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Infectious Disease > Miscellaneous Antibiotics > Flashcards

Miscellaneous Antibiotics Flashcards

1
Q

Fluoroquinolones

A 
ciprofolxacin* 
levofloxacin*
moxifloxacin*
gemifloxacin
norfloxacin
oflaxacin
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2
Q

Distribution of Fluoroquinolones

A
  • good tissue and fluids distribution except CNS
  • all undergo renal elimination except moxifloxacin
  • Half lives range from 4-12 hours (allows for 1/day dosing)
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3
Q

MOA of fluoroquinolones

A

bactericidal

- inhibit DNA gyrase and topoisomerase necessary for replication of bacteria

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4
Q

Spectrum of fluoroquinolones

A

Aerobic gram neg: all fluoroquinolones

Pseudomonas Aeroginosa: cipro or levofloxacin

Gram + (including Strep pneumonia): levofloxacin, moxifloxacin, and gemfloxacin

Anaerobic: moxifloxacin

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5
Q

Clinical uses of fluorquinolones

A

Urinary tract= DOC -> cipro

  • pneumonia
  • STIs
  • skin and soft tissue (not first line)
  • GI infections
  • Traveler’s diarrhea
  • osteomyelitis (good penetration into bone)
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6
Q

What FQ’s are active against gram + respiratory infections (Strep)?

A

Levofloxacin, moxifloxacin, and gemifloxacin

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7
Q

Black box warning of fluorquinolones?

A

associated with an increased risk of tendinitis and tendon ruptures in all ages, risk is increased in older patients usually over 60 you, in patients taking corticosteroids, and pts with kidney, hearth or lung transplants

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8
Q

SE’s of FQ’s

A

N/D, dizziness, confusion, tendon rupture, QT prolongation (ventricular tachycardia= death)
tendonitis -> RF for rupture, peripheral neuropathy (on long term therapy)

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9
Q

Drug interactions of FQ’s

A
  • ciprofloxacin potent inhibitor of CYP4501A2 -> theophylline, warfarin, tizanidine, propranolol
  • antacids, sucrlafate, magnesium, calcium, iron all decrease the absorption of FQs
  • corticosteroids increase risk of tendon ruptures
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10
Q

When would you not have to adjust dose for renal failure pts on FQs?

A

if they are on moxifloxacin

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11
Q

Do FQ’s cover pseudomonas?

A

Yes, contains the only oral agents against pseudomonas

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12
Q

CI of FQs

A

not for use in pregnancy or children -> in pregnancy and lactation= exposure to infant (crosses placental barrier)
in peds= arthropathy and osteochondrosis
- caution when using in hepatic dysfunction

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13
Q

Sulfonamides

A

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

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14
Q

Distribution of Sulfonamides

A

oral med with good distribution to all body tissues and fluids -> CSF, pleural fluid, synovial fluid

-eliminated through liver and kidneys

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15
Q

MOA of sulfonamides

A

Folic acid synthesis inhibitors:
Bacteria need to produce folic acid to survive -> SMX inhibits dihydropteroate syntheses and TMP inhibits dihydrofolate reductase

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16
Q

Clinical uses of sulfonamides?

A 
UTIs
PCP (pneumonia seen in immunocompromised pts)
toxoplasmosis
Gram + and - infections
MRSA
(have resistance to strep pneumo)
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17
Q

SE’s of sulfonamides?

A

**Rash (very obvious it is sulfa related), fever, N/V/D, SJS (shed skin), vasculitis, hemolytic anemia if underlying G6PD deficiency, thrombocytopenia

18
Q

Stevens-Johnson syndrome?

A

cell death causes the dermis and epidermis to separate

-hypersensitivity reaction of skin and mucous membranes

19
Q

Drug interactions of sulfonamides

A

up to 70% protein bound -> displaced other drugs

potentiates the effects of:
warfarin, phenytoin, hypoglycemic agents, methotrexate(folic acid inhibitor -> together could cause folic def)

B blockers: increase activity -> severe bradycardia

20
Q

Metabolism of sulfonamides

A

metabolized in liver
excreted renally
-reduce dose by 50% if CrCl 15-30 not recommended if CrCl

21
Q

Why are sulfonamides CI at end term of pregnancy?

A

due to development of kernicterus in infants (bilirubin induced brain dysfunction b/c of hemolytic anemia leads to increased bilirubin)

22
Q

Sulfonamides allergy?

A

don’t use with a sulfa allergy

23
Q

Nitrofurantoin (Macrobid)

A

only for treatment and prevention of uncomplicated UTIs

PO

24
Q

Metabolism of Macrobid

A

rabidly absorbed and only in serum for 30 minutes

  • cleared renally and concentrated in urine
  • inadequate drug levels in bladder if CrCl abnormal (GFR
25
Q

MOA of macrobid

A

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

26
Q

Macro bids are effective against what organisms?

A 
E. coli
Citrobacter
Staph saprophyticus
enterococus faecalis
enterococcus faecium

-some emerging resistance against enterobacter and Klebsiella

27
Q

SE’s of Macrobid

A

Most common: N/V
pulmonary reactions: pulmonary infiltrates, pneumonitis, pulmonary fibrosis
Hepatic effects (rare): hepatitis, hepatic necrosis
peripheral neuropathy in long term use in patients with renal failure

28
Q

Pulmonary reactions in macrobid use?

A
  • acute pulmonary reactions usually manifested by sudden, severe dyspnea, chills, chest pain, fever, and cough
  • pulmonary infiltration with consolidation or pleural effusion on radiographs and eosinophilia also may occur
  • usually evident within first week of tx and reversible when drug d/c
  • Resolution is often dramatic
29
Q

Drug interactions of Macrobids

A

No significant drug interactions because it isn’t in plasma for more than 30 minutes -> urinary tract

30
Q

Safety of macrobids

A

pregnancy: category B
But CI at term due to possibility of causing hemolytic anemia in newborn
-dont use in lactation
-safety and efficacy not established in children

31
Q

Who should avoid using macrobids?

A

avoid use in older adults, avoid using for long term suppression of infection

32
Q

Anti-anerobic med?

A

Metronidazole (flagyl)

33
Q

Metabolism of flagyl?

A

metabolized by the liver

  • adjust dose with hx of liver failure
  • absorbed well PO
  • good tissue penetration in most locations
  • Half life 6-9 hours
34
Q

MOA of flagyl

A

inhibitor of bacterial protein synthesis -> causes DNA strand breakage therefore inhibiting bacterial protein synthesis

35
Q

Spectrum of Flagyl

A

good against gram + and - anaerobes

Helicobacter pylori

Trichomonas vaginalis (STI in men and women)

36
Q

flagyl is DOC for?

A

Anerobic infections
bacterial vaginosis
trichomoniasis
C. diff diarrhea

37
Q

formulations of flagyl?

A

oral, IV, topical (roseacea), intravaginal

38
Q

Black box warning for flagyl

A

metronidazole has been shown to be carcinogenic in mice and rats. Unnecessary use of drug should be avoided.

39
Q

SE’s of flagyl?

A

most common: N/V, abdominal pain and metallic taste

  • seizures (high doses),
  • peripheral neuropathy (prolonged courses)
  • pancreatitis
40
Q

Drug interactions of flagyl?

A

enhances anticoag effects of warfarin
-alcohol: flushing, palpitations, nausea, vomiting

  • inhibitor of CYP34A so potential for many drug interactions
  • phenobarbital, phenytoin, rifampin: all increase metabolism of metronidazole which decreases the serum concentration and may lead to tx failure

Infectious Disease (27 decks)

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