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102 Cards in this Set
- Front
- Back
What is the mechanism of action for penicillins?
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cell wall synthesis inhibition stage 3 bactericidal
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How are penicillins excreted?
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renal
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What are the adverse reactions of penicillins?
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anaphylaxis (Type I rare) rash (common) convulsions (very high doeses)
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How do you administer penicillin G?
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IM/IV - it is a poor oral drug
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How do you administer penicillin V?
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Good oral
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What spectrum of bugs do penicillins cover?
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Gram+ cocci, gram - cocci, gram+rods, and anaerobes (but not bacteroides)
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What are three gram + cocci?
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staph, strep and entero
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What is our gram - cocci?
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neisseria
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What antibiotics can we use that are penicillinase - resistant
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oxacillin, diclocacillin, methacillin, nafcillin
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Which two penicillinase- resistant drugs can be given oral ?
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oxacillin and dicloxacillin
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What do you give penicillinase - resistant drugs for?
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penicillinase - producing staph aureus (MSSA) - and non MRSA skin infections
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All other penicillin classes are penicillinase suseptible unless combined with what two B-lactamase inhibitors?
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amoxicillin/clavulanate
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What are the extended spectrum penicillins?
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amoxicillin and ampicillin
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How are amoxicillin and ampicillin administered?
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orally
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Amoxicillin and ampicillin are extended spectrum to what bugs?
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gram - rods and gram + cocci
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What are 3 gram - rods?
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H.flu, E.coli, M.Catarr
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What are the adverse reactions to the extendend spectrum penicillins amoxicillin and ampicillin?
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diarrhea and superinfection
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What are the antipsuedomonal penicillins?
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piperacillin and ticarcillin
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What antipseudomonals should be given ?
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IV only
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What spectrum of bugs are antiseudomonal penicillins used for?
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Pseudomonas and bacteroides (and other anearobes)
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What is the mechanism of action for cephalosporins?
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cell wall synthesis inhibition stage 3 - bactericidal
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How are cephalosporins excreted?
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renal
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Cephalosporins work on what spectrum of drugs?
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an extended spectrum... depending on generation
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Are cephalosporins suseptible to penicillases
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no
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What are the adverse reactions associated with cephalosporins?
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allergy (less severe than penicillin)
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What percent of people that are allergic to penicillin will also be allergic to cephalosporins?
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1-5%
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What 1st generation cephalosporins can be given orally?
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cephalexin and cephradine
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1st generation cephalosporins are used against what?
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gram+cocci, gram- rods
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What is an adverse reaction to 1st generation cephalosporins?
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diarrhea
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Which 1st generation cephalosporins can be only given IV/IM?
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cefazolin
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What are three gram - rods that are suseptible to 1st generation cephalosporins?
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proteus, e. coli, and klebsiella
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What are the 1st generation cephalosporins?
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cephalexin, cephradine, and cefazolin
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What are the 2nd generation cephalosporins?
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cefaclor, cefuroxime, cefoxitin
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What 2nd generation cephalosporins are good given orally?
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cefaclor, and cefuroxime
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What 2nd generation cephalsporin can only be given IV/IM
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Cefoxitin
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2nd generation cephalosporins are used for what bugs?
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extended gram rods and anaerobes (what cephalosporins do best)
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2nd generation cephalosporins can cause what adverse reactions
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enhancement of warfarin and superinfection
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What are the 3rd generation cephalosporins?
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cefotaxime, ceftriaxone,
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Third generation cephalosporins can be given?
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orally
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3rd and 4th generation cephalosporins are known for what?
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They have good CNS penetration
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3rd and 4th generation cephalosporins are used for what bugs?
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expanded gram - and less gram + and are ok as an antipseudomonal
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What is an adverse reaction of 3rd and 4th generation cephalosporins?
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superinfection
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What is the 4th generation cephalosporin?
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cefepime
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What is the mechanism of action of vancomycin?
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cell wall synthesis inhibition (stage 2) bacterialcidal
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Vancomycin should not be given how?
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orally
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Vancomycin is excreted how?
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renal
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When to use vanco?
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for narrow spectrum gram+ cocci if someone is allergic to penicillin.... and it works on MRSA! also enterococci, and the anaerobe C. difficile
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What are the adverse reactions to vancomycin?
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chills, fever, rash, ototoxicity, renal toxicity, - Monitor Cp levels
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What are the 3 macrolides?
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Erythromycin, Azithromycin, and clarithromycin
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What is the mechanism of action for macrolides?
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Protein synthesis inhibition (50S) bacteriostatic
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What is the doesing intervals for macrolides?
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Azithromycin (once a day), Clarithromycin (2 times a day), Erythromycin (4 times a day)
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Where do macrolides concentrate?
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in the lungs
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Where are macrolides metabolized?
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liver
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What is important about clarithromycin metabolism
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it metabolizes to an active metabolite.
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What are macrolides used for?
