Antibiotics Flashcards
1
Q
Gram + cocci
A
Streptococcus
Staphy
Enterococcus
2
Q
Gram + Rods
A
- Diphtheriae
- Listeria
- Anthrax
- Clostridium species*
- = anaerobic
3
Q
Gram - Cocci
A
- Neisseriae
- Moraxella
4
Q
Gram - Rods
A
- e. Coli
- Psuedomonas
- Haemophilus Influenzae
- Helicobacter Pylori
- Shigella; Salmonella
- Campylobacter
- Bacteroides. Fragilis
5
Q
Altabax
A
Retapamulin
Cream/ointment used for
- Impetigo!!**
MSSA only!!
6
Q
How to treat MRSA colinization
A
Bactoban Nasal single use tubes
Hibiclens soap sln
- (4% Chlorhexidine)
7
Q
MRSA DOC (PO/IV)
A
PO outpatient ABX:
- Bactrim
- Doxycycline
- Clindamycin
- Linezolid (Zyvox), Tedizolid (Sivextro)
Delafloxacin (Baxdela);
8
Q
MRSA IV ONLY
A
Daptomycin (cubicin)
Cedtaroline (Teflaro)
Quinupristin/ Dalfoprostin (Synercid)
Tigecycline (Tygacil)
Dalbavancin (Dalvance)
Ortivancin (Orbactiv)
TELAVANCIN (Vibativ)
9
Q
ABX for Pseudomonas aeruginose
A
Anti-pseudomonal PCN’s:
- Ticarcillin + Clav(Timentin) - Piperacillin + Tazobactam (Zosyn)
Anti-Pseudomonal CEPH’s:
- Cedtazidine(Fortaz) - Cefepime (Maxipime) - Cedtazidime + Avibactam (avycaz) - Ceftolozane + tazobactam (Zerbaxa) MDR
Carbapenems (NOT ERTAPENEM)
Fluoroquinolones (Cipro/ Levaquin)
Aminoglycosides: (Not as single agent)
Monobactam: Aztreonam (Gram - ONLY)
10
Q
H. Pylori Triple Therapy
A
PO BID x 14 days
1) Clarithromycin 500mg BID
2) Amox 1g BID
3) PPI (BID)
Note: FOR PATIENTS W/ no HISTORY OF MACROLIDE RESISTANCE!!!
Note: If PCN allergy use Flagyl instead
Prevpac: combination package for 14 days:
Amox + Clarithromycin + Lansoprazole (Prevpac)
11
Q
H. Pylori
Bismuth Quadruple therapy (10-14d)
A
1) Bismuth
2) Metronidazole
3) Tetracycline
4) PPI
Note: pts w/ risk factors for MACROLIDE RESIStance
Pylera: combo of Bismuth, Flagyl, Tetracycline
3 CAPS QID after meals and at HS x 10d
Concomitant Therapy:
- Triple Therapy + Metronidazole
Clarithromycin + Amox + Metronidazole + PPI
12
Q
Infective Endocarditis
A
- STREP
- STAPHY
- Enterococcus
Emp Tx:
- pref: Vanco IV +/- gram(-) coverage - alt: Oxacillin/Nafcillin + Gentamicin - **Pathogen specific therapy for 4-6 WEEKS**
13
Q
Infective CARDITIS dental ppx
A
Done in certain CARDIAC patients prior to dental procedures
- AMOX 2g PO 30-60 min prior to procedure
If PCN allergy:
1) Clindamycin 600mg PO
2) Azithromycin 500mg PO
3) Clarithromycin 500mg PO
14
Q
Cellulitis/ Erysipelas/ Abscess
A
Superficial: STAPH AND STREP
-Cellulitis: Mostly STREP and MSSA
DOC: Keflex
Abscess: 50% MRSA
DOC: Bactrim, doxycycline/ Clindamycin —————————————————————— Diabetic skin infections: POLYMICROBIAL
- Gram(+), Gram(-), and anaerobes
