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Antibiotic Agents Flashcards

1
Q

What treatment guidelines are recommended for antibiotic selection?

A
  1. IDSA
  2. CDC
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2
Q

What are boxed warnings with PCNs?

A

Penicillin G benzathine: not for IV use; can cause cardio-respiratory arrest and death

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3
Q

What are CIs to using PCNs?

A

Type 1 HSR to another PCN/ beta-lactam

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4
Q

What is a CI for using Augmentin?

A
  1. history of cholestatic jaundice or hepatic dysfunction associated with previous use
  2. CrCl< 30: do not use amoxicillin/clavulanate ER (Augmentin XR) or 875mg strength
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5
Q

What is a CI for using Unasyn?

A

history of cholestatic jaundice or hepatic dysfunction associated with previous use

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6
Q

What are SEs with PCNs?

A
  1. Seizures (with accumulation when not dosed correctly for renal function)
  2. GI upset
  3. Diarrhea
  4. Rash (including SJS/TENS)
  5. Allergic reactions/Anaphylaxis
  6. Hemolytic anemia (+ Coombs test)
  7. renal failure
  8. elevated LFTs
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7
Q

What should be monitored on PCNs?

A
  1. Renal function
  2. symptoms of anaphylaxis with 1st dose
  3. CBC
  4. LFTs with prolonged use
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8
Q

How is Penicillin V K (potassium) dosed?

A

PO on an empty stomach

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9
Q

How is Penicillin G aqueous dosed?

A

IV

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10
Q

Penicillin G aqueous

A

Pfizerpen

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11
Q

Penicillin G benzathine

A

Bicillin L-A

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12
Q

Penicillin G Procaine

A

Bicillin C-R

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13
Q

How is Penicillin G aqueous/procaine dosed?

A

IM

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14
Q

What PCNs are antistaphylococcal?

A
  1. Dicloxacillin (PO)
  2. Nafcillin (IV/IM)
  3. Oxacillin (IV)
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15
Q

What is the preferred use of antistaphylococcal PCNs?

A

MSSA infections of:
soft tissue
bone and joint
endocarditis
bloodstream infection

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16
Q

Which PCN is a vesicant?

A

Nafcillin

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17
Q

How is extravasation of nafcillin treated?

A
  1. cold packs
  2. hyaluronidase
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18
Q

Which PCNs do not need adjusted for renal impairment?

A

antistaphylococcal PCNs

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19
Q

Why is amoxicillin PO preferred over ampicillin PO?

A

better bioavailability

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20
Q

What should IV ampicillin and Unasyn be diluted in?

A

NS

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21
Q

How is amoxicillin and Augmentin dosed?

A

PO with food

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22
Q

Amoxicillin/Clavulanate

A

Augmentin
Augmentin ES-600

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23
Q

How is ampicillin dosed?

A

PO on an empty stomach 30 min before or 2 h after meals /IV

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24
Q

How is ampicillin/sulbactam dosed?

A

IV

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25
Q

Ampicillin/Sulbactam

A

Unasyn

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26
Q

Pipercillin/tazobactam

A

Zosyn

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27
Q

What drugs interact with PCNs?

A
  1. probenecid can increase levels of beta-lactams
  2. PCNs can increase the concentration of methotrexate
  3. most beta-lactams can enhance warfarin
  4. nafcillin and dicloxacillin decrease warfarin
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28
Q

What populations should PCNs be avoided in?

A
  1. Pregnancy patients (except penicillin G for syphilis)
  2. beta-lactam allergy
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29
Q

What PCN is active against pseudomonas?

A

extended infusion (over 4 hours) piperacillin/ tazobactam maximizes T>MIC

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30
Q

What microbes do PCNs not cover?

A
  1. MRSA
  2. atypical organisms
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31
Q

What is the advantage of adding a beta-lactamase inhibitor to aminopenicillins (clavulanate/sulbactam)?

A

added activity against MSSA, more resistant gram negatives (haemopholis, Neisseria, proteus, e.coli, klebsiella HNPEK), and gram-negative anaerobes (B. fragilis)

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32
Q

What microbes are natural PCNs effective against?

A
  1. gram + cocci (strep and enetrococci)
  2. gram + anerobes (mouth flora)
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33
Q

What microbes are antistaphylococcal PCNs effective against?

A
  1. strep
  2. MSSA
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34
Q

What microbes are aminopenicillins effective against?

A
  1. strep, eneterococci
  2. gram + anerobes (mouth flora)
  3. gram neg: Haemophilis, Neisseria, E.coli. Proteus
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35
Q

What microbes does Zosym cover?

A

same as other PCNs + more gram neg (Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia; CAPES) and pseudomonas

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36
Q

Amoxicillin is first-line for which bacterial infections?

A
  1. acute otitis media (peds: 80-90 mg/kg/day)
  2. infective endocarditis prophylaxis for dental procedure
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37
Q

Penicillin V K is first-line for what infection?

A

pharyngitis

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38
Q

Augmentin is first line for what infection?

A
  1. acute otitis media
  2. bacterial sinusitis
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39
Q

What microbes do cephalosporins not cover?

A
  1. Enterococcus
  2. atypical organisms
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40
Q

What microbes do 1st gen cephalosporins cover?

A
  1. staph, strep, MSSA
  2. some activity against gram neg rods (proteus, e.coli, klebsiella)
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41
Q

What microbes do 2nd generation cephalosporins cover?

