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NR566 Midterm – Complete Guide
Tetracyclines used to treat Right Ans - *H.Pylori *Acne Vulgaris *Rickettsial disease
- Chlamydia Trachomatis *Cholera *M. pneumonia *Lyme Disease *Anthrax Tetracyclines Right Ans - Demeclocycline Doxycycline Minocycline Tetracyline Tetracycline mode of action Right Ans - broad-spectrum; bacteriostatic via inhibition of bacterial protein synthesis Tetracycline adverse effects Right Ans - GI Distress Hepatotoxicity Photosensitivity Vestibular problems (Vertigo) Candida infections; C. diff Tetracycline drug/food interactions Right Ans - *Milk products and antacids, oral contraceptives, digoxin absorption is increased leading to toxicity. *Administer 1 hour before or 2 hours after Tetracycline contraindications Right Ans - *Avoid administration in children younger than 8 and pregnant women or breastfeeding (Category D). Use cautiously in patients with liver, kidney disease. *Pt exposed to direct sunlight Caution in pt's with liver or kidney disease Pt with esophageal obstruction or dysfunction Tetracycline monitoring Right Ans - None
Rx Tetracycline Right Ans - *Bacterial infections-1-2g/day PO divided qid( give 1 hr before or 2 hr after meals) *H.Pylori-500mg PO qid x 10-14 days ( Part of multi-drug regimine *Syphilis (primary, secondary, latent less than a year)- 500mg PO qid x 14 days ( for PCN hypersensitive patients). Latent grater than a year- 500mg PO qid x 28 days. Macrolides Right Ans - Azithromycin Clarithromycin Erythromycin Macrolides mode of action Right Ans - inhibition of protein synthesis Macrolides treat Right Ans - *Corynebacterium diphtheria *Used for diagnosed allergy to PCN for H. Pylori, Chlamydia, disseminated mycobacterium, and M. pneumonia Macrolides Complications Right Ans - *GI symptoms, epigastric pain *Prolonged QT interval which could leat to torsade's and death *High doses can cause Ototoxicity Macrolide Contraindications and Precautions: Right Ans - *Avoid in those taking antidysrhythmic drugs, CYP3A4 inhibitors, CCB( verapamil, diltiazem), Antifungals (-azole), HIV protease inhibitors and nefazodone *Can increase drug levels of Theophylline, Carbamazepine, and Warfarin *Hx of liver disease use with caution *Don't use Chloramphenicol and Clindamycin together Macrolide age related concerns Right Ans - Safe in the pediatric population Clindamycin MOA and use Right Ans - *Binds to 50S ribosomal subunit and inhibits protein synthesis
Gent and Tobramy (CIN Right Ans - Pseudomonas aeruginosa Enterobacteriaceae and eye infections. Amika(CIN) Right Ans - Gram negative bacilli infections Streptomy(CIN) Right Ans - Combined use in the treatment of TB, tularemia, and plague Neomy(CIN) Topical Right Ans - Treatment for eye and ear infections Aminoglycosides Complications Right Ans - Ototoxicity, balance issues, possible permanent deafness in older adults w/ hearing impairment, nephrotoxicity, neuromuscular blockade, hypersensitivity (rash, urticaria), crosses placenta in pregnancy's(Toxic) Monitoring aminoglycosides Right Ans - *Watch trough levels as *Caution in use with diuretics (renal impairment) *Creatinine and BUN *Signs or symptoms of tinnitus, headache, nausea, vertigo **If symptoms are assessed discontinue medication immediately. Aminoglycosides age related Right Ans - *Safe in younger than 8 days to Older adults *Not approved for pregnancy but is approved for breastfeeding Pennicillin Right Ans - B-lactam which disrupts bacterial cell wall causing cell lysis and death Penicillin G and V (Narrow spec) Right Ans - Cell Wall Sythesis Inhibitors: B-lactam antibiotics USE: S. pneumoniae (many resistant), non-lactamase Staph, N. Meningitidis, Clostridium, T. Pallidum SPECTRUM: narrow: G+, G- cocci (NOT G- rods or anaerobes)
KINETICS:
G: Acid LABILE; parenteral admin (usually IM; IV for serious infections); two repository forms for IM injection (procaine and benzathine; water-insoluble for slow release --> blood) V: Acid STABLE, 65% absorption PO TOX: Allergy, Steven-Johnson Syndrome (with Pen G, dose- dependent neurotox / seizures) nafcillin, oxacillin (Narrow spec) Right Ans - (IV) for sensitive s. aureus Ampicillin, amoxicillin (Broad spec) Right Ans - Penicillinase sensitive: Often add Clavulanic acid or sulbactam "Aminopenicillins are AMPed up penicillins:" wider spectrum So all cocci, plus gram negative rods and gram positive rods (Listeria) Amoxicillin has > Oral bioavailability than ampicillin Ampicillin/Amoxicillin "HELPS kill enterococci": H flu, E coli, Listeria, Proteus, Salmonella, Shigella, enterococci Pipercillin Right Ans - Used in *H. Influenzae *E. coli *Enterococci *Neisseria gonorrhoeae *Pseudomonas *Klebsiella Penicillin complications Right Ans - allergies/anaphylaxis( Most common-Allergic to one allergic to all), renal impairment, hyperkalemia/dysrhythmias, hypernatremia Penicillin allergy Right Ans - *use azithromycin, clarithromycin and clindamycin if mild reaction *Safe to use instead of PCN: Vanco, Erythromycin, and Clindamycin
