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antibiotics Flashcards

1
Q

Gentamicin*

A 
Aminoglycoside (IV)
gram neg. + pseudomonas
traditional dosing= 1-3mg/kg/dose (IBW unless obese)
--> CrCl>60mL/min= q8h
extended interval= 4-7mg/kg
AE: neurotoxicity, ototoxicity
monitor trough/peak
peak 5-10, trough <2
synergy for endocarditis (gram positive)
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2
Q

Tobramycin*

A 
Aminoglycoside (IV)
gram neg. + pseudomonas
traditional dosing= 1-3mg/kg/dose (IBW unless obese)
--> CrCl>60mL/min= q8h
extended interval= 4-7mg/kg
AE: neurotoxicity, ototoxicity
monitor trough/peak
peak 5-10, trough <2
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3
Q

Amikacin*

A 
Aminoglycoside (IV)
gram neg + pseudomonas
traditional dosing= 5-7mg/kg/dose
--> CrCl>60mL/min= q8h
extended interval= 15-20mg/kg
AE: neurotoxicity, ototoxicity
peak 20-30, trough <5
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4
Q

Amoxicillin (+/- cavulanate)

A

Amoxil, Augmentin (PCN)
gram + (strep, enterococci)
Clavulanate= gram - (PEK), h.flu, MSSA, anaerobe
dosing= 8-12 hrs (PO)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
refrigerate augmentin susp

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5
Q

Ampicillin (+/- sulbactam)

A

Unasyn (PCN)
gram + (strep, enterococci)
sulbactam= gram neg. (PEK), H.flu, NSSA, anaerobe
dosing= q6h (ampicillin= PO/IV, sulbactam (IV)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
compatible with NS only

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6
Q

Penicillin

A

Pen VK, Bicillin L-A (PCN)
gram + (strep)
VK= q6-8hrs (PO), G= q4-6h (IM/IV)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
VK on empty stomach (refrigerate susp)

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7
Q

Nafcillin*

A 
PCN 
gram + (strep, MSSA)
dosing= 1-2g q4-6h (IV)
AE: rash, acute interstitial nephritis, increased LFTs
NO dose adjustment in renal impairment
VESICANT
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8
Q

Cefazolin

A

Kefzol (1st gen. cephalosporin)
staph + PEK
IV/IM (250-2,000mg q8h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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9
Q

Cephalexin

A

Keflex (1st gen. cephalosporin)
staph + PEK
PO (250-1,000mg q6h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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10
Q

Cefuroxime

A

Ceftin, Zinacef (2nd gen. cephalosporin)
staph + HNPEK
PO/IV/IM (250-1,500mg q8-12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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11
Q

Cefotetan*

A

2nd gen. cephalosporin
staph +HNPEK + ANAEROBES (b. fragilis)
IV/IM (1-2g q12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
–> increased risk of hypothrombinemia (bleeding) and disulfiram with alcohol (NMTT side chain)

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12
Q

Cefoxitin*

A

2nd gen. cephalosporin
staph +HNPEK + ANAEROBES (b. fragilis)
IV/IM (1-2g q6-8h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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13
Q

Cefdinir*

A

3rd gen. cephalosporin
staph/strep + HNPEKS
PO (300mg q12h/600mg QD)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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14
Q

Ceftazidime

A

Fortaz, Tazicef (3rd gen. cephalosporin)
staph/strep + HNPEKS + PSEUDOMONAS
IV/IM (1-2g q8-12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment

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15
Q

Ceftriaxone

A

Rocephin (3rd gen. cephalosporin)
staph/strep + HNPEKS
IV/IM (1-2g q12-24h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
NO DOSE ADJUSTMENT IN RENAL IMPAIRMENT
–> biliary sludging (avoid co-administration with Ca soln)

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16
Q

Cefipime

A 
Maxipime (4th gen. cephalosporin)
staph/strep + HNPEKS + CAPES
IV/IM (1-2g q8-12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
dose adjustment in renal impairment
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17
Q

