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248 Cards in this Set

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active ingredients in St. Johns Wort.
hypericin and pseudohypericin
mechanism of action of St. Johns Wort
unknown
may block serotonin uptake
stimulate GABA
therapeutic uses of St. Johns wort
treat mild to moderate depression
- GABA agonist and SSRI
- hypericin is active component
some effectiveness against retroviruses
what are the side effects of St. John's Wort
phototoxicity
HTN --> HTN crisis because of blockade of NE and 5-HT
Contraindications of St. John's Wort
Tryptophan/tyrosine
foods with tyramine
stimulants
b2-agonist (additive effect may cause HTN crisis)
should a patient with a history of HTN take St. John's Wort?
NO
active ingredient in Ginseng
panaxosides
ginsenosides (more potent)
MOA of Ginseng
anxiolytic activity
possibly via GABA receptor modulation simliar to BZDs
takes 4-5 hours for therapeutic effect
no apparent sedation/muscle relaxant activity
therapeutic use of Ginseng
treatment of depression
colds, flus, influenza, respiratory problems
side effects of Ginseng
precipitate asthma attack
heart palpitations/HTN
NO drug interactions reported
MOA of Gingko Biloba
dilates blood vessels
increases cerebral and peripheral blood flow
decreases cerebral glucose levels
neuro-protective in hypoxia and ischemia
MAO-A/MAO-B inhibitors
Therapeutic uses of Gingko
vascular disorders
mental/emotional fatigue
clotting disorders
headache
Raynaud's
neuroprotectant
side effects of Gingko
excessive bleeding/hemorrhage in the elderly
active ingredients of KAVA
Kavain and Dihydrokavain
methystein and dihydromethystein
MOA of KAVA
biphasic stimulant
stimulates the CNS at low levels of activity
inhibits the CNS at high activity levels
Therapeutic use of KAVA
sedative
muscle relaxant
diuretic
anxiolytic
analgesic in place of ASA, acetaminophen, NSAIDS
Valerian
improves sleep
DO NOT use with BZDs
Cholestin
lowers cholesterol
Echinacea
boost immune system by increasing WBC activity
Goldenseal
antiseptic to treat sores in the mouth
DHEA
supplementation is anti-aging
prolonged use of DHEA
high doses over long periods cause liver dysfunction, decreased CO, masculinization in females
what have low doses of DHEA been shown to do?
have some beneficial effects
- weight loss, improved strength & endurance, improved cholesterol status, improved mental alertness/cognition
Melatonin
sleep aid to combat jet lag
what are the side effects of Melatonin
infertility
loss of libido
what drug would be indicated for treatment of bacterial meningitis (H. influenza) in a 2 year old boy?
Cefotaxime
third generation cephalosporin crosses the CNS and are effective against gram negative organisms
an adult female presents with a UTI caused by an aerobic gram negative bacillus. She has previously had a HSR to penicillin G. What agent should she be given?
Aztreonam
- generally safe in those with allergic to penicillins and cephalosporins
what parentally administered agent would be most effective against b-lactamase producing strains of H. influenza and N. gonorrhoeae?
Ceftriaxone
- 3rd generation cephalosporin with a wide range of activity against gram negative bacteria
what is the most active against Pseudomonas aeruginosa from the penicilian family?
Piperacillin
- extended spectrum
an adult female is admitted to the hospital with endocarditis caused by penicillinase-producing Staphylococcus aureus infection and requires parental therapy. What is indicated?
Nafcillin
- penicllinase resistant and typically given parentally
an 8 year old patient with pharyngitis caused by Chlamydia pneumonia. Previously this child had an adverse reaction to amoxicillin. what should the child be treated with?
Azithromycin
- macrolide very effective against otitis and URI
Cephalexin
1st generation cephalosporin
how is Vancomycin administered?
not readily absorbed orally
given IV
reserved for serious infections
Azithromycin
a macrolide that acts against the 50S ribosomal subunit to inhibit translation of peptidyl-mRNA from the acceptor side to the donor site
Doxycycline
Tetracycline
-binds to the 30S subunit and prevents tRNA from binding to the A site.
