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56 Cards in this Set
- Front
- Back
what is the 1st choice drug for uncomplicated cystitis
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Trimethoprim + sulfamethoxazole
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Useful in treating recurring UTIs
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antiseptic....Nitrofurantoin
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what is meant by an antiseptic
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doesn't do anything systemically
excreted so fast it never reaches significant levels in plasma, and concentrates in urine good for lower bladder infections |
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normally what do you use for an e. coli caused cystitis? what if resistance is greater than 20%?
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TMP/SMX
Fluoroquinolones (ciprofloxacin) |
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DOC for nocardiosis?
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Sulfonamides
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DOC in UTI?
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Sulfamethoxazole + trimethoprim
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DOC for toxoplasmosis?
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Sulfonamides
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Sulfisoxazole is used for what? administered?
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UTI
oral |
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Sulfamethoxazole is used for what? administered?
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UTI
oral |
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Sodium sulfacetamide is used for what? administered?
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Ophthalmic (bacterial conjunctivitis)
Topical uses |
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Silver sulfadiazine is used for? administered?
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Burns
Topical |
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MOA for sulfonamides?
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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 |
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mechs of resistance for sulfonamides?
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cranks up production of PABA so it can make folate
mutate the enzyme used to make folate (so the drug can't bind) |
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what are the pharmocokinetics of sulfonamides
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albumin displacement...leading to large levels of the following drug drug interactions
Oral anticoagulants Sulfonylurea hypoglycemic agents Hydantoin anticonvulsants |
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Oral anticoagulants
Sulfonylurea hypoglycemic agents Hydantoin anticonvulsants may have a problem when used with? |
sulfonamides
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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?
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Sulfonamides
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glucose-6-phosphate dehydrogenase (G6PD) deficiency
associated with? |
Sulfonamides
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aplastic anemia, rare--direct myelotoxicity-- can be fatal
side effect of what? |
sulfonamides
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nursing mothers or preggo women should not use sulfa drugs because?
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it causes Kernicterus:
Displacement of bilirubin from plasma albumin Free bilirubin deposits in basal ganglia and subthalamic nuclei of the brain Causes an encephalopathy |
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MOA for trimethoprim?
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it is an antifolate
competitive inhibitor of dihydrofolate reductase (DHFR)--which is needed to make DNA |
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Used to treat prostatitis and UTI?
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trimethoprim
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resistance to trimethoprim?
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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 |
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skin reactions are an adverse effect of what UTI drug
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trimethprim
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folate deficiency impacting bone marrow can be a side effect of what?
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TMP and SMX
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TMP/SMX is bacteri____
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cidal
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Prostatitis can be treated with?
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TMP/SMX
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DOC prophylaxis and treatment for Pneumocystis (carinii) jiroveci pneumonia (PCP) ?
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TMP/SMX
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this is an alternative to amoxicillin for otitis media?
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TMP/SMX
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DOC for H.influenzae or strep pneumo
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TMP/SMX
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T/F Fqs are good for MRSA
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FALSE
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Are Fluoroquinolones good for pseudomonas?
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generally NO
EXCEPT: Ciprofloxacin is the DOC for it |
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MOA for Cipro?
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directly blocks DNA synth by inhibiting topoisomerases
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DOC for pseudomonas?
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Ciprofloxacin
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DOC for mycoplasma pneumoniae?
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Cipro
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DOC for anthrax
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cipro
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this FQ has expanded activity against G+ to include strep pneumo...still weak against pseudo
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Levofloxacin
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This drug is similar to levofloxacin but includes coverage for E. faecalis
anaerobes (bacteroides fragilis, clostrida except difficile) |
Moxifloxacin
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mech of resistance to FQs?
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Change in drug binding region of enzyme
Change in permeability of organism Outer membrane diffusion channel and efflux pump |
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which FQ has low serum levels (not good for systemic) and is limited to UTI treatment?
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Norfloxacin
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what FQ is not good for UTI? Why
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moxifloxacin – metab in liver thus also has low urinary levels – not good for UTIs
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normally well tolerated, but this drug class can cause:
headache, dizziness (0.9 – 11%) hallucinations, delirium, seizures (rare) |
FQs
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What drug can cause Achilles tendon rupture or tendinitis
** |
FQs
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QTc prolongation is an adverse effect of?
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FQs
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pt has uncorrected hypokalemia with known QTc interval prolongation...what drug shouldn't be used?
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FQs
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these drugs are limited to lower UTIs and have limited systemic exposure...
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urinary antiseptics (Nitrofurantoin)
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pt with chronic UTIs that keep coming back..what should you give them?
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urinary antiseptics (Nitrofurantoin)
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Nitrofurantoin is what kind of drug? commonly used for?
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urinary antispectic
lower UTI |
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MOA for Nitrofurantoin
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highly reactive species formed that chemically damages DNA
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spectrum of activity for Nitrofurantoin
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many G- and G+
Resistant species most species of Pseudomonas & Proteus many species of Enterobacter & Klebsiella |
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how can Nitrofurantoin build up systemically? what is the problem with this?
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if pt has renal failure or disease
this **** gets toxic |
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this drug that is not systmeically used can cause hemolytic anemia in ______
what is the drug and the ____? |
drug: Nitrofurantoin
___: G6PD deficiency |
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Pt is on a drug that turns their urine brown...what is it
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Nitrofurantoin
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what drug class is used for UTIs including some multi-drug resistant (MDR) bugs, eg pseudomonas
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Fluoroquinolones (FQs)
note: moxifloxacin not effective ciprofloxacin effective against pseudomonas |
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what drug class is used for bacterial diarrhea due to shigella, salmonella, e. coli, etc.
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Fluoroquinolones (FQs)
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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
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Fluoroquinolones (FQs)
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____ is often effective in respiratory infections unresponsive to beta-lactams but is not DOC for pneumonia and sinusitis
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ciprofloxacin
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