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41 Cards in this Set
- Front
- Back
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Penicillins MOA
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BACTERICIDAL
Bind to penicillin binding proteins; inhibiting cell wall synthesis and causing cell wall lysis |
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PCN clinical uses
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Clinical Uses
Streptococcal infections Pharyngitis (Streptococcus pyogenes ‑ Group A beta hem. Strep) Impetigo (if caused by Staph., use anti‑staph penicillin) Pneumococcal pneumonia Meningitis – listeria Syphilis Endocarditis |
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PCN administration
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Administration
Allergies Procaine and Benzathine PCN ONLY IM |
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PCN adverse drug events
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Adverse Drug Events:
allergic/hypersensitivity (3-10%) nausea & vomiting (>10%) increased transaminases (oxacillin) interstitial nephritis: check a chem7 every couple of weeks Thrombocytopenia Seizures: reduce seizure threshold Anxiety, hallucinations, confusion, palpitations Procaine penicillin |
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PCN Patient related variables
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Patient related variables
Allergy to PCN or other beta-lactams Renal dysfunction |
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Aminoglycosides
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Mechanism of Action: BACTERICIDAL-bind to the 30S ribosomal subunit and irreversibly inhibit bacterial RNA synthesis
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Aminoglycosides spectrum of activity
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Spectrum of Activity: most aerobic gram-negative; not effective against most anaerobic bacteria or gram-positives alone
Gentamicin – more active against Acinetobacter, Serratia, and enterococci than tobramycin Tobramycin – more active against Pseudomonas than gentamicin Amikacin – broadest antimicrobial activity (usually used against bacteria resistant to other aminoglycosides) |
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Aminoglycosides clinical uses
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Clinical uses
Serious gram-negative infections Gentamicin – gram positive synergy |
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Aminoglycosides Administration
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Administration
These drugs are very poorly absorbed when given orally Note exact time of administration ‑ this will help with the interpretation of blood concentration |
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Aminoglycosides adverse effects
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Adverse effects
Nephrotoxicity: associated with elevated troph Ototoxicity (often irreversible): associated with elevated peak COCHLEAR high tone hearing is affected first, audiograms are usually needed to detect early cochlear damage, the toxicity may progress, however, and total deafness is possible. VESTIBULAR dizziness, headache, vertigo, tinnitus. |
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Aminoglycosides Pt related variables
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Patient Related Variables
Renal dysfunction – dose or dosing interval must be adjusted Liver disease ‑ these patients have an increased risk of developing renal toxicity Drug interactions co -administration with other nephrotoxic drugs such as amphotericin B or colistin |
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Aminoglycosides Drug Levels
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Extended interval dosing possible due to post-antibiotic effect
Decreases risk of nephrotoxicity Obtain peak and trough levels Trough goal is <1 mg/dl for gentamicin and tobramycin |
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Vancomycin MOA
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BACTERICIDAL (except enterococci) - binds to bacterial cell wall and inhibits peptioglycan synthesis
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Vanc Spectum of activity
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staphlycocci, streptococci, enterococci
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Dosing of Van
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Total body weight
Loading dose 20-25 mg/kg 15 mg/kg IV q12h young patients may require q8hr -may need to renal adjust |
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Vanc clinical uses
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Clinical Uses
MRSA Serious Staphylococcal infections in patients allergic to penicillins, cephalosporins, and carbapenems |
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Vanc administration
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Administration
Not absorbed orally Orally only for the treatment of C-diff IM route causes pain and tissue necrosis and should be avoided Red Man Syndrome - related to rate of infusion |
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Vanc toxicity
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Toxicity
Nephrotoxicity – more common with troughs >20 Ototoxicity Phlebitis |
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Vanc pt related variables
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Patient related variables
Renal dysfunction |
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Tetracyclines MOA
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Mechanism of Action: BACTERIOSTATIC – reversible binding to 30S ribosomal subunit blocking attachment of transfer RNA to an acceptor site on the messenger RNA ribosomal complex
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Tetracycline spectrum of activity
