Aminoglycosides, Quinolones, Macrolides, TCNs, Sulfonamides

Gram-negative bacteria (including Pseudomonas)

Traditional dosing (lower doses more frequently) and extended interval dosing (higher doses less frequently)

Complicated UTI and pyelonephritis when there are no alternative treatment options

<p>Less accumulation of drug, decreased nephrotoxicity, and decreased cost</p> Signup and view all the answers

<p>Renal damage and ototoxicity (hearing loss/tinnitus/balance problems)</p> Signup and view all the answers

<p>Give larger doses less frequently to give the kidneys time to recover between doses</p> Signup and view all the answers

<p>Gentamicin, Tobramycin, and Amikacin</p> Signup and view all the answers

<p>Use total body weight for dosing</p> Signup and view all the answers

<p>If obese</p> Signup and view all the answers

<p>1-2.5 mg/kg/dose</p> Signup and view all the answers

<p>4-7 mg/kg/dose (commonly 7 mg/kg)</p> Signup and view all the answers

<p>Pregnancy, ascites, burns, cystic fibrosis, CrCl &lt; 30 mL/min (including end-stage renal disease on dialysis) or when using for synergy in endocarditis</p> Signup and view all the answers

<p>Nephrotoxicity, ototoxicity, (hearing loss, vertigo, ataxia); avoid use with other neurotoxic/nephrotoxic drugs; neuromuscular blockade and respiratory paralysis; fetal harm if given in pregnancy</p> Signup and view all the answers

<p>Nephrotoxicity (acute tubular necrosis), hearing loss (early toxicity associated with high-pitched sounds), vestibular toxicity (resulting in balance deficits)</p> Signup and view all the answers

<p>Drug levels, renal function, urine output, hearing tests</p> Signup and view all the answers

<p>Gentamicin for Gram-negative infection, Trough: &lt; 2 mcg/mL; Tobramycin, Trough: &lt; 2 mcg/mL</p> Signup and view all the answers

<p>Aminoglycosides primarily cover Gram-negative bacteria (including Pseudomonas)</p> Signup and view all the answers

<p>There are two dosing strategies for aminoglycosides; traditional dosing uses lower doses more frequently (e.g., Q8H if renal function is normal). Extended interval dosing uses higher doses (to attain higher peaks) less frequently (e.g., once daily if renal function is normal)</p> Signup and view all the answers

<p>Plazomicin is only indicated for complicated UTI and pyelonephritis when there are no alternative treatment options</p> Signup and view all the answers

<p>Extended interval dosing has been shown to decrease nephrotoxicity and decrease cost, but it is not clinically superior to traditional dosing</p> Signup and view all the answers

<p>The notable toxicities of aminoglycosides include renal damage and ototoxicity (hearing loss, tinnitus, and balance problems)</p> Signup and view all the answers

<p>For underweight individuals (&lt; ideal body weight), total body weight should be used for dosing.</p> Signup and view all the answers

<p>The traditional IV dosing range for Gentamicin and Tobramycin is 1-2.5 mg/kg/dose.</p> Signup and view all the answers

<p>The dosing range for extended interval IV dosing of Gentamicin and Tobramycin is 4-7 mg/kg/dose (commonly 7 mg/kg).</p> Signup and view all the answers

<p>Contraindications for using aminoglycosides include pregnancy, ascites, burns, cystic fibrosis, CrCl &lt; 30 mL/min (including end-stage renal disease on dialysis), and when using for synergy in endocarditis.</p> Signup and view all the answers

<p>The boxed warnings for aminoglycosides include nephrotoxicity, ototoxicity (hearing loss, vertigo, ataxia), avoiding use with other neurotoxic/nephrotoxic drugs, neuromuscular blockade and respiratory paralysis, and fetal harm if given in pregnancy.</p> Signup and view all the answers

<p>The side effects of aminoglycosides include nephrotoxicity (acute tubular necrosis), hearing loss (early toxicity associated with high-pitched sounds), and vestibular toxicity (resulting in balance deficits).</p> Signup and view all the answers

<p>The concentration-dependent kinetics of aminoglycosides can be utilized to minimize toxicity by giving larger doses less frequently, allowing the kidneys time to recover between doses.</p> Signup and view all the answers

<p>Aminoglycosides primarily cover Gram-negative infections.</p> Signup and view all the answers

<p>Adjusted body weight should be used for dosing aminoglycosides in obese individuals.</p> Signup and view all the answers

<p>The main aminoglycosides mentioned in the text include Gentamicin, Tobramycin, and Amikacin.</p> Signup and view all the answers

<p>The target drug concentrations for Gentamicin and Tobramycin when peak and trough levels are drawn are Trough: &lt; 2 mcg/mL. Organism-specific peak goals are typically 2-10 times the MIC of the bacteria causing the infection.</p> Signup and view all the answers

