ABX Flashcards
What three drugs cover VRE
Linezolid, Daptomycin, Colistin
Snoop in the LDC with VRE
What 7 abx groups cover MRSA and MSSA
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)
What 8 drug groups do not cover MSSA
Penicillin, Ampicillin, Azteronam, Ciprofloxin, Azithromycin, Gent/Tobra/Amikacin, Colistin, and metronidazole
Peter And A Cat All Got To Amsterdam Chasing Money
What 9 drug groups cover Abdominal anaerobes
Ampicillin/ sulbactam, Pipercillin/ tazobactam, 2nd gen Cephalosporins, Ertapenem, Imipenem/Cilastatin, Doripenem, Meropenem, Moxifloxacin, TMP/SMX, Clindamycin, Metronidazole
What 5 drug groups cover Atypical gram negs
Moxifloxacin Ciprofloxacin Azithromycin Clindamycin Doxycycline
What do penicillins cover
Many gram postive and some gram neg
What does penicillin cover with an added B-Lactamase inhibitor
More gram pos, gram neg, and some pseudomonas
What do 1st gen Cephalosporins cover
Gram pos and neg
What is the MOA of beta Lactams
MOA: Cell wall synthesis inhibitors
Bactericidal (time dependent)
All beta lactams are renal excretion with an exception for which three
Nafcillin
Oxacillin
Dicloxacillin
(Biliary secretion)
What is the ADE of Penicillins
cross sensitivity with other B-lactams & c. dif
What is the DOC for PCN sensitive gangrene
Penicillin
What is the DOC for syphillis
Penicillin G benzathine
What are the 3 penicillins
Penicillin G, Penicillin G Benzathine, and Penicillin V
What are the three anti staph PCNs
Dicloxacillin
Oxacillin
Nafcillin
D.O.N.
Anti staph penicillins are important because they can cover..
MSSA
And do not require renal adjustment (biliary secretion)
What are the 4 aminopenicillins
Amoxicillin
Ampicillin
Amoxicillin+Clauvanic Acid (Augmentin)
Ampicillin-sulbactam (Unasyn)
What is amoxicillins drug class and use
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
What is the role of ampicillin
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
What is the role of Amoxicillin- Clauvanic Acid
Gram Neg coverage beta lactam
(Augmentin)
Abd. Anaerobes
- Otitis media resistant to amoxicillin
- DOC animal bite
- human bites: Early
In OM, if there is resistance to Amoxicillin , what drug combination should be used
Augmentin
Amoxicillin+Clauvanic Acid
What is the role of Ampicillin+Sulbactam
Gram neg coverage beta lactam
(Unasyn)
Abd. Anaerobes
- Human bites: Later
- HAP
- MSSA
What are the drugs to use in early versus late human bites
Early: Amoxicillin-Clavulanic Acid (Augmentin)
Late: Ampicillin-Sulbactam (Unasyn)
What in the Anti Pseudomonal PCN
Pipercillin/Tazobactam (Zosyn)
What is the role of Pipercillin/ Tazobactam
Beta lactam (often combined with aminoglycoside) -Tx of *Pseudomonas, MSSA, Abd. Anaerobes Severe infx
What are the DDI of Antistaph PCNs
Warfarin
Which cephalosporins x the BBB
3rd Gen- Ceftriaxone (Rocephin)
What are the 4 1st gen Cephalosporins
- Cephradine (Velosef)
- Cefadroxil (Duricef)
- Cephalexin (Kelflex)
- Cefazolin (Ancef)
Phrad-Fad-phal-faz
What are 1st Gen Cephalosporins used for
- Sx/wound prophylaxis,
- Abd Sx prophylaxis (+ metronidazole)
What drug should be combined with 1st gen Cephalosporins for Abd surgery prophylaxis
Metronidazole
What is the MOA of Cephalosporins
Beta Lactams Cell Wall inhibitors Bactericidal Time Dependent Renally secreted Preg Cat B
What drug group should be used for OM if the patient is allergic to PCN
2nd gen Cephlosporins
What are the 6 2nd Gen Cephalosporins
- Cefuroxime axetil
- Cefuroxime
- Cefprozil (Cefzil)
- Cefaclor(Ceclor)
- Cefoxitin (Mefoxin)
- Cefotetan (Cefotan)
Which 2nd gen cephalosporin has anaerobe coverage and is good for pre and post Abd Surgery
Cefoxitin and Cefotetan
What are the 7 3rd gen Cephalosporins
- Ceftriaxone (Rocephin)
- Ceftazidime (Fortaz)
- Cefotaxime (Claforan)
- Cefditoren pivoxil (Spectracef)
- Cefixime (Suprax)
- Ceftibutin (Cedax)
- Cefpodoxime (Vantin)
What is the cephalosporin DOC for meningitis
Ceftriaxone (rocephin)
What 3rd Gen Cephalosporin is the DOC for N. Gonorrhea
Ceftriaxone (Rocephin)
What is the ADE with 3rd Gen Ceftriaxone
Do NOT use on NEONATES,
crystals in lungs
or biliary slugging
What 3rd gen cephalosporin covers pseudomonas
