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IPAP 21-2 Soph Semester > ABX > Flashcards

ABX Flashcards

1
Q

What three drugs cover VRE

A

Linezolid, Daptomycin, Colistin

Snoop in the LDC with VRE

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2
Q

What 7 abx groups cover MRSA and MSSA

A

5th gen Cephalosporins, Vancomycin, Daptomycin, TMP/SMX, CLindamycin, Doxycycline

MRSA (I got 5 on it, 5th gen)
VDC-mycin and doxy
TMP/SMX (just know that one)

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3
Q

What 8 drug groups do not cover MSSA

A

Penicillin, Ampicillin, Azteronam, Ciprofloxin, Azithromycin, Gent/Tobra/Amikacin, Colistin, and metronidazole

Peter And A Cat All Got To Amsterdam Chasing Money

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4
Q

What 9 drug groups cover Abdominal anaerobes

A

Ampicillin/ sulbactam, Pipercillin/ tazobactam, 2nd gen Cephalosporins, Ertapenem, Imipenem/Cilastatin, Doripenem, Meropenem, Moxifloxacin, TMP/SMX, Clindamycin, Metronidazole

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5
Q

What 5 drug groups cover Atypical gram negs

A 
Moxifloxacin
Ciprofloxacin
Azithromycin 
Clindamycin 
Doxycycline
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6
Q

What do penicillins cover

A

Many gram postive and some gram neg

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7
Q

What does penicillin cover with an added B-Lactamase inhibitor

A

More gram pos, gram neg, and some pseudomonas

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8
Q

What do 1st gen Cephalosporins cover

A

Gram pos and neg

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9
Q

What is the MOA of beta Lactams

A

MOA: Cell wall synthesis inhibitors

Bactericidal (time dependent)

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10
Q

All beta lactams are renal excretion with an exception for which three

A

Nafcillin
Oxacillin
Dicloxacillin

(Biliary secretion)

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11
Q

What is the ADE of Penicillins

A

cross sensitivity with other B-lactams & c. dif

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12
Q

What is the DOC for PCN sensitive gangrene

A

Penicillin

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13
Q

What is the DOC for syphillis

A

Penicillin G benzathine

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14
Q

What are the 3 penicillins

A

Penicillin G, Penicillin G Benzathine, and Penicillin V

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15
Q

What are the three anti staph PCNs

A

Dicloxacillin
Oxacillin
Nafcillin

D.O.N.

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16
Q

Anti staph penicillins are important because they can cover..

A

MSSA

And do not require renal adjustment (biliary secretion)

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17
Q

What are the 4 aminopenicillins

A

Amoxicillin
Ampicillin
Amoxicillin+Clauvanic Acid (Augmentin)
Ampicillin-sulbactam (Unasyn)

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18
Q

What is amoxicillins drug class and use

A

Amino penicillin (beta lactam) (Oral)

  • 1st line peds OM
  • Endocarditis prophylaxis going for oral, dental or upper resp sx procedures (or clindamycin allergic).
  • UTI to for pregos
  • duodenal ulcer by H.Pylori
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19
Q

What is the role of ampicillin

A

Gram neg coverage beta lactam that -Combined with Aminoglycosides -Clavulanic Acid/Sulbactam/Tazobactam are B-lactamase inhibitors that prevent bacteria from being resistant to B-lactams

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20
Q

What is the role of Amoxicillin- Clauvanic Acid

A

Gram Neg coverage beta lactam
(Augmentin)

Abd. Anaerobes
- Otitis media resistant to amoxicillin

  • DOC animal bite
  • human bites: Early
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21
Q

In OM, if there is resistance to Amoxicillin , what drug combination should be used

A

Augmentin

Amoxicillin+Clauvanic Acid

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22
Q

What is the role of Ampicillin+Sulbactam

A

Gram neg coverage beta lactam
(Unasyn)

Abd. Anaerobes

  • Human bites: Later
  • HAP
  • MSSA
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23
Q

What are the drugs to use in early versus late human bites

A

Early: Amoxicillin-Clavulanic Acid (Augmentin)
Late: Ampicillin-Sulbactam (Unasyn)

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24
Q

What in the Anti Pseudomonal PCN

A

Pipercillin/Tazobactam (Zosyn)

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25
Q

What is the role of Pipercillin/ Tazobactam

A 
Beta lactam 
(often combined with aminoglycoside)
-Tx of *Pseudomonas, 
MSSA, 
Abd. Anaerobes
Severe infx
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26
Q

What are the DDI of Antistaph PCNs

A

Warfarin

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27
Q

Which cephalosporins x the BBB

A

3rd Gen- Ceftriaxone (Rocephin)

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28
Q

What are the 4 1st gen Cephalosporins

A
  1. Cephradine (Velosef)
  2. Cefadroxil (Duricef)
  3. Cephalexin (Kelflex)
  4. Cefazolin (Ancef)

Phrad-Fad-phal-faz

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29
Q

What are 1st Gen Cephalosporins used for

A
  • Sx/wound prophylaxis,

- Abd Sx prophylaxis (+ metronidazole)

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30
Q

What drug should be combined with 1st gen Cephalosporins for Abd surgery prophylaxis

A

Metronidazole

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31
Q

What is the MOA of Cephalosporins

A 
Beta Lactams 
Cell Wall inhibitors 
Bactericidal 
Time Dependent 
Renally secreted 
Preg Cat B
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32
Q

What drug group should be used for OM if the patient is allergic to PCN

A

2nd gen Cephlosporins

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33
Q

What are the 6 2nd Gen Cephalosporins

A
  1. Cefuroxime axetil
  2. Cefuroxime
  3. Cefprozil (Cefzil)
  4. Cefaclor(Ceclor)
  5. Cefoxitin (Mefoxin)
  6. Cefotetan (Cefotan)
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34
Q