A
  1. staph
  2. resistant strains of S. pneumonia
  3. gm neg (heamophilis, Nisseria, proteus, e.coli,klebsiella)
  4. gm neg anaerobes (B.fragilis)- only cefotetan and cefoxitin
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42
Q

What microbes do the 3rd generation cephalosporins cover (except ceftazidime; group 2)?

A
  1. resistant S.penumoniae and viridans
  2. MSSA
  3. gram-positive anaerobes
  4. resistant strains of HNPEK
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43
Q

What microbes does ceftazidime cover (group 2, 3rd generation)?

A
  1. pseudomonas coverage
  2. no gram-positive coverage
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44
Q

What microbes does cefepime (4th generation) cover?

A
  1. resistant S.penumoniae and viridans
  2. MSSA
  3. gram-positive anaerobes
  4. resistant strains of HNPEK
  5. CAPES
  6. Pseudamonas
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45
Q

What microbes does ceftaroline (5th gen cephalosporin) cover?

A
  1. only beta-lactam that covers MRSA
  2. broad gram-positive activity
  3. some HNPEK
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46
Q

Which cephalosporins are used for MDR organisms?

A

Beta-lactamase inhibitor combinations:
1. ceftazidime/avibactam
2. ceftolozane/ tazobactam

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47
Q

What microbes is cefiderocol (siderophore cephalosporin) effective against?

A
  1. PEK
  2. enterobacter
  3. pseudomonas
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48
Q

What is the MOA of cefiderocol (siderophore cephalosporin)?

A

uses the iron transport system to enter gram-negative cell wall

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49
Q

What agents are 1st generation cephalosporins?

A
  1. Cefazolin (IV/IM)
  2. Cephalexin (PO)
  3. Cefadroxil (PO)
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50
Q

What agents are 2nd generation cephalosporins?

A
  1. Cefuroxime (PO/IV/IM)
  2. Cefotetan (IV/IM)
  3. Cefoxitin (IV/IM)
  4. Cefactor (PO)
  5. Cefprozil (PO)
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51
Q

What agents are 3rd generation cephalosporins?

A

Group 1:
1. Cefdinir (PO)
2. Ceftriaxone (IV-no renal dosage adjustment/IM)
3. Cefotaxime (IV/IM)
4. Cefixime (PO)
5. Cefpodoxime (PO)
Group 2:
Ceftazidime (IV/IM)

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52
Q

What agents are 4th generation cephalosporins?

A

Cefipime (IV/IM)

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53
Q

What agents are 5th generation cephalosporins?

A

Ceftaroline (IV/IM)

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54
Q

Cefazolin

A

Ancef

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55
Q

Cephalexin

A

Keflex

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56
Q

Cefuroxime

A

Ceftin

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57
Q

Cefotetan

A

Cefotan

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58
Q

Cefoxitin

A

Mefoxin

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59
Q

Ceftazidime

A

Fortaz

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60
Q

Cefdinir

A

Omnicef

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61
Q

Ceftriaxone

A

Rocephin

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62
Q

Cefepime

A

Maxipime

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63
Q

Cefixime

A

Suprax

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64
Q

Ceftazidime

A

Tazicef

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65
Q

Ceftaroline

A

Telfaro

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66
Q

Caftazidime/Avibactam

A

Avycaz

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67
Q

Ceftolozane/Tazobactam

A

Zerbaxa

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68
Q

Cefiderocol

A

Fetroja

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69
Q

What is CIs to using Ceftriaxone?

A
  1. Hyperbillirubinemic neonates (causes biliary sludging kernicterus-rare but serious brain damage)
  2. concurrent use with Ca containing IV products in neonates (including administration at different times of day)
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70
Q

What are the warnings with cephalosporins?

A

Cross reactivity with PCN allergy (<10%, likelihood higher with 1st generation)

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71
Q

What warning is specific to cefotetan?

A

disulfiram reaction with alcohol ingestion

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72
Q

What are SEs with cephalosporins?

A
  1. Seizures (with accumulation when not dosed for renal dysfunction)
  2. GI upset
  3. Diarrhea
  4. Rash (including SJS/TENS)
  5. Allergic reactions/ Anaphylaxis
  6. Hemolytic anemia (+ Coombs)
  7. acute interstitial nephritis
  8. myelosuppression with prolonged use
  9. elevated LFTs
  10. drug fever
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73
Q

What should be monitored while on cephalosporins?

A
  1. Renal function
  2. LFTs
  3. CBC
  4. signs of anaphylaxis with 1st dose
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74
Q

Which cephalosporin is available in a chewable tablet?

A

cefixime

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75
Q

Which cephalosporin has activity against some carbapenem-resistant enterobacterales (CRE)?

A

ceftazidime/ avibactam

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76
Q

What is the dose of ceftriaxone required to penetrate the CNS to treat meningitis?

A

2g IV Q12H (no renal dosage adjustments)

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77
Q

What cephalosporins need to be separated from antacids by 2 hours and avoided with H2RAs/PPIs?

A
  1. Cefuroxime
  2. Cefpodoxime
  3. cefdinir
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78
Q

What drugs interact with ceftriaxone?

A

Simultaneous administration with Ca containing IV fluids should be avoided in all patients due to insoluble precipitate; adults may have products administered at different times of day if the IV line is flushed between administration of each product; CI in neonates

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79
Q

What are the common uses of Cephalexin PO (1st gen)?