<p>Aminoglycosides can be dosed using traditional dosing, which uses lower doses more frequently, or extended interval dosing, which uses higher doses less frequently to attain higher peaks. Extended interval dosing has been shown to decrease nephrotoxicity and decrease cost, but it is not clinically superior to traditional dosing.</p> Signup and view all the answers

<p>Aminoglycosides primarily cover Gram-negative bacteria, including Pseudomonas. They are also used in combination with a beta-lactam or vancomycin when treating Gram-positive infections such as enterococcal endocarditis.</p> Signup and view all the answers

<p>Plazomicin is indicated for complicated UTI and pyelonephritis when there are no alternative treatment options.</p> Signup and view all the answers

<p>Aminoglycosides kill Gram-negative bacteria fast, are synergistic with beta-lactams for some organisms, have low resistance, and low drug cost, which contribute to their effectiveness.</p> Signup and view all the answers

<p>Concentration-dependent activity and post-antibiotic effect</p> Signup and view all the answers

<p>Renal damage and ototoxicity (hearing loss/tinnitus/balance problems)</p> Signup and view all the answers

<p>Use total body weight for dosing</p> Signup and view all the answers

<p>Use adjusted body weight for dosing</p> Signup and view all the answers

<p>1-2.5 mg/kg/dose</p> Signup and view all the answers

<p>4-7 mg/kg/dose (commonly 7 mg/kg)</p> Signup and view all the answers

<p>Nephrotoxicity, ototoxicity, neuromuscular blockade and respiratory paralysis, fetal harm if given in pregnancy</p> Signup and view all the answers

<p>Nephrotoxicity (acute tubular necrosis), hearing loss, vestibular toxicity (resulting in balance deficits)</p> Signup and view all the answers

<p>Drug levels, renal function, urine output, hearing tests</p> Signup and view all the answers

<p>Gentamicin: Trough &lt; 2 mcg/mL, Tobramycin: Trough &lt; 2 mcg/mL</p> Signup and view all the answers

<p>Give larger doses less frequently to give the kidneys time to recover between doses</p> Signup and view all the answers

<p>Amikacin</p> Signup and view all the answers

<p>Tendon inflammation and/or rupture, peripheral neuropathy, and CNS effects (seizures)</p> Signup and view all the answers

<p>Concurrent administration of tizanidine</p> Signup and view all the answers

<p>Used for pneumonia with reliable S. pneumoniae activity</p> Signup and view all the answers

<p>Shake vigorously for 15 seconds before each use, and do not put through a NG or other feeding tube</p> Signup and view all the answers

<p>Antacids and other polyvalent cations, multivitamins, sucralfate, bile acid resins, lanthanum carbonate, and sevelamer</p> Signup and view all the answers

<p>QT prolongation, hypoglycemia/hyperglycemia, psychiatric disturbances, and avoiding systemic quinolones in children and pregnancy/breastfeeding</p> Signup and view all the answers

<p>1:1</p> Signup and view all the answers

<p>Moxifloxacin does not require dose adjustment in renal impairment</p> Signup and view all the answers

<p>Quinolones inhibit bacterial DNA topoisomerase IV and DNA gyrase (topoisomerase II) inside the bacteria, preventing supercoiling of DNA and promoting breakage of double-stranded DNA.</p> Signup and view all the answers

<p>Gemifloxacin, levofloxacin, and moxifloxacin are referred to as respiratory quinolones due to enhanced coverage of S. pneumoniae and atypical pathogens.</p> Signup and view all the answers

<p>Moxifloxacin has enhanced Gram-positive and anaerobic activity and can be used alone for mixed infections (e.g., intra-abdominal infections).</p> Signup and view all the answers

<p>Delafloxacin, a newer quinolone approved for skin infections, is active against MRSA.</p> Signup and view all the answers

<p>Quinolones inhibit bacterial DNA topoisomerase IV and DNA gyrase (topoisomerase II) inside the bacteria, preventing supercoiling of DNA and promoting breakage of double-stranded DNA.</p> Signup and view all the answers

<p>Gemifloxacin, levofloxacin, and moxifloxacin are referred to as respiratory quinolones due to enhanced coverage of S. pneumoniae and atypical coverage.</p> Signup and view all the answers

<p>Moxifloxacin has enhanced Gram-positive and anaerobic activity and can be used alone for mixed infections, such as intra-abdominal infections.</p> Signup and view all the answers

<p>Delafloxacin, a newer quinolone approved for skin infections, is active against MRSA.</p> Signup and view all the answers

<p>Levofloxacin, moxifloxacin, gemifloxacin; used for pneumonia with reliable S. pneumoniae activity.</p> Signup and view all the answers

<p>Concurrent administration of tizanidine.</p> Signup and view all the answers

<p>Used for Pseudomonas infections (including pneumonias), UTIs, intra-abdominal infections, travelers’ diarrhea (without dysentery).</p> Signup and view all the answers

