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Chapter 30
Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones
72
Pharmacology
Undergraduate 3
09/12/2011

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Term
Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones are all examples of ______
Definition
Antibacterials
Term
Macrolides, lincosamides, and tetracyclines are primarily (bactericidal/bacteriostatic)
Definition
Bacteriostatic.
However, they may be bactericidal depending on the dose or pathogen.
Term
Glycopeptides, aminoglycosides, and fluoroquinolones are (bactericidal/bacteriostatic)
Definition
Bactericidal.
Term
Macrolides, lincosamides, glycopeptides, and ketolides are sometimes used as a substitute for _____
Definition
Penicillin
Term
What is a drug frequently prescribed if the client has a hypersensitivity to penicillin?
Definition
Erythromycin.
Term
Macrolides are classified as:
Definition
Broad spectrum antibiotics
Term
Examples of extended macrolides are
Definition
azithromycin (Zithromax)
clarithromycin (Biaxin)
erythromycin
Term
Which type of antibiotic may be administered orally or IV, but not IM as it is too painful?
Definition
Macrolides. It should be infused slowly when given IV also, to avoid phlebitis.
Term
What is added to erythromycin to prevent destruction by gastric acid in the stomach?
Definition
acid-resistant salts.
Term
Macrolides are active against most ____ _____ bacteria and moderately active against some _____ _______ bacteria.
Definition
Gram positive
gram negative
Term
Macrolides are commonly used to treat
Definition
Respiratory tract infections
sinus infections
GI infections
Skin infections
Diptheria
Impetigo
STIs
Term
What is the drug of choice for treatment of mycoplasmal pneumonia and Legionnaire's disease?
Definition
Erythromycin
Term
Adverse reactions to Azithromycin include
Definition
Superinfections
Vaginitis
Urticaria
Stomatitis
Hearing loss
HEPATOTOXICITY
ANAPHYLAXIS
Term
The extended macrolide group is like erythromycin in that it is _____ (cidal/static)
Definition
Bacteriostatic
Term
Many drugs in the extended macrolide group have a longer ____ _____ therefore they are administered once a day.
Definition
half life
Term
Side effects common in clarithromycin, such as nausea, diarrhea, and abdominal discomfort are uncommon in which similar drug?
Definition
azithromycin
Term
When administering macrolides, it is important to assess
Definition
Vitals
Urine output
Laboratory tests (liver enzyme values)
Term
T/F Lincosamide, like erythromycin, inhibit bacterial protein synthesis and have both bacteriostatic and bactericidal actions.
Definition
True.
Term
Two examples of Lincosamides
Definition
Clindamycin (Cleocin)
lincomycin (Lincocin)
Term
Which is prescribed more often - Clindamycin or lincomycin?
Definition
Clindamycin, as it is active against most gram-positive organisms and anaerobic organisms.
It is not effective against gram negative bacteria.
It is absorbed better than lincomycin through the GI tract
Maintains a higher serum drug concentration
Fewer toxic effects.
Term
SE (side effects) and AR (adverse reactions) to lincosamides include
Definition
GI irritation (who would have thought, huh?)
N/V
Stomatitis
Rash (occasionally)
COLITIS
ANAPHYLACTIC SHOCK
Term
Vancomycin (Vancocin) is a
Definition
Glycopeptide
Term
Vancomycin (Vancocin) is a
Definition
Glycopeptide
Term
Vancomycin is used against _____ and in cardiac surgical ______ for individuals with penicillin allergies.
Definition
S. aureus
prophylaxis
Term
What should be monitored when administering vancomycin?
Definition
Serum vancomycin levels
Term
What antibacterial is now used to treat life threatening vancomycin-resistant enterococci (VERF) infections?
Definition
Quinupristin/dalfopristin (a combined antibacterial)
Term
What is a new glycopeptide used to treat selected gram positive bacteria, skin infections, and has bactericidal action against MRSA?
Definition
Telavancin (Vibativ)
Term
When taken with vancomycin, _____ can mask ototoxicity.
Definition
Dimenhydrinate (Dramamine)
Term
The risk for nephrotixicity and ototoxicity may be potentiated with vancomycin when given with
Definition
furosemide
aminoglycosides
amphotericin B
colistin
cisplatin
cyclosporine
Term
A new classification of antibiotics, structurally related to macrolides
Definition
Ketolides
Term
_______ is a new drug that is a Ketolide used for adults to treat mild to moderate community-acquired pneumonia.
Definition
Telithromycin (Ketek)
Term
How does telithromycin work against bacteria?
Definition
It is bacteriostatic. It inhibits protein synthesis.
Term
What are the SE and AR to telithromycin?
Definition
Visual disturbances
headache
dizziness
altered taste
N/V
Diarrhea
liver failure
Exacerbation of myasthenia gravis
Term
Which were the first broad-spectrum antibiotics, effective against gram positive and gram negative bacteria?
Definition
Tetracyclines
Term
How do tetracyclines act on bacteria?
Definition
Bacteriostatic effect
Term
What has been used for years to treat severe acne vulgaris?
Definition
Oral and topical tetracycline
Term
Which route is used for tetracycline in severe infections?
Definition
IV
Term
What shouldn't one ingest when taking tetracyclines?
Definition
Magnesium and aluminum antacid preparations
Milk products containing calcium
Iron containing drugs.