Ceftaroline

A 
Teflaro (5th gen. cephalosporin)
Gram + (MRSA)
IV (600mg q12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
dose adjustment in renal impairment
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18
Q

Imipenem/Cilastatin

A

Primaxin (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (250-1,000mg q6-8h)
AE: CNS, SEIZURE, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid

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19
Q

Meropenem

A

Merrem (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (500-2,000mg q8h)
AE: CNS, seizure, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid

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20
Q

Ertapenem

A 
Invanz (carbapenem)
Gram +, Gram -, anaerobes
NO PSEUDOMONAS
IV/IM (1,000mg QD)
AE: CNS, seizure, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
--> decreases concentrations of valproic acid
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21
Q

Doripenem

A

Doribax (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (500mg q8h)
AE: CNS, seizure, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid

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22
Q

Ofloxacin

A 
Floxin-otic (fluoroquinolone)
gram -, gram +
PO (200-400mg q12h)
AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity
extend interval in renal impairment
avoid in children/pregnancy
separate from antacids
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23
Q

Ciprofloxacin

A

Cipro (FQ)
gram -, gram+, PSEUDOMONAS
PO/IV (250-750mg PO/200-400mg IV 8-12h)
AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity
extend interval in renal impairment
avoid in children/pregnancy
separate from antacids
–> oral susp= no NG/feeding tube, no refrigeration
–> can give IR tabs via feeding tube (separate from meal)
–> P-gp substrate, strong 1A2 inhibitor

