Sulfa drugs through anti-anaerobic Flashcards
MOA of sulfamethoxazole and trimethoprim
interferes with bacterial folic acid synthesis
main uses of SMX-TMP and its RoA
staph (MRSA MSSA)
listeria (after ampicillin)
nocardia
aeroPEK
stenotrophomonas maltophilia
pneumocystis jiroveci
toxoplasmosis
IV and po
avoid using SMX-TMP in
gut anaerobes
atypical organisms
important pharmacokinetics of TMP-SMX
highly protein bound
ADR of SMX-TMP
GI - N, V, abdominal pain
hypersensitivity
rash - SJS and toxic epidermal necrolysis
fever
blood dyscrasias “penias”
photosensitivity
hyperkalemia
drug of choice for treatment and prevention of PJP/PCP peumonia (pneumocystis jiroveci) in immunocompromised infections
SMX-TMP
highly effective against skin infections caused by community acquired MRSA
SMX-TMP
colistimethate RoA
IV
what can colistimethate treat
MDR gram negative organisms
E. coli
acinetobacter
pseudomonas
klebsiella pneumoniae
enterobacter (klebsiella aerogenes)
ADR of colistimethate
nephrotoxicity
neurotoxicity
what infection does mycoplasma pneumonia cause
upper and lower respiratory tract infections
what does chlamydophilia infections cause
trachomatis - STI
pneumonia - respiratory tract infection
which atypical bacteria is generally an opportunistic infection affecting immunocompromised patients
mycobacterium avium
fluoroquinolones and their RoA
ciprofloxacin (iv, po)
moxifloxacin (IV, po)
levofloxacin (IV, po)
delafloxacin (IV, po)
ofloxacin (po only)
moa of fluoroquinolones
inhibits DNA gyrase and promotes cell death
what type of killing do fluoroquinolones exhibit
concentration dependent
which fluoroquinolones are respiratory fluoroquinolones
moxifloxacin
levofloxacin
which fluoroquinolones have MRSA activity
delafloxacin
which fluoroquinolones have activity against pseudomonas and which one is more active?
ciprofloxacin > levofloxacin
do fluoroquinolones have activity against acinetobacter
no, activity against atypical pathogens
avoid using fluoroquinolones when
MRSA
acinetobacter
enterococcus
which fluoroquinolone is NOT a reliable UTI drug
moxifloxacin
ADR of fluorquinolones
TENDON RUPTURE
N/D
photosensitivity
CNS side effects: sedation, mental status changes
QTC prolongation
what are respiratory FQ’s engineered to treat?
strep pneumo
what indications should FQ’s be reserved for if patients have no other treatment options (last line)
acute bacterial sinusitis
acute bacterial exacerbation of chronic bronchitis
uncomplicated UTI
macrolides and their RoA’s
erythromycin (IV, oral)
azithromycin (IV, oral)
clarithromycin (IV, oral)
MOA of macrolides
inhibits RNA dependent protein synthesis at the chain elongation step that binds to 50S ribosomal subunit resulting in blockage of transpeptidation
main uses of macrolides
strep
H. flu
M. catarrhalis
Neisseria
legionella
ATYPICALS
mycoplasma
chlamydophilia
mycobacterium
treponema pallidum
borrelia burgdorferi
What did we swear to professor Tuoy?
that we will never use a cephalosporin to treat an enterococcus infection
avoid use of macrolides in
staph
enterococcus
most gram negatives
gut anaerobes
blood stream infections
UTI’s
ADR’s of macrolides
Diarrhea (erythro)
metallic taste clarithromycin)
QTc prolongation (erythro, clarithro >azithro)
macrolides are second line drugs for
strep (URTI’s)
syphillis
N gonorrhea
tissue infections (URTI)
which antibiotic is used as an adjunct to metoclopramide for gastroparesis treatment
erythromycin
antibiotics and drugs with a high what are more likely to have a metallic taste?
volume of distribution
what is a big reason tetracyclines are contraindicated in children?
cause gray teeth
MOA of tetracyclines
inhibits protein synthesis by binding to the 30S (and possibly 50S) ribosomal subunit of susceptible bacteria and may cause alterations in the cytoplasmic membrane
what dosage form is
doxycycline
minocycline
omadacycline
ervacycline
tetracycline
d - IV, po
m - IV, po
o - IV, po
e - IV
t - po
main uses of tetracyclines
gram positive
limited gram negative
atypicals - mycoplasma, chlamydophilia, rickettsia
which tetracyclines have strep pneumo and community acquired MRSA activity
doxycycline
minocycline
ADR’s of tetracyclines
gi - N/V even with IV
photosensitivity
hepatotoxicity
CDAD
oral dosage forms of tetracyclines do what
chelate cations (Al, Mg, Ca) and dairy products
indications of doxycycline
atypical infections
use of outdated tetracyclines can lead to
fanconi’s syndrome
which tetracycline is used in CAP and skin and soft tissue infections
omadacycline
which tetracycline is indicated for complicated intra-abdominal infections
eravacycline
moa of glycylcycline and tigecycline
binds to the 30s ribosomal subunit and inhibits protein synthesis
main uses of glycylcycline and tigecycline
gram positive (MRSA and MSSA)
VRE
gram negative
E. coli
stenotrophomonas maltophilia
gut anaerobes
atypicals
probably won’t be the answer
Anti-anaerobic agents and their RoA
metronidazole IV, po
tinidazole po
secnidazole po
clindamycin IV, oral
main uses of metronidazole
gut anaerobes
c difficile
trichomoniasis (UTI)
bacterial vaginosis or vaginitis
ADR of metronidazole
N/V
HA
metallic taste * Vd probably
urine discoloration
peripheral neuropathy
disulfuram interaction with alcohol
rule of thumb for metronidazole
treats below the diaphragm anaerobes
what do tinidazole and secnidazole treat
bacterial vaginosis
trichomoniasis
main uses of clindamycin
MRSA/MSSA
mouth anaerobes
gut anaerobes
allergies
bacterial vaginosis
no gram negative
ADR clindamycin
N/V
CDAD and colitis with prolonged use**
rule of thumb for clindamycin
used for above the diaphragm anaerobes
