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Flashcards in antimicrobials Deck (262):
1

complications of antibiotic therapy

1) hypersensitivity
2) Direct toxicity
3) superinfection

2

beta lactam abx

PCN, cephalosporins, carbapenems, monobactams

3

beta-lactamases

bacterial enzymes: penicillinases, cephalosporinases that hydrolyze beta lactam ring

4

PCNs MOA

inhibit last step in PGN synthesis via PBP binding

PBPs = inactivate bacterial enzymes

autolysin production

5

PCNs are inactive against

mycoplasma
protozoa
fungi
viruses

organisms without PGN cell walls

6

PCN G use

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

most anaerobes - not bacteroides

7

DOC for syphillis and rheumatic fever prophylaxis

PCN G benzathine

8

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

PCN V more acid stable and oral

9

DOC for strep throat

PCN V

10

antistaphylococcal PCNs

b-lactamase resistant
methicillin
nafcillin
oxacillin
dicloxacillin

11

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

antistaphylococcal PCNs
methicillin
nafcillin
oxacillin
dicloxacillin

12

extended spectrum pcn

ampicillin
amoxicillin

13

which PCN has higher oral bioavailability

amoxicillin

14

extended spec PCN use

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

15

prophylaxis for dental or respiratory tract procedures

amoxicillin

16

combination tx for enterococci and listerial infections

ampicillin + aminoglycoside

17

prophylactic tx for dog, cat and human bites

amoxicillin + clauvinic acid

18

antipseudomonal PCN

carbenicillin
ticarcillin
piperacillin

19

antipseudomonal PCN use

gram neg and gram pos

PSEUDOMONAS

20

injectable tx of gram -

antipseudomonal PCNs: carbenicillin, ticarcillin, piperacillin

21

PCN AE***

GI distrubance: diarrhea

22

PCN + aminoglycoside

synergistic effect: PCN facilitate movement of aminoglycosides into cell wall

- DONT place in same infusion fluid

23

empiric tx for infective endocarditis

PCN + aminoglycoside

24

PCN resistance mechanisms (4)

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

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