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24
Q

Levofloxacin

A 
Levaquin (FQ)
gram -, gram+, PSEUDOMONAS, ATYPICAL
respiratory FQ
PO/IV (250-750mg QD)
AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity
extend interval in renal impairment
avoid in children/pregnancy
separate from antacids
--> soln= empty stomach, room temperature
--> renal clearance
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25
Moxifloxacin
``` Avelox, Vigamox- opth (FQ) gram -, gram+, ATYPICAL, ANAEROBE IV/PO (400mg QD) AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity NO RENAL DOSE ADJUSTMENT avoid in children/pregnancy separate from antacids ```
26
Azithromycin
Zithromax (macrolide) gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium) upper/lower resp. tract, sexually transmitted infection PO/IV (PO ZPak, IV 250-500mg QD) AE: QT prolongation, hepatotoxicity, increased LFTs no dose adjustment in renal impairment susp= no refrigeration minimal drug interactions
27
Clarithromycin
Biaxin (macrolide) gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium) upper/lower resp. tract, sexually transmitted infection PO (250-500mg PO q12h or 1g PO QD) AE: QT prolongation, hepatotoxicity, increased LFTs decrease dose in renal impairment (50% if CrCl <30) take with food susp= no refrigeration 3A4 substrate and INHIBITOR
28
Erythromycin
E.E.S, Ery-tab, Erythrocin (macrolide) gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium) upper/lower resp. tract, sexually transmitted infection PO/IV (q6-12h) AE: QT prolongation, hepatotoxicity, increased LFTs no renal dose adjustment refrigerate EES susp erythromycin powder stable @ RT 3A4 substrate and INHIBITOR
29
Doxycycline
Vibramycin, Oracea, Doryx, Monodox, Atridox, Adoxa (Tetracycline) gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria USE: MRSA (mild skin infection), VRE (UTI) PO/IV (100mg q12h) --> Oracea= empty stomach AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression NO dose adjustment in renal impairment separate from antacids avoid in children <8 and pregnancy avoid with retinoic acids (pseudotumor cerebri) IV:PO= 1:1 susp= no refrigeration enhance neuromuscular blockin agent, warfarin decrease effectiveness of PCN
30
Minocycline
Minocin, Dynacin, Solodyn (tetracycline) gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria USE: skin infection, acne PO/IV (50-100mg q12-24h) AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression NO dose adjustment in renal impairment separate from antacids avoid in children <8 and pregnancy avoid with retinoic acids (pseudotumor cerebri) enhance neuromuscular blockin agent, warfarin decrease effectiveness of PCN
31
Tetracycline
Tetracycline gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria --> rarely used (in H.pylori Tx) PO (250-500mg q6h) take on empty stomach AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression --> extend interval in renal impairment separate from antacids avoid in children <8 and pregnancy avoid with retinoic acids (pseudotumor cerebri) 3A4 substrate and inhibitor enhance neuromuscular blockin agent, warfarin decrease effectiveness of PCN
32
Sufamethoxazole/Trimethoprim
``` Bactrim, septra (Sulfonamides) gram + (MRSA), gram - (H-PEK, enterobacter, shigella, salmonella), opportunistic pathogens (nocardia, pnsumocystis, toxoplasmosis) PO/IV --> UTI= 1 DS tab BID x3 days --> PCP prophylaxis= 1 DS or SS tab QD CI in sulfa allergy AE: skin reactions (SJS, TEN), crystalluria, photosensitivity, hyperkalemia, hypoglycemia, increased LFTs, CNS, QT prolongation Avoid in pregnancy @ term (kernicterus, spinal cord defects) use caution in G6PD deficiency IV= store @ RT, dilute with D5W only susp= RT reduce dose in renal impairment IV:PO= 1:1 2C8/9 inhibitor (warfarin) ```
33
Vancomycin
``` Vancocin gram + (MRSA), c.diff MRSA= 15-20mg/kg q8-12h IV C.diff= 125-500mg QID x10-14 days PO AE: red man syndrome, nephrotoxicity, ototoxicity monitor trough (10-20 extend interval in renal impairment ```
34
Linezolid
``` Zyvox (oxazolidinone) gram + (MRSA, VRE faecium/faecalis) USE: pneumonia, SSTI, VRE PO/IV (600mg q12h) AE: HA, diarrhea, taste alteration, increased LFT/pancreatic enzymes, neuropathy weak MAOI (avoid tyramine-containing foods) IV:PO= 1:1 no adjustment in renal impairment susp= room temp ```