Ceftrazidime (FortaZ)
3rd Gen Cephlosporins are mostly good for what three conditions
OM
Meningitis
N. Gonorrhea
What is the 4th Gen cephalosporin
Cefepime
What is the role of 4th gen cefepime
- Broadest spectrum
- ICU
- MSSA
- Pseudomonas Coverage
What is a cephalosporin that can be used in complicated UTI
4th gen Cephalosporin
Cefepime
What is the 5th gen cephalosporin
Ceftaroline (Teflaro)
What is 5th gen Ceftraroline good for
SSTI
CAP
MRSA/MSSA
Which gen of cephalosporins covers MRSA and MSSA
5th Gen
Ceftaroline
What are the combination cephalosporins that can be used to treat psuedmonas
(last line cover eagle)
1.Ceftolozane/Tazobactam(Zerbaxa) 2.Ceftazidime/Avibactam(Avycaz)
What are the 4 Carbapenems
Dorienem
Imipenem/ Cilastatin
Meropenem
Etrapenem
(DIME)
All 4 Carbapenems are good against pseudomonas except for..
Ertapenem
What are Carbapenems used for
Very broad- should not be used liberally
MSSA
Pseudomonas (Except Ertapenem)
anaerobic coverage
What is the one Monobactam
Aztreonam
What is axtreonam used for
Monobactam used for
- Pseudomonas
- No gram (+) coverage
- Can use in PCN/cephalosporin allergic PTs
Aztreonam can be used when a pt is allergic to what other ABX
PCN/cephalosporin allergic PTs
If the pt is allergic to ceftazadime what drug can you also not use
Aztreonam
What is the risk with taking Imipenam <4g/day
SZR
What are the 4 drug groups that fall under beta lactams
Penicillins
Cephalosporins
Carbapenems
Monobactams
What is the MOA of Glycopeptides and Lipoglycopeptides
MOA: cell wall synthesis inhibitor Bactericidal Time dependent Renal adjust Safe for pregnancy (B)
What drug class in Vancomycin
Glycopeptides & Lipoglycopeptides
Cell wall synth inhibitor
What is the 1st line DOC for C. Diff
Vancomycin
What is the role of Vancomycin
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
Does PO vancomycin need renal adjust?
Does IV?
PO no, 100 percent remains in intestines
IV yes, renally secreted
What is the MOA of Cyclic Lipopeptides
MOA: bacterial cell membrane inhibitor Bactericidal CONCENTRATION dependent Renal adjust Pregnancy: adv events not observed in animal studies
What is the MOA of Daptomycin
Cell membrane inhibitor
-cidal, concentration dependent
Renal excreted
What is the role/ use of Daptomycin
MRSA/MSSA/VRE (Covers the big three)
Only gram +
USE: Complicated SSTI, MRSA/MSSA
Bacteremia, Endocarditis, Osteomyelitis
Daptomycin can not be used to pulm infx because of what
It’s degraded by surfactant
What is Daptomycins ADE
ADV: Nephrotoxicity
-Rhabdomyolysis (MUST MONITOR CK)
What drug class does Daptomycin fall under
Cyclic Lipopeptide
What is the MOA of polymyxins
acts as detergent and damages bacterial cytoplasmic membrane
Bactericidal
Renal adjust
Nephro and Neuro toxic
What drug class does Colistimethate (Colistin) fall under
Polymixins
What is Colistimethate (Colistin) used for
Only gram –
Pseudomonas
INH (INHALED) for pulmonary infections (pneumonia with Cystic Fibrosis)
Complicated gram – infections
What is the polymixin to use in complicated gram neg infections
Colistimethate (Colistin) IV/INH
What is the ADE of Colistimethate (Colistin)
nephrotoxicity
neurotoxicity (neuromuscular blockade)
What is the rout of admin for Colistimethate (Colistin)
IV and inhaled (Pulm INfx w/ cystic fibrosis)
What is the DOC for a pulm infx with cystic fibrosis
Colistimethate (Colistin)
What is Topical Polymixin B used for
Gram (-)
USE: ear infections, bladder irrigation, ocular infections
What is the MOA of topical polymixin B
MOA: acts as detergent and damages bacterial cytoplasmic membrane
Bactericidal
What is the MOA of bacitracin
MOA: Inhibits cell wall synthesis
What is the coverage of bacitracin
Gram +
What is the MOA of neomycin
Protein synth inhibitor
What is the coverage of neomycin
Gram -
What are the three drugs that make up neosporin
Polymixin B, Bacitracin, Neomycin
What is the MOA of Tetracyclines and Glycylcyclines
MOA: Protein synthesis inhibitor
Bacteriostatic
What are the ADE of Tetracyclines & Glycylcyclines
Tissue hyperpigmentation
(major risk in children, irreversible teeth stains)
Photosensitivity
NOT SAFE FOR PREGNANCY!
