ABXSH4-macrolides Flashcards

1
Q

Macrolides

A

MOA: inhibit protein synthesis by binding 50S ribosomal subunit
Watch for QT prolongation
• erythromycin: GI upset ( can use if patient allergic to PCN for strep, syphilis, gonorrhea
• clarithromycin ( biaxin ) -metallic taste
•azithromycin - empty stomach
-chlamydia/ N. Gonorrhea: 1 G single dose ( For gonorrhea we gave ceftriaxone 250 mg IM plus 1 gram azithromycin )
MAC ( mycobacterium avian complex ) prophylaxis : 1200 mg once weekly- for HIV when CD4 ≤50

Fidamoxicin ( Dificid ) - indicated for C. diff

  • Telithromycin ( Ketek ) - CAP ( liver failure DSC ) : was not a macrolide. A ketolide
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2
Q

Clarithromycin

A

Biaxin , Biaxin XL ( XL form with food )

Group A strep, sinusitis, CAP, MAC

Dont refrigerate suspension

DDI: 3a4 and 1a2 inhibitor
( increases levels of digoxin, carbamazepine, simvastatin, theophylline, INR )
QT prolong

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3
Q

Azithromycin

A

Pregnancy category B
Zithromax

Zpak: 6 of the 250 mg
Tri-pak: 3 500mg tabs

Take suspension : on empty stomach. Comes in suspension for kids.
DOC for otitis media is amoxicillin, if you fail amoxicillin give Augmentin, and if PCN allergy can give azithromycin
Can give for CAP

give IV over 1 hour.

Opthalmic formulation in refrigerator

SE: hearing loss ( IV ), QT prolongation, does not inhibit p450, dont take with antacids, GI

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4
Q

Fidaxomicin

A

Dificid
Indication: C. Difficile only ( not well aborbed so oral just works for c diff )
Preg B

MOA: inhibit RNA synthesis by inhibiting RNA polymerases. Bactericidal against C. Diff

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5
Q

Tetracyclines

A

MOA: inhibits protein synthesis. Binds to 30s subunit of bacterial ribosome. Blocks tRNA to the mRNA ribosome complex

Spectrum : broad spectrum bacteriostatic w/activity against aerobic gram positive and gram negative bacteria and atypical pathogens ( mycoplasma and chlamydia )

Also can use for syphilis if PCN allergy

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6
Q

Different tetracyclines

A

Doxycycline ( vibramycin , adoxa, acticlat, doryx MPC, Oracea( only indicated for rosacea. Low dose not for antibacterial effect but to reduce redness ) ) :
-CAP, bronchitis
-Lyme disease ( minimum of Lyme disease ) , rosacea, PID,
-Doryx MPC ( delayed release ) : decreased exposure in upper GI
-if RENAL IMPAIRMENT, Then recommend doxycycline

Minocycline:
-acne , prosthetic joint infection
-watch for hepatoxicity, lupus, dizziness
-solodyn and ximino ( er forms to decrease dizziness for patient )

Tetracycline ( sumycin )
-empty stomach
-Chronic bronchitis, acute exacerbation; PUD

Dont give tetracycline less than 8. Also Pregnancy category D. Teeth discoloring

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7
Q

Chloramphenicol

A

Used mostly in other countries
MOA: binds to the bacterial 50S ribosomal submit and inhibits protein synthesis.
-bone marrow toxicity /supression
-absolutely cant give to kids. Gray baby syndrome. Can’t excrete the drug.

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8
Q

Clindamycin

A

( Cleocin )
Clinda, Linda this girl is so positive. Covers gram positive and all anaerobes ( no gram ( - ) )

SE: #1 cause of C. Diff
Pseudomembranous colitis

IV/IM/ PO / Soln

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9
Q

Lincomycin

A

Lincocin
IV / IM only

Clindamycin and lincomycin should never be given with erythromycin. ( consider antagonistic )

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10
Q

Metronidazole

A

Flagyl
MOA: disruption of bacterial DNA synthesis
Spectrum: B fragilis, giardia, C diff

Contraindicated in 1st trimester, then considered preg category B

SE: disulfiram reaction ( avoid alcohol 3 d caps/ER )
Darkens urine, metallic taste, GI upset

DDI: increases INR with warfarin ( 2c9 inhibitor )

Scenario: if patient is taking metronidazole for bacterial vaginosis, recommend vaginal clindamycin instead IF patient on warfarin

Dosage forms: IV ( protect from light) ( refrigerate : crystals may from , just re-dissolve on warming room temp ( recall mannitol)
NS dilution : metroNidazole

