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antimicrobials Flashcards

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1
Q

complications of antibiotic therapy

A

1) hypersensitivity
2) Direct toxicity
3) superinfection

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2
Q

beta lactam abx

A

PCN, cephalosporins, carbapenems, monobactams

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3
Q

beta-lactamases

A

bacterial enzymes: penicillinases, cephalosporinases that hydrolyze beta lactam ring

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4
Q

PCNs MOA

A

inhibit last step in PGN synthesis via PBP binding

PBPs = inactivate bacterial enzymes

autolysin production

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5
Q

PCNs are inactive against

A

mycoplasma
protozoa
fungi
viruses

organisms without PGN cell walls

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6
Q

PCN G use

A 
syphillis
strep
pneumococci
gram positives, 
some gram negatives - 
NOT STAPH

most anaerobes - not bacteroides

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7
Q

DOC for syphillis and rheumatic fever prophylaxis

A

PCN G benzathine

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8
Q

PCN G vs V, which is more stable? oral?

A

PCN V more acid stable and oral

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9
Q

DOC for strep throat

A

PCN V

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10
Q

antistaphylococcal PCNs

A 
b-lactamase resistant
methicillin
nafcillin
oxacillin
dicloxacillin
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11
Q

1st line tx for staphylococci endocarditis in pt w/o artificial heart valves

A 
antistaphylococcal PCNs
methicillin
nafcillin
oxacillin
dicloxacillin
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12
Q

extended spectrum pcn

A

ampicillin

amoxicillin

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13
Q

which PCN has higher oral bioavailability

A

amoxicillin

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14
Q

extended spec PCN use

A

OM, strep throat, PNA, skin infections, UTI, URI

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15
Q

prophylaxis for dental or respiratory tract procedures

A

amoxicillin

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16
Q

combination tx for enterococci and listerial infections

A

ampicillin + aminoglycoside

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17
Q

prophylactic tx for dog, cat and human bites

A

amoxicillin + clauvinic acid

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18
Q

antipseudomonal PCN

A

carbenicillin
ticarcillin
piperacillin

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19
Q

antipseudomonal PCN use

A

gram neg and gram pos

PSEUDOMONAS

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20
Q

injectable tx of gram -

A

antipseudomonal PCNs: carbenicillin, ticarcillin, piperacillin

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21
Q

PCN AE***

A

GI distrubance: diarrhea

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22
Q

PCN + aminoglycoside

A

synergistic effect: PCN facilitate movement of aminoglycosides into cell wall

  • DONT place in same infusion fluid
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23
Q

empiric tx for infective endocarditis

A

PCN + aminoglycoside

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24
Q

PCN resistance mechanisms (4)

A

1) inactivation by b-lactamase
2) modified PBP target
3) impaired penetration of drug to target PBP
4) inc efflux