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Spectrum of Activity: atypicals, Borrelia recrrentis, Vibrio, MRSA, MRSE, Pasteurella multocida, Propionibacterium acnes
Doxycycline – Mycobacterium fortuitum and M chelonae, Streptococcus pneumoniae Pseudomonas and Proteus are resistant to tetracyclines |
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Tetracyclines clinical uses
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Clinical Uses
Mycoplasma pneumonia Urethritis and PID Rocky Mountain Spotted Fever tic borne illness Gonorrhea Syphilis Preventing travelers diarrhea Acne MRSA skin infections |
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Tetracyclines adminisration
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Administration
Full glass of water to minimize GI upset make sure at a 30degree angle if bedridden Dairy products, iron products and antacids |
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Tetracyclines toxicity
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Toxicity
GI irritation, stay upright 30 minutes after dose Dental effects in children (not for children <8 yo) Photosensitivity Vestibular symptoms ‑ dizziness, headache, vertigo (especially MINOCYCLINE) |
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Metronidazole MOA
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Mechanism of Action: BACTERICIDAL – exact mechanism unknown
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Metronidazole spectrum of activity
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Spectrum of Activity: anaerobic bacteria and sensitive protozoans (Giardia, Trichomonas)
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Metronidazole clinical uses
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Anaerobic bacterial infections
Trichomonas Amebiasis Giardia Helicobacter pylori infection Bacterial vaginosis C. difficile |
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Metronidazole adverse effects
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Adverse effects
Nausea Disulfiram-like reaction with alcohol - flushing, nausea, vomiting, etc. NO ALCOHOL CNS excitability, seizures Peripheral neuropathy: with long term use: 1mo+ |
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Metronidazole pt related variables
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Patient Related Variables
Severe hepatic impairment - reduce dose Drug interactions - warfarin |
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Fluoroquinolones (Cipro) MOA
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Mechanism of Action: BACTERICIDAL – inhibit bacterial DNA topoisomerase causing breakage of DNA strandsSpectrum of Activity:
Good gram –negative Pseudomonas: levofloxacin, ciprofloxacin |
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Cipro clinical uses
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Ciprofloxacin
Infections of inner ear, soft tissue, and bone Urinary tract infections |
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Fluoroquinolones (Cipro) adverse effects
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Adverse effects
Tendonitis & tendon rupture: blackbox warning Increased risk with concomitant steroids Confusion/hallucinations esp. in the elderly (and hard to recognize when used with UTI) Dizziness or lightheadedness Hypersensitivity reactions QT prolongation hyperglycemia |
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Fluoroquinolones (Cipro) Pt related variables
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Patient related variables
Decrease dose in patients with renal impairment (levofloxacin/cipro) |
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Fluoroquinolones (Cipro) drug interactions
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Drug interactions
Sucralfate, antacids, tube feeds, and iron-containing multi-vitamins decrease absorption Inhibit metabolism of theophylline, warfarin, cyclosporine |
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Piperacillin-tazobactam
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Zoysn: broadest spectrum of the penicillins; More gram-positive, gram-negative, and anaerobic coverage than ticarcillin-clavulanic acid
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Azole Antifungals (fluconazole/Diflucan): MOA
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Inhibits fungal cytochrome P450 enzyme activity = decreased ergosterol production
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Azole Antifungals (fluconazole/Diflucan) clinical uses
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Clinical Uses
Candidal infections - oral, esophageal, blood, peritonitis, vaginal infections, etc Cryptococcal infections Blastomycosis, histoplasmosis |
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Azole Antifungals (fluconazole/Diflucan)
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Oral or IV (voriconazole, fluconazole)
100% bioavailable Posaconazole should be given with food (best with high fat meal) to increase absorption and with acidic environment*** (throw a shasta down the tube) |
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Azole Antifungals (fluconazole/Diflucan) Pt related variables
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Patient Related Variables
Renal impairment - decrease dose Drug interactions - P450 enzymes Phenytoin ( Dilantin ) Warfarin ( Coumadin ) Statins (esp with voriconazole) Immunosuppressants (tacrolimus, cyclosporine) |
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Bactericidal abx classess
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Beta lactams
Aminoglycosides Fluoroquinolones Trimethoprim/Sulfamethoxazole Clindamycin Vancomycin |
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Bactericidal
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Macrolides
Tetracyclines Sulfonamides Vancomycin(against enterococcus) Linezolid |
