Antimicrobials Pharm I
Terms
undefined, object
copy deck
- Fluoroquinolones MOA
- inhibit DNA replication in bacterial cell wall (DNA gyrase inhibitors)
- fluoroquinolones routes of admin
- PO, IV, topical
- FQ coverage
- gram +, gram - very limtited anaerobe coverage (Avelox)
- excretion of FQ
- renal
- FQ meds
-
Norfloxacin (Noroxin) UTI only
Ciprofloxacin (Cipro)good bone penetration; 45% pseudo. resistance
Ofloxacin (Floxin)
Enoxacin (Penetrex) UTI, STD
Levofloxacin (Levaquin) HAP 65% pseudo. sens.
Moxifloxacin (Avelox) some anaerobic coverage - FQ contraindications
-
pregnancy
pediatrics
pts on meds known to cause QT seg prolongation - FQ SE
- n/v/d, CNS effects, phototoxicity, liver toxicity, connective tissue problems, QT segment elongation
- FQ great "switch" drug secondary to __________ when taken po
- approx 100% bioavailability
- Vancomycin MOA
- inhitibs wall synthesis
- Vancomycin coverage
- Must have MRSA if using on pt with staph
- Vancomycin routes of admin
- IV or oral (no absorption) is acutally topical to GI lumen
- Vancomycin SE
- "red man", ototoxicity, ?nephrotoxicity (pt also on aminoglycoside)
- when should peak and trough levels be check when using Vanco?
- never, unless renal dysfxn or endocarditis
- excretion of Vanco
- renal, but not dialyzed
- Daptomycin (Cubicin) MOA
- unique mechanism; binds to bacterial cell wall causing rapid depolarization of membrane potential (decrease replication)
- Daptomycin coverage
- gram +, MRSA and ?VRE
- daptomycin is alternative to ______
- vancomycin
- Linezolid (Zyvox) MOA
- unique mechanism; binds to 50s ribosomal subunit, prevens translation
- Linezolid coverage
- gram +, MRSA, VRE
- Linezolid routes of admin
- IV and PO both give 100% bioavailability
- Metronidazole (Flagyl) coverage
- anaerobes and some parasites
- Metronidazole routes of admin
- PO, IV, topical
- Metronidazole SE
- GI (nausea, metalic taste), peripheral neuropathy (prolonged use), disulfiram-like rxn (etoh, perfume/cologne)
- antifungal agents
- amphotericin B, Fluconazole (difulcan, Miconazole (Monistat), Flucytosine (Ancobon), Ketoconazole (Nizoral), Itraconazole (Sporanox), Clotrimazole (Myclelex), Echinocandins, Boriconazole(Defend)
- 1st line non albicans tx
- amphotericin B
- 1st line candida albican tx
- Fluconazole (tx only c. albicans)
- topical cream suppository
- Miconazole, Flucytosine, Ketoconazole
- tx for c. albicans and aspergilas
- Itraconazole and Boriconazole
- Flucytosine coverage
- non albicans
- Echinocandins coverage
- candida albicans, c. glabrata, c tropicalis
- Best anitfungal around
- Amphotericin B (ampho "terrible")
- Amphotericin B admin
- IV, irrigational, topical, liposomal preparations
- dosing of Amphotericin B
- 1/2 mg/kg Q D also hydrocortisone to decrease SE
- Amphotericin B SE
- electrolyte imbalance (decrease Mg, K), renal toxicity, hepatotoxicity
- other antifungals
-
Nystatin (Mycostatin)-topical for thrush
Terbinafine (Lamisil)-cream or po for onychomycosis - Urinary Antispetics
-
Ntrofurantoin (Macrodantin) negative SE in pregnancy
Nalidixic acid (Negram) indwelling catheters
Methenamine mandelate (Mandelamine) breaks down formaldihyde ototoxicity - Pentamidine coverage
- anitprotozan
- Pentamidine admin
- IV (tx only)or inhalation (only for prophylaxis)
- Pentamidine SE
-
hyper and hypoglycemia-FSBS QD
electrolyte disturbance-dec K
renal dysfxn-BUN and creatinine - Antiviral agents for Herpes
- acyclovir (Zovirax), Famcylovir (Famvir), Velacyclovir (Valtrex) PO and IV, don't use topical unless liver dysfxn and must have tx
- Antivirals for CMV
-
