REVIEW_MODULE_3_PHARM_ 1.2023

REVIEW_MODULE_3_PHARM_ 1.2023 1 Penicillins: weaken bacterial cell wall Beta lactam ring-beta lactimases split this ring and render Pcn inactive Pen G and Pen V: Narrow spectrum good for strep and syphilis Amoxicillin/Ampicillin: broad spectrum: Strep and AOM and lyme disease in children < 8 Adverse reactions: allergic Macrolides drugs of choice for patients with allergies Narrow spectrum with penicillinase resistance Oxacillin, Nafacillin, dicloxacillin:staph aureusstaff epidermis Dicloxacillin, Nafacillin, Oxacillin, can be given po Ticarcillin/piperacillin: effective against pseudomonas and Enterobacter, Bacteroidesfragilis and Klebsiella Beta Lactamase inhibitors Clavulanic acid, tazobactam,sulbactam- extend coverage when added to another antibiotic: Ampicillin/sulbactam Amoxicillin clavulanic acid Ticarcillin/clavulanic acid Piperacillin/tazobactam-effective against pseudomonas No MRSA coverage Cephalosporins: weaken bacterial cell wall First generation: Cephalexin, cefazolin, cefadroxil mostly used for presurgical prophylaxis(mostly gram positive) Second generation: Cefoxitin (anerobeic bacteriodesfragilis); Cefaclor; Cefotetan; Cefprozil, Cefuroxime (mostly gram positive) Cefuroxime is good for URI pneumonia from : h flu; pneumococci and staphylococci Givessome beta lactamase coverage but does not cover pseudomonas or meningitis Third generation Cefotaxime, Cefdinir, Cefditoren; Cefixime; cefpodoxime; ceftazidime; Ceftibuten; Ceftriaxone All can penitrate spinal fluid and have good gram negative coverage Fourth generation: Cefepime pseudomonas only; Ceftolozane 2 Pseudomonas and hospital acquired infections Fifth generation: - Ceftaroline MRSA only Cross allergy with PCN: do not use if anaphylaxis Alcohol reactions: cephazolin and cefetotan Bleeding: cefotetan and ceftriaxone decrease prothrombin through interference with vitamin K Cross reaction with Pcn Carbapenems Imipenem- not given alone Meropenem Ertapenem- not effective against pseudomonas Doripenem Big guns cover almost everything but atypicals Good for gram negative and gram positive and anerobes Vancomycin-inhibits cell wallsynthesis Narrow spectrum only used for MRSA and C diff Oral can only be used for Cdiff Side effects: ototoxicity; red man syndrome; thrombocytopenia and renal failure Telavancin is new class Fosfomycin-single dose therapy for UTI from E coli or Enterococcus faecalis Tetracyclines- bacteriostatic protein synthesis inhibitor Doxycycline, Minocycline, Demeclocycline, tetracycline Broad spectrum: inhibit protein synthesis Uses: Doxycycline: CAMRSA Pneumonia (chlamydia and mycoplasma) RMSF (even children under 8), Lyme, acne, PUD, RA (minocycline), anthrax, chlamydia Stain deciduous teeth and can cause liver and renal toxicity and cause photosensitivity Cannot take with calcium, milk, iron, magnesium or antacids 3 Macrolides-inhibit protein synthesis Used in patients allergic to PCN Azithromycin Erythromycin Clarithromycin- can be used in CAMRSA; BB Warning for C diff Cover pneumonia, mycobacterium avian complex (HIV patients), chlamydia H flu All cause QT prolongation: Azithromycin is the least likely to cause this Avoid statins because of muscle breakdown and simvastatin prolonged QT Linezolid and Tedizolid-Oxazolidinonones Bacteriostatic inhibiotor of protein synthesis CAMRSA and aerobic bacteria, VRE Very expensive Can cause myelosuppression Telithromycin: Close relation to macrolides It is a ketolide Works againststrep pneumoniae Liverinjury, prolongs QT, visual disturbances and muscle weaknessin patients with myasthenia gravis(BB warning) Dalfopristin/Quinupristin- inhibit protein synthesis Streptogramins Only treatment VRE in those not responding to Vancomycin Hepatotoxicity Chlroamphenicol Causes fatal aplastic anemia and bone marrow depression Only used in life threatening emergencies Aminoglycosides- cause misreading of the code on the MRNA template to inhibit protein synthesis Gentamycin, tobramycin, amikacin, neomycin, kanamycin, streptomycin paromomycin Not used alone: PCN, Cephalosporins, and Vanc 4 Monitor peak and trough levels and if they become abnormal you stop, reduce or extend time between doses because of danger of renal failure Also ototoxicity and blood dyscrasias, nephrotoxicity Teratogenic Trimethoprim/sulfamethoxazole-inhibitsynthesis of folic acid CAMRSA and UTI In children dosage based on amount of trimethoprim not so in adults Skin reactions most common reaction Can cause low BS especially with decreased renal function Crossreaction with thiazides, loop diuretics, Celebrex and sulfonureas Silvadene ointment used for burns CANNOT USE IN PREGNANCY BLOCKS FOLATE Quinolones: Gram positive and negative Good for empiric therapy First gen- ciprofloxacin Pyelo and uti; and intractable infectious diarrhea Cipro can increase muscle weaknessin myasthenia gravis SecondLevofloxacin-resp and uti and intractable infectious diarrhea; pyelo and prostatitis Ofloxacin: eye and ear, skin, lungs, prostate, UTI ThirdMoxifloxacin- resp tract infections Norfloxacin- prostate, UTI, gonorrhea Bacterial resistance is common: Tendon rupture, now AAA and mental changesin elderly, photosensitivity Cannot be given in pregnancy interfere with DNA Nalidixic acid is synthetic fluroquinilone for gram neg UTI 5 Causes cartiliage erosion Metronnidazole: Gut and vagina Protozoal infections, anaerobes, H pylori, c diff, trichimonias, BV, giardiasis, diarrheal amoebiasis Disulfuram reaction with ETOH, neurotoxicity, cancer in rats Daptomycin MRSA IV only Topicals Mupirocin- impetigo Retapamulin- new fluro for impetigo Bacitracin Polymyxin B- topical for ears, eyes and skin UTIs Mostly gram negative e coli, proteus, klebsiella, enterococcusfaecalis Amoxicillin Nitrofurantoin- not pregnancy Demyelinization and nerve degeneration, hepatoxicity, pulmonary issues, Concentrates in bladder only due to rapid metabolism TMP/SMZ Cipro Levoquin Drugs for influenza ■ Neuraminidase inhibitors – Oseltamivir [Tamiflu] can be given in children 2 weeks and older; pill and suspension; given 2 times daily for 5 days; side effects nausea and vomitting – Zanamivir [Relenza] can be given in children 7 and older; powder and should not be given to patients with asthma or COPD; side effects bronchospasm – Peramivir [Rapivab] can be given in children 2 and older;IV only; side effects diarrhea 6 – Baloxavir marboxil [Xofluza] can be given in children 12 and older; given once po; not recommended for pregnant or lactating wormen Needs to be given within 48 hours of onset to be effective. Some sources recommend not using at all because benefits are minimal and drugs are expensive and have some