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25
PCN distribution
therapeutic levels everywhere EXCEPT prostate and eye also - poor CNS penetration
26
PCN excretion
kidney - be careful in kidney failure exception: nafcillin = excreted in bile
27
nafcillin excretion
bile
28
oxacillin excretion
renal and biliary excretion
29
dicloxacillin excretion
renal and biliary excretion
30
PCN hypersensitivity AE
penicilioc acid = major antigenic determinant
31
which PCN cause maculopapular rash
ampicillin | amoxicillin
32
beta lactamase inhibitors (3)
clavulanic acid sulbactam tazobactam
33
cephalosporins 1st-3rd generation
gram +
34
cephalosporins 4th generation
gram + and gram -
35
cephalosporins 5th generation
only one activate against MRSA. works against gram + and -; not effective against pseudomonas
36
1st generation cephalosproin drugs
cefazolin cephalexin can substitute PCN G resistance to staph penicillinase
37
DOC for surgical prophylaxis****
cefazolin: 1st generation cephalosporin
38
2nd generation cephalosporin drugs
cefaclor cefoxitin cefotetan cefamandaole
39
2nd generation cephalosporin use
gram negative - greater against h.flu, enterobac | sinusitis, otitis, lower resp tract infections
40
DOC prophylaxis and therapy of abdominal and pelvic cavity infections
cefotetan | cefoxitin
41
3rd generation cephalosporin drugs
``` ceftriaxone cefoperazone cefotaxime ceftazidime cefixime ```
42
3rd generation cephalosporin use
gram negative cocci h flu, neisseria, enterobacter - pseudomonas less active against gram pos
43
which 3rd generations are useful for pneumococci
ceftriaxone | cefotaxime
44
DOC for gonorrhea
ceftriaxone
45
DOC for meningitis d/t ampicillin-resistant h.flu
ceftriaxone
46
DOC prophylaxis of meningitis of exposed individuals
ceftriaxone
47
which 3rd generation cephalosporin can help tx lyme's (but is not DOC)
ceftriaxone
48
4th generation cephalosporin
cefipime - parenteral admin only
49
cefipime use
wide spectrum - only use as empiric therapy and you're not sure gram + like 1st generation and gram - of 3rd generation = enterbac, hemophilus, neisseria, e.coli, pneumococci, proteus, pseudo UTIs, complicated intra-abdominal infections, febrile neutropenia
50
5th generation cephalosporin
ceftaroline
51
5th generation cephalosproin use
ONLY FOR MRSA - reserved drug - similar to 3rd generation parenteral only
52
drug tx for skin/soft tissue infection due to MRSA (esp with gram - coinfection)
ceftaroline
53
which cephalosporins are not given parenterally
cephalexin cefaclor cefixime
54
which generatoin cephalosporin reaches adequeate levels in CSF
3rd generation - useful for meningitis
55
elimination of cephalosporins
kidneys
56
which cephalosporins are excreted in bile
ceftriaxone | cefoperazone
57
cephalosporins AE
``` allergic reaction pain at infection site (IM) thrombophlebitis (IV) superinfection: c. diff kernicterus: pregnant ```
58
If pt has allergy to PCN, what should you remember about cephalosporin use
cross sensitivity with cephalosporin CAN occur only okay if the PCN allergic reaction was very mild - but don't risk it
59
which cephalosporins can cause hypoprothrombinemia and disulfiram like reactions?
cefamandole cefoperazone cefotetan all contain methyl-thiotetrazole group
60
if woman is pregnant and has meningitis, is ceftriaxone safe?
YES - risk outweighs benefit - even with possible kernicterus risk - but if pregnant mother has OM, choose ampicillin or another Abx
61
2 carbapenems
imipenem | meropenem
62
carbapenem use
empiric therapy - multiple infections - resists b-lactamases very broad spectrum: pencillinase producing gram positive and negative, aerobes, anaerobes, pseudomonas not active against carbapenemase producing organisms not active against MRSA
63
DOC for enterobacter infections
carbapenems