Ceftriaxone--gonorrhea and meningitis Ceftazidime--Pseudomonas Generation 4--Cefepime, both gram + and serious gram negative infections SE = disulfiram-like reaction with EtOH; hypersensitivity rxn (10% of those allergic to penicillin will get this) Cephalosporins MOA Right Ans - inhibit cell wall synthesis 1st generation cephalosporins Right Ans - * Narrow spectrum *Cefazolin, cephalexin *Use: Gram(+)positive cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae. *Cefazolin used prior to surgery to prevent S. aureus wound infections 2nd generation cephalosporins Right Ans - *A more broad spec than 1st gen *Cefoxitin, cefaclor, cefuroxime *Use: gram(+)positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens, otitis media, sinusitis, Resp Tract infection. 3rd generation cephalosporins Right Ans - *More broad than the 1st and 2nd gen *Ceftriaxone, cefotaxime, ceftazidime) *Use: serious gram(-)negative infections resistant to other β- lactams. Ceftriaxone—meningitis, gonorrhea, disseminated lyme disease; ceftazidime—Pseudomonas 4th generation cephalosporins Right Ans - *Narrow spec
*Cefepime *Use: gram(-)negative organisms, with activity against Pseudomonas and gram-positive organisms. HAP and complicated intraabdominal infections as well as UTI 5th generation cephalosporins Right Ans - *Narrow spec *Ceftaroline *Use: broad gram(+)positive and gram-negative organism coverage, including MRSA; does not cover Pseudomonas. cephalosporin complications Right Ans - *Allergy- Maculopapular rash which starts several days after administration-D/C *If history of SEVERE PCN allergy then dont prescribe. If mild PCN allergy then ok to use for treatment. *C.diff Cephalosporin monitoring Right Ans - * No routine monitoring. *Watch Renal impairment for dose adjustments Cephalosporins Lifespan Right Ans - * 3rd gen treatment for infant & neonatal bacterial infections *Treatment for otitis media, Gonoccoal, and Pneumococcal infections in children & Adolescents. *Elderly dose rate adjustments based on renal impairment. *PREGNANCY- AVOID Vancomycin (Vancocin) Right Ans - GLYCOPEPTIDE Cell Wall Synthesis Inhibitor Vancomycin uses Right Ans - *Alternative for PCN or Cephalosporin allergy *Serious G+ infections. *MRSA
*Use with nephrotoxic medications ( NSAIDs, ACE, & aminoglycosides) Monobactams (Aztreonam) Right Ans - *narrow-spectrum drug for infections by gram(-)negative aerobic bacilli; may be used by people allergic to penicillin *cell wall inhibitor Phosphonic Acid Derivatives Right Ans - Fosfomycin *Disrupts sythesis of peptidoglycan polymer strand killing bacteria Phosphonic acid Right Ans - *Single dose treatment in femals for uncomplicated UTI from E.coli & E.Faecalis Phosphonic acid side effects Right Ans - *D/N *Headache *vaginitis *abd pain *Drowsiness *rash *rinitis Sulfonamides Right Ans - *Sulfamethoxazole (SMX) *sulfisoxazole *sulfadiazine *inhibit folate synthesis. Para-aminobenzoic acid (PABA) antimetabolites inhibit dihydropteroate synthase. Bacteriostatic (bactericidal when combined with trimethoprim). -Resistance: Altered enzyme (bacterial dihydropteroate synthase), decreased uptake, or increased PABA synthesis. Sulfonamides used to treat Right Ans - *lepromatous leprosy, is a closely related drug that also inhibits folate synthesis.) *Gram(+)positives & gram(-)negatives *Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
