Advanced Pharmacology test 1, study set. Rated A+. 2022

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Advanced Pharmacology test 1, study set. Rated A+. 2022 Beta lactamase inhibitors - ✔✔Clavulanic acid, sublactam, taxobactam Unasyn - ✔✔Ampicillin and sulbactam Augmentin - ✔✔Am... oxicillin clavulanic acid Hapten - ✔✔Drug +plasma protein severe allergic reaction Mechanisms resistance to beta lactamase - ✔✔Inactivation by beta lactamase, mutation trans peptidase target, impaired penetration of drug into organism, drug effluent pumps MRSA - ✔✔Resistant organisms produce PBPs with decreased affinity for binding beta lactam antibiotics Impaired penetration of drug into organosm - ✔✔Absence of porins or down regulation of porins or porins smaller Drug efflux pumps - ✔✔Nonspecific, spit out whatever bacteria doesn't need, major mechanism MDR Prevention of resistance steains - ✔✔Testing, choose right antibiotic, complete course therapy, don't use antibiotic when not indicated Mutidrug resistant organisms - ✔✔Organisms that are resistant to 1 or more class of organisms. Drug efflux pumps Penicillin - ✔✔Bactericidal Penicillin adverse effects - ✔✔GI distress, oral/vaginal candidiasis, rash, anaphylaxis Cephalosporins - ✔✔More stable against beta lactamases, increased range activity 1st generation cephalosporin - ✔✔Cefazolin, cephalexin G+, susceptible beta lactamase 2,3 generations cephalosporins - ✔✔Broader spectrum, Increase resistance beta lactamase, increase half life, some cross BBB 4,5 generations cephalosporins - ✔✔Cefepine, excellent resistance most beta lactamase, excellent CNS penetration, ceftaroline against MRSA Adverse reactions cephalosporins - ✔✔Hypersensitivity, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia, anorexia Cefotetan - ✔✔Avoid ETOH! Disulfiram like reaction with this cephalosporins Treatment for C diff from broad spectrum cephalosporin - ✔✔Vancomycin, metrondiszole Example monobactam - ✔✔Aztreonam IV or IM Active against G neg only Tolerated by PCN allergic patiemts Example carbapenem - ✔✔Imipenem, IV or IM only Widest spectrum of any beta lactam, must prescribe with cilastin to inhibit first pass elimination by renal enzyme dehydropeptidase, low crossreactivity for PCNs. Good for meningitis, peritonitis in really sick patients Vancomycin - ✔✔Cell wall inhibitor but not beta lactam, glycopeptide structure, best treatment for MRSA and G+. Only use Italy to treat antibiotic induced colitis, C. difficile and staph entericolitis Must monitor peak and trough, poorly absorbed po Vancomyicin - ✔✔Bacterocidal for G + Vancomycin - ✔✔Poor oral bioavailability, 90% GFR eliminated, if renal impairments can have accumulation. Vancomycin Adverse Effect - ✔✔Ototoxicity if given with aminoglycoside!! Tissue irritation at injection site, chill and fever Red man syndrome - ✔✔Vancomycin if Tate of infusion too fast. Histamine release, hypotension, flush, skin rash. Prevent by 1-2 hr infusion or pretreat with antihistamine Advantages vancomycin - ✔✔Not susceptible to beta lactamase, no PCN allergy Classes of protein synthesis inhibitors - ✔✔Tetracycline, macrolides, oxazolidinones and aminoglycosides Inhibitors bacterial translation - ✔✔Interfere with bacterial ribosome, may affect protein synthesis in human cells, complete inhibition of protein synthesis may not be enough to kill bacteria. Antibiotics bind to bacterial ribosome to block bacterial protein synthesis Examples of Tetracyclines - ✔✔Tetracycline, oxytetracycline, doxycycline, demeclocycline Tetracycline uses - ✔✔H pylori, cholera, acne, tick fever Elimination tetracycline - ✔✔Bile and urine, Hilary excretion effects flora of lower regions GI tract Absorption tetracycline - ✔✔Oral absorption decreased by antacids, dairy