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NAPLEX > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillins: drug interactions

A

Probenecid - increases levels of beta lactams by inhibiting their excretion. This is sometimes done intentionally.

Methotrexate - penicillins can increase the concentration of MTX

Warfarin - peniciilins EXCEPT nafcillin and dicloxacillin can enhance the anticoagulant effect of warfarin by inhibiting the production of clotting factors. Nafcillin and dicloxacillin can inhibit the anticoagulant effect of warfarin because they are CYP inducers.

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2
Q

Which penicillin is a vesicant?

A

Nafcillin; use cold packs and hyaluronidase injections

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3
Q

Penicillins: side effects (8)

A
  1. Seizures (with accumulation); must renally dose adjust
  2. GI upset, diarrhea
  3. Rash - including SJS/TEN and allergic reactions
  4. Anaphylaxis
  5. Hemolytic anemia; identified with positive Coombs test
  6. Myelosuppression with prolonged use
  7. Renal failure
  8. Increased LFTs
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4
Q

Penicillins: monitoring

A

Renal function
Symptoms of anaphylaxis
CBC and LFTs with prolonged courses

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5
Q

Penicillins: contraindications

A

All penicillins: type 1 hypersensitivity reaction to other penicillin or beta lactams

Amp/sulbactam and Amox/Clav: history of cholestatic jaundice or hepatic dysfunction with prior use

Extended-release forms of amoxicillin and amox/clav: severe renal impairment (CrCl < 30) - do not use extended-release forms (Augmentin XR) or the 875 mg dose of amox/clav

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6
Q

Which penicillin has a boxed warning and why?

A

Penicillin G benzathine: not for IV use, can cause cardiorespiratory arrest and death. IM use only.

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7
Q

Antistaphylococcal penicillins are preferred for…

A

MSSA soft tissue, bone and joint, endocarditis, and bloodstream infections

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8
Q

Cephalosporins: contraindications

A

Ceftriaxone: hyperbilirubinemic neonates; causes biliary sludging and kernicterus

Ceftriaxone: concurrent use with calcium-containing IV products in neonates

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9
Q

Cephalosporins: warnings

A

Cross-reactivity with penicillin allergy (< 10%)

Cefotetan has a side chain that can increase the risk of bleeding and cause a disulfiram-like reaction with alcohol ingestion

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10
Q

Cephalosporins: side effects (8)

A
  1. Seizures (with accumulation); must renally dose adjust
  2. GI upset, diarrhea
  3. Rash, allergic reactions, anaphylaxis
  4. Serious skin reactions (SJS/TEN)
  5. Hemolytic anemia; identified with positive Coombs
  6. Drug fever
  7. Myelosuppression with prolonged use
  8. Increased LFTs
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11
Q

Cephalosporins: monitoring

A

Renal function
Symptoms of anaphylaxis
CBC, LFTs

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12
Q

Which cephalosporin is available as a chewable tablet?

A

Cefixime

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13
Q

Which cephalosporine has activity against MRSA?

A

Ceftaroline

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14
Q

Ertapenem is the Exception because…

A

It has no activity against PEA: Pseudomonas, Enterococcus, or Acinetobacter

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15
Q

Carbapenems: contraindications

A

Anaphylactic reactions to other beta lactams

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16
Q

Carbapenems: warnings

A

Do not use with penicillin allergy

CNS adverse effects - states of confusion and seizures; highest risk with imipenem/cilastatin, large doses, and renal impairment

Doripenem: do not use for treatment of pneumonia, including HAP and VAP

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17
Q

Carbapenems: monitoring

A

Renal function
Symptoms of anaphylaxis
CBC, LFTs

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18
Q

Carbapenems: drug interactions

A

Valproic acid (divalproex, etc.): carbapenems decrease serum valproic acid concentrations, leading to loss of seizure control - avoid combination

Drugs that lower seizure threshold (clozapine, quinolones, bupropion, tramadol)

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19
Q

Ertapenem can only be diluted with…

A

normal saline

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20
Q

Cephalosporins: drug interactions

A

Ceftriaxone and calcium-containing IV products: precipitates form when used together. Concurrent use is contraindicated in neonates. In adults, avoid simultaneous administration and flush line between each product.

Drugs that decrease stomach acid and oral cephalosporins: decreased bioavailability of cephalosporin. Cefuroxime, cefpodoxime, and cefdinir should be separated by 2 hours from antacids. Avoid H2RAs and PPIs.