A

1.MSSA
2. strep throat

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80
Q

What are the common uses of Cefuroxime PO (2nd gen)?

A
  1. acute otitis media
  2. CAP
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81
Q

What are the common uses of Cefdinir PO (3rd gen)?

A

acute otitis media

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82
Q

What are the common uses of IV Cefazolin (1st gen)?

A

surgical prophylaxis

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83
Q

What are the common uses of cefotetan and cefoxitin IV (2nd gen)?

A
  1. surgical prophylaxis (GI procedures)
  2. anaerobic coverage (B fragilis)
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84
Q

What are the common uses of Ceftriaxone IV (3rd gen)?

A
  1. CAP
  2. meningitis
  3. SBP
  4. pyelonephritis
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85
Q

Which IV cephalosporins cover pseudomonas?

A
  1. ceftazidime (3rd gen)
  2. cefepime (4th gen)
  3. ceftolozane/tazobactam
  4. ceftazidime/avibactam
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86
Q

What are common uses for IV ceftaroline (5th gen)?

A
  1. CAP
  2. SSTI
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87
Q

What are carbapenems (except ertapenem) effective in covering?

A
  1. MDR gram neg
  2. ESBL bacteria
  3. most gram pos
    NO coverage against:
    MRSA
    VRE
    atypicals
    C.diff
    Stenotrophomas
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88
Q

What organisms does ertapemen NOT cover?

A
  1. Pseudamonas
  2. Acinetobacter
  3. Enterococcus
    PLUS
    MRSA
    VRE
    atypicals
    C.diff
    Stenotrophomonas
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89
Q

What are CIs with carbapenems?

A

anaphylactic reaction to beta-lactam antibiotics

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90
Q

What are warnings with carbapenems?

A
  1. Do not use in patients with PCN allergy (risk of cross reactivity)
  2. CNS adverse effects, including confusion and Seizures
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91
Q

What are SEs with carbapenems?

A
  1. diarrhea
  2. rash/severe skin reactions (DRESS)
  3. bone marrow suppression with prolonged use
  4. elevated LFTs
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92
Q

What should be monitored if on a carbapenem?

A
  1. Renal function
  2. anaphylaxis with 1st dose
  3. LFTs
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93
Q

What must ertapenem be diluted in?

A

NS

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94
Q

What drugs interact with carbapenems?

A
  1. decrease the serum concentration of valproic acid; loss of seizure control
  2. caution in patients with seizures or other meds that lower the seizure threshold (clozapine, quinolones, bupropion, tramadol)
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95
Q

Meropenem

A

Merrem

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96
Q

Meropenem/Vaborbactam

A

Vabomere

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97
Q

Imipenem/Cilastatin

A

Primaxin I.V.

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98
Q

Imipenem/Cilastatin/ Relebactam

A

Recarbrio

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99
Q

Ertapenem

A

Invanz

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100
Q

What microbes does aztreonam cover?

A

gram neg: pseudomonas and CAPES
NO COVERAGE:
gram pos or anerobes

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101
Q

What are SEs with aztreonam?

A
  1. rash
  2. N/V/D
  3. elevated LFTs
    (similar to PCNs)
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102
Q

What is an advantage of aztreonam?

A

can be used with PCN allergy (monobactam structure)

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103
Q

Aztreonam

A

Azactam
Caystan (inhaled for cystic fibrosis)

104
Q

What is the MOA of beta-lactams?

A

Inhibit bacterial wall synthesis by binding to PBPs (penicillin-binding proteins) inhibiting final step of peptidoglycan synthesis

105
Q

What is the MOA of aminoglycosides?

A

bind to the ribosome which interferes with bacterial protein synthesis and results in defective bacterial cell membrane

106
Q

What agents are aminoglycosides?

A
  1. Gentamicin (IV/IM/OS/top)
  2. Tobramycin (IV/IM/OS,inh)
  3. Amikacin (IV/IM)
  4. Streptomycin (IM)
  5. Plazomicin IV (Zemdri-complicated UTI only)
107
Q

What microbes are aminoglycoside effective against?

A
  1. gram neg (including pseudomonas)
  2. synergystic for gram-positive organisms when combined with a beta-lactam/Vanco
  3. post-antibiotic effect; continues killing after serum level drop below the MIC
108
Q

What are the advantages of an extended interval dosing strategy for aminoglycosides?

A
  1. lower accumulation of drug
  2. lower risk of nephrotoxicity
  3. lower cost
109
Q

What are boxed warnings with aminoglycosides?

A
  1. Nephrotoxicity
  2. Ototoxicity (hearing loss, vertigo, ataxia)
  3. Neuromuscular blockade/respiratory paralysis
  4. Avoid with other neurotoxic/ nephrotoxic agents
  5. fetal harm if given in pregnancy
110
Q

What are the warnings with aminoglycosides?

A
  1. Caution with impaired renal function
  2. Caution in older adults
  3. Caution with other nephrotoxic agents (amphotericin B, cisplatin, polymixins, loop diuretics, radiocontrast dye, tacrolimus, NSAIDS, vanco)
111
Q

What is monitored with aminoglycosides?

A
  1. Renal function
  2. Traditional dosing: trough 30 min before 4th dose and peak 30 min after infusion of the 4 the dose
  3. Extended interval: random level per timing on nomogram
  4. urine output
  5. hearing tests
112
Q

How are aminoglycosides dosed based on body weight?