Sulfonamides contraindications Right Ans - *Impaired hepatic function *Impaired renal function or ua obstruction *Blood dyscrasias *Severe allergies or asthma *Pregnancy or lactation Sulfonamides typically prescribed for Right Ans - *Primary treatment of UTIs & Ulcerative colitis *Topically for superinfection of the eye & to suppress bacterial colonizatoin in burns *Broad Spec for both Gram (+) and Gram (-) cocci & Gram(-) bacilli. (Listeria monocytogenes, actinomycetes, Chalamydiae *Toxoplasma,plasmodia, isopora belli *Protozoa *Fungi Pneumocytis jirovecii, paracoccidioides brasiliensis Sulfonamides Complications Right Ans - *Blood Dyscrasias *Hemolytic anemia with history of G6PD deficiency (African Americans and Mediterranean descent.) *Agranulocytosis *Thrombocytopenia *Aplastic Anemia *MONITOR CBC Sulfonamides Lifespan Right Ans - *Can cause kernicterus *Rule is NOT GIVEN under 2 months, NOT GIVEN after week 32 gestation, and NOT GIVEN when breastfeeding Sulfonamides: Risks Right Ans - *Renal damage due to low solubility forming cystalline aggregates in kidney, ureter & Bladder leading to irritation , obstruction, and possible death. *Teach to drink 8-10 glasses of water a day Sulfonamides Drug-to-Drug Interactions Right Ans - *Cross sensitivity with thiazide diuretics *Sulfonylureas *Phenytoin *Warfarin
Hematologic reactions with Trimethoprim Right Ans - *Pallor, Sore throat, & Fever *Obtain CBC and D/C med if blood count has decreased. *Start Leucovorin to restore hematopoiesis Trimethoprim complications Right Ans - *Suppresses renal excretion of vit K *At risk patients who take High doses, Have renal impairment, take meds that elevate vit K such as ARBs, ACE, K-sparing diuretics, Aldosterone antagonists Trimethoprim Monitoring Right Ans - Check vit K levels 4 days after initiating treatment. Trimethorpim contraindications for Rx Right Ans - * Pregnancy & lactation Bactrim Right Ans - sulfamethoxazole/trimethoprim Bactrim MOA Right Ans - inhibits folic acid synthesis Bactrim contraindications Right Ans - late pregnancy Bactrim uses Right Ans - *UTI uncomplicated *Otitus media *Bronchitis *Shingellosis *whooping cough *Pneumonia (P. jirovecii,-Fungus) in immunocompromised patients Bactrim complications Right Ans - *N/V, Rash *Hypersensitivity, Kernicterus in neonates, Renal Damage *Megaloblastic anemia *Hyperkalemia
*HA, Depression, Hallucinations *Toxicity in AIDS patients Bactrim drug interactions Right Ans - *Warfarin *Phenytoin *Sulfonylureas *Methotrexate Bactrim contraindications Right Ans - *Pregnancy and breast feeding *Folate deficiency *Creatinine clearance 15-30 half medication dose *Creatinine below 15 D/C Bactrim monitoring Right Ans - *CBC *CD4+ count in HIV *K level after 4 days *Renal function Fluoroquinolones Right Ans - *Ciprofloxacin *norfloxacin *levofloxacin *ofloxacin *moxifloxacin *Gemifloxacin *enoxacin. Fluoroquinolones MOA Right Ans - Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV. Bactericidal. Must not be taken with antacids. Fluoroquinolones uses Right Ans - *Cipro used for Respiratory tract, Urinary tract, GI, Bones, Joints, Skin, Soft tissue, anthrax *Ofloxacin used for respiratory, Urinary, GI, Skin, Soft tissue
*S. pneumo
- Mycoplasma *chlamydia, viral *H influ
- M catarrha(COPD) *legionella
- klebsiella
- GNR (esp alcohol), *s. aureus.. Hosp acquired: GNR including *pseudomonas *Klebsiella *enterobacter *serratia *acinetobacter *s. aureus Mycoplasma pneumonia Right Ans - CAP common in children and young adults CAP streptococcus pneumonia Right Ans - *Most common fatal CAP caused by gram (+) cocci *If organism is not resistant treatment consits of macrolides at 1.5-2 g/day (azithro, Clarithro, Erythro) *Can use select cephalosporins or tetracyclines including doxy CAP 1st line in pt with no comorbidites Right Ans - *Amoxicillin *Doxycycline *Macrolides Usage of Fluoroquinolone for CAP Right Ans - *Use when pt has had treatment with antibiotic in last 90 days due to risk of drug resistance Gold standard Diagnosis CAP Right Ans - *Chest X-ray Comorbidities CAP treatment Right Ans - *DM *COPD
*ETOH
*Cancer *Immunosupressive medications/disorder *If no antibiotics in last 90 days then try monotherapy or a respiratory fluoroquinolone or B-lactam with a macrolide CAP alternative Medication Right Ans - *Doxy Recommendation if ATB therapy in last 90 days for CAP Right Ans - *Dont use the same medication class but a different one to help fight resistance CAP preferred B-lactamase Right Ans - *High dose amoxicillin (3g) or Amoxicillin/Clavulante(Augmentin)(4g) CAP B-lactamase alternative Right Ans - *2nd/3rd generation cephalosporins to include cefuroxime, cefpodoxime, and ceftriaxone M. pneumonia and C. pneumonia Right Ans - *Transmitted through coughing especially in closed facilities *Treatment is macrolides, respiratory fluoroquinolones, tetracyclines( +doxy) CAP Right Ans -