Gentamycin
aminoglycoside
fixes the 30-50S complex at the start codon of mRNA
Mupirocin
prevents addition of isoleucine to nascent peptides.
Topical treatment for impetigo caused by streptococci and staphylococci and nasal MRSA infections
Tetracycline
acts at the 30S subunit
what drug must be given for a 7 days course of treatment in order to be effective against uncomplicated gonorrhea?
Doxycycline
what drugs can be given in a single dose and be effective against uncomplicated gonorrhea?
azithromycin
ceftriaxone
ciproflaxin
Fosfomycin
uncomplicated UTI
- E.coli, Staph, enterococci
H. influenza, M. catarrhalis, and N. gonorrhoeae are all beta-lactamase producers. What drug is effective against all three organisms?
Ceftriaxone
IM DOC
4th generation cephalosporin
Is amoxicillin sensitive to beta-lactamase?
YES
B-lactam antibiotics
inhibit cell wall synthesis
list the b-lactam antibiotics
penicillins
b-lactamase inhibitors
cephalosporins
monobactams
carbapenems
what are b-lactamases?
bacterial enzymes which hydrolyze the b-lactam ring and inactivate antibiotics
what are the narrow spectrum penicillins?
Penicillin G
Penicillin V
MOA of penicillins?
binds to penicillin binding protein
- bacterial enzyme responsible for the assembly, maintenance, and regulation of the peptidoglycan portion of the cell wall
- inhibition of the PBP-1 prevents cross linking of peptidoglycans
- inhibition of PBP-2 results in loss of rod shape
Peptidoglycan linkage is catalyzed by transpeptidase
- penicillin irreversibly binds to active site of transpeptidase mimicing the D-alanyl-D-alanine residue that would normally bind the site
If a bacteria is penicillinase resistant what b-lactam would you use for tx?
Dicloxacillin
Nafcillin
what are the extended spectrum b-lactams?
amoxicillin
ampicillin
pipercillin
ticarcillin
of the b-lactams which are acid stable and can be given orally?
amoxicillin
dicloxacillin
naficillin
penicillin V
what b-lactams must be given parenterally because they are acid-labile?
pipercillin
ticarcillin
b-lactams are usually widely distributed throughout the body, except in what tissue?
brain
prostatic secretions
introcular secretions
how are b-lactams excreted from the body?
glomerular filtration and renal tubular secretion
- ampicillin and naficillin are excreted in the bile
What two b-lactams in the penicillin family are not excreted by the kidney?
Ampicillin
Naficillin
- they are excreted in the bile
how can you prolong the half life of penicillins?
administer Probencid with the penicillins because it prolonges the half life of the penicillins by competing for transport to the proximal tubule
what occurs when penicillin and vancomycin are administered together?
with monotherapy both drugs are bacteriostatic
- when administered together they synergistically cause bactericidal activity
- used in the treatment of enterococcal endocarditis
if you wanted to enhance the uptake of an aminoglycoside, what would be an appropriate drug to administer with it to increase the uptake of the aminoglycoside?
penicllins increase bacterial uptake of the aminoglycosides
T/F
Broad spectrum antibiotics should be used as surgical prophylaxis.
False
the antibiotic should be specific to the surgical wound pathogen
concentration at time of surgery more important than MIC
DOC for most prophylaxis of surgery
Cefazolin
DOC for anthrax prophylaxis
Ciprofloxacin
Doxycycline
prophylaxis of Cholera
Tetracycline
prophylaxis of Endocarditis
amoxicillin
clindamycin
prophylaxis of HIV
Zidovudine + lamivudine
otitis media prophylaxis
amoxicillin
T/F
Until it is certain that the infection isolate is penicillin sensitive a 3rd generation cephalosporin or vancomycin is indicated for meningitis
True
you have isolated meningococci from your patient. what penicillin would you administer?
Penicillin G (narrow spectrum)
A 20 year old male presents with s/s of syphilis. What medication would you prescribe?
