Week 10 - Lincosamides, Macrolides, Tetracyclines

Question 1

Lincosamides: example

Answer 1

Clindamycin

Question 2

Lincosamides (Clindamycin): activity

Answer 2

Gram (+), bacteriostatic

S. pneumoniae, s. pyogenes, methicillin-resistant staph aureus, p. acnes

Question 3

Lincosamides (Clindamycin): indications

Answer 3

MRSA skin infection, drug resistant strep pharyngitis, PID

Infections in PCN allergic patients, dental infections

Question 4

Lincosamide (Clindamycin): MOA

Answer 4

Binds to 50S subunit of bacterial ribosome and suppresses protein synthesis

Question 5

Lincosamide (Clindamycin): ADR

Answer 5

• BLACK BOX: colitis, c. diff
• Maculopapular rash, abdominal pain, N/V, dizziness
• Rare: hypersensitivity reaction, anaphylaxis, agranulocytosis

Question 6

Lincosamide (Clindamycin): caution and contraindications

Answer 6

• Caution w/ hx of GI disease
• Caution in hepatic impairment
• Caution in lactation
• Approved in pediatrics, BUT other abx preferred

Question 7

Macrolides: examples

Answer 7

Azithromycin, erthromycin, clarithromycin, fidaxomicin

Question 8

Macrolides (-mycin): activity

Answer 8

Broad spectrum gram (+) AND gram (-) coverage

S. pneumoniae, MSSA, h. flu, bordetalla pertussis, mycoplasma, chlamydia, m. catarrhalis, h. pylori

Bacteriostatic

Question 9

Which macrolide is pregnancy category C?

Answer 9

Azithromycin

Question 10

Macrolides (-mycin): MOA

Answer 10

Bind to 50S subunit of bacterial ribosome and suppresses protein synthesis

Question 11

Macrolides (-mycin): ADR

Answer 11

N/V/D, abdominal pain, skin rash

Rare: liver abnormalities, hypersensitivity reactions

Question 12

Macrolides (-mycin): caution and contraindications

Answer 12

• Risk for OT prolongation
• Avoid in patients at risk for torsades de pointes
• Caution in renal and hepatic impairment
• Approved in pregnancy, lactation, pediatrics

Question 13

Tetracyline: examples

Answer 13

Doxycyline, tetracycline

Question 14

Tetracyclines: activity

Answer 14

Broad spectrum w/ good coverage for gram (+) AND gram (-) bacteria

S. aureus, MRSA, s. pneumoniae, p. acnes, h. flu, chlamydia, mycoplasma pneumniae, rickettsia, t. pallidum, h. pylori

Question 15

Tetracyclines: MOA

Answer 15

Inhibits protein synthesis by reversibly binding to 30S subunit of bacterial ribosome

Question 16

Tetracyclines: ADR

Answer 16

Anorexia, N/V/D, lightheadedness, dizziness, photosensitivity, HTN

Rare: c. diff, severe skin reactions

Question 17

Tetracyclines: caution and contraindications

Answer 17

• Caution in renal and hepatic impairment
• Short term use in lactation ONLY
• Avoid in pregnancy
• Avoid in children younger than 8 years
  
  • Can cause teeth discoloration, impaired growth

Question 18

Tetracycline: patient education

Answer 18

• Use sunscreen
• Doxycycline can be used in children w/ Rocky Mountain Spotted Fever
• Use backup contraceptive w/ tetracycline
• Food, milk, calcium decrease absorption

Question 19

Lincosamide (Clindamycin): patient education

Answer 19

• Stop medication if significant diarrhea occurs (risk for c. diff)
• DO NOT START IMMODIUM
• Considered second-line therapy, but first line for special populations (pregnant women and children)

Question 20

Macrolides (-mycin): patient education

Answer 20

Combination w/ statins can increase risk for myopathy

Question 21

Macrolide: Fidaxomicin (Dificid)

Answer 21

• 18 ring macrolide
• Active against c. diff
• Drug interactions –> rifampin or rifaximin

Question 22

Oxazolidinones: example

Answer 22

Linezolid

Question 23

Oxazolidinones: MOA

Answer 23

• Inhibitors of bacterial ribosomal protein synthesis
• Most effective against aerobic gram (+) bacteria

Question 24

Oxazolidinones: ADR

Answer 24

• N/D, HA, myelosuppression (resolves w/ discontinuation of drug)

Question 25

Tetracycline: indications

Answer 25

Community acquired PNA, rocky mountain spotted fever, **Lyme disease**, p. acnes