Breastfeeding (pump and dump)
No children under 8 years old!
What is the 1st line Tetracycline that is used for Tick borne diseases
Doxycycline (Vibramycin)
Does Doxy need to be renal adjusted
No
What is the MOA of doxy
Protein synthesis inhibitor
-static
What is Doxy good for
MRSA
Option for Malaria prophylaxis & treatment
Option for chlamydia trachomatis
Resp tract infections (S. Pneumonia)
H.Pylori
SSTI
What are the 3 tetracyclines
Doxy
Tetracycline
Minocycline
Does Doxy cover pseudomonas
No
What are the ADE of Doxy
N/V, Tissue Hyperpigmentation (teeth) , Photosensitivity
What is the one Glycylcyclines
Tigecycline (IV)
What does Tigecycline (IV) cover
Is a Glycylcyclines (protein synth inhibitor)
- MRSA (good)
- VRE
What is Tigecycline (IV) used for
-Increases all-cause mortality and should be reserved for cases when other therapies are not suitable.
What is the dose adjustment for the gylcyline: tigecycline
-Eliminated hepatically, only adjust in severe hepatic impairment.
What is the MOA for Aminoglycosides
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)
What are the 5 aminoglycosides
- Gentamicin
- Tobramycin
- Amikacin
- Streptomycin
- Neomycin B
STAN-G
How are aminoglycosides used
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)
Do Aminoglycosides have anaerobic coverage
No
What is the coverage of Aminoglycosides
Gram (– ) more potent
Pseudomonas
Amikacin or streptomycin > Tobramycin or Gentamicin
What is the ADE of Aminoglycosides
ADV: Nephrotoxicity (acute but reversible)
And ototoxic
Use in caution with elderly pts (5 days)
Aminoglycosides can be used with what other ABX groups to help cover pseudomonas
B-lactams, Vancomycin and Daptomycin
For the test gentamicin only covers
Pseudomonas
For the test tobramycin only covers
Pseudomonas
For the test Amikacin and Stroptomycin only cover
Pseudomonas
What is the MOA of Macrolides and Ketolides
MOA: Protein synthesis inhibitors
Bacteriostatic
Both time/concentration dependent
Atypicals
What is the ADE of macrolides and Ketolides
ADV: Acute cholestatis, hepatotoxicity
NONE ARE A GOOD CHOICE FOR INFECTIONS THAT REQUIRE BACTERIOCIDIAL ACTIVITY!
If a infx requires -cidal activity can you use Erthymoycin or Azithromycin
No they are -static
Macrolides are a good alternative agent for pts allergic to..
B-lactams
What are the three macrolides
Erythromycin
Azithromycin
Clarithromycin
All end in romycin
What is the ADE of erythromycin
causes most GI problems, used as a promotility agent.
Cardiac QT interval prolongation (pharmacy will verify with you if safe)
Acute cholestatis, hepatotoxicity
What is Azithromycin good for
Macrolide
Alternative for B-Lactam pts
Chlamydia Infections
Safe for Pregnancy
Low DDI
What is the MOA of Erythromycin, Azithromycin, and Clarithromycin
Protein synth inhibitors
-static
What is clarithromycin used for
H. Pylori/ GI ulcer
Can clarithromycin be used in pregnancy
NO
What are Ketolides good for
Have activity against strains resistant to macrolides
What is the one Ketolide
Telithromycin
What is the MOA of telithromycin
Protein synth inhibitor
-static
What is the MOA of drugs that end in -romycin
Macrolides & Ketolides
MOA: Protein synthesis inhibitors
Bacteriostatic
Both time/concentration dependent
What is the MOA of drugs that in the -damycin
Lincosamides
MOA: Protein synthesis inhibitor Safe for pregnancy (B)
Does not cross BBB.
No renal adjustment
What is the MOA of clindamycin
Lincosamides
MOA: Protein synthesis inhibitor Safe for pregnancy (B)
Does not cross BBB.
