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Dermatology > Sweatman Staph and Strep Antibiotics > Flashcards

Sweatman Staph and Strep Antibiotics Flashcards

1
Q

MOA for Daptomycin

A

Cyclic lipopeptide that rapidly disrupts bacterial cell membranes
*depolarization and efflux of K+

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2
Q

resistance to Daptomycin

A

rare at present, no MOR identified, no known transferable resistance gene

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3
Q

administration of daptomycin

A

IV once daily

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4
Q

Toxicities with Daptomycin

A

direct muscle injury preclude IM injection

administer after dialysis

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5
Q

Met and Elim for daptomycin

A

90% bound to albumin

Renal elim with DOSE ADJUSTMENT (no adjutment for hepatic)

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6
Q

side effects of Daptomycin

A

monitor serum CPK elevation
*avoid coinciciding statins–>
rhabdomyolysis
NO CYP interactions

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7
Q

what type of bacteria get Daptomycin

A

aerobic, gram positive

MDR staph, strep and enterococcus

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8
Q

therapuetic indications for daptomycin

A

MRD staph, strep and enteroccocus
*complicated skin and soft tissue infections
MSSA and MRSA bacteremia
*right side endocarditis–> IVDU

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9
Q

do not use daptomycin in

A

staph pneumonia–> inactivated by surfactant

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10
Q

MOA for linezolid

A

inhibits protein synthesis by inhibiting 23s of 50s ribosomal subunit

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11
Q

linezolid is bacteriostatic for

A

staph and enterococci

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12
Q

linezolid is bacteriocidal for

A

strep

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13
Q

MOR for Linezolid

A

pt. mutation inf 23s subunit, no cross resistance with other classes,
(EMERGING RESISTANCE SEEN IN STAPH AUREUS AND ENTEROCCOCUS)

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14
Q

indications for linezolid

A

PENICILLIN RESISTANT SA–>
MRSA
ENTEROCOCCUS
RESERVE FOR VANC RESISTANT ENTEROCOCCUS

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15
Q

PK/PD OF LINEZOLID

A 
ORAL AND IV ROUTES
100% absorption of oral-. delayed by food but not peak drug levels
metabolized by NEoxidation
elim=renal and non renal mechs
No renal adjustment
NO cyp inh/ind
suppl dose needed following hemodialysis
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16
Q

possible side effect with LInezolid

A 
pseumomembranous cholitis
myelosupression after 2 weeks
(thrombocytopenia, anemia, neutropenia)
Optic and peripheral neuropathy, lactic acidosis
N/V/D/HA
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17
Q

PKU pt.’s beware

A

of linezolid–> contains aspartame in the oral suspension form

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18
Q

drug interations with linezolid

A

inihibitor of MAO–> caution with other drugs metabolized by MAO
ex. psuedaphed, phenylephrine, SSRI’s,
POSSIBLE SEROTONIN SYNDROME
possible HTn from decreased breakdown of ttyramine in the diet

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19
Q

Streptogrammins

A

dalfopristin-quinipristin (70-30)

remotely related to macrolides but no cross reactivity

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20
Q

oxazolidinones

A

Linezolid

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21
Q

MOA for dalfopristin-quinipristin

A

protein synthesis inhibition
(bind to ribosyl peptidyl transferase domain)
tRNA synthase is inhibited
aa addition to peptide chain is blocked

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22
Q

action on bacteria for syndercid

A

“synergistic bacteriocidal combination”

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23
Q

resistance to Synercid

A

changes in 23s ribosomal target site

erm gene encoding MLSb phenotype

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24
Q

pharmacology of Syncercid

A

IV only–> central line best
hepatic metab- conjugation via CYP 3A4
*metabolites still have activity
BILLIARY EXCERETION

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25
Q

if unabel to tolerate synercid

A

increase dosing from Q8 HRS TO Q12 HRS

26
Q

ADverRSE EFFECTS OF SYNCERCID

A 
thrombophlebitis
pain at injection site
inrease conj. bilirubin
Elevated LEnzymes
Joint pain (in chronic liver dz)
inhibits CYP 3A4
27
Q

Syncerid through its action with CY3a4 wil increase the concent. of

A

cyclosporin, midazolam, statins, HIV protease inhibitors

28
Q

Spectrum for Streptogrammins

Dalfopristin-Quinipristin

A

> gram positive (not enterococcus faecalis)
VRE-> Enterococcus faecium
Skin and SKin Strcuture infections SSI’s from MRSA or Strep Pyogenes
bone infection from VRE and MRSA

29
Q

name the glycylcyline

A

tigecylcine

30
Q

MOA for tigecycline

A

SIMILAR TO TETRACYCLINES
inhibits protein translation but binding to 30s subunit
*expanded broad spectrum