Which 2nd gen cephalosporin has anaerobe coverage and is good for pre and post Abd Surgery

A

Cefoxitin and Cefotetan

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35
Q

What are the 7 3rd gen Cephalosporins

A
  1. Ceftriaxone (Rocephin)
  2. Ceftazidime (Fortaz)
  3. Cefotaxime (Claforan)
  4. Cefditoren pivoxil (Spectracef)
  5. Cefixime (Suprax)
  6. Ceftibutin (Cedax)
  7. Cefpodoxime (Vantin)
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36
Q

What is the cephalosporin DOC for meningitis

A

Ceftriaxone (rocephin)

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37
Q

What 3rd Gen Cephalosporin is the DOC for N. Gonorrhea

A

Ceftriaxone (Rocephin)

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38
Q

What is the ADE with 3rd Gen Ceftriaxone

A

Do NOT use on NEONATES,
crystals in lungs
or biliary slugging

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39
Q

What 3rd gen cephalosporin covers pseudomonas

A

Ceftrazidime (FortaZ)

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40
Q

3rd Gen Cephlosporins are mostly good for what three conditions

A

OM
Meningitis
N. Gonorrhea

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41
Q

What is the 4th Gen cephalosporin

A

Cefepime

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42
Q

What is the role of 4th gen cefepime

A
  • Broadest spectrum
  • ICU
  • MSSA
  • Pseudomonas Coverage
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43
Q

What is a cephalosporin that can be used in complicated UTI

A

4th gen Cephalosporin

Cefepime

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44
Q

What is the 5th gen cephalosporin

A

Ceftaroline (Teflaro)

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45
Q

What is 5th gen Ceftraroline good for

A

SSTI
CAP
MRSA/MSSA

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46
Q

Which gen of cephalosporins covers MRSA and MSSA

A

5th Gen

Ceftaroline

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47
Q

What are the combination cephalosporins that can be used to treat psuedmonas
(last line cover eagle)

A

1.Ceftolozane/Tazobactam(Zerbaxa) 2.Ceftazidime/Avibactam(Avycaz)

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48
Q

What are the 4 Carbapenems

A

Dorienem
Imipenem/ Cilastatin
Meropenem
Etrapenem

(DIME)

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49
Q

All 4 Carbapenems are good against pseudomonas except for..

A

Ertapenem

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50
Q

What are Carbapenems used for

A

Very broad- should not be used liberally
MSSA
Pseudomonas (Except Ertapenem)
anaerobic coverage

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51
Q

What is the one Monobactam

A

Aztreonam

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52
Q

What is axtreonam used for

A

Monobactam used for

  • Pseudomonas
  • No gram (+) coverage
  • Can use in PCN/cephalosporin allergic PTs
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53
Q

Aztreonam can be used when a pt is allergic to what other ABX

A

PCN/cephalosporin allergic PTs

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54
Q

If the pt is allergic to ceftazadime what drug can you also not use

A

Aztreonam

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55
Q

What is the risk with taking Imipenam <4g/day

A

SZR

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56
Q

What are the 4 drug groups that fall under beta lactams

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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57
Q

What is the MOA of Glycopeptides and Lipoglycopeptides

A 
MOA: cell wall synthesis inhibitor 
Bactericidal
Time dependent
Renal adjust
Safe for pregnancy (B)
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58
Q

What drug class in Vancomycin

A

Glycopeptides & Lipoglycopeptides

Cell wall synth inhibitor

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59
Q

What is the 1st line DOC for C. Diff

A

Vancomycin

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60
Q

What is the role of Vancomycin

A 
cell wall synthesis inhibitor 
Bactericidal
Time dependent
 Renal adjust
Safe for pregnancy (B)

Gram + only
MRSA/MSSA
1st line C. difficile oral only
100% remains in intestines

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61
Q

Does PO vancomycin need renal adjust?

Does IV?

A

PO no, 100 percent remains in intestines

IV yes, renally secreted

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62
Q

What is the MOA of Cyclic Lipopeptides

A 
MOA: bacterial cell membrane inhibitor
Bactericidal
CONCENTRATION dependent
Renal adjust
Pregnancy: adv events not observed in animal studies
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63
Q

What is the MOA of Daptomycin

A

Cell membrane inhibitor
-cidal, concentration dependent
Renal excreted

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64
Q

What is the role/ use of Daptomycin

A

MRSA/MSSA/VRE (Covers the big three)

Only gram +

USE: Complicated SSTI, MRSA/MSSA
Bacteremia, Endocarditis, Osteomyelitis

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65
Q

Daptomycin can not be used to pulm infx because of what

A

It’s degraded by surfactant

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66
Q

What is Daptomycins ADE

A

ADV: Nephrotoxicity

-Rhabdomyolysis (MUST MONITOR CK)

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67
Q

What drug class does Daptomycin fall under

A

Cyclic Lipopeptide

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68
Q

What is the MOA of polymyxins

A

acts as detergent and damages bacterial cytoplasmic membrane

Bactericidal

Renal adjust

Nephro and Neuro toxic

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69
Q

What drug class does Colistimethate (Colistin) fall under

A

Polymixins

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70
Q

What is Colistimethate (Colistin) used for

A

Only gram –

Pseudomonas

INH (INHALED) for pulmonary infections (pneumonia with Cystic Fibrosis)

Complicated gram – infections

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71
Q

What is the polymixin to use in complicated gram neg infections

A

Colistimethate (Colistin) IV/INH

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72
Q

What is the ADE of Colistimethate (Colistin)

A

nephrotoxicity

neurotoxicity (neuromuscular blockade)

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73
Q

What is the rout of admin for Colistimethate (Colistin)

A

IV and inhaled (Pulm INfx w/ cystic fibrosis)

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74
Q

What is the DOC for a pulm infx with cystic fibrosis

A

Colistimethate (Colistin)