#Deep: Also cover Gram(-) and Anaerobes
——————————————————————
Animal/ Human bites:
- Tx: Augmentin, Tdap
15
Q
Intra-Abdominal Infections
- Usually post surgery
A
B. Frag: Gram(-) Rod
E. Coli: gram (-) Rod
Enterococci: gram(+) cocci
Peudomonas: gram(-)
Empiric Tx:
———————
1)single agent:Ertapenem, Zosyn, Timentin
2)combos: Levaquin/ Cipro + Metronidazole
16
Q
Acute Gastroenteritis
A
Diarrhea, abd pain, n/v, maybe fever
Majority: VIRAL, Rotavirus in children and Norovirus in children
Tx: supp care and volume/ electrolyte replacement
————————————
Bacterial causes: Salmonella, Shigella, Campylobacter, e.coli,
Tx: levaQuin, Rifaximin, Azithromycin
Giardia: Treat w/ METRONIDAZOLE
C.diff: flagyl or oral vanco
17
Q
Diverticulosis/itis
A
Osis: high fiber diet
Diverticulitis: Infection of bulging pouches in colon wall
Tx: E.coli and b.frag
- Cipro + Metro - Bactrim + Metro
18
Q
Osteomyelitis
A
- STAPH aureus
- Aerobic bacilli (Pseudomonas)
Tx: Outpatient IV Abx therapy via PIC line 6 weeks
- Zosyn(Pip-taz) - unasyn(amp-sulbactam)
If PCN allergy: cipro/levQuin + metro or Clinda
Id MRSA: Vanco/ Daptomycin
19
Q
UTI/PYELONEPHRITIS
A
Bugs: PEKEPS (Proteus, E.colo, Klebsiella, Enterococci, Pseudomonas, Staph saprophyticus)
——————————————
Tx: Acute cystitis
- Bactrim, Nitrofurantoin, Fosfomycin
Pyelonephritis
- Bactrim, URINARY FQ(cipro/ levaquin)
-MOXIFLOXACIN- AVELOX NOT USED FOR UTI- doesnt concentrate in URINE/Kidneys
20
Q
Prostatitis
A
Urinary FQ for 28-30 days
21
Q
Community acquired pneumonia
CAP
A
Bugs: Pneumococcus, Mycoplasma, Legionell, Haemophilus, Klebsiella, Pseudomonas, MRSA
OUT-PATIENT:
- Low rate (<25%) of macrolide RESIST
(MACROLIDE OR DOXYCYCLINE)
-High rate (>25%) of Macrolide resist: DOXY
Comorbid conditions, recent ABX, or ^ rate of local Doxy RESIST:
- Beta-Lactam PLUS MACROLIDE OR DOXY
- Resp Quinolone (Levo, moxi, gemi)
**NOT CIPRO** ———————————————————
Adult Inpatient Non-ICU:
- IV beta-lactam + Macrolide OR
- IV Resp FQ
Adult inpatient ICU:
- IV Beta-Lactam + Macrolide or FQ
- IV FQ + aztreonam
—————————————————————
If susp of MRSA: vanco, Linezolid, Clindamycin
If susp Gram(-) bacilli
- RECENT HOSPITILIZATIONS, CYSTIC FIBROSIS, ALCOHOLICS, COPD
- TREAT w/ ANTIPSEUDOMONAL BETA-lactamb+ RESP FQ!!
——————————————————
PEDIATRIC CAP: - Outpatient: ^ dose of Amox, cefdinir, Clinda, macrolide
- Inpatient:Ampicillin, PCN G, Ceftriaxone, Cefotaxime
22
Q
Meningitis
A
Bugs: Pneumococcus, Neisseria, H.influ
Empiric tx: Ceftriaxone + Vanco
Close contact: Vaccine and Abx ppx
——————————————-
Neonatal Meningitis: Exposure to E.coli and GBS during BIRTH. 3rd most common cause is LISTERIA!!