No renal adjustment
What ABX has the highest risk of causing C. Diff
Clindamycin
What is the ADE that clindamycin causes in HIV pts
Rash
What is Clindamycin used for
USE: SSTI, MRSA, MSSA, Malaria
anaerobic intra-abdominal infections associated with trauma
ORAL cavity, ACNE, Diabetics, Atypicals, Anearobes
What is the MOA of drugs that end in -pristin
Streptogramins
MOA: Conformational change
Bactericidal
What is the MOA of Quinupristin/Dalfopristin
Streptogramins
MOA: Conformational change Bactericidal
What is the ADE of Quinupristin/Dalfopristin
Hyperbillirubinemia
What is Quinupristin/Dalfopristin good for
Good MRSA/MSSA, VRE (the big three)
USE: MDR organisms, endocarditis, bacteremia, SSTI
What is the MOA of oxazolidinones
MOA: Protein synthesis inhibitor
Bacteriostatic
Pregnancy (C)
No dose adjustment for renal or hepatic dysfunction
What is the MOA of linezolid and tedizolid
MOA: Protein synthesis inhibitor
Bacteriostatic
Pregnancy (C)
No dose adjustment for renal or hepatic dysfunction
What is Linezolid and tedizolid used for
Good MRSA/MSSA, VRE (The big three)
Widely distributed
CANNOT be used for bacteremia
Can linezolid be used for bacteremia
NO
What is the coverage of linezolid
Gram + only
What is the MOA of floroquinolones
MOA: DNA gyrase inhibitors
Bactericidal
Concentration dependent
Pregnancy C
What are the three Fluoroquinolones
Cirpofloxacin
Levofloxacin
Moxifloxacin
What is the MOA of drugs that end in floxcain
MOA: DNA gyrase inhibitors
Bactericidal
Concentration dependent
Pregnancy C
What is the DOC for anthrax
Ciprofloxacin
What is Ciprofloxacin good for
- Pseudomonas &
- UTI
- DOC for anthrax
What is levofloxacin good for
- Better Pseudomonas coverage than ciprofloxacin
- S. pneumonia (CAP)
- UTI
What is Moxifloxacin good for
Anaerobic coverage
S. Pneumonia
CAP
Oral absorption of Ciprofloxacin, levofloxacin, and Moxifloxacin are all reduced by
Antacids
What is the ADE of fluroquinolones
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
Which fluoroquinolones should be used for UTI/ GU
Ciprofloxacin and levofloxacin
Which fluoroquinalones should be used for Resp infx
Levofloxacin and Moxifloxacin
When dealing with athletes/ runners what precautions should be used with fluoroquinolones
Runner: 10% increase in load after use per week (5 weeks)
Athletes: 2-4 weeks off of sports
Tendon ruptures
What is the MOA of Sulfonamides
MOA: Folate synthesis inhibitor
Bacteriostatic
Time dependent
Adjust for renal
Not safe for pregnancy (D)
Pump and dump for breastfeeding
NO to G6PD!
What are the three Sulfonamides
- Sulfamethoxazole/Trimethoprim (SMX/TMP) (Bactrim)
- Sulfadoxine & Pyrimethamine
3 Pyrimethamine(anti-malarial)
What is Sulfamethoxazole/Trimethoprim
(SMX/TMP) (Bactrim) good for
Sulfonamide
MRSA/MSSA
Resp infections
Opportunistic infections TX or prophylaxis
What are SMX/TMP (Sulfonamides), Sulfadoxine & Pyrimethamine all good for
Cross BBB
Contraindicated <2mos
MRSA/MSSA
Use in Malaria UTI/GU OM RTI SSTI
If a pt has G6PD def.
what drugs can not be used
Sulfonamides Nitrofurantoin Dapsone Primaquine Quinidine
What is the ADE of Sulfonamides
SMX/TMP
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!
