only w/ B-lactams b/c can’t penetrate cell wall on own
No anaerobic

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When to give/not to give aminoglycosides

IV only - hospital use for systemic GN infections
High [ ] in ear and kidney - use for complex UTIs
AVOID with:
- Pneumonia - inactivated pH
- Abscesses

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Tetracycline other name & mechanism

Doxycycline
Reversible 30S binding
STATIC
Lipophilic = GN & P entry

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2 resistance mechanisms vs tetracycline

Active efflux
Ribosomal protection proteins!!
Resistance to tetra = common, major limiting factor for clinical use

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Tetracycline spectrum of activity

Broad GN (limited by resistance)
GP (some CA-MRSA)
Some anaerobic 
Chlamydia
Mycoplasma

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When are you going to give tetracycline? When are you going to avoid it?

Bronchitis
CA pneumonia
Chlamydia 
AVOID: (bone growth side effect concerns)
- Kids
- Pregnant women

What’s the other name for glycylcycline? Mechanism

= Tigecycline
Synthetic tetracycline
Broader coverage & works for tetracycline resistant bugs

Spectrum of activity glycylcycline

VERY BROAD
GN w/o proteus or pseudo 
- *Rapid resistance may develop*
GP w/ MRSA &amp; VRE
Most anaerobes

When are you going to use glycylcycline? Avoid?

IV only:
Complicated skin/ST or intra-ab infections
CA pneumonia
- Careful about increased mortality risk

3 macrolides

Azithromycin
Erythromycin
Clarithromycin

Macrolide mechanism

50S binding
Static
Azithro - long 1/2 life
Erythro - Cp450 metabolism therefore many drug interactions

Macrolide spectrum of activity

GN
GP
Some GN anaerobes 
Chlamydia
Legionella
Mycoplasma

When are you using each of the 3 microlide options?

Azithro: CA pneumo/bronchitis, atypical pneumo, chlamydia
Erythro: gut motility
Clarithro: mycobacterium avium complex disease, vs. H. pylori

Mechanism of lincosamide/clindamycin

Binds 50S | Static - cidal at high doses

Which drug might induce clindamycin resistance

Erythromycin

Clindamycin spectrum of activity

GP only w/ CA MRSA Anaerobes: - Above the diaphragm - Bacteroides fragillis

When are you using clindamycin

``` Community aspiration pneumo Oral/ENT infections Human bite wounds Abscesses S/ST due to CA MRSA ```

2 names for oxazolidinones

Linezolid | Tedizolid - overcomes resistance to other forms of this drug

Oxazolidinone mechanism of action

``` Binds 50S Increased potency b/c additional target site @ binding region of rRNA Static 100% bioavailability PO or IV ```

What is/how would serotonin syndrome present?

Excess serotonin when oxazolidnones are given with SSRIs - B/c oxazolidinones block monamine oxidase activity Hyperthermia CV instability

Linezolid spectrum of activity

GP ONLY w/ MRSA & VRE | Mycobacteria

Clinical use for linezolid

VRE infection MRSA nosocomial pneumo S/ST infection

Mupirocin mechanism

Binds tRNA synthetase reversibly

Mupirocin spectrum of activity

GP only Weaker activity against "normal" skin flora No GN or anaerobic

Mupirocin clinical uses

Topical only S.aureus or strep skin infections Decolonize MRSA from the nose Prophylaxis of catheter related infections

What are the DNA synthesis inhibitors

Imidazoles (metronidazole & tinidazole)

Imidazole mechanism of action

Diffuses into bacteria | Produces free radicals --> kills bacteria

Imidazole adverse effects

Pills taste metallic CNS - vertigo, confusion, psychosis + alcohol --> vomiting, flushing

Imidazole spectrum of activity

Anaerobes - "Below the diaphragm" - Bracteroides fragillis Protozoa

When are you using imidazole

Anaerobic infections: C.diff Intra-ab infection