Empiric tx(Nosocomial)
- amp+ gent
Empiric Tx(Community)
- amp+ gent
23
Q
Chlamydia
A
Tx:
- Doxyycline 100mg BID X 7 days
- Azithromycin(preferred) 1 g x 1 dose
24
Q
Gonorrhea
A
- Ceftriaxone 250mg IM x1
PLUS
- Azithromycin 1g x 1
NOTE: **If allergy to cephs, Then Azithromycin 2g PLUS Gentamicin or gemifloxacin
25
Syphillis
- Benzathine PCN G IM
2. 4 MILLION UNITS X 1-2
If PCN allergy: THEN DOXY for 14-28 DAYS
26
Genital Herpes
Supression
- Valacyclovir (Valtrex) 500mg po QD
- Acyclovir (Zovirax) 400mg po BID
- Famciclovir (Famvir) 250mg po BID
27
Trichimonas
- Single 2 g dose of either
- METRONIDAZOLE
- TINIDAZOLE(TindaMAX)
28
Human papillomavirus (HPV)
| Warts/ Cervical CA
- Vaccinations, Cyrotherapy, Liquid Nitrogen,
| - Trichloroacetic acid, Imiquimod(Aldara), podofilox
29
Scabies (MiTES)
Severe Itching that is usually WORST at night,
SCRATCH can cause Impetigo
Tx: Topical PERMETHRIN (Elimite)CREAM
ORAL ivermectin (Stromectol) (off-label)
TOPICAL SULFUR
30
Pinworm
-Enterobius vermicularis
Anal itching
(Scotch tape and paddle test)
COMMON IN CHILDREN
Tx:
——-
- Treat WHOLE FAMILY
- Mebendazole(Emverm) single tablet 100mg x1
- Albendazole(Albenza) 400mg x1
- Oral pyrantel Pamoate (REESE Pinworm med) OTC
31
Common Bugs
Otitis Media
* Pneumococcus,
- H.influenzae
- Moraxella
32
common BUGS
Meningitis in NEWBORN
GBS
E.Coli
Listeria
33
Common BUGS
MENINGITIS IN INFANTS/CHILDREN
*Pneumococcus
Neisseria
H.Influ, type b
34
Common BUGS
MENINGITIS IN ADULTS
*Pneumococcus
Neisseria
Haemophilus. Influ
35
COMMON BUGS
MENINGITIS IN ADOLESCENTS
* Neisseria
Pneumococcus
36
UTI (COMMON BUGS)
*E.coli
PEKEPS(proteus, E.coli, Klebsiella, Enterococci, Pseudomonas, staph. Saprophyticus)
37
Endocarditis (COMMON BUGS)
* staph aureus
Strep viridans
Enterococcus
38
Cellulitis (COMMON BUGS)
*staph aureus(MRSA;MSSA),
Strep, Type A
39
Cystic Fibrosis (COMMON BUGS)
Pseudomonas, Haemophilus
40
Infected diaper RASH
Candida albicans
41
Penicillin
MOA: Inhibit cell wall
Forms: VK; GK; Benzathine (IM)
Spectrum: Strep, Peptostrep, Treponema
Treats: *DOC(syphillus)*, dental ppx, pharyngitis,
Kinetics: KIDNEY (Watch for RENAL) fx**
Pregnancy category B (GENERALLY safe in PREGNANCY)
42
Bicillin L-A
Benzathine Penicillin
Treats: Group A strep: 1.2 million U x 1
RF: 1.2 million U IM QMONTH
SYPHILLUS: 2.4 MU IM x1 dose
- Tertiary syphillis: IM qW x3 doses
* NOT given IV
* LAST 2-4 weeks
43
Bicillin C-R
Procaine penicillin + benzathine penicillin
Caution: *NOT EQ TO BICILLIN LA*
Treats: Scarlet fever, skin/soft tissue, Group A strep
2.4 Million Units IM x 1 dose
Caution: *NOT USED FOR SYPHILLUS*
*NOT GIVEN IV*
44
Penicillin G
IV FORMULATION!!
```
Treats:
———————————————
1) Pneumococcal Pneumonia
2) Meningitis
3) Neurosyphilis
4) Anthrax (Bioterrorism)
```
8-24 million U/d IV divided 4-6 hours
Decrease dose by 1/2 if CrCl< 10
45
Pen-Vee K; Veetids
Penicillin V
ORAL FORMULATION
250-500mg PO qid EMPTY STOMACHE
SOLUTION IS stable in refrigerator for 14 days
46
Pre-Pen
Benzylpenicilloyl polylysine
-skin testing for allergic patients:
1 drop in needle scratch; then 0.01-0.02ml intradermally if no reaction
47
Penicillinase Resistant PCN’s
COND
Cloxacillin (not avail)
Oxacillin: *HEPATOTOXIC*: if dose > 12 QD: LFT
NAFCILLIN: MSSA: 1-2g IV q4-6h
(**NO ADJUSTMENT IN RENAL IMPAIRMENT**)
Dicloxacillin - Empty stomache
METHICILLIN: Not avail
——————————————————
Note: THESE DRUGS ARE USED FOR STAPH AUREUS ONLY. MSSA BUT NOT MRSA.
