Antibiotics 1 Flashcards

Question

Dosage Forms - Mupirocin

Answer 1

ALL 2% Topical Ointment Topical Cream Nasal Ointment

Answer 2

Inhibits bacteria DNA gyrase, an enzyme responsible for the unwinding of DNA for transcription and subsequent supercoiling of DNA for packaging into chromosomal subunits

Answer 3

Broad-spectrum | Highly active against aerobic, Gram (-) bacilli

Answer 4

1. Otitis externa, acute (adults and children >1 year of age): 0.25 mL (entire single-use container) into affected ear(s) BID (approximately q12h) x 7 days 2. Otitis media with effusion: 0.1 mL (6 mg) once intratympanically to each affected ear following suctioning of middle ear effusion during tympanostomy tube placement

Answer 5

1. Anthrax, post-exposure prophylaxis Adults - 500 mg q12h x at least 60 days Children - 15 mg/kg BID x at least 60 days, max 500 mg/dose 2. Bacterial prostatitis, chronic: 500 mg q12h x 28 days 3. Bronchitis, lower respiratory tract infection, infection of bone, skin, or soft tissue, sinusitis: 500-750 mg q12h x 7-14 days 4. UTI: 250-500 mg q12h x 3 days (IR); 500 mg q24h x 3 days (ER)

Answer 6

1. Traveler's diarrhea: 750 mg as a single dose (mild); 500 mg BID x 3 days (sever) 2. Diabetic foot infection: 500 mg q12h (750 mg q12h if P. aeruginosa is suspected), duration dependent

Answer 7

Inhibits bacterial DNA gyrase and topoisomerase IV

Answer 8

Broad-spectrum Highly active against aerobic, gram-negative bacilli, especially Enterobacteriaceae Has poor activity against streptococci and anaerobes

Answer 9

1. Bacterial conjunctivitis (adults and children > 1 year): 0.5 % ophthalmic solution - 1 drop into affected eye(s) q2h while awake on day 1 (MAX 8 doses/day), then QID while awake for 6 more days

Answer 10

Inhibits bacterial DNA gyrase, an enzyme responsible for the unwinding of DNA for transcription and subsequent supercoiling of DNA for packing into chromosomal subunits

Answer 11

Broad-spectrum | Highly active against aerobic, gram-negative bacilli

Answer 12

1. Bacterial prostatitis, chronic: 500 mg QD x 28 days 2. Bacterial sinusitis, acute: 750 mg QD x 5 days 3. Bronchitis, chronic, acute bacterial exacerbation: 500 mg QD x 7 days 4. Community-acquired pneumonia: 500 mg QD x 7-14 days, or 750 mg QD x 5 days 5. Infection of skin and/or subcutaneous tissue (uncomplicated): 500 mg QD x 7-14 days 6. Pyelonephritis, acute: 250 mg QD x 10 days

Answer 13

1. Chlamydial inflection: 500 mg QD x 7 days | 2. Traveler's diarrhea: 500 mg QD x 1-3 days

Answer 14

Inhibits bacterial topoisomerase II and IV

Answer 15

Broad-spectrum Anaerobes Effective for respiratory tract infections caused by S. pneumoniae, H. influenzae, and others

Answer 16

1. Bacterial conjunctivitis (adults and children >4 months of age): 1 drop into affected eye(s) BID (Moxeza) or TID (Vigamox) x 7 days

Answer 17

1. Acute bacterial exacerbation of chronic bronchitis: 400 mg QD x 5 days 2. Bacterial sinusitis, acute: 400 mg QD x 10 days 3. Community-acquired pneumonia: 400 mg QD x 7-14 4. Infection of skin and/or subcutaneous tissue: 400 mg QD x 7-21 days 5. Complicated intra-abdominal infections: 400 mg QD x 5-14 days

Answer 18

1. Tuberculosis: 400 mg QD x 6 months

Answer 19

Synthetic nitrofuran inactivates bacterial ribosomes and is bactericidal in urine at therapeutic doses