35
Quinupristin/Dalfopristin
``` Synercid (streptogramin) gram + (MRSA, VRE faecium) USE: complicated SSTI IV (7.5mg/kg q8-12h) AE: arthralgias/myaglias, infusion reaction, hyperbilirubinemia, CPK elevation no adjustment in renal impairment D5W only, refrigerate after reconstitution weak 3A4 inhibitor ```
36
Daptomycin
Cubicin (cyclic lipopeptide) gram + (MRSA, VRE faecium/faecalis) USE: complicated SSTI, staph bloodstream (endocarditis) IV (4-6g/kg QD) AE: myopathy, eosinophilic pneumonia, GI upset, increased CPK/myopathy, increased LFT extend interval in renal impairment (q48h) cannot use for pneumonia only mix with NS false elevation in PT/INR
37
Telavancin
``` Vibativ (lipoglycopeptide) derivative of Vanco gram + (MRSA) USE: complicated SSTI, HA-pneumonia IV (10mg/kg QD) AE: nephrotoxicity, QT prolongation, red man syndrome, metallic taste, N/V, increased SCr fetal risk (Category C) reduce dose/extend interval in renal impairment MedGuide admin. ```
38
Aztreonam
``` Azactam (monobactam) Gram - (pseudomonas) IV (500-2,000mg q6-12h) AE: increased LFTs, N/V/D, rash reduce dose in renal impairment safe in PCN allergy ```
39
Colistimethate
Colistin (polymixin Abx) gram - (pseudomonas) USE: MDR gram-neg pathogen IV (2.5-5mg/kg/day divided in 2-4 doses) AE: nephrotoxicity, neurologic disturbances reduce dose/extend interval in renal impairment
40
Tigecycline
Tygacil (Minocycline derivative) gram + (MRSA, VRE), gram -, anaerobe, atypical use LAST LINE (complicated SSTI/intraabdominal, CAP) IV (100mg x1 then 500mg q12h) BBW= increased risk of death AE: hepatotoxicity, photosensitivity, increased LFTs avoid in children <8 and pregnancy no adjustment in renal impairment decrease dose in severe hepatic impairment avoid in bloodstream infection
41
Clincamycin
``` Cleocin gram +, anaerobes PO/IV AE: SJS, increased LFTs, C.DIFF no adjustment in renal impairment ```
42
Metronidazole
``` Flagyl anaerobes, protozoal PO/IV --> c.diff= 500mg TID x10-14 days AE: GI upset, metallic taste, furry tongue, darkened urine, CNS no adjustment in renal impairment ER tabs= empty stomach IV:PO= 1:1 avoid in 1st trimester avoid alcohol (disulfiram) 3A4 and 2C9 inhibitor ```
43
Rifaximin*
Xifaxan structurally related to rifampin USE: traveler's diarrhea, hepatic encephalopathy prevention PO (200-550mg BID-TID) AE: flatulence, GI, rash, peripheral edema not for systemic infection no adjustment in renal impairment
44
Nitrofurantoin
``` Macrodantin, Macrobid, Furadantin USE: uncomplicated UTI macrodantin= QID PO (QD prophylaxis) macrobid= BID PO AE: pulmonary toxicity (long-term), hepatotoxicity/neuropathy (rare), N/HA, darkened urine Category B (CI @ term) CI when CrCl<60 ```
45
Fidaxomicin
``` Dificid USE: c.diff AE: N/V, abdominal pain, GI bleed not for systemic infection no adjustment in renal impairment ```
46
Rifampin
Rifadin, Rifamate (isoniazid), Rifater (INH/pyrazinamide) USE: TB PO (empty stomach) AE: increased LFT, GI upset, rash, orange-red discoloration of fluids, flu-like syndrome CYP INDUCER
47
Isoniazid
``` Rifamate (isoniazid), Rifater (rifampin/pyrazinamide) USE: TB PO (empty stomach) AE: HA, GI upset, increased LFT, peripheral neuropathy, lupus-like syndrome, hyperglycemia, hepatitis, agran/thrombocytopenia/anemia pyridoxime (Vit B6)= reduce neuropathy avoid in liver disease CYP inhibitor avoid tyramine-containing foods increase folic acid, niacin, and Mg ```
48
Pyrazinamide
Rifater (rifampin/INH) USE: TB PO (empty stomach) AE: GI upset, malaise, hepatotoxicity, arthralgias, hyperuricemia/gout extend interval if CrCl <30 fatal hepatotoxicity with rifampin (monitor)
49
Ethambutol
Myambutol USE: TB PO (2-3x/week) AE: optic neuritis
50
Streptomycin*
USE: TB PO (2-3x/week) AE: neurotoxicity, nephrotoxicity, neuromuscular blockage/respiratory paralysis extend interval for CrCl <50
51
Bedaquiline
``` Sirturo USE: MDR-TB PO (QD--> 3x/week) AE: QT prolongation, increased risk of death, chest pain, increased LFTs Take with food ```
52
Amphotericin B