What is the MOA of Nitroimidazoles
MOA: Protein synthesis inhibitor
What is the DOC for Trichamonas vaginalis
Metronidazole (Flagyl) & Tinidazole (Tindamax)
What is the DOC for giardiasis
Metronidazole (Flagyl) & Tinidazole (Tindamax)
Vancomycin is the 1st line for C. Diff, was is a good alternative
Metronidazole (Flagyl) & Tinidazole (Tindamax)
Pts taking Metronidazole (Flagyl) & Tinidazole (Tindamax) shroud avoid what due to the disulfiram reaction
Alcohol
What is Metronidazole (Flagyl) & Tinidazole (Tindamax) good for
DOC Trichomonas vaginalis and giardiasis
Good, C. diff alternative (Vancomycin 1st choice)
Moderate, H. pylori (TX in combo PPI/acid suppressant and Metronidazole)
What is the DDI interaction for Metronidazole (Flagyl) & Tinidazole (Tindamax)
Warfarin
What is the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)
Metallic taste
What is the 2nd line agent to treat C.diff
- Fidaxomicin (Dificid)
What is the MOA for Fidaxomicin (Dificid)
MOA: inhibit protein synthesis
If a pt is allergic to macrolides (Clindamycin and Azithromycin) what other drug can they not take
Fidaxomicin (Dificid)
What is the DOC in impetigo
Mupirocin (Bactroban)
What is the coverage for Mupirocin (Bactroban)
MRSA/ MSAA
What is the MOA of Mupirocin (Bactroban)
MOA: inhibit protein synthesis
What is Mupirocin (Bactroban) good for
DOC for impetigo
Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks
What are the three specific UTI agents
- Nitrofurantoin
- Fosfomycin
- Methenamine
- Phenazopyridine (Pyridium)
What is the drug that is used for the Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks
Mupirocin
Of the UTI Agents, which is for prophylaxis only
Fosfomycin
What is the use of Nitrofurantoin
Uncomplicated UTI Tx
What is the MOO of Nitrofurantoin
Protein Synth Inhibitor
What is the ADV and Preg Cat for Nitrofurantoin
ADV: NO G6PD! Discolors urine brown
Safe for pregnancy (B)
For UTI, how is Methanamine used
Prophylaxis/suppression (recurring on elderly)
What are the ADE of Methanamine
ADV: crystalurea, painful urination
What is the preg cat for Methanamine
C
For UTI, how is phenzaopyridine used
An analgesic only product that discolored the urine orange, can be used for 3 days
What are the 5 prophylaxis malaria ABXs
Doxycycline Chloroquine Atovapuone-proguanil Melfoquine Primaquine
D-CAMP
What is the use of chloroquine
Not really used
1-2 was before
4 weeks after
Use: areas without resistant P. falciparum
What is the use of Atovoquone-proguanil
1-2 days before
1 week after
Use: areas with chloroquine resistant P. falciparum
FOLATE INHIBITOR
Thx and prophylaxis of Uncomplicated Malaria
What is the MOA of atovaqoune-proguanil
Atovaqoune: interfere with electron transport in the parasitic mitochondria
Proguanil: selective inhibition of plasmodial dihydrofolate reductase; key enzyme for synthesis of folate.
What is the advantage of atovaqoune-proguanil
requires shorter periods of treatment before and after travel.
1,2 days before, 1 week after travel
What is the food instructions for atovaqoune- proguanil
Take with food/ milk to enhance absorption
What are the ADE of atovaqoune-proguanil
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.
What is the time and location use of Melfoquine
Use: areas with chloroquine resistant P. falciparum
2 weeks before
4 weeks after travel
Which ABX should be used in areas without P. Falciparum resistance
Chloroquine
Which ABX should be used in areas with chloroquine resistant P. falciparum
Melfoquine Or Atovaqoune-proguanil
What is the DOC for malaria prophylaxis
Doxycycline
What ABX should be used in areas with MDR P. falciparum
Doxycycline
What are the restrictions and advantages of using doxycycline for malaria
DOC for chemoprophylaxis
No <8 y/o, or pregnant.
Prevents additional infections for hike, camp, swim in freshwater.
What is the use a length of Primaquine for Malaria
Use: Terminal prophylaxis of P.vivax & ovale infections.
Alternate for primary prevention.
Daily for 7 days post travel
Which malaria drugs work on the blood stage
Chloroquine
Atovaqoune-proguanil
Melfoquine
Doxycycline
D-CAM no P
Which malaria drugs work on the Liver Stage
Atovaqoune-proguanil
Primaquine
PA
Which Malaria dug works on both the liver and blood stage
Atovaqoune- proguanil
For Tx malaria, what is the DOC for pregnant women
Melfoquine
What are the ADV for Melfoquine
-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
Which Malaria ABX has the advantage of only requiring weekly dosing
Mefloquine
When using Primaquine for malaria it must be combined with one of two other drugs..
Chloroquine or Hydroxychloroquine
What is the only malaria ABX that prevents relapse of P. Vivas and P. Ovale strains
Primaquine
Primaquine Prevents Relapse
What drug that is used for the chemoprophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS, is also used to treat Malaria
Primaquine
What are the 6 Quinolones
Chloroquine Mefloquine Primaquine Quinidine Quinine Hydroxycholoquine
What are the 2 folate synth inhibitor ABX
Atovaqoune-proguanil
Pyrimethamine & Sulfadiazine
What is the MOA and ADE of Pyrimethamine & Sulfadiazine
Folate Inhibitor
ADE: Mouth Ulcers and Alopecia
What are the two Tx uses of Pyrimethamine & Sulfadiazine
Malaria Tx and Toxoplasma Gondi
Which ABX is good for last minute travelers for the prophylaxis of Malaria
Atovaquone- Proguanil
What are the wanrnings and ADE for Atovaqoune-proguanil
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.
