Pharmacology

FLASHCARD

Anti-infective Drugs
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Name: Lourenz S. Bontia

Address: Nagustan, Nabas, Aklan
Phone Number: 09359200939 / 09306510215
E-mail Address: enzobontia@gmail.com
Facebook: facebook.com/lourenz.bontiau

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Antiinfectives
Key Points

N203
ATI (Unit 2)
Antiinfectives -
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Broad-spectrum vs. narrow-spectrum antibiotics
Antimicrobials treat bacterial, viral, and fungal infections
Culture and sensitivity specimens should be collected prior to
initiation of therapy.
Adverse reactions include:
Hypersensitivity & anaphylaxis Superinfection
Organ toxicity (ototoxic,
warfarin activity
nephrotoxic)
efficacy of oral contraceptives
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Penicillins

N203
ATI (Unit 2)
Antiinfectives -
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Expected Action:
-lactam destroys bacteria by weakening cell wall
Therapeutic Uses:
Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes)
Med of choice for
First choice for meningitis
syphilis
Prophylaxis against bacterial endocarditis
Extended spectrum against Pseudomonas, Proteus, Klebsiella
Adverse Effects:
Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)
Contraindications:
Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction
Interactions:
Aminoglycosides / Oral Contraceptives
Education:
Take orals H2O, food (some may be taken food)
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Cephalosporins

N203
ATI (Unit 2)
Antiinfectives -
 7
Expected Action:
-lactam destroy bacteria by destroying cell wall
Four generations, each is: against G- and anaerobes more resistant to
lactamase more able to reach CSF
Therapeutic Uses:
Broad spectrum with TI for postop infections, meningitis, pelvic infections
Adverse Effects:
Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to
penicillins / AA-pseudomembranous colitis
Contraindications:
Allergies to Penicillin / Kidney Dysfunction
Caution with anticoagulants, antiplatelets, and thrombolytics
Interactions:
EtOH intolerance (disulfiram reaction) / Probenecid renal excretion
Education:
Take food
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Carbapenems

N203
ATI (Unit 2)
Antiinfectives -
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Expected Action:
-lactam destroy bacteria by destroying cell wall
Therapeutic Uses:
Broad spectrum effective for serious infections such as pneumonia, peritonitis,
and UTIs. P. aeruginosa develops resistance (use combo) [broadest spectrum
available]
Adverse Effects:
Allergy / GI symptoms / Superinfection
Contraindications:
Caution with renal impairment
Interactions:

Education:

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Monobactams

N203
ATI (Unit 2)
Antiinfectives -
 11

Expected Action:
-lactam destroy bacteria by destroying cell wall
Therapeutic Uses:
MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile
Adverse Effects:
Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis
Contraindications/Precautions:
Caution with renal impairment
Infuse over 60 minutes
Very low therapeutic index
Interactions:

Education:

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Tetracyclines

N203
ATI (Unit 2)
Antiinfectives -
 13
Expected Action:
Bacteriostatic by preventing protein synthesis
Therapeutic Uses:
Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus
fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI
Adverse Effects:
GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /
superinfection of bowel
Contraindications/Precautions:
Renal disease (except doxycycline) / Use during pregnancy will stain deciduous
teeth but not permanent teeth
Interactions:
Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to )
of oral contraceptives
Education:
Give with water on an empty stomach (except doxycycline & minocycline)
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Bacteriostatic Inhibitors
(Macrolides / Ketolides)

N203
ATI (Unit 2)
Antiinfectives -
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Expected Action:
Bacteriostatic by inhibiting protein synthesis Bactericidal at high doses
Therapeutic Uses:
Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires
Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes
Adverse Effects:
GI discomfort / thrombophlebitis
Contraindications/Precautions:
Pre-existing liver disease
Interactions:
Toxic with: antihistamines, theophylline (asthma med), carbamazepine
(anticonvulsant), warfarin
Education:
Administer on empty stomach with water IV is rarely used
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Aminoglycosides
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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gentamicin amikacin kanamycin

tobramycin sulfate neomycin paromomycin
streptomycin
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Aminoglycosides

N203
ATI (Unit 2)
Antiinfectives -
 19
Expected Action:
Kill bacteria by disrupting protein synthesis
Therapeutic Uses:
Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.
aeruginosa)
Oral paromomycin use for amebiasis and tapeworm
Adverse Effects:
Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity
Streptomycin: Neurologic disorders
Contraindications/Precautions:
Renal impairment reduced doses
Interactions:
Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /
tubocurarine / penicillins ( AG)
Education:

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Penicillins
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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Penicillin G
Augmentin (amoxicillin-clavulanate) - Broad spectrum
Nafcillin - Carbenicillin -
Antistaphylococcal Antipseudomonas

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Cephalosporins
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
 23

1 Cephalexin (Keflex) Cephapirin (Cefadyl)

2 Cefaclor (Ceclor) Cefotetan (Cefotan)
3 Cefatriaxone (Rocephin) Cefotaxime (Claforan)
4 Cefepime (Maxipime)
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Carbapenems
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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Imipenem (Primaxin)
Meropenem (Merrem IV)

