Clinical uses for FQs? 5

1. Urinary tract (DOC)- cipro 2. Sexually transmitted 3. GI infections 4. Traveler’s diarrhea 5. Osteomyelitis- good penetration into the bone

Miscellaneous Antibiotics Flashcards by Sarah Feeney

Name the types of Fluoroquinolones
3 most common
3 others

Ciprofolxacin* (Cipro)
Levofloxacin* (Levaquin)
Moxifloxacin* (Avelox)
Gemifloxacin (Factive)
Norfloxacin (Noroxin)
Oflaxacin (Floxin)

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Are FQ bacterocidal or bacteriostatic?

bacterocidal

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Describe the Distribution of FQs?

Elimination of FQs?

Good tissue distribution
Good distribution into fluids except CNS

All undergo renal elimination except moxifloxacin

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MOA of FQs?

Inhibit DNA gyrase and topoisomerase IV necessary for replication of bacteria

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What FQs would cover Aerobic gram negative bacteria?

All fluoroquinolones

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What FQs would cover Pseudomonas Aeruginosa?

ciprofloxacin and levofloxacin

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What FQs would cover Gram positive including Streptococcus spp, (Streptococcus pneumonia)-ear, upper, and lower resp infection
3

Levofloxacin, moxifloxacin and gemfloxacin

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What FQs would cover Anaerobic

bacteria?

Moxifloxacin

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Clinical uses for FQs?

Urinary tract (DOC)- cipro
Sexually transmitted
GI infections
Traveler’s diarrhea
Osteomyelitis- good penetration into the bone

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Drug of choice for UTIs?

cipro

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What FQs (3) are classified as Respiratory FQs and why are they used for this?

FQ’s that have activity against Gm+ organisms including Streptococcus.

Levofloxacin, moxifloxacin and gemifloxacin

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What is the BBW on FQs?

What demographics is this increased in?3

Fluoroquinolones, including LEVAQUIN®, are associated with an increased risk of tendinitis and tendon rupture in all ages

60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants

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SE of FQs?

Nausea
Diarrhea
Dizziness
Confusion
Tendon rupture
QT prolongation- higher risk to go to  vtach/death
Tendonitis
Peripheral neuropathy

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What are the common drug interactions for cipro?

CYP4501A2
Theophylline, 
warfarin,
tizanidine, 
propranolol

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What drugs all decrease absorption in FQs?

Antacids, sucralfate, magnesium, calcium, iron all decrease the absorption of FQs

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In which meds do you have to adjust the dose on for FQs with renal considerations?

What other dosing should you be careful about (pts with what?)

Adjust dose for renal failure patients unless using moxifloxacin

Caution when using in patients with history of ventricular arrhythmias secondary to QT prolongation

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Dosage forms of FQs?

Can be given oral or IV

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FQs contain the only oral agents against what?

Pseudomonas

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In what demographics is it contraindicated in?

Why?

Not for use in pregnancy or in children
Pregnancy & lactation = exposure to infant
Pediatrics = arthropathy and osteochondrosis

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What is the drug in the sulfonamides class that we talked about?

Sulfamethoxazole/Trimethoprim (SMX-TMP) (Bactrim DS, Septra)

Describe the distribution of Sulfamethoxazole/Trimethoprim (SMX-TMP) (Bactrim DS, Septra)?

What about elimination?

Distribution to body tissues, CSF, pleural fluid, synovial fluid

Eliminated through liver and kidneys

What is the MOA for sulfonimides?

Describe the mechanism in SMX and TMP?

Folic acid synthesis inhibitors

Bacteria need to produce folic acid to survive:

SMX inhibits dihydropteroate synthetase

TMP inhibits dihydrofolate reductase

Clinical uses for sulfas?

Urinary tract infections
PCP or P. jiroveci pneumonia!!!!
Toxoplasmosis
Gram positive and negative infections
MRSA!!!

Most common side effects with sulfas are?
3

Ones that we need to watch out for???
2

rash, fever and GI symptoms.