Answer 20

Active against most bacteria that cause UTIs except nearly all strains of Pseudomonas are resistant

Answer 21

1. UTI treatment (adults and children >12 years of age): Macrobid 100 mg BID x 5-7 days; Furadantin, Macrodantin 50-100 mg q6h x 5-7 days 2. UTI treatment (children >1 month of age): 5-7 mg/kg/day in divided doses q6h x 7 days (max 400 mg/day) 3. UTI prophylaxis (adults): 50-100 mg QHS 4. UTI prophylaxis (children > 1 month of age): 1 mg/kg/day in divided doses every 12-24 hours (max dose 100 mg/day)

Answer 22

1. Asymptomatic bacteriuria in pregnancy: 100 mg BID x 4-7

Answer 23

SMZ competitively inhibits the synthesis of dihydropteroic acid (an inactive folic acid precursor) in microorganisms. TMP inhibits the enzymatic reduction of dihydrofolic acid to tetrahydrofolic acid. The combination is active against many bacteria and P. carinii. SMZ/TMP has in vitro activity against MRSA, but clinical success has been variable and unpredictable

Answer 24

1. Acute infective exacerbation of COPD: 800 mg SMZ and 160 mg TMP q12h x 3-7 days 2. HIV infection, Pneumocystis pneumonia: 1600 mg SMZ and 320 mg TMP BID x 21 days 3. HIV infection, Pneumocystis pneumonia, prophylaxis (adults): 800 mg SMZ and 160 mg TMP QD 4. HIV infection, Pneumocystis pneumonia, prophylaxis (children > 1 month of age): 750 mg/m^2/day SMZ and 150 mg/m^2/day TMP in 2 divided doses 3 times/week on consecutive days 5. Traveler's diarrhea: 800 mg SMZ/160 mg TMP BID x 5 days 6. UTI (adult): 800/160 BID x 10-14 days 7. UTI (children > 2 months of age): 8 mg/kg TMP component/day BID x 10 days

Answer 25

1. Sinusitis: 800 mg/160 mg BID x 10-14 days | 2. Prostatitis: 800 mg/160 mg BID x 4-6 weeks

Answer 26

Inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase. Because of this unique mechanism, mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents

Answer 27

1. Impetigo: apply topically TID x 3-5 days, reevaluate if no response 2. Secondary skin infections: apply topically TID x 10 days, reevaluate if no response in 3-5 days 3. Eradication of nasal colonization of MRSA during institutional outbreaks: apply 1/2 of single use tube to each nostril BID x 5 days

Answer 28

1. Surgical prophylaxis in MRSA carriers: apply 1/2 of single tube to each nostril BID x 5 days

Answer 29

Absorption: F = 50-80%, minor food effect Distribution: widespread (bile, CSF, gyn tissue, liver, lung, prostate, peritoneum, synovial fluid, sputum, etc) Metabolism: not metabolized; P-gp substrate, strong inhibitor of CYP1A2 Elimination: renal 30-57%; T1/2 = 3-6 hours Hepatic Dose Adjustment: none Renal Dose Adjustment: CrCl 30-50 mL/min = 250-500 mg q12; CrCl 5-29 mL/min = 250-500 mg q18h

Answer 30

Absorption: F = 99%, no food effect, take without regard to meals Distribution: widespread (bile, blister, CSF, gyn tissues, lung, prostate, synovial fluid, sputum, tonsils) Elimination: renal 87%; T1/2 = 6-8 hours Hepatic Dose Adjustment: none Renal Dose Adjustment: CrCl 20-50 mL/min = reduce dose by 50%; CrCl 5-19 mL/min = extend dosing interval to q48h

Answer 31

Absorption: F = 90%, no food effect, take without regard to meal Distribution: Vd = 1.7-2.7 L/kg; abdominal tissue, bronchial mucosa, CSF, sinus, sputum; 30-50% protein binding Metabolism: 52% hepatic via glucuronide and sulfate conjugation Elimination: renal 20%; T1/2 of 12 h Hepatic and Renal Dose Adjustment: none