64
DOC for extended spec B-lactamase producing gram negatives
carbapenems
65
Imipenem danger
can form nephrotoxic metabolite - combine with cilastatin prevents metabolism and toxicity = increased bioavailability not needed for meropenem- not metabolized by same enzyme
66
carbapenem AE
``` n/v/d high imipenem = seizures allergic reaction (with PCN cross reactive) ```
67
Monobactam drug
aztreonam
68
monobactam use
AEROBIC gram - rods only (includes pseudomonas) not active against gram positive or anaerobes UTIs (for pt who's infection hasn't been tx properly with 1 or 2nd line) lower resp tract infections septicemia...
69
monobactam PK
IV, IM, inhalation for CF) | can penetrate CSF when inflamed (not normally)
70
monobactam excretion
urine
71
best route of administration in CF patients
inhalation
72
monobactam AE
IV: phlebitis/thrombophlebitis skin rashes, inc serum aminotransferases GI upset little cross hypersensitivty with other b-lactam abx
73
vancomycin
bactericidal bacterial glycoprotein ONLY gram +: multi-drug resistant organisms gram - organisms are resistant
74
vancomycin MOA
binds @ D-Ala-D-Ala terminus of nascent peptidoglycan pentapeptide - therefor inhibits bacterial cell wall synthesis and polymerization (NOT cross linking**** like PCN)
75
development of vancomycin resistance
modified D-ala-D-ala binding site plasmid mediated changes in drug permeability
76
enterococcal endocarditis tx
vancomycin + aminoglycoside
77
empirical infective endocarditis tx
aminoglycoside + vancomysin
78
tx gram + in pt severely allergic to b-lactams
vancomycin
79
tx b-lactam resistance gram + organisms (MRSA)
vancomycin
80
staphylococcal enterocolitis tx
vancomycin orally
81
antibiotic associated pseumembranous colitis tx
vancomycin orally
82
when is vancymycin used orally
for GI infections
83
vancomycin PK
SLOW IV infusion - if too quick --> red man syndrome
84
vancomycin excretion
kidneys
85
red man syndrome
fast vancomycin administration = massive histamine release - flushing to face and upper torso
86
vancomycin AE
fever/chills/phlebitis red neck syndrome otoxocitiy and nephrotoxicity with drug accumulation
87
daptomycin for PNA treatment
NO EFFECT: can't reach cell membranes passing through surfactant
88
daptomycin
bactericidal Gram positive organisms - MRSA, enterococci inactive against gram negative
89
daptomycin MOA
binds cell membrane via calcium dependent insertion of lipid tail = K+ leaks out - depolarization = cell death useful for multidrug resistant bacteria
90
daptomycin clinical app
severe infections with MRSA or VRE tx complicated skin/structure infections d/t s. aureus
91
daptomycin administration
IV if accumulate - renal insufficiency
92
daptomycin AE
inc creatine phosphokinases (MYOPATHY)- discontinue coadministration of statins will c/o muscle pains
93
which Abx should not be used with statins
daptomycin | macrolides
94
Bacitracin MOA
interferes in late stage cell wall synthesis = effective against gram positive
95
bacitracin unique mechanism
NO cross resistance
96
Bacitracin AE
nephrotoxicity - mainly topical
97
Fosfomycin MOA
inhibits cytoplasmic enzyme enolpyruvate transferase in early stage cell wall synthesis (compare to bacitracin - late stage) Gram + and Gram -
98
tx of uncomplicated lower UTI (not DOC)
fosfomycin
99
tetracycline
protein synthesis inhibitior
100
glycylcylines
protein synthesis inhibitior
101
aminoglycosides
protein synthesis inhibitior
102
macrolides
protein synthesis inhibitior
103
chloramphenicol
protein synthesis inhibitior
104
clindamycin
protein synthesis inhibitior
105
streptogramins
protein synthesis inhibitior
106
linezolid
protein synthesis inhibitior
107
mupirocin
protein synthesis inhibitior
108
bacterial vs mammalian ribosome
bacterial - 70s mammaliam - 80s bacteriostatic
109