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extended spectrum: cocci/rods: gram+ (so good for PCN allergy) rods: some gram - bacilli (legionella, bordetella, h. pylori)...atypicals:mycoplasma/chlamydia pneumonia
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What are the adverse reactions to macrolides?
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GI ick! DD interactions due to inhibition of P450
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What is the mechanism of action for tetracyclins?
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protein synthesis inhibition (30s) bacteriostatic
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What are the 3 tetracyclins?
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tetracycline, doxycycline, and minocycline
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Tetracycline is administered and excreted how?
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orally, and renal
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Doxycycline and minocycline are administered and excreted how?
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orally and biliary
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What would you use a tetracycline for?
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broad spectrum... (uh oh many gram+/- are now resistant, choice in CA-MRSA . It has good activity for atypicals like chlamydia... also used against mycoplasma, rickettsia, spirochetes
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What are the adverse reactions to tetracyclines?
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abnormal bone/tooth development - avoid in pregnancy, gi stuff, fungal superinfection... DD with metal cations (antacids/dairy/iron) in stomach
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What is the mechanism of action for clindamycin?
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protein synthesis inhibition (50S) bacteriostatic
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How can clindamycin be administered?
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orally and IV
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How is clindamycin metabolized?
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hapatic
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What is interesting about the pharmacokinetics of clindamycin?
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it penetrates into bone!
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What is clindamycin used for
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narrow spectrum - fram+ cocci (PCN alternative), anaerobes, acne (topically) chaice in CA-MRSA
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What are the adverse reactions caused by clindamycin?
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severe diarrhea - pseudomembranous colitis
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Aminoglycosides have what mechanism of action?
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protein synthesis inhibition (30s) bactericidal
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What are the three aminoglycosides?
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tobramycin, gentamicin, neomycin
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How are aminoglycosides excreted?
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renal
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How are aminoglycosides delivered?
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IV, IM, or inh because the have poor oral absorption
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Where do aminoglycosides located?
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extracellular fluid, accumulates in kidney, inner ear
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What do you use aminoglycosides for?
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narrow spectrum: gram- aerobes (e.coli, pseudomonas) bowel sterilization presurgery (Neomycin)
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What are the adverse reactions caused by aminoglycosides?
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vestibular and auditory toxicity, nephrotoxicity - must monitor Cp levels
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What is the mechanism of action for chloramphenical?
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protein synthesis inhibition (50s) bacteriostatic
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How can chloramphenicol be administered?
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orally and IV
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Where does chloramphenicol distribute?
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CNS/CSF
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How is chloramphenicol metabolized?
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Glucuronidation
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What is chloramphenicol used for?
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broad spectrum: gram +/- cocci, H.flu, Neisseria, anaerobes,rickettsia
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What are the adverse reactions to chloraphenicol?
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bone marrow toxicity, gray baby syndrome, gi upset
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Fluoroquinolones have what mechanism of action?
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inhibition of DNA gyrase - bacteriostatic
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Fluoroquinolones can be administered how?
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oral and IV
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Fluoroquinolones are used for what kinds of bugs?
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extended spectrum
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What are the three fluoroquinolones?
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ciprofloxacin, levofloxacin, and mexifloxacin
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What is the 2nd generation fluoroquinolone?
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ciprofloxacin
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What is the 3rd generation fluoroquinolone?
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levoflocacin
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What is the 4th generation fluoroquinolone?
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Moxifloxacin
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Which fluoroquinolone is excreted differently?
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Moxifloxacin - 80% hepatic and 20% renal
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What is ciprofloxacin used for?
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gram- (psuedomonas and UTIs)
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What is levofloxacin used for?
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gram+/- (respiratory, UTIs)
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What is moxifloxacin used for?
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gram+/- (respiratory, plus some anaerobes/ atypical)
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What are the adverse reactions brought about by fluoroquinolones?
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well tolerated, gi ick, superinfections DD interactions: theophylline (decreased metabolism) and antacids (decreased absorption) rare: CNS disorders
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What is the mechanism of action of Nitrofurantoin?
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reduced in cell to intermediates that damage bacterial DNA - bactericidal
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What happens with Nitrofurantoin?
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rapid and complete GI absorption - rapid excretion via kidneys, a urinary antiseptic
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When do you use nitrofurantoin?
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2nd line in UTIs (used if TMP-SMX resistant (E.coli)
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What are the adverse reactions due to nitrofurantoin?
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gi side effects, macrocrystalline forms are better tolerated
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What is the mechanism of action for metronidazole?
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reduced intracellulary to active form; interference with DNA fxn- bactericidal
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How is metronidazole metabolized?
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hepatic
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how is metronidazole administered?
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oral
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What is metronidazole used for?
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anaerobic bacteria (C.diff) and protozoa (trichomoniasis, amebiasis giardiasis
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What are the adverse reactions to metronidazole?
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nausea, headache, antabuse like rxn, candidal superinfections
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