31
Q

resistance to Tigecycline

A

overcomes key mechs of resistance to tetracylcine by

  1. higher binding affinity to more ribosomal sites
  2. no efflux
32
Q

Pharmacology to tigecycline

A
  1. slow IV infusion
    1. lower dose with liver failure
  3. no renal adjustment
  4. extensive distribution beyond plasma volumes and into tissue
  5. Very little metab–> 1/2 life= 27hours
  6. excretion= billiary/fecal and renal
33
Q

adverse effects of Tigecycline

A

Hepatic and pancreatic toxicity
Teeth, bones, photosensitivity, superinfections

NVD, injection site pain,

34
Q

Spectrum of Tigecycline

A

BROAD SPECTRUM= gram +, gram-, anaerobes, MRSA
>SSTI’S AND INTRABDOMINAL INFECTIONS,
*no activity against pseudomonas or proteus

35
Q

TIGECYLINE CANNOT BE SUED IN

A

PATIENTS UNDER 18

36
Q

RIFAMPIN MOA

A

Rifampicin inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase–> inhibiting protein synthesis

37
Q

spectrum of Rifampin

A
  1. MRSA (in combo with beta lactam or vanc)
  2. TB primary agent
  3. leprosy
  4. staph epi
38
Q

rifampin when use to treat staph aureus, MRSA or Staph epi…

A

is combined with Vancomycin or a beta lactam

39
Q

another use of Rifampin for prophylaxis

A

household members exposed to H FLu

40
Q

Rifampin causes eradication of _____ in ______

A

staph in nasal carriers

41
Q

Most active anti-leprosy drug at present

A

rifmapin
another is dapsone
another is clofazimine

42
Q

MOA for clindamycin

A

inhibits protein synthesis byt binding up the 50s ribosomal subunit,

  • very similar to erythromycin
  • not effective if erythromycin and clinda re given together
43
Q

MOR for clinda

A

slowly and step-wise

Methylation of erm encoded genes

44
Q

Spectrum for clindamycin

A 
ANAEROBES
*BOTH GRAM + AND GRAM -
*PEPTOSTREP, BACTEROIDES, ACTINOMYCES
MRSA AND 
GROUP A STREP
45
Q

PHARMACOLOGY OF CLINDAMYCIN

A

NEAR COMPLETE ORAL ABSORPTION
rapid
widely dist, PENETRATES BONE AND ABCESSES
*does not penetrate CSF onr intracellular
does not cross placenta and is found in breast milk

46
Q

metabolism of clinda

A

liver–. adjustment for liver fialure

half life is 2.7 hours

47
Q

is clinda removed by hemodialysis

48
Q

excretions of clinda

A

bile and urine excrete metabolites from liver breakdown

No renal adjustment

49
Q

Side effect of Clindamycin

A

PSUEDOMEMBRANOUS COLITIS from C. Diff.

-hypersensitivity and diarrhea

50
Q

tx for Pseudomembrandous colitis in clinda therapy

A

metronidazole or vancomycin

51
Q

spectrum of clindamycin

A

bacteroides fragilis (outside CNS–> no access)

  • oral infections (peptostrep)
  • toxo in AIDS with pyrimethine
  • prophylaxis with penicillin allergy (staph and strep) MSSA and MRSA of soft tissue
  • for PCP with primaquine
52
Q

Mupirocin MOA

A

BINDS REVERSIBLY TO STAPH ISOLEUCYL TRNA SYNTHETASE

-inhibits rna and protien synthesis

53
Q

SPECTRUM FOR MUPIROCIN

A

TOPICALLY FOR IMPETIGO

  • GRAM + BACTERIA**
  • STAPH
  • STREP
  • MRSA
54
Q

SYSTEMIC ABSORPTIONS WITH MUPIROCIN

55
Q

ADEVRSE EFFECTS WITH MURPIROCIN

A

VEHICLE PEG can cause renal failure

56
Q

polypeptide antibiotic

A

bacitracin

57
Q

MOA for bacitracin

A

inhibits cell wall synthesis by inihbiting movement of peptidoglycan building blocks of the cell wall from inside to outside the cell membrane by INHIBITING DEPHOSPHORYLATION OF ISOPRENYL PYROPHOSPHATE CARRIER PROTEIN

58
Q

spectrum Bacitracin

A

gram + cocci and bacilli

59
Q

Major adverse effect with bacitracin

A

nephro toxicity with IV

*used topically with neomycin and polymyxin B

60
Q

MOA for vancomycin

A

binds to the D-Ala-D-Ala prevents cell wall synthesis of the long polymers of N-acetylmuramic acid (NAM) and N-acetylglucosamine (NAG) that form the backbone strands of the bacterial cell wall, and it prevents the backbone polymers that do manage to form from cross-linking with each other.

61
Q

major VANC adverse effects

A

nephro and ototoxicity

62
Q

review MOAS for penicillin, anti-staph penicillin, cephs, vanc, azithromycin, bactrim,

Dermatology (12 decks)

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