tetracyclines (3)
doxycycline minocycline tetracycline
110
tetracycline use
broad spectrum bacteriostatic - (don't want to use with PCN - b/c only attacks actively dividing cells) aerobic and anaerobic gram + and -
111
tetracycline MOA
binds 30S subunit = no attachment of aminoacyl tRNA entry via passive diffusion/energy dependent transport drug concentrated intracellularly
112
tetracycline resistance
WIDESPREAD 1) imparied influx/inc efflux by active protein pump 2) proteins produced that interfere with ribosome binding 3) enzymatic inactivation
113
tetracycline clinical app
severe acne and rosacea empiric therapy for CAP respiratory tract, sinuses, middle ear, UT, intestinal infections syphillis
114
severe acne and rosacea tx
tetracycline
115
syphillis tx for pt allergic to PCN
tetracyclines
116
empiric therapy for community acquired PNA
tetracycline
117
DOC for chlamydia
tetracycline
118
DOC for mycoplasma pneumoniae
tetracycline
119
DOC for lyme disease
tetracycline
120
DOC for cholera
tetracycline
121
DOC for anthrax prophylaxis
tetracycline
122
DOC for ricketssia: RMSF, typhus
tetracycline
123
Tetracycline combo tx for
``` h. pylori malaria prophylaxis and tx plague tularemia brucellosis ```
124
tetracycline PK
variable oral absorption - dec by divalent/trivalent cations
125
which tetracycline is preferred for parenteral admin, STDs, prostatitis
doxycycline
126
which tetracycline reaches high concentrations in all secretions - spec for tx of meningitis
minocycline - eradicate meningococcal carrrier
127
tetracycline excretion
urine - except doxy in bile
128
doxycycline excretion
bile
129
tetracycline and pregnancy
TERATOGENIC | category D
130
tetracycline AE
discoloration/hypoplasia of teeth stunting growth (avoid in pregnant female and kids under 8) photosensitization hepatotoxicity exacerbate renal dysfunction
131
glycylcyclines
tigecycline | broad spec against multidrug resistant: gram pos, some gram neg and anaerobics
132
Glycylcyclines clinical app
complicated skin, soft tisue and intraabd infections
133
glycylcyclines AE
Black box warning = inc mortality risk - FDA recommend alternative antimicrobial use similar AE as tetracyclines contraindicated in pregnancy and children under 8
134
glycylcyclines PK
IV only | biliary and fecal elimination
135
Only protein synthesis inhibitor that is bactericidal
aminoglycoside
136
amikacin
aminoglycoside
137
gentamicin
aminoglycoside
138
tobramycin
aminoglycoside
139
streptomycin
aminoglycoside
140
neomycin
aminoglycoside
141
aminoglycosides MOA
passive diffuse across Gram - membranes active transp (O2 dependent) across cytoplasmic membrane = AEROBIC GRAM NEG only bind 30s = mRNA misreading, inhibits translocation serious toxicities - replaced by other abx
142
aminoglycosides resistance
1) plasmid associated syntehsis of enzymes that modify/inactivate drug 2) decreased accumulation of drug 3) 30s receptor protein may be deleted
143
aminoglycoside clinical pp
in combo empiric therapy of speticemia, nocosomial respiratory tract infections, complicated UTIs, endocarditis
144
DOC for empiric therapy of infective endocarditis
PCN/vancomycin + aminoglycoside
145
DOC for plague/Y. pestis
streptomycin
146
Aminoglycoisdes admin
parenteral admin only 1x daily high levels accum in renal cortex and inner ear except neomycin = dopical
147
aminoglycoside excretion
urine | dec dose in renal insufficiency
148
aminoglycoside AE
**time and concentration dep** ototoxicity nephrotoxicity - contraindicated in MG NM blockade pregnancy - category D
149
aminoglycosides PD
postAb effect + concentration dependent killing - ONCE DAILY DOSING doesn't matter if concentration falls below MIC - already gets greatest killing at peak
150
time dependent drugs
PCN cephalosporins concentration dep: aminoglycosides
151
Oral neomycin
