med agents final

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Author:
hanne046
ID:
56824
Filename:
med agents final
Updated:
2010-12-19 14:04:10
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comparision within class
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Description:
quinolones, tetracyclines, aminoglycosides, antifungals
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  1. CIPRO
    • most potent FQ against GM- bacteria
    • limited activity vs strep and anareobes
    • UTI=GM- =cipro but resistance with monotherapy
    • BID dosing t1/2=5 hours
    • first broad spec
  2. LEVOfloxacin
    • GM+ anaerobe
    • upper respieratory tract
    • active vs pen presistant and macrolide resistant strep pneumo and pseudomonasaeruginosa
    • 5x more soluble than oflox
  3. MOXIfloxacin
    • gm + anaerobe
    • upper respiratory tract
    • improved activity vs strep pneumoniae
    • resaonable anaerobic activity
    • mainly metbaolized by conjugation
    • NO URINARY EXCRETION
    • longest t/12
    • dont need to adjust in renal failure
    • watch interaction with antiarrhythmics
    • active for MDRTB
  4. norfloxacin
    • first FQ
    • low bioavailability
  5. ofloxacin
    • racemate has 1/2 the activity of LEVOfloxacin
    • opthlamic available
    • IV/PO
    • generic available
  6. DOXYcycline
    • DOC chlamydia trachomatis (7d) borellia, anaplasma, ehrlichia and rickettsia
    • bronchitis,
    • CAP--not atypicals
    • broad spec gm + gm - atypical organisms tick borne pathogens
    • take on an empty stomach avoid vitamins do not lay down x30 minutes
  7. TIGEcycline
    • very broad spec MRSA and VRE and nosocimial enterobacteriaciae
    • IV only
    • NAUSEA 40%
    • photosensitivity
  8. MINOcycline
    • metabolized
    • somewhat more lipophilic at physiological pH reaches higher concentrations in tears and saliva --useful for meningococcal carrier state
  9. GENTAmicin
    • not for pseudomonas auerginosa (76%R) okay for serratia (93%)
    • good for gram negative
    • mixture of drugs
    • inactivated by 2' adenylation and acetylation at the 2'6'and 3' positions
  10. TOBRAmycin
    • good for pseudomonas aerginosa (95%) not for serratia(79%)
    • good for gram - infections
    • less renal dysfunction
    • inactivated by 2' adenylation and acetylation at the 2'6'and 3' positions
  11. amikacin
    • synthetic AG analog
    • used for infections resistant to other AG
    • not good for pseudomonas
    • exellent gm -
    • only inactivated by 6'acetylation and is resistant to other inactiviating enzymes
  12. ORDER OF MOST TOXIC TO LEAST TOXIC nephrotoxic AG
    neomycin>gentamicin=amkikacin= netilmicin>tobramycin>streptomycin
  13. ORDER OF MOST TOXIC TO LEAST TOXIC ototoxic AG
    streptomycin =kanamyin > amikcacin=gentamicin = tobramycin>netlimycin
  14. amphotericin B
    • combines with cytoplasmic membran sterols
    • broad specturm of ctivity versus a variety of funagl pathogens TOXIC
    • first line for cryptococcus neoformans, histoplasma capsulatim blastomyces
    • highest concentrations in liver > spleen = kidneys> lungs>heart = muscles>bone
    • LOW RENAL not UTI
    • adverese effects--RENAL TOXICITY, binds renal sterols, GI problems, hypokalemia, phlebitis, thrombophlebitis at injection site
    • give APAP 500 mg 30 min prior to to prevent rigors
  15. fungizone
    amphotericin B, toxicity effects, 0.5mg/kg/dose
  16. abelcet
    amphotericin B lipid complex,
  17. ambisome
    more effective less toxic than fungizone, $$$$$
  18. flucytosine
    • candida albicans--UTIs
    • cryptococcal meningitis first line
    • if fail azoles
    • PO
    • well distrubited reaches joints, CSF levels high
    • 80-90% renally eliminated
  19. fluconazole
    • water soluble triazole, PO and IV
    • tx thrush, candida albicans esophagitis cryptococcus
    • paritally effective for inital teatment of cryptococcal meningitis in AIDS to prevent candida infections
    • achieve adequate CFS concentrations preferred for meningitis
    • adjust in renal failure
    • best tolerated
  20. ketoconazole
    • broad spec not as efective as amb for serious systemic fungal injfections
    • highly protein bound ery lipophilic go to fat, liver kidney and skin
    • primarily metabolized--excreted in bile
  21. itraconazole
    • broad spec
    • expanded spec including ASPERGILLUS
    • primary indications--blastomycosis pumonary and extrapulmonary and histoplasmosis DOC sporotrix schenkii, toenail infections $$
    • hepatic metabolized--almost entirely, active metabolite hydroxyitraconazole
    • Take with food
    • highly protein bound
  22. voriconazole
    • second generation triazole enhanced activity vs flucoanzole resistnat C Krusei and grabrata IV and PO
    • GOLD STANDARD FOR ASPERGILLUS
    • ideal po to IV switch
    • LARGE volume of distribution
    • almost completley metabolized--saturable, CYP2C19 drug interactions!!
    • VISUAL DISTURBANCES
  23. posaconazole
    • ORAL PROPHYLAXIS FOR ASPERGILLOSIS
    • auc 4 x higher when given with fatty meal vs fatty state
    • large volume of distrubution
    • PROLONG QTC interval
  24. drug interactions with AZOLES?
    • AZOLES=INHIBITORS!!DRUGS HAVE INCREASED LEVEL!! therefore you will need to redraw levels of cyclosproin, HIV protease inhibitors tacrolimus (keto) phenytoin, warfarin (fluc)-- rifampin decreaesd auc of fluc 25%
    • itraconazole---tacrolimus, cyclosporin, warfarin
    • VORICONAZOLE--antiregctuoin drug, rifabutin increased 331% 3A4 substrate!!
    • posaconazole--inhibits rifabutin but induces metabolism of rifampin.
  25. caspofungin
    echinocandin--aspergillus not first line , long half life and large volume of distrubution. load dose

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