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Monobactams
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
 27

Vancomycin (Vancocin)
Aztreonam (Azactam)
Fosfomycin (Monurol)

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Tetracyclines
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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Tetracycline hydrochloride (Sumycin)

Doxycycline (Vibramycin)
Minocycline

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Macrolides / Ketolides
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Dirithromycin
Erythromycin
Clindamycin (Cleocin)
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Sulfonamides & Trimethoprim

(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim)

Cotrim
Septra
Sulfadiazine
Sulfamethoxazole
Sulfisoxazole
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Sulfonadmides-Trimethoprim

N203
ATI (Unit 2)
Antiinfectives -
 35

Expected Action:
Bacteriostatic by inhibiting folate synthesis
Therapeutic Uses:
Med of choice for UTI by E. coli and Pneumocystis carinii.
Adverse Effects:
Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics)
Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity
Contraindications/Precautions:
Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min
Reduce dosages with renal dysfunction
Interactions:
Warfarin / phenytoin / tolbutamide ( effects of these)
Education:
Empty stomach with full glass of water
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Urinary Tract Aseptics

N203
ATI (Unit 2)
Antiinfectives -
 37

Expected Action: Damages DNA Prototype: Nitrofurantoin

Static a@ doses, Cidal @ doses
Therapeutic Uses:
Acute UTIs / Prophylaxis for recurrent lower UTI
Adverse Effects:
GI / hypersensitivity / blood dyscrasias / peripheral neuropathy
Contraindications/Precautions:
Renal dysfunction creatinine clearance < 40
Interactions:

Education:
Urine will be brown
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Antimycobacterial

N203
ATI (Unit 2)
Antiinfectives -
 39
Prototypes: isoniazid (INH), streptomycin, ethambutol,
Expected Action: pyrazinamide
Prevents synthesis of mycolic acid
Therapeutic Uses:
Active and latent tuberculosis
Adverse Effects:
Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)
Hepatotoxicity
Contraindications/Precautions:
Liver disease
Interactions:
Phenytoin (accumulates)
INH with EtOH, rifampin, pyrazinamide hepatotoxicity
Education:
Empty stomach but food if needed
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Anti-Hansens Disease

N203
ATI (Unit 2)
Antiinfectives -
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Expected Action: Prototype: Dapsone Others: Clofazimine, Rifampin

Prevents synthesis of folate which inhibits M. leprae.
Therapeutic Uses:
Used in combination therapy to treat leprosy
Adverse Effects:
Rifampin: Discoloration of body fluids / Hepatotoxicity
GI discomfort
Contraindications/Precautions:
Use caution with liver dysfunction
Interactions:
Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)
Education:

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Antiviral

N203
ATI (Unit 2)
Antiinfectives -
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Prototype: Acyclovir
Expected Action: Others: ganciclovir, interferon, ribavirin, amantadine
Prevents reproduction of viral DNA
Therapeutic Uses:

Adverse Effects:
Acyclovir: Phlebitis, nephrotoxicity, nausea & headache
Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity /
teratogenic
Contraindications/Precautions:
Pregnancy / neutrophil count (<500/cc)
Interactions:

Nursing Info: Acyclovir: Never give IV bolus, Infuse over 1 hour min.

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Fluoroquinolones
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -
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Expected Action: Prototype: Ciprofloxacin

Bactericidal by inhibition of enzyme needed for DNA
Therapeutic Uses:
Broad spectrum / prevention of inhaled anthrax
Adverse Effects:
GI discomfort / Achilles tendon rupture / superinfection
Contraindications/Precautions:
Avoid use in children <18 d/t risk for tendon rupture
Interactions:
Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels)
Education:
Infuse slowly over 60 minutes
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Antiprotozoals

N203
ATI (Unit 2)
Antiinfectives -
 47
Expected Proto: Amphotericin
Action: Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole
permeability leakage of intracellular cations (static or cidal)
Therapeutic Uses:
Systemic or cutaneous fungal infections
Adverse Effects:
Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity /
hypokalemia / marrow suppression
Ketoconazole: Hepatotoxicity / Sex hormone effects

Contraindications/Precautions: Renal dysfunction

Interactions:
Aminoglycosides (streptomycin, cyclosporine) additive nephrotoxicity
Flucytosine antifungal effects are potentiated with amphotericin
Education: Highly toxic, infuse slowly (2-4 hr)
Renal damage limited by infusing 1 L NS on day of amphotericin infusion
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Antiprotozoals

N203
ATI (Unit 2)
Antiinfectives -
 49
Expected Action: Proto: metronidazole (Flagyl)
Broad spectrum with anaerobic activity
Therapeutic Uses:
Protozoal infections / Bacterial infections against obligate anaerobes
Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal,
abdominal, colorectal)
H. pylori with tetracycline and bismuth salicylate
Adverse Effects:
GI discomfort / metallic taste / darkening of urine / CNS symptoms
Contraindications/Precautions:
Caution with renal dysfunction / avoid during 1st trimester of pregnancy
Interactions:
Disulfiram-like reaction EtOH
Warfarin Flagyl inhibits inactivation of warfarin
Education: