Ribosomal and DNA Abx Flashcards Preview

Clinical Pharmacology > Ribosomal and DNA Abx > Flashcards

Flashcards in Ribosomal and DNA Abx Deck (48)
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1

Tetracyclines

-Tetracycline
-Minocycline
-Doxycycline***

2

Tetracycline MOA/MOR

MOA: 30S bacterial ribosome inhibition

MOR: Ribosomal binding site alterations, efflux pumps

3

Tetracycline pharm/interactions

-May increase INR
-Can't combine isotretinoin --> Causes pseudotumor cerebri
-Multivalent cations may decrease absorption

-Split excretion (60% hepatic/40% renal)

4

Tetracycline Pearls

-Doxy can come in many different "salts" that drastically vary in price
-Use generic doxycycline hyclate
-These drugs seem protective against C diff

5

Tetracycline ADRs

-Nausea
-Photosensitivity
-Contraindicated pregnant women
-Hyperpigmentation (minocycline)
-Black hairy tongue

6

Doxycycline microbial coverage

-CAP typicals
-CAP atypicals
-Rickettsia, Ehrlichia/Anaplasma, B burger
-Pasteurella
-Staph aureus
-Chlamydia trachomatis

7

Common indications for Doxycycline

-URTI*
-CAP
-NGU
-Tick-borne disease (cutaneous manifestations)

8

Extended-spectrum Tetracyclines

-Tigecycline
-Omadacycline
-Eravacycline

MOA: 30S ribosome inhibition

9

Extended-spectrum Tetracyclines pharmacology

-Drug interactions
-Split excretion
-Bacteriostatic
-Higher mortality, don't use unless we have to!

10

Extended-spectrum tetracyclines

-Broad-spectrum of activity that includes G=, G-, atypical, & anaerobic pathogens

-Does NOT get pseudomonas

-Used mostly for nosocomial infections

11

Macrolides

-Erythromycin
-Azithromycin***
-Clarithromycin

MOA: 50S ribosome
MOR: Binding site alterations, efflux pumps

12

Macrolide interactions/pharm

-All agents known to increase INR
-Clarith/erythromycin: potent inhibitor of CYP3A4
-All agents should not be used with other QT prolongers

-Hepatic excretion, bacteriostatic

13

Macrolide class ADRs

-All associated with prolonged QTc

14

Erythromycin ADRs

-Activate motilin receptors causing uncoordinated peristalsis and N/V/D
-Used off-label as an agent in gastroparesis

15

Clarithromycin ADRs

-Metallic taste

16

Azithromycin ADRs

-Generally well tolerated
-high dose can cause N/V

17

Macrolide coverage

Azithromycin: S pyogenes, S pneumo, Hib, M catarrhalis, chlamydial, legionella, mycoplasma, Bordetella pertussis (resistance to S pneumo + Hib limits use)

Clarithromycin: mostly used for H. pylori

18

Macrolide indications

-URTIs ID hates em tho
-CAP*
-NGU*
-Enteritis
-H pylori (Clarithromycin)

19

Fidaxomicin pearls

MOA: Macrolide inhibits RNA polymerase

-BACTERICIDAL against C diff

Little to no activity against anything else other than clostridia

20

Lincosamides

-Clindamycin

MOA: 50S ribosomal inhibition

MOR: Efflux pump, ribosomal target modification

21

Lincosamides coverage

-Covers most anaerobes
-best above the diaphragm with oropharyngeal microbes
-Often used to cover SA, S pyogenes, viridans strep in those with serious PCN allergies

22

Lincosamide indications

-Substitute for B lactam allergy in SSTI, strep pharyngitis
-Anaerobic infections/abscesses

23

Oxazolidinones, drug and MOA and MOR

-Linezolid
-Tedizolid
-MOA: binds ribosomal 50s subunit
-MOR: multiple mutations, slow to develop

24

Drug interactions with oxazolidinones

-MAOI -> levodopa
-Concomitant serotonergic drugs -> serotonin syndrome

25

Oxazolidinones ADRs

-Reversible thrombocytopenia (monitor platelets x2 weeks)
-Watch dietary tyramine due to MAOI
-Peripheral neuropathy
-Serotonin syndrome

26

Oxazolidinones uses

-MRSA and VRE infections (has broad gram + activity)

27

Aminoglycosides, main drugs and MOA and MOR

-Gentamicin
-Tobramicin
-Amikacin
-MOA: inhibits 30s ribosome
-MOR: ribosomal binding site alterations, efflux pumps, AGases

28

Aminoglycoside pharmacology

-Additive nephrotoxicity
-Renal excretion
-Bactericidal
-Measure trough conc 30 min before next dose
-Narrow spectrum abx, only covers aerobic gram negative****

29

Aminoglycosides ADRs

-Nephrotoxicity
-Ototoxicity (genta>tobra)

30

Aminoglycosides clinical indications

-Genta: aerobic GNBs (severe infections), endocarditis
-Tobra: most GNBs including pseudomonas