<p>Shake vigorously for 15 seconds before each use. Do not put through a NG or other feeding tube (the oil-based suspension adheres to the tubing). Can crush immediate-release tablets, mix with water and give via a feeding tube. Hold tube feedings at least 1 hour before and 2 hours after the dose.</p> Signup and view all the answers

<p>Antacids and other polyvalent cations (e.g., magnesium, aluminum, calcium, iron, zinc), multivitamins, sucralfate, and bile acid resins can chelate and inhibit quinolone absorption. Lanthanum carbonate (Fosrenol) and sevelamer (Renvela) can decrease the serum concentration of oral quinolones.</p> Signup and view all the answers

<p>1:1</p> Signup and view all the answers

<p>Boxed warnings for tendon inflammation and/or rupture, peripheral neuropathy, CNS effects (seizures); warnings for QT prolongation, hypoglycemia/hyperglycemia, psychiatric disturbances; avoid in children and in pregnancy/breastfeeding.</p> Signup and view all the answers

<p>Moxifloxacin does not require dose adjustment in renal impairment.</p> Signup and view all the answers

<p>Quinolones inhibit bacterial DNA topoisomerase IV and DNA gyrase (topoisomerase II) inside the bacteria. This prevents supercoiling of DNA and promotes breakage of double-stranded DNA.</p> Signup and view all the answers

<p>Gemifloxacin, levofloxacin, and moxifloxacin are referred to as respiratory quinolones due to enhanced coverage of S. pneumoniae and atypical coverage.</p> Signup and view all the answers

<p>Moxifloxacin has enhanced Gram-positive and anaerobic activity and can be used alone for mixed infections (e.g., intra-abdominal infections).</p> Signup and view all the answers

<p>Delafloxacin, a newer quinolone approved for skin infections, is active against MRSA.</p> Signup and view all the answers

<p>Moxifloxacin does not require dose adjustment in renal impairment.</p> Signup and view all the answers

<p>Boxed warnings for quinolones include tendon inflammation and/or rupture, peripheral neuropathy, CNS effects (seizures), hypoglycemia and hyperglycemia, and psychiatric disturbances. They should also be avoided in children and in pregnancy/breastfeeding due to the risk of musculoskeletal toxicity.</p> Signup and view all the answers

<p>Concurrent administration of tizanidine is contraindicated with Ciprofloxacin.</p> Signup and view all the answers

<p>Respiratory quinolones such as levofloxacin, moxifloxacin, and gemifloxacin are used for pneumonia and have reliable activity against S. pneumoniae.</p> Signup and view all the answers

<p>Antipseudomonal quinolones like Ciprofloxacin and levofloxacin are used for Pseudomonas infections, UTIs, intra-abdominal infections, and travelers' diarrhea without dysentery.</p> Signup and view all the answers

<p>Cipro oral suspension should be shaken vigorously for 15 seconds before each use. It should not be put through a NG or other feeding tube, and immediate-release tablets can be crushed, mixed with water, and given via a feeding tube with precautions to hold tube feedings at least 1 hour before and 2 hours after the dose.</p> Signup and view all the answers

<p>Notable drug interactions with quinolones include chelation and inhibition of quinolone absorption by antacids and other polyvalent cations, multivitamins, sucralfate, and bile acid resins. Lanthanum carbonate and sevelamer can decrease the serum concentration of oral quinolones. Specific counseling for patients is recommended regarding these interactions.</p> Signup and view all the answers

<p>Patients taking quinolones should be counseled to avoid sun exposure, separate from cations, and monitor blood glucose for diabetic patients. They should also be informed about potential drug interactions and advised on proper administration of the medication.</p> Signup and view all the answers

<p>Macrolides bind to the 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis.</p> Signup and view all the answers

<p>Macrolides are treatment options for community-acquired upper and lower respiratory tract infections and certain sexually transmitted infections (e.g., chlamydia, gonorrhea).</p> Signup and view all the answers

<p>Clarithromycin and erythromycin should not be used with lovastatin or simvastatin, pimozide, ergotamine, or dihydroergotamine.</p> Signup and view all the answers

<p>Macrolides have warnings for QT prolongation (highest risk with erythromycin), hepatotoxicity, and caution in patients with CAD for clarithromycin.</p> Signup and view all the answers

<p>The major side effects include GI upset (diarrhea, abdominal pain, and cramping) and severe (but rare) skin reactions (SJS/TEN/ DRESS).</p> Signup and view all the answers

<p>Erythromycin and clarithromycin are major substrates of CYP3A4 and are CYP3A4 inhibitors (moderate for erythromycin and strong for clarithromycin).</p> Signup and view all the answers

