Antibiotics That Interfere With Folate Synthesis or Nucleic Acid Processing Flashcards by Meg Dolohanty

What step of the bacterial folic acid pathway do sulfonamides stop?

First step

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Disruption of the folate pathway is generally ______ in single agent therapy

bacteriostatic

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What was the first sulfonamide that is no longer used? Was a pro-drug. worked against staph and strep

Prontosil

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What type anitiobitcs are sulfonamides considered on their own?

Bacteriostatic

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What bacteria do sulfonamides work against?

Gram positive and negative bacteria

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How do bacteria have resistance against sulfonamides?

Additional production of PABA

changes in binding sites from sulfonamides

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What are the three sulfonamides used today (oral absorbable)?

Sulfadiazine
Sulfisoxazole
Sulfamethoxazole (+Trimethoprim)

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What is the oral, non absorbable sulfonamide?

Sulfasalazine

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What is sulfasalazine used for?

Anti-rheumatic (used for RA)

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What are 2 topical sulfonamides agents?

Sodium sulfacetamide

Silver sulfadiazine

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What topical sulfonamide is used in opthalmic solution or ointment for bacterial conjunctivitis or treatment of chalmydia trachoma?

Sodium sulfacetamide (Sulamyd)

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What is a topical sulfonamide used for topical burn infection prophylaxis?

Siver sulfadiazine (Silvadene)

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Are sulfas well absorbed?

Yes, excpet sulfasalazine

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What sulfa drug is highly protein bound to albumin?

Sulfamethoxazole

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What are other protein bound drugs that you should be careful with prescribing sulfamethoxazole with?

Warfarin
Phenytoin
Sulfonylureas

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What is the most common AE with sulfonamides?

Photosensitivity (N/V/D, HA)

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What is the pregnancy category of silver sulfadizine?

Category B (because it is applied topically)

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What is the problem with giving sulfa drugs to pregnant patients?

Neonatal kernicterus

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What part of the folic acid pathway does trimethoprim interfere with?

Second part

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Are trimethoprim or sulfa drugs more potent?

Trimethoprim

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What is the prime indication of sulfa plus trimethoprim?

UTIs

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When sulfas are combined with trimethoprim, what type antibiotic does it turn into?

Bactericidal

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What sulfa drug is trimethoprim combined with?

Sulfamethoxazole

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What is sulfamethoxazole/ trimethoprim the drug of choice for?

Pneumocystis carinii
bacterial diarrhea
prophylaxis for UTI
Periotonitis prevention in patients w/ cirrhosis

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Is there a lot of resistance to sulfamethoxazole/ trimethoprim?

Yes

What is sulfamethoxazole/ trimethoprim used for in AIDS patients?

PCP & toxoplasma gondii

What is another name for sulfamethoxazole/ trimethoprim?

Bactrim

What are three drugs that inhibit DNA processing?

Quinolones (same as floroquinolones) Rifampin Nitrofuratoin

How do quinolones block bacterial DNA synthesis ?

Inhibit DNA topoisomerases

What bacterias do quinolones act against?

Gram + and gram - bacteria

What type antibiotic are quinolones considered?

Bactericidal

What type bacteria does ciprofloxacin cover?

Really good gram - | lost a lot of gram positive

Levofloxacin and moxifloxacin cover against what bacterias and how well?

Really good gram negative covered | even better gram positive coverage than Cipro

What quinolone class has continued gram negative and gram positive coverage but also covers anaerobic (B. fragilis)

trovafloxacin

What atypical pneumonia organisms do quinolone cover?

CHalymydia penumoniae | mycoplasm pneumoniae

What intracellular pathogens do quinolones cover?

Legionella Mycobacteria TB mycobacteria avium complex

what quinolone is indicated for post-exposure prophylaxis for anthrax?

Cipro

What quinolone treats anthrax?

Levofloxacin

What is trovafloxacin restricted to due to severe hepatic toxicity?

FDA restricted to life or limb threatening infections

What should quinolones not be used for in order to avoid increase in resistance?

Upper or lower respiratory infections | Skin/ soft tissue infections

What do the quinolone class end in?

"floxacin"

How are most quinolones excreted?

renally

How is Cipro excreted?

50% renal, 40% bile (still need dose adjustment for renal insufficiency)

What are the most common AE for quinolone?

N/V/D

What are some people who may have seizures with cipro?

little old ladies with renal impairments, on NSAIDs

What are some rare AEs of quinolones?

Seizures blood dyscarsias peripheral neuropathy (irreversible)

What is the most common type of interaction with cipro?

CYP interactions

What drugs can cipro interact with?

Antacids sucralfate Iron Multivitamins

What type patients do you want to be worried about tendinitis and tendon rupture on Cipro?

Elderly | Renal failure, glucoccorticoid use

With Cipro, levels of what drugs will be increased due to CYP interactions?

Increased levels of methadone and theophyilline | with glyburide- will get severe levels hypoglycemia

What forms is moxifloxacin avaliable as?

Oral or IV; broad spectrum single dose

What is gemifloxacin used to treat?

mild-moderate CAP due to multi-drug resitsanct Streptococcus pneumoniae

What type antibiotic is metronidazole?

bactericidal

How is metrondiazole avalaible?

Oral IV Topical

What is the main type organism that metrondiazole works against?

Anaerobic and protozoan infections

Metrondiazole treats what two GI conditions? (main indications)

C. diff | H. pylori

What trimesters of pregnancy in metrondiazole ok in?

2nd and 3rd (not in first trimester)

What 3 drugs does metrondiazole interact with?

Warfarin (increased INR) cimetidine (increase metrondiazole levels) lithium toxicity

What happens when metrondiazole and ETOH?

disulfiram-liek rxn. (flushin, HA< N/V)

What are some side effects with metrondiazole?

N/V/D/ constipation Darkened urine Edema (patients w/ heart failure) transient luekopenia, neutropenia

When is nitrofurantoin bacteriostatic? Bactericidial?

Bacteriostatic in low concentrations | bactericidal in high concnetrations

Nitrofuratoin reaches high concentrations where?

In the urine

What are some side effects with nitrofuratoin?

N/V | interstitial pulmonary fibrosis w/ chronic use

Patients with G6PD deficiency will experience what with nitrofuratoin?

hemolysis

What type antibiotic is polymyxin B?

Bactericidial (leads to lysis)

What type bacteria does plymyxin B work against?

Gram negative (Pseudomonas aeruginosa)

Polymyxin B has high rates of what toxicities, so it is limited to only topical use?

Nephro and neuro toxicity

What is polymyxin B used for (topical)?

gut sterilization bladder irrigation ophthalmic

How can polymyxin B be used?

only topically

What is daptomycin used for (what type bacteria)?

Multi-drug resistant gram + bacteria

What are some side effects of daptomycin?

Reversible myopathy, GI

What type antibiotic is daptomycin?

Bactericidal

Antibiotics That Interfere With Folate Synthesis or Nucleic Acid Processing Flashcards

(72 cards)