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Dermatology > Sweatman Staph and Strep Antibiotics > Flashcards

Sweatman Staph and Strep Antibiotics Flashcards

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1
Q

MOA for Daptomycin

A

Cyclic lipopeptide that rapidly disrupts bacterial cell membranes
*depolarization and efflux of K+

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2
Q

resistance to Daptomycin

A

rare at present, no MOR identified, no known transferable resistance gene

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3
Q

administration of daptomycin

A

IV once daily

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4
Q

Toxicities with Daptomycin

A

direct muscle injury preclude IM injection

administer after dialysis

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5
Q

Met and Elim for daptomycin

A

90% bound to albumin

Renal elim with DOSE ADJUSTMENT (no adjutment for hepatic)

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6
Q

side effects of Daptomycin

A

monitor serum CPK elevation
*avoid coinciciding statins–>
rhabdomyolysis
NO CYP interactions

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7
Q

what type of bacteria get Daptomycin

A

aerobic, gram positive

MDR staph, strep and enterococcus

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8
Q

therapuetic indications for daptomycin

A

MRD staph, strep and enteroccocus
*complicated skin and soft tissue infections
MSSA and MRSA bacteremia
*right side endocarditis–> IVDU

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9
Q

do not use daptomycin in

A

staph pneumonia–> inactivated by surfactant

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10
Q

MOA for linezolid

A

inhibits protein synthesis by inhibiting 23s of 50s ribosomal subunit

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11
Q

linezolid is bacteriostatic for

A

staph and enterococci

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12
Q

linezolid is bacteriocidal for

A

strep

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13
Q

MOR for Linezolid

A

pt. mutation inf 23s subunit, no cross resistance with other classes,
(EMERGING RESISTANCE SEEN IN STAPH AUREUS AND ENTEROCCOCUS)

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14
Q

indications for linezolid

A

PENICILLIN RESISTANT SA–>
MRSA
ENTEROCOCCUS
RESERVE FOR VANC RESISTANT ENTEROCOCCUS

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15
Q

PK/PD OF LINEZOLID

A 
ORAL AND IV ROUTES
100% absorption of oral-. delayed by food but not peak drug levels
metabolized by NEoxidation
elim=renal and non renal mechs
No renal adjustment
NO cyp inh/ind
suppl dose needed following hemodialysis
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16
Q

possible side effect with LInezolid

A 
pseumomembranous cholitis
myelosupression after 2 weeks
(thrombocytopenia, anemia, neutropenia)
Optic and peripheral neuropathy, lactic acidosis
N/V/D/HA
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17
Q

PKU pt.’s beware

A

of linezolid–> contains aspartame in the oral suspension form

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18
Q

drug interations with linezolid

A

inihibitor of MAO–> caution with other drugs metabolized by MAO
ex. psuedaphed, phenylephrine, SSRI’s,
POSSIBLE SEROTONIN SYNDROME
possible HTn from decreased breakdown of ttyramine in the diet

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19
Q

Streptogrammins

A

dalfopristin-quinipristin (70-30)

remotely related to macrolides but no cross reactivity

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20
Q

oxazolidinones

A

Linezolid

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21
Q

MOA for dalfopristin-quinipristin

A

protein synthesis inhibition
(bind to ribosyl peptidyl transferase domain)
tRNA synthase is inhibited
aa addition to peptide chain is blocked

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22
Q

action on bacteria for syndercid

A

“synergistic bacteriocidal combination”

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23
Q

resistance to Synercid

A

changes in 23s ribosomal target site

erm gene encoding MLSb phenotype

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24
Q

pharmacology of Syncercid

A

IV only–> central line best
hepatic metab- conjugation via CYP 3A4
*metabolites still have activity
BILLIARY EXCERETION