Answer 32

Absorption: F = 94%, food increases absorption Distribution: 60-90% protein bound Metabolism: in all tissues to inactive metabolite Elimination: renal 20-25%; T1/2 = 1 hour Hepatic Dose Adjustment: none Renal Dose Adjustment: contraindicated if CrCl <60 mL/min

Answer 33

Absorption: F = 90%, no effect of food on absorption Distribution: CSF, middle ear fluid, sputum, and vaginal fluid Metabolism: hepatic >90%, TMP is CYP2C9 and CYP3A4/5 substrate; TMP is moderate inhibitor of CYP2C8 and CYP2C9 Elimination: SMZ - renal 10-30%; T1/2 = 8-11 hours TMP - renal 50-75%; T1/2 = 6-17 hours Hepatic Dose Adjustment: none Renal Dost Adjustment: CrCl 15-30 mL/min = reduce dose by 50%; CrCl <15 mL/min = avoid, or reduce by 50% and increase interval to 24 hour

Answer 34

1. CYP3A4 and CYP3A5 inducers/inhibitors 2. CYP2C8 and CYP2C9 substrates 3. Agents that prolong QTc interval/antiarrhythmics - increased risk for arrhythmia (avoid use when possible) 4. Methotrexate - synergistic antifolate effects (avoid use or monitor closely)

Answer 35

1. Fluconazole - increased risk for hepatic and pulmonary toxicity, mechanism unknown (avoid use or monitor closely)

Answer 36

1. Di- and trivalent cations (Ca++, etc.), iron, sevelamer = decreased absorption by chelation (take 2 hour before or 6h after) 2. Antidiabetic agents = hypo-and hyperglycemia, mechanism unknown (monitor closely) 3. Corticosteroids = increased risk for tendon rupture (avoid concomitant use when possible) 4. Warfarin - increased bleed risk (monitor INR closely) 5. Agents that prolong QTc interval/antiarrhythmics - increased risk for arrhythmia (avoid use) 6. Ciprofloxacin interacts with P-gp inducers/inhibitors

Answer 37

Pregnancy: category C 2. Lactation: weigh risks and benefits

Answer 38

Pregnancy: category C Lactation: weigh risks and benefits

Answer 39

Pregnancy: category C Lactation: avoid

Answer 40

Pregnancy: category C Lactation: avoid

Answer 41

Pregnancy: category B Lactation: usually safe

Answer 42

Pregnancy: avoid in pregnancy due to risk for malformations Lactation: weigh risks vs. benefits

Answer 43

Pregnancy: category B Lactation: weigh risks vs. benefits

Answer 44

May exacerbate muscle weakness in patients with myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac dermatologic and hypersensitivity reactions, aortic dissection and rupture, hypoglycemia, mental health adverse effects

Answer 45

May exacerbate muscle weakness in patients with myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac, dermatologic and hypersensitivity reactions, aortic dissection and rupture

Answer 46

May exacerbate muscle weakness in patients with myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, aortic dissection and rupture, hypoglycemia, delirium (oral only)

Answer 47

Concomitant tizanidine with oral ciprofloxacin, hypersensitivity to any fluoroquinolone

Answer 48

Hypersensitivity to any fluoroquinolone

Answer 49

Hypersensitivity to any fluoroquinolone

Answer 50

Hypersensitivity to any fluoroquinolone

Answer 51

Hypersensitivity to nitrofurantoin, use in neonates or pregnant patients at term (38-42 wk) due to risk of hemolytic anemia, anuria or oliguria

Answer 52

Hypersensitivity to sulfonamides, children <2 mo, pregnant patients at term, megaloblastic anemia due to folate deficiency, history of drug-induced thrombocytopenia with use of sulfonamides or trimethoprim, marked hepatic damage or severe renal disease, concomitant administration with dofetilide

