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ID Pharm > Misc Antibiotics > Flashcards

Misc Antibiotics Flashcards

1
Q

Fluoroquinolones

A 
Ciprofloxacin (Cipro) - MC
Levofloxacin (Levaquin) - MC
Moxifloxacin (Avelox) - MC
Gemifloxacin (Factive)
Norfloxacin (Noroxin)
Ofloxacin (Floxin) - otitis externa
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2
Q

PK of Fluoroquinolones

A

Distribution: tissue and fluids except CNS
Elimination: renal except moxifloxacin
Half-life: 4-12 hours

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3
Q

Fluoroquinolone MOA and Resistance

A

Inhibit ability of DNA gyrase and/or topoisomerase IV - inhibit ability of the bacterial DNA to replicate
Resistance: spontaneous mutations in genes of DNA gyrase or topoisomerase IV to reduce FQ affinity
Plasmid mediated

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4
Q

Fluoroquinolones SOA

A

Aerobic Gm neg. = all FQs
Pseudomonas aeruginosa = cipro and levo
Gm pos. streptococcus sp (respiratory) = levo, moxi, gemi
Anaerobic = moxifloxacin

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5
Q

Fluoroquinolone Clinical uses

A 
UTI - cipro
pneumonia - levo, moxi, gemi
STI
skin and soft tissue infx
GI infections - good gm. neg coverage
traveler's diarrhea - cipro
osteomyelitis
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6
Q

Fluoroquinolones BBW

A

spontaneous tendon rupture

Esp. if >60 years, on corticosteroids, or kidney, heart, or lung transplants

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7
Q

Fluoroquinolones SE

A

nausea, diarrhea, dizziness, confusion, tendonitis, myopathy, peripheral neuropathy, aortic dissection/aneurysm, tendon rupture, QT prolongation

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8
Q

Fluoroquinolones drug interactions

A

Cipro = potent 1A2 inhibitor –> theopyhlline, warfarin, tizanidine, propranolol
Antacids, sucralfate, magnesium, calcium, iron = decreased absorptions of FQs

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9
Q

Fluoroquinolones Pseudomonas and special populations

A

Only oral agent against pseudomonas
Pregnancy and Lactation: exposure to infant
Peds: arthropathy and osteochondrosis
Caution in hepatic dysfunction

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10
Q

Sulfonamides

A

Sulfamethoxazole/Trimethoprim (SMX-TMP, Bactrim DS, Septra)
Good distribution to body tissues, CSF, pleural fluid, synovial fluid
Eliminated through liver and kidneys

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11
Q

Sulfonamide MOA and Resistance

A

Folic acid synthesis inhibitors to inhibit DNA synth
Mutations result in additional production of PABA, changes in enzyme binding sites for sulfonamids
Plasmid mediated

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12
Q

Sulfonamide SOA and Clinical Uses

A

SOA: no anaerobic coverage, wide Gm + and - coverage
Uses: UTI, toxoplasmosis, MRSA, PCP or PJP in AIDS, sinusitis and otitis media but not recommended

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13
Q

Sulfonamide SE

A

SE: rash, fever, NVD, SJS, vasculitis, thrombocytopenia

W/ G6PD deficiency = hemolytic anemia

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14
Q

SJS

A

cell death causes the dermis and epidermis to separate

Hypersensitivity reaction of skin and mucous membranes

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15
Q

Sulfonamide DI

A

up to 70% protein bout = displaces other drugs

Potentiates the effects of warfarin, phenytoin, hypoglycemic agents, methotrexate

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16
Q

Sulfonamide Excretion and special populations

A 
Metabolized in liver
Renally excreted - reduce dose by 50% if CrCl = 15-30 mL/min
Don not use if CrCl < 15 mL/min
Not for children < 2 mo
Oral only
Pregnancy Category C - CI at term due to kernicterus in infants
Good for MRSA
Do not use if sulfa allergy
17
Q