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75
Q

What is Topical Polymixin B used for

A

Gram (-)

USE: ear infections, bladder irrigation, ocular infections

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76
Q

What is the MOA of topical polymixin B

A

MOA: acts as detergent and damages bacterial cytoplasmic membrane
Bactericidal

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77
Q

What is the MOA of bacitracin

A

MOA: Inhibits cell wall synthesis

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78
Q

What is the coverage of bacitracin

A

Gram +

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79
Q

What is the MOA of neomycin

A

Protein synth inhibitor

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80
Q

What is the coverage of neomycin

A

Gram -

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81
Q

What are the three drugs that make up neosporin

A

Polymixin B, Bacitracin, Neomycin

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82
Q

What is the MOA of Tetracyclines and Glycylcyclines

A

MOA: Protein synthesis inhibitor

Bacteriostatic

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83
Q

What are the ADE of Tetracyclines & Glycylcyclines

A

Tissue hyperpigmentation
(major risk in children, irreversible teeth stains)

Photosensitivity

NOT SAFE FOR PREGNANCY!
Breastfeeding (pump and dump)

No children under 8 years old!

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84
Q

What is the 1st line Tetracycline that is used for Tick borne diseases

A

Doxycycline (Vibramycin)

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85
Q

Does Doxy need to be renal adjusted

A

No

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86
Q

What is the MOA of doxy

A

Protein synthesis inhibitor

-static

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87
Q

What is Doxy good for

A

MRSA

Option for Malaria prophylaxis & treatment

Option for chlamydia trachomatis

Resp tract infections (S. Pneumonia)

H.Pylori

SSTI

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88
Q

What are the 3 tetracyclines

A

Doxy
Tetracycline
Minocycline

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89
Q

Does Doxy cover pseudomonas

A

No

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90
Q

What are the ADE of Doxy

A

N/V, Tissue Hyperpigmentation (teeth) , Photosensitivity

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91
Q

What is the one Glycylcyclines

A

Tigecycline (IV)

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92
Q

What does Tigecycline (IV) cover

A

Is a Glycylcyclines (protein synth inhibitor)

  • MRSA (good)
  • VRE
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93
Q

What is Tigecycline (IV) used for

A

-Increases all-cause mortality and should be reserved for cases when other therapies are not suitable.

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94
Q

What is the dose adjustment for the gylcyline: tigecycline

A

-Eliminated hepatically, only adjust in severe hepatic impairment.

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95
Q

What is the MOA for Aminoglycosides

A

MOA: Protein synthesis inhibitors.

Bactericidal

Concentration dependent

Excreted unchanged renally, dose based on creatine clearance.

NOT SAFE FOR PREGNANCY (D)

Not absorbed orally/topically; route is highly relevant to site of infection (IV, INH, Topical)

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96
Q

What are the 5 aminoglycosides

A
  1. Gentamicin
  2. Tobramycin
  3. Amikacin
  4. Streptomycin
  5. Neomycin B

STAN-G

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97
Q

How are aminoglycosides used

A

Mono Therapy rarely used
only for complicated infections with susceptible gram (–) UTI

Combination with cell-wall inhibitors used for severe infections caused by Gram +/- pathogens (no anaerobic coverage)

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98
Q

Do Aminoglycosides have anaerobic coverage

A

No

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99
Q

What is the coverage of Aminoglycosides

A

Gram (– ) more potent

Pseudomonas

Amikacin or streptomycin > Tobramycin or Gentamicin

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100
Q

What is the ADE of Aminoglycosides

A

ADV: Nephrotoxicity (acute but reversible)
And ototoxic
Use in caution with elderly pts (5 days)

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101
Q

Aminoglycosides can be used with what other ABX groups to help cover pseudomonas

A

B-lactams, Vancomycin and Daptomycin

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102
Q

For the test gentamicin only covers

A

Pseudomonas

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103
Q

For the test tobramycin only covers

A

Pseudomonas

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104
Q

For the test Amikacin and Stroptomycin only cover

A

Pseudomonas

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105
Q

What is the MOA of Macrolides and Ketolides

A

MOA: Protein synthesis inhibitors

Bacteriostatic

Both time/concentration dependent

Atypicals

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106
Q

What is the ADE of macrolides and Ketolides

A

ADV: Acute cholestatis, hepatotoxicity

NONE ARE A GOOD CHOICE FOR INFECTIONS THAT REQUIRE BACTERIOCIDIAL ACTIVITY!

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107
Q

If a infx requires -cidal activity can you use Erthymoycin or Azithromycin

A

No they are -static

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108
Q

Macrolides are a good alternative agent for pts allergic to..

A

B-lactams

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109
Q

What are the three macrolides

A

Erythromycin
Azithromycin
Clarithromycin

All end in romycin

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110
Q

What is the ADE of erythromycin

A

causes most GI problems, used as a promotility agent.
Cardiac QT interval prolongation (pharmacy will verify with you if safe)

Acute cholestatis, hepatotoxicity

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111
Q

What is Azithromycin good for

A

Macrolide

Alternative for B-Lactam pts

Chlamydia Infections

Safe for Pregnancy

Low DDI

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112
Q

What is the MOA of Erythromycin, Azithromycin, and Clarithromycin

A

Protein synth inhibitors

-static

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113
Q

What is clarithromycin used for

A

H. Pylori/ GI ulcer

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114
Q

Can clarithromycin be used in pregnancy

A

NO

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115
Q

What are Ketolides good for

A

Have activity against strains resistant to macrolides

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116
Q

What is the one Ketolide

A

Telithromycin

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117
Q

What is the MOA of telithromycin

A

Protein synth inhibitor

-static

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118
Q

What is the MOA of drugs that end in -romycin

A

Macrolides & Ketolides
MOA: Protein synthesis inhibitors
Bacteriostatic
Both time/concentration dependent

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119
Q

What is the MOA of drugs that in the -damycin

A

Lincosamides

MOA: Protein synthesis inhibitor Safe for pregnancy (B)

Does not cross BBB.