adjunt for hepatic encephalopathy tx
152
Alt tx options for hepatic encephalopathy
lactulose oral vanco oral metro rifaximin
153
Lactulose
nonasorbable disaccharide
154
lactulose MOA
degraded by intestinal bacteria --> lactic acid + other organic acids gut becomes acidic NH3 --> NH4 - trapped in colon = dec ammonia concentrations osmotically active laxative prebiotic (supresses urase producing organisms)
155
erthryomycin
macrolide
156
clarithromycin
macrolide
157
azithromycin
macrolide
158
telithromycin
macrolide
159
macrolides function
tx gram positive infection bacteriostatic - bactericidal at high concentrations
160
macrolides MOA
reversible binding to 23S rRNA of 50S = stops translocation similar binding site to that of clindamycin and chloramphenicol
161
macrolides resistance
1) dec membrane permeability or active efflux 2) production of esterase - hydrolyzing drugs 3) modification of ribosomal bidning site** cross resistance b/c erythrromcyin, azithromycin, clarithromycin - partially with clindamycin and streptogramins
162
macrolides with broader spectrum
azithromycin clarithromycin telithromycin
163
DOC mycoplasma pneumoniae
macrolides - erythromycin AND tetracycline If pregnant female - go for erythromycin
164
DOC pertussis
macrolides - erythromycin
165
macrolide clinical app
empiric therapy of CAP with b-lactam if an inpatient upper respiratory tract, soft tissue infections substitute for PCN allergy
166
which macrolides have long t 1/2
clarithromycin azithromycin telithromycin - better oral absorption = longer half life (compared to erythromycin)
167
which macrolides have greater tissue penetration
azithromycin | telithromycin
168
macrolides AE
GI irritation = activate motilin!!!** hepatic abnormalities: erythromycin, azithromycin QT prolongation - only contraindicated in people with CAD, prolonged QT
169
which macrloides inhibit CYP P450
erythromycin clarithromycin telithromycin
170
macrolides contraindications
statins telithromycin = lots of toxicity, dont use if minor. can cause fatal hepatotoxicity, exacerbations of MG, visual disturbances
171
tetracyclines contraindicated with
beta lactams TC: static lactam: cidal
172
CAP empirical tx
macrolide (bacteriostatic) + b lactam (bactericidal) ``` macrolides = coverage for atypicals beta-lactams = good coverage over s. pneumoniae ``` GOOD coverage for most likely agents
173
chloramphenicol
protein synthesis inhibitor
174
chloramphenicol use
broad spec: aerobic and anaerobic - gram + and negative TOXICITY limits use only to life threatening infections with no alternatives. active against many VREs. topical tx of eye infections bacteriostatic
175
chloramphenicol MOA
reversible binding to 50S ribosomal subunit = inhibits peptidyltransferase
176
chloramphenicol toxicity
can also inhibit protein synthesis in mitochondrial ribosomes = BM toxicity **aplastic anemia can occur
177
chloramphenicol resistance
presence of factor that codes for chloramphenicol acetyltransferase changes in membrane permeability
178
chloramphenicol PK
inhibits hepatic oxidases: 3A4, 2C9
179
chloramphenicol AE
BM depression = dose related reversible depression gray baby syndrome = cyanosis - restricted in newborns
180
clindamycin
MOA same as macrolides - binding 50s bacteriostatic GRAM POS ANAEROBIC - and bacteroides and gram + aerobes "anaeroboic infections above diaphragm"
181
anaerobic infections below diaphgragm
metronidazole
182
clindamycin resistance
* ** 1) mutated ribosomal receptor site 2) modified receptor 3) enzymatic inactivation most gram - aerobes and enterococci are intrinsically resistant with macrolides and chloramphenicol
183
clindamycin use
anaerobic infections: bacteroides, abscesses, abd infections complicated skin and soft tissue infections: strep, staph, some MRSA
184