48
Ampicillin
Aminipenicillin
Spectrum: strep, enterococci, LiSTERiA
Form: IV/PO (EMPTY STOMACHE)
SE: RASH, Diarrhea
**DOC for ENTEROCOCCUS**
Suspension stability
- 7 days at room temp
- 14 days in refrigerator
Decrease dose if CrVl < 10
49
Amoxicillin
MoxaTag (ER, 775mg QD)
AminoPCN
Dose: 250-500mg q8H or 500-875 po Q12
Forms: TABS IR/ER: Oral SUSP/ Infant Drops (stable for 14 days room temp & refrigerator)
Indications: OTITIS MEDIA( 1st Line) - 90mg/kg/d**
**Dental ppx (2G 1 hour prior) **
REMEMBER THE DOSAGES. TOP 100 drug
50
Beta-lactam combo’s
Spectrum of coverage
Zosyn (pip-taz) IV
Unasyn (Ampicillin/sulbactam) IV
Augmentin (Amox/ clavulanate) PO/SUSP ORAL
Zosyn/ Timentin are anti-pseudomonal
————————————————————-
By adding B-lactamase we gain BACK activity
- staph aureus
- Enterococcus
- Streptococcus
- B.frag
- H.influ
- M. Cat
**Pseudomonas (Zosyn/ Timentin ONLY)
51
Unasyn
AminoPCN + Beta-Lactamase Inhibitor
Amp/Sulbactam
Forms: IV/IM ONLY
DOSE: 1.5-3.0 g q6H
Most stable: **NORMAL SALINE**
52
Augmentin (amox+clav)
Forms: tabs BID
CHEWABLE/ SUSP BID
AUGMENTIN ES: 600mg susp. BID W/ Food
AUGMENTIN XR: 1000mg amox + 62.5mg claV BID W/ FOOD
- contraindicated w/ crcl < 30ml/min
- REFRIGERATE SUSP
53
Zosyn
Piperacillin/tazobactam
- Dose adjust in RENAL iMPAIRment
**COVERS PSEUDOMONAS**
**DOSE ADJUST IN RENAL iMPAiRMENT**
54
Adverse EFFECTS of PCN and METABOLITES
HYPERSENSITIVITY
CNS: **SEIZURES**
GI TOXICITY: Diarrhea
55
Which bugs are cephalosporins NOT effective w?
1) anaerobes
2) Enterococci
3) MRSA
4) ListeriA
(MEAL)
56
First GEN CEPHS
GENERAL INFO
Spectrum: Gram(+) and PEK organisms(Proteu, E.coli, Klebsiella)
- ALL pregnancy CATEGORY B and RENAL
- USUALLY FIRST LINE FOR SURGICAL PPX!
57
Keflex
Cephalexin
1st GEN
58
Ancef
Cefazolin (1st GEN)
Forms: IV/IM Q6-8h;DOC for surgical PPX
59
Duricef
Cefadroxil
1st GEN ceph
Forms: PO/suspension
60
Second generation CEPHS
Spectrum of ACTIVITY!!
2nd GEN are a 2nd line for OTITIS MEDIA(AMOX IS 1st LINE)
Greater activity against gram (-) organisms HENPEKS
———————————-
H. Influ
ENterobacter
neisseria
E.coli
Klebsiella
Strep pneumoniae
61
Cefaclor
2nd GEN
FORMS: PO
Not used as much
62
Cefzil
2nd GEN
FORM: PO ONLY
63
CEFTIN; ZiNACEF
**VERY COMMON**
CEFURIXIME
FORMS: IM/IV/PO
64
Mefoxin
Cefoxitin
2nd GEN
FORM: IV ONLY
65
Cefotetan
2nd GEN CEF
FORMS: IM/IM
66
Which 2nd gen CEPHS do have activity against anaerobes (b. Fragilis)
1) Cefoxitin
2) cefotetan
(CAN BE USED FOR INTRAABDOMINAL SURG)
67
Which CEPHS cover pseudomonas?