What is the DOC for trichomoniasis vaginalis
Metronidazole (Flagyl) & Tinidazole (Tindamax)
DAZOLE
What is the MOA of Metronidazole (Flagyl) & Tinidazole (Tindamax)
Protein synth inhibitor
Vancomycin is the 1st choice to for C. Diff,
What is an alternative to this 1st choice drug for C. Diff
Metronidazole (Flagyl) & Tinidazole (Tindamax)
IF combined with a PPI, Metronidazole (Flagyl) & Tinidazole (Tindamax) can be used to treat what stomach infections
H. Pylori
What are the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)
ADV: metallic taste
Drug interaction: Inhibit Warfarin
AVOID ALCOHOL, due to disulfiram reaction
What drug is used for the prophylaxis of Toxoplasmosis Gondi
Sulfamethoxazole- Trimethoprim (Septra)
What drugs are used for the Tx of Toxoplasmosis Gondi
Pyrimethanine + (clindamycin or sulfamyicn)
Metronidazole (Flagyl) & Tinidazole (Tindamax) is the DOC for Trichamonasis vaginalis, but can also be used to treat what other conditions
TX for symptomatic
- Invasive intestinal amebiasis
- Invasive extraintestinal amebiasis
What is the ABX to use with Intestinal protozoans
Metronidazole or Tinidazole
Covers abd anaerobes
What are the two ABX used on Pinworms
Albendazole
Pyrantel Pamoate
What is the MOA of Albendazole
Disruption of growth and division of pinworms
What is the use of Albendazole
Preferred Tx for pinworms
What are the ADE and warnings with Albendazole
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!
What is the MOA of pyrantel pamoate
MOA: depolarizing NMB, paralysis in worm.
OTC product, not safe for <2 y/o.
What are the 3 drugs to use for lice
Permethrin and Pyrethrins
Malathion
Benzyl Alcohol Lotion
What is the 1st line agent in the Tx of live
Permethrin and Pyrethrins
What is the MOA of Permethrin and Pyrethrins
Neurotoxic agents to lice
What are the age restrictions for Permethrin and Pyrethrins
permethrin, 2mos<
Pyrethrins, 2y/o
What is the MOA and use for Malathion
Neurotoxic agent for lice
MOA: Neurotoxic
- High ovicidal activity
- Single application adequate
Is Permethrin and Pyrethrins single or multiuse?
Multi
Is malathion single or multi use ?
Single use adequate
What is the ADE of malathion
HIGHLY FLAMMABLE
Not to use around smokers or open flames
What is the MOA and use of Benzyl Alcohol Lotion
MOA: occlusive-(suffocates lice) based therapy
- Reapply in 1 wk
- Can be used as young as 6mos of age.
Of the lice tx, which is single use, which is multiuse and which has to be reapplied in 1 wk
Permethrin- multi use
Malathion- single use
Benzyl Alcohol- reapply in 1 wk
What are the 3 antivirals used for Influenza
- Oseltamivir (Tamiflu)
- Zanamivir (Relenza)
- Peramivir (IV)
(OPZ)
What is the MOA of antivirals used to treat influenza
MOA: inhibits viral neuraminidase, prevent the release of new virus from host cell.
Influenza A & B.
What is the length of treatment for Oseltamivir (Tamiflu)
5 days
What are the age and time requirements to use Oseltamivir (Tamiflu) for Influenza
5-day TX
TX: >2wk old.
No symptoms no longer than 48 hrs
Prophylaxis: >3 mos old
Oral preferred for pregnant women
What is the tax length for Zanamivir for influenza
5 days
What are the tax lengths and age restrictions for zanamivir in the tax of influenza
5-day TX
TX: 7y/o<
Prophylaxis: 5 y/o
What are the ADE of Zanamivir (Relenza)
Not for athsma, COPD, or resp problems
Can cause orphayngeal and facial edema
What are the tx lengths and age restrictions when using Peramivir (IV) for tx of influenza
1 day TX (uncomplicated)
TX: 18y/o<
Not for Prophylaxis
What are the 2 VZV (Herpes/ Shingles) vaccines
- Zostavax: Herpes zoster vaccine
2. Varivax: Varicella zoster vaccine
What is the time frame to start Shingles/ Herpes Zoster tx
C/in 72 hrs
What are the 3 drugs to use for Genital HSV
Valacyclovir
Famciclovir
Acyclovir
F.A.V.
