ABX NC.txt

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Anonymous
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34022
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ABX NC.txt
Updated:
2010-09-11 12:12:24
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antibiotics
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Antibiotic NC 9/13
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  1. example of synergy
    penicillin & aminoglycosides for endocarditis
  2. time dependent killers
    • 1) PCN
    • 2) CEPHS
    • 3) Carbapenems
    • 4) Vancomycin
  3. Concentration Dependent Killers
    • 1) FQs
    • 2) AMGs
    • 3) Daptomycin
    • 4) Telithromycin
  4. DI w/ warfarin
    May increase INR (vitamin K absorption in gut)
  5. DI Antacids/cations
    inhibit ABX absorption - esp FQs - 2 hrs B4, 4 hrs after
  6. DI: CYP450 interactions
    • 1) Cipro (1A2 inh)
    • 2) Erythro (1A2 & 3A4 Inh)
    • 3) Quin/Dalfo (3A4 inh)
    • 4) Telithromycin (3A4 inh)
  7. DI: Antiarrythmics
    FQs
  8. Penicillin MOA
    Inhibit bacterial cell wall synthesis - B Lactam antibiotics
  9. Penicillin ex & pen
    • 1) ex - primarily kidneys (ex naf & oxa)
    • 2) pen - good - lung, liver, kidney, muscle, bone
  10. Penicillins SE:
    • 1) Diarrhea
    • 2) Rash
    • 3) Fever
    • 4) Neutropenia
    • 5) Thrombocytopenia
    • 6) Seizures
  11. Nafacillin and Oxacillin - warning & elimination
    • 1) High Na+ in IV form - watch in pts with HTN
    • 2) Hepatically eliminated, no renal adj.
  12. Amino PCNS -
    Ampicillin, Amoxicillin, Bacampicillin
  13. Antipsuedomonal PCNs
    • (Carboxypenicillins, Ureidopenicillins)
    • Piperacillin,
    • Ticarcillin
  14. AB Lactamase Inhibitor PCNS: Agents
    • 1) Augmentin PO (Amox/Clavulanate)
    • 2) Timetin IV (Ticarcillin/Clavulanate)
    • 3) Zosyn IV (Piperacilli/nzobactam)
    • 4) Unasyn IV (Ampicillin/Sulbactam)
  15. Cephalosporins MOA, Excretion, SE
    • Inhibit bacterial cell wall synthesis
    • - renal excretion
    • - GI, rash, neutropenia, seizures
  16. 1st generation cephalosporins
    • 1) Cefazolin
    • 2) Cephalexin (PO)
    • 3) Cefaclor
    • 4) Cefadroxil
  17. 2nd generation cephalosporins
    • Cefuroxime (IV, PO)
    • Cefotetan
    • Cefoxitin
    • Cefprozil (PO)
  18. 2nd generation coverage
    1) Gram (+) - >60%: Strep: Pneumo, ABCG, viridans, MSSA -30-60%: Staph epidermidis 2) Gram - >60%: Proteus, E. Coli, Klebsiella, Moraxella, Neisseria gonorrheae, H. Influenzae, Serratia (cefotetan only) - 30-60%: Citrobacter, Enterobacter (not cefoxitin Cefotetan/Cefoxitin: anaerobic coverage - >60%: Clostridium (not difficile), B. fragilis
  19. 3rd Generation Cephalosporins
    • IV: Ceftriaxone, Ceftazidime, Cefotaxime
    • PO: Cefpodoxime, Cefixime, Cefdinir, Ceftobiprole
  20. Carbepenam MOA
    Lysis of bacterial cell wall - only IV
  21. carbapenams have PAE vs
    gram - bugs
  22. carbapenam elimination
    renal - may require adjustment
  23. ertapenam dosing
    QD
  24. Meropenam and Doripenman
    QID & TID dosing
  25. Monobactams: Aztreonam - MOA & coverage
    inhibit bacterial cell wall synthesis - gram - only - covers psuedomonas
  26. Gycopeptides
    • Vacomycin
    • Teicoplanin
    • Televancin
  27. Gycopeptides (Vacomycin, Teicoplanin, Televancin) MOA & Toxicities
    Inhibit bacterial cell wall synthesis - 1) Ototoxicity 2) Renal Dysfunction (trough 5-15 mg/dL)
  28. SE of Vanco
    Red Man's Syndrome - always infuse vanco over 6- min - less with ticoplanin
  29. VRE -use:
    • 1) Quinpristin/Dalfopristin (Synercid)
    • 2) Linezolid (Zyvox)
  30. Floruoquinolone MOA
    target bacterial topoisomerases - inhibit bacterial DNA replication - many QD dosing - post antibiotic effect vs gram -
  31. Fluoroquinolones SE
    • Gi
    • - Seuizures
    • - Rash
    • - Tendon Rupture
    • - CNS SE
    • - Hyper/Hypoglycemia
    • - Photosensitivity
    • - QT prolongation
    • - Bone Effects: chondrocyte tox, growth in kids, risk vs benefit
  32. Oxafloxacin/Norfloxacin
    Older, cover primarily gram -
  33. Ciprofloxacin
    most potent vs pseudomonas - less gram - vs levo/gati
  34. Levo/Gemi
    new agents - respiratory quinolones - good gram -, some gram + - better coverages vs. strep, H flu, atypic, pseudos
  35. Moxifloxacin
    like levo/gemi, adds anaerobic coverage
