Dizziness dont drive Tetracyclines Pharmaco dynamics inhibit protein synthesis

Dizziness dont drive tetracyclines pharmaco dynamics

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Dizziness-don’t drive Tetracyclines Pharmaco - dynamics inhibit protein synthesis by reversibly binding to the 30S subunit & preventing the addition of amino acids preventing the addition of amino acids; anti-inflammatory properties Tetracycline & Doxycycline Precauti on & contra- indicatio n Tetracycline: cautious use in hepatic (IV tetracycline, long-term Tx of doxy or minocycline) & renal impairment, pregnancy (doxy—category D, others is X), children < age of 8 (decrease bone growth, permanent teeth discoloration) Interactio n Warfarin (increase its effect), antacids, dairy foods, iron salts, NaHCO3, cimetidine (decrease absorption); barbiturates, carbamazepine, hydantoins (decrease therapeutic level); digoxin increase toxicity; Lithium & oral contraceptive (decrease its effects) ADRs GI irritation (Take w/ food), esophageal ulcer (w/ full glass of water & erect after taking meds), CDI Lightheadedness, dizziness, vertigo in minocycline & doxycycline; Pseudotremeor cerebri (benign intracranial HTN) in tetracycline Photosensitivity, maculopapular & erythematous rashes, SJS, toxic epidermal necrolysis Clinical use & dosing Genitourinary infection C. trachomatis & nongonococcal urethritis & cervicitis (100mg of Doxy is the first line tx) Doxy + ceftriaxone (250mg IM) for empirical Tx of epididymorchitis Acne Tetracycline 500mg bid for 1-2 mo, then 500mg daily for 1-2 mo if acne is controlled, then maintenance dose of 123-500mg daily Minocycline, alternative, 100mg bid, then lower to 50mg daily PUD Lyme dz Doxy 100mg bid (first-line tx) Monitorin g Long-term therapy needs periodic hematopoietic, hepatic, renal function tests Education No outdated tetracycline causing serious toxicity; no driving, hepatotoxicity, backup contraception during tetracycline therapy until next menses; exacerbation of hot flashes (on hormone therapy) Glycopeptides Vancomycin, telavancin (Vibativ), dalbavancin (Zeven) MOA Narrow-spectrum ABX for G (+) resistance first line Tx: weakened cell wall (bactericidal) Pharmaco -kinetic Poor GI absorption IV form (Pregnancy C) excreted in kidney Contra- indication Oral formulation (pregnancy B) is not for systemic effects ADRs nephrotoxicity; ototoxicity (cautious in elders); Rad man syndrome Interactio Aminoglycosides; telavancin affects renal function (ACEIs, Loop diuretics,
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n NSAIDs) Clinical Us & dosing Mild to Mod CDI: Metronidazole first and then Vanco if not improved Monitorin g Oral Vanco responds to therapy, diarrhea and associate Sx will be disappear (No follow-up Cx or toxin assays needed); IV route needs WBC, audiometry for extended or repeat therapy Education Cholestyramine should be several hours apart; antiperistaltic antidiarrhea (atropine, diphenoxylate, loperamide, opioids) contraindicated Antimycobacterials Pharmaco -dynamics Isoniazid (INH) & ethambutol—inhibit synthesis of mycolic acids Rifamycin (rifampin) binds to the beta subunit of mycobacteria DNA- dependent RNA polymerase and inhibits RNA synthesis (combined therapy needed d/t high resistance development) Ethambutol inhibits synthesis of arabinogalactan, an essential component of mycobacteria cell walls
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  • Spring '14
  • Henrikson,J
  • Clostridium difficile, Renal function

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