What is the MOA of Antivirals used to treat HSV
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
What are the three drugs to use for HIV
- Tenofovir DF (TDF)
- Tenofovir alafenamide (TAF)
- Emtricitabine
What is the MOA of
- Tenofovir DF (TDF)
- Tenofovir alafenamide (TAF)
- Emtricitabine
HIV tx/ prophylaxis
NucleoSIDE/TIDE Reverse Transcriptase inhibitors
How long can HIV live in an unused needle?
42 days
What is the ADE of:
- Tenofovir DF (TDF)
- Tenofovir alafenamide (TAF)
- Emtricitabine
Used for HIV
ADV: hyperpigmentation of the palms or soles
What is the combination of HIV drugs used for POST Prophylaxis tax of HIV
Truvada: Tenofovir + Emtricitabine
What is the USE and MOA of
- Dolutegravir (DTG)
- Raltegravir (RAL)
MOA: Integrase inhibitor Initial treatment for naïve PTs
What is the recommended therapy for post needle stick HIV exposure
- Truvada QDAY
- Dolutegravir BID
* PRE-Exposure Prophylt
START within 72hr!
Take on empty stomach. Ca, Mg, Fe decrease effectiveness.
What are the HIV drugs used for pre exposure prophylaxis of HIV
Tenofovir DF + Emtricitabine (Truvada)
What are the 4 first line agents for TB
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
RIPE
What is the MOA of rifampin
MOA: Inhibits RNA synthesis by targeting RNA polymerase
What is the MOA of isoniazid
MOA: interferes with enzymes responsible for assembly of mycolic acids, essential for mycobacterial cell walls.
What is the MOA of ethambutol
MOA: Inhibits an enzyme essential for cell wall synthesis of mycobacterium.
What is the DOC for TB
Rifampin
What is the DOC for latent TB
Isoniazid
What effect does adding pyrazinamide to TB tx have
By adding this we reduce TX from 9mos to 6mos.
When would we use Ethambutol in TB tx
- 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.
What is the ADE of Rifampin
ADV: Orange-red secretions (urine, tears, feces ect.).
Can stain contact lenses.
POTENT CYP 450 inducers.
Hepatitis leading to liver failure.
What is the DDI of isoniazid
Drug Interaction: Inhibitor of CYP 3A4.
Metabolized in liver
What is the ADE of isoniazid
ADV: peripheral neuropathy, due to excretion of pyridoxine (B6).
MUST GIVE PYRIDOXINE WITH INH!
Hepatotoxic.
NO G6PD PT!
What are the ADE of ethambutol
ADV: Optic Neuritis, red-green color blindness.
In Tx Tb what group of people can you not use Ethambutol on
Contraindicated on red-green color blind,
<5y/o
What are the 5 second line agents for TB
Rifabutin Rifapentine Streptomycin Fluoroquinolones Kanamycin/ Amikacin
RRFSK
What is the active TB ABX regiment/ plan
RIPE for 2 months
(RIF, ISO, PZA, EMB)
Then
IR for 4 months
(ISO, RIF)
In treating Active TB, what drug should be substituted inplace of Rifampin if the pt has HIV
Rifabutin
What is the drug that has to be added when treating pregnant women with active TB
-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
What is the DOC combination when to Latent TB
Isoniazid
+
Pyridoxine (B6)
X9months
What are the age ranges and restrictions on treating latent TB with Isoniazid and Pyrdoxine
Preferred TX for -HIV PTs -Children <2 y/o -Pregnant women (Qday or twice weekly)
What is the Tx combination for Latent Tb in children older than 2 years old
Isoniazid
Rifapentine
+
Pyridoxine (B6)
X3 months
Not recommended for pregnant women
What is the DOC for Mycobacterium Avium Complex
Rifabutin
What is the MOA of Rifabutin
MOA: Inhibits RNA synthesis by targeting RNA polymerase
Derivative of Rifampin, less potent induction of CYP450 enzyme system.
Rifabutin is the DOC for MAC, what are its ADE
ADV: uveitis, skin hyperpigmentation, neutropenia
If a TB patient has HIV what drug should be substituted for rifampin
Rifabutin
What is the MOA of Rifapentine
MOA: Inhibits RNA synthesis by targeting RNA polymerase
What is the dosing of Rifapentine
Analog of rifampin.
Longer half life than Rifampin & Rifabutin, permits weekly dosing.