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21
Q

Aminoglycosides demonstrate … activity

A

Concentration-dependent

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22
Q

If a patient is underweight, how do you dose an aminoglycoside?

A

Total body weight

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23
Q

If a patient is obese, how do you dose an aminoglycoside?

A

Adjusted body weight

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24
Q

Using traditional dosing, what is the dose (mg/kg) of gentamicin or tobramycin for gram-positive infections? Gram-negative infections?

A

1 mg/kg/dose for gram-positive

2.5 mg/kg/dose for gram-negative

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25
Q

Using extended-interval dosing, what is the dosing range (mg/kg) of gentamicin or tobramycin?

A

4-7 mg/kg/dose - usually 7 mg/kg

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26
Q

What is Plazomicin used for?

A

Complicated, MDR gram-negative UTI

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27
Q

Aminoglycosides: boxed warnings (4)

A

Nephrotoxicity
Ototoxicity - hearing loss, vertigo, ataxia
Neuromuscular blockade and respiratory paralysis - avoid with other neurotoxic/nephrotoxici drugs

Fetal harm if given during pregnancy

28
Q

Aminoglycosides: warnings

A

Use caution in patients with impaired renal function, the elderly, and patients taking other nephrotoxic drugs.

29
Q

Aminoglycosides: monitoring

A

Drug levels
Renal function, urine output
Hearing tests

30
Q

When using extended-interval aminoglycoside dosing nomograms, if a level plots on a line, how do you choose the dosing interval?

A

Round up to the next dosing interval to avoid toxicity

31
Q

When using traditional aminoglycoside dosing, what is the goal trough of gentamicin or tobramycin when treating a gram-negative infection?

A

< 2 mcg/mL

32
Q

“Respiratory quinolones” are…
Why are they called that?

A

Levofloxacin and moxifloxacin
Because they have enhanced coverage of S. pneumo and atypical pathogens

33
Q

Which quinolone is active against MRSA and is the preferred quinolone for SSTI caused by MRSA?

A

Delafloxacin

34
Q

Can moxifloxacin be used for UTI?

A

No.

34
Q

Which quinolone has enhanced gram-positive and anaerobic activity and can be used alone for polymicrobial infections?

A

Moxifloxacin

35
Q

Which quinolones have enhanced gram-negative activity and activity against Pseudomonas?

A

Ciprofloxacin and levofloxacin

36
Q

Quinolones: boxed warnings (5)

A
  1. Tendon inflammation and/or rupture - within hours/days after starting and up to several months after treatment. Increased risk with concurrent steroids, organ transplant patients, and age > 60 years. DC immediately if symptoms occur.
  2. Peripheral neuropathy - can last months to years after discontinuation, may be permanent. DC immediately if symptoms occur.
  3. CNS effects - seizures, tremor, restlessness, confusion, hallucinations, depression, paranoia, nightmares, insomnia, increased intracranial hemorrhage. Use caution in patients with CNS disorders or with drugs that cause seizures or lower seizure threshold.
  4. Avoid in patients with myasthenia gravis - exacerbates weakness
  5. Use last-line for bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTI
37
Q

Quinolones: contraindications

A

Ciprofloxacin: concurrent use with tizanidine

38
Q

Quinolones: warnings (8)

A

QT prolongation (highest risk with moxifloxacin) > levofloxacin > ciprofloxacin

Hypo- or hyperglycemia

Psychiatric disturbances

Avoid systemic quinolones in children, pregnancy, and breastfeeding due to musculoskeletal toxicity

Aortic aneurism or dissection - increased risk with longer durations

Photosensitivity
Hepatotoxicity
Crystalluria

39
Q

Which liquid antibiotic can not be put through an NG or other feeding tube?

A

Cipro oral suspension; ok to crush tablets and give via feeding tube.

40
Q

Quinolones: drug interactions (7)

A

Antacids, polyvalent cations, multivitamins, sucralfate, and bile acid resins - chelation and inhibition of quinolone absorption.

Phosphate binders - lanthanum carbonate and sevelamer - can decrease concentration of PO quinolones; separate by at least 2 hours with lanthanum carbonate, or 6 hours after sevelamer.