Answer 53

Hypersensitivity

Answer 54

Avoid in renal dysfunction, avoid long-term use

Answer 55

Common: tooth discoloration in infants, musculoskeletal signs and symptoms Less common: N/V/D, rash, myalgia, arthralgia, tendonitis, headache, dizziness Rare but serious: SJS, renal failure, anemia, neutropenia, thrombocytopenia, seizure, cardiac effects, liver failure, myasthenia gravis, tendon rupture, renal failure psychosis, QTc prolongation, peripheral neuropathy, CNS effects, severe cardiac, dermatologic, and hypersensitivity reactions

Answer 56

Common: application site pain/itching Less common: fungal ear superinfection Rare but serious: hypersensitivity reaction

Answer 57

Common: none Less common: Conjunctivitis, dry eyes, eye pain, subconjunctival hemorrhage, tearing and burning of the eyes, decreased visual acuity Rare but serious: conjunctival hemorrhage

Answer 58

Common: photosensitivity Less common: N/V, rash, myalgia, arthralgia, tendonitis, headache Rare but serious: Stevens-Johnson syndrome, renal failure, severe hypersensitivity, anemia, neutropenia, thrombocytopenia, seizure, cardiac arrest, cardiac arrhythmias, liver failure, tendon rupture, psychosis, glucose abnormalities, C. difficile colitis, peripheral neuropathy, CNS effects, severe cardiac, dermatologic and hypersensitivity reactions

Answer 59

Common: none known Less common: N/D, dizziness, headache Rare but serious: Stevens-Johnson syndrome, renal failure, severe hypersensitivity, anemia, neutropenia, thrombocytopenia, seizure, cardiac arrhythmias, liver failure, tendon rupture, psychosis, exacerbation of myasthenia gravis, peripheral neuropathy, CNS effects, severe cardiac, dermatologic and hypersensitivity reactions

Answer 60

Common: none known Less common: Conjunctivitis, dry eyes, eye pain, subconjunctival hemorrhage, tearing and burning of the eyes, decreased visual acuity Rare but serious: fungal or bacterial ocular superinfection

Answer 61

Common: discoloration of urine Less common: D/N, headache, superinfection Rare but serious: Severe hypersensitivity, hepatic failure, hemolytic anemia, interstitial lung disease

Answer 62

Common: D/N Less common: skin rash, urticaria Rare but serious: Severe hypersensitivity, renal failure, hepatic failure, pancytopenia, arrhythmias, Stevens-Johnson syndrome, hyperkalemia, hypoglycemia, hemolytic anemia

Answer 63

Common: none known Less common: headache, pruritis, burning at site of application, stinging sensation, rhinitis Rare but serious: C. difficile diarrhea

Answer 64

Efficacy: resolution of signs and symptoms of infection Toxicity (systemic): renal function, baseline SCr Toxicity (otic): secondary fungal infection, topical reactions

Answer 65

Efficacy: resolution of signs and symptoms of infection Toxicity: topical reactions

Answer 66

Efficacy: resolution of signs and symptoms of infection Toxicity: renal function, baseline SCr

Answer 67

Efficacy: resultion of signs and symptoms of infection Toxicity (systemic): renal function, baseline SCr Toxicity (otic): topical reactions

Answer 68

Efficacy: resolution of clinical signs and symptoms within 2-3 days Toxicity: Severe diarrhea, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath. Signs of pulmonary reaction, numbness or tingling of extremities. With long-term use, CBC, LFTs, SCr.

Answer 69

Efficacy: resolution and improvement of clinical signs of infection within 2-3 days Toxicity: monitor renal function (SCr), potassium in those with concurrent ACEIs. Monitor FBG with concurrent sulfonylureas, insulin. CBC monthly if using for PCP prophylaxis.

