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Pharmacology Elon > Macrolides > Flashcards

Macrolides Flashcards

1
Q

Macrolides (specificity)

A

Gram +(staph, strep)

Gram - (Nisseria, Bordatela, Campylobacter, H. Pylori, Listeria)

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2
Q

Macrolides (Clinical Uses)

A

PCN allergy pts
AOM
GAS
SSTI (Erysipelas and cellulitis prevention)
Rheumatic fever prophylaxis

Also
Community acquired (CAP) and atypical Pneumonia
Gastroparesis

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3
Q

Macrolides (Adverse Effects)

A

Long QT syndrome
-Ventricular arrythmia
-Prolonged Qt on EKG

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4
Q

Macrolides (other)

A

41% of strep in US is resistant due to efflux, decreased membrane perm., and modded binding site.

Concentration-dependent bacterial action
(Static until cidal), depends on concentration and target organ.

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5
Q

Erythromycin (forms)

A

Base
Stearate
Estolate
Ethylsuccinate (EES)

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6
Q

Erythromycin (specificity)

A

Concentration dependent

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7
Q

Erythromycin (clinical uses)

A

Respiratory infections
SSTI
Chlamydia (Pregnancy)
Pertussis
Diptheria
Campylobacter gastroenteritis (2nd line)
Rheumatic fever prophylaxis
Endocarditis prophylaxi (in dental procedures)

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8
Q

Erythromycin (contraindications)

A

Hypersensitivity
Stevens-Johnson Sydrome
Toxic Epidermal Necrolysis (Ten)
Drug Interaction (Pimozide)
Liver disease (Estolate)
Pertusis -crossess placenta and is found in breast milk and may cause IHPS

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9
Q

Erythromycin (AE’s)

A

Long QT syndrome
-stimulates gastric emptying

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10
Q

Erythromycin (drug interactions)

A 
P450 inhibitor (CYP 3A4) 
long QT drugs

-need to know pt. allergies, Cardiac status, pregnancy, liver status, and med list

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11
Q

Erythromycin (PK)

A 
Stearates are acid susceptible
Estolates and (EES) are used orally and are acid stable.

Short half life (1.5-2 hours) why dosed several times per day

Eliminated by liver via bile

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12
Q

Erythromycin (other)

A

IHPS= Infantile hypertrophic pyloric stenosis
Pimozide drug interaction is life threatening

For Chlamydia:
Pregnancy
Ophthalmia neonatorum tx
Lymphogranuloma venereum (Second line)

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13
Q

Clarithromycin (specificity)

A

Synthetic more acid-stable then erthromycin

Broader spectrum, better tolerability

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14
Q

Clarythromycin (clinical uses)

A

2nd line for PCN allergy
Pertussis (DOC)
CAP
H. pylori/duodenal ulcer (+ amoxicillin & a PPI)
Lyme Disease
Mycobacteria (DOC Prophylaxis and tx for AIDS pts)
Taxoplasmosis
Cryptosporidiosis
Endocarditis prophylacxis(in dental procedures/PCN allergy)
SSTI
Bartonella (cat scratch fever)

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15
Q

Clarythromycin (contraindications)

A

Hypersensitivity
Stevens-Johnson
Toxic Epidermal Necrolysis (Ten)
Interacting drugs
Liver disease
Congenital long QT

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16
Q

Clarythromycin (AE’s)

A

N/V/D
Dysgeusia
Bad taste from suspension

17
Q

Clarythromycin (PK)

A

Metabolized by CYP 3A4

Drug Interactions:
P450 inhibitor and long QT drugs

18
Q

Clarythromycin (warnings)

A

Pregnancy cat. C

19
Q

Clarythromycin (other)

A

DOC for primary prevention in HIV pt’s with HIV pts

Metabolite also has antimicrobial actions

20
Q

Azithromycin (specificity)

A

Broader spectrum, better tolerability

21
Q

Azithromycin (clinical uses)

A

Step pharyngitis for pt’s w/ PNC allergy
Uncomplicated skin infection
Legionella pneumonia (DOC)
Mycobacteria (Prophylaxis and tx for AIDS pts) Chylamydia/Neisseria
Pertussis PEP infants

22
Q

Azithromycin (CI’s)

A

Hypersensitivity
Stevens-Johnson
Toxic Epidermal Necrolysis (Ten)
Interacting drugs
Liver disease

23
Q

Azithromycin (AE’s)

A

N/V/D
Abd pain
CDAD
Long QT
Angioedema
Cholestatic jaundice

**less GI effects than erythromycin and clarithromycin

24
Q

Azithromycin (warnings)

A

Not used in severe pneumonia

Pregnancy cat. B

25
Q

Azithromycin (PK’s)

A

NOT PY450 drug
Biliary excretion

1/2 life 68 hrs (long)

26
Q

Azithromycin (other)

A

Genital ulcer dz occurs in men w/ Haemophilus ducreyi (chancroid)

Studies show that may decrease acute exacerbation of chronic bronchitis with daily use x 1yr –> may indicate some anti-inflammatory effects (concern about hearing loss and long qt)

27
Q

Fidaxomicin (MOA)

A

Inhibit protein synthesis by reversibly binding bacterial 50s ribosomal subunit (bactericidal)

28
Q

Fidaxomycin (specificity)

A

C-diff. (CDAD) (bactericidal)

29
Q

Fidoxomycin (AE’s)

A

Nausea Vomiting Abdominal pain
GI hemorrhage
Neutropenia
Anemia

30
Q

Macrolides (MOA)

A

Inhibit protein synthesis by reversibly binding bacterial 50S ribosomal subunit

Bacteriostatic until bacteriacidal

Pharmacology Elon (2 decks)

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