NR565 Week 5 Study Outline

NR565 Week 5 Study Outline Many questions are written to assess your clinical application of the material from the textbook, in real-world scenarios. Chapter 24: Drugs used in treating infectious diseases (p. 692-760) SEE DRUG CHART BELOW Know the following for each drug class (penicillins, cephalosporins, fluoroquinolones, lincosamides, macrolides, sulfonamides, trimethoprim, nitrofurantoin, lipoglycopeptides): • • Spectrum of coverage for various organisms • • Pharmacodynamics • • Pharmacokinetics • • Pharmacotherapeutics • • Clinical indications & dosing • • ADRs • • Monitoring • • Patient education Antimicrobial resistance Treatment of Group A and Group B beta streptococci Cross sensitivity with cephalosporins anaerobes and gram negative (MSSA, strep, H.flu, E.coli, Klebsiella, Neisseria meningitides); amoxicillin, ampicillin; combined with betalactamase inhib Pcnase-resistant – (pcnase staph, strep, MSSA); not effective against MRSA; cloxacillin, dicloxacillin, methicillin, nafcillin, oxacillin Antipseudomonal – gramneg bacilli (pseudo aeruginosa, enterbacter, morganella); piperacillin, ticarcillin binding, well distributed, inflammation enhance distribution, crosses placenta/breast milk Metabolism – minimal metab except for nafcillin/oxacill in Excretion – primarily unchanged in urine, caution in renal insufficiency (increase half life) infectio - Seizures ability - Decreas oral contrap ves effectiv - Interstit nephriti * Severe, type I allergic reaction to cephalospori carbapenems, o beta-lactamase inhibitors may contraindicate u penicillins. Cephalosporins – 1st Generation (Cephalexin) & 2nd Generation (Cefuroxime) 3rd Generation (ceftriaxone) & 4th Generation (cefepime) 1st – narrow spectrum 5th – broad spectrum Bactericidal Increase in gram neg up the generations and decreases in gram pos. Treat surgical prophylaxis, resp tract infx, strep pharyngitis/sinusi tis, CAP, skin, soft tissues, bones/joints, UTI (2nd line for kids), STI First  gram pos and limited gram neg; doesn’t enter CSF, staph aureus, strep, pna/resp infx (cephalexin, cefazolin) Second  gram + and H. flu, more potent, broader spectrum, gonorrhea, resp infx (cefaclor (CAP), cefziroxine) Third  some gram + and -, not active against MRSA, effective against pseudomonas, less freq dosing, crosses BBB with inflammation Absorption  oral, GI tract, rate of absorption delayed by food, IM – absorbed by muscle Distribution  widely distributed to most tissue, variation in protein binding, penetration CSF varies by generation Metabolism  hepatic metabolism – insignificant Excretion  In pregnancy d/t increase fluid  shorter half life, lower serum levels and larger Vd Lactation  safe Pediatrics  in neonates immature renal fx causes increased half life and accumulation; kids – varies by drug - GI distuban (C.diff) - Alterati blood clotting - Combin with alc (disulfir rxn – flushing dizzines n/v, coa problem - Nephrot ty - Superin n - Renal/h c dysfun extends halflife - Anaphy rxn to p don’t gi cephalo acid; Metabolism – metabolized in liver, erythromycin, heavily metabolized by CYP3A4 Excretion – excreted in feces and urine, caution with clarithromycin increased renal excretion halved Pregnancy - Erythromyci n: cat B - Clarithromy cin: cat C - Azithromyci n: cat B Lactation - Safe Pediatrics - Safe over age 6 months - Rash, fe eosinop - Metab. Interacti esp with erythro - Prolong QT syndrom maligna arrthym Interactions - Colchic - Warfari - Digoxin increase effect Lincosamides (clindamycin - Cleocin) Bacteriostatic in usual doses; suppresses protein synthesis – binds to 50S subunit of the bacterial ribosome First line tx in MRSA, primarily gram +, some anaerobic pathogens Absorption – good oral absorption Distribution – highly protein bound Metabolism – metabolized in liver Excretion – excreted in bile and urine Cautions - Asthma - Severe allergies - Severe renal/liver impairment Pregnancy - Category B - Okay for 3rd trimester Lactation - Present in breast milk – weigh risk/benefit Pediatrics - Severe infx only - GI symp - Dizzine vertigo, - C.diff ( serious Quinolones (Levofloxacin, Ciprofloxacin, Moxifloxacin) Bactericidal for DNA gyrase (needed to synthesize bacterial DNA) Broad spectrum; extensive gram -; later generations increased activity against gram +; only moxifloxacin has activity against anaerobic bacteria; PO and IV formulations; resistance already occurring from inappropriate use Absorption – well absorbed after PO admin, IV and oral  similar serum concentration Distribution – widely distributed; high tissue, urinary prostate, sinus and lung penetration; variable protein binding; moderately Cautions - Renal dysfunction: can cause increase half-life with majority of drug excreted unchanged in urine - CrCl 50mL/min: adjust dosage - Cautious in patients - GI - CNS - Phototo - Skin - Superin n - Muscul etal - Renal - Diabetic - Serious effect: dysrhyt