ABX Flashcards
What to know about vancomycin
cell wall synth interupter - gram + only
used for Cdiff and MRSA
nephrotoxicity - avoid NSAIDs
check serum levels
ototoxicity
IV admin - rapid infusion - red man syndrome
PCNs
cell wall weakeners
resistance is common -beta lactamase
pcn G - 1st pcn - narrow spectrum - stomach acid - IV or IM
#1 allergy inducer
gram + only
broad spectrum penecillin
Ampicillin, amoxicillin
extended spectrum PCN
pipercillin
tetracycline
broad spectrum protein synthesis inhibitor
2nd line for infectious dx
1st line for a range of infx - ricketts, chlamydia, cholera, lyme, anthrax, mycoplasma pna
treats acne - PO and topical
used for PUD - H.pylori - in combo w/ metronidazole
contraindicated for children developing teeth/pregnant women - binds to Ca+ (also chelates with other metals -zinc,mg, fe, aluminum)
empty stomach
hepatotoxic, nephrotoxic
Clindamycin
broad spectrum, anaerobic gram + outside of CNS (think moist and dark)
Strongly associated with the development of Cdiff superinfection
Azithromycin and other macrolides
broad spectrum - used instead of PCN in case of allergy
look out for prolonged QT interval
newer generation (azithromycin, clarithromycin) - Zpack - daily dosing - easier adherence than earlier generation
Aminoglycosides
tobramycin, gentamycin etc
narrow spectrum - aerobic gram - bacilli
ototoxic, nephrotoxic (usually reversible) - elevated trough levels can indicate toxicity
monitor serum levels (check peak -therapeutic and trough-toxicity)
only IM or IV (highly polar) - cannot cross GI or BBB
Sulfonamides
important use - UTI trmt
- Trimethoprim/Sulfa-methoxazole (Bactrim)
closely following PCNs for allergy inducing
rash mild –> severe - Steven Johnson Syndrome - flu-like plus severe rash/blisters
x in pregnancy or infants <2mo - kernicterus (displacement of bilirubin to brain)
Topical: Silver Sulfadiazine (Silvadene)
metronidazole
protein synthesis disruptor
anaerobic (broad spectrum) and anti-protozoal
DOC for Cdiff
monitor for phlebitis
ADRS: CNS, rash –> SJ’s
*avoid alcohol - causes disulfiram-like rxn
Cephalosporin
Cell wall weakener
5 generations - increased effectiveness to gram - and ability to reach CSFwith each generation
- used to treat difficult to reach infections like **meningitis **(5th gen)
- use in lower doses for renal impairment
many require IV or IM (poor abs. in GI)
avoid alcohol - strong disulfiram-like effect
cross allergy w/ PCNs
Carbapenem
cell wall weakener
broad-spectrum gram+ and gram -
IV admin- not absorbed
judicious use to avoid resistance
not effective x MRSA
fluoroquinalone
disrupt DNA replication
eg ciprofloxacin
-preferred s/p anthrax
choice for pyelonephritis
may worsen myesthenia gravis
tendonitis - especially achilles - under 18 and elderly
avoid in pts on glucocorticoids
QT prolongation
CNS
photosensitivity
Acyclovir
topical/PO antiviral
can be used in pregnancy (esp near term to prevent transmission)
do not spread between sites
IV - phlebitis
prolonged/IV use - nephrotoxicity, neurotoxicities
decrease dose for renal impairment
gancyclovir
rarely used because of significant ADRs/*black box warning**
only approved to prevent cytomegalovirus in immunocompromised pts
- bone marrow suppression, immunosuppression and thrombocytopenia, teratogenic, hepatotoxic, neurotoxic, nephrotoxic
careful handling - absorbs into skin
interferon alpha
part of HCV cocktail
SQ or IM
flu-like sx, depression
black box warning - SI
Ribavirin
part of HCV cocktail
ADRs - hemolytic anemia/cardiac effects, flu like sx, depression
fetal injury
Protease Inhibitors for hcv
simeprevir etc (previr)
hepatotoxic, significant photosensitivity
PEP vs PrEP
PEP - occupational - post-exposure
When do we check labs when exposed - baseline, 6 wks, 12 wks, months later
28 days treatment - good
effective trmt starts early (w/in 1-2 hrs)
PrEP - high risk exposure - pre-exposure
PEP - NRTIs and PI
PrEP - 2 NRTIs
linezolid
used for multidrug resistant organisms, reserved for MRSA and VRE
ADR- myelosuppression - monitor CBC
amphotericin B
anti-fungal - polyene macrolide
not used much anymore - azoles preferred as broad spectrum anti-fungal
ADR - infusion reaction - fever, chills, rigors, HA, n/v, hypotension, dyspnea, resp failure (1-3 hrs post start)
pretreat with tylenol + diphenhydramine
azoles
systemic mycoses
PO or IV
less toxic
Itraconazole - avoid in HF - negative inotrope
echinocandins
IV only
disrupt cell wall
use: intolerant/unresponsive to other meds
for candidiasis
Vulvovaginal candidiasis
1-3 days clotrimazole (or other azole)
PO - single dose fluconazole
Nystatin
polyene macrolide
topical/mouth rinse
rare/minor ADR- GI, topical irritation
ok for infant thrush/diaper rash
HIV drug: NRTIs
(Specifically Zidovudine AZT)
black box warning:
severe anemia, neutropenia
potentially fatal lactic acidosois with hepatic steatosis
no longer recommended, except for short-term to reduce perinatal transmission
Protease Inhibitors “avir”
reduces HIV viral count to undetectable
providers must check d-d interactions
hyperglycemia
fat redistribution - lipodystrophy
hyperlipidemia
Phenazopyridine
non opioid urinary analgesic “AZO”
bright orange urine
treatment of UTI
nitrofurantoin (macrobid) - “urinary tract antiseptic”
rust colored urine
contraindicated in pregnancy
hepatotoxicity
check renal fxn - can accumulate to toxicity
CNS
peripheral neuropathy
pulmonary rxns (acute hypersensitivity –> subacute dyspnea, cough, pna)
sulfanamide/trimethoprim
fosfomycin
phenazopyridine (not ABX - pain relief - “AZO”) - orange urine
