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75 Cards in this Set
- Front
- Back
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most common aminoglycosides
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gentamicin
tobramycin amikacin |
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less common aminoglycosides
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kanamycin
paromomycin streptomycin neomycin |
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MOA for aminoglycosides
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bidn irreversibly to 30S ribosomal subunit
-inhibit bacterial synthesis -interfere with initiation -induce misreading -cause breakup of polysomes to nonfunctional monosomes -rapidly bacericidal and exhibit concentration dependent killing |
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what is PAE with aminoglycosides
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long
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types of resistance to aminoglycosides
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enzyme inactivation
decreased cell wall permeability change in 30s subunit |
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absorption of aminoglycosides
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poor oral
good IM site injection |
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topical absorption of aminoglycosides can lead to what
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toxic levels
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areas with good distribution of aminoglycosides
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ECF, most body fluids, urninary
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areas with poor distribution of aminoglycosides
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CNS and eye
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metabolism of aminoglycosides
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not metabolized
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elimination of aminoglycosides
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renally eliminated
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what should aminoglycosides be dose adjusted for
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renal function to avoid toxicity
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aminoglycosides action on G+
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no activity alone
synergistic effect with beta-lactams to treat enterococcal or staphylococcal infections |
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aminoglycosides coverage of G-
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excellent
enterobacteriaceae and pseudomonas aeruginoasa |
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should aminoglycosides be used alone
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not unless treating a UTI
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aminoglycosides coverage of anaerobes
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none
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misc coverage of aminoglycosides
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amikacin some activity against mycobacteria
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adverse reactions of aminoglycosides
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nephrotoxicity
ototoxicity neuromuscular blockage ` |
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ototoxicity from aminoglycosides is associated with what
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increased troughs for prolonged periods of time and total duration of therapy
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mechanism for neuromuscular blockage with aminoglycosides
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inhibition of prejunctional release of Ach and reduction of postsynaptic sensitivity to the transmitter
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when should serum monitoring take place with aminoglycosides
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30 min after the completion of 30 min infusion
trough drawn prior to next scheduled dose |
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amikacin concentration should be what
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3-4x that of gentamincin /tobramycin
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what should be done when peak and trough are low
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dose should be increased and interval should remain the same
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what should be done when peak in therapeutic and trough is high
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interval and dose should be increased
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what should be done when peak is low and trough is high
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the interval and dose should be increased
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what is the mechanism or action for vanco
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inhibits cell wall synthesis prevents the binding of the d-alanyl-d-alanine portion
affects permeability of cytoplasmic membrane bacerialcidal and exhibits time dependent killing |
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what bug is vanco bacteriostatic for
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enterococci
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resistance to vanco
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enterococcus
staphylococcus |
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absorption of vanco
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not absorbed orally
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what is the distribution of vanco
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good penetration
-serous membranes, pleural, pericardial, ascitic, synovial fluids |
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vanco elimination
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70-90% excreted unchanged in urine
half life prolonged in renal dysfunction |
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vanco spectrum on G+
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staphylococcus, streptococcus, enterococcus,
corynebacterium, bacillus |
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which enterococci is resistant to vanco
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VRE
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vanco spectrum on G-
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no activity
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vanco spectrum on anerobic
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anaerobic cocci
clostridia |
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adverse reactions of vanco
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nephrotoxicity
ototoxicity red man syndrome neutropenia thrombophlebitis allergic reactions |
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what mediates red man syndrome
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histamine
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drug interactions of vanco
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aminoglycosides synergistic effect of nephrotoxicity and ototoxicity
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what levels are usually drawn with vanco
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trough levels
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mechanism of action for tetracyclines
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bind to 30s subunit
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types of resistance to tetracyclines
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decreased intracellular accumulations due to efflux pump
change in ribosomal binding site enzymatic inactivation |
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tetracyclines
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tetracycline
doxycycline minocycline oxytetracycline demeclocycline |
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administration of tetracycline
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PO
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admin of doxycycline and minocycline
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PO/IV
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admin of oxytetracycline
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IM
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oral absorption of doxy and tetra
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doxy=90-100
tetra=75 |
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effects of food on doxy and tetra
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doxy=none
tetra=decreased |
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half life of doxy and tetra
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doxy=12-22
tetra=6-11 |
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effect of renal insufficiency on doxy and tetra
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doxy=none
tetra=significantly prolonged |
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elimination of doxy and tetra
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doxy=hepatobiliary
tetra=renal |
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when do you see decreased concentrations of doxy
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concurrent use of divalent and trivalent cations
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distribution of tetracyclines
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widley including urine and prostate
do not cross placenta accumulate in reticuloendothelial cells of liver, spleen, bone and enamel of unerupted teeth crosses placenta |
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metabolism of doxy and tetra
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doxy=liver
tetra=none |
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when should tetra be avoided
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renal dysfunction
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tetracycline spectrum with G+
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staphylococci
streptococci |
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tetracycline spectrum with G-
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H. influenzae, some E. Coli and klebsiella
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tetracycline spectrum with anaerobes
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many anaerobes with increasing resistance
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tetracycline misc spectrum
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brucella, vibrio cholerae, legionella, campylobacter jejuni, H pylori, yersinia pestis, rickettsiae, borrelia burgdorferi, treponema pallidum
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Adverse reactions of tetracycline
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gastrointestinal
photosensitivity bone and teeth hepatotoxicity nephrotoxicity vestibular toxicity blue or blueblack oral pigmentation |
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when are tetracyclines contraindicated
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pregnancy, breast feeding, and children <8yrs
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which tetracycline has adverse effect of vestibular toxicity
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minocycline
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what is interaction of tetracyclines with divalent and trivalent cations
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chelation
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what drugs cause a decreased effect of doxycycline
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phenytoin
carbamazepine |
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tigecylcline
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synthetic tetracycline analogue
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resistance to tigecycline
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not affected by typical tetracycline resistance mechanisms
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absorption of tigecycline
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only available in IV form
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distribution of tigecycline
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distrubts well into most tissues
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elimination of tigecycline
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primarily biliary excretion
20% unchanged in urine |
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spectrum of tigecyclin on gram +
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enterococcus
staphylococcus aureus(including MRSA) staphylococcus epidermidis Group A strepto coccus viridans group streptococcus listeria monocytogenes |
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spectrum of tigecycline on gram-
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citrobacter sp
enterobacter sp escherichia coli klebsiella sp serratia sp acinetobacter baumannii stenotrophomonas maltophilia |
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spectrum of tigecyclines on anaerobes
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bacteroides sp
clostridium perfringens peptostreptococcus micros |
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Misc spectrum of tigecyclines
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mycobacterium abscessus
mycobacterium chelonae mycobacterium fortuitum |
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adverse reactions with tigecycline
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hypersensitivity
nausea vomiting diarrhea teeth discoloration less than 8 yrs or pregnant hyperbilirubinemia elevated BUN photosensitivity pancreaititis |
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tigecycline is contraindicated in what
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pregnancy and children under 8yrs old
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drug interactions of tigecycline
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warfarin
oral contraceptives |
