Antibiotics

Amoxicillin (Amoxil®) indication: __ caused by susceptible strains of Gram-__ bacteria as well as some Gram-__ __

infections, positive, negative aerobes

Amoxicillin (Amoxil®) MOA:

Cell wall active, PBP binding causing cell lysis and death

Amoxicillin (Amoxil®) adverse effects

confusion, hallucinations, seizures, hypersensitivity

Amoxicillin (Amoxil®) interactions

warfarin

Amoxicillin (Amoxil®) caution if they have history of:

b-lactam allergy, interstitial nephristis

Amoxicillin may be combined with __

clavulanate

Amoxicillin + Clavulanate =

Augmentin

clavulanate MOA

b-lactamase inhibitor

Cephalexin (Keflex®) class:

Cephalosporin (1st generation)

Cephalexin (Keflex®) indication:

infections caused by bacteria including Staphylococci and Streptococci

Cephalexin (Keflex®) MOA:

Cell wall active: PBP binding causing cell lysis and death

Cephalexin (Keflex®) adverse effects:

hypersensitivity

Cephalexin (Keflex®) interactions:

enhance nephrotoxic effects of aminoglycosides

Cefepime (Maxipime®) class:

Cephalosporin (4th generation)

Cefepime (Maxipime®) indication:

infections caused by Gram+ and Gram- bacteria including Staph, Strep, Neisseria, Hæmophilus, and Pseudomonas

Cefepime (Maxipime®) MOA:

Cell wall active: PBP binding causing cell lysis and death

Cefepime (Maxipime®) adverse effects:

encephalopathy, seizures, thrombophlebitis, hypersensitivity

Cefepime (Maxipime®) nursing advice:

rotate infusion sites during IV infusion, thrombophlebitis

Cefepime (Maxipime®) interactions:

aminoglycosides

Imipenem (Primaxin®) Class

Carbapenem

Imipenem (Primaxin®) indication

infections caused by G+ cocci, G- bacilli and cocci, and mixed aerobic/anaerobic infections. Extremely broad antimicrobial spectrum

Imipenem (Primaxin®) MOA

Cell wall active: PBP binding causing cell lysis and death

Imipenem (Primaxin®) adverse effects

seizures, superinfections, hypersensitivity

Imipenem (Primaxin®) MOA binds to 2 PBPs:

PBP1 and PBP2

Imipenem (Primaxin®) interactions

valporate

Imipenem (Primaxin®) Note

always combined w/ cilastatin to increase half-life and tissue penetration

cilastatin is a

DHP-1 inhibitor

Vancomycin (Vancocin®) class

Glycopeptide

Vancomycin (Vancocin®) indication

Serious infections caused by MRSA or MRSE, or other infections caused by G+ bacteria (only)

Can Vancomycin (Vancocin®) be used for patients with b-lactam allergy?

Yes cause it is not a b-lactam

Oral form of Vancomycin (Vancocin®) is used to treat?

C. diff infections

Vancomycin (Vancocin®) MOA:

Cell wall active: Binds to cell wall synthesis precursor molecules, preventing elongation and cross-linking of peptidoglycan --> cell lysis and death. Doesn't bind to PBPs

Vancomycin (Vancocin®) adverse effects:

renal failure, nephrotoxicity, ototoxicity, thrombophlebitis, vancomycin infusion rxn

vancomycin infusion reaction: histamine release causes

rash, pruritus, urticaria, flushing, SOB, hypotension, tachycardia

Vancomycin (Vancocin®) Nursing note:

infuse over 60 min or more, rotate infusion sites

Vancomycin (Vancocin®) interactions:

other ototoxic agents, other nephrotoxic agents

Doxycycline (Vibramycin®) class

Tetracycline

Doxycycline (Vibramycin®) indication

broad spectrum, active against a wide variety of G+ and G- bacteria

Doxycycline (Vibramycin®) MOA

Interferes with protein synthesis by binding to ribosomal subunit

Doxycycline (Vibramycin®) First-line for

tick-borne diseases, cholera, pneumonia, malaria prophylaxis, MRSA

Doxycycline (Vibramycin®) treats these tick-borne diseases

Rocky Mountain Spotted Fever and Lyme disease

Doxycycline (Vibramycin®) adverse effects

photosensitivity, tooth discoloration

Doxycycline (Vibramycin®) interactions:

warfarin, calcium, decreased iron absorption

Azithromycin (Zithromax®) class

Macrolide

Azithromycin (Zithromax®) indication

infections caused by G+ and G- bacteria

Azithromycin (Zithromax®) MOA

Interferes with protein synthesis by binding to ribosomal subunit

Azithromycin (Zithromax®) adverse effects

dysrhythmia - long QT syndrome, hepatotoxicity

Azithromycin (Zithromax®) long QT syndrome can lead to

Torsades de Pointes, which can be fatal

Azithromycin (Zithromax®) long QT syndrome increased risk for pts with

Long QT, other dysrhythmias, low K+ or Mg++, bradycardia

Gentamicin (Garamycin®) class

Aminoglycoside

Gentamicin (Garamycin®) indication

serious infections caused by aerobic G- bacilli

Gentamicin (Garamycin®) MOA

Interferes with protein synthesis by binding to ribosomal subunit

Gentamicin (Garamycin®) adverse effects

irreversible ototoxicity, nephrotoxicity

Gentamicin (Garamycin®) interactions

penicillins - don't mix together in IV bag

Linezolid (Zyvox®) class

Oxazolidinone

Linezolid (Zyvox®) indication

severe infections caused by multi-drug resistant strains of G+ bacteria (like MRSA)