Stevens-Johnson syndrome
Hemolytic anemia if underlying G6PD deficiency

Describe the MOA of stevens/johnsons syndrome? | 2

1. Cell death causes the dermis and epidermis to separate | 2. Hypersensitivity reaction of skin and mucous membranes

Describe the drug interactions with Sulfas? | 5

``` Up to 70% protein bound. Displaces other drugs Potentiates the effects of: Warfarin Phenytoin Hypoglycemic agents Methotrexate Beta-blockers ```

What are sulfas metabolized by? Where are they excreted? If CrCl is 15-30 what shouldwe do? What about below 15?

liver kidney Reduce dose by 50% Stop use

Sulfa doasge forms? What is it most commonly used for? Pregnancy category?

For oral use only UTIs C

Do sulfas cover MRSA?

yes. | MRSA. cellulitis skin infections

What are Nitrofurantion (Macrobid) used for? Dosage forms?

Only for treatment and prevention of uncomplicated urinary tract infections PO

How would you describe the absorption of Nitrofurantion (Macrobid) and clearance?

Rapidly absorbed and only in the serum for about 30 minutes. Cleared renally and is concentrated in the urine Inadequate drug levels in the bladder if the creatinine clearance is abnormal

At what CrCl level is Nitrofurantion (Macrobid) contraindicated in?

What do we think the MOA of Nitrofurantion (Macrobid) is?

Thought to disrupt bacterial cell wall synthesis through inhibition of bacterial enzymes

Nitrofurantion (Macrobid) is Effective against common organisms that cause UTIs. What are they? 5

``` E. Coli Citrobacter Staph saprophyticus Enterococcus faecalis Eneterococcus faecium ```

Most common side effects of Nitrofurantion (Macrobid)? Whats the one we have to watch for/ the most dangerous?

Nausea and vomiting Pulmonary reactions (toxicity) - Pulmonary infiltrates, - pneumonitis, - pulmonary fibrosis

How to the pulmonary reactions manifest in pts with Nitrofurantion (Macrobid)? How fast is this usually discovered and how do we fix it?

usually manifested by sudden, severe dyspnea, chills, chest pain, fever, and cough consolidation or pleural effusion Usually evident within the first week of treatment and reversible when drug discontinued Resolution often is dramatic

Drug interactions of Nitrofurantion (Macrobid)?

none

Nitrofurantion (Macrobid) Pregnancy cat? Except... Lactation?

B contraindicated at term (38-42) due to the possibility of causing hemolytic anemia in the newborn due to immature erythrocytes Dont use

Due to concerns for pulmonary toxicity who do we not use Nitrofurantion (Macrobid) in? 2

Avoid use in older adults | Avoid using for long term suppression of infection

Metronidazole (Flagyl) | treats what kind of infections?

Anti-Anerobic

Describe the metabolism of Metronidazole (Flagyl)? Absorption? Distribution?

Metabolized by the liver Adjust dose with a history of liver failure Absorbed well PO Good tissue penetration in most locations

Metronidazole (Flagyl) MOA?

Inhibitor of bacterial protein synthesis. | -Causes DNA strand breakage therefore inhibiting bacterial protein synthesis

Spectrum of activity for Metronidazole (Flagyl) MOA? Treatment of choice for: 4

Good activity against gram positive and negative anaerobes Helicobacter pylori Trichomonas vaginalis Anerobic infections Bacterial vaginosis Trichomoniasis C. difficile diarrhea

What dosage forms does Metronidazole (Flagyl) come in? | 4

Oral IV Topical (roseacea) Intravaginal

BBW for Metronidazole (Flagyl) ?

carcinogenic in mice and rats (see PRECAUTIONS). Unnecessary use of the drug should be avoided.

Most common side effects of Metronidazole (Flagyl)? 3 Ones we should look out for/more dangerous? 3

Nausea, vomiting, abdominal pain and metallic taste ``` Seizures (high doses) Peripheral neuropathy (prolonged courses) Pancreatitis ```

Drug interactions for Metronidazole (Flagyl)? | 2

Enhances anticoagulant effect of warfarin Alcohol!!!!! Flushing, palpitations, nausea, vomiting Inhibitor of CYP34A so potential for many drug interactions

What drugs would increase the metabolism of metronidazole which decreases the serum concentration and may lead to treatment failure? 3

Phenobarbital, phenytoin, rifampin