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Session 3 Pharm- 9
Pharm -9- protein synthesis inhibitors
| Question | Answer |
|---|---|
| What type of drug is erythromycin (E-mycin) | Macrolide (50s) |
| What type of drug is azithromycin (Zithromax) | Macrolide (50S) |
| What type of drug is Clarithromycin (Biaxin) | Macrolide (50s) |
| What type of drug is Dirithromycin (Dynabac) | Macrolide (50s) |
| Why would you probably avoid prescribing erythromycin | Many drug interactions (CYP450-3A4), Poor Half life, GI effects, No H. Flu coverage and poor S. Pneumoniae |
| What would you prescribe Azithromycin and Clarithromycin for | good for Gram + (not MRSA), some gram neg, good for atypicals like Legionella sp., mycoplasma pneumoniae, and chlamydia pneumonia |
| Which of the macrolides requires adjustment in renal impairment | Clarithromycin |
| How do the macrolides work | inhibit translocation steps by binding 50s subunit |
| What are the major s/e of using macrolides | GI s/e, Hepatitis (mostly with erythromycin) cholestatic hepatitis, QTc prolongation, allergic reactions |
| What resistance mechanisms have bacteria developed to macrolides | altered target site, antibiotic efflux pump, |
| What type of drug is Telithromycin (Ketek) | Ketolide |
| What is the advantage of the ketolide telithromycin | less resistance than macrolides but still has drug interactions (3A4) |
| What are the major s/e of using telithromycin the ketolide | diarrhea, visual changes (blurry, difficulty focusing), QTc Prolongation, Hepatotoxicity, |
| Is a ketolide a first-line therapy | no only approved for CAP not used first line |
| What place in therapy does clindamycin have | covers CA-MRSA but not HA-MRSA, covers anaerobes. Mostly used for its coverage of anaerobes. Commonly used in pts with PCN allergy |
| What are the s/e of clindamycin | diarrhea, (C. Difficile), hepatotoxicity, Rash |
| What type of drug is linezolid (Zyvox) | Oxazolidinones |
| What is the clinical use for linezolid (Zyvox) | used against gram + bacteria and HA- MRSA, Enterococcus faecalis and Faecium including VRE. Becoming first line DOC for MRSA |
| Why is Linezolid (Zyvox) becoming the drug of choice for MRSA | PO formulation with 100% bioavailability doesn't need adjustment in renal or hepatic failure |
| What are the s/e of Linezolid (Zyvox) | Myelosuppression (thrombocytopenia), Peripheral/optic neuropathy, lactic acidosis, serotonin syndrome (inhibits MAOI) |
| Pt is taking an MAOI for depression and has come down with a MRSA infection would you prescribe them Linezolid (Zyvox) if so why if not why | Though it is considered first line therapy for MRSA you would avoid using it in this case because Zyvox inhibits MAOI as well and can cause serotonin syndrome if combined with MAOI drugs |
| What is the DOC when switching from IV vancomycin | Linezolid (Zyvox) |
| What type of drug is Quinupristin-dalfopristin (Synercid) | Streptogramin |
| What is the place in therapy for Quinupristin-dalfopristin (Synercid) | Good against Gram +, enterococcus faecium (VRE)a and MRSA (not approved though). ITS MAIN ROLE IT TO TX VRE |
| What are the major s/e of Quinupristin-dalfopristin (Synercid) | Infusion related reactions, elevation of conjugated bilirubin, arthralgias/myalgias |
| What type of drug is doxycycline | tetracycline |
| What type of drug is minocycline | tetracycline |
| What type of drug is demecyclocycline | tetracycline |
| What type of drug is Oxytetracycline | tetracycline |
| What is the DOC for rickettsial infections (Lyme disease, Q fever, Rocky Mt spotted fever, Ehrlichiosis) | Doxycycline |
| What is the 2nd line agent for CAP, COPD exacerbation and can be used to tx Acne and Chlamydia | Doxycycline |
| What is the primary use of Demeclocycline | used in SIADH, blocks ADH induced water resorption |
| What drug of the tetracycline family is prescribed for Rheumatoid arthritis and can be used for Staph infections including CA-MRSA but is limited due to is s/e profile | Minocycline |
| What are the major s/e of using minocycline | deposition in calcified tissue= tooth discoloration, deformation of bone/growth inhibition. Avoid giving with calcium, causes photosensitivity, GI upset, Vestibular rxn, hepatotoxicity |
| Why should you counsel pt to throw away old tetracycline meds | they decompose into toxic compounds |
| What type of med is Tigecycline (Tygacil) | Glycylcyclines |
| What is the probably future use for Tigecycline (Tygacil) | broad spectrum of activity covers MRSA, enterococcus faecalis, gram negatives except Pseudomonas and some of the anaerobes. Currently approved for cSSSI, intra-abdominal infections and Acinetobacter |
| Tigecycline works at the exact same site as the tetracycline why is it more effective | it overcomes all the resistance mechanisms bacteria have to tetracycline like the efflux pumps and ribosomal modifications |
| What are the major s/e of Tigecycline | GI disturbances, photosensitivity, Pseudotumor cerebri |
| What is the use for chloramphenicol | Last resort for tx of rickettsial infections in children |
| What drug can cause gray baby syndrome | Chloramphenicol |
| What drug can cause aplastic anemia | chloramphenicol |
| What type of drug is Gentamicin | Aminoglycoside |
| What type of drug is Tobramycin | Aminoglycoside |
| What type of drug is Amikacin | Aminoglycoside |
| What type of drug is streptomycin | Aminoglycoside |
| What type of drug is Netilmicin | Aminoglycoside |
| What type of drug is Kanamycin | Aminoglycoside |
| What type of drug is Neomycin | Aminoglycoside |
| What is the primary use for the aminoglycosides | lesser and greater gram neg coverage IE Pseudomonas A., Serratia Marcescens, Acinetobacter |
| What do you usually prescribe with an aminoglycoside and why | a beta lactam because they have synergy working together |
| What types of resistance are there to aminoglycosides | altered ribosomes, altered uptake |
| Why don't aminoglycosides cover the anaerobes | require oxygen to get across the cell membrane to exert their action |
| What concerns do you need to be aware of when prescribing an aminoglycoside | it is cleared renally and has a narrow therapeutic index monitor peaks and troughs and caution in renally impaired pt |
| What are the major s/e of the aminoglycosides | Nephrotoxicity (tubular necrosis), Ototoxicity/vestibulotoxicity (often permanent careful with high doses) |
Created by:
smaxsmith
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