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56 Cards in this Set

  • Front
  • Back
what is the 1st choice drug for uncomplicated cystitis
Trimethoprim + sulfamethoxazole
Useful in treating recurring UTIs
antiseptic....Nitrofurantoin
what is meant by an antiseptic
doesn't do anything systemically

excreted so fast it never reaches significant levels in plasma, and concentrates in urine

good for lower bladder infections
normally what do you use for an e. coli caused cystitis? what if resistance is greater than 20%?
TMP/SMX

Fluoroquinolones (ciprofloxacin)
DOC for nocardiosis?
Sulfonamides
DOC in UTI?
Sulfamethoxazole + trimethoprim
DOC for toxoplasmosis?
Sulfonamides
Sulfisoxazole is used for what? administered?
UTI

oral
Sulfamethoxazole is used for what? administered?
UTI

oral
Sodium sulfacetamide is used for what? administered?
Ophthalmic (bacterial conjunctivitis)

Topical uses
Silver sulfadiazine is used for? administered?
Burns

Topical
MOA for sulfonamides?
work as antimetabolite (pathway that is essential for life)

competitive inhibitor

in essence: the bacteria cannot use exogenous folate. Thus they must make it from PABA. So we competitively inhibit the site for PABA, so they cannot replicate their genome.

note the enzyme is dihydropteroate synthetase
mechs of resistance for sulfonamides?
cranks up production of PABA so it can make folate

mutate the enzyme used to make folate (so the drug can't bind)
what are the pharmocokinetics of sulfonamides
albumin displacement...leading to large levels of the following drug drug interactions

Oral anticoagulants
Sulfonylurea hypoglycemic agents
Hydantoin anticonvulsants
Oral anticoagulants
Sulfonylurea hypoglycemic agents
Hydantoin anticonvulsants

may have a problem when used with?
sulfonamides
person has a UTI and stops drinking water because it hurts when they pee. Suddenly they have crystals in their urine and the UTI is not getting better with treatment. What was likely given?
Sulfonamides
glucose-6-phosphate dehydrogenase (G6PD) deficiency

associated with?
Sulfonamides
aplastic anemia, rare--direct myelotoxicity-- can be fatal

side effect of what?
sulfonamides
nursing mothers or preggo women should not use sulfa drugs because?
it causes Kernicterus:

Displacement of bilirubin from plasma albumin
Free bilirubin deposits in basal ganglia and subthalamic nuclei of the brain
Causes an encephalopathy
MOA for trimethoprim?
it is an antifolate

competitive inhibitor of dihydrofolate reductase (DHFR)--which is needed to make DNA
Used to treat prostatitis and UTI?
trimethoprim
resistance to trimethoprim?
overexpression of the enzyme Dihydrofolate reductase
(where as it was overexpression of the substrate in sulfa!)

Most commonly: altered (mutated) DHFR with decreased drug binding
skin reactions are an adverse effect of what UTI drug
trimethprim
folate deficiency impacting bone marrow can be a side effect of what?
TMP and SMX
TMP/SMX is bacteri____
cidal
Prostatitis can be treated with?
TMP/SMX
DOC prophylaxis and treatment for Pneumocystis (carinii) jiroveci pneumonia (PCP) ?
TMP/SMX
this is an alternative to amoxicillin for otitis media?
TMP/SMX
DOC for H.influenzae or strep pneumo
TMP/SMX
T/F Fqs are good for MRSA
FALSE
Are Fluoroquinolones good for pseudomonas?
generally NO

EXCEPT: Ciprofloxacin is the DOC for it
MOA for Cipro?
directly blocks DNA synth by inhibiting topoisomerases
DOC for pseudomonas?
Ciprofloxacin
DOC for mycoplasma pneumoniae?
Cipro
DOC for anthrax
cipro
this FQ has expanded activity against G+ to include strep pneumo...still weak against pseudo
Levofloxacin
This drug is similar to levofloxacin but includes coverage for E. faecalis
anaerobes (bacteroides fragilis, clostrida except difficile)
Moxifloxacin
mech of resistance to FQs?
Change in drug binding region of enzyme
Change in permeability of organism
Outer membrane diffusion channel and efflux pump
which FQ has low serum levels (not good for systemic) and is limited to UTI treatment?
Norfloxacin
what FQ is not good for UTI? Why
moxifloxacin – metab in liver thus also has low urinary levels – not good for UTIs
normally well tolerated, but this drug class can cause:
headache, dizziness (0.9 – 11%)
hallucinations, delirium, seizures (rare)
FQs
What drug can cause Achilles tendon rupture or tendinitis

**
FQs
QTc prolongation is an adverse effect of?
FQs
pt has uncorrected hypokalemia with known QTc interval prolongation...what drug shouldn't be used?
FQs
these drugs are limited to lower UTIs and have limited systemic exposure...
urinary antiseptics (Nitrofurantoin)
pt with chronic UTIs that keep coming back..what should you give them?
urinary antiseptics (Nitrofurantoin)
Nitrofurantoin is what kind of drug? commonly used for?
urinary antispectic

lower UTI
MOA for Nitrofurantoin
highly reactive species formed that chemically damages DNA
spectrum of activity for Nitrofurantoin
many G- and G+

Resistant species
most species of Pseudomonas & Proteus
many species of Enterobacter & Klebsiella
how can Nitrofurantoin build up systemically? what is the problem with this?
if pt has renal failure or disease

this shit gets toxic
this drug that is not systmeically used can cause hemolytic anemia in ______

what is the drug and the ____?
drug: Nitrofurantoin

___: G6PD deficiency
Pt is on a drug that turns their urine brown...what is it
Nitrofurantoin
what drug class is used for UTIs including some multi-drug resistant (MDR) bugs, eg pseudomonas
Fluoroquinolones (FQs)

note: moxifloxacin not effective
ciprofloxacin effective against pseudomonas
what drug class is used for bacterial diarrhea due to shigella, salmonella, e. coli, etc.
Fluoroquinolones (FQs)
what drug class is used for Infections of soft tissues, bones and joints. Intra-abdominal and respiratory tract infections including MDR bugs eg pseudomonal and enterobacter
Fluoroquinolones (FQs)
____ is often effective in respiratory infections unresponsive to beta-lactams but is not DOC for pneumonia and sinusitis
ciprofloxacin