A
  1. underweight: TBW
  2. not underweight or obese: IBW
  3. obese >120% IBW: AdjBW
113
Q

What is the traditional dosing for IV tobramycin/gentamicin?

A

1-2.5 mg/kg/dose; lower doses for gram pos and higher doses for gram neg

114
Q

What is the traditional dosing intervals based on renal function for IV tobramycin/gentamicin?

A
  1. CrCl≥60: Q8H
  2. CrCl 40-60: Q12H
  3. CrCl: 20-40: Q24H
  4. CrCl <20: dose by level
115
Q

What is the extended interval dosing for IV tobramycin/gentamicin?

A

4-7 mg/kg (commonly 7mg/kg) interval based on Hartford nomogram

116
Q

What is a therapeutic trough when dosing gentamicin/tobramycin?

117
Q

What is the MOA of quinolones?

A

Inhibit bacterial topoisomerase IV and DNA gyrase (topoisomerase II); concentration-dependent

118
Q

What are the respiratory quinolones?

A

(enhanced coverage of S. pneumoniae and atypicals)
1. levofloxacin
2. moxifloxacin (anaerobic activity)

119
Q

Which quinolone cannot be used for UTI?

A

Moxifloxacin

120
Q

Which quinolone has activity against MRSA?

A

Delafloxacin

121
Q

Which quinolones have activity against pseudomonas and gram neg?

A
  1. cipro
  2. levofloxacin
122
Q

Which quinolone does NOT require renal dosage adjustment?

A

Moxifloxacin

123
Q

What are boxed warnings with quinolones?

A
  1. Tendon inflammation/rupture up to several months after completing treatment; increased risk with concurrent systemic steroid use, > 60 y/o, solid organ transplant; D/C immediately if occurs
  2. Peripheral neuropathy lasting months to years after D/C
  3. Seizures/ CNS effects; use caution in CNS disorders, drugs that cause seizure, or lower seizure threshold
  4. avoid in myasthenia gravis
  5. Use last-line for: bacterial sinusitis, acute exacerbation of chronic bronchitis, and complicated UTI
124
Q

Which quinolone has a CI with tizanidine administration?

125
Q

What are warnings with quinolones?

A
  1. QT prolongation (M>L>C)
  2. Hypoglycemia/Hyperglycemia
  3. Psychiatric disturbances
  4. Avoid systemic quinolones in children or pregnancy/breastfeeding musculoskeletal toxicity
  5. Photosensitivity
  6. aortic aneurysm and dissection
  7. hepatotoxicity
  8. crystalluria (must stay hydrated)
126
Q

What are SEs with quinolones?

A
  1. nausea
  2. diarrhea
  3. headache
  4. dizziness
  5. serious skin reactions (SJS/TENS)
127
Q

What are counseling points with Cipro?

A
  1. suspension: DO NOT put through NG tube or other feeding tube
  2. Cipro IR tab: can crush and mix with water and give via the feeding tube, hold tube feedings at least 1 hour before and 2 hours after feedings
128
Q

What drugs do quinolones interact with?

A
  1. antacids/polyvalent cations
  2. lanthanum/ sevelamer phos binders (separate administration)
  3. QT prolonging drugs (azole antifungals, antipsychotics, methadone, macrolides) , CVD, low K/Mg
  4. Cipro can increase levels of theophylline/caffine (CYP1A2 inhibitor)
129
Q

What is the MOA of macrolides?

A

bind to the 50S ribosomal subunit, resulting in the inhibition of protein synthesis

130
Q

What microbes do macrolides cover?

A
  1. atypicals (legionella, chlamydia, mycoplasma, MAC
  2. S. penumoniae
  3. Heamopholis
  4. Moraxella
131
Q

What are common uses for macrolides (resistance on the rise tho)?

A
  1. CAP
  2. lower respiratory tact infections
  3. chlamydia
132
Q

What are CIs to using macrolides?

A

history of cholestatic jaundice/hepatic dysfunction with prior use

133
Q

What are CIs to using clarithromycin?

A
  1. do not use with Lovastatin or Simvastatin, pimozide, ergotamine or dihydroergotamine
  2. concurrent use of colchicine in patients with renal/hepatic impairment
134
Q

What are CIs to using erythromycin?

A

do not use with Lovastatin or Simvastatin, pimozide, ergotamine or dihydroergotamine

135
Q

What are warnings with macrolides?

A
  1. QT prolongation (erythromycin>azithromycin> clarithromycin); caution with known QT prolongation/hypokalemia
  2. Hepatotoxicity; caution in liver disease
  3. exacerbation of myasthenia gravis
  4. CAD: increased mortality ≥ 1 year after a 2 week course with clarithromycin
136
Q

What are SEs with macrolides?

A
  1. GI upset (diarrhea, abdominal pain, cramping)
  2. taste pervertion
  3. otoxocity (rare, reversible)
  4. severe but rare skin reactions (SJS/TENS/DRESS)
137
Q

How is azithromycin dosed?

A
  1. Z-Pak: 500mg day 1, then 250mg days 2-5
  2. Tri-Pak: 500mg x 3 days
  3. no renal dosage adjustment required
138
Q

Erythromycin

A

E.E.S
Ery-Tab
Erythrocin

139
Q

What are DIs with macrolides?

