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46 Cards in this Set
- Front
- Back
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What is the drug of choice for anaerobic infections?
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Clindamycin (Cleocin)
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What combination has become the standard of care in treatment of mixed aerobic and anaerobic infections?
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Clindamycin / Gentamicin
(Garamycin) |
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What are the antianerobic agents?
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Clindamycin (Cleocin)
Metronidazole (Flagyl) |
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What is clindamycin used to treat primarily?
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Gram-positive infections
Anaerobic infections |
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What was oral clindamycin originally used for?
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Strep and Staph infections
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What was metronidazole (flagyl) first used to treat? Why?
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Trichomonas vaginalis infections.
It's antiprotozoal activity |
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With which infection has metronidazole (flagyl) become the treatment of choice?
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C-diff colitis
H-Pylori duodenal ulcers |
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What infections is metronidazole (Flagyl) used to treat?
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Trichomonal vaginalis
C-Diff colitis H-Pylori duodenal ulcers Bacteroides fragilis |
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What are the oral Adult dosages of Flagyl?
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250 - 500 mg PO q6 - 8 hours
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What are the IV Adult dosages of Flagyl?
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500 mg IV q6 - 12 hours.
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What are the oral Pediatric dosages of Flagyl?
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30 mg/kg/d q6 hours
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What is the Adult oral dosages of Clindamycin (cleocin)?
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150 - 450 mg PO q6 hours
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What is the Adult IV dosages of Clindamycin (Cleocin?
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600 mg IV q 8 hours
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What is the Pediatric oral dosages of Clindamycin (Cleocin)?
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10 - 30 mg/kg/d PO q6 - 8 hours
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What is the Pediatric IV dosages of Clindamycin (Cleocin)?
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25 - 40 mg/kg/d IV q 6 - 8 hours.
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What are the pharmacokinetics and pharmacodynamics of Clindamycin?
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Both Clindamycin esters, palmitate and phosphate are absorbed and converted to active forms in the blood.
Reaches most tissue and bone Limited CSF distribution |
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Half-life of Clindamycin (Cleocin)?
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Approximately 3 hours
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Where is Clindamycin (Cleocin) metabolized?
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Liver
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What would necessitate dosage adjustments of Clindamycin (Cleocin)?
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Patients with Liver impairments
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Does dialysis remove clindamycin (Cleocin)?
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No it does not
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What is the mechanism of action of Clindamycin (Cleocin)?
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Binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis.
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What medicines act on the same binding site as clindamycin (Cleocin)?
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chloramphenicol
macrolides |
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What is the principal activity of clindamycin (Cleocin)?
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aerobic gram-positive cocci
gram-positive and gram-negative anaerobic organisms Bacteroides Protozoa |
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What organisms do clindamycin (cleocin) lack coverage?
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gram-negative organisms
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What causes an organisms resistance to clindamycin (Cleocin)?
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Alterations of the binding site on the 50S ribosomal subunit.
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What are the clinical uses of clindamycin (Cleocin)?
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anaerobic coverage in mixed infections
gram-positive infections toxoplasmosis Pneumocystis carinii pneumonia Staph and strep toxic shock PID |
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How does clindamycin (Cleocin) treat staph and strep toxic shock?
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Inhibits toxin production
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What are the major side effects of clindamycin (Cleocin)?
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diarrhea
C-Diff colitis Unrelated to dose Potentiates neuromuscular blockade with concommitant use of muscle relaxants (rarely) |
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Where does absorbtion of metronidazole (Flagyl) occur?
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Completely absorbed from the GI tract after oral administration.
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What is the distribution of metronidazole (Flagyl)?
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Penetrates into most tissues.
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What is the volume of distribution (Vd) of metronidazole (Flagyl)?
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0.6 - 0.9 L/kg.
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Does metronidazole (Flagyl) bind to protein?
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Binding to plasma protein is minimal
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Where is metronidazole (Flagyl) metabolized?
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Liver
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When are dose adjustments required when using metronidazole (Flagyl)?
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When there are hepatic impairments.
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What is the half-life of metronidazole (Flagyl)?
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6 - 9 hours
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Is metronidazole (Flagyl) removed by dialysis?
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Yes it is removed by hemodialysis and peritoneal dialysis.
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What is the mechanism of action of metronidazole (Flagyl)?
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reduced to a toxic product that interacts with DNA, causing
strand breakage resulting in protein synthesis inhibition |
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What is the spectrum of activity of metronidazole (Flagyl)?
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Active against both gram-positive and gram-negative anaerobes.
H. pylori protozoa such as T. vaginalis |
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What would make an organism resistant to metronidazole (Flagyl)?
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decreased enzymatic activity of reductase, resulting in less activation and uptake of the drug.
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What are the clinical uses of metronidazole (Flagyl)?
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Anaerobic coverage in mixed infections
C. diff bacterial vaginosis and trichomoniasis |
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What are common adverse events for metronidazole (Flagyl)?
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GI side effects:
N/V, abdominal pain, metallic taste in the mouth Serious but rare: seizures peripheral neuropathy pancreatitis |
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When does seizures normally occur while taking metronidazole (Flagyl)?
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Associated with high doses
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When does peripheral neuropathy usually take place while taking metronidazole (Flagyl)?
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In patients receiving prolonged courses.
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Drug-drug interactions with metronidazole (Flagyl) administration?
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Warfarin-enhances anticoagulant effect
Phenobarbital, phenytoin, rifampin-increase metabolism of Flagyl Cimetadine-decreases metabolism of Flagyl |
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When taking metronidazole (Flagyl) when would a disulfram-like reaction take place?
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When concurrently drinking alcohol
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What are the symptoms of a disulfram-like reaction?
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flushing
palpitations nausea vomiting |