Penicillin G
You have isolated a Gram + cocci from a patient with pneumonia. What penicillin would you administer?
Penicillin G for treatment of pneumococci
you have diagnosed your patient with pharyngitis caused by Streptococcus pyogens. What penicillin would you administer?
Penicillin V
how is Dicloxacillin administered?
orally
how is Nafcillin administered?
parentally
what are Nafcillin and Dicloxacillin used to treat?
Penicillinase resistant infections
- serious penicillinase producing Staphyloccus
- osteomyolytis
- endocarditis
- skin and soft tissue infections
T/F
Dicloxacillin/Nafcillin are effective against gram negative bacteria.
False
only Gram + bacteria
used in penicillinase producing organisms
You have diagnosed your patient with MRSA. What do you treat with?
Vancomycin
what are the extended spectrum penicillins?
Amoxicillin
Ampicillin
Pipercillin
what bugs are extended spectrum penicillins able to used to treat a patient for an infection of?
H. influenza
E. coli
Proteus misabilis
A 2 year old child is diagnosed with otitis media. What penicillin do you treat with?
Amoxicillin
A patient has an URT infection caused by H. influenza. What penicillin do you use to treat?
Amoxicillin
Your patient has an infection caused by S. pneumonia of the upper respiratory system. What penicillin do you use for treatment?
amoxicillin
An immunocompromised patient presents with s/s of meningitis. You perform a spinal tap. The gram stain comes back positive for L. monocytogenes. What do you use for treatment?
Ampicillin
- extended spectrum penicillin
what type of infection is Pipercillin used to treat?
anti-pseudomonal agent
- Gram (-) bacteria P. aeruginosa causing a nonsocomial pneumonia
You prescribe penicillin to a patient. They did not know that they were allergic to it. What type of HSR is this. What occurred?
Type 1 HSR: IgE mediated response
degradation products of penicillin combine with protein > antigenic compounds > rash, nephritis, serum sickness, anaphylactic shock possible
Treatment of Penicillin sensitive streptococcus pneumonia.
Amoxicillin in children
Azithromycin
Cetriaxone
Penicillin-resistant Streptococcus pneumonia
Levo/monofloxacin
treatment of acute pharyngitis with penicillin?
Penicillin G
Scarlet fever treatment with a penicillin.
Penicillin G
Acute otitis media treatment with a penicillin.
Amoxicillin
H. pylori treatment with a penicillin.
Amoxicillin + clarithromycin
Treatment of impetigo caused by staphylococci with a penicillin.
Dicloxacillin
Cephalexin
Mupirocin
treatment of impetigo caused by streptococcal infection.
amoxicillin
mupirocin
what is the mechanism of action of Cephalosporins?
inhibitors of cell wall synthesis
how are most cephalosporins administered?
orally
- absorbed readily from gut and food has minimal effect on bioavailability.
how are cephalosporins excreted?
renal excretion
what cephalosporin is not excreted by the kidneys?
Ceftriaxone
what generation of cephalosporin is Cephalexin?
1st generation cephalosporin
what type of infections is Cephalexin or other 1st generation antibiotics used to treat?
skin and soft tissue infections
Gram + cocci
few Gram - organisms
You have a patient with a streptococci infection of the skin. What cephalosporin would you treat it with?
CEphalexin
Do 1st generation cephalopsporins enter the CNS?
NO
Cefazolin
1st generation cephalosporin
- parentally administered
- treatment of serious streptococci
- surgical prophylaxis against staphylococci
- Gram (-) enteric bacilli
what are the second generation cephalosporins?
Cefprozil
Cefuroxime sodium
Ceotetan
Cefoxitin
Cefprozil
2nd generation of activity against Gram (-) bacteria
- oral administration
- Otitis caused by amoxicillin resistant H. influenza
your patient has amoxicillin resistant otitis media caused by H. influenza. What do you treat them with?
Cefprozil
what is the only 2nd generation cephalosporin to cross into the CNS?
Cefuroxime sodium
Cefuroxime sodium used for treatment of what?
emperic treatment of community acquired pneumonia
Cefotetan
2nd generation cephalosporin
intra-abdominal, GYN, biliary tract infections
what is a second generation cephalosporin used for surgical prophylaxis?
