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Clinical Pharmacology > Drugs for bacterial infections 2 > Flashcards

Drugs for bacterial infections 2 Flashcards

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1
Q

What should you NOT compare on a C&S report?

A

the MIC of different classes of antibiotics

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2
Q

What are examples of tetracyclines?

A

tetracyclline, doxycycline, minocycline

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3
Q

are tetracyclines bacteriostatic or bactericidal?

A

bacteriostatic

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4
Q

What’s the MOA of tetracyclines?

A

inhibit protein synthesis w/ binding to 30S ribosomal subunit and blocking binding of aminoacyl transfer-RNA

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5
Q

What are ADRs of tetracyclines?

A

photosensitivity, GI intolerance, stain on developing teeth (<8yo), cannot take in pregnancy!

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6
Q

What do tetracyclines have a drug interaction with?

A

DI w/ polyvalent cations decreasing absorption – must take two hours before or after medications

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7
Q

When are tetracyclines reliable to use?

A

atypicals, plasmodium (malaria), rickettsia, spirochetes

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8
Q

When are tetracyclines moderate to use?

A

staph (MRSA), s pneumoniae

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9
Q

What can you not gram-stain b/c they lack a peptidoglycan layer?

A

atypicals

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10
Q

When are tetracyclines clinically utilized?

A

respiratory tract infections, SSTI, syphilis, PID (w/ cefoxitin), malaria prophylaxis, acne

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11
Q

When are tetracyclines your DOC?

A

tick-borne diseases, chlamydia

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12
Q

What are examples of macrolides?

A

erythromycin, clarithromcin, azithromycin

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13
Q

What’s the MOA of macrolides?

A

bacterioSTATIC
inhibit protein synthesis by binding to 50s ribosomal units, inhibiting translocation of peptidase chain

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14
Q

What do macrolides do that cause major DIs?

A

inhibit CYP450 clarithro and erythro only major DIs!

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15
Q

What are ADRs of macrolides?

A

GI effects (erythro is the worst), hepatic effects, Qtc prolongation

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16
Q

When are macrolides relibale?

A

atypicals, h. flu (NOT erythro), h. pylori (clarithro), mycobacterium avium

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17
Q

When are macrolides moderate?

A

s. pneumoniae, s. pyogenes

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18
Q

When are macrolides clinically utilized?

A

resp infections, atypical mycobacterial infections, traveler’s diarrhea (azi), SSTI if PCN allergic

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19
Q

When are macrolides your DOC?

A

chlamydia (azithromycin) H. pylori (clarithromycin –metallic taste)

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20
Q

What are examples of oxazolidinones?

A

linezolid and tedizolid

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21
Q

What’s the MOA of oxazolidinones?

A

bacterioSTATIC
inhibit protein synthesis by binding to 23S RNA of 50s subunit, preventing translation

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22
Q

How are oxazolidinones orally bioavailble?

A

100%

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23
Q

When should you be cautious with using oxazolidinones?

A

sympathomimmetics and SSRIs – weak MAO inhibitor and can cause serotonin syndrome

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24
Q

What are ADRs of oxazolidinones?