clindamycin + primaquine
PCP tx alternative
185
clindamycin + pyrimethamine
toxoplasmosis of brain tx alternative
186
prophylaxis of endocarditis in valvular pt allergic PCN
clindamycin (s. viridans is covered) - normally PCN or IV ampicillin
187
clindamycin AE
fatal c. diff superinfection
188
quinupristin
streptogramin
189
dalfopristin
streptogramin
190
streptogramins
give both together - synergistic effect is bactericidal, alone is bacteristatic
191
streptogramin MOA
bind 50s resistance is uncommon = needs two different mutations b/c of both drugs used
192
streptogramin use
gram pos cocci and multi drug resistant bacteria RESTRICTED USE: drug resistant staph or VRE
193
streptogramin PK
CYP3A4 inhibitor
194
Linezolid
bacteriostatic - cidal for strep and clostridium perfringes | - good for multi drug resistant bacteria
195
linezolid MOA
inhibits formation of 70s initation complex **UNIQUE SITE to 23S on 50S subunit - thats why it works on drug resistant drugs
196
linezolid resistance
dec binding to drug site no cross resistance with other drug class **could occur very rapidly with a single course of tx
197
linezolid use
advantage: ORAL - 100% bioavailable most gram positive, some activity against m. tuberculosis
198
linezolid PK
weak reversible inhibitor of MAO - lots of interactions; serotonin syndrome oral!!! 100% bioavailability
199
linezolid AE
long term: reversible myelosuppression optic/peripheral neuropathy lactic acidosis
200
linezolid contraindications
reversible MAOI = interaction with adrenergic and serotinergic drugs --> serotonin syndrome (ex used in clicker: amitrytiline)
201
fidaxomicin
narrow spectrum macrocyclic Abx = ORPHAN DRUG active against gram + aerobes and anerobes - esp CLOSTRIDIA not active against gram -
202
fidaxomicin MOA
bind RNA polymerase: inhibits bacterial protein synthesis
203
Fidaxomicin use
C. diff **advantage: prevents reoccurence!!! despite high price, saves money in long run that using vanco or metronidazole
204
fidaxomicin PK
systemic absorption = negligible fecal concentration = high
205
mupirocin
topic and nasal tx of MRSA monoxycarbolic acid class of abx gram + cocci (MRSI and most strep - not enterococci)
206
only topical agent against MRSA
mupirocin
207
mupirocin MOA
binds bacterial isoleucyl transfer RNA synthetase = inhibit protein synthesis
208
mupirocin use
nasal MRSA impetigo, secondary skin infection via s. aureus or s. pyogenes HIGH rate of resistance
209
drugs that affect nucleic acid synthesis
fluoroquinolones sulfonamides trimethoprim
210
nalidixic acid/quinolone
1st generation fluroquinolones
211
ciprofloxacin
2nd generation fluroquinolones
212
levofloxacin
3rd generation fluroquinolones synergistic with beta lactams
213
gemifloxacin
4th generation fluroquinolones
214
moxifloxacin
4th generation fluroquinolones
215
fluoroquinoles MOA
broad spec enters bacterium via porins = inhibits DNA replication vai topoisomeriase II (DNA gyrase) and IV interference
216
fluorquinolones resistance
chromosomal mutations: encode subunits of DNA gyrase and topo IV regulate expression of efflux pumps cross resistance b/w drugs
217
Lower generations of fluoroquinolones
gram -
218
higher generation of fluoroquinolones
gram +
219
which generation fluoroquinlones is good against s. pneumoniae
3rd = levofloxacin
220
first line traveller's diarrhea
ciprofloxacin
221
alternative ceftriaxone and rifampin for meningitis prophylaxis
2nd gen fluoroquinolone = ciprofloxacin
222
suspect CAP in admitted pt
fluroquinolones: 3rd and 4th generation reserved for aggressive tx: when 1st lines failed, comorbidities
223
fluoroquinolones PK
iron, zinc, calcium interfere with absorption = don't give with antacids or milk adjust doses in renal dysfunction
224
fluoroquinolones AE