Cefoxitin
3rd generation cephalosporins?
Ceftriaxmine
Ceftriaxone
what are 3rd generation cephalosporins used for treatment of?
Cefotetan, Ceftrixamine
- wider range of activity against Gram (-) including Enterobacteria, H. influenza, M. catarrhalis
what drugs can be used to treat Gonorrhea, UTI, intra-abdominal infections, otitis media, meningitis, pneumonia, and Lyme's disease
3rd generation cephalosporins
- Cefotaxamine
- Ceftriaxone
Do 3rd generation cephalosporins enter the CNS?
YES
List the 4th generation cephalosporin.
Cefepime
what is Cefepime used for?
4th generation cephalosporin
- very resistant BLM
- targets Gram - bacteria
- Nosocomial pathogens
what do you used to treat a nonsocial infection of Citrobacter freundi or Enterobacter cloacae?
4th generation cephalosporin
- Cefepime
What are Cephalosporins not effective against?
LAME
- Listeria monocytogenes
- Atypical (Chlamydia/Mycoplasma)
- MRSA
- Enterococci
T/F
Cephalosporins exhibit cross sensitivity with penicillins
True
If your patient has had a mild reaction to treatment with penicillins should they be treated with a cephalosporin?
YES, cephalosporins are usually tolerable
If your patient has had a severe reaction to treatment with penicillin, should they be treated with a cephalosporin?
NO
contraindicated
List b-lactamase inhibitors
Clavulanate
Sulbactam
Tazobactam
- irreversibly bind b-lactamase produced by bacteria
Aztreonam
monobactam
- monocyclic b-lactam
effective against many Gram (-) bacteria
- Enterobacter, Citrobacter, Kleibsiella, Proteus, P. aeriginosa
what type of bacteria are resistant to Aztreonam?
Gram positive and anaerobic bacteria
T/F
A patient that is allergic to penicillins and cephalosporins are generally NOT allergic to aztreonam.
True
what type of drug is Imlpenem and Meropenem?
Carbapenems
- active against a wide range of Gram +/- bacteria, anerobic/aerobic gram - bacilli systemic infections
Why is Cilastin administered with Imipenem?
Imipenem is inactivated by renal dehydropeptidase
Cilastin is an enzyme inhibitor
Do Carbapenems have cross sensitivity with penicillins, cephalosporins, and b-lactams?
YES
- avoid in allergic patients
Vancomycin
active against Gram + cocci and bacilli
- reserved for serious infections caused by penicillin resistant organisms (MRSA/enterococci)
Bacitracin
topical treatment of minor skin and ocular infections
- Gram + staphylococci and streptococci
Fosfomycin
irreversibly inhibits enolypyruval transferase in the initial stage of cell wall peptidoglycans synthesis
- treatment of uncomplicated UTIs (single dose)
patient has Klebseilla pneumonia. treatment with carapenems.
impenem/meropenem
patient has penicillin sensitive streptococcus pneumonia. Treatment with what?
amoxicillin in children
azithromycin
ceftriaxone (3rd generation)
Patient has penicillin resistant streptococcus pneumonia. Treatment?
Levo/moxifloxacin
child presents with impetigo. you determine it is caused by Staphylococci. treatment?
dicloxacillin
cephalexin
mupirocin
child present with impetigo. you determine it is caused by Streptococcal origin. treatment?
amoxicillin
mupirocin
your patient has a Pseudomonas infections of the lung. what penicillin do you use for treatment?
Piperacillin
your patient has a Pseudomonas infection of the heart what do you use for treatment?
Tobramycin
what is the mechanism of action of Tetracyclines?
bind the 30S bacterial ribosome and prevents access to aminoacyl-tRNA to the A site
mechanism of action fo aminoglycosides.