A

thrombocytopenia, peripheral and optic neuropathy, lactic acidosis

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25
When are oxazolidinones reliable?
MSSA, MRSA, strep (resistant s. pneumoniae), enterococci (including VRE) hospital based!
26
When are oxazolidinones moderate?
some atypicals
27
When are oxazolidinones clinically utilized?
infections caused by GPC (MRSA, VRE) like SSTIs, and hospital associated pneumonia
28
What's clindamycin?
lincosamide
29
What's the MOA of lincosamides?
inhibits protein synthesis by reversibly binding to 50S
30
What's the oral bioavailability of lincosamides?
90%
31
What's the eagle effect?
bacteria exposed to concentrations higher than optimal concentration survive more
32
What are ADRs of lincosamide?
GI intolerance (C. dif colitis)
33
When are lincosamides reliable?
many G+ anaerobes, plasmodium species (malaria)
34
When are lincosamides moderate?
s. aureus (MRSA) but not DOC, strep, G- anaerobes
35
When are lincosamides clinically utilized?
SSTIs, infections of oral cavity, anaerobic intra-abdominal infections, acne (topically)
36
What are folate antagonists?
sulfamethoxazole and trimethoprim bactericidal combo!
37
What's the MOA of folate antagonists?
sulfa = structurally similar to PABA and block incorporation of PABA tri = prevents reduction of dihydrofolate to tetra by inhibiting enzyme
38
What's folate antagonists bioavailability?
90-100%
39
How should you always prescribe folate antagonists?
1:5 ratio of TMP and SMX
40
What are ADRs of folate antagonists?
hypersensitivity, hematologic toxicity, hyperkalemia, obstructive uropathy
41
When is there a DDI with folate antagonists?
warfarin! displaces warfarin from albumin - higher conc in blood
42
When are folate antagonists clinically reliable?
h. flu, pneumocystis jirovecii, s. aureus (some MRSA), strenotrophomonas maltophilia
43
When are folate antagonists moderate?
enteric GNRS, s. pneumoniae, shigella, nocardia
44
When are folate antagonists clinically utilized?
UTIs, SSTIs, GI infections
45
When are folate antagonists your DOC?
stenotrophomonas maltophilia, nocardia, pneumocystitis jiroveci pneumonia
46
What's the MOA of fluoroquinolones?
bactericidal! MOA: Inhibit DNA gryase preventing DNA synthesis
47
What's the oral bioavailability of fluoroquinolones?
80-100%
48
How are cipro/levo eliminated vs moxi?
renally versus hepatically
49
What are ADRs for fluorquinolones?
GI, headache, photosenstivity rare: glycemic changes, seizures, **prolongation of QT interval**, arthralgias, **Achilles tendon rupture**, CNS
50
When are fluorquinolones contraindicated?
pregnant women and mostly children
51
What are some DIs of fluoroquinolones?
polyvalent cation binding & inhibits warfarin metabolism
52
When are fluoroquinolones reliable?
atypicals, enteric GNRs, H. flu, s. pneumoniae (NOT cipro)
53
When are fluoroquinolones moderate?
pseudomonas (levo/cipro), MSSA, anaerobes (moxi)
54
When are fluoroquinolones clinically utilized?
UTIs (NOT moxi), resp tract infections (NOT cipro), intra-abdominal infections w/ metronidazole, osteomyelitis
55
When are fluoroquinolones your DOC?
complicated UTIs (cipro/levo), severe pneumonia (not cipro)
56
What's the MOA of metronidazole?
bactericidal! disrupts DNA's helical structure 90% orally available
57
What are ADRs of metronidazole?
GI effects, metallic taste, headache, dark urine rare: peripheral neuropathy (prolonged use), seizures, SJS
58
What are DIs with metronidazole?
disulfuram-like reaction w/ EtOH; increases INR of warfarin
59
When is metronidazole reliable?
G- and G+ anaerobes
60
When is metronidazole moderate?
H. pylori
61
When is metronidazole clinically utilized?
addition of anerobic coverage, vaginal trichomoniasis, GI infections from protozoa
62
When is metronidazole your DOC?
mild-moderate C. dif
63
What's the MOA of nitrofurantoin?
static or cidal depending on concentration! reduced by flavoproteins to active intermediatese that inactivate/damage ribosomal proteins
64
In who can you not prescribe nitrofurantoin?
poor renal function patients (CrCl<50)
65
What are ADRs of nitrofurantoin?
GI effects rare: peripheral neuropahty and pulmonary fibrosis (long term)
66
When is nitrofurantoin clinically good?
e. coli, staph saprophyticus
67
When is nitrofurantoin moderate?
citrobacter, klebsiellla, enterococci
68
When are nitrofurantoins clinically utilized?
uncomplicated UTIs
69
When is nitrofurantoin your DOC?
uncomplicated UTis and uncomplicated UTIs in pregnancy
70
What is can't see, can't pee, can't climb a tree?
gonorrhea! can spread to their joints
71
What is trichomoniasis vaginitis?
anaerobic protozoan trophozoite -- STD with malodorous, yellow-green discharge, dyspareunia, strawberry cervix
72
What's the treatment for trichomoniasis vaginitis?
metronidazole
73
What's syphillis?
treponema pallidum, spirochete PAINLESS chancre followed weeks later by malaise, fever, pharyngitis, LAD, can go for years and cause inflammatory reaction in every organ
74
What's the treatment for syphilis?
<1 year = benzathine PCN G >1 year w/ no CNS ssxs = benzathine PCN G weekly x 3 weeks neurosyphilis = IV every 4 hours 10-14 days
75
What should you treat pharyngitis with if PCN allergy w/o anaphylaxis?
keflex
76
What should you treat pharyngitis with for PCN allergy WITH anaphylaxis?
macrolide or clindamycin
77
What's important to ask when looking at pneumonia treatments?
community or hospital acquired? outpatient or inpatient treatment? healthy w/no risk for MRSA/pseudomonas? comorbidities? LOTS of bacteria that can cause pneumonia!
78
How do you treat community acquired pneumonia outpatient in a healthy patient?
doxycycline, clarithromycin, azithromycin
79
How do you treat community acquired pneumonia outpaitent w/ comorbidites?
* macrolide * doxy AND beta-lactam (augmentin, cefuroxime, cefpodoxime) * fluoroquinolones (levaquin, moxifloxacin)
80
What organisms commonly cause TSS?
staph aureus, coagulase-neg staph, strep, mycoplasma
81
How do you treat TSS?
supportive! staph = nafcillin or oxacillin AND clindamycin (MSSA), vancomycin AND clindamycin (MRSA) strep = PCN G AND clindamycin, vancomycin AND clindamycin (PCN allergic), ceftriaxone AND clindamycin
82
REVIEW: How do you treat hidradenitis suppurativa?
stage 1 = topical benzoyl peroxide or clindamycin stage 2 = above + Doxycycline (oral abx) stage 3 = derm referral
83
REVIEW: how do you treat erysipelas?
IV dicloxacillin or 1st gen cephs (I have penicillin on mine but she doesn't have that on hers)
84
Covering anaerobes : CAMP MUC
Clindamycin Augmentin Metronidazole Piperacillin/tazobactam Moxifloxacin Unasyn Carbapenems

Clinical Pharmacology (14 decks)

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