No renal adjustment

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120
Q

What is the MOA of clindamycin

A

Lincosamides
MOA: Protein synthesis inhibitor Safe for pregnancy (B)
Does not cross BBB.
No renal adjustment

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121
Q

What ABX has the highest risk of causing C. Diff

A

Clindamycin

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122
Q

What is the ADE that clindamycin causes in HIV pts

A

Rash

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123
Q

What is Clindamycin used for

A

USE: SSTI, MRSA, MSSA, Malaria
anaerobic intra-abdominal infections associated with trauma

ORAL cavity, ACNE, Diabetics, Atypicals, Anearobes

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124
Q

What is the MOA of drugs that end in -pristin

A

Streptogramins

MOA: Conformational change

Bactericidal

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125
Q

What is the MOA of Quinupristin/Dalfopristin

A

Streptogramins

MOA: Conformational change Bactericidal

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126
Q

What is the ADE of Quinupristin/Dalfopristin

A

Hyperbillirubinemia

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127
Q

What is Quinupristin/Dalfopristin good for

A

Good MRSA/MSSA, VRE (the big three)

USE: MDR organisms, endocarditis, bacteremia, SSTI

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128
Q

What is the MOA of oxazolidinones

A

MOA: Protein synthesis inhibitor

Bacteriostatic

Pregnancy (C)

No dose adjustment for renal or hepatic dysfunction

129
Q

What is the MOA of linezolid and tedizolid

A

MOA: Protein synthesis inhibitor

Bacteriostatic

Pregnancy (C)

No dose adjustment for renal or hepatic dysfunction

130
Q

What is Linezolid and tedizolid used for

A

Good MRSA/MSSA, VRE (The big three)

Widely distributed

CANNOT be used for bacteremia

131
Q

Can linezolid be used for bacteremia

132
Q

What is the coverage of linezolid

A

Gram + only

133
Q

What is the MOA of floroquinolones

A

MOA: DNA gyrase inhibitors
Bactericidal
Concentration dependent
Pregnancy C

134
Q

What are the three Fluoroquinolones

A

Cirpofloxacin
Levofloxacin
Moxifloxacin

135
Q

What is the MOA of drugs that end in floxcain

A

MOA: DNA gyrase inhibitors

Bactericidal
Concentration dependent
Pregnancy C

136
Q

What is the DOC for anthrax

A

Ciprofloxacin

137
Q

What is Ciprofloxacin good for

A
  • Pseudomonas &
  • UTI
  • DOC for anthrax
138
Q

What is levofloxacin good for

A
  • Better Pseudomonas coverage than ciprofloxacin
  • S. pneumonia (CAP)
  • UTI
139
Q

What is Moxifloxacin good for

A

Anaerobic coverage
S. Pneumonia
CAP

140
Q

Oral absorption of Ciprofloxacin, levofloxacin, and Moxifloxacin are all reduced by

141
Q

What is the ADE of fluroquinolones

A

ADV: CNS elderly/critically ill cause hallucinations, delirium, seizures Muscular skeletal, tendon rupture (Achilles most common, athletes beware) QT prolongation

Not recommended for CNS or bone

142
Q

Which fluoroquinolones should be used for UTI/ GU

A

Ciprofloxacin and levofloxacin

143
Q

Which fluoroquinalones should be used for Resp infx

A

Levofloxacin and Moxifloxacin

144
Q

When dealing with athletes/ runners what precautions should be used with fluoroquinolones

A

Runner: 10% increase in load after use per week (5 weeks)
Athletes: 2-4 weeks off of sports

Tendon ruptures

145
Q

What is the MOA of Sulfonamides

A

MOA: Folate synthesis inhibitor

Bacteriostatic

Time dependent

Adjust for renal

Not safe for pregnancy (D)
Pump and dump for breastfeeding

NO to G6PD!

146
Q

What are the three Sulfonamides

A
  1. Sulfamethoxazole/Trimethoprim (SMX/TMP) (Bactrim)
  2. Sulfadoxine & Pyrimethamine
    3 Pyrimethamine(anti-malarial)
147
Q

What is Sulfamethoxazole/Trimethoprim

(SMX/TMP) (Bactrim) good for

A

Sulfonamide

MRSA/MSSA

Resp infections

Opportunistic infections TX or prophylaxis

148
Q

What are SMX/TMP (Sulfonamides), Sulfadoxine & Pyrimethamine all good for

A

Cross BBB

Contraindicated <2mos

MRSA/MSSA

Use in Malaria 
UTI/GU 
OM
RTI 
SSTI
149
Q

If a pt has G6PD def.

what drugs can not be used

A 
Sulfonamides 
Nitrofurantoin 
Dapsone 
Primaquine 
Quinidine
150
Q

What is the ADE of Sulfonamides

SMX/TMP

A

ADV: Cross reactivity with sulfonamide moiety. Renal, crystalurea is possible, drink lots of water.

Contraindicated <2mos

Not safe for pregnancy (D)/Pump and dump for breastfeeding

NO to G6PD!

