ID: SHAEER PACKET PART 7 (2 of 2) (AMINOGLYCOSIDES -> RIFAMYCINS)

Aminoglycosides include... (four)

1. Gentamicin (Garamicin)

2. Tobramycin (Nebcin, TOBI, Tobrex)

3. Amikacin (Amikin)

4. Plaxomicin (Zemdri)

Dosage forms available for gentamicin? (two)

IV

Ophthalmic

Dosage forms available for tobramycin? (three)

IV

Neb

Opthalmic

Dosage forms available for amikacin? (two)

IV

Neb

Dosage forms available for plazomicin? (one)

IV

T/F: Aminoglycosides have limited anaerobic coverage.

False; no anaerobic coverage.

When targeting a *gram positive* bug with an aminoglycoside, what *MUST* we administer in combination?

B-lactam

In what case, when targeting a *gram negative* bug for treatment with an aminoglycoside, are we NOT administering in combination with a B-lactam?

UTI

Gram-positive spectrum of activity for aminoglycosides? (five)

1. MSSA

2. CONS

3. S. pyogenes

4. S. viridans

5. Enterococcus spp.

Gram-negative spectrum of activity for aminoglycosides? (eleven)

1. Acinetobacter spp.

2. Citrobacter spp.

3. Enterobacter spp.

4. Klebsiella spp.

5. M. morganii

6. Proteus spp.

7. Providencia spp.

8. Pseudomonas aeruginosa (A>T)

9. Salmonella spp.

10. Shigella spp.

11. S. marcescens

MOA of aminoglycosides?

Irreversibly bind bacterial 30S ribosomal subunit leading to disruption in protein synthesis

Side effects associated with aminoglycosides (three big ones)

1. Nephrotoxicity

2. Ototoxicity

3. Neuromuscular blockade

Risk factors contributing to aminoglycoside-associated ototoxicity? (eleven)

1. Age

2. Impaired renal function

3. Dehydration

4. Elevated trough concentration

5. Elevated peak concentration

6. Total daily dose

7. Cumulative dose

8. Concurrent ototoxic drugs

9. Prior AMG exposure

10. Dialysis

11. Duration of treatment

Risk factors contributing to aminoglycoside-associated nephrotoxicity? (eleven)

1. Age

2. Impaired renal function

3. Sepsis

4. Elevated trough conc.

5. Elevated peak conc.

6. Total daily dose

7. Cumulative dose

8. Concurrent nephrotoxic drugs

9. Prior AMG exposure

10. Sex

11. Duration of treatment

T/F: AMGs low risk and routinely used in pregnancy.

False; blackbox warning actually.

Clinical uses for AMGs? (eight)

1. Bacteremia

2. Bowel sterilization prior to GI and/or abdominal surgery (N)

3. Endocarditis (G/S)

4. IA infections

5. Osteomyelitis/septic arthritis

6. UTI

7. Lower respiratory tract infections

8. Multi-drug resistant organisms (MDRO) (A)

Role of plazomicin?

Reserved for use in MDRO as practically last line

MOA of plazomicin?

Irreversibly bind bacterial 30S ribosomal unit leading to disruption in protein synthesis

Clinical uses for plazomicin? (one really)

Complicated UTI, including pyelonephritis

Macrolides include... (four)

1. Erythromycin (E.E.S., Ery-Tab, Eryc, Erycette, Eryped)

2. Clarithromycin (Biaxin, Biaxin XL)

3. Azithromycin (Zithromax, Zpak, Tri-pack, Zmax)

4. Fidaxomicin (Dificid)

Dosage forms available for erythromycin? (four)

1. IV

2. PO

3. Topical

4. Opthalmic

Dosage forms available for clarithromycin? (one)

1. PO

Dosage forms available for azithromycin? (three)

1. IV

2. PO

3. Ophthalmic

Order of gram-positive coverage amongst macrolides? (erythromycin, clarithromycin, azithromycin ranked from most to least)

1. Clarithromycin

2. Erythromycin

3. Azithromycin

Order of gram-negative coverage amongst macrolides? (erythromycin, clarithromycin, azithromycin ranked from most to least)

1. Azithromycin

2. Clarithromycin

3. Erythromycin

Which macrolide has anaerobic coverage? Which bugs does it cover?

Fidaxomicin

Covers Peptostreptococcus spp., Prevotella spp., (not B. fragilis) and C. difficile

T/F: Macrolides have atypical coverage.

True

Which atypicals are covered by the ACE macrolides? (four)

Chlamydia pneumoniae

Chlamydia trachomatis

Legionella pneumophila

Mycoplasma pneumoniae

T/F: Azithromycin and clarithromycin cover mycobacteria avium complex (MAC).

True

T/F: Clarithromycin covers H. pylori.

True

Macrolides which cover borrelia burgdorferi? (two)

1. Azithromycin

2. Clarithromycin

Mechanism of action of the ACE macrolides?

Reversibly bind 50S bacterial ribosomal unit leading to disruption of protein synthesis

Mechanism of action of fidaxomicin?

Inhibits RNA synthesis by binding to RNA polymerases

Macrolides eliminated primarily by the liver? (two)

Erythromycin

Clarithromycin

TBC

MAcrolides spectrum of activity and stuff