Lecture 14: Miscellaneous Flashcards
Erdman's Section
What are the Tetracyclines that are used, both original and analogs?
- OG: Tetracycline, Doxycycline, Minocycline
- Analog: Tigecycline, Eravacycline, Omadacycline
What is the mechanism of action for the Tetracyclines?
- Reversibly binds to 30s, blocking binding of tRNA to the A-site = inhibits protien synthesis
What are the mechanisms of resistance for the Tetracyclines and do these effect the analogs?
- Efflux Pumps: decreased tetra
- Altered binding
- NOT affect the analogs
What is the Gram (+) spectrum of activity for the Tetracyclines?
- Group/Viridans Strep, PSSP [doxy], MSSA
Doxy & Mino most active
What is the Gram (-) Spectrum of activity for the Tetracyclines
- Resistant to Enterbacteriaceae
- H. Influenzae, H. Durcryi, Campylobacter, Helicobacter, Acintobacter Baumannii [Mino IV]
What are the Atypicals that are affected by the Tetracyclines?
- Legionella, Chlamydophilla, Psittaci
FQ, MAC, Tetra = Legionella
What is the Gram (+) Spectrum of Activity for the Tetracycline Analogs?
- Group/Viridan Strep, E. Faecalis, MSSA, MRSA, Listeria
What are the Gram (-) Spectrum of Activity for the Tetracycline Analogs?
- “EEACKSS”: E. Coli, Enterbacter sp., A. Baumanii, Citobacter sp., Klebsella sp., S. Marcescens, Strenotrophomnas
- NOT active to Proteus or Pseudomonas
What is the Pharmacology for the Tetracyclines and Tetracyclines Analogs?
A: Good oral absorption; Divalent & Trivalent interation = decrease absorption [Same as FQ]
D: Tissues and Fluids; Little in CSF
E: Dem/Tetra = urine; Doxy/Mino = nonrenal; Analogs = biliary
Tige & Erav = IV; Doxy, Mino, Omad = IV & PO; Tetra = PO
What are the Clinical Uses for the Tetracyclines and Tetracycline Analogs?
- CAP [Doxycycline]
- Chlamydial Infections [maybe 1g azith]
- Nongonococcal Urethritis [Doxycycline]
- Skin and intra-abdominal [Analogs]
NOT proteus or pseudo for Analogs
What are the Adverse Effects for the Tetracyclines and Tetracycline Analogs?
- GI Issues [mainly with Tige]
- Photosensitivity
- Cat D Pregnancy
What is the important things to note about the Pregnancy Cat D warning for the Tetracyclines and Tetracycline Analogs?
- NOT recommend during pregnancy/lactation
- Discoloration to teeth and Decreased bone growth
What is the Mechanism of action foe SMX-TMP?
- Blocks bacteria folate synthesis
- SMX: Inhibits dihydropteroate
- TMP: Inhibits dihydrofolate
Bactericidial
What is the mechanism of resistance for SMX-TMP?
- Point Mutations of Dihydropteroate
- Altered Production of Dihydrofolate
What is the Spectrum of Activity for SMX-TMP?
- Gram (+): MRSA/CA-MRSA
- Gram (-): “HENPEACKSSSS”; Strenotrophomonas
- NOT active to Pseudomonas
What is the Pharmacology for SMX/TMP?
- A: Great oral availability [90-100%]
- D: Most tissues [Urine, Prostate]
- E: Urine; HL ~ 10h; dose adjustment when CrCl <30
Want fixed oral dose of 1:5 ratio
What are the Clinical Uses of SMP-TMP?
- UTI [DOC]
- Prostatits
- Pneumocystis Carinii/Jirovecii [THE DOC]
- Strenotrophomonas
What are the Adverse Effects of SMP-TMP?
- Rash [Sulfa Allergy], Renal Issues [Crystalluria], Hyperkalemia, Cat C Pregnancy
What are the Drug Interaction of SMP-TMP?
- Warfarinm
What is the Mechanism of Action for Polymixin/Colistin?
- Binds to outer membrane of Gram (-), causing leakage and death
Conc. Dependent Bactericidal
What is the Mechanism of Resistance for Polymixin/Colistin?
- Alteration of Outer Membrane
- Cross Resistance
What is the Spectrum of Activity for Polymixin/Colistin?
- “PEEACKSSS”
- Strenotropomonas
- Pseudomonas & Acinobacter
- NOT active against Proteus, Provdencia, Serratia
ONLY GRAM (-)
What is the Pharmacology of Polymixin/Colistin?
- A: Poor Orally
- D: Extracellularly because of Polarity
- E: 50% of CMS in urine by Glomerular; dose adjustment
CMS is the one that is the USA
What are the Adverse effects of Polymixin/Colistin?
- Hephrotoxicity & Neurotoxicity
