USMLE Step 2 Review 19 04 Drugs of Choice Tetracyclines

USMLE Step 2 Review 19 04 Drugs of Choice Tetracyclines

 

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Begin 19 04 Drugs of Choice Tetracyclines Transcription

Which class of antibiotic must not be used in children 8 years old or younger?

  • The Tetracyclines.

What are 3 adverse effects Tetracyclines may have on developed bone and teeth?

  • Depression of linear bone growth, stained teeth, and defects in enamel.

Toxic effects from Tetracyclines involve what organ systems?

  • Potentially, Tetracyclines can be toxic to virtually every organ system.

What type of patient is particularly at risk for hepatic injury from Tetracyclines?

  • Pregnant women.

What adverse effect can be caused by taking outdated, degraded Tetracyclines?

  • Fanconi renal syndrome.

What function and part of the kidney is damaged in Fanconi renal syndrome, which may be congenital or acquired due to insult, due to degraded tetracycline, or heavy metal poisoning, amyloidosis, vitamin D deficiency, and so on?

  • Renal proximal tubulular fuction.

What 2 adverse effects on the skin can occur with Tetracyclines, even though Tetracycline is often used for acne with teenagers?

  • Photosensitivity to sunlight and exfoliative dermatitis.

Which class of antibiotics is possibly the safest, especially compared with Aminoglycosides and Tetracyclines, is usually associated with gastric distress only at higher doses, and while it doesn’t cover as many different organisms as Penicillins or Cephalosporins, actually has broader coverage in terms of some important pathogens, such as H. flu, Pertussis, Diphtheria, Mycobacteria, Chlamydia, and Gonorrhea?

  • The Macrolides.

Which are the 3 Macrolides currently available which may be the safest of all antibiotics?

  • Erythromycin, Azithromycin, and Clarithromycin.

Which is the older Macrolide? It does have more side effects than the new ones, and it can cause stomach upset in many patients. And finally, with has been reported infrequently to cause transient loss of hearing?

  • Erythromycin.

Erythromycin comes in a combination syrup, with a Sulfa. Sulfasoxizole for pediatrics. What’s the trade name?

  • Pediazole.

What is Pediazole specifically indicated for? Give type of infection and organism.

  • Acute otitis media due to H. influenzae.

There are, of course, other antibiotics also specifically indicated for acute otitis media, which are covered in another section. Let’s look at the 2 newer Macrolides for a minute. What are they again?

  • Azithromycin and Clarithromycin.

And the trade name for Azithromycin?

  • Zithromax.

And the trade name for Clarithromycin?

  • Viaxin.

Now, while the newest Macrolide, Azithromycin/Zithromax may be used for quite a number of conditions, there are 2 conditions and organisms for which it is recognized as a first-line drug of choice. What are these 2 conditions and organisms for which Azithromycin/Zithromax is recognized as a drug of choice?

  • Trichoma due to Chlamydia trachomatis, and chancroid due to Hemophilus ducrei.

Again, both of the newer macrolides, Clarithomycin/Viaxin and Azithromycin/Zithromax may be used in a number of situations, there are 2 situations where either would be an excellent choice as a first line agent. What are these 2?

  • H. influenzae infections that are not life-threatening, and Moraxella catarallis.

What kind of respiratory disorder is Moraxella catarallis associated with, especially in adult smokers?

  • ABECB, which stands for Acute Bacterial Exacerbation of Chronic Bronchitis, especially seen in adult smokers.

What organism, often implicated in teenage bronchitis, is Erythromycin, Azithromycin, and Clarithromycin all drugs of choice for?

  • Mycoplasma pneumonia.

What other drug have we already encountered in a different class that’s also a drug of choice for Mycoplasma pneumonia?

  • Doxycycline.

What serious adverse effect has been found in young animals with the use of Quinolones and Fluoroquinolones, although this has not been documented in young children, which makes physicians reluctant to use Quinolones and Fluoroquinolones in pediatrics?

  • Cartilage damage.

In general, what class of organisms are best covered by the Quinolones and Fluoroquinolones?

  • Gram negative.

What 3 types of infection, by location, are Quinolones and Fluoroquinolones used for in adults?

  • UTIs, skin, lower respiratory tract.

What may large doses of Quinolones or Fluoroquinolones precipitate in the elderly?

  • Hypoglycemia.

In addition to disorientation and nausea, what life-threatening condition can be caused in the elderly when they have an episode of hypoglycemia?

  • Cardiac arrhythmia or heart block.

What is the common adverse reaction to Sulfonamides, especially with higher doses?

  • Hypersensitivity rash.

What is the rare adverse effect associated with Sulfonamides, especially with the very long acting sulfas, which are no longer available?

  • Stevens-Johnson Syndrome.

Stevens-Johnson syndrome can be fatal. What 3 groups of patients are most commonly affected?

  • Children, teenagers, young adults.

What single word is used frequently to describe the process of pathology that is in Stevens-Johnson syndrome?

  • Inflammation.

What are the 6 major signs of Stevens-Johnson syndrome?

  • Fever, blisters on skin, open sores on mucous membranes, pneumonia, painful joints, weakness.


****END OF TRANSCRIPTION****

 

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