151
Q

What is the MOA of Nitroimidazoles

A

MOA: Protein synthesis inhibitor

152
Q

What is the DOC for Trichamonas vaginalis

A

Metronidazole (Flagyl) & Tinidazole (Tindamax)

153
Q

What is the DOC for giardiasis

A

Metronidazole (Flagyl) & Tinidazole (Tindamax)

154
Q

Vancomycin is the 1st line for C. Diff, was is a good alternative

A

Metronidazole (Flagyl) & Tinidazole (Tindamax)

155
Q

Pts taking Metronidazole (Flagyl) & Tinidazole (Tindamax) shroud avoid what due to the disulfiram reaction

156
Q

What is Metronidazole (Flagyl) & Tinidazole (Tindamax) good for

A

DOC Trichomonas vaginalis and giardiasis

Good, C. diff alternative (Vancomycin 1st choice)

Moderate, H. pylori (TX in combo PPI/acid suppressant and Metronidazole)

157
Q

What is the DDI interaction for Metronidazole (Flagyl) & Tinidazole (Tindamax)

158
Q

What is the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)

A

Metallic taste

159
Q

What is the 2nd line agent to treat C.diff

A
  1. Fidaxomicin (Dificid)
160
Q

What is the MOA for Fidaxomicin (Dificid)

A

MOA: inhibit protein synthesis

161
Q

If a pt is allergic to macrolides (Clindamycin and Azithromycin) what other drug can they not take

A

Fidaxomicin (Dificid)

162
Q

What is the DOC in impetigo

A

Mupirocin (Bactroban)

163
Q

What is the coverage for Mupirocin (Bactroban)

A

MRSA/ MSAA

164
Q

What is the MOA of Mupirocin (Bactroban)

A

MOA: inhibit protein synthesis

165
Q

What is Mupirocin (Bactroban) good for

A

DOC for impetigo

Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks

166
Q

What are the three specific UTI agents

A
  1. Nitrofurantoin
  2. Fosfomycin
  3. Methenamine
  4. Phenazopyridine (Pyridium)
167
Q

What is the drug that is used for the Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks

168
Q

Of the UTI Agents, which is for prophylaxis only

A

Fosfomycin

169
Q

What is the use of Nitrofurantoin

A

Uncomplicated UTI Tx

170
Q

What is the MOO of Nitrofurantoin

A

Protein Synth Inhibitor

171
Q

What is the ADV and Preg Cat for Nitrofurantoin

A

ADV: NO G6PD! Discolors urine brown

Safe for pregnancy (B)

172
Q

For UTI, how is Methanamine used

A

Prophylaxis/suppression (recurring on elderly)

173
Q

What are the ADE of Methanamine

A

ADV: crystalurea, painful urination

174
Q

What is the preg cat for Methanamine

175
Q

For UTI, how is phenzaopyridine used

A

An analgesic only product that discolored the urine orange, can be used for 3 days

176
Q

What are the 5 prophylaxis malaria ABXs

A 
Doxycycline 
Chloroquine 
Atovapuone-proguanil 
Melfoquine 
Primaquine

D-CAMP

177
Q

What is the use of chloroquine

A

Not really used
1-2 was before
4 weeks after

Use: areas without resistant P. falciparum

178
Q

What is the use of Atovoquone-proguanil

A

1-2 days before
1 week after

Use: areas with chloroquine resistant P. falciparum
FOLATE INHIBITOR
Thx and prophylaxis of Uncomplicated Malaria

179
Q

What is the MOA of atovaqoune-proguanil

A

Atovaqoune: interfere with electron transport in the parasitic mitochondria

Proguanil: selective inhibition of plasmodial dihydrofolate reductase; key enzyme for synthesis of folate.

180
Q

What is the advantage of atovaqoune-proguanil

A

requires shorter periods of treatment before and after travel.
1,2 days before, 1 week after travel

181
Q

What is the food instructions for atovaqoune- proguanil

A

Take with food/ milk to enhance absorption

182
Q

What are the ADE of atovaqoune-proguanil

A

ADV: avoid in renal impairment PT (creatinine <30mL/min).
Not safe for pregnant or breastfeeding women <11kg babies.
May not prefer due to daily medication intake.

183
Q

What is the time and location use of Melfoquine

A

Use: areas with chloroquine resistant P. falciparum

2 weeks before
4 weeks after travel

184
Q

Which ABX should be used in areas without P. Falciparum resistance

A

Chloroquine

185
Q

Which ABX should be used in areas with chloroquine resistant P. falciparum

A

Melfoquine Or Atovaqoune-proguanil

186
Q

What is the DOC for malaria prophylaxis

A

Doxycycline

187
Q

What ABX should be used in areas with MDR P. falciparum

A

Doxycycline

188
Q

What are the restrictions and advantages of using doxycycline for malaria

A

DOC for chemoprophylaxis

No <8 y/o, or pregnant.

Prevents additional infections for hike, camp, swim in freshwater.

189
Q

What is the use a length of Primaquine for Malaria

A

Use: Terminal prophylaxis of P.vivax & ovale infections.
Alternate for primary prevention.

Daily for 7 days post travel

190
Q

Which malaria drugs work on the blood stage

A

Chloroquine
Atovaqoune-proguanil
Melfoquine
Doxycycline

D-CAM no P

191
Q

Which malaria drugs work on the Liver Stage

A

Atovaqoune-proguanil
Primaquine

PA

192
Q

Which Malaria dug works on both the liver and blood stage

A

Atovaqoune- proguanil

193
Q

For Tx malaria, what is the DOC for pregnant women

A

Melfoquine

194
Q

What are the ADV for Melfoquine

A

-ADV: No psych patients.
Psych disturbances, vivid dreams, mood swings ect.

Drug label states neuro side effects could be permanent.

No patients under 6mos.

No to PTs with cardiac conduction abnormalities.m QTC elongation

195
Q

Which Malaria ABX has the advantage of only requiring weekly dosing

A

Mefloquine

196
Q

When using Primaquine for malaria it must be combined with one of two other drugs..

