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Aminoglycosides
Question | Answer |
---|---|
Aminoglycosides Drugs ? | * Gentamicin --- Amikacin --- Tobramycin --- Streptomycin --- Neomycin |
Basic MOA ? | * Protein Synthesis Inhibitors acting at the 30S ribosome |
Aminoglycosides (AGs) basics ? | * Most commonly used in Gram (-) Aerobes ..... * Always used in combo, usu b-lactams ..... * Use is limited due to severe toxicity |
AGs most Cx use ? | * empiric therapy of serious infections, when we think it is a severe G (-) bacteria.... * use in hospital bc given IV and once the culture is done, an appropriate drug is used |
AGs spectrum of activity to use in ? | * Serious infections by aerobic G- bacilli, including Pseudomonas, Proteus, Serratia, and G+ Staph .... * Used in b-lactam combo for Pseudomonas, Invasive enterococcal infections and Serious Stap. |
When AGs can be used as a monotherapy ? | * Tularemia - Plague - UTIs |
Gentamicin basics and use ? | * one of the most used AGs ..... *Usually used in combination with a cillin for severe infections: Pseudomonas (a DOC) -- Enterococcal (a DOC)...... * Enterococcal endocarditis and tularemia |
Amikacin unique features and uses? | * Primarily used for pseudomonas and other serious infections caused by organisms resistant to other AGs..... * broadest spectrum due to its unique metabolism |
Streptomycin use ? | * Used as single agent to treat tularemia and plague |
Neomycin use ? | * primarily OTC drugs.... * primarily for gut sterilization before surgery |
Aminoglycosides – MOA ? | * Irreversibly binds to 30S ribosome --> interferes with initiation complex formation --- causes misreading of mRNA --- restricts polysome formation ..... * Unique bc it is Bactericidal |
AG drug resistance is common in ? | * Especially a problem for enterococci , due to AME (Aminoglycoside Modifying Enzyme) |
AG Pharkokinetics ? | * Must know and monitor kidney function (CrCl) bc they are eliminated by glom. filtration in the kidneys....* so adjust dose based on kidney monitoring |
AGs Dosing ? | * Intermittent Dosing - 3 x a day small doses and Extended Dosing - 1 time a day |
Extended Dosing Advantages ? | * compariable outsomes to intermittent, seems to be better on the kidneys, don't have to monitor serum levels of the drug as much, |
Extended Drug Dosings 2 advantages ? | * Post-antibiotic effect (PAE) and Concentration-dependent killing ....* basically, more drug is on board, so it will kill more and since we have PAE (post antibiotic effect), we still get killing after concentrations drop below the MIC |
How is it less toxic ? | * Bc it is time and concentration dependent.... * get less drug accumulation due to the once a day dosing |
When not to use extended AG dosing ? | * Pts w/ unstable renal function --- CrCl < 60ml/min --- Endocarditis or meningitis --- Increased Vd (pregnancy, ascites, edema) --- Pts receiving concurrent nephrotoxic or ototoxic drugs |
AGs SEs ? | * Very low TI .....* Can cause ireeversible Ototoxicity, reversible neuromuscular block (CI in myasthenia gravis), and causes Nephrotoxicity |
Why we see the SEs ? | * the more you use the drug, the more likely it is to have a SE.... * Ototoxicity is due to it being trapped in the endolymph |
TmT for AGs Toxicity ? | * IV Calcium Salts |
*b-Lactam Drugs* --> Monobactams --> Aztreonam basics ? | * Effective against gram negatives only ...... *Same mechanism of action as other b-lactams by only binds to a PBP (penicillin binding protein) present in gram negatives |
Aztreonam uses ? | * Almost the same use as AGs ...... *serious gram negative aerobes infections --> Pseudomonas (DOC), Enterobacter........ * Good for MDR pseudomonas and for those with a penicillin allergy |
Streptogramins --> quinupristin + dalfopristin MOA ? | * Protein Synthesis Inhibitors acting at the 50S ribosome |
Quinupristin + Dalfopristin use ? | * Always used in combo with each other...... * Drug resistant G+ cocci infections like Staph. or Entero Faecium that is Vanc resistant (VREF) |
Quinupristin + Dalfopristin SEs ? | * myalgias and inhibit p450s |
Urinary Antiseptic --> Nitrofurantoin basics ? | * a very rapidly excreted drug that is used exclusively in uncomplicated UTIs....* not a first line drug....* also can be used for reoccurring/chronic UTIs |
Nitrofurantoin MoA ? | * ROS that damages DNA... * true MoA not really known |
Nitrofurantoin SEs ? | * Hypersensitivity reactions - skin rashes..... * Causes Hemolytic anemia in G6PD deficiency...... * Acute pneumonitis in Elderly..... * Turns the Urine BROWN |