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11
Q

Secnidazole

A

Solosec
Indications: fishy Odor vaginal discharge, in reproductive age women : BACTERIAL Vaginosis
What was first line? Metronidazole : BAC to the metro 500 mg or vaginal gel
- other drugs you can use : clindamycin oral or 2%cream vaginally 7d
-then you can use secnidazole ( or tinidazole ) :
- benefit of secnidazole 2 gram single dose ( packet sprinkle on applesauce ( dont chew ). Consume mixture within 30 mins

No hepatic or renal

Adverse : HA , GI

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12
Q

Nitrofurantoin

A

Macrobid ( look for RENAL if CrCl < 60 dont give Nitrofurantoin )
Furadantin ( suspension ), macrodantin( 50-100 mg po Q6H x 3 to 7 d w/food ) , macrobid
Spectrum: all UTI gram negatives except pseudomonas and proteus ( Kl/B)

Pregnancy category B: except do not give after 38 weeks of pregnancy
-DO not use in infant <1 month
Dose: macrobid : 100 mg po BID w/food 7d

SE: discorlation of urine ( brown ) hepatic reactions, peripheral neuropathy , pulmonary toxicity

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13
Q

Fosfomycin

A

Monurol
Indication: simple uncomplicated UTI in women

  • one 3 gram packet simple dose ( dissolve in 1/2 cup of water )

DDI : metoclopramide decreases urinary excretion

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14
Q

Oxazolidinones

A

MOA: 50 s bacterial ribosomal subunit / Gram +

  • Linezolid ( zyvox ) : oral ( comes in an oral suspension too but dont shake gently turn good 21 days ) and IV / BID
  • Tedizolid ( sivextro ) : oral and IV / QD

Linezolid:
Spec: VRE, MRSA, other gram ( + ) //// DOES NOT COVER gram ( - )
Dose: 600 mg q 12 hours
SE: THrombocytopenia, check CBC. Peripheral and optic neuropathy ( monitor vision if on it >3 months ) linez👀lid
DDI: slight MAOI
Preg: C
Premade in NS

Tedizolid ( sivextro) :
Prodrug binds to 50s ribosomal subunit
spec: skin ifx ( gram + ) , staph ( MRSA ) strep, & enterococcus faecalis
You make this one so remember in NS ( recall: daptomycin, cubicin , Unasyn, ampicillin, metronidazole)
Common SE: GI, dizziness, thrombocytopenia, MAOI, and if on long period check eyes
No RENAL or hepatic dose adjustment

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15
Q

Synercid

A

( Quinupristine / Dalfopristin )
MOA: inhibits protein synthesis
Spectrum: VRE, MRSA, other gram ( + ) ( covers E. faecium only)
( recall : linezolid, tedizolid, daptomycin, tigecycline, cover both VRE ( e faecalis and E faecium )

SE: venous irritation, arthralgia, myalgia

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16
Q

Tigecycline

A

Tygacil ( IV only )
Broad activity:
FDA later proved increased chance of death.

Structure similar to tetracycline, binds to ribosomes 5x higher affinity than tetracycline

Preg: D
Do not give younger than 8 years old and dont give in pregnancy
Increase INR

17
Q

Lipoglycopeptides

A

IV/Gram ( + ) skin and structure infections )
Similar to vancomycin ( covers MSSA/ MRSA , strep GBA GBS, Enterococcus faecalis )

  • telavancin ( vibativ ) - QD IV
    -dalbavancin ( dalvance ) - once weekly IV x2
  • Ortivancin ( orbactiv ) single dose IV treatment
  • good med bc can give once and send patient home

SE: qt prolongation, nephrotoxicity ( like vanco ) , give over 60 mins ( reduce red man syndrome )

No therapeutic drug monitoring needed.

18
Q

Dalvance

A

Dalbavancin ( IV D5W) D in dalbavancin for D5W
MOA: lipoglycopeptide which interferes with cell wall synthesis.
Long plasma half life ( 2 dose regimen or 1 dose ( 1000 mg Iv single dose ) )
Spec: gram + / skin infection by staph ( MRSA yes ) , strep

19
Q

Oritavancin

A

Orbactiv
MOA: cell wall synthesis
Single dose but infusion over 3 hours
D5W only: good for 6 hours room temp, good for 12 hours. If you have it hanging around 4 hours and try

Contraindications : use of IV heparin for 120 hours after orbactive; aPPT test results falsely elevated ( you can miscalculate and give wrong dose ) for 120 hours after orbactiv. Can increase bleeding if on Coumadin

SE: takes time to go away if you get them bc long half life.