Miscellaneous Agents Flashcards
tetracycline drugs
tetracycline
minocycline
doxycycline
tetracycline analog drugs
tigecycline
eravacycline
omadacyclin
mechanism of action tetracycline and analogs
bind reversibly to 30S ribosome to inhibit protein synthesis
tetracycline and analogs static or cidal, time or conc dep
static
time dependent
TMP-SMX MOA
sequential inhibition of microbial folic acid synthesis pathway by inhibiting bacterial dihydropepteroate synthetase and dihydrofolate reductase
sulfamethoxazole MOA
inhibits dihydropteroate synthetase
trimethorpim MOA
inhibits activity of bacterial dihydrofolate reductase
polymixin B and Colistin MOA
binds phospholipids in cell membrane causing displacement of Ca and Mg, which leads to changes in cell wall permeability and leakage of cellular contents
TMZ-SMX cidal or static, conc or time
bactericidal
time dependent
polymixin B and colistin citdal or static, conc or time
bactericidal
concentration dependent
clindamycin MOA
inhibits protein synthesis by binding to 50S ribosomal subunit reversibly
clindamycin static or cidal time or conc
bacteriostatic
time dependent
metronidazole MOA
inhibits DNA synthesis
metronidazole cidal or static, conc or time dep
bactericidal
concentration dependent
resistance mechanism tetracyclines
tetracycline specific efflux pumps
ribosomal protection proteins
enzymatic inactivation
resistance mechanism tetracycline analogs
multi drug efflux pumps
resistance mechanism TMX-SMP
mutation in dihydrofolate reductase or dihydropteroate synthase
polymixins resistance mechanism
alteration in outer cell membrane
(dec in Ca or Mg content, dec lipopolysacchardie content, dec outer membrane proteins)
clindamycin resistance mechanism
alteration in ribosomal binding site
NOT efflux pumps
metronidazole resistance mechanism
altered growth requirements, reduced transcription of ferredoxin gene
tetracyclines spectrum of activity
gram positive
gram negative
anaerobes
tetracycline analogs spectrum of activity
gram positive
gram negative
anaerobes
TMP-SMX spectrum of activity
gram positive
gram negative
polymyxins spectrum of activity
gram negative only
clindamycin spectrum of activity
gram positive
anaerobes
metronidazole spectrum of activity
only anaerobes
tetracyclines target organisms
MSSA
MRSA
legionella
tetracycline analogs target organisms
MSSA
MRSA
BDA
TMP-SMX target organisms
MSSA
MRSA
polymyxins target organisms
pseudomonas
clindamycin target organisms
MSSA
MRSA
BDA
ADA
metronidazole target organisms
c. diff
BDA
tetracyclines - CSF penetration?
minimal CSF penetration
TMP-SMX - CSF penetration?
yes with inflamed meninges
polymyxins - CSF penetration?
no
clindamycin - CSF penetration?
no
metronidazole CSF penetration?
yes
which miscellaneous need renal dose adjust?
tetracycline
SMP-TMZ CrCl<30
colistin CrCl <80
adverse effects of tetracyclines and tigecycline
N/V
photosensitivity
adverse effects of TMP-SMX
GI
Leukopenia, thrombocytopenia
hypersensitivity
crystalluria
hyperkalemia
renal insufficiency
adverse effects of polymyxins
nephrotoxicity
neurotoxicity (dizzy,weak)
advers effects of clindamycin
c. diff colitis
hepatotoxicit
metronidazole adverse effects
metallic taste
stomatitis
peripheral neuropathy
seizures
CNS disorders
which miscellaneous agents interact with chelating agents
oral tetracyclines
omadacycline
(ZICAM, bismuth salicylate, dairy)
misc agents interacting with warfarin
TMP-SMX
metronidazole
which misc interacts with alcochol
metronidazole
can you use tetracyclines in pregnancy
no
can you use TMP-SMX in pregnancy
no
can you use clindamycin in pregnancy
yes
can you use polymyxins in pregnancy
yes
can you use metronidazole in pregnancy
no
which misc drugs can we not use in children
tetracyclines and analogs, teeth discolor and decreased bone growth
CMS which dosing weight
IBW
polymyxin which dosing weight
TBW