- Ceftazidime (Fortaz) 3rd gen
- Cefepime (4th gen)
- ceftolozane/tazobactam (Zerbaxa) (5th gen)
68
3rd GEN ORALS
PO DRUGS ONLY
```
Omnicef (Cefdinir) - PO
**COMES IN SUSP AND YOU DO NOT REFRIGERATE**
**DONT COMBINE WITH MULTIVIT OR ANTACIDS
—————————————————
SPECTRACEF (cefditoren)
**CONTRAINDICATED WITH MILK/PROTEIN ALLERGY**
—————————————————
Suprax (cefixime)
-CoverGe against N.gonorrhea
———————————————-
Vantin (cefpodoxime)
```
Cedax (Cefibutin)
69
3rd GEN CEPHS (Parenteral)
*Ceftazidime (Fortaz;Tazicef
IM/IV, Antipseudomonal
Ceftaz/avibactam (Avycaz)
TYPICALLY FOR MORE RESISTANT Enterobacteriaceae, Klebsiella, Pseudomonas, BUT NOT USED FOR ACINETIBACTER
IV- Over 2H for conplicated abdominal inf and UTi
Cefotaxime (Claforan): IM/IV
70
Rocephin
KNOW VERY WELL (COMMON)
Ceftriaxone
Form: IM/IV ONLY
Treats: 1) Meningitis and ENDOcarditis
(2g IV Q12)
2) Goborrhea: Ceftriaxone 250mg IM +
Azithromycin 1g
*NO RENAL ADJUSTMENTS*
71
Maxipime
Cefepime (4th GEN)
Anti-pseudomonal covers gram-/+
72
Fifth GEN CEPHS
Teflaro (Ceftaroline) - IV
CEFTOLOZANE/Tazobactam (ZERBAXA) - IV
73
Teflaro
Ceftaroline (5th GEN)
Forms- IV ONLY
Treats: CAP (but not for MRSA PNA)
SSTI (MRSA APPROVAL IS FOR SKIN INFECTIONS ONLY
74
Zerbaxa
Ceftolozane/ tazo
5th GEN
IV ONLY
TREATS: IntraAbdominal Infections w/ FLAGYL
COMPLICATED UTI*
RENALLY DOSE ADJUST
75
Carbapenems
Spectrum and GENERAL INFO
SOA: Gram(+) EXCEPT MRSA
GRAM (-) and Anaerobes
- ALL cover Pseudomonas, acinetoBACTER, Enterococcus EXCEPT ERTAPENEM
- Useful for intraabdominal infections and DOC for pancreatitis
Vabomere(Meropenem + vaborbactM)
Complited UTI/puelonephritis
***TECHNICALLY DO NOT GIVE WITH PENICILLIN ALLERGY***
Cause SUPER-INFECTUONS: Fungus!!
**DOSE DEP SEIZURE** (ESPECIALLY W/ Primixin)
——————————————————
DI: Decrease VALPROIC ACID LEVELS AND CAN CAUSE SEIZURE IN PATIENTS WHO HAVE SEIZURES
^ Increase seizures w/ ganciclovir
76
Azactam
Aztreonam (MonoBActaM)
Aerobic gram(-) ONLY, w/ Pseudomonas
Treats: UTi (IM,IV): 500mg to 1g q8-12H
SEVERE SYSTEMIC UNFECTIONS
CYSTIC FIBROSIS
ADVERSE EVENTS: SKIN RASH
- Used if nephrotoxicity from AG
* USED FOR PENICILLIN ALLERGY*
77
VancOmyciN
MOA: InhibITS CELL WALL phospholipids
Spectrum: MRSA; ALL GRAM(+), PCN/ceph allergic patientz
AR: OTOTOXICITY, NEPHROTOXICITY, RED-MAN SYNDROME
Peak 20-30 mcg/l
**TROUGH: 10-20 mcg/ml**
**HIGHER TROUGHS OF 15-20 are RECOMMENDED FOR: Bacteremia, Endocarditis, Osteomyelitis, Meningitis, HAP PNA CAUSED BY S.aureus**
Trough: USUALLY DRAW WHEN STEADY-STATE HAS BEEN REACHED USUALLY BEFORE THE 4th DOSE
2nd line agent for: c.diff oral form (REALLY THIS IS FIRST LINE NOW!!!)
