Other (Drugs not in family) Flashcards
Aztreonam Mechanism of Action
Binds PBP, inhibiting peptidoglycan cross-linking
Aztreonam: Spectrum of Activity
Gram - (up to SPACE)
T/F Aztreonam has antimicrobial activity against gram + and anaerobes
False
When is aztreonam a good drug to use?
Penicillin anaphylactic patients
What 2 drugs should you always check peak and trough levels
- Aminoglycosides
- Vancomycin
Vancomycin Mechanism of Action
Inhibits peptidoglycan formation by binding D-ala-D-ala portions of precursor molecules
T/F Vancomycin does NOT show PAE (post antibiotic effect)
False it does
Vancomycin: Spectrum of Activity
Gram + only
*Think MRSA or penicillin allergy
T/F Vancomycin covers most enterococcal species
True, except the VRE (vancomycin resistant enterococcus)
What is the usage of the oral form of vancomycin
C. diff infections
Vancomycin, CNS activity
Only during inflammation
3 most common symptoms of vancomycin usage
- Ototoxicity
- Nephrotoxicity
- Red-man Syndrome
Red-man Syndrome
Histamine-like reaction that generally begins after rapid vancomycin administration, causes facial flushing and rash
Name of medication that is used to treat superficial, topical MRSA
Mupirocin
Drug combination that makes up Synercid
Quinupristin/Dalfopristin
Synercid Mechanism of Action
- Inhibit protein synthesis
- Both components irreversibly bind to the 50S ribosomal subunit
How should synercid be administered
- PICC/Central line
- Infusion sites with IV can cause thrombophlebitis
Synercid: Spectrum of Activity
- Really resistant Gram + organisms
- Possible PIDDLY
- Possible Anaerobes
- Should only be used in patients who cannot tolerate Vancomycin with MRSA infection
- Treatment of VRE Faecium
Linezolid Mechanism of Action
- Inhibit protein synthesis
- Binds to the 23S subunit (of the 50S ribosomal subunit)
Linezolid: Spectrum of Activity
- Really resistant Gram + organisms
* Treatment of VRE Faecalis
2 major adverse effects associated with Linezolid
- Thrombocytopenia (long term use)
- Serotonin Storm
Linezolid associated with serotonin syndrome
Weak MAO inhibitor. Watch giving to patients on SSRI (anti-depressants). Can cause large increase in serotonin in the synaptic cleft leading to hyperthermia and clonic activity
Colistin Mechanism of Action
- Detergent-like effect that disrupts cell membrane integrity
- Leakage of cellular components and eventual cell death
Colistin: Spectrum of Activity
Gram - (up to SPACE)
When should colistin be used
Last ditch efforts against resistant gram - organisms
2 common, adverse reactions associated with colistin use
- Neurotoxicity
- Nephrotoxicity
Fosfomycin Mechanism of Action
-Inhibit cell wall synthesis by blocking peptidoglycan synthesis
Fosfomycin: Spectrum of Activity
- Gram +
- Gram - (up to SPACE)
Fosfomycin main usage
-Resistant UTI treatment
Tigecycline Mechanism of Action
- Inhibit protein synthesis
- Binds the 30S ribosomal subunit
Tigecycline: Spectrum of Activity
- Gram +
- Limited Gram -
- Covers VRE, CRE (carbapenem resistant enterobacteria) and Acinetobacter
- Anaerobes
T/F Tigecycline can be used to treat pseudomonas, PIDDLY, and PEK bugs
False, limited gram negative coverage
Tigecycline main usage
Complicated:
- Skin infection
- Intra-abdominal infection
- Community acquired pneumonia
T/F Tigecycline does NOT treat bacteremia
True, does not obtain high serum concentrations
Daptomycin Mechanism of Action
Lipopeptide that disrupts cell membrane
Daptomycin: Spectrum of Activity
-Gram +
Daptomycin main usage
MRSA or VRE
- Skin infection
- Bacteremia
Daptomycin and treatment of pneumonia
None, it is inactivated by lung surfactant
2 most common adverse effects with daptomycin usage
- Rhabdomyolysis
- Eosinophilic pneumonia
What 2 drugs/drug class have limited use to treat pulmonary infections
- Aminoglycosides
- Daptomycin
Telavancin Mechanism of Action
Semi-synthetic derivative of Vancomycin, so same mechanism of action
Telavancin: Spectrum of Activity
-Gram +
Telavancin main use
Skin and soft tissue infections caused by MRSA, strep, or enterococcus
3 common side effects associated with telavancin use
- Nephrotoxicity
- Red-man syndrome
- QT prolongation
Sulfonamide Mechanism of Action
- PABA analog
- Disrupts folic acid synthesis
Sulfonamide: Spectrum of Activity
- Gram +
- Gram - (up to SPACE)
- Chlamydia
Main use for sulfonamides
Uncomplicated UTI
3 main side effects of sulfonamide usage
- Steven-Johnson Syndrome
- Kernicterus
- Nephrotoxicity
Steven-Johnson Syndrome
Life threatening skin reaction where the dermis and epidermis separate. Thought to be caused by a hypersensitivity reaction.
