Pharm Antibiotics Part 2

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cswett
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136406
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Pharm Antibiotics Part 2
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2012-02-20 15:21:22
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Pharm Antibiotics Part
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Pharm Antibiotics Part 2
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  1. -mycin
    comes from bacterial source - does not denote class of drug or how it acts
  2. Aminoglycosides
    • Protein systnesis inhibitor
    • Gentamycin/ Maramycin
    • Tobramycin/ Nebcin

    PD: Inhibit protien synthesis (Ribosome)Cover G(-) only but can cover G(+) if combined with a beta lactam or Vanco....combo = Synergy

    • PK: Has a therapeutic window - requires peaks, troughs & randoms (TIME)
    • Straight to renal excretion (BUN/ Creat)

    • SE/ADR(Toxic) Ototoxicity & Nephrotoxicity
    • Ototoxicity - vestibular toxicity (affects balance)
  3. Macrolides
    • Protein synethsis inhibitor
    • Erythromycin
    • Clarithromycin/ Biaxin
    • Axithromycin/ Z-pak/ Zithromax

    PD: Cover G(+) G(-), but tend to be bacteriostatic for common infections bacteriostatic - dosnt kill bacteria but stops its spread - relies upon healthy immune system to kill

    PK: Hepatically metabolized & hepatically excreted - keep liver busy

    • Potent enzyme inhibitors - can effect metabolism of other drugs
    • Azithromycin: longest halflife of all antibiotics ~ 65 hours takes 5 half-lives for drug to be gone from body single dose give ~14 days of therapeutic level

    SE - diarrhea (prototillin - induces peristalsis)
  4. Tetracyclines
    • Protien synthesis inhibitor
    • - older drug/ not used as often
    • used to treat bubonic plague & anthrax
    • sometimes used by dermatologist
    • cant be given to children (stains teeth/ bones)
  5. Quinolones:
    • Alter DNA structure/ function
    • dont work in Japan - universal resistance
    • suffix: -floxicin

    • PD: prevent reading of bDNA
    • Older: ciprofloxicin/ Cipro - cover G(-)
    • Newer: Levofloxicine/ Levaquin - cover G(-) = G (+) - Next Gen - not out yet G(+) coverage

    PK: can inhibit metabolism of some drugs

    • SE/AVR: *will be teaching quesiton*-photosensitivity
    • - avoid sun
    • - heat of the day
    • - 10-4 -wear sunscreen
    • -avoid Calcium within 2 hours of PO doses (+/-)

    *BLACK BOX WARNING -usual morbidity/ mortality-tendon rupture up to six months after last dose - no strenuous activity for 6 months
  6. Sulfa drugs - Sulfonimides
    - been around since 30s v-Sulfamethoxizol - Bactrim DS/ Septra DS DS= double strenght

    • PD: Inhibit thymadine synthesis -
    • Thymadine - nucleic acid - component of DNA
    • Cover G(-) only BUT in some regions, near toxic doses, can cover community acquired MRSA
    • -used very commonly for UTI

    PK: renal excretion

    • SE/AVR PHOTOSENSITIVITY
    • crystaluria - microscopic crystals in usine - sulfa drugs dont like to stay in solution
    • *Drink plenty of water
    • Elderly population - hyperkalemia - high K in blood - if have muscle wakness or twitches or heart rate/ rhythem changes -cal DR immediately
    • Flagyl / Metronidozol
    • *DO NOT DRINK ALCOHOL -
  7. Drugs for protozoal infections
  8. Flagyl / Metronidozol
    *DO NOT DRINK ALCOHOL -
  9. TB
    • Mycobacterium Tuberculosis
    • -Tuberculosi / Mycobacteria
    • slow growing: divided once q 24 hours - long term therapy - 6 months to greater than 2 years

    Bodywide treatment - need mutiple drugs

    *compliance issues*-drugs often make person feel worse than disease-all TB regimens are hepatotoxic **report jaundice, ashen colored stools, malaise - call DR immediatley- poo is brown due to breakdown of bilirubin - poo not brown if no bili in stool

    • ***AVOID ETOH CONSUMPTION
    • AVOID ACETAMINOPHEN (hepatotoxic) containing products
  10. DRUG REGIMENS FOR ACTIVE TB
    • 4 to 7 drugs
    • C & S takes at least 2 weeks
    • 2 "must" drugs are Rifampin & INH (isoniazid)

    Rifampin SE/ADV - red orange staining of tears & urine

    • Isoniazid - INH
    • SE/AVR - peripheral neuropathy -tingling, burning, numbness in fingers & toes amelaorated (lessened) by Pyredoxine (Vit B 6)

    • Ethambutol/ Myambutol
    • SE/ADR - uveitis - inflamation of optic nerve (Rare)manifents as reg/green color blindness - call DOC stat - can lead to blindness

    • Ciprofoxicine/ Cipro
    • SE/AVR-photosensitivity-tendon damage for 6 month post dose

    Steptomycin - IV only first aminoglycoside

    • Cyclocerine
    • SE/ADR-violent psycoses

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