Maint dose: 15-20mg/kg given over ATLEAST 1 hour
REDMAN SYNDROME W/ rapid IV infusion
Crcl > 50 Q8-12
20-49 QD
< 20, depends on serum levels
C.diff: 125mg PO QID x10 days
78
AmiNOglycosides
GENTAMYCIN/TOBRAMYcin, NEOMYcin, and Amikacin!!
Coverage: Pseudomonas and gram(-)
SE: NEPHROTOXICITY
OTOTOXICITY
- Neuromuscular BLOCK
- POST AB EFFECT
- Conc DEP killing
Gentamicin/Tobramycin
```
- Peak 5-10, Trough <2
—————————————-
Amikacin
-peak 20-30, trough <5
—————————————-
Trough: drawn immediately after next dose 30 min prior
```
Prak: 15-20 min after IV Infusion or 90 mins after an IM injection
79
Cortisporin
Neomycin/ polymyxin B, Hydrocortisone
80
Cubicin
Daptomycin w/ NORMAL SALINE
FORM: IV ONCE DAILY
TREATS: complicated SKIN, not used in PNA.
Unlabled use: VRE!!!
MOA; Binds to cell membrane and cause depolarization. CIDAL.
Gram(+) ONLY; NEVER IN THE LUNGS!!
RENAL
SE: Neuropathy/ Myopathy
PREGANCY CAT B
***Dont use for PNA***
81
What alternatives can you use for GRAM(+) for Cubicin
Zyvox (Linezolid)
Synercid
82
FLOUROQUINOLONES (FQ)
General INFO
MOA: DNA GYRASE
SPECTRUM: gram(-); ATYPICALS
Treat: CAP; UTI; STD’s
Caution: AVOID IN CHILDREN AND PREGNANCY (Can cause arthropathy; cartilage erosion)
Counseling pts: SEPERATE ANTACIDS, Vitamins, Didanosine (quinALONE)
NOT FOR CHILDREN < 18YO
DRUG INT: ^ THEOPHYLLINE; ^Warfarin
83
FQ SIDE EFFECTS:
CNS: (HA, Dizziness, seizures)
CRYSTALLURIA: Nephrotoxicity (DRINK FLUID!!!)
**PHOTOSENSITIVITY**
QT prolongation(moxi-Avelox)
**TENDON RUPTURE** especially if on CORTICOSTEROID: BBW!!
PSEUDomembranous COLITIS
PERIPHERAL NEUROPATHY/ exacerbate MUSCLE WEAKNESS
ASSOCIATED W/ HYPO: HYPERGLYCEMIA
84
2nd GEN FQ’s
CiPRO
OFLOXACIN (Ocuflox; eye/ear/ PO tabs)
Cover: UTI’s/ PSEUDOMONAS/ Gram(-)/ SSTi/ Osteomyelitis
CAUTION: $$$$****NEVER USE 2nd gen for PNEUMONIA, NEVER USE CIPRO FOR PNA!!!****$$$$
85
3rd GEN CEPH’s
Levofloxacin(LEVAQUIN)
Covers: MSSA, Gram(-), & atypicals: C. Pneumoniae and M,Pneumoniae
Respiratory tract (PNA)/ SSTI/ UTi
Note: LEVAQUIN IS PROBABLY MOST BROARD SPECTRUM AND CAN BE USED AGAINST UTI AND PNA$$
86
Fourth GEN CEPH’s
Gatifloxacin, Moxifloxacin
Coverage: Anaerobic bacteria
(Dont use MOXIFLOXACIN: AVELOX AGAINST UTI
87
Baxdela
Delafloxacin
Forms: PO/IV
MRSA/ strep/ e.coli/ klebsiella, Enterobacter, Pseudomonas
88
Cipro/ cipro XR/ ProQuin XR
Ciprofloxacin
Dose: 250-500 q12H
Forms: ciproDEX (otic)(Cipro/dexamethasone)
Otolevel (cipro/fluocinolone)
Ciloxan (ophthalmic; EYE)
**IV is 80% of ORAL**
Reduce dose in RENAL IMPAIRMENT
DI: Inhibits cyp1A2 - caffeine/theophylline/ warfarin/ hypoglycemia w/ glyburide
- 2h before or 6h AFTER ANTACIDS/ Ca+ products/ viramins
OATP Inhibitors: Orange juice, apple juice, green tea DECREASE LEVELS OF CIPRO!!