A

Chloroquine or Hydroxychloroquine

197
Q

What is the only malaria ABX that prevents relapse of P. Vivas and P. Ovale strains

A

Primaquine

Primaquine Prevents Relapse

198
Q

What drug that is used for the chemoprophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS, is also used to treat Malaria

A

Primaquine

199
Q

What are the 6 Quinolones

A 
Chloroquine 
Mefloquine 
Primaquine 
Quinidine
Quinine
Hydroxycholoquine
200
Q

What are the 2 folate synth inhibitor ABX

A

Atovaqoune-proguanil

Pyrimethamine & Sulfadiazine

201
Q

What is the MOA and ADE of Pyrimethamine & Sulfadiazine

A

Folate Inhibitor

ADE: Mouth Ulcers and Alopecia

202
Q

What are the two Tx uses of Pyrimethamine & Sulfadiazine

A

Malaria Tx and Toxoplasma Gondi

203
Q

Which ABX is good for last minute travelers for the prophylaxis of Malaria

A

Atovaquone- Proguanil

204
Q

What are the wanrnings and ADE for Atovaqoune-proguanil

A

Should be taken with food or milk to enhance absorption

Advantage: requires shorter periods of treatment before and after travel. 1,2 days before, 1 week after travel.

ADV: avoid in renal impairment PT (creatinine <30mL/min).
Not safe for pregnant or breastfeeding women <11kg babies.
May not prefer due to daily medication intake.

205
Q

What is the DOC for trichomoniasis vaginalis

A

Metronidazole (Flagyl) & Tinidazole (Tindamax)

DAZOLE

206
Q

What is the MOA of Metronidazole (Flagyl) & Tinidazole (Tindamax)

A

Protein synth inhibitor

207
Q

Vancomycin is the 1st choice to for C. Diff,

What is an alternative to this 1st choice drug for C. Diff

A

Metronidazole (Flagyl) & Tinidazole (Tindamax)

208
Q

IF combined with a PPI, Metronidazole (Flagyl) & Tinidazole (Tindamax) can be used to treat what stomach infections

209
Q

What are the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)

A

ADV: metallic taste

Drug interaction: Inhibit Warfarin

AVOID ALCOHOL, due to disulfiram reaction

210
Q

What drug is used for the prophylaxis of Toxoplasmosis Gondi

A

Sulfamethoxazole- Trimethoprim (Septra)

211
Q

What drugs are used for the Tx of Toxoplasmosis Gondi

A

Pyrimethanine + (clindamycin or sulfamyicn)

212
Q

Metronidazole (Flagyl) & Tinidazole (Tindamax) is the DOC for Trichamonasis vaginalis, but can also be used to treat what other conditions

A

TX for symptomatic

  • Invasive intestinal amebiasis
  • Invasive extraintestinal amebiasis
213
Q

What is the ABX to use with Intestinal protozoans

A

Metronidazole or Tinidazole

Covers abd anaerobes

214
Q

What are the two ABX used on Pinworms

A

Albendazole

Pyrantel Pamoate

215
Q

What is the MOA of Albendazole

A

Disruption of growth and division of pinworms

216
Q

What is the use of Albendazole

A

Preferred Tx for pinworms

217
Q

What are the ADE and warnings with Albendazole

A

ADV: drug-induced killing of parasite release antigens that can cause allergic reactions.

Not safe for pregnancy or breastfeeding.

Not safe for <2 y/o

Must treat the whole family!

218
Q

What is the MOA of pyrantel pamoate

A

MOA: depolarizing NMB, paralysis in worm.

OTC product, not safe for <2 y/o.

219
Q

What are the 3 drugs to use for lice

A

Permethrin and Pyrethrins

Malathion

Benzyl Alcohol Lotion

220
Q

What is the 1st line agent in the Tx of live

A

Permethrin and Pyrethrins

221
Q

What is the MOA of Permethrin and Pyrethrins

A

Neurotoxic agents to lice

222
Q

What are the age restrictions for Permethrin and Pyrethrins

A

permethrin, 2mos<

Pyrethrins, 2y/o

223
Q

What is the MOA and use for Malathion

A

Neurotoxic agent for lice

MOA: Neurotoxic

  • High ovicidal activity
  • Single application adequate
224
Q

Is Permethrin and Pyrethrins single or multiuse?

225
Q

Is malathion single or multi use ?

A

Single use adequate

226
Q

What is the ADE of malathion

A

HIGHLY FLAMMABLE

Not to use around smokers or open flames

227
Q

What is the MOA and use of Benzyl Alcohol Lotion

A

MOA: occlusive-(suffocates lice) based therapy

  • Reapply in 1 wk
  • Can be used as young as 6mos of age.
228
Q

Of the lice tx, which is single use, which is multiuse and which has to be reapplied in 1 wk

A

Permethrin- multi use
Malathion- single use
Benzyl Alcohol- reapply in 1 wk

229
Q

What are the 3 antivirals used for Influenza

A
  1. Oseltamivir (Tamiflu)
  2. Zanamivir (Relenza)
  3. Peramivir (IV)

(OPZ)

230
Q

What is the MOA of antivirals used to treat influenza

A

MOA: inhibits viral neuraminidase, prevent the release of new virus from host cell.

Influenza A & B.

231
Q

What is the length of treatment for Oseltamivir (Tamiflu)

232
Q

What are the age and time requirements to use Oseltamivir (Tamiflu) for Influenza

A

5-day TX

TX: >2wk old.

No symptoms no longer than 48 hrs

Prophylaxis: >3 mos old

Oral preferred for pregnant women

233
Q

What is the tax length for Zanamivir for influenza

234
Q

What are the tax lengths and age restrictions for zanamivir in the tax of influenza

A

5-day TX

TX: 7y/o<
Prophylaxis: 5 y/o

235
Q

What are the ADE of Zanamivir (Relenza)

A

Not for athsma, COPD, or resp problems

Can cause orphayngeal and facial edema

236
Q

What are the tx lengths and age restrictions when using Peramivir (IV) for tx of influenza

A

1 day TX (uncomplicated)

TX: 18y/o<

Not for Prophylaxis

237
Q

What are the 2 VZV (Herpes/ Shingles) vaccines

A
  1. Zostavax: Herpes zoster vaccine

2. Varivax: Varicella zoster vaccine

238
Q

What is the time frame to start Shingles/ Herpes Zoster tx

A

C/in 72 hrs

239
Q

What are the 3 drugs to use for Genital HSV

A

Valacyclovir
Famciclovir
Acyclovir

F.A.V.