What is the ADE of Rifapentine
ADV: POTENT CYP 450 inducers.
What are the 4 rifamycins
Rifampin, Rifabutin, Rifapentine, Rifamixin
Outside of TB tx when would you used rifamycins
USE: Endocarditis of a prosthetic valve!
What is the MOA of all Fungal Agents
Cell Membrane Inhibitors
What are the 2 imidazoles
Ketoconazole
Clotrimazole
Micanazole
What is the DOC of tinea versicolor
Ketoconazole (topical only)
What is the use of topical and oral clotrimazole
Topical: cutaneous or vaginal candidiasis
Oral: oropharyngeal/esophageal candidiasis
When treating Influenza, Oseltamivir has what ADE in the Jap population
Sporadic neuro events
What are the 3 Triazoles
Fluconazole
Voriconazole
Posaconazole
(CONAZOLE)
What is the DOC for fungal infections, including invasive and noninvasive candidiasis.
Fluconazole (diflucan)
What is the DOC for Vulvovaginitis Candidiasis (oral)
Fluconazole
How is Fluconazole used as a prophylaxis agent
Prophylaxis against invasive fungal infections in immunocompromised (ex. HIV pts for thrush) and organ transplant.
What is the DDI of Fluconazole
Least effect on human CYP450 enzymes of all azoles. Warfarin interaction.
What is the DOC in invasive pulmonary or extra pulmonary infections caused by Candida Spp.
Voriconazole
What is the DOC aspergillus infections
Voriconazole
What are the ADE and Warnings associated with voriconazole
Take without food.
ADV: high trough concentrations associated with transient visual disturbances.
Auditory hallucination.
Hepatotoxic.
When would you use Posacanazole when treating a fungal infections
Immuno comp pts
What is the DDI of posaconazole
Avoid PPI and H2 blockers
What are the 3 allylamines
Terbinafine
Butenafine
Naftifine
Ally-BNT
What is the DOC for onchymycosis
Terbinafine (oral)
What is the ADE of Terbinafine
( DOC on onychomycosis)
ADV: avoid in pregnancy and do not breast feed (oral)
Monitor LFT!
Taste disturbance
What are the 2 polyenes
Amphotericin B systemic (lipid formula)
Nystatin
What is the DOC for Invasive fungal infx
Amphotericin B systemic (lipid formula)
What is the anti fungal used Prophylactically for bone marrow transplant.
Amphotericin B systemic (lipid formula)
Amphotericin B systemic (lipid formula) can be used empirically to tx what?
Empirically for prolonged neutropenia
CA or immunocompromised PT
What is the ADE of Amphoterecin B
Nephrotoxic
What is Nystatin used for
Oropharyngeal/esophageal
-Oral candidiasis (thrush).
Swish & swallow.
What drug/ anti fungal agent is used on Topical- axillae, groin, gluteal folds, diaper rash.
Nystatin
What Anitfungal can be used in Pt w/ liver problems than cant take oral meds
Ciclopirox: Nail lacquer
What is the DOC Pneumocystis Jiroveci pneumonia (PCP) in AIDS PTs.
Sulfamethoxazole- Trimethoprim (Septra)
What is the oral DOC for Vulvovaginal Candidiasis (VVC)
DOC Oral Fluconazole
What are the two Indra-vaginal azoles that can be used for Vulvovaginal candidiasis
- Clotrimazole
2. Miconazole
If a pt is pregnant with VVC what is the DOC
Pregnancy- Imidazole (topical) 7 days.
What is the Tx length for complicated VVC
TX 10-14 days.
What is the extended spectrum B- lactamase resistant organisms
(SPACE)
Serratia Pseudomonas aeruginosa Acinetobacter Citrobacter Enterobacter
Which two ABX cause Nephrotoxicity
aminoglycosides and vancomycin
What three ABX cause Photosensitivity
quinolones, tetracyclines, sulfonamides
What are the ABX that are Cell WAll Synth Inhibitors
B- Lactams Carbapenems Monobactams PCN Bacitracin Fosfomycin Vancomycin
What is the only ABXs that is a DNA gyrase Inhibitor
Fluoroquinolones
What are the ABXs that are Protein Synth Inhibitors
Aminoglycosides Chloramphenicol Clindamycin Macrolides Mupirocin Streptogramins Tetracyclines
What are the 5 drugs that are cell membrane inhibitors
Amphotericin Ketoconazole Polymixin Colistimethate Daptomycin
What ABX are RNA polymerase inhibitors
Rifampin
What ABX are Folate synth inhibitor
Sulfonamides
Trimethoprim
What is the only ABX currently approved for the TX of early or late syphilis ?
PCN G Benzathine