A
  1. use caution with QT-prolonging drugs (azole antifungals, antipsychotics, methadone, quinolones)
  2. use caution CVD, decreased K and Mg- can cause QT prolongation and arrhythmias
140
Q

Which macrolides have major CYP interactions?

A

erythromycin and clarithromycin: major substrates and inhibitors of CYP3A4; CI with simvastatin and lovastati, caution with warfarin

141
Q

What is the MOA of tetracyclines?

A

reversibly bind to 30S ribosomal subunit and inhibit protein synthesis

142
Q

What are uses for Doxyxycline?

A
  1. CAP/respiratory tract infections
  2. tickborne/rickettsial diseases
  3. STI (chlamydia)
  4. CA-MRSA
  5. VRE UTIs
  6. atypical infections
143
Q

What are warnings with tetracyclines?

A
  1. Children <8 years, pregnancy and breastfeeding (suppresses bone growth/skeletal development)
  2. Photosensitivity
  3. tissue hyperpigmentation
  4. severe skin reactions (DRESS/SJS/TENS)
  5. exfoliative dermatitis
  6. GI inflammation/ulceration
  7. drug-induced lupus erythematosus (minocycline)
144
Q

What are SEs with tetracyclines?

A
  1. N/V/D
  2. rash
145
Q

What should be monitored with tetracyclines?

A
  1. LFT
  2. renal function
  3. CBC
146
Q

What is an important counseling point with tetracyclines?

A
  1. tablets and capsules should be taken with 8oz of water
  2. sit upright for at least 30 minutes after dose (doxycycline)
  3. take with food to decrease GI irritation (except Oracea)
147
Q

How is doxycycline dosed?

A
  1. PO:IV ratio is 1:1
  2. no renal dosage adjustment
148
Q

What are DIs with tetracyclines?

A

chelate and inhibit the absorption of tetracyclines, separate:
1. antacids
2. polyvalent cations
3. sucralfate
4. bismuth subsalicylate
5. bile acid resins
6. dairy (avoid 1 hour before or 2 hours after teatracycline)

149
Q

Doxycycline

A

Vibramycin

150
Q

Minocycline

A

Minocin
Solodyn

151
Q

What is the MOA of Sulfamethoxazole/Trimethoprim?

A

SMX: inhibits dihydrofolic acid formatio, interfere with folic acid synthesis
TMP: inhibition of the folic acid pathway

152
Q

What microbes does SMX/TMP cover?

A
  1. gram neg including Shigella, Salmonella, and Stenotrophomonas
  2. MRSA
  3. NO coverage against pseudomonas, enterococci, atypicals, or anerobes
153
Q

What are CIs with SMX/TMP?

A
  1. Sulfa allergy
  2. anemia due to folic acid deficiency
  3. renal/hepatic disease
  4. infants <2 months
154
Q

What are warnings with SMX/TMP?

A
  1. Skin reactions: SJS/TENS, thrombotic thrombocytopenic purapura
  2. Hemolytic anemia: immune-mediated (+ Coombs) or due to G6PD deficiency; D/C if hemolysis occurs
  3. blood dyscrasias (including agranulocytosis and aplastic anemia
  4. hypoglycemia
  5. thrombocytopenia
  6. Pregnancy (benefit>risk)
155
Q

What are SEs with SMX/TMP?

A
  1. Photosensitivity
  2. Hyperkalemia
  3. Crystalluria (take with 8oz of water)
  4. N/V/D
  5. anorexia
  6. skin rash
  7. low folate
  8. false elevation in SCr (inhibition of creatinine tubular secration)
    9.renal failure
156
Q

What is monitored with SMX/TMP?

A
  1. renal function
  2. electrolytes
  3. CBC
  4. folate
157
Q

How is SMX/TMP dosed?

A

SS: 400mg SMX/ 80mg TMP
DS: 800mg SMX/160mg TMP
SMX:TMP= 5:1; dosed based on TMP
CrCl 15-30: renal adjustment required

158
Q

What is the dosing of SMX/TMP for uncomplicated UTI?

A

1 DS PO BID x 3 days

159
Q

What is dosing of SMX/TMP for severe infections?

A

PO/IV: 10-20 mg TMP/kg/day Q-6-12H

160
Q

What are DIs with SMX/TMP?

A
  1. CYP2C9 inhibitor: can increase INR with warfarin
  2. Increased risk of hyperkalemia in patients with renal dysfunction if used in combination with ACE/ARBs, K-sparing diuretics, cyclosporine, tacrolimus, drospierenone OCs, canagliflozin
  3. enhance toxic effects of methotrexate
  4. leucovorin decreases effectivness
161
Q

What is the MOA of Vancomycin?

A

inhibits bacterial wall synthesis binding to the D-alanyl-D-alanine, blocking peptidoglycan polymerization

162
Q

What microbes does vanco cover?

A
  1. gram pos (MRSA, strep, enterococci)
  2. C.diff (PO)
  3. does NOT cover VRE
163
Q

What are warnings with vanco?

A
  1. Ototoxicity; caution with other otoxic drugs
  2. Nephrotoxicity; caution with other nephrotoxic drugs
  3. PO formulation only for C.diff (IV formulation not effective for C.diff)
  4. Do not infuse faster than 1g/h to prevent Vancomycin infusion reaction
164
Q

What are SEs with vanco?

