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ClinMed_II > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

What causes vancomycin resistant?

A

Alteration of binding site to D-ala-D-lac

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2
Q

What does vancomycin cover?

A

MRSA and Clostridium

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3
Q

What medications are used for C Dif?

A

Orał vanycomycin

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4
Q

What do we need to do when we start giving Vancomycin?

A

Give a loading dose (for severe infections)
25-30mg/kg, to nearest 250mg increment
Monitor to adjust dose based on AUC
If not severe monitor adjust based on through levels

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5
Q

When do we monitor when giving vancomycin?

A

When it is a severe MRSA infection such as…
Bacteremia
Infective endocarditis
Meningitis
Osteomyelitis
Pneumonia
Sepsis

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6
Q

What are some adverse effects of vancomycin?

A

Hyperemia(red man syndrome)
Nephrotoxicity/ototoxicity

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7
Q

How does one get red man syndrome from vancomycin?

A

Rapid infusion or high doses

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8
Q

How do you avoid or treat red man syndrome?

A

Take slow infusions (1-2hours)
Pretreat with antihistamines

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9
Q

What causes nephrotoxicity/ototoxicity in taking vancomycin?

A

Increasing daily dose >4g
Renal impairment
Elderly
Use in combination with aminoglycosides

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10
Q

What do you need to monitor for nephrotoxicity/otoxicity?

A

BUN/Creatinine

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11
Q

What are some alternative medications for MRSA infections other than vancomycin?

A

Televancin, Dalbavancin, Oritavancin (same class as vancomycin)
Daptomycin (good for VRE)
Lizolid

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12
Q

Which alternatives to vancomycin are not effective against VRE?

A

Talavancin
Dalbavancin

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13
Q

What is daptomycin?

A

DNA/RNA inhibitor
Not for pneumonia treatment

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14
Q

How does linezolid work?

A

Inhibit bacterial protein synthesis

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15
Q

What are the aminoglycosides?

A

Gentamicin
Tobramycin
Amikacin
Streptomycin

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16
Q

What is the MOA for aminoglycosides?

A

Binds to 30S subunit inhibiting bacterial protein synthesis (bacteriostatic, bactericidal at high concentrations)
Post antibiotic suppression of bacterial growth

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17
Q

What subunits are responsible for mRNA translation for protein synthesis within a cell?

A

30S and 50S

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18
Q

What are ways bacteria can get resistance from aminoglycosides?

A

Chromosomal mutations
Enzymatic destruction of drug
Lack of permeability through cell wall
Efflux pumps(pumps out abx if entered in cell)

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19
Q

What are aminoglycosides indicated for?

A

Gram -
Mycobacterium tuberculosis

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20
Q

What are the BBW warning for aminoglcyosides?

A

Ototoxicity
Nephrotoxicity
Neuromuscular paralysis

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21
Q

What pregnancy category is aminoglycosides?

A

D

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22
Q

What are ways bacteria get resistance to Tetracyclines?

A

Active efflux of drug
Enzymatic deactivation

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23
Q

What first line treatments are for tetracyclines?

A

Lyme disease
Rocky Mountain spotted fever
Cholera
Acne

24
Q

What other diseases are treated by tetracyclines?

A

Chlamydia infections
Empiric therapy for CAP

25
Q

What are the contraindications for tetracyclines?

A

Children <8-9 (teeth discoloration)
Children <13
Pregnancy (hepatotoxicity, fetal affect)

26
Q

What do you NOT take with tetracyclines?

A

Antacids
Dairy products

27
Q

What are SE of tetracyclines?

A

GI distress
Hepatotoxicity
Photosensitivity
Vestibular problems(vertigo) especially with minocycline
Candida infections, C Dif

28
Q

What are the macrocodes?

A

Erythromycin
Azithromycin
Clarithromycin

29
Q

What is the MOA?

A

Inhibits protein synthesis and translation needed to replication 50S subunit (bacteriostatic)

30
Q

What are ways bacteria can build resistance against macrocodes?