Lipid formulations= Abelcet, AmBisome (antifungal) broad spectrum= yeast, mold, dimorphic fungi AE: fever, chills, malaise, rigors, hypokalemia, hypomagnesemia, nephrotoxicity, anemia, hypotension/hypertension Ambisome= back/chest pain with 1st dose D5W only lipid formulations= decreased nephrotoxicity infusion related reaction (premedicate= APAP/NSAID, Benadryl, Merperidine, Fluid bolus)
53
Ketoconazole
Nizoral, Ketodan, Extina, Xologel (azole antifungal) USE: androgen-related disorders AE: hepatotoxicity, increased LFTs, QT prolongation, hypertriglyceridemia, hypokalemia hepatic clearance CYP 3A4 inhibitor pH dependent absorption
54
Fluconazole
Diflucan (azole antifungal) yeast (candida albicans, cryptococcus), dimorphic fungi IV/PO (100-800mg QD) AE: increased LFTs, QT prolongation, hypertriglyceridemia, hypokalemia CNS penetration (fungal meningitis) IV:PO= 1:1 CYP 3A4 inhibitor (not hepatically cleared)
55
Voriconazole
VFEND (azole antifungal) yeast, dimorphics, ASPERGILLOSIS (DOC), mold IV/PO (q12h) AE: QT prolongation, increased LFTs, visual changes, increased SCr, CNS, photosensitivity avoid direct sunlight and driving at night avoid IV formulation for CrCl <50 take on empty stomach CYP3A4 inhibitor CYP substrate (2C9, 2C19, 3A4)*** (michaelis-menten kinetics)
56
Posaconazole
Noxafil (azole antifungal) yeast, dimorphics, aspergillosis, mold, MUCORMYCOSIS, ZYGOMYCOSIS PO (6-12h) must be taken with full meal AE: QT prolongation, increased LFTs, hypokalemia CYP 3A4 inhibitor
57
Caspofungin
Cancidas (echinocandin) USE: systemic candida infection IV (QD) do not mix with dextrose AE: increased LFTs, hypotension, fever, diarrhea, hypokalemia, hypomagnesemia, rash no dose adjustment in renal impairment (few DI's) + cyclosporine= hepatotoxicity (reduce dose)
58
Micafungin
Mycamine (echinocandin) IV (candidemia 100mg QD, esophageal 150mg QD) AE: increased LFTs, hypotension, fever, diarrhea, hypokalemia, hypomagnesemia, rash no dose adjustment in renal impairment (few DI's)
59
Terbinafine
Lamisil (antifungal) PO (250m in 1-2 divided doses)/topical AE: taste disturbances, systemic lupus exacerbation, HA, skin rash, increased LFTs strong CYP 2D6 inhibitor (SSRIs)
60
Oseltamivir
``` Tamiflu (antiviral) PO (Tx 75mg BID x5d, prophylacis 75mg QD x10d) AE: CNS, vomiting start within 48 hrs of symptoms decrease frequency for CrCl <30 ```
61
Acyclovir
Zovirax (antiviral) USE: HSV, VZV PO/IV (IBW in obese patients), topical AE: thrombocytopenic purpura/hemolytic uremic syndrome, renal impairment, malaise, HA/N/V/D, increased LFTs/SCr/BUN, neutropenia infuse over 1 hr (min) + hydration (prevent renal damage) full glass of water (PO) extend interval in renal impairment
62
Valacyclovir
``` Valtrex (antiviral) prodrug of acyclovir USE: HSV, VZV PO (500-1,000mg QD-TID) AE: thrombocytopenic purpura/hemolytic uremic syndrome, renal impairment, malaise, HA/N/V/D, increased LFTs/SCr/BUN, neutropenia full glass of water extend interval in renal impairment ```
63
Valganciclovir
Valcyte (antiviral) prodrug of ganciclovir USE: CMV (DOC), HSV, VZV PO (450-900mg QD-BID) TAKE WITH FOOD AE: myelosupression, fever, N/V/D, anorexia, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, seizure (rare) extend interval and reduce dose in CrCl <60
64
Atovaquone/Proquanil
``` Malarone (antimalarial) PO (QD) initiation 1-2 days, D/C 7 days AE: increased LFTs take with food or milk avoid prophylaxis when CrCl <30 ```
65
Mefloquine
``` Lariam (antimalarial) PO (qWeek) initiation 1-2 weeks, D/C 4 weeks DOC for resistance AE: seizure, neuropsychiatric effects, loss of balance/dizziness, GI upset, chills, tinnitus take with food and 8oz. water ```
66
Quinine
Qualaquin (antimalarial) PO (q8h) must be given with doxy, tetracycline, clindamycin AE: QT prolongation, SJS/TEN, visual changes, hypoglycemia avoid in G6PD deficiency
67
Chloroquine
Aralen (antimalarial) PO (qWeek) initiation 1-2 weeks, D/C 4 weeks AE: retinopathy, QT prolongation, GI upset, visual disturbances, hair loss, myopathy/neuropathy, psoriasis exacerbation
68
Primaquine*
``` (antimalarial) PO (QD) initiation 1 day, D/C 7 days USE: p.vivax AE: agran, anemia avoid in G6PD deficiency (hemolytic anemia) ```

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