A
  1. abdominal pain
  2. nausea (PO)
  3. phlebitis
  4. myelosuppression (neutropenia, thrombocytopenia)
  5. drug fever
  6. severe skin reactions
165
Q

What should be monitored on Vanco?

A
  1. renal function
  2. WBCs
  3. Serious MRSA inf (bacteremia, sepsis, endocarditis, pneumonia, osteomylitis,meningitis): AUC/MIC 400-600 or trough 15-20 mcg/mL
166
Q

What are uses for vancomycin?

A

1st line treatment for systemic MRSA infection; consider alternative regimen when MIC ≥2 mcg/mL

167
Q

How is vancomycin dosed?

A

IV: 15-20 mg/kg Q8-12H based on TBW
CrCl <20-49: Q24H
PO: 125mg QID x 10 days (no renal adjustment PO)

168
Q

What are DIs with vanco?

A
  1. Other nephrotoxic drugs (aminoglycosides, cisplatin, amphotericin B, polymixins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, radiographic contrast dye
  2. Other otoxic drugs (aminoglycosides, cisplatin, loop diuretics)
169
Q

Vancomycin

170
Q

What is the MOA of lipoglycopeptides (telavancin, oritavancin, dalbavancin)?

A
  1. inhibits bacterial wall synthesis binding to the D-alanyl-D-alanine, blocking peptidoglycan polymerization
  2. lipophilic side chain disrupts bacterial cell membrane potential, changing permeability
  3. concentration dependent
171
Q

What are uses for lipoglycopeptides (-vancin)?

A
  1. SSTIs
  2. HAP/VAP (only telavancin)
172
Q

What are boxed warnings with telavancin?

A
  1. Fetal risk- obtain pregnancy test prior to starting therapy
  2. Nephrotoxicity (increased mortality with pre-existing mod-severe renal impairment CrCl≤50 when compared to vanco in pneumonia trials
173
Q

What are CIs to using televancin?

A

concurrent use of IV unfractionated heparin

174
Q

What are CIs to using ortavancin?

A

do not use IV unfractionated heparin for 120 hours (5 days) after ortivancin administration due to false elevations with aPTT

175
Q

What are warnings with all lipoglycopeptides -vancin?

A

Infusion reaction with rapid IV administration (similar to vanco)

176
Q

What are warnings with televancin?

A
  1. Falsely elevate aPTT but does not increase bleeding risk
  2. QT prolongation
  3. renal dose adjustment required
177
Q

What are warnings with ortavancin?

A
  1. Falsely elevate aPTT but does not increase bleeding risk
  2. use a different ABX if osteomylitis confirmed or suspected
  3. renal dose adjustment requires
178
Q

What are warnings with dalbavancin?

A

elevated ALT >3x ULN

179
Q

What are DIs with televancin?

A
  1. patients with congenital QT syndrome
  2. known QT prolongation
  3. HF
  4. use with caution with medications that prolong the QT interval
180
Q

What is the MOA of daptomycin?

A

binds to cell membrane components causing rapid depolarization- inhibits all intracellular processes; concentration dependent

181
Q

What are uses for daptomycin?

A
  1. gram pos
  2. MRSA
  3. VRE
    4.NO gram neg
182
Q

What are warnings with daptomycin?

A
  1. Myopathy or Rhabdomyolysis: D/C with s/sx and CPK>1000 or asymptomatic and CPK>2000; consider holding statins
  2. Falsely elevate PT/INR but does not increase bleeding risk
  3. Compatible with NS and LR (not D5W)
  4. NOT used to treat pneumonia; drug inactivated in the lungs
  5. peripheral neuropathy
  6. DRESS/eosinophilic pneumonia- develops 2-4 weeks after treatment initiation
183
Q

What are SEs with daptomycin?

A
  1. Elevated CPK (more frequent with statin/ renal impairment)
  2. abdominal pain
  3. pruritus
  4. chest pain
  5. edema
  6. HTN
  7. AKI
184
Q

Daptomycin

A

Cubicin (brand D/C, name used)

185
Q

What is the MOA of oxazolidinones (linezolid/tedizolid)?

A

bind to the 50S subunit of the bacterial ribosome, inhibiting translation and protein synthesis

186
Q

What are uses for oxazolidinones (linezolid/tedizolid)?

A
  1. gram pos (MRSA)
  2. VRE
187
Q

What are CIs with linezolid?

A

DO NOT use within 2 weeks of MAO inhibitors

188
Q

What are warnings with linezolid?

A
  1. Duration-related myelosuppression (Thrombocytopenia, anemia, leukopenia)
  2. Optic neuropathy
  3. Serotonin syndrome
  4. Hypoglycemia (caution with insulin and antihyperglycemics)
  5. peripheral neuropathy
  6. hyponatremia
  7. lactic acidosis
  8. seizures
  9. HTN (caution with with uncontrolled HTN/hyperthyroidism)
189
Q

What are SEs with linezolid?

A
  1. Low Platelets
  2. low Hgb
  3. low WBCs
  4. headache
  5. nausea/diarrhea
  6. elevated LFTs
190
Q

What should be monitored with linezolid?

A
  1. Weekly CBC
  2. HR
  3. BP
  4. BG (in diabetes)
  5. visual function
191
Q

What are the counseling points with linezolid dosing?

