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PHRM 865: Theraputics V > Lecture 14: Miscellaneous > Flashcards

Lecture 14: Miscellaneous Flashcards

Erdman's Section

1
Q

What are the Tetracyclines that are used, both original and analogs?

A
  • OG: Tetracycline, Doxycycline, Minocycline
  • Analog: Tigecycline, Eravacycline, Omadacycline
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2
Q

What is the mechanism of action for the Tetracyclines?

A
  • Reversibly binds to 30s, blocking binding of tRNA to the A-site = inhibits protien synthesis
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3
Q

What are the mechanisms of resistance for the Tetracyclines and do these effect the analogs?

A
  • Efflux Pumps: decreased tetra
  • Altered binding
  • NOT affect the analogs
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4
Q

What is the Gram (+) spectrum of activity for the Tetracyclines?

A
  • Group/Viridans Strep, PSSP [doxy], MSSA

Doxy & Mino most active

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5
Q

What is the Gram (-) Spectrum of activity for the Tetracyclines

A
  • Resistant to Enterbacteriaceae
  • H. Influenzae, H. Durcryi, Campylobacter, Helicobacter, Acintobacter Baumannii [Mino IV]
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6
Q

What are the Atypicals that are affected by the Tetracyclines?

A
  • Legionella, Chlamydophilla, Psittaci

FQ, MAC, Tetra = Legionella

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7
Q

What is the Gram (+) Spectrum of Activity for the Tetracycline Analogs?

A
  • Group/Viridan Strep, E. Faecalis, MSSA, MRSA, Listeria
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8
Q

What are the Gram (-) Spectrum of Activity for the Tetracycline Analogs?

A
  • “EEACKSS”: E. Coli, Enterbacter sp., A. Baumanii, Citobacter sp., Klebsella sp., S. Marcescens, Strenotrophomnas
  • NOT active to Proteus or Pseudomonas
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9
Q

What is the Pharmacology for the Tetracyclines and Tetracyclines Analogs?

A

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

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10
Q

What are the Clinical Uses for the Tetracyclines and Tetracycline Analogs?

A
  • CAP [Doxycycline]
  • Chlamydial Infections [maybe 1g azith]
  • Nongonococcal Urethritis [Doxycycline]
  • Skin and intra-abdominal [Analogs]

NOT proteus or pseudo for Analogs

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11
Q

What are the Adverse Effects for the Tetracyclines and Tetracycline Analogs?

A
  • GI Issues [mainly with Tige]
  • Photosensitivity
  • Cat D Pregnancy
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12
Q

What is the important things to note about the Pregnancy Cat D warning for the Tetracyclines and Tetracycline Analogs?

A
  • NOT recommend during pregnancy/lactation
  • Discoloration to teeth and Decreased bone growth
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13
Q

What is the Mechanism of action foe SMX-TMP?

A
  • Blocks bacteria folate synthesis
  • SMX: Inhibits dihydropteroate
  • TMP: Inhibits dihydrofolate

Bactericidial

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14
Q

What is the mechanism of resistance for SMX-TMP?

A
  • Point Mutations of Dihydropteroate
  • Altered Production of Dihydrofolate
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15
Q

What is the Spectrum of Activity for SMX-TMP?

A
  • Gram (+): MRSA/CA-MRSA
  • Gram (-): “HENPEACKSSSS”; Strenotrophomonas
  • NOT active to Pseudomonas
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16
Q

What is the Pharmacology for SMX/TMP?

A
  • 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

17
Q

What are the Clinical Uses of SMP-TMP?

A
  • UTI [DOC]
  • Prostatits
  • Pneumocystis Carinii/Jirovecii [THE DOC]
  • Strenotrophomonas
18
Q

What are the Adverse Effects of SMP-TMP?

A
  • Rash [Sulfa Allergy], Renal Issues [Crystalluria], Hyperkalemia, Cat C Pregnancy
19
Q

What are the Drug Interaction of SMP-TMP?

A
  • Warfarinm
20
Q

What is the Mechanism of Action for Polymixin/Colistin?

A
  • Binds to outer membrane of Gram (-), causing leakage and death

Conc. Dependent Bactericidal

21
Q

What is the Mechanism of Resistance for Polymixin/Colistin?

A
  • Alteration of Outer Membrane
  • Cross Resistance
22
Q

What is the Spectrum of Activity for Polymixin/Colistin?

A
  • “PEEACKSSS”
  • Strenotropomonas
  • Pseudomonas & Acinobacter
  • NOT active against Proteus, Provdencia, Serratia

ONLY GRAM (-)

23
Q

What is the Pharmacology of Polymixin/Colistin?

A
  • 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

24
Q

What are the Adverse effects of Polymixin/Colistin?

A
  • Hephrotoxicity & Neurotoxicity
25
Q

What is the Mechanism of Action for Clindamycin?

A
  • Inhibits protein synthesis by binding to 50s
  • Bacteriostatic

Time-dependent

26
Q

What are the Mechanism of Resistance for Clindamycin?

A
  • Alteration of Binding Site [Erm gene]
  • NOT effected by efflux pump
27
Q

What is the Gram (+) Spectrum of Activity for Clindamycin?

A
  • Group/Viridan Strep, PSSP, MSSA, CA-MRSA
28
Q

What are some of the Anaerobes Spectrum of Activity for Clindamycin?

A
  • Gram (+): Peptostreptococcus; Clostridum..
  • Gram (-): Bacteroides, Fusobacterium

WILL CAUSE C.DIFF

29
Q

What is the Pharmacology of Clindamycin?

A
  • A: Good Orally
  • D: Most tissues; NOT CSF
  • E: Liver; Enterohepatic Circulation is a concern = C.Diff
30
Q

What are the Clinical Uses of Clindamycin?

A
  • Anaerobes OUTSIDE the CNS; Pulmonary, Diabetic Foot
  • CA-MRSA
  • Penicillin Alleriges
31
Q

What are some of the adverse effects of Clindamycin?

A
  • GI Issue [Nausea, Vomiting, Diarrhea]
  • C. DIFF
  • Hepatotoxicity
32
Q

What is the Mechanism of Action for Metronidazole?

A
  • Prodrug; Makes Ferredoxins into radicals causing DNA damage and cell death

Conc. Dependent Bactericidal

33
Q

What is the Mechansim of resistacne for Metronidazole?

A
  • Altered Growth
  • Altered Ferredoxin levels
34
Q

What is the Anaerobe Gram (-) Spectrum of activity for Metronidazole?

A
  • B. Fragilis [DOT]
35
Q

What is the Anaerobic Gram (+) Spectrum of Activity for Metronidazole?

A
  • C. DIFF

1st line is Oral Vancomycin

36
Q

What is the Pharmocology of Metronidazole?

A
  • A: Good Orally
  • D: Body Tissues and Fluids; EVEN CSF & BRAIN TISSUE
  • E: Liver; 6-15% excreted in poo
37
Q

What are the clinical uses of Metronidazole?

A
  • Anaerobic Infections [May need aerobic drugs too]
  • Pseudomembranous Colitits [C. DIFF]
  • Trichomonas Vaginalis & Giardia [DOC]
38
Q

What are the Adverse Effects of Metronidazole?

A
  • GI Issues, Metallic Taste, Perpheral Neuropathy [STOP if this happens], Teratogenic?
39
Q

What are the Drug interactions for Metronidazole?

A
  • Warfarin & Alcohol

PHRM 865: Theraputics V (42 decks)

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