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Flashcards in L34 - Drugs Deck (41):
1

Adverse effect for aminoglycosides

Oto/nephrotoxicity
*Irreversible*
Neuromuscular blockade - avoid for MG patients

2

Adverse event for tetracyclines

Bone/teeth
Photo-sensitivity (sunburn easily)

3

Adverse events for ery/azithromycin

GI
QT prolongation

4

Adverse events for clindamycin

C.diff infection

5

Adverse events for linezolid

BM suppression
Serotonin syndrome

6

What drugs are your first choice for anaerobes (3)

Clindamycin
Metronidazole
Tigecycline

7

GP only protein synthesis inhibitors (2)

Linezolid
Mupirocin

8

Bacterial ribosome structure

30S + 50S = 70S
vs humans: 40S + 60S = 80S

9

Are most protein synthesis inhibitors cidal or static

STATIC

10

Common aminoglycosides (2)

Gentamicin
Amikacin

(Streptomycin)

11

Mechanism of action for aminoglycosides

Binds 30S - X protein synthesis
Cidal or static - depends on [ ]

12

Spectrum of action aminoglycosides

GN w/ pseudo
GP only w/ B-lactams b/c can't penetrate cell wall on own
No anaerobic

13

When to give/not to give aminoglycosides

IV only - hospital use for systemic GN infections
High [ ] in ear and kidney - use for complex UTIs
AVOID with:
- Pneumonia - inactivated pH
- Abscesses

14

Tetracycline other name & mechanism

Doxycycline
Reversible 30S binding
STATIC
Lipophilic = GN & P entry

15

2 resistance mechanisms vs tetracycline

Active efflux
Ribosomal protection proteins!!
Resistance to tetra = common, major limiting factor for clinical use

16

Tetracycline spectrum of activity

Broad GN (limited by resistance)
GP (some CA-MRSA)
Some anaerobic
Chlamydia
Mycoplasma

17

When are you going to give tetracycline? When are you going to avoid it?

Bronchitis
CA pneumonia
Chlamydia
AVOID: (bone growth side effect concerns)
- Kids
- Pregnant women

18

What's the other name for glycylcycline? Mechanism

= Tigecycline
Synthetic tetracycline
Broader coverage & works for tetracycline resistant bugs

19

Spectrum of activity glycylcycline

VERY BROAD
GN w/o proteus or pseudo
- *Rapid resistance may develop*
GP w/ MRSA & VRE
Most anaerobes

20

When are you going to use glycylcycline? Avoid?

IV only:
Complicated skin/ST or intra-ab infections
CA pneumonia
- Careful about increased mortality risk

21

3 macrolides

Azithromycin
Erythromycin
Clarithromycin

22

Macrolide mechanism

50S binding
Static
Azithro - long 1/2 life
Erythro - Cp450 metabolism therefore many drug interactions

23

Macrolide spectrum of activity

GN
GP
Some GN anaerobes
Chlamydia
Legionella
Mycoplasma

24

When are you using each of the 3 microlide options?

Azithro: CA pneumo/bronchitis, atypical pneumo, chlamydia
Erythro: gut motility
Clarithro: mycobacterium avium complex disease, vs. H. pylori

25

Mechanism of lincosamide/clindamycin

Binds 50S
Static - cidal at high doses

26

Which drug might induce clindamycin resistance

Erythromycin

27

Clindamycin spectrum of activity

GP only w/ CA MRSA
Anaerobes:
- Above the diaphragm
- Bacteroides fragillis

28

When are you using clindamycin

Community aspiration pneumo
Oral/ENT infections
Human bite wounds
Abscesses
S/ST due to CA MRSA

29

2 names for oxazolidinones

Linezolid
Tedizolid - overcomes resistance to other forms of this drug

30

Oxazolidinone mechanism of action

Binds 50S
Increased potency b/c additional target site @ binding region of rRNA
Static
100% bioavailability
PO or IV

31

What is/how would serotonin syndrome present?

Excess serotonin when oxazolidnones are given with SSRIs
- B/c oxazolidinones block monamine oxidase activity
Hyperthermia
CV instability

32

Linezolid spectrum of activity

GP ONLY w/ MRSA & VRE
Mycobacteria

33

Clinical use for linezolid

VRE infection
MRSA nosocomial pneumo
S/ST infection

34

Mupirocin mechanism

Binds tRNA synthetase reversibly

35

Mupirocin spectrum of activity

GP only
Weaker activity against "normal" skin flora
No GN or anaerobic

36

Mupirocin clinical uses

Topical only
S.aureus or strep skin infections
Decolonize MRSA from the nose
Prophylaxis of catheter related infections

37

What are the DNA synthesis inhibitors

Imidazoles (metronidazole & tinidazole)

38

Imidazole mechanism of action

Diffuses into bacteria
Produces free radicals --> kills bacteria

39

Imidazole adverse effects

Pills taste metallic
CNS - vertigo, confusion, psychosis
+ alcohol --> vomiting, flushing

40

Imidazole spectrum of activity

Anaerobes
- "Below the diaphragm"
- Bracteroides fragillis
Protozoa

41

When are you using imidazole

Anaerobic infections:
C.diff
Intra-ab infection