Kernicterus
Increased level of fetal bilirubin caused by drugs that compete for bilirubin binding sites
T/F sulfonamides can be given in the 3rd trimester of pregnancy
HELL NO, kernicterus
Trimethoprim Mechanism of Action
- Inhibits dihydrofolate reductase
- Disrupts tetrahydrofolic acid synthesis
Main use for trimethoprim alone
UTI prophylaxis
What combination of drugs makes up Bactrim
Trimethoprim/Sulfamethoxazole
Trimethoprim/Sulfamethoxazole combination is better than each drug alone, why
Synergistic affect making 2 bacteriostatic agents bactericidal
Main uses of Bactrim
- UTI
- Pneumonia
- Acute otitis media
- Acute sinusitis
T/F use of Trimethoprim/Sulfamethoxazole (bacterim) should be limited in warfarin patients
True, potentiates the anticoagulant effect
Nitrofurantoin Mechanism of Action
Unknown
Nitrofurantoin: Spectrum of Activity
- Gram +
- Gram - (up to SPACE)
- Covers MRSA
Only known use of nitrofurantoin
Acute uncomplicated UTI, serum levels are insignificant to treat any other body system
Methenamine Mechanism of Action
Must reach the urine to be hydrolyzed to formaldehyde, which kills virtually all bacteria
Only known use of methenamine
UTI prophylaxis
T/F Methenamine can be used to treat acute UTI
False
Clindamycin Mechanism of Action
- Inhibit protein synthesis
- Binds 50S ribosomal subunit
Clindamycin: Spectrum of Activity
- Gram +
- Anaerobes
Main side effect clindamycin
Pseudomembranous colitis caused by C. Diff
Chloramphenicol Mechanism of Action
- Inhibit protein synthesis
- Binds 50S ribosomal subunit
T/F Chloramphenicol can be used to treat CNS infections
True, excellent CNS concentrations
Chloramphenicol: Spectrum of Activity
- Gram +
- Gram -
- Anaerobes
- Chlamydia
2 major adverse reactions with chloramphenicol use
- Idiosyncratic Aplastic Anemia
- Grey Baby Syndrome
Idiosyncratic Aplastic Anemia
Basically shuts down production of all cell lines. No test to determine who is susceptible to developing this. IRREVERSIBLE!!!
Grey Baby Syndrome
Neonates have trouble eliminating this drug, which causes circulatory collapse
Main use of chloramphenicol
Bacterial Meningitis
Fanconi-like syndrome
- N/V leading to hypokalemia
- Generally seen with use of outdated tetracyclines
- Most drugs can be taken LONG after expiration date
What tetracycline is commonly used to combat SIADH (syndrome of inappropriate antidiuretic hormone)
Demeclocycline
*Causes sodium retention and there for increase fluid load
Tetracycline Mechanism of Action
- Inhibit protein synthesis
- Binds to 30S ribosomal subunit
What 2 tetracyclines have the most bioavailibity and therefore the most commonly prescribed ones
- Doxcycline
- Minocycline
Common side effects associated with tetracycline use
- Discoloration of teeth
- Fanconi-like syndrome
Tetracycline: Spectrum of Activity
- Gram +
- Gram - (up to PIDDLY)
- Atypicals
- Rickettsia
What medication combination is used to treat Brucellosis
Tetracycline + Gentamicin
T/F Tetracyclines can be used to treat cholera
True
T/F Tetracyclines can NOT be used to treat Lyme disease
False
2 caveats with using tetracyclines
- NO in pregnancy
- NO in young kids
Penicillins that cover pseudomonas
Pipercillin/Ticarcillin
Penicillins that cover Staph. Aureus
- Dicloxacillin
- Nafcillin
- Oxacillin
- Methicillin
- Any penicillin added to a beta-lactamase inhibitor
What bacteria commonly cause cellulitis (2)
- Stapylococcus
- Streptococcus
Penicillin used to treat cellulitis (non-diabetic individual)
- Dicloxacillin
- Nafcillin
- Oxacillin
- Methicillin
Penicillin used to treat cellulitis (diabetic individual)
- UNASYN
- AUGMENTIN
What bacteria commonly community acquired pneumonia (3)
- Steptococcus
- Haemophilus
- Morexella
Macrolide used to treat community acquired pneumonia
Strep pneumonae = Erythromycin, Clarithromycin, Azithromycin
Haemophilus/Morexella = Clarithromycin or Azithromycin
Can daptomycin be used to treat community acquired pneumonia?
No, it is inactivated by lung surfactant
Why can’t aminoglycosides be used to treat community acquired pneumonia caused by Streptococcus
They only cover gram - bacteria
Can vancomycin be used to treat community acquired pneumonia?
Only if the causative agent is Staph or Strep
What bacteria commonly cause otitis media (3)
- Streptococcus
- Haemophilus
- Morexella
What macrolide should be used to treat otitis media and why
Azithromycin because it has less side effects when compared to the other 2
What bacteria commonly cause UTI (2)
- E.Coli
- Staph saprophyticus
Penicillin to treat UTI caused by E.coli
Ampicillin/Amoxicillin
What penicillin was used solely to treat UTIs but is now off the market
Carbenicillin
Penicillin to treat UTI caused by Staph
- Dicloxacillin
- Nafcillin
- Oxacillin
- Methicillin
- Any penicillin with beta-lactamase inhibitor
When should fosfamycin be used to treat UTI?
When dealing with a multi-drug resistant organism
What bacteria commonly cause COPD exacerbation (3)
- Streptococcus
- Haemophilus
- Morexella
Macrolide to treat COPD exacerbation if the patient is on theophylline and warfarin
Azithromycin, less drug interactions that the other 2 in this class
Erythromycin or Azithromycin: IV formulation
Azithromycin, Erythromycin causes thrombophlebitis
T/F macrolide can be given orally
True
*Except in pregnant patient do not give erythromycin estolate
Fluoroquinolone or Aminoglycoside: Double cover pseudomonas pneumonia infection in patient who is dehydrated and already on Zosyn
Fluoroquinolone, less toxic to the kidney when compared to aminoglycosides
*Can cause QT prolongation however
What 3 drug/drug classes have an adverse effect of QT prolongation
- Telavancin
- Quinolones
- Macrolides
Common side effect with long term nitrofurantoin use
Pulmonary infiltrates (kind of odd because serum levels are never high). Long term use is associated with UTI prophylaxis