photosensitivity (like with tetracyclines) * ** Black box warning: CT problems = rupture of tendons - contraindicated in pregnant, nursing, under 18 - stop if c/o tendon pain peripheral neuropathy QT prolongation: moxifloxacin, gemifloxacin, levofloxacin risk of superinfections: c.diff, candida, streptococci
225
which fluoroquinolones can cause QT prolongation
moxifloxacin, gemifloxacin, levofloxacin
226
what drug can cause tendon ruptures
fluoroquinolones - black blox warning
227
fluoroquinolones interactions
inc toxicity with theophyllin, NSAIDs, corticosteroids 3rd/4th gen can inc levels of warfarin, caffeine, cyclosporine
228
sulfonamides
sulfamethoxazole sulfadiazine sulfasalazine
229
tx chlamydia in pregnant female
azithromycin
230
sulfonamides use
bacteriostatic against gram + and negative
231
sulfonamides MOA
inhibit bacterial folic acid synthesis PABA analog - comp inhibitor of dihydropteroate synthase. inc p-aminobenzoic acid (accumulates)
232
sulfonamide resistance
plasmid transfer/mutations: - alterated dihydropteroate synthase - dec cellular permeability - enhanced PABA - dec intracellualr drug accum
233
sulfonamide clincial app
topical agents = ocular/burns oral: UTIs sulfasalazine: oral - UC, enteritis, IBD
234
sulfonamide PK
can accumulate in renal failure acetylated in liver = kidney damage
235
sulfonamides AE
crystaluria: nephrotoxic HS rxn hematopoeitic disturb = G6PD def kernicterus (contraindic in babies <2 mo)
236
sulfonamides interaction
inc plasma levels with: warfarin phenytoin MTX
237
sulfonamide contraindication
babies < 2 mo | drugs that compete with bilirubin for binding sites on albumin
238
trimethoprim
bacteriostatic against gram + and negative
239
trimethoprim MOA
inhibitor of bacterial dihydrofolate reducatse = inhibits purine, pyrimidine, aa synthesis accumulate dihydrofolic acid no THF made
240
trimethoprim use
UTI | bacterial prostatitis, vaginitis
241
trimethoprim excretion
kidney
242
trimethoprim AE
antifolate - COMPLETELY CONTRAINDICATED IN PREGNANCY
243
cotrimoxazole
TMP-MTX combination | bactericidal
244
cotrimoxazole MOA
synergistic - inhib THF synthesis
245
DOC for uncomplicated UTIs
cotrimoxazole*********
246
DOC for PCP
cotrimoxazole
247
DOC for cardiosis
cotrimoxazole
248
toxoplasmosis tx alternative
cotrimoxazole
249
h. flu and m.catarrhalis URI, OM, sinus infections tx
cotrimoxazole
250
cotrimoxazole AE
dermatological hemolytic anemia in G6PD** AIDS pt = higher incidence of all the AE - specifically dermatological (rashes) CONTRAINDICATED IN PREGNANCY (1st trim)
251
metronidazole
antimicrobial amebicide antiprotozoal active against anaerobic bacteria: bacteroides, clostridium bactericidal
252
metronidazole MOA
anaerobic vital for optimal activity = reductive bioactivity of nitro group by ferredoxin. forms cytotoxic productions that interfere with nucleic acid synthesis
253
metronidazole clincial app
``` c. diff anerobic/mix intra abd vaginitis brain abscess h. pylori ```
254
DOC c. diff
metronidazole
255
metronidazole elimination
hepatic
256
metronidazole AE
leukopenia, ataxia opp fungal infection peripheral neuropathy with prolonged use disulfiram like effect with alcohol (anything with azole group) not advised in 1st trimester
257
nitrofurantoin
urinary antiseptic: bacteriostatic and cidal gram pos and gram - activity
258
nitrofurantoin MOA
reduction by bacteria in urine = metabolites damage bacterial DNA
259
nitrofurantoin AE
anorexia, n/v | neuropathies, hemolytic anemia in G6PD
260
nitrofurantoin contraindication
renal insufficiency pregnant 38-42 weeks (at term) -- used regularly in other stages of pregnancy infants : b/c of possible G6PD deficiency
261
1st line of UTI in pregnant female (NOT AT TERM)
nitrofurantoin
262
PCNs resistance
via PBP mutations

PHARM 2 (18 decks)

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