Pharm-Lung infections Flashcards
What do macrolides end in?
mycin
Which two classes of penicillins are used in treating pulmonary infections?
Natural and aminopenicillins
What are the natural penicillins?
G and V
What are the aminopenicillin drugs?
Ampicillin and amoxicillin
Penicillin V is used for which pathogens specifically?
Strep A, B, C, G, Actinomyces, Corynebacterium (PENISillin - SAC)
Aminopenicillins are used for which pathogens specifically?
Strep pneumo
H influenzae
E coli
Listeria
Natural penicillins are effective for which types of bacteria?
G+ cocci and bacilli; some G- cocci; Spirochetes
Aminopenicillins are effective for which types of bacteria?
G+ cocci and bacilli; some G- cocci; Spirochetes;
ALSO some G- rods and bacilli (natural penicillins not useful for those)
Do natural penicillins work against Staph?
No
Pen V administration constrictions
1 hr before or 2 hrs after meal
How is penicillin mostly excreted?
90% tubular secretions
What are the third generation cephalosporins?
Ceftriaxone
Ampicillin - major side effect to think of!
Diarrhea
How can penicillin affect electrolytes?
- It’s an acid, so in large doses, it can cause water retention (think about people with HTN or CHF)
- In kidney, penicillin is non-absorbable that’s secreted; K+ moves in in exchange for H+ out, which can exacerbate hypokalemia
What bacteria do 3rd-gen cephalosporins target?
Enteric G-
Describe what cephalosporins 3rd gen are used for
G-
Very serious infections only
Crosses BBB
H influenza, Serratia
What is the drug of choice for gonorrhea?
Ceftriaxone
Do 3rd gen cephalosporins work on enterococci?
NO
What is the deal with cephs and renal dysfunction?
Dose adjustment! Supplemental doses needed after dialysis except for Ceftriaxone
What are the major ceph AEs?
Diarrhea and GI disturbance
Carbapenems belong to this class of antibiotics
Beta-lactams (subclass)
What is the MOA of beta lactams
Binds transpeptidase proteins and blocks cross-linking of peptidoglycan strands
What is so great about carbapenems?
Highly resistant to beta lactamases
Which beta lactam has the broadest spectrum?
Imipenem
Erythromycin and clarithro MOA
Reversibly binds 50S
What does imipenem target?
Broad - empiric - G+ and G-, anaerobes, and P aeruginosa
What drug is C/I for patients with CNS seizures?
Imipenem!
Which drug must be co-administered with cilastatin and why?
Imipenem; it inhibits renal toxicity and breakdown of imipenem
Macrolides excretion elim
Bile and feces
Meropenem salient facts
Less likely to cause seizures
Less effect on G+
Erythromycin static or cidal?
Static
Azithromycin and clarithromycin static or cidal?
Depends on concentration
What would be a good drug for prostatic infections?
Erythromycin - diffuses well into prostate
FQs don’t go well with:
Antacids and iron and zinc
FQs excretion
unchanged in urine and also bile
FQs AEs
GI, Head, phososensitivity, QT prolongation, articular cartilage erosion (AVOID IN PREGOS)
FQs interactions?
Inhibits P450A2 (cipfo and levo do)
Describe the coverage of FQs
Broad G- coverage!
Describe the coverage of tetracyclines
BROAD
Tetracyclines static or cidal
static - ribosome binding is reversible
Sulfonamides AEs
Urinary aggregates; hematologic disorders with G6PD; allergy, displacing plasma binders
Resistance of tetracyclines?
Resistance to one means resistance to all
Discuss important tetracycline ADME
Abs is inhib by di/trivalent cations so do not take with dairy or antacids
Doxy excretion?
hepatic - bile - so no dosing adjustment needed
Tetracycliens - ok for pregos?
No - crosses over and deposits into developing bones
Most toxic effects of tetracyclines are due to
The effect the drug has on normal gut flora, especially candidiasis infections of the GI tract
Tetracyclines common AEs and doxy specifics
avitaminosis, superinfections, gut flora chgs, bone growth depression, complexing with Ca2+
Vestibular toxicity
Doxy - photosensitivity
Specific indications for tetracyclines?
Atypical pneumonia - mycoplasma, legionella, chlamydia
Sulfonamides MOA
Inhibit use of PABA in folic acid synthesis pathway
Sulfonamides alone static or cidal?
static
Sulfonamides excretion
renal
FQ MOA?
Topo II inhibitor
FQs end in?
oxacin
