Miscellaneous Abx Flashcards
FLuoroquinolones (FQ)
- distribution
- excretion
- good distribution to tissue and fluids except for CNS.
- all undergo renal elimination except for moxafloxacin (dont have to adjust the dose)
FQ Clinical Uses
Urinary Tract (Drug of Choice)
pneumonia
STI
Skin and soft tissue (not usually first line)
GI infections
Travelers Diarrhea
Osteomyelitis
Black Box Warning for FQ
- levoquin(levofloxacin) is associated w/ increased risk of tendinitis and tendon rupture, especially in pts taking corticosteroids and patients w/ kidney, heart, or lung transplant.
Side Effects of FQ
- nausea
- diarrhea
- dizziness
- confusion
- tendon rupture
- QT prolongation
- tendonitis
- peripheral neuropathy
What are major drug interactions of FQs?
warfarin, antidiabetics, antacids, propranolol, magnesium, calcium, iron
Coritcosteroids increase risk of tendon rupture
Cirpofloxacin is potent inhibitor of CYP450
Which drug type contains the only oral agents against pseudomonas?
-FQs!
FQ are not to be used in which populations?
- pregnancy, lactation, pediatrics
- caution in hepatic dysfunction
Sulfonamides
- metabolism
- distribution
- excretion
- metabolized in the liver
- good distribution to all body tissues and fluids… CSF, pleural fluid, and synovial fluid.
- eliminated through liver and kidney
Sulfa Clinical Use
- UTI
- PCP (pneumonia in immunocompromised pt)
- Toxoplasmosis
- Gram +/-
- MRSA***
SE of Sulfa
- Rash*
- Fever
- GI (nausea, vommiting, diarrhea)
- Stevens-Johnsons Syndrome*
- Vasculitis
- Hemolytic Anemia if underlying G6PD deficiency*
- Thrombocytopenia
Sulfa Drug Interactions
sulfa is 70% protein bound and displaces other drugs.
Potentiates the effects of:
- warfarin
- phenytoin
- hypoglycemic agents
- methotrexate
- beta blockers
What are the routes of administration of sulfas? What is sulfa most commonly used for?
- ORAL ONLY!!!
- most commonly used for UTI, MRSA skin infections
Nitrofurantion
- route of administration
- use for prevention and tx of what?
- How long is it in the serum?
- excretion
- CI
- oral
- uncomplicated UTI
- in serum for 30minutes before it knows to go to the urinary tract.
- renal clearance
- CI in kidney dysfunction. creatinine clearance
What are some common organisms that cause UTIs?
- E. Coli
- Citrobacter
- Staph saprophyticus
- Enterococcus faecalis
- Enterococcus faecium
SE of Nitrofurantion
- nausea/vominting*
- pulmonary rxn : pulmonary infiltrates, pneumonitis, pulmonary fibrosis
- hepatic effects (rare)
- Peripheral neuropathy in long term use
pulmonary rxns of Nitrofurantion sx and precautions
- sudden, sever dyspnea, chill,s chest pain, fever, and cough
- pulmonary infiltration w/ consolidation or pleural effusion
- usually evident within first week of treatment, reversible w/ drug discontinuation.
- avoid in older adults and avoid using for long term suppression of infection.
Drug interactions of Nitrofurantion
NONE!!!!!!!!!!!!!!! …only in plasma for 30mins
Metronidazole (Flagyl)
- metab
- absorption
- tx of choice for,….
- routes of admin
- metabolized in liver
- absorbed PO, good penetration in most locations
- anerobic infections, bacterial vaginosis, trichomoniasis, c. diff.
-Oral, IV, topical, intravaginal
Black Box warning fo Metronidazole (Flagyl)
-shown to be carcinogenic in mice an rats. unnecessary use should be avoided.
SE of Metronidazole (Flagyl)
- nausea, vomiting, abd pain, metallic taste
- seizure at high dose
- peripheral neuropathy
- pancreatitis
Drug Interactions of Metronidazole (Flagly)
- enhances warfarin
- alcohol (flushing, palpitation, nausea, vomiting)
- inhibitor of CYP34A, potential for many drug interactions
- phenobarbital, phenytoin, rifampin (these increase the metabolism of flagyl decreasing serum conc. leading to tx failure.)
