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248 Cards in this Set
- Front
- Back
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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 |
|
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therapeutic uses of St. Johns wort
|
treat mild to moderate depression
- GABA agonist and SSRI - hypericin is active component some effectiveness against retroviruses |
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what are the side effects of St. John's Wort
|
phototoxicity
HTN --> HTN crisis because of blockade of NE and 5-HT |
|
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Contraindications of St. John's Wort
|
Tryptophan/tyrosine
foods with tyramine stimulants b2-agonist (additive effect may cause HTN crisis) |
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should a patient with a history of HTN take St. John's Wort?
|
NO
|
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|
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 |
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therapeutic use of Ginseng
|
treatment of depression
colds, flus, influenza, respiratory problems |
|
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side effects of Ginseng
|
precipitate asthma attack
heart palpitations/HTN NO drug interactions reported |
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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 |
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Therapeutic uses of Gingko
|
vascular disorders
mental/emotional fatigue clotting disorders headache Raynaud's neuroprotectant |
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side effects of Gingko
|
excessive bleeding/hemorrhage in the elderly
|
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|
active ingredients of KAVA
|
Kavain and Dihydrokavain
methystein and dihydromethystein |
|
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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 |
|
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Valerian
|
improves sleep
DO NOT use with BZDs |
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Cholestin
|
lowers cholesterol
|
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Echinacea
|
boost immune system by increasing WBC activity
|
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Goldenseal
|
antiseptic to treat sores in the mouth
|
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DHEA
|
supplementation is anti-aging
|
|
|
prolonged use of DHEA
|
high doses over long periods cause liver dysfunction, decreased CO, masculinization in females
|
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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
|
|
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what are the side effects of Melatonin
|
infertility
loss of libido |
|
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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 |
|
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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 |
|
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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
|
|
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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 |
|
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what are b-lactamases?
|
bacterial enzymes which hydrolyze the b-lactam ring and inactivate antibiotics
|
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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 |
|
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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 |
|
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what b-lactams must be given parenterally because they are acid-labile?
|
pipercillin
ticarcillin |
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b-lactams are usually widely distributed throughout the body, except in what tissue?
|
brain
prostatic secretions introcular secretions |
|
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how are b-lactams excreted from the body?
|
glomerular filtration and renal tubular secretion
- ampicillin and naficillin are excreted in the bile |
|
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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
|
|
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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
|
|
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You have isolated a Gram + cocci from a patient with pneumonia. What penicillin would you administer?
|
Penicillin G for treatment of pneumococci
|
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you have diagnosed your patient with pharyngitis caused by Streptococcus pyogens. What penicillin would you administer?
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Penicillin V
|
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how is Dicloxacillin administered?
|
orally
|
|
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how is Nafcillin administered?
|
parentally
|
|
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what are Nafcillin and Dicloxacillin used to treat?
|
Penicillinase resistant infections
- serious penicillinase producing Staphyloccus - osteomyolytis - endocarditis - skin and soft tissue infections |
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|
T/F
Dicloxacillin/Nafcillin are effective against gram negative bacteria. |
False
only Gram + bacteria used in penicillinase producing organisms |
|
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You have diagnosed your patient with MRSA. What do you treat with?
|
Vancomycin
|
|
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what are the extended spectrum penicillins?
|
Amoxicillin
Ampicillin Pipercillin |
|
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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
|
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A patient has an URT infection caused by H. influenza. What penicillin do you use to treat?
|
Amoxicillin
|
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Your patient has an infection caused by S. pneumonia of the upper respiratory system. What penicillin do you use for treatment?
|
amoxicillin
|
|
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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 |
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what type of infection is Pipercillin used to treat?
|
anti-pseudomonal agent
- Gram (-) bacteria P. aeruginosa causing a nonsocomial pneumonia |
|
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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 |
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Treatment of Penicillin sensitive streptococcus pneumonia.
|
Amoxicillin in children
Azithromycin Cetriaxone |
|
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Penicillin-resistant Streptococcus pneumonia
|
Levo/monofloxacin
|
|
|
treatment of acute pharyngitis with penicillin?
|
Penicillin G
|
|
|
Scarlet fever treatment with a penicillin.
|
Penicillin G
|
|
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Acute otitis media treatment with a penicillin.
|
Amoxicillin
|
|
|
H. pylori treatment with a penicillin.
|
Amoxicillin + clarithromycin
|
|
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Treatment of impetigo caused by staphylococci with a penicillin.
|
Dicloxacillin
Cephalexin Mupirocin |
|
|
treatment of impetigo caused by streptococcal infection.
|
amoxicillin
mupirocin |
|
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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
|
|
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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 |
|
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You have a patient with a streptococci infection of the skin. What cephalosporin would you treat it with?
|
CEphalexin
|
|
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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 |
|
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your patient has amoxicillin resistant otitis media caused by H. influenza. What do you treat them with?
|
Cefprozil
|
|
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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
|
|
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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
|
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|
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
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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 |
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Mechanism of action of Sulfamethoxazole.
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inhibits Dihydropteroate synthase
|
|
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mechanism of action of Trimethoprim.
|
inhibits folate synthase
|
|
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what is Sulfamthoxazole primarily used in the treatment of?
|
primarily UTIs
|
|
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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 |
|
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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
|
|
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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
|
|
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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
|
