Clindamycin, Colistin, Fosfomycin, Macrobid, Fluoroquinolones, macrolides Flashcards Preview

Pharmacology > Clindamycin, Colistin, Fosfomycin, Macrobid, Fluoroquinolones, macrolides > Flashcards

Flashcards in Clindamycin, Colistin, Fosfomycin, Macrobid, Fluoroquinolones, macrolides Deck (41):
1

Clindamycin (Cleocin) MOA

binds 50S ribosome to inhbitis RNA-dependent protein synthesis, bactericidal for GPCs

2

Spectrum of clindamycin

gram positive, aerobes, CA-MRSA, MSSA, drug resistant S. pneu, anaerobes, bacteroides, prevotella, clostridium perfringens, p. jiroveci, toxoplasmosis gondii

3

What are negatives of clindamycin?

may induce C. Dif, carries risk of inducible resistance during single course therapy

4

ADRs of clindamycin (Cleocin)

Gi intolerance, C. diff

5

Normal dose of clindamycin

PO- 150-300 mg QID, IV- 600-900 mg Q6h

6

Clinical uses of clindamycin

CA- MRSA SSTI, B. fragilis, anaerobes, acne, encephalitis due to toxoplasma gondii, PCP pneumonia in AIDS pt w/ bactrim allergy, bacterial vaginosis, ASP pneu, "above diaphragm"

7

Colistin MOA

cationic detergent that binds to and damages bacterial membrane, causes leakage of intracellular contents, rapidly bactericidal, conc dependent

8

Specctrum of activity of colistin

GNR, enterobacteriaceae, pseudomonas, all MDR GNR, carbapenem resistant pathogens

9

Colistin PK

IV only, sometimes nebulizer, renally eliminated

10

ADRs of colistin

nephrotoxicity, common but reversible, neurotoxic- paresthesias, slurred speech, confusion, coma, and seizures

11

Use of colistin

only when have to!

12

Fosfomycin (Monurol) MOA

inhibits bacterial cell wall synthesis by inactivating an enzyme critical in development of the cell wall, bactericidal

13

Spectrum of activity of fosfomycin (Monurol)

e. coli, enterococcus, k. pneu, proteus, S. aureus

14

Fosfomycin PK

PO only, concentrates well in urine and maintains adequate [urine]

15

ADRs of fosfomycin

well tolerated, HA, N/V/D

16

Dose of fosfomycin

3 gm PO x 1, for UTIs x1, for complicated- q 2-3 days, x2-3 dose

17

Clinical use of fosfomycin

because of activity against MDR pathogenscan easily solve a therapeutic dilemma, UTI, limited use in non-UTI infxns

18

nitrofurantoin (Macrobid) MOA

inhibit protein synthesis via several mechanisms, little bacterial resistance, bactericidal

19

Spectrum of activity of nitrofurantoin (macrobid)

e. coli, enterococcus, s. aureus, klebsiella, enterobacter, resistance increasing

20

Nitrofurantoin PK

PO only, preg cat B, functioning kidneys, contraindicated with CrCl

21

Clinical use of nitrofurantoin

UTI, UTI prophylaxis, acute cystitis

22

Fluoroquinolone options

Ciprofloxacin, levofloxacin (Levaquin), Moxifloxacin (Factiv), gemifloxacin, ofloxacin

23

MOA of fluoroquinolones

inhibit replication of bacterial DNA by inhibiting DNA gyrase, gram +: readily pass through cell membrane and enter cytoplasm to reach target site; gram -: diffusion through outer wall and cytoplasmic membrane via porins

24

Fluoroquinolones PK

well absorbed IV/PO, bactericidal, concentration dependent, all except moxi are renally eliminated

25

Spectrum of fluoroquinolones

good gram - coverage, enterobacteriaceae, pseudomonas, h. influenzae, neisseria, m. catarrhalis, aerobic gram +, MSSA (not cipro), s. pneu (not cipro), mycobacteria, atypicals- very active

26

What should fluoroquinolones not be used for?

CA- MRSA, or anaerobes

27

DI of fluoroquinolones

antiacids (administer 4 hrs apart), warfarin (reduce by 50%), food- take on empty stomach

28

Fluoroquinolones ADRs

N/V/D (induce C. diff), rash, avoid in children, QTc prolongation, achilles tendon rupture

29

Clinical use of fluoroquinolones

UTI (not moxi), U/LRTI, pneumonia, COPD, sinusitis, CF, abd infxns, skin, osteo, great s. pneu and atypical coverage

30

Macrolides options

azithromycin (Zithromax), erythromycin, clarithromycin (Biaxin), fidaxomicin (Dificid)

31

Azithromycin (Zithromax) dose

Z-pak: 500 mg PO daily x1 then 250 mg daily x4, 500 mg IV daily

32

Macrolids MOA

bind to 50 S ribosome to inhibit RNA- dependent protein synthesis, time dependent, slowly bactericidal or bacteriostatic

33

Spectrum macrolides

streptococci, H. influenzae, M. Catarrhalis (bactericidal), staph- clarithromycin best, atypicals and mycobacteria, bordetella, syphillis and chlamydia

34

Macrolides PK

less absorbed/ effective at acidic pH, very large Vd, azithromycin t1/2= 66 hrs

35

ADRs of macrolides

GI, taste disturbances- clarithromycin, QTc prolongation

36

Macrolide DI

lots with erythromycin and clarithromycin, not as many w/ azithromycin

37

Clinical use of macrolides

U?LRTI- azithro, atypical- azithro, H. pylori- clarithromycin, chlamydia

38

Fidaxomicin (Dificid) MOA

a macrolide, PO only

39

Fidaxomicin (Dificid) spectrum of activity

C. diff

40

Fidaxomicin (Dificid) ADRs

well tolerated, GI, GI bleed

41

Fidaxomicin (Dificid) pearls

$$$$$, more efficacious than vancomycin