FINAL EXAMS FOR NR566

FINAL EXAMS FOR NR566 Tetracyclines used to treat - CORRECT ANSWER-*H.Pylori *Acne Vulgaris *Rickettsial disease * Chlamydia Trachomatis *Cholera *M. pneumonia *Lyme Disease *Anthrax Tetracyclines - CORRECT ANSWER-Demeclocycline Doxycycline Minocycline Tetracyline Tetracycline mode of action - CORRECT ANSWER-broad-spectrum; bacteriostatic via inhibition of bacterial protein synthesis Tetracycline adverse effects - CORRECT ANSWER-GI Distress Hepatotoxicity Photosensitivity Vestibular problems (Vertigo) Candida infections; C. diff Tetracycline drug/food interactions - CORRECT ANSWER-*Milk products and antacids, oral contraceptives, digoxin absorption is increased leading to toxicity. *Administer 1 hour before or 2 hours after Tetracycline contraindications - CORRECT ANSWER-*Avoid administration in children younger than 8 and pregnant women or breastfeeding (Category D). Use cautiously in patients with liver, kidney disease. *Pt exposed to direct sunlight Caution in pt's with liver or kidney disease Pt with esophageal obstruction or dysfunction Tetracycline monitoring - CORRECT ANSWER-None Rx Tetracycline - CORRECT ANSWER-*Bacterial infections-1-2g/day PO divided qid( give 1 hr before or 2 hr after meals) *H.Pylori-500mg PO qid x 10-14 days ( Part of multi-drug regimine *Syphilis (primary, secondary, latent less than a year)- 500mg PO qid x 14 days ( for PCN hypersensitive patients). Latent grater than a year- 500mg PO qid x 28 days. Macrolides - CORRECT ANSWER-Azithromycin Clarithromycin Erythromycin Macrolides mode of action - CORRECT ANSWER-inhibition of protein synthesis Macrolides treat - CORRECT ANSWER-*Corynebacterium diphtheria *Used for diagnosed allergy to PCN for H. Pylori, Chlamydia, disseminated mycobacterium, and M. pneumonia Macrolides Complications - CORRECT ANSWER-*GI symptoms, epigastric pain *Prolonged QT interval which could leat to torsade's and death *High doses can cause Ototoxicity Macrolide Contraindications and Precautions: - CORRECT ANSWER-*Avoid in those taking antidysrhythmic drugs, CYP3A4 inhibitors, CCB( verapamil, diltiazem), Antifungals (-azole), HIV protease inhibitors and nefazodone *Can increase drug levels of Theophylline, Carbamazepine, and Warfarin *Hx of liver disease use with caution *Don't use Chloramphenicol and Clindamycin together Macrolide age related concerns - CORRECT ANSWER-Safe in the pediatric population Clindamycin MOA and use - CORRECT ANSWER-*Binds to 50S ribosomal subunit and inhibits protein synthesis *Anaerobic infections ( does not cross blood-brain barrier) *Preferred for A Streptococcal infection, Gas Gangrene. *Clostridium perfringens, Fusobacterium, Anaerobic streptococci *Used as an alternative for PCN because of efficacy to gram positive cocci Clindamycin contraindications - CORRECT ANSWER-*History of GI or, hepatic or renal disease *older adults and children, (caution), pregnancy and lactation *Fever, ABD pain, and leukocytosis *C.diff can start the first week of treatment or develop 4 to 6 weeks after treatment is complete. Can be fatal if left untreated. Clindamycin C.Diff treatment - CORRECT ANSWER-*Discontinue medication and give oral Vancomycin or metronidazole *Hydrate with water and electrolytes Aminoglycosides MOA - CORRECT ANSWER-Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Also block translocation. Require O2 for uptake; therefore ineffective against anaerobes. Aminoglycosides - CORRECT ANSWER-*Gentamycin *Kanamycin *Neomycin *Streptomycin *Tobramycin * Amikacin *Plazomycin *Paromicin (OTOTOXICITY KIDNEY DAMAGE) effects of aminoglycosides - CORRECT ANSWER-Lasts hours after breakdown in the system. Still bactericidal. Aminoglycosides Uses - CORRECT ANSWER-*Primary bactericidal for aerobic gram negative bacilli Gent and Tobramy (CIN - CORRECT ANSWER-Pseudomonas aeruginosa Enterobacteriaceae and eye infections. Amika(CIN) - CORRECT ANSWER-Gram negative bacilli infections Streptomy(CIN) - CORRECT ANSWER-Combined use in the treatment of TB, tularemia, and plague Neomy(CIN) Topical - CORRECT ANSWER-Treatment for eye and ear infections Aminoglycosides Complications - CORRECT ANSWER-Ototoxicity, balance issues, possible permanent deafness in older adults w/ hearing impairment, nephrotoxicity, neuromuscular blockade, hypersensitivity (rash, urticaria), crosses placenta in pregnancy's(Toxic) Monitoring aminoglycosides - CORRECT ANSWER-*Watch trough levels as *Caution in use with diuretics (renal impairment) *Creatinine and BUN *Signs or symptoms of tinnitus, headache, nausea, vertigo **If symptoms are assessed discontinue medication immediately. Aminoglycosides age related - CORRECT ANSWER-*Safe in younger than 8 days to Older adults *Not approved for pregnancy but is approved for breastfeeding Pennicillin - CORRECT ANSWER-B-lactam which disrupts bacterial cell wall causing cell lysis and death Penicillin G and V (Narrow spec) - CORRECT ANSWER-Cell Wall Sythesis Inhibitors: B-lactam antibiotics USE: S. pneumoniae (many resistant), non-lactamase Staph, N. Meningitidis, Clostridium, T. Pallidum SPECTRUM: narrow: G+, G- cocci (NOT G- rods or anaerobes) KINETICS: G: Acid LABILE; parenteral admin (usually IM; IV for serious infections); two repository forms for IM injection (procaine and benzathine; water-insoluble for slow release -- blood) V: Acid STABLE, 65% absorption PO TOX: Allergy, Steven-Johnson Syndrome (with Pen G, dose-dependent neurotox / seizures) nafcillin, oxacillin (Narrow spec) - CORRECT ANSWER-(IV) for sensitive s. aureus Ampicillin, amoxicillin (Broad spec) - CORRECT ANSWER-Penicillinase sensitive: Often add Clavulanic acid or sulbactam "Aminopenicillins are AMPed up penicillins:" wider spectrum So all cocci, plus gram negative rods and gram positive rods (Listeria) Amoxicillin has Oral bioavailability than ampicillin Ampicillin/Amoxicillin "HELPS kill enterococci": H flu, E coli, *Listeria*, Proteus, Salmonella, Shigella, enterococci Pipercillin - CORRECT ANSWER-Used in *H. Influenzae *E. coli *Enterococci *Neisseria gonorrhoeae *Pseudomonas *Klebsiella Penicillin complications - CORRECT ANSWER-allergies/anaphylaxis( Most commonAllergic to one allergic to all), renal impairment, hyperkalemia/dysrhythmias, hypernatremia Penicillin allergy - CORRECT ANSWER-*use azithromycin, clarithromycin and clindamycin if mild reaction *Safe to use instead of PCN: Vanco, Erythromycin, and Clindamycin