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RavLect18: TCNs


Tetracycline MoA Bind to the 30S ribosomal subunit, reversibly inhibiting the binding of aminoacyl-tRNA (no protein synth, no cell wall) Mainly Static
Tetracycline ADRs Erosive/sclerosing Renal fail @ expirn Teeth staining; bone growth impaired; teratogenic Photosenstivity (highest w/ democlocycline) Hepatotoxicity (w/ high dose in renal failure) NVD anti-anabolic: raise BUN, acidosis, hyperphosphatemia
Minocycline ADRs Vertigo (more in women) Skin & mucous membrane pigmentation Lupus-like symptoms
TCN DDIs Anticonvulsants (Carbamazepine, Phenytoin, Phenobarbital) decrease [TCN] Antagonistic w/ PCNs (static, while PCNs are cidal) Lowers efficacy of OCs! Complex w/ Fe, Zn, Ca, Mg, Al, bismuth, binding resins Isotretinoin causes benign cranial hype
TCN on food/empty stomach? Tetracycline on empty stomach Doxy & Minocycline w/ food
TCN IV or PO? PO: TCN, Doxycycline, Minocycline IV: Doxy, Mino, Tigecycline
Doxycycline DON'T inject IM! It will burn tissue to death Don't dose adjust in renal dysfunction
Tetracycline PK TCNs distribute to all tissues, liver, bile, prostate, urine, CSF, Synovial
Tigecycline (Tigacil) distributes best to GI organs. Indicated for IA infections. Can Tx DR enterococcus. Also for cSSIs. Don't give in pneumonia; increases mortality! Requires dose adjustment in hepatic impairment Elevates LFTs NV (slow rate to fix), AAD
Drugs for IA infections Tigecycline, cefoxitan and cefotetan, moxiflox, iminem, erbipenem. Zosyn & Unasyn too, but freq dosing is inconvenient
Tetracycline SoA (all TCNs except Tigecycline) They treat rare/WEIRD organisms. 2nd line for atypicals (after 1st line Quinolones) along with macrolides broad spectrum of aerobic and anaerobic bacteria including intracellular pathogens G- & G+ We don't use very often though b/c of ADRs
Demeclocycline for Tx of SIADH only! Causes hyponatremia, fluid overload, concentrated urine.
General Use for TCNs CAP Non-gonococcal UTI (chlamydia trachomatis) PID - IV doxycycline w/ cefoxitin or cefotetan Atypical pneumonia/bronchitis: Chlamydia pneum, C. psittaci, Mycoplasma pneu, Legionella Lyme disease Rickettsia H. pylori (TCN w/ other drug
Which drugs should NOT be used in babies? TCNs & Quinolones
Created by: cheeoh