Nitrofurantoin (Macrobid) Indications and PK

A

treatment and prevention of uncomplicated UTIs
PO = oral only
Rapidly absorbed = only in serum for 30 min then to urine
Cleared renally - only give if GFR normal

18
Q

Macrobid MOA and indications

A

Disrupts bacterial cell wall synthesis through inhibition of bacterial enzymes
Effective against: E. coli, citrobacter, Staph saprophyticus, Enterococcus
Some eneterobacter and klebsiella resistance
Good for uncomplicated cystitis and lower UTI

19
Q

Macrobid SE

A

MC: nausea and vomiting
Pulmonary reactions: pulmonary infiltrates, pneumonitis, pulmonary fibrosis
Hepatic effects: hepatitis, hepatic necrosis
Peripheral neuropathy

20
Q

Macrobid Special Populations

A

No significant DI
Pregnancy Cat B - CI at term due to hemolytic anemia in neonate
Not for lactation
Safety and efficacy not established in <12 years & CI < 1 mo
Pulmonary toxicity = avoid in older adults and long term use

21
Q

Metronidazole (Flagyl) PK/PD and MOA

A

Metabolized in liver - adjust for liver failure
Absorbed well PO
Good tissue penetration
Half-life 6-9 hrs
MOA: inhibits bacterial protein synthesis by causing DNA strand breakage

22
Q

Flagyl SOA and Indications

A

SOA: Gm + and - anaerobes
C. diff, Giardia, H. pylori, trichomoniasis, BV
DOC for anaerobic infections, BV, trichomoniasis, C. diff

23
Q

Flagyl Formulations

A

Oral
IV
Topical (roseacea)
Intravaginal

24
Q

Flagyl Warning and SE

A

Warning: carcinogenic in mice and rats
SE: NV, abdominal pain, metallic taste, seizure w/ high doses, peripheral neuropathy w/ prolonged courses, pancreatitis

25
Q

Flagyl DI

A

Enhances anticoag effect of warfarin
Alcohol: flushing, palpitations, nausea, vomiting
Inhibitor of 3A4 - DI with phenobarbital, phenytoin, rifampin = increased flagyl metabolism

26
Q

Vancomycin type, MOA, resistance, ROA,

A

glycopeptide
inhibits cell-wall biosynthesis, alters cell membrane permeability, and RNA synthesis
Inhibits biosynthesis of peptidoglycan - complexes with D-ala-D-ala sequence to inhibit transpeptidation/cross-linking
Resistance occurs by substituting d-lactate for d-alanine decreasing affinity x 1000
ROA: IV, oral for C. diff only

27
Q

Vancomycin SOA and Indications

A 
SOA: Gram + with aminoglycoside
Indications:
MRSA, PCN allergy patients, failure to respond to other abx, endocarditis, septicemia, bone infections, lower resp. infx
DOC for MRSA when IV therapy needed
PO 2nd line for C. diff
28
Q

Vancomycin SE

A

Rapid administration = red man syndrome - histamine and hypotension
Ototoxicity: transient or permanent
Nephrotoxicity: adjust in renal dysfunction

29
Q

Vancomycin DI

A

Aminoglycosides: nephrotoxic effects of aminoglycosides enhanced
Neuromuscular blocking agents: enhance NM blockade
NSAIDs: increase serum concentration of vancomycin
Piperacillin: enhance nephrotoxicity of vanco

30
Q

Vancomycin Special Populations

A

Pregnancy: B for oral, C for IV
Lactation: excreted in breast milk IV, less so in oral

31
Q

Vanco PK/PD

A

Time-dependent antimicrobial killing - slowly bactericidal = AUC/MIC correlates with efficacy
Target range: use troughs to ensure efficacy
Absorption: bowel inflammation increases systemic oral absorption
Distributes widely except CSF, only crosses BBB with inflammation
50% protein binding
Eliminated 80-90% in urine unchanged
Half-life = 5-11 hours

ID Pharm (6 decks)

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