Antimicrobials: Sulfas, Nitros, Oxals, and Lipos Flashcards by jennifer cortese

tst

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Nitroimidazoles: Metronidazole

MoA

enters the cell, then is reduced to free radicals which damage bacterial DNA.

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Nitroimidazoles: Metronidazole

bacteriocidal or static?

cidal.

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Nitroimidazoles: Metronidazole

dose adjustment

no need for hepatic or renal adjustment

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Nitroimidazoles: Metronidazole and ANY form of alcohol

Disulfiram reaction due to effect on alcohol dehydrogenase, alcohol cannot be broken down.

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Nitroimidazoles: Metronidazole and warfarin

increased INR

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Nitroimidazoles: Metronidazole pt education

absolutely no alcohol, not even mouthwash with alcohol

also tastes horrible

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Nitroimidazoles: Metronidazole coverage

ANAEROBES

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Nitroimidazoles: Metronidazole

activity

not active against most gram pos or neg because it does not provide aerobic coverage

active against all anaerobes including c. diff

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Nitroimidazoles: Metronidazole and h pylori

active against

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Nitroimidazoles: Metronidazole AE (5)

poor taste
GI disturbance
reversible neutropenia
dark urine
rash

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fever of unknown origin: treatment (3)

cover MRSA - vanco
cover anaerobes - metronidazole
everything else, including psuedomonas - cefepime

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Oxalinediones: linezolid

MoA

Binds to 50S ribosomal subunit, inhibits the early phase of protein synthesis.

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Oxalinediones: linezolid

bacteriostatic or bacteriocidal?

bacteriostatic

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Oxalinediones: linezolid was made to

combat increasing resistance against vancomycin

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Oxalinediones: linezolid

activity

gram positive pathogens:

enterococci faecium and faecalis which are vanco sensitive and resistant organisms

staph: MRSA and MSSA
strep: including PCN resistant strains

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Oxalinediones: linezolid

when may you expect to see it?

if you cannot use vanco because of allergy, resistance, or issues with levels

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Oxalinediones: linezolid AEs

diarrhea/nausea
taste
inc LFT
thrombocytopenia

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Oxalinediones: linezolid should be reserved for

patients who cannot be helped by vanco

otherwise it is a very expensive drug

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lipopeptide drug

daptomycin

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lipopeptide (daptomycin) MoA

binds to bacterial cell membranes causing rapid depolarization of membrane potential, leading to inhibition of protein/dna/rna synthesis and ultimately bacterial cell death

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lipopeptide (daptomycin) is bacteriostatic or bacteriocidal?

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bacteriocidal

lipopeptide (daptomycin) gram positive activity:

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streptococci
s epidermidis
enterococci (VRE*)
S aureus (MSSA, MRSA, GISA, GRSA)

lipopeptide (daptomycin) is the first bacteriocidal drug against

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gram positive organisms

lipopeptide (daptomycin) distrubution

everywhere EXCEPT lungs

why is lipopeptide (daptomycin) ineffective for pneumonia?

it cannot get through the surfactant in the lungs

lipopeptide (daptomycin) adverse event and implication

increase in CK get CK at baseline and then weekly as long as the patient is on the drug. could become rhabdomyolysis

lipopeptide (daptomycin) and renal insufficiency

dose reduce

Sulfas, Nitros, Oxals, and Lipos | monitoring

C&S CBC RFT dap: CK

Sulfas and Linezolid | pregnancy/lactation

metronidazole and daptomycin pregnancy category

Daptomycin lactation consideration

excreted in milk

daptomycin and MAOIs

myopathy

dosing daptomycin: obesity

actual weight

Sulfa drug

bactrim: trimethoprim/sulfamethoxazole

MoA: bactrim (trimethoproim/sulfamethoxazole)

trimethoprim: folic acid antagonist, starves organism sulfamethoxazole: inhibition of bacterial cell growth by inhibiting purine synthesis.

distribution of sulfas (bactrim)

widely distributed, but CSF levels are just about 40%

sulfas (bactrim) are one of the few PO drugs for

MRSA cellulitis

patient/clinician education regarding sulfas (bactrim)

need to be adequately hydrated because crystalluria can form.

drug interaction: sulfa (bactrim)

will increase activity of warfarin or phenytoin because it displaces it from protein binding sites. may need to dose them down.

sulfas (bactrim) and electrolytes

can cause hyperkalemia as it can block the excretion of potassium

sulfas (bactrim) and renal function

likely to bump up creatinine- check BMP | avoid in dialysis patients

Sulfas (Bactrim) activity: gram neg aerobes

good

sulfas (bactrim) activity for gram pos aerobes

good

sulfas (bactrim) and MRSA

moderate activity against MRSA

Sulfas (bactirm) and anaerobes

no coverage

PCP pneumonia and sulfas (bactrim)

effective against this opportunistic infection.

sulfas (bactrim) in HIV patients

prophylaxis for PCP and toxoplasmosis. 3x a week not enough to elicit resistance

sulfas (bactrim) GI AE

GI intolerance

Sulfas (bactrim) and hypersensitivity

stevens-johnsons syndrome

Sulfas (bactrim) AEs: lab values (4)

anemia neutropenia hyperkalemia elevated serum creat

If a patient tells you they have a bactrim allergy

do not give, especially if it was a skin reaction.

t 1/2 of sulfas (bactrim)

9-11 hours | dose 2x/day

dose adjustment for sulfas (bactrim)

CrCl < 15mL/min

Antimicrobials: Sulfas, Nitros, Oxals, and Lipos Flashcards

(54 cards)