<p>Macrolides have excellent coverage of atypicals (Legionella, Chlamydia, Mycoplasma, and Mycobacterium avium complex) and Haemophilus.</p> Signup and view all the answers

<p>For azithromycin, Z-Pak consists of 500 mg on day 1, then 250 mg on days 2-5, and Tri-Pak consists of 500 mg daily for 3 days.</p> Signup and view all the answers

<p>Simvastatin, lovastatin, apixaban, colchicine, dabigatran, rivaroxaban, theophylline, and warfarin.</p> Signup and view all the answers

<p>Azithromycin is commonly used for CAP, COPD exacerbations, monotherapy for chlamydia, combination therapy for gonorrhea, prophylaxis for MAC, and as the drug of choice for severe travelers’ diarrhea (including dysentery, diarrhea with bloody stools).</p> Signup and view all the answers

<p>Two 250 mg tablets PO x1, then 250 mg PO daily x 4 days.</p> Signup and view all the answers

<p>Common uses include CAP, strep throat, H. pylori treatment, and azithromycin is a minor substrate of CYP3A4 with fewer clinically significant drug interactions. Caution is advised with CVD, reduced potassium and magnesium levels, and with other QT-prolonging drugs.</p> Signup and view all the answers

<p>They are strong CYP3A4 inhibitors, contraindicated with lovastatin and simvastatin due to the increased risk of muscle toxicity.</p> Signup and view all the answers

<p>Use caution with CVD, reduced potassium and magnesium levels, and with other QT-prolonging drugs such as azole antifungals, antipsychotics, methadone, and quinolones.</p> Signup and view all the answers

<p>Erythromycin causes the most gastrointestinal upset due to increased gastric motility.</p> Signup and view all the answers

<p>Azithromycin is a minor substrate of CYP3A4 and a weak inhibitor of CYP1A2 and P-gp, with fewer clinically significant drug interactions compared to other macrolides.</p> Signup and view all the answers

<p>Macrolides bind to the 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis.</p> Signup and view all the answers

<p>Macrolides are treatment options for community-acquired upper and lower respiratory tract infections and certain sexually transmitted infections (e.g., chlamydia, gonorrhea).</p> Signup and view all the answers

<p>Clarithromycin and erythromycin should not be used with lovastatin or simvastatin, pimozide, ergotamine or dihydroergotamine.</p> Signup and view all the answers

<p>The warnings for macrolides include QT prolongation (highest risk with erythromycin), hepatotoxicity, and caution in patients with coronary artery disease (CAD).</p> Signup and view all the answers

<p>The major side effects associated with macrolides include gastrointestinal upset (diarrhea, abdominal pain and cramping) and severe (but rare) skin reactions (SJS/TEN/DRESS).</p> Signup and view all the answers

<p>Erythromycin and clarithromycin are major substrates of CYP3A4 and are CYP3A4 inhibitors (moderate for erythromycin and strong for clarithromycin).</p> Signup and view all the answers

<p>Z-Pak: 500 mg on day 1, then 250 mg on days 2-5; Tri-Pak: 500 mg daily for 3 days.</p> Signup and view all the answers

<p>Macrolides have excellent coverage of atypical organisms (Legionella, Chlamydia, Mycoplasma and Mycobacterium avium complex) and Haemophilus.</p> Signup and view all the answers

<p>Examples include simvastatin, lovastatin, apixaban, colchicine, dabigatran, rivaroxaban, theophylline, and warfarin.</p> Signup and view all the answers

<p>Azithromycin is used for COPD exacerbations, monotherapy for chlamydia, combination therapy for gonorrhea, and prophylaxis for MAC; it is also the drug of choice for severe travelers’ diarrhea. Clarithromycin is used for the treatment of H. pylori.</p> Signup and view all the answers

<p>Two 250 mg tablets PO x1, then 250 mg PO daily x 4 days.</p> Signup and view all the answers

<p>They are strong CYP3A4 inhibitors and may lead to contraindications with medications like lovastatin and simvastatin, increasing the risk of muscle toxicity.</p> Signup and view all the answers

<p>Caution should be exercised with cardiovascular disease, reduced potassium and magnesium levels, and with other QT-prolonging drugs like azole antifungals, antipsychotics, methadone, and quinolones.</p> Signup and view all the answers

<p>Azithromycin is a minor substrate of CYP3A4 and a weak inhibitor of CYP1A2 and P-gp, leading to fewer clinically significant drug interactions.</p> Signup and view all the answers

<p>Erythromycin causes the most GI upset due to increased gastric motility.</p> Signup and view all the answers

<p>Use caution with cardiovascular disease, reduced potassium and magnesium levels, and with other QT-prolonging drugs.</p> Signup and view all the answers

<p>Simvastatin, lovastatin, apixaban, colchicine, dabigatran, rivaroxaban, theophylline, and warfarin</p> Signup and view all the answers

