Red/Bolded Words/Review - Deck 3 Flashcards by Rebecca Lea

Describe general characteristics of aminoglycosides

how do they get into cell?

only effective against what kind of bacteria?

polar

need active transport (requires O2)

gram (-) aerobes due to process above

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Aminoglycosides have broad or narrow spectrum

narrow

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Aminoglycosides are typically given when you have what kind of infection

serious

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Aminoglycosides are usually administered how?

parenterally - again, typically with very serious diseases

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Why do you typically give aminoglycosides in combination?

empirical therapy, serious infection, broad spectrum

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Aminoglycosides are cidal/static?

cidal

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What type of drugs are aminoglycosides administered with

Inhibitors of cell wall synthesis

2 cidal drugs - one inhibits cell wall synthesis and the other inhibits protein synthesis

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Aminoglycosides: DOFC

pseudomonas

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Aminoglycosides active against Gram (___) and anaerobes or aerobes

Administered how?

Gram - aerobes

Parenteral

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Aminoglycosides are active against what pathogens?

enterococcus

tularemia

pseudomonas

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Aminoglycosides toxicities (2)

Ototoxicity

Nephrotoxicity

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Nephrotoxicity and ototoxicity are what kind of side effects?

Concentration and time dependent

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Aminoglycosides concentrate where?

inner ear - hence the ototoxicity

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Aminoglycosides are best given in what kind of doses?

Why?

Mega

Because the mega dose results in less time over the concentration threshold

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Aminoglycosides have significant

post-antibiotic effect

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What does post-antibiotic effect mean?

When concentration dips below threshold, we still have suppression of bacterial growth.

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How does post-antibiotic effect affect the time between doses?

What effect does PAE have on adverse side effects?

increases the time between doses

reduces chance of adverse side effects (concentration dependent)

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With enterococci, how do aminoglycosides and penicillins work together to produce synergism?

No.

Use penicillin to open up cell wall and then aminoglycosides do not need O2 to get through and the two together produce synergistic effect.

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Chloramphenicol: what kind of spectrum

broad

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Chloramphenicol toxicity level

HIGH

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When would you use chloamphenicol?

with life-threatening disease due to broad spectrum and high toxicity levels

Benefit must outweigh risk (pt will be killed)

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Chloamphenicol binds to what subunit?

Cidal/static?

50S

Static

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Chloramphenicol’s claim to fame?

100% CNS bioavailability without inflammation

THE BEST DRUG WE HAVE FOR CNS INFECTIONS

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Chloramphenicol can be used for ______ instead of penicillin if there is a penicillin allergy

meningitis

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Chloramphenicol is a DOFC for

Rocky Mountain Spotted Fever (life-threatening)

Chloramphenicol: for elimination, drug must be:

conjugated to glucuronic acid

Chloramphenicol cannot be used in what populations? Why?

Neonates Naive livers - cannot make glucuronyl transferase, so cannot conjugate and eliminate.

If you give chloramphenicol to a neonate what happens?

Gray Baby Syndrome Life-threatening

Chloramphenicol toxicities: Dose-dependent: Dose-independent

D-D: bone marrow suppression - reversible upon discontinuation of drug D-I: fatal aplastic anemia - can be from single dose OR can occur months after drug has been discontonied

Tetracyclines bind to what subunit

30S

Tetracyclines: cidal/static

Static

Tetracyclines are broad/narrow spectrum

BROAD: Gram+/- anaerobes and aerobes

3 organisms resistant to tetracyclines

B. fragilis Proteus Pseudomonas

Which GI bacterial infection can tetracyclines be used against in combination with metronodazol and bismuth?

H. Pylori

DOC for what intestinal bacterial infection?

Cholera

What three drugs can be used against Lyme Disease?

doxycycline ceftriaxone ampicillin

What can be used in rocky mountain spotted fever?

doxycycline

For tetracycline (ONLY), what is main mode of resistance?

efflux pumps doxy and mino are not good substrates for those pumps, so they can still be used

Tetracycline (doxy and mino are better than tetra) should not be taken when vitamins why?

Because they chelate with Al, Ca, Fe

Tetracyclines deposit where?

bone and teeth

Tetracyclines contraindications?

pregnant women and children under age of 8

What is the major adverse reaction associated with tetracyclines?

photosensitivity

Tigecycline is a good alternative for what?

tetracycline-resistant organisms

Tigecycline binds to what subunit? Static/cidal

30S Static

All of the floxacins are under what class of drugs?

fluoroquinolones

How do fluoroqiunolones work?

inhibit DNA gyrase which prevents relaxation of positively supercoiled DNA that is required for transcription and replication

Fluroquinolones: cidal/static?

cidal

Ciprpofloxacin is used for what kind of infections:

UTI

Ciprofloxacin has/does not have antipseudomonal activity?