Linezolid (Zyvox®) MOA

Interferes with protein synthesis by binding to ribosomal subunit

Linezolid (Zyvox®) adverse effects

hematologic

hematologic:

bone marrow suppression. CBC must be done weekly

Linezolid (Zyvox®) interactions

SSRIs - risk of serotonin syndrome

Clindamycin (Cleocin®) class

Lincosamide

Clindamycin (Cleocin®) indication

infections caused by anaerobes and some GP aerobes. Second-line treatment for MRSA

Clindamycin (Cleocin®) MOA

Interferes with protein synthesis by binding to ribosomal subunit

Clindamycin (Cleocin®) adverse effects

Superinfection, Cardiovascular effects

Clindamycin (Cleocin®) superinfection w/

C. diff causing pseudomembranous colitis

Clindamycin (Cleocin®) cardiovascular effects can happen with

rapid IV administration, can lead to cardiac arrest and hypotension

Levofloxacin (Levaquin®) class

Fluoroquinolone

Levofloxacin (Levaquin®) indication

infections caused by G- and some G+ organisms, and atypicals

FDA says you shouldn't prescribe fluoroquinolones for what conditions?

acute uncomplicated cystitis, bacterial sinusitis, bronchitis

Levofloxacin (Levaquin®) MOA

Interferes with nucleic acids by inhibiting bacterial DNA gyrase, and topoisomerase IV. Prevents bacterial DNA replication and cell division processes from completing

Levofloxacin (Levaquin®) adverse effects BBWs

tendinitis, tendon rupture, peripheral neuropathy, CNS effects

Levofloxacin (Levaquin®) adverse effects

phototoxicity, QT prolongation w/ Torsades de Pointes, crysalluria

Levofloxacin (Levaquin®) interactions

warfarin, Calcium, aluminum

Levofloxacin (Levaquin®) causes Calcium and aluminum to

bind levofloxacin and reduce bioavailability

Levofloxacin (Levaquin®) pt teaching point

give 2 hrs before or 4 hrs after eating food or taking supplements

Metronidazole (Flagyl®) indication

infections caused by anaerobes, including C. difficile. Also used for protozoal infections, ameobal infections and bacterial vaginosis

Metronidazole (Flagyl®) MOA

Interferes with nucleic acids. Causes strand breaks in DNA structure

Metronidazole (Flagyl®) is what kind of drug

Prodrug

Metronidazole (Flagyl®) prodrug action

once inside an anaerobic cell, it's converted to highly reactive metabolites that cause DNA strand breaks

Metronidazole (Flagyl®) adverse effects

metallic taste, temp dark urine

Metronidazole (Flagyl®) interactions

ethanol

Metronidazole (Flagyl®) teaching point

Avoid ALL alcoholic beverages and products containing alcohol

Metronidazole (Flagyl®) w/ alcohol can cause

disulfiram-like rxn and can cause violent vomiting

Trimethoprim (Proloprim®) indication

infections, including UTIs, caused by G+ and G- bacteria

Trimethoprim (Proloprim®) MOA

anti-metabolite: inhibits synthesis of tetrahydrofolic acid, necessary for bacterial DNA, RNA and protein synthesis

Trimethoprim (Proloprim®) adverse effects

hyperkalemia

Trimethoprim (Proloprim®) caution

potential folate deficiency

Trimethoprim (Proloprim®) interactions

any drug that can cause hyperkalemia, like ACE inhibitors, ARBs, potassium-sparing diuretics

Trimethoprim/Sulfamethoxazole (Bactrim®) class

sulfonamide

Trimethoprim/Sulfamethoxazole (Bactrim®) indication

infections caused by wide range of G+ and G- bacteria and some protozoa

Trimethoprim/Sulfamethoxazole (Bactrim®) is a common med for

UTI and MRSA

Trimethoprim/Sulfamethoxazole (Bactrim®) MOA

Anti-metabolite: synergistic effect on synthesis of tetrahydrofolic acid

Trimethoprim/Sulfamethoxazole (Bactrim®) how many MOAs

2: trimethoprim + sulfamethoxazole

Trimethoprim/Sulfamethoxazole (Bactrim®) MOA - tetrahydrofolic acid

inhibits synthesis of tetrahydrofolic acid, by blocking a different step in the synthesis than trimethoprim. able to block because of its structural similarity to PABA

Trimethoprim/Sulfamethoxazole (Bactrim®) interactions

warfarin

Trimethoprim/Sulfamethoxazole (Bactrim®) adverse effects

rash, stevens-johnson syndrome, hemolytic anemia, crystalluria

If on Trimethoprim/Sulfamethoxazole (Bactrim®) what should a pt do if they notice a rash?

report it to provider immediately

If on Trimethoprim/Sulfamethoxazole (Bactrim®) what can pts do to avoid crystalluria?

drink 8 - 10 glasses of water daily to dilute urine

Trimethoprim/Sulfamethoxazole (Bactrim®) can cause hemolytic anemia in patients with?

G6PD deficiency

Pts should avoid Trimethoprim/Sulfamethoxazole (Bactrim®) if they have what allergy?

sulfonamide allergy, sulfa allergy