A

Suspension: DO NOT shake
IV:PO ratio = 1:1
No renal dosage adjustments

192
Q

Linezolid

193
Q

What are warnings with tedizolid?

A
  1. consider alternative treatment with neutropenia
  2. approved only for SSTIs
  3. IV:PO= 1:1
  4. no renal adjustments
194
Q

What are SEs with tedizolid?

A
  1. nausea/diarrhea
  2. dizziness
  3. infusion related reactions
195
Q

What are DIs with linezolid/tedizolid?

A
  1. Reversible MOA inhibitors; Avoid tyramine-containing foods and Serotonergic drugs
  2. exacerbate hypoglycemia (linezolid)
196
Q

What microbes does tigecycline cover?

A
  1. gram pos
  2. MRSA/VRE
  3. No activity against: pseudomonas, proteus, Providencia
197
Q

What are boxed warnings with tigecycline?

A

Increased risk of death, use only when alternative treatments are not suitable

198
Q

What are warnings with tigrcycline?

A
  1. Anaphylactic reaction; avoid in patients with tetracycline-class allergy)
  2. hepatotoxicity
  3. photosensitivity
  4. bone growth suppression and teeth discoloration in children <8 years old (avoid use)
  5. DO NOT use for blood stream infections; does not achieve adequate concentrations
199
Q

What are SEs with tigecycline?

A
  1. N/V(can be intractable)/D
  2. headache
  3. dizziness
  4. elevated LFTs
  5. rash/severe skin reactions (SJS)
200
Q

What is a counseling point with tigecycline?

A

Reconstituted solution should be yellow-orange; discard of not this color

201
Q

Tigecycline

202
Q

What is the MOA of polymixins?

A

colistimethate is the prodrug of colistin; colistin and polymyxin act as cationic detergents damaging bacterial cell membrane

203
Q

What are uses for polymixins?

A

MDR gram neg (enterobacter, E.coli, klebsiella, pseudomonas)

204
Q

What are warnings with colistimethate?

A
  1. Dose-dependent nephrotoxicity (monitor renal function)
  2. Neurotexicity (dizziness, headache, oral parathesia, vertigo, respiratory paralysis from neuromuscular blockade)
  3. Assess dose carefully; avalible in units of colistmethate, mg of colistmethate, or mg of colistin
205
Q

What are boxed warnings with polymixin B?

A
  1. Dose dependent nephrotoxicity
  2. Neurotoxicity (Respiraotry paralysis from Neuromuscular Blockade, dizziness, headache, oral parathesia, vertigo)
  3. Only administerin hospitalized patients
  4. Avoid use of other neurotoxic or nephotexic drugs
206
Q

What are DIs with polymixins?

A

Avoid use with nephrotoxic drugs (aminoglycosides, cisplatin, radiocontrast dye, vancomycin, amphotericin B, tacrolimus, cyclosporine, loop diuretics, NSAIDs)

207
Q

Why is chloramphenicol not used?

A

SEs:
fatal blood dyscrasis
Cray syndrome (circulatory collapse, cyanosis, acidosis)

208
Q

What are uses for clindamycin?

A
  1. gram pos (not enterococcus)
  2. anerobes
  3. NO gram neg
209
Q

What are boxed warnigns with clindamycin?

A

colitis (C.difficile)

210
Q

What are warnings with clindamycin?

A
  1. Induction D test should be performed on S. aureus that is susceptible to clindamycin but resistant to erythromicin; A Flattened Zone between disks (pos D test) indicates inducible clindamycin resistance and should NOT be used
  2. Severe/fatal skin reactions (SJS/TENS/DRESS)
  3. no renal adjustment reauired
211
Q

What are SEs with clindamycin?

A
  1. N/V/D
  2. rash/ urticaria
  3. elevated LFts (rare)
212
Q

Clindamycin

A

Cleocin
Topical: Cleocin-T, Clindagel

213
Q

What is the uses for metronidazole/tinidazole?

A

Metronidazole: anaerobes and protozoal organisms; bacterial vaginosis, trichominiasis, intra-abdominal infections
Tinidazole: protozoal; giardiasis, amebiasis

214
Q

What are boxed warnings with metronidazole?

A

possible carcinogenic based on animal data

215
Q

What are CIs to using metronidazole?

A
  1. Pregnancy 1st trimester
  2. Use of alcohol or propylene glycol during treatment or within 3 days of treatment D/C (disulfiram reaction)
  3. use of disulfiram within the past 2 weeks (metronidazole)
  4. breastfeeding (tinidazole)
216
Q

What are warnings with metronidazole/tinidazole?

A
  1. CNS effects: seizures, peripheral neuropathy
  2. aseptic meningitis, encephalopathy, optic neuropathy (metronidazole)
217
Q

What are SEs with metronidazole/tinidazole?

A
  1. Metallic taste
  2. headache
  3. nausea
  4. furry tongue
  5. dizziness
  6. rash/severe skin reactions (SJS/TENS)
218
Q

How is metronidazole dosed/ dosage forms?

A
  1. IV:PO= 1:1
  2. topical
  3. vaginal
219
Q

What are the warnings with secnidazole?

A
  1. vulvovaginal candidiasis, possible carcinogenic
  2. Only for bacterial vaginosos and trichomoniasis
  3. administered PO as a single dose
220
Q

What are SEs with secnidazole?

A
  1. headache
  2. N/V
221
Q

Metronidazole

222
Q

What are DIs with metronidazole?