Ca, bismuth, Fe, food, alkaline pH, Adverse effects tetracycline - ✔✔B/c interaction with Ca can sequester in bone and teeth. Don't use in pregnancy or kids less than 8. Also photosensitive Adverse effects tetracycline - ✔✔With diuretics causes nephrotoxicity. Nausea/vomit, epigastric, heartburn, diarrhea Macrolides example - ✔✔Erythromycin, azithromycin, clarithtomycin Macrolides - ✔✔Broad spectrum, bacteriostatic, at high levels bacteriocidal, enhanced activity at alkaline pH, H pylori treatment - ✔✔Clarithromycin and ompeprazole Macrolides interactions - ✔✔Erythromycin and clarithromycin potent inhibitors of CYP 450!! Affect blood levels of warfarin, statins, Ca channel blockers, azolve antifungals Azithromycin does not inhibit CYP450!!! Macrolides adverse effects - ✔✔GI especially with erythromycin, N/V, diarrhea, hepatptoxic, flatulemce, jaundice, anorexia. Erythromycin increases GI motility Adverse effects azythromycin and clarithromycin - ✔✔Less adverse GI than erythro, longer duration action, increased efficacy and tissue penetration Oxazolidinones - ✔✔Linezolid, rescue antibiotic, active against drug resistant gram +, MRSA, VRE. MOA linezolid - ✔✔Inhibit protein synthesis, prevention of formation of ribosome complex that initiates protein synthesis, unique binding site, no cross resistance. Resistance caused by muation of binding site Adverse effects linezolid - ✔✔Mild thrombocytopenia and neutropenia Black box linezolid - ✔✔SSRIs and SNRIs , zyvox inhinits MAO, can get serotonin syndrome Examples aminoglycosides - ✔✔Streptomycin, gentamicin, tobt Examples aminoglycosides - ✔✔Streptomycin, gentsmicin, tobramycin, amikacin Aminoglycosides - ✔✔Bactericidal inhibitors of protein synthesis. Useful against gram neg, acts at 30s ribosome subunit. Used in combo with other abx for synergistic. Used for gram + infections that are resistant to other abx Side effects aminoglycosides - ✔✔Ototoxicity: auditory/vestibular. And Nephrotoxicity. More toxicity in elderly, renal jnsufficency and dosing >5 days. Avoid use with loop diuretics or vancomycin or amphotericin. Inhibitors bacterial DNA synthesis - ✔✔Antifolate drugs, DNA gyrase inhibitors, sulfonamides Sulfonamides - ✔✔SMX-TMP, Bactrim, bacteriostatic action: prevents synthesis of folic acid required for purines and núcleos acid to make DNA. Concentrated in kidneys, mainstay for UTIs Sulfonamides - ✔✔Effective against gram +\- bacteria. UTIs, PJP, shigella. Very water soluble. High concentration in urine Sulfonamides Adverse effects - ✔✔Crystalluria, hypersensitivity SO groups sulfur allergies, N/V, rare: bone marrow fxn, aplastic anemia, agranulocytosis Supplement folic acid Fluoroquinolone Examples - ✔✔Ciprofloxacin, levofloxacin Fluoroquinolones - ✔✔Bactericidal, alter DNA, block bacterial DNA synthesis by inhibiting DNA gyrase, prevents opening of DNA supercoil for transcription and replication Fluoroquinolones Absorption elimination - ✔✔Excellent po absorption, really good bioavailability. Renal elimination. Absorption decreased by antacids, MVI, ca, MG, Iron Adverse effects fluoroquinolones - ✔✔Generally well tolerated, NVD, HA Potential QT elongation, worse with uncorrected hypokalemia, may damage growing cartilage. No for kids Black box fluoroquinolones - ✔✔Increased risk of tendinitis and tendon rupture. Risk increased by older, renal insufficiency and steroid use Nursing implications Sulfonamides - ✔✔Hydration! Assess RBC prior to therapy, oral dose with food Nursing implications Penicillin - ✔✔Oral dose with water not acid juice(nullifies), empty stomach, monitor allergic reaction Nursing implications Cephalosporin - ✔✔Assess PCN allergy. Give with good to decrease GI ups [Show More]

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