  36. Aminoglycosides MOA
    inhibit protein synthesis by binding to 30s ribosomal subunit
  37. aminoglycoside SE:
    • Ototoxicity (irreversible, uncommon)
    • - Renal dysf - moon BUN/ Scr, adj dose - goal trough <1mg/dL for QD dosing - neuromuscular block is rare, associated with rapid IV infusion
  38. For less nephro with aminoglycosides, use
    extended interval dosing - post antibiotic effect against gram -
  39. Aminoglycosides: Agents
    • - Gentamycin
    • - Tobramycin
    • - Amikacin
    • - Netilmicin
    • - Streptomycin
  40. Aminos: Primary Coverage
    **GRAM -** - Including Pseudomonas - very little gram + - synergy for endocarditis - staph, enterococcus
  41. Macrolides MOA
    inhibit bacterial protein synthesis - bind to 50s subunit
  42. erythromycin
    more SE (esp GI) & more DI (cyp1A2 & 3A4 inhibitor)
  43. azithro/clarithro
    better tolerated - less SE, QD - BID dosing vs QID
  44. clarithromycin
    needs renal adj at circle <30 ml/min
  45. azithromycin
    very few clinically significant drug interactions
  46. erythro SE
    GI upset, rash, LFTs, rare hearing loss
  47. clarithro/azithro SE
    Gi upset - rare rash, lfts, transit hearing loss
  48. macrolides
    • erythromycin
    • clarithromycin
    • azithromycin
  49. macrolide primary coverage
    **ATYPICALS** clamydia, legionella, mycoplasma - mod gram + & -
  50. Ketolides (Telithromycin) - MOA
    inh bacterial protein synthesis, bind to 50s subunit - activity against resistant strains
  51. ketolides are:
    • conc dependent, bactericidal
    • - Po formulation
    • - many DIs
    • - 3A4 inhibitor
  52. FDA indication for Telithromycin
    community acq pneumonia
  53. Telithromycin - adjustments
    renal and hepatic
  54. telithromycin - adverse effects
    Vision problems, di, nausea, dizziness, HA - preg category C
  55. Trimethroprim-Sulfamethoxazole (Bactrim, Cotrim, Septra) MOA
    each inhibits step in folic acid synthesis - bactericidal - high urinary conc
  56. Primary use for Trimethroprim-Sulfamethoxazole (Bactrim, Cotrim, Septra)
    UTI, HIV prophylaxis of opportunistic infections
  57. Trimethroprim-Sulfamethoxazole (Bactrim, Cotrim, Septra) SE
    N/V, di, rash, feer, leuko/thrombo, stevens-johnson syndrome
  58. Trimethroprim-Sulfamethoxazole (Bactrim, Cotrim, Septra) DI
    bacterium may displace other highly protein bound drugs (warfarin, phenytoin, methotrexate)
  59. CI for Trimethroprim-Sulfamethoxazole (Bactrim, Cotrim, Septra)
    - Pregnancy (3rd trimester only), severe liver disease
  60. Clindamycin & Metronidazole
    Grouped together - potent at treating anaerobes
  61. Clindamycin MOA
    inhibit bacterial protein synthesis
  62. CLindamycin SE
    GI!!!!!!! - number one cause of C diff - inc LFs, rash
  63. Clindamycin DIs
    may enhance nm blockade of such agents
  64. Clinda also active against
    Strep, MSSA
  65. Metronidazole MOA
    damage bacterial DNA --> bacteriocidal
  66. metronidazole SE
    gi, seizures, pancreatits rare, DARK URINE
  67. DIs
    ETOH: disulfram-like reaction
  68. Metronidazole: renal dosing
    only if <10 ml/mind
  69. Tetracyclines: Doxycycline, tetracycline, Minocycline MOA
    binds to 30s ribosomal subunit to inhibit bacterial protein synthesis - not used as much anymore
  70. Doxycycline used for:
    output tx of CAP
  71. Tetracyclines can be used to tx
    acne
  72. Quinupristin/Dalfopristin (SYnercid) MOA
    inhibits protein synthesis
  73. Quinupristin/Dalfopristin (SYnercid) coverage that differs from Linezolid (Zyvox)
    only entercoccus faccium
  74. Quinpristine/Dalfopristin SE
    increase bilirubin, infusion rxn, myalgia/arthlalgia
  75. Quinpristine/Dalfopristin DI
    CYP3A4 inhibitor
  76. Linezolid SE
    thrombocytopenia, GI, CNS
  77. Linezolid DI
    - weak MAOI - PPA or sudafen (HTN, SSRI, TCAs (SS) - Tramadol
  78. Cyclic Lipopeptides: Daptomycin - MOA
    binds to bacterial membrane, causes rapid depolarization of membrane potential
  79. Daptomycin DI & FDA Indication
    few DIs, not hepatically metabolized - complicated skin & skin-structure infections (CSSSIs)
  80. Daptomycin - renal dosage
    >30 = 4mg/kg IV q 24h - < 30 ml/min: 4 mg/kd IV q 58
  81. Daptomycin AE
    constipation, di, vomiting, CPK increase = peg cat B

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