THESE SUBSTANCES BIND TO TETRACYCLINE AND PREVENT ABSORPTION. TAKE ON AN EMPTY STOMACH 1 HOUR BEFORE OR 2 HOURS AFTER MEALTIME.. YUM
Term
What is an example of a tetracycline?
Definition
Doxycycline (Vibramycin, Vibra-Tabs)
Term
SE and AR of doxycycline (tetracyclines)
Definition
N/V
Diarrhea
PHOTOSENSITIVITY
PRURITUS
COLOR VISION CHANGES
SUPERINFECTION
BLOOD DYSCRASIAS
HEPATOTOXICITY
INTRACRANIAL HYPERTENSION
PSEUDOMEMBRANOUS COLITIS
Term
Pregnant women should not take tetracycline during the ____ trimester of pregnancy b/c of possible tetrogenic effects.
Definition
First
Term
Women in the ______ trimester of pregnancy and children younger than 8 yoa should not take tetracycline because it ___________________.
Definition
Last
Irreversibly discolors the permanent teeth
Term
T/F Outdated tetracyclines can be substitutes for tic-tacs as they taste similar.
Definition
False. They taste more like M&M's.
More importantly, THEY ARE TOXIC IF THEY ARE OUTDATED AND SHOULD PROBABLY JUST BE DISCARDED
Term
Tetracyclines can be ______ in high doses.
Definition
Nephrotoxic
Term
What type of infection can also result when administering tetracyclines?
Definition
Superinfection (a secondary infection resulting from drug therapy)
Term
The desired action of what can be lessened when taken with tetracycline?
Definition
Oral contraceptives
Term
Tigecycline is an antibiotic in a new category called ________, a synthetic analogue of the tetracyclines.
Definition
Glycylcyclines
Term
What method does glycylcycline take against bacteria?
Definition
Blocks protein synthesis - Bacteriostatic
Term
Indications for use of glycylcyclines are
Definition
Complicated skin infections
intraabdominal infections
Term
SE and AR of glycylcyclines
Definition
GI upset - N/V, abdominal, diarrhea
Pseudomembraneous colitis (rare)
Photosensitivity
Headache
Dizziness
Insomnia
Hyper/hypotension
Anemia
Leukocytosis
Thrommbocythemia
Term
Warfarin levels may be increased and may lead to bleeding when taken with
Definition
tigecycline (a glycylcycline)
Term
Oral contraceptives may be less effective when given concurrently with
Definition
tigecycline (a glycylcycline)
Term
Aminoglycosides commonly end in "-___"
Definition
"-cin"
ex. gentamicin sulfate (Garamycin)
Term
Aminoglycosides act by
Definition
inhibiting bacterial protein synthesis
Term
Aminoglycosides are used against what type of bacteria?
Definition
Gram -negative.
Some gram-positive cocci are resistant to aminoglycosides, so penicillins or cephalosporins may be used
Term
What can aminoglycosides do in children, but not in adults?
Definition
Cross the BBB (blood-brain barrier)
Term
Aminoglycosides are primarily given how?
Definition
IV.
Few are given orally to decrease bacteria in the bowel.
Term
To ensure a desired blood level, aminoglycosides are usually administered IV. What is done to monitor/maintain a therapeutic drug level?
Definition
The client's blood levels are drawn periodically to determine the peak and trough levels. A therapeutic drug level can be maintained by monitoring the trough level, and peak levels are useful in monitoring for toxicity.
Term
What are two serious adverse reactions to aminoglycosides?
Definition
Ototoxicity and nephrotoxicity
Term
T/F IV aminoglycosides can be given with penicillins and cephalosporins, and can be mixed in the same container.
Definition
False. They can be given concurrently, but they cannot be mixed in the same container
Term
The mechanism of action of fluroquinolones is to
Definition
Interfere with the enzyme DNA production
Term
Fluroquinolones work on (G+/G-)
Definition
Gram positive and gram negative
Term
The fluoroquinolone group of antibiotics is useful in the treatment of
Definition
UT, bone and joint infections
bronchitis
pneumonia
gastroenteritis
gonorrhea
Term
Examples of fluoroquinolones are
Definition
Ciprofloxacin
levofloxacin
lomefloxacin
moxifloxacin
norfloxacin
ofloxacin
Term
Two fluoroquinolones with a broad spectrum of action are
Definition
Ciprofloxacin (has more uses)
Norfloxacin.
Term
Levofloxacin is used primarily to treat
Definition
respiratory problems
Term
Moxifloxacin is prescribed to treat the same infections other fluoroquinolones are effective against, but is more active than ________ against S. pneumoniae and some strains of S. aureus and enterococci, but not VERF.
Definition
levofloxacin
Term
SE & AR of fluoroquinolones may include
Definition
N/V
diarrhea
fatigue
restlessness
insomnia
tinnitus
photosensitivity
Stevens-Johnson syndrome
encephalopathy
pseudomembraneous colitis
dysrhythmias
Term
Lipopeptides method of action
Definition
inhibit DNA and RNA synthesis
Term
Daptomycin is an example of a
Definition
lipopeptide
Term
AR of lipopeptides (daptomycin)
Definition
Chest pain
hypo/hyperkalemia
hypo/hyperglycemia
bleeding
rhabdomyolysis
pleural effusion
Term
An example of an unclassified antibacterial drug is
Definition
Quinupristin/dalfopristin (Synercid)
May cause pain, edema, and phlebitis when administered IV
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