240
Q

What is the MOA of Antivirals used to treat HSV

A

MOA: elongating viral DNA, and halt viral replication.

Good, HSV 1 & 2.

Moderate, VZV

  • Suppressive therapy for recurrent genital herpes
  • HIV, recommended regimen for episodic infection
  • HIV, daily suppressive therapy

take ASAP if suspecting a breakout

241
Q

What are the three drugs to use for HIV

A
  1. Tenofovir DF (TDF)
  2. Tenofovir alafenamide (TAF)
  3. Emtricitabine
242
Q

What is the MOA of

  1. Tenofovir DF (TDF)
  2. Tenofovir alafenamide (TAF)
  3. Emtricitabine
A

HIV tx/ prophylaxis

NucleoSIDE/TIDE Reverse Transcriptase inhibitors

243
Q

How long can HIV live in an unused needle?

244
Q

What is the ADE of:

  1. Tenofovir DF (TDF)
  2. Tenofovir alafenamide (TAF)
  3. Emtricitabine
A

Used for HIV

ADV: hyperpigmentation of the palms or soles

245
Q

What is the combination of HIV drugs used for POST Prophylaxis tax of HIV

A

Truvada: Tenofovir + Emtricitabine

246
Q

What is the USE and MOA of

  1. Dolutegravir (DTG)
  2. Raltegravir (RAL)
A

MOA: Integrase inhibitor Initial treatment for naïve PTs

247
Q

What is the recommended therapy for post needle stick HIV exposure

A
  1. Truvada QDAY
  2. Dolutegravir BID
    * PRE-Exposure Prophylt

START within 72hr!

Take on empty stomach. Ca, Mg, Fe decrease effectiveness.

248
Q

What are the HIV drugs used for pre exposure prophylaxis of HIV

A

Tenofovir DF + Emtricitabine (Truvada)

249
Q

What are the 4 first line agents for TB

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

RIPE

250
Q

What is the MOA of rifampin

A

MOA: Inhibits RNA synthesis by targeting RNA polymerase

251
Q

What is the MOA of isoniazid

A

MOA: interferes with enzymes responsible for assembly of mycolic acids, essential for mycobacterial cell walls.

252
Q

What is the MOA of ethambutol

A

MOA: Inhibits an enzyme essential for cell wall synthesis of mycobacterium.

253
Q

What is the DOC for TB

254
Q

What is the DOC for latent TB

255
Q

What effect does adding pyrazinamide to TB tx have

A

By adding this we reduce TX from 9mos to 6mos.

256
Q

When would we use Ethambutol in TB tx

A
  • Provides additional coverage if the isolate proves to be resistant to INH, rifampin, or both.
  • May d/c if known to be susceptible to INH & RIF, after 2 mos or once susceptibility is found know.
257
Q

What is the ADE of Rifampin

A

ADV: Orange-red secretions (urine, tears, feces ect.).

Can stain contact lenses.

POTENT CYP 450 inducers.

Hepatitis leading to liver failure.

258
Q

What is the DDI of isoniazid

A

Drug Interaction: Inhibitor of CYP 3A4.

Metabolized in liver

259
Q

What is the ADE of isoniazid

A

ADV: peripheral neuropathy, due to excretion of pyridoxine (B6).

MUST GIVE PYRIDOXINE WITH INH!

Hepatotoxic.

NO G6PD PT!

260
Q

What are the ADE of ethambutol

A

ADV: Optic Neuritis, red-green color blindness.

261
Q

In Tx Tb what group of people can you not use Ethambutol on

A

Contraindicated on red-green color blind,

<5y/o

262
Q

What are the 5 second line agents for TB

A 
Rifabutin 
Rifapentine 
Streptomycin 
Fluoroquinolones 
Kanamycin/ Amikacin

RRFSK

263
Q

What is the active TB ABX regiment/ plan

A

RIPE for 2 months
(RIF, ISO, PZA, EMB)

Then
IR for 4 months
(ISO, RIF)

264
Q

In treating Active TB, what drug should be substituted inplace of Rifampin if the pt has HIV

265
Q

What is the drug that has to be added when treating pregnant women with active TB

A

-Treating pregnancy, when DZ is moderate to high.

Treat with INH, RIF, EMB for 9 months.
(DONT USE Pyrazinamide)

Add Pyridoxine (Vitamin B6), because of INH.

-Safe for breastfeeding women

266
Q

What is the DOC combination when to Latent TB

A

Isoniazid
+
Pyridoxine (B6)

X9months

267
Q

What are the age ranges and restrictions on treating latent TB with Isoniazid and Pyrdoxine

A 
Preferred TX for
-HIV PTs
-Children <2 y/o
-Pregnant women
(Qday or twice weekly)
268
Q

What is the Tx combination for Latent Tb in children older than 2 years old

A

Isoniazid
Rifapentine
+
Pyridoxine (B6)

X3 months
Not recommended for pregnant women

269
Q

What is the DOC for Mycobacterium Avium Complex

270
Q

What is the MOA of Rifabutin

A

MOA: Inhibits RNA synthesis by targeting RNA polymerase

Derivative of Rifampin, less potent induction of CYP450 enzyme system.

271
Q

Rifabutin is the DOC for MAC, what are its ADE

A

ADV: uveitis, skin hyperpigmentation, neutropenia

272
Q

If a TB patient has HIV what drug should be substituted for rifampin

273
Q

What is the MOA of Rifapentine

A

MOA: Inhibits RNA synthesis by targeting RNA polymerase

274
Q

What is the dosing of Rifapentine

A

Analog of rifampin.