1. block initiation complex of protein synthesis by fixing the 30S/50S complex to the start codon
2. causes misreading of the mRNA leading to premature termination of translation
- incorporation of incorrect amino acids
- bacteriostatic effect
what are the drugs that affect the 30S subunit of bacteria ribosome?
aminoglycosides
tetracyclines
examples of aminoglycosides
amikacin
gentamycin
neomycin
streptomycin
tobramycin
Are aminoglycosides readily absorbed by the gut?
NO
- poorly absorbed in the gut
what do aminoglycosides require?
oxygen and ATP
- active against aerobic bugs
Aminoglycosides: bactericidal or bacterostatic?
Bactericidal
what a aminoglycosides blocked by?
blocked by low pH, anaerobic bacteria, divalent cations
how are aminoglycosides excreted?
excreted by renal glomerular filtration
how are aminoglycosides administered?
parentally for systemic infections
what are the adverse effects seen with aminoglycosides?
Nephrotoxicity: accumulation in proximal tubules > acute necrosis
Ototoxicity: accumulation in the labyrinth and hair cells of cochlea
what are aminoglycosides most effective against?
Aerobic Gram Negative Bacilli
Streptomycin
aminoglycoside
- treat multi-drug resistant TB, plaque (Yersina pestis) and Tularemia (Francisella tularenesis)
Gentamicin
aminoglycoside
most active against Enterobacterinceae species
Tobramycin
aminoglycoside
most active against P. aeruginosa
Amikacin
aminoglycoside
resistant to enzyme inactivation
used when infection is resistant to other amionglycosides
Neomycin
aminoglycoside
MOST NEPHROTOXIC
limited to topical therapy
Mechanism of action of Tetracyclines.
bind to 30S bacterial ribosome and prevent access to aminoacyl-tRNA to the A-site
List Tetracyclines.
Tetracycline
Doxycycline
Minocycline
Are Tetracyclines bacteriostatic or bactericidal?
Bacteriostatic
Are tetracyclines broad spectrum antibiotics?
YES
What is the oral bioavailability of tetracyclines?
oral bioavailability of 70
what type of medication should tetracyclines not be taken with?
antacids/iron supplements
how are tetracyclines excreted?
urine and feces
Is Doxycycline excreted by the kidneys?
NO
not dependent upon renal elimination
what tetracycline reaches the CNS and penetrates the skin efficiently?
Minocycline
what are the adverse side effects of Tetracyclines?
discoloration of teeth
photosensitivity
what is the DOC for Rocky Mountain Spotted fever?
Doxycycline
what is the DOC for Lyme's disease?
Doxycycline
your patient is diagnosed with Borrelia burgdorferi. What should your treatment plan be?
Doxycycline
what is an alternative choice of treatment for Treponema pallidum (syphilis)?
Doxycyline
what type of antibiotic is used for treatment of Acne vulgaris?
a tetracycline
- doxycycline
what type of antibiotic is used for treatment of genital infections caused by Chlamydia?
Doxycycline
what drugs affect the 50S ribosomal subunit of the bacteria ribosome?
macrolides
chloramphenicol
clindamycin
quinuproston-dalfopristin
Linezolid
list the macrolides
Azithromycin
Clarithromycin
Erythomycin
what is the mechanism of action of macrolides (azithromycin, clarithromycin, erythromycin)?
binds the 50S subunit
- prevents translation of the nascent peptide from A > P site
- inhibits binding of next aminoacyl-tRNA
how are macrolides administered?
Orally
which macrolide's absorption is decreased by gastric acid?
Erythromycin
which macrolides are readily absorbed by the gut?
Azithromycin and Clarithromycin
- readily absorbed, longer half-life, achieve higher concentrations in tissues
- less likely to cause GI distress
how are macrolides excreted?
excreted in the bile and urine
which macrolides inhibit the CYP3A4 enzymes?
Erythromycin
Clarithromycin
T/F
Azithromycin has very little effect on the CYP3A4 enzymes.
True
Erythromycin and Clarithromycin inhibit CYP3A4
what pathogens is azithromycin extremely effective against?
Chlamydia
H. influenza: otitis media, sinusitis
M. pneumonia
L. pneumophilia
what type of infections are macrolides used to treat?