A

50S subunit target modifcation
Efflux pumps
Degradation enzymes

31
Q

What are the first line treatments for macrolides?

A

Community acquired pneumonia
Increasing resistance with strep
Atypicals: mycoplasma, chlamydia
legionella
Diphtheria
COPD

32
Q

What are the 2nd line treatments for macrolides?

A

OM
Pharyngitis

33
Q

What is the PK of macrolides?

A

Metabolized by liver: CYP450 inhibitor (not azithromycin)
Eliminated in bile
Use with caution in liver impairment

34
Q

What are the adverse effects of macrolides?

A

GI: N/D, C dif
Hepatotoxicity
Prolonged QT interval
Ototoxicity(transient)
Pregnancy Category B

35
Q

What are possible routes for clindamycin?

A

Capsulse
IV/IM
Vaginal cream/supp

36
Q

What is the BBW for clindamycin?

A

C dif

37
Q

What are the SE of clindamycin?

A

Diarrhea
Nausea
Skin rashes
Pregnancy category B

38
Q

What are types of quinolones?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin

39
Q

What is the MOA of quinolones?

A

Inhibits DNA gyrase and topoisomerase IV(bactericidal)

40
Q

Clinically, what significant use are the quinolones for?

A

Cipro is good for the belly button down
Levo and moxi are good for belly button up

41
Q

What are the first line treatments for quinolones?

A

Otitis externa, ophthalmic infections
Pheylonephritis
Prostatitis
Traveler’s diarrhea/infectious diarrhea
Anthrax
URI’s/Pneumonia with commorbitidies

42
Q

What is the BBW for quinolones?

A

Tendinitis/Tendon rupture?

43
Q

What are the SE of quinolones?

A

GI distress
Nephrotoxicity
Lowers seizure threshold
C dif
HA/dizziness
Hepatotoxicity
Alterations in glucose level
Photosensitivity

44
Q

What is the MOA for Trimethoprim/Sulfamethoxazole (Bactrim)?

A

Trimethoprim: folate reeducates inhibitor, inhibits bacteria AA synthesis
Sulfamethoxazole: folate synthesis inhibitor
(bacteriostatic)

45
Q

What is the MOA for Trimethoprim/Sulfamethoxazole (Bactrim)?

A

Trimethoprim: folate reeducates inhibitor, inhibits bacteria AA synthesis
Sulfamethoxazole: folate synthesis inhibitor
(bacteriostatic)

46
Q

When do we use Bactrim or vancomycin for MRSA?

A

Bactrim for mild cases
Vancomycin for serious cases

47
Q

What is CI for Trimethoprim/Sulfamethoxazole (Bactrim)?

A

Sulfa allergy

48
Q

What are the SE of Trimethoprim/Sulfamethoxazole (Bactrim)?

A

Megaloblastic anemia (folic acid def.)
GI distress: N/V/D
Photosensitivity
Hepatotoxicity
Pregnancy category C

49
Q

What are the types of nitrofurantoin?

A

Macrobid/Macrodantin

50
Q

What drug treats simple cystitis and is safe for pregnancy?

A

Cephalexin (Keflex), 1st gen

51
Q

What do you not take with Metronidazole (flagyl)?

A

Alcohol

Causes disulfiram-like reaction

52
Q

What do you not take with Metronidazole (flagyl)?

A

Alcohol

Causes disulfiram-like reaction

53
Q

What is silver sulfadiazine (silvadene)

A

Folate synthesis inhibitor
Topical cream for burns

54
Q

What is Bacitracin?

A

Polypeptide
Use for Gram +
Topical application only due to nephrotoxicty

55
Q

What is chloramphenicol?

A

Misc Synthetic abx
Broad spectrum (G-,G+, anaerobes)
Rarely used too dangerous (hematologic toxicity)

56
Q

What do you do to choose the abx for treatment?

A

Empiric treatment and get narrowest spectrum of activity
Consider…
Resistance, cost, dosage, I/CI
Pt compliance and education

ClinMed_II (15 decks)

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