Gancylcovir (Cytovene), Valgancyclovir (Valcyte) IV, PO, intraocular
Foscarnet (Foscavir)
Cidofovir (Vistide) tx with IV then oral for life - antivirals for tx of influenza
- Amantadine (symmetrel), Rimantadine (Flumadil), Zanamavir (Relenza)-inhaled, Oseltamivir (Tamiflu)-oral
- concentration-dependent killing exhibited by
- FQ and aminoglycosides
- Concentration-dependend killiing defined as
- rate and extent of bacterial killing maximized at high concentrations (doses)
- usually occurs when drug concentration is ____ the MIC
- 10 times
- MIC is
- minimum inhibitory concentration
- Time-dependent killing defined as
- killing activity depends on the time drug concentration remains above MIC
- time-dependent killing exhibited by
- beta-lactams, vancomycin, clindamycin, and ees
- dosing stratey for Time dependent killing
-
maximize time above MIC
(should be above MIC 50%) - bacteriology of community acquired respiratory infxn
- s. pneumoniae, h. influenzae, k. pneumoniae, m. catarrhalis, mycoplasma, legionella, TB
- bacgteriolgoy of nosocomial acquired resp. infxn
- s. aurea, p. aeruginosa, enerobacger cloacae, fusobacterium species, peptococcus, legionella
- tx comm. acquired resp. infx
- PCN, Amox, 2nd gen. ceph., macrolides, FQ
- tx nosocomial resp. infx
- pipercillin/tazobactam, ticaricillin/clavulanic acid, 3rd gen. ceph, add aminoglycoside, FQ, macrolide
-
CNS infxns:
neonates
infants/childrens
children/young adults -
s. pnuemonia, e. coli, listeria
h. flu, s. pneumonia, n. meningiditis
s. pneumo, n. meningiditis -
CNS infxns:
adults
elderly -
s. pneumo, n. meningiditis
s. pneumo, n. meningiditis, e. coli, klebsiella, listeria -
CNS infxns:
neurosurgery
closed head trauma
open head trauma -
s. aureus, s. epidermiditis, gram -
s.pneumo, h. flu
look at environ (sewage ditch vs concrete) - CNS tx:
-
must penetrate CNS
cephalosporins
PCN - Bacteriology of endocarditis
- s. viridans, s. epidermidis, entercoccus, c. albicans
- tx endocarditis
- PCN, vancomycin, add aminoglycoside, long duration
- prophylaxis of endocarditis
-
dental/oral procedure: amox 3g 1 hr prior, 1.5 g 6 hr later
GI/GU procedure: ampicillin, amox, gentamicin - bacteriology of skin and ST infxn
-
Cellulitis: strep and staph
add DM
pseudomonas and anaerobes - Tx skin and ST infxn
-
cefzolin, macrolides, amp/sulbactam or ticarcillin/cavulanic acid
FQ with metronidazole -
GI infxn tx
travellers diarrhea
psuedomembranous colitis
h. pylori -
pepto-bismol, TMP/SMX, doxy, FQ
oral metronidazole adn vanco
amox, clarithromycin, tcn, metronidazole plus PPI - bacteriology of intra-abdominal infx
-
gram +: enterococcus
gram -: e.coli, enterobacter cloacae, acineobacter
anaerobes: bacteroides - tx intra-abdominal infx
-
2nd and 3rd gen. ceph
extended spectrum pcn
metronidazole
imipenem-cilastatin - bacteriology of UTI
- e.coli, enterococcus, klebsiella, proteus
- tx UTI
- sulfa, trimethoprim, 1st gen ceph, nitrofurantoin, FQ
- bacteriology of STD
- syphyllis, gonorrhea, chlamydia, gential herpes, trichomoniasis
- tx STD
-
syphillis:pcn, spectinomycin
Gonorrhea:3rd gen ceph, ofloxacin, enoxacin, cipro
chlamydia:doxy, ees,FQ,azith
Gent herpe: acyclovir, famcyclovir
trich: metronidazole - bacteriology of osteomylitis
-
hematogenous:staph, gram neg
adjacent infx:staph, gram neg, anaerobes
vascular insuff:staph, g -, anaerobes - tx osteomylitis
- bone penetration, IV, oral therapy (cipro)
- azithryomicin doesn't cover
- septicemia
- cipro doesn't cover
- strep
- nosocomial infxn tx
- need broad spectrum and somthing to cover gram - (aspiration)
- ventilation associated pneumonia caused by
- pseudomonas aeruginosa