Longer half life than Rifampin & Rifabutin, permits weekly dosing.

275
Q

What is the ADE of Rifapentine

A

ADV: POTENT CYP 450 inducers.

276
Q

What are the 4 rifamycins

A

Rifampin, Rifabutin, Rifapentine, Rifamixin

277
Q

Outside of TB tx when would you used rifamycins

A

USE: Endocarditis of a prosthetic valve!

278
Q

What is the MOA of all Fungal Agents

A

Cell Membrane Inhibitors

279
Q

What are the 2 imidazoles

A

Ketoconazole
Clotrimazole
Micanazole

280
Q

What is the DOC of tinea versicolor

A

Ketoconazole (topical only)

281
Q

What is the use of topical and oral clotrimazole

A

Topical: cutaneous or vaginal candidiasis

Oral: oropharyngeal/esophageal candidiasis

282
Q

When treating Influenza, Oseltamivir has what ADE in the Jap population

A

Sporadic neuro events

283
Q

What are the 3 Triazoles

A

Fluconazole
Voriconazole
Posaconazole

(CONAZOLE)

284
Q

What is the DOC for fungal infections, including invasive and noninvasive candidiasis.

A

Fluconazole (diflucan)

285
Q

What is the DOC for Vulvovaginitis Candidiasis (oral)

A

Fluconazole

286
Q

How is Fluconazole used as a prophylaxis agent

A

Prophylaxis against invasive fungal infections in immunocompromised (ex. HIV pts for thrush) and organ transplant.

287
Q

What is the DDI of Fluconazole

A

Least effect on human CYP450 enzymes of all azoles. Warfarin interaction.

288
Q

What is the DOC in invasive pulmonary or extra pulmonary infections caused by Candida Spp.

A

Voriconazole

289
Q

What is the DOC aspergillus infections

A

Voriconazole

290
Q

What are the ADE and Warnings associated with voriconazole

A

Take without food.

ADV: high trough concentrations associated with transient visual disturbances.

Auditory hallucination.

Hepatotoxic.

291
Q

When would you use Posacanazole when treating a fungal infections

A

Immuno comp pts

292
Q

What is the DDI of posaconazole

A

Avoid PPI and H2 blockers

293
Q

What are the 3 allylamines

A

Terbinafine
Butenafine
Naftifine

Ally-BNT

294
Q

What is the DOC for onchymycosis

A

Terbinafine (oral)

295
Q

What is the ADE of Terbinafine

( DOC on onychomycosis)

A

ADV: avoid in pregnancy and do not breast feed (oral)
Monitor LFT!

Taste disturbance

296
Q

What are the 2 polyenes

A

Amphotericin B systemic (lipid formula)

Nystatin

297
Q

What is the DOC for Invasive fungal infx

A

Amphotericin B systemic (lipid formula)

298
Q

What is the anti fungal used Prophylactically for bone marrow transplant.

A

Amphotericin B systemic (lipid formula)

299
Q

Amphotericin B systemic (lipid formula) can be used empirically to tx what?

A

Empirically for prolonged neutropenia

CA or immunocompromised PT

300
Q

What is the ADE of Amphoterecin B

A

Nephrotoxic

301
Q

What is Nystatin used for

A

Oropharyngeal/esophageal
-Oral candidiasis (thrush).

Swish & swallow.

302
Q

What drug/ anti fungal agent is used on Topical- axillae, groin, gluteal folds, diaper rash.

303
Q

What Anitfungal can be used in Pt w/ liver problems than cant take oral meds

A

Ciclopirox: Nail lacquer

304
Q

What is the DOC Pneumocystis Jiroveci pneumonia (PCP) in AIDS PTs.

A

Sulfamethoxazole- Trimethoprim (Septra)

305
Q

What is the oral DOC for Vulvovaginal Candidiasis (VVC)

A

DOC Oral Fluconazole

306
Q

What are the two Indra-vaginal azoles that can be used for Vulvovaginal candidiasis

A
  1. Clotrimazole

2. Miconazole

307
Q

If a pt is pregnant with VVC what is the DOC

A

Pregnancy- Imidazole (topical) 7 days.

308
Q

What is the Tx length for complicated VVC

A

TX 10-14 days.

309
Q

What is the extended spectrum B- lactamase resistant organisms
(SPACE)

A 
Serratia
Pseudomonas aeruginosa
Acinetobacter
Citrobacter
Enterobacter
310
Q

Which two ABX cause Nephrotoxicity

A

aminoglycosides and vancomycin

311
Q

What three ABX cause Photosensitivity

A

quinolones, tetracyclines, sulfonamides

312
Q

What are the ABX that are Cell WAll Synth Inhibitors

A 
B- Lactams 
Carbapenems 
Monobactams 
PCN 
Bacitracin 
Fosfomycin 
Vancomycin
313
Q

What is the only ABXs that is a DNA gyrase Inhibitor

A

Fluoroquinolones

314
Q

What are the ABXs that are Protein Synth Inhibitors

A 
Aminoglycosides 
Chloramphenicol 
Clindamycin 
Macrolides 
Mupirocin
Streptogramins 
Tetracyclines
315
Q

What are the 5 drugs that are cell membrane inhibitors

A 
Amphotericin 
Ketoconazole 
Polymixin 
Colistimethate 
Daptomycin
316
Q

What ABX are RNA polymerase inhibitors

317
Q

What ABX are Folate synth inhibitor

A

Sulfonamides

Trimethoprim

318
Q

What is the only ABX currently approved for the TX of early or late syphilis ?

A

PCN G Benzathine

IPAP 21-2 Soph Semester (20 decks)

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