Answer 70

Efficacy: resolution of clinical signs of infection within 3-5 days, eradication of nasal colonization Toxicity: seek medical attention if local adverse effects are severe

Answer 71

Counseling: 1. Seek medical attention immediately for any s/s of serious adverse effects, such as blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations. 2. May take with or without food, but do not take with dairy products no any other food containing high calcium 3. Separate from antacids, vitamins/minerals, sucralfate, or other chelating agents by 2hrs before or 6hrs after 4. If tendon pain occurs, stop use and seek medical attention 5. Shake ciprofloxacin oral suspension well before use 6. Ciprofloxacin oral suspension may be stored at room temperature Pearl 1. Not approved for use in children <18 yrs (except cipro for anthrax or complicated UTI) 2. Increased risk of tendon rupture in patients >60 y of age 3. Due to risk of adverse reactions and availability of alternatives, patients with common infections (acute bacterial sinusitis, acute uncomplicated cystitis, etc) should not receive quinolone therapy 4. Medication guide required at dispensing

Answer 72

Counseling 1. May warm solution in hands for 1 minute prior to administration 2. Complete full course of therapy even if symptoms improve 3. Otic: administer with affected ear upward, maintain position for at least 1 minute after instillation 4. Ophthalmic: Wash hands with soap and water before/after use. Lie down or tilt head back. With index finger, pull down the lower lid of eye to form a pocket. Hold the dropper close to eye, but not touching, with the other hand. Drop the correct number of drops into the pocket between lower lid and eyeball. Gently close eyes. Place index finger over inner corner of eye for 1 min. Do not rinse or wipe the dropper or allow it to touch anything, including eye Pearls 1. Ciprofloxacin otic is not approved in children <1 y of age, not for ophthalmologic use, otic use only 2. Intratympanic cipro product for use only during tympanostomy tube placement 3. Available in otic formulation in combination with hydrocortisone (Cipro HC) 4. Bacterial conjunctivitis is very contagious and spread by direct contact

Answer 73

Counseling 1. May warm solution in hands for 1 minute prior to administration 2. Complete full course of therapy even if symptoms improve 3. Otic: administer with affected ear upward, maintain position for at least 1 minute after instillation 4. Ophthalmic: Wash hands with soap and water before/after use. Lie down or tilt head back. With index finger, pull down the lower lid of eye to form a pocket. Hold the dropper close to eye, but not touching, with the other hand. Drop the correct number of drops into the pocket between lower lid and eyeball. Gently close eyes. Place index finger over inner corner of eye for 1 min. Do not rinse or wipe the dropper or allow it to touch anything, including eye Pearls 1. Ciprofloxacin otic is not approved in children <1 y of age, not for ophthalmologic use, otic use only 2. Intratympanic cipro product for use only during tympanostomy tube placement 3. Available in otic formulation in combination with hydrocortisone (Cipro HC) 4. Bacterial conjunctivitis is very contagious and spread by direct contact

Answer 74

Counseling 1. May make urine brown or red-tinged; this is not harmful and is a breakdown product of the drug 2. Complete full course of therapy. 3. For the suspension, shake well and store at room temperature, use within 30 days 4. Avoid mixing suspension with food or beverages, but food can be taken afterward 5. Symptoms should improve within 2-3 days; if they worsen, seek follow-up care Pearls 1. Nitrofurantoin does not reach effective levels in tissue and is only indicated for UTIs (not pyelonephritis) 2. May resume normal activities after 24 h of antibiotics if afebrile 3. Used to prevent recurrent UTIs but is also effective in the treatment of uncomplicated UTIs

Answer 75

Counseling 1. Complete full course of therapy 2. Symptoms should improve in 2-3 days; if they worsen, seek follow-up with health-care practitioner 3. For suspension, shake well and store at room temperature and protect from light 4. May cause photosensitivity; use sunscreen 5. Maintain adequate hydration during therapy to prevent kidney complications 6. Seek medical attention for severe diarrhea, dark urine, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath Pearls 1. Avoid use in patients with G6PD deficiency (increased risk of hemolytic anemia) 2. Preferred agent for Pneumocystis pneumonia prevention in HIV-infected patients when CD4 count is <200

Answer 76

Counseling: instruct patient on proper application technique. Avoid drug exposure to open wounds, burns, or eyes Pearls: the area treated may be covered with gauze dressing if desired