Warfarin: quinolones can increase anticoagulant effects of warfarin

Sulfonylureas, insulin, and other hypoglycemic drugs: quinolones can increase effects

QT prolonging drugs, potassium, and magnesium - QT prolongation

Probenecid and NSAIDs - increased quinolone levels

Ciprofloxacin (strong CYP1A2 inhibitor) increased levels of caffeine, theophylline, and tizanidine

41
Q

Macrolides are commonly used for…

A

Upper and lower respiratory tract infections, and some STIs chlamydia

42
Q

Azithromycin “Tri-Pak” dosing

A

500 mg daily x 3 days

43
Q

Macrolides: contraindications (3)

A
  1. History of cholestatic jaundice or hepatic dysfunction with prior use
  2. Clarithromycin and erythromycin: do not use with simvastatin and lovastatin pimozide, ergotamine, or dihyrdroergotamine
  3. Clarithromycin concurrent use with colchicine in patients with renal or hepatic impairment
44
Q

Macrolides: warnings (4)

A

QT prolongation (erythromycin > azithromycin > clarithromycin)

Hepatotoxicity

Exacerbation of myasthenia gravis

Clarithromycin - caution in patients with CAD (increased mortality)

45
Q

Macrolides: side effects (4)

A
  1. GI upset (diarrhea, abdominal pain, cramping)
  2. Taste perversion
  3. Ototoxicity
  4. Severe skin reactions (SJS/TEN/DRESS)
46
Q

Macrolides: drug interactions

A

Erythromycin and clarithromycin - major substrates of CYP3A4 and are CYP3A4 inhibitors; Contraindicated with simvastatin and lovastatin. Caution with other substrates, including apixaban, colchicine, dabigatran, rivaroxaban, theophylline, and warfarin.

Azithromycin - minor substrate of CYP3A4 and weak CYP1A2 and Pgp inhibitor; fewer clinically significant drug interactions.

All macrolides - caution with CVD, low potassium or magnesium, and with other QT prolonging drugs.

47
Q

Common uses of doxycycline

A

CAP, tickborne illnesses, community-acquired MRSA (CA-MRSA) skin infections, chlamydia, COPD exacerbations, bacterial sinusitis, VRE UTI, acne

48
Q

Tetracyclines: warnings

A

Children age < 8 years, pregnancy, and breastfeeding: suppresses bone growth and discolors teeth do not use

Photosensitivity

Severe skin reactions (SJS/TEN/DRESS)

GI inflammation/ulceration

Minocycline - drug-induced lupus erythematosus (DILE)

49
Q

Tetracyclines: side effects

A

N/V/D, rash

50
Q

Tetracyclines: monitoring

A

LFTs, renal function, CBC

51
Q

Doxycycline/minocycline IV:PO ratio

A

1:1

52
Q

Doxycycline oral administration counseling

A

Take with at least 8oz of water, sit upright for at least 30 minutes to avoid esophageal irritation

53
Q

Tetracycline drug interactions

A

Antacids, polyvalent cations, multivitamins, sucralfate, bismuth subsalicylate, and bile acid resins - chelation of tetracycline and inhibited absorption. Separate tetracycline by 1-2 hours before or 4 hours after chelating drug.

Lanthanum carbonate can decrease concentration of tetracyclines; take at least 2 hours before or after lanthanum.

54
Q

Sulfonamides: general MOA

A

inhibition of the folic acid pathway

55
Q

Bactrim dosing is based on which component (SMX or TMP)?

A

TMP

56
Q

Bactrim SS dose

A

400 mg SMX/80 mg TMP

57
Q

Bactrim DS dose

A

800 mg SMX/160 mg TMP

58
Q

Bactrim dosing for uncomplicated UTI

A

1 DS tablet PO BID x 3 days

59
Q

Bactrim dosing for PCP prophylaxis

A

1 DS or SS tablet daily

60
Q

Sulfonamides: contraindications

A

Sulfa allergy
Anemia due to folate deficiency
Renal or hepatic disease
Infants < 2 months

61
Q

Sulfonamides: warnings

A
  1. Blood dyscrasias - including agranulocytosis and aplastic anemia
  2. Skin reactions (SJS/TEN, thrombocytopenic purpura (TTP))
  3. Hemolytic anemia - can be immune related (positive Coombs test) or due to G6PD deficiency - do not use with known G6PD deficiency
  4. Thrombocytopenia
  5. Hypoglycemia
  6. Pregnancy - use only if benefit > risk; blocks folic acid metabolism, causes congenital deficits
62
Q

Sulfonamides: side effects (9)

A
  1. Photosensitivity
  2. Hyperkalemia
  3. Crystalluria
  4. N/V/D
  5. Anorexia
  6. Rash
  7. Decreased folate
  8. False elevations in SCr
  9. Renal failure
63
Q

Sulfonamides: monitoring

A

Renal function, electrolytes, CBC, folate

64
Q
A

NAPLEX (2 decks)

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