URI and pneumonia
Adverse effects of macrolides (azithromycin, clarithomycin, erythromycin)
GI upset
ototoxicity
what is the most effective macrolide against H. pylori?
Clarithromycin
Clindamycin
suppresses protein synthesis by inhibiting the 50S ribosomal subunit
what is Clindamycin used to treat?
penicillin resistant streptococci
anaerobic bacteria (Bacteroides fragilis, Clostridium perferinges)
what is a patient at risk for when being treated with Clindamycin?
Clostridium difficile causing severe diarrhea
how is clindamycin excreted?
in bile and urine
Chloramphenicol
binds 50S subunit at peptidyltransferase site, inhibiting it.
BROAD spectrum antibiotic
what is a risk of treating neonates with Chloramphenicol for meningitis caused by pneumococci?
Chloramphenicol is highly lipophilic and readily enters the CNS
- it is metabolized by glucuronate-conjugation and excreted in the urine
NEONATES are relatively deficient in this enzyme > can lead to toxicity
MUST decrease drug levels to prevent toxicity
Adverse effects of Chloramphenicol.
anemia
toxicity in neonates
Quinupriston-Dalfopristin
streptogramins
IV administration
- doesn't enter the CNS
- inhibits synthesis of tRNA and peptidyltransferase
- used in Vancomycin resistant infections
what drug is used in vancomycin resistant infections?
Quinupristin-Dalfopristin
Linezolid
oxazolidinediones
-IV/oral administration
- binds 23S ribosomal RNA of 50S subunit > prevents formation of functional 70S initiation complex
- REDUCES resistance
- clinical: active against many aerobic Gram + organisms
- vancomycin resistant E. faecium and MRSA
Mupirocin
contains a side chain similar to Isoleucine
- competes for bacterial isoleucine tRNA synthase
- NO Cross resistance
- clinical: active against most Staphylococci
what is the fist effective treatment topically of impetigo?
Mupirocin
Bordetella pertusis treatment
Azithromycin
Acne vulgaris treatment
Tretinoin
Erythromycin
Clindamycin
what are the antifolate drugs?
Sulfamethoxazole
Trimethoprim
why are anti-folate drugs effective against bacteria?
bacteria must make their own folate > folate is necessary for DNA synthesis
- folate synthesis is initiated by fusion of pteridine and PABA > DHF
Mechanism of action of Sulfamethoxazole.
inhibits Dihydropteroate synthase
mechanism of action of Trimethoprim.
inhibits folate synthase
what is Sulfamthoxazole primarily used in the treatment of?
primarily UTIs
what drug may cause crystaluria? mechanism?
Sulfamethoxazole
- inactivated by N-acetylation > precipitation in renal tubules > crystaluria
T/F
Sufficient hydration is necessary when taking Sulfamethoxazole.
True
to prevent crystaluria
what anti-folate drug may be used in the treatment of ocular infections?
Sulfacetamide
- topical treatment
what is a topical anti-folate that is used in the treatment of burns to prevent infection? BROAD spectrum
Silver sulfadiazine
Trimethoprim
weak base, concentrated in tissues that are more acidic than plasma
- prostate and vaginal fluids
what is Trimethoprim used to treat?
used to treat bacterial prostatitis and vaginitis
what is TMP-SMX primarily used in the treatment of?
primarily UTI and prostate infections
- E. coli, K. pneumonia, Proteus species, Enterobacter species
DOC for pulmonary infections caused by Pneumocystisis jiroveci or Nocardia asateroides
TMP-SMX
Is TMP-SMX active against Pseudomonas aeruginosa infections?
NO
often causes UTI in hospitalized patient
what are the Fluroquinolones?
Ciprofloxacin
Levofloxacin
Moxifloxacin
Gentifloxacin
Gemifloxacin
side effects of Fluroquinolones (ending in -floxacin)
joint and bone damage in children
what are Fluroquinolones most effective in treating?
- ends in -floxacin
- treatment against gram negatives
do Fluroquinolones have a long post antibiotic effect?
