Aminoglycosides, tetracyclines, flagyl, bactrim and tigecycline Flashcards Preview

Pharmacology > Aminoglycosides, tetracyclines, flagyl, bactrim and tigecycline > Flashcards

Flashcards in Aminoglycosides, tetracyclines, flagyl, bactrim and tigecycline Deck (41):
1

Aminoglycoside options

Gentamysin, tobramycin, amikacin, streptomycin, neomycin

2

MOA of aminoglycosides

actively transported across cytoplasmic membranes into the interior of the bacterial cell, requires energy, o2 and a higher pH, bind to 30S ribosome inhibiting protein synthesis

3

PK of aminoglycosides

bactericidal activity, and concentration dependent, IV only, also IM, IT, intraventricullarly, inhaled and topical, 100% renaly eliminated, wt based dosing

4

Spectrum of activity of aminoglycosides

aerobic, gram negative rods, enterobacteriaceae, S. Aureus- not monotherapy

5

What is generally considered best option for GNR?

tobramycin

6

In what bacteria is gentamycin used for synergistic purposes?

S. Aureus

7

What is reserved for tobramycin and gentamycin resistant?

amikacin

8

Clinical use of aminoglycosides?

only use monotherapy for UTI, gram- sepsis, HCAP, bacteremia, gram+ synergy

9

What should aminoglycosides not be used for?

skin infections

10

ADRs of nephrotoxicity

Nephrotoxic and ototoxic; usually develops 5-7 days after therapy, generally milk AKI and reversible

11

What does it mean if a pt develops drop in creatinine after start of aminoglycoside therapy

It may just be to course of disease--- not therapy, because it takes 5-7 days for there to be negative affect on kidneys from the therapy

12

Trimethoprim/Sulfamethoxazole (Bactrim) typical form?

used as double strength, 1 tab PO BID, 400, 800 mg

13

MOA of bactrim?

inhibits sequential steps in folate synthesis of susceptible organisms, bacteriostatic when alone, but combined is bactericidal

14

Spectrum of bactrim?

aerobic gram+, staph (MRSA and MSSA, CA not HA), strep- resistance increasing, listeria monocytogenes, nocardia- DOC, Aerobic gram -, e.bacteriaceae- resistance inc, M. catarrhalis, H. influenza, s.maltophilia, b. cepacia, p. jiroveci

15

What is Bactrim DOC for?

nocardia, burkholderia cepacia, pneumocystis jiroveci

16

What does bactrim not cover?

pseudomonas

17

Bactrim PK?

IV and PO, renally eliminated, DI w/ warfarin (should dec warfarin dose by 50%)

18

when on bactrim IV, what should be done?

concurrent fluid administration- 2 L/day

19

ADRs of Bactrim?

N/V/D, anorexia, hematologic, hyperkalemia

20

Clinical use of bactrim

CA- MRSA SSTI, UTI- resistance worsening, PSP p. jiroveci, nocardia infections DOC- requires very high dose, pyelonephritis, prostatitis

21

What is bactrim DOC for?

nocardia infections with high doses, and PCP P. jiroveci

22

What are the tetracyclines?

doxycycline (Vibramycin), ,tetracycline, minocycline (Minocin)

23

What is the dose of doxycycline?

100 mg PO BID

24

MOA of tetracyclines?

binds to 30 s ribosome to inhibit RNA-dependent protein synthesis, bacteriostatic

25

Spectrum of tetracyclines?

gram +, staph, strep- not PCN resistant, e.bacteriaceae, h. influenzae, m. catarrhalis, tick bourne disease, acne vulgaris and borrelia burgdorferi

26

What is doxycylcine for?

CA-MRSA, and rickettsia

27

What is doxycycline and minocycline used for?

all the atypicals, legionella, mycoplasma pneu, chlamydophilia pneu

28

What forms of tetracyclines are available?

All po, doxy and minocycline are available IV

29

ADRs of tetracyclines?

N/V/D, photosensitivity, dec oral contraceptives, discoloration of teeth, dec bone development

30

Clinical use of tetracycline?

CA-MRSA- doxy, chlamydia, lyme disease, PID-Doxy, rocky mountain spotted fever, acne- minocycline, atypical infections

31

Tigecycline (Tygacil) MOA

a glycylcycline, inhibits protein synthesis, bacteriostatic, IV only

32

Spectrum of activity of tigecylcine?

aerobic Gram +, MSSA, MRSA, strep- multidrug resistant s. pneu, enterococci- VRE, very broad spectrum gram -, drug resistant e. bacteriaceae, carbapenem resistant, anaerobes, atypicals, good for abd infections

33

What is tigecycline not good for?

proteus or pseudomonas

34

Tigecycline (Tygacil) clinical use

complicated SSTI, intra-abd, culture proven pan-resistant pathogens

35

ADRs of tigecycline (Tygacil)

N/V/D- significant, use cautiously if tetracycline allergy, photosensitivity, discoloration of teeth

36

Metronidazole (Flagyl) MOA

binds to and disrupts DNA and nucleic acid synthesis, bactericidal, conc dependent

37

Dose of flagyl

500 mg PO/IV TID-QID

38

Spectrum of activity of flagyl

only anaerobic , gram -: bacteroides, fusobacterium, prevotella, C. dif, trichomonas vaginalis, giardia lamblia

39

Flagyl adrs

N/V/D, metallic taste, pancreatitis, CNS complications, disulfiram rxns- avoid w/ EtOH

40

What should be done if people on flagyl develop CNS sx

must d/c therapy, seen w/ large doses or prolonged therapy, peripheral neuropathy, , seizures, confusion, ataxia, vertigo

41

Flagyl Clincial use

first line option for c. diff, add on therapy for other abd infxns- diverticulitis etc, bacterial vaginosis, STD, "below diaphragm"