<p>Azithromycin: COPD exacerbations, monotherapy for chlamydia, combination therapy for gonorrhea, prophylaxis for MAC, severe travelers’ diarrhea. Clarithromycin: used for treatment of H. pylori</p> Signup and view all the answers

<p>Two 250 mg tablets PO x1, then 250 mg PO daily x 4 days</p> Signup and view all the answers

<p>Commonly used for CAP, alternative to beta-lactam for strep throat, used for various infections such as COPD, chlamydia, gonorrhea, MAC, and severe travelers’ diarrhea. Caution with CVD, reduced potassium and magnesium levels, and with other QT-prolonging drugs.</p> Signup and view all the answers

<p>They are strong CYP3A4 inhibitors; lovastatin and simvastatin are contraindicated due to increased risk of muscle toxicity.</p> Signup and view all the answers

<p>Caution should be exercised with cardiovascular disease, reduced potassium and magnesium levels, and with other QT-prolonging drugs such as azole antifungals, antipsychotics, methadone, and quinolones.</p> Signup and view all the answers

<p>Azithromycin is a minor substrate of CYP3A4 and a weak inhibitor of CYP1A2 and P-gp; it has fewer clinically significant drug interactions.</p> Signup and view all the answers

<p>Erythromycin causes the most GI upset due to increased gastric motility.</p> Signup and view all the answers

<p>Macrolides bind to the 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis.</p> Signup and view all the answers

<p>Macrolides are treatment options for community-acquired upper and lower respiratory tract infections.</p> Signup and view all the answers

<p>Azithromycin is commonly used for community-acquired upper and lower respiratory tract infections and certain sexually transmitted infections (e.g., chlamydia, gonorrhea).</p> Signup and view all the answers

<p>Clarithromycin and erythromycin: do not use with lovastatin or simvastatin, pimozide, ergotamine or dihydroergotamine.</p> Signup and view all the answers

<p>Side effects include GI upset (diarrhea, abdominal pain and cramping) and severe (but rare) skin reactions (SJS/TEN/ DRESS).</p> Signup and view all the answers

<p>Erythromycin and clarithromycin are major substrates of CYP3A4 and are CYP3A4 inhibitors (moderate for erythromycin and strong for clarithromycin).</p> Signup and view all the answers

<p>Warnings include QT prolongation (highest risk with erythromycin), hepatotoxicity, and caution in patients with CAD for Clarithromycin.</p> Signup and view all the answers

<p>Macrolides have excellent coverage of atypicals (Legionella, Chlamydia, Mycoplasma and Mycobacterium avium complex) and Haemophilus.</p> Signup and view all the answers

<p>Tetracyclines inhibit bacterial protein synthesis by reversibly binding to the 30S ribosomal subunit.</p> Signup and view all the answers

<p>Doxycycline has broader indications, including respiratory tract infections (e.g., CAP), tick-borne/rickettsial diseases, spirochetes and sexually transmitted infections (chlamydia and gonorrhea).</p> Signup and view all the answers

<p>Children &lt; 8 years of age, pregnancy and breastfeeding (suppresses bone growth and skeletal development, and permanently discolors teeth). Photosensitivity, tissue hyperpigmentation, severe skin reactions (DRESS/SJS/TEN), exfoliative dermatitis. Gastrointestinal inflammation/ulceration.</p> Signup and view all the answers

<p>Antacids and other polyvalent cations (e.g., calcium, magnesium, aluminum).</p> Signup and view all the answers

<p>CA-MRSA skin infections, acne, first line for Lyme disease, Rocky Mountain Spotted Fever (tick-borne illnesses), CAP.CORD exacerbations, sinusitis (if an antibiotic is indicated), VRE UTI.monotherapy for chlamydia, combination therapy for gonorrhea</p> Signup and view all the answers

<p>Tetracycline</p> Signup and view all the answers

<p>Tetracycline can chelate and inhibit tetracycline absorption when taken with certain medications such as magnesium, aluminum, calcium, iron, zinc, multivitamins, sucralfate, bismuth subsalicylate, bile acid resins, and lanthanum carbonate. Dairy products should also be avoided 1 hour before or two hours after tetracycline.</p> Signup and view all the answers

<p>In pregnancy, breastfeeding, or in children under 8 years of age.</p> Signup and view all the answers

<p>Tetracyclines target the 30S ribosomal subunit and inhibit bacterial protein synthesis by reversibly binding to it.</p> Signup and view all the answers

<p>Doxycycline has broader indications, including respiratory tract infections (e.g., CAP), tick-borne/rickettsial diseases, spirochetes, and sexually transmitted infections (chlamydia and gonorrhea). Minocycline is often preferred for skin infections, including acne.</p> Signup and view all the answers

