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Drugs Pneumo/Pert

Drugs for the Treatment of Pneumonia and Pertussis, 1/22/2013

QuestionAnswer
Drug class and mechanism of action: Azithromycin, Clarithromycin Macrolides, Protein Synthesis inhibitors acting at the 50S ribosomes
Drug class and mechanism of action: Ciprofloxacin, Levofloxacin, Moxifloxocin Fluoroquinolones, Bacterial DNA synthesis blockers (DNA gyrase, Topoisomerase IV inhibitors)
Drug class and mechanism of action: Doxycycline Tetracyclines, Protein synthesis inhibitors acting at the 30S ribosomes
Drug class and mechanism of action: Ampicillin, Amoxicillin Extended-Specrtum Penicillin, Cell wall synthesis inhibitors
Drug class and mechanism of action: Ticarcillin, Piperacillin Antipseudomonal penicillin, Cell wall synthesis inhibitors (Inhibits crosslinking by way of PBPs)
Drug class and mechanism of action: Imipenem, Meropenem Carbapenems (B-Lactam), Cell wall synthesis inhibitor
Drug class and mechanism of action: Sulbactam, Tazobactam, Beta Lactamase inhibitors, Bind to B-lactamase and inactivate the enzyme
Drug class and mechanism of action: Trimethoprim+Sulfamethoxazole Antifolates, Inhibit folate production in bacteria which is needed for nucleic acid synthesis
Drug class and mechanism of action: Cetriaxone, Ceftazidime, Cefotaxime, CCefdinir 3rd gen cephalopsorin, Cell Wall synthesis inhibitors
Drug class and mechanism of action: Cefepime 4th gen cephalosporin, Cell wall synthesis inhibitor
Drug class and mechanism of action: Tobramycin, gentamycin, Aminoglycoside, Binds to 30S and 50S ribosomes to prevent the 70S complex
Drug class and mechanism of action: Aztreonam Beta-lactam, Blocks peptidoglycan crosslinking in cell wall
Macrolide Toxicities GI effects, Hepatotoxicity (primarily seen with erythromycin estolate), Prolonged QT
Fluoroquinolones Adverse effects Increased incidence of tendon rupture and tendonitis (Do not give for pregnant, nursing or children), Prolonged QT (Do not give in hypokalemia or QT problems)
Tetracyclines are cleared by the Metabolically so you don't have to worry about renal failure!
Do not take a tetracycline with Anything that will increase the stomach pH
Why can't you give a tetracycline to a child? It chelates with calcium and stains teeth brown and leaves bone rings
Tetracycline Adverse effects GI, Bones/teeth, Liver toxicity, Tissue hyperpigmentation, Photosensitization, Risk of pseudomembranous colitis
Precautions for Tetracyclines Do not give to pregnant patients, children under the age of 8 and always use skin protection and DO NOT TAN
Avoid a Carbapenem if An CNS lesion is present, renal insufficiency, Penicillin allergy
Bactrim adverse effects Allergies, Anemia, Kernicterus/encephaolopathy
If you are allergic to Pens, you are more likely to be allergic to Cephalosporins and Carbapenems
What is the mechanism of action for a Beta lactamase inhibitor They bind to the B-lactamase and inactivate the enzyme
What is the role of a B-lactamase inhibitor in anitmicrobial therapy? The extend "penicillin drugs" spectrum against lactamase producers (Staphs and Klebsiella)
Why is imipenem always used in combination with cilastatin? To prevent rapid breakdown in the kidneys
First line treatment in Community-aquired pneumonia for outpatients with no comorbities and no recent antibiotic use Macrolide (Azithromycin or Clarithromycin) OR Doxycycline
If local macrolide-resistant pneumonia is high,treatment in Community-aquired pneumonia for outpatients with no comorbities or recent antibiotic use Fluoroquinolone
First line treatment in Community-aquired pneumonia for outpatients with comorbities or recent antibiotic use Fluoroquinolone (Levofloxacin or moxifloxacin) OR Amoxicillan+Macrolide(or Doxycycline)
Preferred treatment for hospital acquired pneumonia Fluoroquinolone OR 3rd gen Cephalosporin+Macrolide(or Doxycycline)
If MRSA is a concern in the treatment, add Vanc or linezolid
For an ICU patient, what is the preferred pneumonia treatment? Combination of Antipseudomonal B-lactam (cephalosporin, meropenem, or aztreonam[if patient is allergic to B-lactam]), Fluoroquinolones (Ciprofloxacin/Levoflaxacin), and Aminoglycosides(Gentamycin)
Doxycyline is not used in which cases Severe
If Pseudomonas is a concern (pulmonary complications), administer Ciprofloxacin
Treatment of Pertussis for newborn Azithromycin
Treatment of Pertussis over 1 month old Macrolide(Azithromycin), alternate could be Bactrim
Created by: mcasto