A
  1. Do NOT drink alcohol during and for 3 days after D/C due to potential disulfiram reaction
  2. inhibitor of CYP2C9 can cause increased INR with warfarin
223
Q

What is the MOA of metronidazole/tinidazole/secnidazole?

A

loss of helical DNA structure

224
Q

What is the MOA of Lefamulin

A

binds to the 50S subunit of the ribosome

225
Q

What are CIs to using lefamulin?

A

use with CYP3A4 substrates that prolong QT interval

226
Q

What are warnings with lefamulin?

A
  1. Pregnancy (teratogenic)
  2. QT prolongation
227
Q

What are SEs with lefamulin IV/PO?

A
  1. injection site reactions
  2. nausea/diarrhea
228
Q

What is the MOA of fidaxamin?

A

inhibits RNA polymerase, inhibiting protein synthesis

229
Q

What is fidaximin used for?

230
Q

What are the warnings with fidaximin?

A

Not effective for systemic infections-minimal absorption (PO only)

231
Q

What are SEs with fidaximin?

A
  1. N/V
  2. abdominal pain
  3. GI bleeding
  4. anemia
232
Q

Fidaximin

233
Q

What is the MOA of rifaximin?

A

binds to DNA-dependent RNA polymerase

234
Q

What are uses for rifaximin?

A
  1. traveler’s diarrhea
  2. hepatic encephalopathy
  3. IBS with diarrhea
235
Q

What are SEs with rifaximin?

A
  1. peripheral edema
  2. dizziness
  3. headache
  4. nausea
  5. abdominal pain
  6. rash/pruritis
236
Q

What are counseling points with rifaximin?

A
  1. Not effective for systemic infections (PO abs minimal)
  2. Off-label for C.diff
  3. no renal adjustments
237
Q

What is the dosing for fosfomycin by indication?

A

Uncomplicated UTI (female): 3g (1 granule packet) PO x 1 mixed with 3-4 oz of cold water

238
Q

What are SEs with fosfomycin?

A
  1. headache
  2. nausea/diarrhea
  3. concentrated in the urine
239
Q

What is the MOA of nitrofurantoin?

A

Bacterial cell wall, DNA, RNA, and protein synthesis inhibitor

240
Q

What are uses for nitrofurantoin?

A

Uncomplicated UTI (E.coli, klebsiella, enterobacter, enterococcus, VRE)

241
Q

What are CIs to using nitrofurantoin?

A
  1. Renal impairment CrCl <60: inadequate urine concentration and risk for accumulation of neurotexins
  2. hx of cheolestatic jaudice/hepatic dysfunction with previous use
  3. pregnancy (at term)
242
Q

What are warnings with nitrofurantoin?

A
  1. GPD6 deficiency (can cause Hemolytic anemia)
  2. optic neuritis
  3. hepatotoxicity
  4. pulmonary toxicity
243
Q

What are SEs with nitrofurantoin?

A
  1. GI upset (take with food)
  2. Brown urine discoloration (harmless)
  3. headache
  4. rash
  5. concentrates in the urine
244
Q

What is the dosing of Macrobid (nitrofurantoin)?

A

100mg PO BID x 5 days

245
Q

Nitrofurantoin

A

Macrobid
Macrodantin

246
Q

What are uses for mupirocin topically in the nares?

A

eliminate MRSA colonization

247
Q

Which ABX require refrigeration after reconstitution?

A
  1. Penicillin VK
  2. Augmentin
  3. Cephalexin
  4. valganciclovir
248
Q

Which ABX should be refrigerated?

A

Amoxicillin- better taste
Oseltamivir- increases shelf life

249
Q

What ABX should NOT be refrigerated?

A
  1. Cefdinir
  2. doxy
  3. quinolones
  4. pretty much everything else (except other cephalosporins)
250
Q

Which IV ABX should NOT be refrigerated?

A
  1. Metronidazole
  2. Moxifloxacin
  3. SMX/TMP
  4. acyclovir
251
Q

Which ABX do NOT require renal dose adjustments?

A
  1. antistaphylococcal PCNs
  2. Azythromicin/erythromycin
  3. Ceftriaxone
  4. Clindamycin
  5. Doxy
  6. Metronidazole
  7. moxifloxacin
  8. linezolid
252
Q

Which ABX should NOT be taken with food?

A
  1. Ampicillin PO caps
  2. Levofloxacin PO sol
  3. Penicillin VK
  4. tetracycline
  5. doxy (Orecea brand)
  6. rifampin
  7. isoniazid
  8. itraconazole PO sol
  9. voriconazole
253
Q

Which IV ABX require protection from light?

A
  1. Doxycycline
  2. Micafungin
254
Q

Which ABX are only compatible with D5W?

A
  1. SMX/TMP
  2. Amphotericin B
  3. pentamide
255
Q

Which ABX are compatible with NS only?

A
  1. Ampicillin
  2. Unasyn
  3. Ertapenem
256
Q

Which ABX are compatible with NS or LR only?

A
  1. Capsofungin
  2. Daptpmycin
257
Q

Which ABX has 1:1 IV:PO dosing?

A
  1. Azythromycin
  2. levfloxacin/moxifloxacin
  3. doxy, minocycline
  4. linezolid/tinezolid
  5. metronidazole
  6. SMX/TMP

RxPrep (67 decks)

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