<p>The warnings for tetracycline drugs include avoiding use in children &lt; 8 years of age, pregnancy, and breastfeeding due to the risk of suppressing bone growth, skeletal development, and permanently discoloring teeth. It also includes warnings about photosensitivity, tissue hyperpigmentation, severe skin reactions (DRESS/SJS/TEN), and exfoliative dermatitis. The noted drug interactions include avoiding concurrent use with antacids and other polyvalent cations.</p> Signup and view all the answers

<p>The IV to PO ratio for doxycycline and minocycline is 1:1. Important tetracycline drug interactions include avoiding concurrent use with antacids and other polyvalent cations.</p> Signup and view all the answers

<p>Tetracyclines can chelate and inhibit absorption of certain medications such as antacids, multivitamins, sucralfate, bismuth subsalicylate, and bile acid resins. They can also be affected by dairy products and lanthanum carbonate. Additionally, tetracyclines are substrates of CYP3A4 and can interact with CYP3A4 inhibitors and inducers. They can also enhance the effects of warfarin and neuromuscular blocking drugs.</p> Signup and view all the answers

<p>Doxycycline and minocycline are used for CA-MRSA skin infections, acne, Lyme disease, Rocky Mountain Spotted Fever, community-acquired pneumonia (CAP) exacerbations, sinusitis, VRE UTI, monotherapy for chlamydia, and combination therapy for gonorrhea.</p> Signup and view all the answers

<p>Tetracycline is used in H. pylori treatment, as mentioned in the Gastroesophageal Reflux Disease &amp; Peptic Ulcer Disease chapter of the text.</p> Signup and view all the answers

<p>Tetracyclines should not be used in pregnancy, breastfeeding, or in children under 8 years of age.</p> Signup and view all the answers

<p>Tetracyclines inhibit bacterial protein synthesis by reversibly binding to the 30S ribosomal subunit. They cover many Gram-positive bacteria (Staphylococci, Streptococci, Enterococci, Nocardia, Bacillus, Propionibacterium spp.), Gram-negative bacteria, including respiratory flora (Haemophilus, Moraxella, atypicals) and other unique pathogens (e.g., spirochetes, Rickettsiae, Bacillus anthracis, Treponema pallidum).</p> Signup and view all the answers

<p>Doxycycline has broader indications, including respiratory tract infections (e.g., CAP), tick-bome/rickettsial diseases, spirochetes and sexually transmitted infections (chlamydia and gonorrhea). Doxycycline is also an option for the treatment of mild skin infections, caused by CA-MRSA, and VRE urinary tract infections. Minocycline is often preferred for skin infections, including acne.</p> Signup and view all the answers

<p>Tetracycline warnings include avoiding use in children &lt; 8 years of age, pregnancy, and breastfeeding due to the suppression of bone growth and skeletal development, as well as permanent tooth discoloration. They also carry warnings for photosensitivity, tissue hyperpigmentation, severe skin reactions (e.g., DRESS/SJS/TEN), and exfoliative dermatitis. Minocycline specifically has a warning for drug-induced lupus erythematosus (PILE).</p> Signup and view all the answers

<p>Tetracycline drug interactions include avoidance of concomitant use with antacids and other polyvalent cations. The IV:PO ratio is 1:1 for both Doxycycline and Minocycline.</p> Signup and view all the answers

<p>Doxycycline and minocycline are commonly used for CA-MRSA skin infections, acne, Lyme disease, Rocky Mountain Spotted Fever, CAP.CORD exacerbations, sinusitis (if an antibiotic is indicated), VRE UTI, monotherapy for chlamydia, and combination therapy for gonorrhea.</p> Signup and view all the answers

<p>Tetracyclines should be taken 1-2 hours before or four hours after consuming dairy products. When taken with other medications such as magnesium, aluminum, calcium, iron, zinc, multivitamins, sucralfate, bismuth subsalicylate, and bile acid resins, tetracyclines can chelate and inhibit their absorption, so separate doses by 1-2 hours before or four hours after.</p> Signup and view all the answers

<p>Tetracycline is a major substrate of CYP3A4 and a moderate CYP3A4 inhibitor. Caution should be used with CYP3A4 inhibitors, which increase tetracycline levels, and CYP3A4 inducers, which decrease tetracycline levels.</p> Signup and view all the answers

<p>Tetracyclines should not be used in pregnancy, breastfeeding, or in children under 8 years of age.</p> Signup and view all the answers

<p>CA-MRSA skin infections, acne. Doxycycline: first line for Lyme disease, Rocky Mountain Spotted Fever (tick-borne illnesses), CAP. CORD exacerbations, sinusitis (if an antibiotic is indicated), VRE UTI. Monotherapy for chlamydia, combination therapy for gonorrhea</p> Signup and view all the answers

<p>Tetracycline</p> Signup and view all the answers

<p>Tetracycline can chelate and inhibit absorption when taken with certain minerals (e.g. magnesium, aluminum, calcium, iron, zinc), multivitamins, sucralfate, bismuth subsalicylate, and bile acid resins. It can also enhance the effects of warfarin and neuromuscular blocking drugs.</p> Signup and view all the answers

