others

Question 1

Carbapenems

Answer 1

Broad spectrum effectiveness across many microbes
Contain beta-lactam ring & inhibit construction of the cell wall; bactericidal.
This beta lactam ring is very resistant to destruction by beta-lactamase
ertapenem (Invanz): abdominal/pelvic, skin, pneumonia, & UTI
meropenem (Merrem): to treat peritonitis & bacterial meningitis
Carbapenems can only be given parenterally
Side effects: diarrhea, nausea, rashes

Question 2

Lincosamides

Answer 2

clindamycin (Cloecin, others)
Gram-negative & gram-positive bacteria
Treat abdominal infection
Limited use develop Pseudomembranous colitis (PMC)
Side effects: diarrhea, rashes, difficulty breathing, itching, difficulty swallowing

Question 3

metronidazole (Flagyl)(amebicide)

Answer 3

Anaerobes
Common causes of abscesses, gangrene, diabetic skin ulcer, deep wound infections, H. Pylori infections (newer use for this drug), trichomonas
Side effect: nausea, dry mouth, headache, high doses can produce neurotoxicity
Can treat bacteria & parasites
Avoid Alcohol Disulfiram reaction

Question 4

vancomycin (Vancocin)

Answer 4

Severe infections, gram(+)
S. aureus & Streptococcus pneumoniae
Often used once resistant (MRSA) or allergy to PCN/cephalosporins
Side effects: ototoxicity (evaluate hearing throughout treatment), nephrotoxicity (evaluate levels & kidney function), chills, fever, nausea
Rapid infusion  flushing of upper body & hypotension (red man syndrome) due to large amounts of histamine released

Question 5

isoniazid (INH)

Answer 5

Mechanism of action: inhibits synthesis of mycolic acids, essential components of mycobacterial cell walls
Primary use: alone for chemoprophylaxis or in combination with other anti-TB drugs for treating active disease
Contraindicated severe hepatic impairment
Hepatotoxicity in 1-3 mo. & at any time
Jaundice, fatigue, elevated liver enzymes, loss of appetite
Alcohol may increase the risk for hepatotoxicity
Antacids decrease the drug absorption
Food containing tyramine (aged cheeses, certain meats & sausages, liver, sour cream, soy sauce, raisins, bananas, avocados) may increase INH toxicity
Chemoprophylaxis

Adverse Effects: Neurotoxicity, paresthesia of hands & feet, convulsion, optic neuritis, dizziness, coma, memory loss, various psychoses, & hepatotoxicity

Question 6

Antifungals

Answer 6

Yeast or mold-like diseases
Inhibit Fungi by: 
Ergosterol in fungal cell membranes
Bind to form membrane holes
Inhibit synthesis
Glucan in fungal cell walls
nystatin, fluconazole, ketoconazole, amphotericin B

Question 7

nystatin

Answer 7

Fungistatic & fungicidal activity
Allows intracellular components to leak through cell membrane by binding to sterols in cell membrane
Use: intestinal, vaginal, oral fungal caused by susceptible strains of Candida
Adverse effects: nausea, vomiting, diarrhea