UTI Flashcards
(1) Nausea, vomiting
(2) Rash
(3) Hepatitis (rare but fatal), elevated liver enzymes
(4) Endocrinologic abnormalities, e.g., women, menstrual
irregularities; men, gynecomastia; due to inhibition of steroid
biosynthesis; more important for ?
Azoles
ketoconazole
(1) Nausea, vomiting and diarrhea (take with meals to decrease adverse effects)
(2) Hemolytic anemia associated with G6PD deficiency
(3) Colors the urine brown
Nitrofurantoin
a. GI: nausea, vomiting, abdominal discomfort
b. CNS: headache, dizziness
c. Have been shown to cause arthropathy in immature animals of a variety of species
Fluoroquinolones
ciprofloxacin, levofloxacin
Acute hemolytic anemia (G6P deficiency)
Steven Johnson Syndrome
Crystalluria
Kernicterus in newborns
Trimethoprim-Sulfamethoxazole
Administration of what can overcome the neuromuscular blockade associated with aminoglycosides?
calcium salt
Contraindications: Anesthetics and neuromuscular blockers due to neuromuscular blockade; overcome by calcium salt administration
Aminoglycosides
are cell wall synthesizing enzymes
which are the binding sites for the β-lactam antibiotics
Penicillin Binding Proteins (PBPs)
Bacterial enzymes reduce the drug to reactive intermediates which are responsible for damaging DNA.
Bacteria reduce the drug more
than mammalian cells which accounts for its selectivity
Nitrofurantoin
Bacteriostatic agents (e.g., TCN) are antagonistic
Penicillins - Piperacillin-tazobactam; 3rd Generation Cephalosporin - Ceftriaxone
bind to the 30S ribosome inhibiting protein synthesis by interfering with the initiation complex
Cause misreading of the mRNA template leading to incorrect amino acids
incorporated into the protein
Aberrant proteins inserted into cell membrane leading to altered
permeability and cell death
Aminoglycosides
block the enzyme lanosterol 14-α-demethylase inhibiting the conversion of lanosterol to ergosterol. There is an
accumulation of 14-α-methylsterols which disrupt cell membranes
or inhibit cell functions
Azoles
Candidiasis pyelonephritis
Azoles (fluconazole)
characterized by blistering of the mucous membranes (mouth, eyes, vagina) with patchy rashes over most of the body. Patients may also experience fever,
headache, and cough
Stevens-Johnson Syndrome; a/e of SMX-TMP
Complicated pyelonephritis
Penicillins - Piperacillin-tazobactam; 3rd Generation Cephalosporin - Ceftriaxone; Aminoglycosides
Concurrent use with methotrexate, 6-mercaptopurine, and azathioprine–> bone marrow suppression
PREGNANCY (can cross placenta)
Trimethoprim-Sulfamethoxazole
Contraindicated in pregnant patients at term, during labor and delivery, or when
onset of labor is imminent; this is due to the possibility of hemolytic anemia in the neonate
Nitrofurantoin
Diarrhea, nausea
Fosfomycin
effective only against aerobic gram-negative organisms
Ciprofloxacin
Hypersensitivity reactions
GI distress and diarrhea
Neurotoxicity (myoclonus or seizures, agitation, confusion and hallucinations, or lethargy and stupor progressing to coma)
Ampicillin rash
Penicillins - Piperacillin-tazobactam
Hypersensitivty
Local reactions at injection site
Nephropathy (Risk of tubular necrosis in patients with underlying renal disease or who are taking potentially nephrotoxic drugs)
3rd Generation Cephalosporin - Ceftriaxone
In a cell in which cell wall synthesis is inhibited, (1) degrade the cell wall forming weak points through which
the cell membrane can extrude and eventually rupture killing the cell.
- autolysins (murein
hydrolases)
Inactivates the enzyme pyruvyl transferase, which is responsible for transformation of N-acetylglucosamine into N-acetyl-muraminic acid;
the latter is required for synthesis of the cell wall peptidoglycan by bacteria
Fosfomycin
inhibit incorporation of PABA into dihydropteroic acid interfering with folate metabolism (1); competitive inhibitor of dihydrofolate reductase (2)
- SMX
- TMP
Trimethoprim-Sulfamethoxazole
Inhibition of DNA gyrase (primary target in many gram-negative organisms) which is responsible for formation of negative DNA supercoils
Inhibition of topoisomerase IV (primary target in many gram-positive organisms) which is responsible for separating the interlinked daughter DNA molecules that are a product of DNA replication
Bactericidal
Fluoroquinolones
ciprofloxacin, levofloxacin
