Sulfonamides And Fluoroquinolones

Front 1

Explain Bacteristatic

Back 1

Relies on the pt's immune system to clear the infection

Front 2

Explain Bactericidal

Back 2

Killing the bacteria by lysis, typically at the cell wall

Front 3

Age factors when choosing an Rx

Back 3

Renal Function: PCN - neurotoxicity; aminoglycosides - ototoxic, nephrotic
Neonates: Sulfonamides lead to Kernicterus; stay away from protein bound drugs in late pregnancy and neonates
Tetracyclines: Cross placenta, slow bone growth and bind to Ca++ in bones/teeth
Fluoroquinolones: Can cause cartilage damage and arthropathy

Front 4

Genetic consideration eg's

Back 4

Acetylation - Asians typically faster metabolizers
G6PD - Sulfonamides, nitrofurantoin and chloramphenicol increase risk of hemolysis if low levels of G6PD

Front 5

Diabetics and sulfonamides

Back 5

Sulfonamides potentiate hypoglycemic effect of oral sulfonylureas.

Front 6

Sulfonylureas action in pancreatic islet of Langerhans cells

Back 6

Release of insulin is Ca++ dependent and sulfonylureas block K+ channels which depolarizes cell bc Ca++ channel is kept open.
Sulfonamides have same effects

Front 7

Aminoglycosides and vancomycin distribution

Back 7

Oral administration only provides local effect. Must give parenterally for systemic effect.

Front 8

Rx-Lab interactions for urine sugar

Back 8

PCN, cephalosporins, and tetracyclines give false pos for urine sugar. Use Dextrostix and Labstix that are specific for only glucose

Front 9

Sulfonamides and Trimethoprim inhibitions?

Back 9

These inhibit sequential steps in synthesis of folate.
Sulfonamides - inhibit first step (PABA + pteridine); Dihydropteroate synthase

Front 10

Sulfonamides and synergistic drug?

Back 10

Typically used w/ a DHFRI for synergistic effect

Front 11

DHFRI's?

Back 11

Trimethoprim (Primsol)
Pyrimethamine (Daraprim)
Methotrexate (Trexall)

Front 12

Trimethoprim (Primsol)

Back 12

inhibits bacterial DHFR; side effect = blood dyscrasias
Sulfonamide

Front 13

Pyrimethamine (Daraprim)

Back 13

antimalarial; inhibits protozoal DHFR
Sulfonamide

Front 14

Methotrexate (Trexall)

Back 14

inhibits mammalian, bacterial, and protozoal DHFR. Used to treat psoriasis and various ca's
Sulfonamide

Front 15

Sulfisoxazole (Gantrisin Pediatric)

Back 15

Oral, prophylaxis in kids w/ recurrent otitis media.
Available w/ erythromycin as Pediazole for otitis media
Sulfonamide

Front 16

Sulfamethoxazole

Back 16

Available w/ Trimethoprim (Bactrim; Septra); aka TMP-SMZ.
Oral only, useful synergism
Tx for UTI, respiratory infections, and GI infections
Sulfonamide

Front 17

Sulfacetamide (Bleph-10=10%)

Back 17

Tx for Ulcerative blepharitis from S. aureus and S. epi; or Bacterial conjunctivitis.
Topical
Sulfonamide

Front 18

Silver Sulfadiazine(Silvadine)

Back 18

For burns to prevent sepsis, Silver is toxic.
Topical, caution: Sulfa can be absorbed if over large area
Sulfonamide

Front 19

Mafenide (Sulfamylon)

Back 19

for burns, caution: can cause metabolic acidosis by inhibiting carbonic anhydrase
Topical
Sulfonamide

Front 20

Side effects of all Sulfas

Back 20

Crystalluria
Kernicterus
Blood Dyscrasias!!!
Hypersensitivity (Stevens-Johnson syndrome)

Front 21

Fluoroquinolones use

Back 21

Broad spectrum CIDAL agents used mostly for G- and some G+

Front 22

Fluoroquinolone mechanisms

Back 22

G-: Inhibits bacterial DNA gyrase
G+: Inhibits topoisomerase IV

Front 23

Ciprofloxacin

Back 23

Ophthalmic= Ciloxan, Otic = CIPRO HC OTIC, best G- activity of FQ's

Front 24

Cipro Rx interactions

Back 24

decreases clearance of theophylline.
Avoid Tizanidine (Zanaflex)-Cipro inhibits CYP1A for tizanidine metabolism
Also inhibits CYP3A4 (Metabolism of methadone)

Front 25

Norfloxacin(Noroxin)

Back 25

Least active, UTI ONLY
FQ

Front 26

2nd Gen FQ's

Back 26

Cipro
Norfloxacin(Noroxin)
Ofloxacin(Floxin)

Front 27

3rd Gen FQ's

Back 27

Gatifloxacin(zymar)
Gemifloxacin (Factive)
Levofloxacin (Levaquin)
Moxifloxacin(Avelox)

Front 28

Gatifloxacin(zymar)

Back 28

ophthalmic solution ONLY
FQ

Front 29

3rd Gen Respiratory FQ's

Back 29

Gemifloxacin (Factive)
Levofloxacin (Levaquin)
Moxifloxacin(Avelox)

Front 30

Levofloxacin (Levaquin)

Back 30

Increase risk of prolonging QT interval in elderly (Torsades de pointes)
Risk of acute hepatitis and fatal events (rare)

Front 31

Moxifloxacin (Avelox)

Back 31

Ophthalmic = Vigamox; Metabolized by liver/caution w/ liver disease. Can prolong QT in HEALTHY pt's

Front 32

Side effects of all FQ's

Back 32

Phototoxicity
Arthropathy
Tendon rupture (BBW)
Diabetics
CNS stimulation
Nausea, vomiting, diarrhea

Front 33

C. difficile and pseudomembranous colitis

Back 33

FQ's major cause of C. difficile and pseudomembranous colitis bc C. difficile sporulates and produces two toxins. Damages mucosa and lyses cells.

Front 34

FQ Rx interaction

Back 34

avoid antacids and Fe supplements; they chelate w/ mono and divalent cations decreasing absorption of Rx

Front 35

Sulfonamide targets

Back 35

Broad spectrum STATIC vs G+/G-