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90 Cards in this Set
- Front
- Back
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quinolones
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ciprofloxacin
levofloxacin moxifloxacin norfloxacin |
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mechanism of action for fluoroquinolones
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-inhibit bacterial DNA gyrase resulting in inhibitionof DNA replication, recombination, and transcription
-bind to topoisomerase 4 an enzyme involved in the separation of interlinked chromosomesafter replication |
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what type of antibiotic are the fluoroquinolones
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bacteriocidal
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fluoroquinolones exhibit what kind of killing
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concentration dependent killing
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resistance mechanisms for fluoroquinolones
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chromosomal mutations of DNA gyrase and topo 4
efflux pumps cross resistance with gram- |
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absorption of fluoros
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oral good
food does not impair divalent and trivalent cations can block absorption |
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norfloxacin used for what
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UTI
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distribution of fluoros
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good into most tissues
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which fluoro undergoes extensive metabolism and does not need renal adjustment
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moxifloxacin
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elimination of fluoros
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renal elimination and most must be renally adjusted
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ciprofloxacin spectrum on gram +
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none
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ciprofloxacin spectrum on gram -
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enterobacteriaceae
haemophilus influenzae moraxella catarrhalis pseudomonas aeruginosa |
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anaerobe activity of ciprofloxacin
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none
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quinoione withbest pseudomonal activity
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ciprofloxacin
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gram + spectrum of levofloxacin
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staphylococci
streptococci |
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gram - spectrum of levofloxacin
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enterobacteriaceae
h influenzae M catarrhalis P aeruginosa |
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anerobe spectrum of levofloxacin
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none
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levofloxacin is active against what
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s. pneumoniae including penicillin resistant strands
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gram + spectrum of moxifloxacin
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staphylococcus
streptococci |
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gram - spectrum of moxifloxacin
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enterobacteriaceae
haemophilus influenzae moraxella catarrhalis pseudomonas aeruginosa |
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anerobic spectrum of moxifloxacin
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yes including b fralis
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moxifloxacin is active against what
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s pneumoniae including penicillin resistant strains
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adverse effects of quinolones
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NVD
CNS arthropathies and osteochondrosis tendon rupture hypoglycemia rare skin allergic reactions phototoxicity |
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what pregnancy class are quinolones
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class C
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which quinolones are most phototoxic
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sparfloxacine>ciprofloxacin=levofloxacin, glatifloxacin, moxifloxacin
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which quinolone prolongs QT interval
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moxifloxacin
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quinolones are cautioned in what patients
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pro-arrhythmic conditions such as hypokalemia, significant brady, congestive heart failure, MI and atrial fib
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boxed warning with quinolones
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associated tendonitis and tendon rupture
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risk factors for tendon rupture
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age greater than 60
concomitant corticosteroids transplant recipients |
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what things should be covered in patient education in regards to possible tendon rupture
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snap or pop in tenon area
bruising after an injury in tendon area inability to move or bear weight avoid exercise call healthcare provider if symptoms develop |
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how should divalent and trivalent cation be administered with levo/cipro
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admin cations and drug two hours apart
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how should divalent and trivalent cations be admin with moxi
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admin 4 hr before or 8 hr after
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what drugs need to be avoided when using moxi
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other drugs that prolong QT interval
quinidine procainamide disopyramide amiodarone sotalol |
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what drugs should be admin with caution when on moxi
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cisapride
erythromycin antipsychotics tricyclic anitdepressants |
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misc anerobic microbial agents
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metronidazole
clindamycin |
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misc gram + microbial agents
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qquinupristin/dalfopristin
linezolid daptomycin |
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MOA of metronidazole
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anerobic bacteria reduce metro to toxic compounds that disrupt bacterial DNA causing cell death
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metronidazole apsorption
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rapid and complete after oral administraion
food does not effect may delay time to peak |
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metronidazole distribution
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widely distributed to body tissues
low protein binding good for abcess |
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metronidazole metabolism
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metabolized into several compounds some of which are active metabolites
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metronidazole elimination
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parent drug and metabolites excreted in urine 60-80% the rest in feces
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metronidazole spectrum of activity
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active against most gram + and - anerobic bacteria
-peptostreptococci -clostridium perfringens -clostridium difficile -bacteroides fragilis -fusobacteria |
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metronidazole spectrum against protozoa
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trichomonas vaginalis
giardia lamblia entamoeba histolytica |
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GI reactions to metro
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NVD
