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What is the Moa kind of sulfonamides/pyrimidines?
What kind of effect does sulfonamides/pyrimidines have?
Which enzyme does sulfonamides compete against PABA for?
Which enzyme does pyrimidines (Trimethoprim) work on?
What does sulfonamides compete with for dihydropteroate synthase?
What are the 3 major groups of sulfonamides?
- Oral absorbable (Bactrim DS)
- Oral nonabsorbable (sulfasalazine)
- Topical (Silvadene cream)
What are the clinical uses of sulfonamides?
- use early on
- use in combination with topical agents
What are the adverse effects of sulfonamides?
- fever, rash, photosensitivity, urticaria, GI upset
- Steven-Johnson Syndrome
- UTI problems (drink lots of fluids with)
- Hematopoietic Problems (glucose-6-phosphate dehydrogenase deficiency)
- which helps with production of RBC's
- Kernicterus in newborns if given during pregnancy (elevated bilirubin that causes neuro effects)
What is Stevens-Johnson Syndrome?
systemic reaction to a med in which the mucous membranes slough off
What is Trimethoprim & Trimethoprim-Sulfamethoxazole (TMP-SMZ) Moa?
synergistic combo of folate antagonists that blocks purine production & nucleic acid synthesis
What is the pk of TMP-SMZ?
- given as 1:5 ratio
- reduce in renal failure
- Pregnancy Category C if given late in pregnancy
- Concentrates in prostatic/vaginal fluids
- excreted in breast milk
- Contraindicated in infants <2 months
What are uses of oral TMP-SMZ?
- resistant pneumococci & E. coli
What are the uses for IV TMP-SMZ?
- pneumocystitis PNA (agent of choice)
- bacterial sepsis
What other things does TMP-SMZ treat?
What are the adverse effects of TMP-SMZ?
- rash, urticaria, photosensitivity, GI upset,
- bone marrow suppression
- partial cross allergy w/ diuretics, diazoxide, sulfonylurea hypoglycemic agents
- AIDS Pt's have worse reactions
What is the adverse effects of Trimethoprim alone?
- Megaloblastic anemia
What is the Moa of Flouroquinolones?
Inhibition of DNA gyrase (Toposomerase II/IV) so bacteria can't reproduce
What is chemistry of flouroquinolones?
synthetic fluorinated analogs of nalidixic acid
What is the pk of flouroquinolones?
- blocks bacterial DNA synthesis
- dosage adjustment if CC<50 ml/min (except Moxifoaxacin)
- Crosses the placenta
- Pregnancy Category C
- Divalent & trivalent cation products can impair oral absorption
What is flouroquinolones used for?
- bacterial diarrhea (salmonella, E. coli)
- bones, joints, soft-tissues, intra-abdominal
- atypical PNA
Which antibiotic is not longer recommended to treat gonococcal infections?
Which flouroquinolone is the DOC for tx/prophylaxis of anthrax?
What is Levofloxacin known as?
respiratory fluroquinolone (pneumococcus)
What are adverse effects of flouroquinolones?
- QT interval prolongation
- Not for Pt <18 yrs
- tendon rupture
- risk for Sz
Which antibiotic has a Black Box warning for myasthena gravis, tendonitis, & tendon rupture?