Pharm Antimicrobials Part 2

Inhibit Bacteria Protein Synthesis

Ribosome Inhibitors

Buy AT 30, CELL at 50

30s Ribosome inhibitors

Aminoglycosides

Tetracyclines

50s Ribosome inhibitors

Chloramphenicol

Erythromycin (Macrolides)

Lincosamide (Clindamycin)

Linezolid

50s INHIBITORS

Chloramphenicol

Binds to 50s subunit and blocks peptidyl transferase

Bacteriostatic (relies on immune system)

Not widely used topically in the US (topical)

Chloramphenicol black box warning and ADR

Fatal aplastic anemia (rare)

Gray baby syndrome

KNOW THIS

Clindamycin

Binds to 50s subunit

Bacteriostatic

MRSA

What treats MRSA

Clindamycin

Doxy

Sulfa agent

What are bactriostatic agents

Chloramphenicol

Clindamycin

Clindamycin ADR

Clostridium difficle (C. Difficle) overgrowth --> pseudomembranous colitis

Most infamous agent for AAD (antibiotic-associated diarrhea)

30s Inhibitors

Tetracyclines

Tetracycline

Doxycycline

Minocycline

Topical prophylaxis

gonococcal ophthalmia neonatorum

Topical/systemic

chlamydial ophthalmia neonatorum

All tetracyclines are ------ PO ingestion

incompletely absorbed after

Chelation

decreases absorption when we give drug along with anything that is cationic

anything with calcium or postive charge (milk, aluminum, magnesium, antacids)

Which drug class should be avoided with cations?

tetracycline

which tetracycline does not have this chelatoin problem?

doxycycline

TAKE WITH FOOD

what are the tetracyclines

tetracycline

doxycycline

minoycline

Tetracycline ADR

Topical: allergy

Systemic:

- *Photosensitivity*

- GI side effects (doxy)

- *Inhibit bone growth/tooth discoloration*

- potentiate effects of Coumadin (Warfarin)

Limit use of tetracycline in

pregnant/lactating women; kids , 8 THIS IS ON THE EXAM

inhibition of bone growth/tooth discoloration

What drugs can cause photosensitivity

Loops

Thiazide Diuretics (HTN)

Tetracyclines

Flouroquinolines

Sulfa

What agents don't cause photosensitivity?

-

Betalactams

-

Penicillin

-

Cephalosporins

-

Vancomycin

-

Bacitracin

-

macrolides

Which antibiotic can be used for MGD due to anticollagenolytic activity?

- Doxy & azithromycin

ON THE EXAM

doxcycline ia drug of choice for

* marginal inflammatory blepharitis

o posterior blepharitis

o MGD

o evaporative disease

docxycycline ADR

GI upset TAKE W FOOD

Skin discoloraton

headache

photosensitivity

Gut microbiome disruptun

docxycycline do not use in kids

Tetracycline can cause

benign intracranial hypertension

optic nerve edema

skin discoloration (DOXY)

Aminoglycosides

Gentamicin

Tobramycin

Amikacin

Aminoglycosides high concentration are found in only two areas

kidney and inner ear

ototoxic/nephrotoxic potential

Which agents have ototoxic/nephrotoxic potential?

Loop diuretics (HTN lecture)

Vancomycin

Gentamicin (aminoglycosides)

Tobramycin (aminoglycosides)

Aminoglycosides cover

psuedomonas aeruginosa

gram negative

Aminoglycosides ADR

ototoxic/nephrotoxic potential

DNA INHIBITORS

Flouroquinolones

Respiratory FQs

Respiratory FQs

Levofloxacin

Moxifloxacin

Gemifloxacin

Which of the following antimicrobials will have good empiric coverage?

High dose amoxicillin

Which of the following drugs covers streptococcus pneumoniae at high doses?

Amoxicillin

Amoxicillin clavulanate/augmentin

Respiratory FQs cover

Strep pneumoniae

MSSA

The rest of Fqs

Ciproflaxacin

Ofloxacin

Ciproflaxacin uses

corneal ulcers

conjunctivitis

Ciproflaxacin covers

psuedomonas auruginosa

FQs ADR

* GI upset

• Joint pain

• Tendon pain/rupture

• Peripheral neuropathy

• Muscle weakness

• In patients with vascular disease: Aortic aneurysm dissection

• Arrhythmias (moxi > levoflox/ciproflox)

o Incidence is likely < azithromycin

• Photosensitivity

• Gut microbiome disruption

cartilage damage

connective tissue issues

retinal detachment

hurt hips

tendonititis

if they have an itis !

Fluoroquinolones do not use in

kids less than 16

pregnancy

breastfeeding

Floxed by Cipro

do not use FQ systemically unless you have not other choice

Besifloxacin

DOC for corneal ulcers

Folic Acid synthesis inhibitors

TMP- sulfa (bactrim, septra)

sodium sulfacetamide

TMP- sulfa (bactrim, septra)

sodium sulfacetamide

sulfa antimicrobials!

--> sulfa allergy

TMP- sulfa (bactrim, septra) civerage

MRSA

TMP- sulfa (bactrim, septra)

sodium sulfacetamide ADRs

- steven johnson syndrome

- toxic epidermal necrolyisis

- phototoxicity

- increase INR in warfarin

- contra indicated in 3rd trimester of pregnancy

ALL Antibiotics perforantiate effects of warfarin

List of not to use in pregancy

tetracycline

fluoroquinolone

bactrim

What do you do if a patients presents with a sulfa allergy?

ask what happens

they

Are patients allergic to the sulfa?

no they are a;;ergic to the N-arylamine

hapten + protein

Sulfonamide nonantimicrobial agents

Loop or Thiazide diuretics

acetazoladide

sulfonylurea

COd2 inhibitors

drug containing arylamine at N4

Metronidazole

Flagyl

Metronidazole spectrum of activity

anaerobes

c diff ACC - 1st line of treatment

stds

parasitic infection

Metronidazole (flagyl) ADR

avoid alcohol

disulfiram