YES
0 concentration dependent killing
what effect does fluroquinolones have on caffeine?
inhibits the metabolism of caffeine
MOA of fluroquinolones (-floxacin).
inhibits bacterial DNA topoisomerase
Norfloxacin
fluroquinolone
- only indicated for UTI due to rapid rate of excretion
what type of UTIs can Fluroquinolones be used to treat?
many members of Enterobacteriacae
P. aeruginosa
Fluroquinolones are used to treat bacterial diarrhea. What causes indicated Fluroquinolones?
Campylobacter
Salmonella
E. coli
Respiratory tract infections can be treated with Fluroquinolones (-floxacin). which Fluroquinolone is used to treat respiratory infections?
Levofloxacin
- advanced fluroquinolone
- treatment of pneumococci, H. influenza, M. catarrhalis
what fluroquinolone can be used to treat ocular infections?
Levofloxacin
Nitrofurantoin
treatment of UTIs: particularly acute infections localized to urinary bladder (E. coli and enterococci sensitive)
what bacteria are resistant to Nitrofurantoin?
Proteus
Pseudomonas
Enterobacter
Kleibsiella
Daptomycin
unique lipopeptide antibiotic
-RESERVED FOR RESISTANT BUGS
- disrupts plasma membrane function without entering cytoplasm
what is Doptomycin used to treat?
Gram positive drug resistant organisms
- MRSA
- Vancomycin-RSA
- Vancomycin-R-enterococci
Polymyxin B
polypeptide antibiotic (Gram - only)
topical preparations > interacts with phospholipid component of the bacterial cell wall to disrupt membrane integrity
Rifaximin
nonabsorbed antibiotic
inhibits RNA synthesis by inhibiting the DNA dependent RNA polymerase
-treatment of travelers diarrhea (E. coli/noninvasive)
immunocompromised patient has Nocardia asteroides infection. What is the DOC?
TMP-SMX
E.coli is causing a UTI. what anti-folate drug is used?
TMP-SMX
E. coli is causing a GI infection causing diarrhea. DOC?
Ciprofloxacin/levofloxacin
DOC for Salmonella paratyphi?
Ciprofloxacin
what is Dapsone used in the treatment of ?
M. leprae
- inhibits folate acid synthesis
adverse effect of Dapsone?
hemolytic anemia common in G6PD deficiency
Isoniazid MOA
inhibits mycolic acid synthesis by inhibiting enoyl reductase
how does M. tuberculosis develop resistance to Isoniazid?
mutation of katG
adverse effects of Isoniazid?
hepatitis (monitor serum transaminases)
peripheral neuritis > paraesthsias, numbness of fingers and toes bc inactivation of vitamin B6 (pyroxidine)
what drug is effective against TB meningitis? (TB and MAC)
Ethambutol
MOA Ethambutol?
inhibits RNA synthesis and arabinosyl transferase (mycobacterium cell wall synthesis)
adverse effects of Ethambutol.
increase urate (gout like)
optic neuritis
impaired red-green color discrimination
Pyrazinamide
converted to pyrazinoic acid by mycobacterium > reduces ambiant pH
widely distributed in the CNS
adverse reactions in Pyrazinamide.
hepatic toxicity
hyperuricemia
Rifampin
broad spectrum antibiotic
- binds RNA polymerase > inhibits DNA transcription
- significant enterohepatic cycling
- excreted in bile and urine
- penetrates BBB
- Adverse rxns: significant drug rxns bc of induction of hepatic enzymes
what drug is bactericidal to M. leprae?
Clofazimine
Clofazimine MOA
binds DNA > disrupts replication
general anti-inflammatory properties > prevents erythema nodosum leprosum
adverse effects of Clofazimine
GI distress
hepatitis
discoloration of body secretions
Mycobacterium tuberculosis treatment
isoniazid
rifampin
pyrazinamide
ethambutolol
MAC prophylaxis
Azithromycin
treatment: azithromycin+ethambutolol+rifampin
M. leprae tuberculoid
dapsone + rifampin
M. leprae lepromatous
dapsone + rifampicin + clofazimine