ABX: PK-PD

Question 1

Conc dependent

Answer 1

Aminoglycoside
Fluoroquinolones

Daptomycin
Polymyxin B/ Polymyxin E (colistin)

Question 2

Time dependent

Answer 2

Penicillin (40-50)
Cephalosporin (40-50)
Carbapenem (40-50)
Monobactam (50-60)

Question 3

Special property of polymyxin

Answer 3

can be applied to intact/broken skin/ mucous m
wont be absorbed into the skin (no A, no systemic effect)
sutiable for ear, eyes, skin, mucous m infection (use in combi with other API for creams, opthalmic prep etc)

Question 4

Monitoring parameters

Answer 4

Penicillin:
monitor pt for 30min for 1st time IV, give E if anaphylaxis occurs
: monitor renal cardiac, electrolytes to avoid toxic levels
: ticarcillin monitor for circulating overload and bleeding tendencies

Daptomyxin: weekly creatinine phosphokinase level

AG:

1. oto: hearing ability and vestibular balanc (can walk in a straight line or not)
2. nephro: proteinuria, BUN, SrCr

Linezolid:

1. BP for serotonin syndrome
2. visual change (optic neuropathy)
3. weekly FBC for myelosuppression

5-FC: serious bone marrow suppresision, so monoitor WBC and plt weekly (those t1/2 is the shortest) 
and hepatotoxicity (monitor AST, ALT weekly)

Question 5

CSF

Answer 5

1. Poor: penicillin, cephalosporin (cefazolin, cefadrolin, cefalexin, cephalomycin, cefoxitin, ceftaroline), dori/ertapenem, daptamycin, polymyxin BEAg, tetracycline, macrolides, clindamycin, linzeloid (30%) (ALL PROTEIN SYNTHESIS I)
2. Good: cephalosporin (cefuroxime/3rd/4th gen), imi/meropenemantifolate (TMP>SMZ),fluoroquinones

(CSF : Cephalosporin, Carbapenem (imi, meropenem), SXT, Fluoroquinolones)

3. Inflammed meninges: monobactam, vancomycin

Can be used to treat CNS Infection (inflamed meninges) from Christine Teng
Penicillin
Ceftriaxone, ceftazidine, cefepine
Meropenem,
Monobactam,
Vanco
Fluoroquinolones,
SXT

Question 6

E by bile

E by breastmilk or other fluids

Answer 6

tetracyclin (significantly)
clindamycin
linezolid (non-renal)
Rifampicin (rapidly via bile & breastmik)

Special:
SMZ: breastmilk
TMP: acidic fluids like vaginal/prostatic secretion

Question 7

Time dependent with persistent effect

Answer 7

Vancomycin
Tetracycline, tigecycline
Macrolides
Clindamycin
Linezolid 

Goal: optimise AUC: MIC ratio (e.g. vancomycin: target of 400 for MRSA ) and it depends on total daily dose

Qn: vanco: should we dose 500mg QDS or 1g BD? Choose 1g BD, bc total daily dose is the same. So bd can cut cost.