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25
if unabel to tolerate synercid
increase dosing from Q8 HRS TO Q12 HRS
26
ADverRSE EFFECTS OF SYNCERCID
``` thrombophlebitis pain at injection site inrease conj. bilirubin Elevated LEnzymes Joint pain (in chronic liver dz) inhibits CYP 3A4 ```
27
Syncerid through its action with CY3a4 wil increase the concent. of
cyclosporin, midazolam, statins, HIV protease inhibitors
28
Spectrum for Streptogrammins | Dalfopristin-Quinipristin
>gram positive (not enterococcus faecalis) >VRE-> Enterococcus faecium >Skin and SKin Strcuture infections SSI's from MRSA or Strep Pyogenes > bone infection from VRE and MRSA
29
name the glycylcyline
tigecylcine
30
MOA for tigecycline
SIMILAR TO TETRACYCLINES inhibits protein translation but binding to 30s subunit *expanded broad spectrum
31
resistance to Tigecycline
overcomes key mechs of resistance to tetracylcine by 1. higher binding affinity to more ribosomal sites 2. no efflux
32
Pharmacology to tigecycline
1. slow IV infusion 2. 2. lower dose with liver failure 3. no renal adjustment 4. extensive distribution beyond plasma volumes and into tissue 5. Very little metab--> 1/2 life= 27hours 6. excretion= billiary/fecal and renal
33
adverse effects of Tigecycline
Hepatic and pancreatic toxicity Teeth, bones, photosensitivity, superinfections NVD, injection site pain,
34
Spectrum of Tigecycline
BROAD SPECTRUM= gram +, gram-, anaerobes, MRSA >SSTI'S AND INTRABDOMINAL INFECTIONS, *no activity against pseudomonas or proteus
35
TIGECYLINE CANNOT BE SUED IN
PATIENTS UNDER 18
36
RIFAMPIN MOA
Rifampicin inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase--> inhibiting protein synthesis
37
spectrum of Rifampin
1. MRSA (in combo with beta lactam or vanc) 2. TB primary agent 3. leprosy 4. staph epi
38
rifampin when use to treat staph aureus, MRSA or Staph epi...
is combined with Vancomycin or a beta lactam
39
another use of Rifampin for prophylaxis
household members exposed to H FLu
40
Rifampin causes eradication of _____ in ______
staph in nasal carriers
41
Most active anti-leprosy drug at present
rifmapin another is dapsone another is clofazimine
42
MOA for clindamycin
inhibits protein synthesis byt binding up the 50s ribosomal subunit, * very similar to erythromycin * not effective if erythromycin and clinda re given together
43
MOR for clinda
slowly and step-wise | Methylation of erm encoded genes
44
Spectrum for clindamycin
``` ANAEROBES *BOTH GRAM + AND GRAM - *PEPTOSTREP, BACTEROIDES, ACTINOMYCES MRSA AND GROUP A STREP ```
45
PHARMACOLOGY OF CLINDAMYCIN
NEAR COMPLETE ORAL ABSORPTION rapid widely dist, PENETRATES BONE AND ABCESSES *does not penetrate CSF onr intracellular does not cross placenta and is found in breast milk
46
metabolism of clinda
liver--. adjustment for liver fialure | half life is 2.7 hours
47
is clinda removed by hemodialysis
no | _
48
excretions of clinda
bile and urine excrete metabolites from liver breakdown | No renal adjustment
49
Side effect of Clindamycin
PSUEDOMEMBRANOUS COLITIS from C. Diff. | -hypersensitivity and diarrhea
50
tx for Pseudomembrandous colitis in clinda therapy
metronidazole or vancomycin
51
spectrum of clindamycin
bacteroides fragilis (outside CNS--> no access) - oral infections (peptostrep) - toxo in AIDS with pyrimethine - prophylaxis with penicillin allergy (staph and strep) MSSA and MRSA of soft tissue - for PCP with primaquine
52
Mupirocin MOA
BINDS REVERSIBLY TO STAPH ISOLEUCYL TRNA SYNTHETASE | -inhibits rna and protien synthesis
53
SPECTRUM FOR MUPIROCIN
TOPICALLY FOR IMPETIGO * *GRAM + BACTERIA*** - STAPH - STREP - MRSA
54
SYSTEMIC ABSORPTIONS WITH MUPIROCIN
LITTLE
55
ADEVRSE EFFECTS WITH MURPIROCIN
VEHICLE PEG can cause renal failure
56
polypeptide antibiotic
bacitracin
57
MOA for bacitracin
inhibits cell wall synthesis by inihbiting movement of peptidoglycan building blocks of the cell wall from inside to outside the cell membrane by INHIBITING DEPHOSPHORYLATION OF ISOPRENYL PYROPHOSPHATE CARRIER PROTEIN
58
spectrum Bacitracin
gram + cocci and bacilli
59
Major adverse effect with bacitracin
nephro toxicity with IV | *used topically with neomycin and polymyxin B
60
MOA for vancomycin
binds to the D-Ala-D-Ala prevents cell wall synthesis of the long polymers of N-acetylmuramic acid (NAM) and N-acetylglucosamine (NAG) that form the backbone strands of the bacterial cell wall, and it prevents the backbone polymers that do manage to form from cross-linking with each other.
61
major VANC adverse effects
nephro and ototoxicity
62
review MOAS for penicillin, anti-staph penicillin, cephs, vanc, azithromycin, bactrim,
pk

Dermatology (12 decks)

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