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- Multiple choice 50 questions - Only know dosage for STD tx - Don’t spend a lot of time on side effects - Fluoroquinolones can cause long QT, Achilles rupture, mental issues in geriatric - Know drug class side effects not side effects for every single medication - Monoclino antibodies – increase risk for infection and cancer - Macrolides – main se prolonged qt , clindamycin can cause c diff - Antibiotics know bacteria not just infections - Staph strep Proetus, e coli - Know generic names
- Metabolism o CYP o Substrate: an agent that is metabolized by an enzyme into a metabolite and product and eventually excreted o Inhibitors: compete with other drugs for a particular enzyme decreasing the metabolism of the substrate and decreases the excretion of the substrate = increasing circulating drug ▪ Need to reduce dose of substrate o Inducers: compete with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drug ▪ Increase dose of substrate o Inhibitors and inducers and what they do o See what drugs interacts with Organisms - Tables 652, 653, 655-658 in summary of module 2 - Know if organism is gram positive or negative - Gram positive o staph, strep, enterococcus (main ones) o some other a typical, o everything else gram negative o most UTI is e. coli o most URI are strep pneumonia or hemophiles influenza o know which organisms cause which diseases
o broad spectrum o narrow spectrum : mostly cover gram + o extended spectrum o remember that there ca be adverse reactions: anaphylaxis ▪ macrolides can be used in patients with these allergies ▪ theres cross sensitivity between cephalosporins and pcn but if people don’t have anaphylactic rxn to PCN you can use cephalosporins
- Beta lactamase inhibitors o Clavulanic acid, tazobactam, sulbactam o give extended coverage when added to pcn ▪ ampicillin/sulbactam ▪ amoxicillin clavulanic acid ▪ piperacillin/tazobactam – effective against pseudomonas o No MRSA coverage - Cephalosporins o most widely used abx o the higher the generation the more gram-negative coverage you will get o You want to use higher generation LAST! o ONLY time you start with broad: when you don’t know what disease you’re dealing with till culture results come back
- Vancomycin o COVERS GRAM + ONLY!! o glycopeptide anibiotic o inhibits cell wall synthesis o covers only mrsa and c diff o oral can only be used for c diff o always start with vancomycin unless theyre vanco resistant, then work your way to broader spectrums o narrow spectrum o trough levels just before the 4 th^ dose of a new regimen ▪ trough levels need to be obtained within 30 minutes before next schedules dose o side effect: ototoxity, red man syndrome, thrombocytopenia renal failure and rashes - know which drugs prolong qt: statin, azole antifungals , telavancin - always start with vanco unless disease is vanco resistant - teicoplanin narrow spectrum only covers mrsa - Fosfomycin
o 1 st^ line for uti o Single dose therapy for UTI from E. Coli or enterococcus faecalis o Can be given in pregnancy o One time dose – good for compliance
- Tetracyclines o Broad spectrum o One of the few that hasn’t developed resistance for h pylori o Bacteriostatic, Inhibit protein synthesis o Used for everything : ear infection, uti, pna, resp infection, eye infection o 1 st^ line for tick born illnesses, lyme disease o Don’t give anyone under 8 years old except in ticks o They have an affinity for bones so they can stain teeth that’s why we don’t give to children o Can cause photosensitivity – sunscreen o Long term use – super infection o Can cause liver and renal toxicity o Cant take milk, calculium, mg or antacids– remember!!!! ▪ Interferes with absorption of drug - Macrolides o Inhibit protein synthesis o Been overused so much that theres some resistance
- Dalfopristin/quinupristin o Inhibit prtein synthesis o Only treat vre - Chlorphenicol o Only in life threatening emergenies due to side effects - Aminoglycosides (BIG GUNS) o Typically not given alone – given with PCN, cephalosporins and vanco o Pseudomons, klebsiella, serratia, proteus o Monitor peak troughs ▪ Monitor trough levels 2 and 12 hours after dosing o They can stay in system a while after you stop them o Can cause ototoxicity, nephrotoxicity, blood dyscrasias
o Do not use for pregnant!! – teratogenic
- Antimetabolites o Trimethoprim rarely given alone o Trimethoprim/sulfamethoxazole ▪ Inhibit synthesis of folic acid ▪ CAMRSA, UTI, listeria ▪ Lots of resistance to Bactrim so shouldn’t be first line to uti ▪ In children dosage based on amount of trimethoprim NOT sulfamethoxazole - Opposite in in adults ▪ Can cause low blood sugar ▪ Cannot use in pregnancy!!! Blocks folate ▪ Cross rxn with thiazide loop diuretic Celebrex and sulfonylureas
Inhibitors of bacterial nucleic acid synthesis
- Dazoles (metro, tini, secnidazole)