<p>In pregnancy, breastfeeding, or children age &lt; 8 years.</p> Signup and view all the answers

<p>Calcium and iron. Doses should be separated 1-2 hours before or 4 hours after tetracycline.</p> Signup and view all the answers

<p>Common uses include CA-MRSA skin infections, acne, Lyme disease, Rocky Mountain Spotted Fever, chronic obstructive pulmonary disease (COPD) exacerbations, sinusitis, VRE UTI, monotherapy for chlamydia, and combination therapy for gonorrhea.</p> Signup and view all the answers

<p>Tetracycline should not be used in pregnancy, breastfeeding, or in children under 8 years of age.</p> Signup and view all the answers

<p>Tetracyclines can interact with warfarin, neuromuscular blocking drugs, lanthanum carbonate, CYP3A4 inhibitors, and CYP3A4 inducers.</p> Signup and view all the answers

<p>Tetracyclines can be chelated and inhibited by various medications including antacids, multivitamins, sucralfate, bismuth subsalicylate, and bile acid resins. They can also interact with lanthanum carbonate, CYP3A4 inhibitors and inducers, warfarin, and neuromuscular blocking drugs.</p> Signup and view all the answers

<p>Doxycycline and minocycline are used for CA-MRSA skin infections, acne, Lyme disease, Rocky Mountain Spotted Fever, community-acquired pneumonia exacerbations, sinusitis, VRE UTI, chlamydia, and gonorrhea.</p> Signup and view all the answers

<p>Tetracyclines should be taken on an empty stomach, 1-2 hours before or 4 hours after dairy products and certain medications to avoid chelation and reduced absorption. Doxycycline and minocycline can be taken with food to reduce gastrointestinal upset.</p> Signup and view all the answers

<p>Tetracyclines should not be used in pregnancy, breastfeeding, or in children under 8 years of age.</p> Signup and view all the answers

<p>Inhibits dihydrofolic acid formation from para-aminobenzoic acid, which interferes with bacterial folic acid synthesis.</p> Signup and view all the answers

<p>Inhibits dihydrofolic acid reduction to tetrahydrofolate, resulting in inhibition of the folic acid pathway.</p> Signup and view all the answers

<p>Staphylococci (including MRSA and CA-MRSA); Gram-negative bacteria including Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella and Stenotrophomonas.</p> Signup and view all the answers

<p>Nocardia, Pneumocystis, Toxoplasmosis.</p> Signup and view all the answers

<p>Sulfa allergy.</p> Signup and view all the answers

<p>Skin reactions (SJS/TEN, TTP), G6PD deficiency, photosensitivity, increased potassium, hemolytic anemia, crystalluria; monitoring of renal function, electrolytes, CBC, folate.</p> Signup and view all the answers

<p>Moderate-strong inhibitor of CYP2C8 and CYP2C9, can cause significantly increased INR.</p> Signup and view all the answers

<p>SS dose is 400 mg SMX/80 mg TMP; DS dose is 800 mg SMX/160 mg TMP.</p> Signup and view all the answers

<p>Dihydrofolic acid formation from para-aminobenzoic acid</p> Signup and view all the answers

<p>Inhibits dihydrofolic acid reduction to tetrahydrofolate</p> Signup and view all the answers

<p>Staphylococci (including MRSA and CA-MRSA), Gram-negative bacteria such as Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella, and Stenotrophomonas</p> Signup and view all the answers

<p>Sulfa allergy</p> Signup and view all the answers

<p>Photosensitivity, increased potassium, hemolytic anemia, crystalluria</p> Signup and view all the answers

<p>It is a moderate-strong inhibitor of CYP2C8 and CYP2C9 and can cause significant increase INR</p> Signup and view all the answers

<p>Renal function, electrolytes, CBC, folate</p> Signup and view all the answers

<p>Warnings for skin reactions, SJS/TEN, TTP, and caution in G6PD deficiency</p> Signup and view all the answers

<p>Sulfamethoxazole (SMX) inhibits dihydrofolic acid formation from para-aminobenzoic acid, while Trimethoprim (TMP) inhibits dihydrofolic acid reduction to tetrahydrofolate, resulting in inhibition of the folic acid pathway.</p> Signup and view all the answers

<p>Sulfamethoxazole/trimethoprim covers Staphylococci (including MRSA and CA-MRSA); S. pneumoniae and Group A Strep coverage is unreliable. It also includes activity against Gram-negative bacteria such as Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella and Stenotrophomonas.</p> Signup and view all the answers

<p>Contraindications include sulfa allergy, and warnings include skin reactions like SJS/TEN, thrombotic thrombocytopenic purpura (TTP) G6PD deficiency; do not use with known deficiency and discontinue drug if hemolysis occurs.</p> Signup and view all the answers