metallic taste |
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Neuro reactions to metro
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peripheral neuropathy
-reversible siezures, cerebellar dysfunction, encephalopathy |
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teratogenetic reactions to metro
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avoid during 1st trimester and during breastfeeding
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drug interactions of metro
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increase effect of warfarin
disulfiram like reaction occurs when drinking alcoholic beverages may also happen with listerine |
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MOA of clindamycin
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binds to 50s subunit of bacterial ribosomes and supresses protein synthesis
facilitates opsonization, phagocytosis, and intracellular killing of bacteria |
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what type of antibiotic is clindamycin
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bacteriostatic
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resistant mechanism for clindamycin
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changes in ribosomal binding site
enzyme inactivation gram - anerobes intrinsically resistant because of poor permeability of the outer membrane |
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clinda absorption
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oral food does not interfere
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distribution of clinda
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penetrates most tissue including bone does not penetrate CSF
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where does clinda accumulate
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in polymorphonuclear leukocytes alveolar macrophages and abscesses
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clinda metabolism
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inactivated to two metabolites in the liver
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clinda excretion
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less than 10% as unchanged in urine
metabolites excreted in urine |
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gram + spectrum of clinda
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staphylococci
streptococci including s pneumoniae no enterococci |
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gram - spectrum of clinda
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none
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anerobic spectrum of clinda
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active against gram + and - including
-peptostreptococci -clostridium perfringens -bacteroides fragilis -fusobacteria -actinomyces |
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GI reactions to clinda
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diarrhea
C. Diff colitis anorexia nausea vomiting |
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other ADRs of clinda
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rash
elevated liver function tests neutropenia thrombocytopenia |
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drug interactions of clinda
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neuromuscular blockers
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MOA of quinupristin/dalfopristin
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bind sequentially to 50s ribosomal subunit inhibiting protein synthesis and leading to cell death
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what type of antibiotics are quinupristin/dalfopristin
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indivdually bacteriostatic
together bacteriocidal |
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resistance mechanisms of quinupristin/dalfopristin
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change in ribosomal binding site
efflux pump enzyme inactivation |
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absorption of quin/dalfo
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poor IV is only form
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distribution of quin/dalfo
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widely distributed
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metabolism of quin/dalfo
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quin to 2 active metabolites
dalfo to 1 active metabolite |
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elimination of quin/dalfo
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mostly in feces
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gram + spectrum of quin/dalfo
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streptococci including penicillin resistant strains
staphylococci including MRSA enterococci |
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anerobic spectrum of quin/dalfo
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limited
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adverse reactions of quin/dalfo
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myalgias/arthralgias
thrombophlebitis increases in bilirubin |
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drug interactions of quin/dalfo
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inhibits 3A4 pathway and therefore will increase levels of any drug that is metabolized by this route
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MOA of linezolid
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inhibits protein synthesis by binding to 23S subunit of the 50S ribosome
eventually results in inhibition of translocation |
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resistance mechanisms for linezolid
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mutation of ribosomal subunit binding site
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absorption of linezolid
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oral food does not effect
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distribution of linezolid
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widely distributes including CSF
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metabolism of linezolid
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in liver by oxidation to 3 metabolites
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elimination of linezolid
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only 20% unchanged in urine
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spectrum of activity for linezolid
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streptococci including penecillin resistant strains
staphylococci including MRSA enterococci including vanco resistant strains |
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hematologic side effectsof linezolid
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thrombocytopenia
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GI side effects of linezolid
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NV rare
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mitochondrial toxicities with linezolid
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peripheral neuropathy, optic neuritis and lactic acidosis
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drug interactions of linezolid
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weak nonspecific monoamineoxidase inhibitor
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caution with linezolid in what patients
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patients recieving adrenergic or sertonergic agents
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MOA daptomycin
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irreversibly binds to the bacterial cell membrane
rapidly depolarizes cell membrane cell death |
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daptomycin spectrum of activity
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gram positive bacteria
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daptomycin absorption
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not absorbed IV only
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dapto should not be used for what
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treatment of pneumonia
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elimination of dapto
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80% kidneys the rest in feces
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adverse reactions of dapto
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constipation
nausea headache insomnia, diarrhea, dermatitis, vomiting and pruritis |