o Gut and vaginal infections o Can cause disulfiram reaction with alcohol!!!! o Can cause neurotoxicity o Do not use in 1 st^ trim pregnancy o Metallic taste in mouth --- clarithromycin(macrolide) can also cause that o Can darken urine – let patients know that’s normal o DON’T drink alcohol
- Topicals
o Mupirocin - impetigo o Retapamulim – impetigo o Ozenoaxcin – new fluoriquinoline for impetigo, expensive, can be given 2 months or older o bactricin o polymyxin-B
- Uncomplicated UTI
o amoxicillin is good drug for pregnant patients. o given 3-5 days o if allergic to sulfa or nitrofurantoin may use amoxicillin clavulanate or cephalexin o if allergic to beta lactams may use fluoriquinlones
- Complicated uti and acute uncomplicated pyelonephritis o patients can need hospitalizations o can run fever up to 104 o pyelonephritis: give 7-14 days o uti very uncommon in males usually 35 and under is typically stds o broad spectrum abx o should really get a culture in male patients o chronic uti or recurrent or prophylaxis ▪ 6 months tx o Recurrent UTI: trimethoprim/sulfa 3 times weekly for 6 months or trimethoprim 100 mg for 6 months o After intercourse: give nitrofurantoin or Bactrim
- Anti-inflammatories o Main SE: GI bleed, renal issues ▪ Any diabetic or high risk renal issue patients be careful about using these long terms o Cox 1 and 2 inhibitors: ▪ Cox 2 only one left is Celebrex - Less risk for GI bleed - Less risk for renal problems - Higher risk for heart attack
- Aspirin: o Recommendation: shouldn’t be used for cardiovascular disease 1 st^ line primary prevention or secondary but can be put on low dose o AE: ▪ Don’t given high risk of GI bleeds or peptic ulcer disease ▪ Smoking ▪ Alcohol - Non aspirin first gen NSAIDs o Don’t protect against MI and stroke but they don’t increased risk as much as cox 2 inhibitors o Ibuprofen (advil, motrin), aleve, diclofenac o All 1 st^ gen nsaids are associated with risk of GI bleeding o 2 nd^ gen lower risk for GI bleed
- Glucocorticoids o They can elevate blood glucose so can cause DM and in diabetic patients need to monitor blood sugar o They can reduce muscle mass can cause bone thining o Adrenal suppression MOST DANGEROUS THING THEY CAN CAUSE ▪ Taper patients off of these o Do not give to fungal infection pts or live virus vaccines o Use with caution in children and pregnant women - RA: o Read article!! About ra recommendations o Autoimmune disorder – different from osteoarthritis which is degenerative ▪ Goal of tx is to prevent as much of joint erosion as you can - Decrease inflammation and pain - Preserving function and preventing deformity
o Start patient on DMARD instead of nsaid o They’re going to be on these long term so they get yearly TB testing o Methotrexate : 1 st^ line for moderate to severe ▪ Can damage bone marrow and live and lungs o Hydroxychloroquine 1 st^ line for mild disease
- If patients still getting bone damage with traditional then need to start on biological response modifiers - Gout : o Read article o Prevention is best – watch diet lose weight – NSAIDS can be used unless theres 2 more attacks per year, tophaceous got, damage on xray – then they need to be on drugs for prevention
o Abortive: need to keep headache diary to know what triggers them ▪ Stay on meds 2 months before you change meds ▪ All other triptipans ▪ Trial and error ▪ All should NOT be given with SSRI, SNRI or MAOI ▪ All should NOT be given in CAD patients or patients with uncontrolled HTN o Treximet is a combo of naproxen and sumatriptan – work better than either alone o If they miss work or anything debilitating they need preventative meds o Beta blockers and anti seizure meds were used for prevention ▪ Topiramate and Depakote work very well o Ergotamine – super vasoconstrictor – be careful to give o Ubrogepant – new drug can be used for abortive and preventative – works very well ▪ Used for acute treatment of migraine ▪ Don’t take with azoles, macrolides, floxins or grapefruit o Rimegepant – can be for prevention and abortive as needed ▪ If you have patient who has 2 -3 headaches a month and they already tried triptans then you can switch them to this and they’ll only have to worry about 1 drug o Lasmitidan – drowsiness is main side effect – controlled substance o Injectables very expensive
- Triptans then preventative then beta blockers or antiseizure meds - New drugs – injectables o Calcitonin gene-related peptide receptor antagonists o The zumabs o Injections – very expensive - Cluster headaches : o Main tx glucocorticoids o Atogepant – oral med for prevention – new medication - Tension headache o Should use otc meds - Medication overuse ha o Preventive meds shouldn’t cause headaches but abortive will o Keep headache diary o If patient can afford it we start them on Rimegepant - Preventative meds don’t cause rebound headaches but abortive meds can
- Beta blockers then antiepileptics