<p>Side effects include photosensitivity, increased potassium, hemolytic anemia (identified with a positive Coombs test), and crystalluria (which can be managed by taking the medication with 8 oz of water). Monitoring should include renal function, electrolytes, CBC, and folate levels.</p> Signup and view all the answers

<p>SMX/TMP is a moderate-strong inhibitor of CYP2C8 and CYP2C9 and can cause a significant increase in INR.</p> Signup and view all the answers

<p>Dose (including weight-based dosing) is based on the TMP component. Single Strength (SS) dose is 400 mg SMX/80 mg TMP, and Double Strength (DS) dose is 800 mg SMX/160 mg TMP. Uncomplicated UTI dose is 1 DS tablet PO BID x3 days.</p> Signup and view all the answers

<p>Pseudomonas, Enterococci, atypicals and anaerobes are not covered by Sulfamethoxazole/Trimethoprim (SMX/TMP).</p> Signup and view all the answers

<p>Coverage includes some opportunistic pathogens such as Nocardia, Pneumocystis, and Toxoplasmosis.</p> Signup and view all the answers

<p>SMX inhibits dihydrofolic acid formation from para-aminobenzoic acid, interfering with bacterial folic acid synthesis, while TMP inhibits dihydrofolic acid reduction to tetrahydrofolate. It covers Staphylococci (including MRSA and CA-MRSA), Gram-negative bacteria (Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella, and Stenotrophomonas), and some opportunistic pathogens (Nocardia, Pneumocystis, Toxoplasmosis).</p> Signup and view all the answers

<p>Contraindications include sulfa allergy. Warnings include skin reactions (SJS/TEN, TTP), G6PD deficiency, and caution in patients with known deficiency and a need to discontinue the drug if hemolysis occurs.</p> Signup and view all the answers

<p>Safety/side effects/monitoring considerations include contraindications for sulfa allergy, warnings for skin reactions (SJS/TEN, TTP) and G6PD deficiency, and monitoring for renal function, electrolytes, CBC, and folate.</p> Signup and view all the answers

<p>Dose is based on the TMP component. Single Strength (SS) dose is 400 mg SMX/80 mg TMP. Double Strength (DS) dose is 800 mg SMX/160 mg TMP. Uncomplicated UTI dose is 1 DS tablet PO BID x3 days.</p> Signup and view all the answers

<p>SMX/TMP is a moderate-strong inhibitor of CYP2C8 and CYP2C9 and can cause a significant increase in INR.</p> Signup and view all the answers

<p>TMP inhibits dihydrofolic acid reduction to tetrahydrofolate, resulting in the inhibition of the folic acid pathway.</p> Signup and view all the answers

<p>SMX/TMP covers Staphylococci (including MRSA and CA-MRSA), Gram-negative bacteria (Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella, and Stenotrophomonas), and some opportunistic pathogens (Nocardia, Pneumocystis, Toxoplasmosis).</p> Signup and view all the answers

<p>Side effects include photosensitivity, increased potassium, hemolytic anemia (identified with a positive Coombs test), and crystalluria (take with 8 oz of water). Safety considerations include contraindications for sulfa allergy, warnings for skin reactions (SJS/TEN, TTP) and G6PD deficiency, and monitoring for renal function, electrolytes, CBC, and folate.</p> Signup and view all the answers

<p>SMX inhibits dihydrofolic acid formation from para-aminobenzoic acid, which interferes with bacterial folic acid synthesis.</p> Signup and view all the answers

<p>TMP inhibits dihydrofolic acid reduction to tetrahydrofolate, resulting in inhibition of the folic acid pathway.</p> Signup and view all the answers

<p>Staphylococci (including MRSA and CA-MRSA); S. pneumoniae and Group A Strep coverage is unreliable. Activity against Gram-negative bacteria is broad, and includes Haemophilus, Proteus, E. coli, Klebsiella, Enterobacter, Shigella, Salmonella and Stenotrophomonas.</p> Signup and view all the answers

<p>Sulfa allergy.</p> Signup and view all the answers

<p>Skin reactions: SJS/TEN, thrombotic thrombocytopenic purpura (TTP) G6PD deficiency; do not use with known deficiency and discontinue drug if hemolysis occurs.</p> Signup and view all the answers

<p>Side effects: Photosensitivity, increased potassium, hemolytic anemia (identified with a positive Coombs test), crystalluria (take with 8 oz of water). Monitoring: Renal function, electrolytes, CBC, folate.</p> Signup and view all the answers

<p>SMX/TMP is a moderate-strong inhibitor of CYP2C8 and CYP2C9 and can cause significantly increase INR.</p> Signup and view all the answers

<p>1 DS tablet PO BID x3 days.</p> Signup and view all the answers