Does have antipseudomonal activity

Ofloxacin is used for what? Why?

Prostatitis - penetrates dense prostate gland

Levofloxacin used mainly for?

community acquired pneumonia

Moxifloxacin and Gemifloxacin are the ONLY two fluroquinolones that work on what kind of organisms:

ANAEROBIC

Gatifloxacin is used for?

ocular application only

How are fluoroquinolones administered?

orally

What should you warn your patient about when taking fluroquinolones with other medications?

Do not take iron, magnesium, aluminum, calcium

Fluoroquinolones can be given with _____ to:

probenecid to increase retention so it is not excreted as quickly and increase the therapeutic effect

What makes fluoroquinolines contraindicated in pregnant women and in children under age of 18

Cartilage erosions

4 main adverse effects of fluoroquinolines

increase QT interval cartilage erosions tendon rupture photosensitivity

Metronidazole is only active against anaerobes/aerobes?

anaerobes

Metronidazole: Mechanism of Action

prodrug non-enzymatically reduced by reacting with reduced ferredoxin (only found in anaerobes) Prodrug b/c metronidazole metabolites are taken up into bacterial DNA and form unstable molecules

Metronidazole: static or cidal Gram (___)

Cidal Positive and negative (ANAEROBES)

Metronidazole is an OPTION for which two intra-abdominal infections

C. Diff (alternate to vanco) and H. pylori (multi-drug regimen)

2 main adverse effects of metronidazole?

Disulfram-like reaction Digeusia - metallic taste

What are the two EXCLUSIVE UTI drugs?

Nitrofurantoin Methenamine

What makes Nitrofurantoin and Methenamine exclusively UTI drugs?

1. renal excretion 2. must achieve high urinary concentrations to become effective - only place they concentrate 3. require acidic pH to be active

What is nitrofurantoin mechanism of action?

damages bacterial DNA is a prodrug

Nitrofurantoin spectrum

BROAD - EXCEPT PROTEUS (makes urine more basic) AND PSEUDOMONAS

Nitrofurantoin: adverse effect if patient has Glucose-6-Phosphate Deficiency

hemolytic anemia

Contraindication of nitrofurantoin

late-term pregnancy because we do not know if child has G-6-P-D deficiency

Other adverse side effect of nitrofurantoin - especially in elderly

pulmonary fibrosis

Methanamine is decomposed to:

formaldehyde and ammonia in the acidic medium of UT

When would you NOT use methanamine? It will result in:

if your patient has hepatic or renal insufficiency and cannot handle the byproduct of ammonia hepatic encephalopathy

Main sulfonamide

Sulfamethoxazole + trimethoprim = BACTRIM

How is Bactrim administered?

Orally and parenterally

What is a good example of synergism with sulfonamides?

sulfamethoxazole and trimethoprim

Sulfamethoxazole MOA: Trimethoprim MOA: Remember - these work together! Synergism.

Sulfa - competes with PABA in syn of bacterial folic acid Tri - prevent reduction of dihydrofolate to tetrahydrofolate which is essential for one carbon transfer

3 resistance mechanisms of sulfamethoxazole + trimethoprim

efflux pumps increased prodcution of essential metabolite - PABA Alternative metabolic pathway for synthesis of essential metabolites (plasmid)

Bactrim: static or cidal

static BUT in urinary tract, it is CIDAL if high concentrations are obtained

Bactrim is DOFC for:

UTI (first attack)

Sulfa drugs inhibit Gram (__) drugs

+ and -

4 Adverse Effects of Sulfa Drugs

aplastic anemia photosensitivity hypersensitivity SJS

What class has second highest drug sensitivity after penicillins

Sulfas

What is Kernicterus and what class of drugs is it associated with? Should not give these drugs to children under

binding of bilirubin to plasma proteins sulfas 2 months of age

Daptomycin MOA static/cidal

binds to bacterial membrane and cause rapid depolarization of membrane potential cidal

Daptomycin is good against gram (__) aerobes/anaerobes

positive both

How does muciprocin work?

bacterial protein and RNA synthesis are inhibited when mupirocin binds to bacterial t-RNA synthetase

Mupirocin is adminstered

topically

Mupirocin: static or cidal

static at low, cidal at high concentrations

Besides skin, where is mupirocin applied?

intranasally

Polypeptide antibiotics used against gram (_) infections

gram -

Polypeptide MOA

binds to G- bacterial cell membrane phospholipids which increases permeability of cell membrane and loss of metabolites essential to bacterial existence

Polymyxin is used in combination with:

neomycin and bacitracin

Red/Bolded Words/Review - Deck 3 Flashcards

(92 cards)