- DO NOT GIVE ORAL SUSP THROUGH A FEEDING TUBE!!
89
Levaquin
Levofloxacin (3rd GEN)
Forms: IV/PO/ORAL Solution
750mg QD for CAP
500mg Qd for 7DAYS
*PROSTATITIS: use for 28 DAYS*
^ INR, monitor SUGARS with SULFONYL UREAS
90
Zymaxid
Gatifloxacin
Ophthalmic 0.5% soln
4th GEN
91
Factiva
GEMIFLOXACIN
PO TABLETS
4th GEN
Chronic bronchitis
Community acquired pneumonia
- D/C if pts get a RASH
92
Avelox
Vigamox- Eyes
Moxeza- Eyes
Moxifloxacin
4th GEN CEF.
NEVER GIVE FOR UTi!!!
Form: 400mg PO/IV
ADMIN: INFUSE OVER 1 HOUR (Like Vanco)
CONTRAINDICATED W/ Ziprasidone (GEONDON)
AVOID IN HEPATIC FAILURE!!
Safe in renal impairment????
93
Besivance
Besifloxacin
0.6% ophthalmic (SUSPENSION)
Make sure to SHAKE BEFORE USING
94
Baxdela
Delafloxacin
Treats: SSTI(MRSA), PseudomoNAS, gram(-)
Dose: IV/PO
NOT RECOMMENDED IN ESRD <15
95
HOW TO TREAT UTI!???
Uncomplicated cystitis (UTI)
- BACTRIM
- Nitrofurantoin (Macrobid)
- Fosfomycin (Monurol)
**If need quinolone, suggest CIPRO, Levaquin is too broad unless PYELONEPHRITIS**
Advise physician to not use Moxiflox/gemifloxacin as it does NOT REACH THE URINE
———————————————-
1st Line for Pyelonephritis: CiPRO, Levaquin/ Bactrim
96
Biaxin; Biaxin XL
Clarithromycin
Treats: Group A strep, sinusitis, CAP, MAC 250-500mg BID
```
P450 INHiBiTOR
——————————-
Renal
Decrease by 50% for 30-60ml
Decrease by 75% for < 50ml
```
Counseling: Take Biaxin XL w/ food
Forms: *DO NOT REFRIGERATE SUSPENSION**
97
zMax; ZithroMAX
Azithromycin
Forms: Tabs: 250, 500, 600
Suspension 100;200/5mL - EMPTY STOM.
Z-pack # six 250mg tablets x5 days
Tri-Pack # THREE 500mg tabs
Zmax: XR oral SUSP. 2 GRAMS 60mL single dose BOTTLE. Store at ROOM TEMP. MUST USE W/I 12 HRS) - EMPTY STOMACHE
```
- IV 500mg over 1 HOUR
———————————————————-
Caution: - IV site rxn.
- HEARING LOSS
- QT prolongation
- DOES NOT INHIBIT P450
- DONT TAKE W/ antacids
- OBSERVE patient for GI upset; if vomit after 1 hour, no need to redose.
```
98
Dificid
Fidaxomicin
MOA: Inhibit RNA synthesis by inhibiting RNA polymerase.
Dose: 200mg bid x10
SE: nausEa/vomiting
Pregnancy CATEGORY B
99
Tetracyclines
MOA: Binds to 30S sub-unit of RiBOSOME
SPECTRUM: gram(+), gram(-), ATYPICALS!!
Also can use foR SYPILLIS IF PCN ALLERGY!!
100
**VibraMYCiN**, Adoxa, Acticlat, Doryx, Oracea
DoxyCYCLiNE
- IV/PO
TREATS: CAP, Bronchitis, **Lyme Disease**,Rosacea, PID,
- Doryx MPC (Delayed Release)
- OK TO GIVE IN RENAL IMPAIRMENT!!
101
Minocin, Dynacin, Solodyn, Ximino
Minocycline
- 200mg IV/PO first dose then 100mg BID
Hepatotoxic, LUPUS
Treats: Acne, PROSTHETIC JOINT INFECTXN.
102
Sumycin
Tetracycline
Treats: chronic bronchitis
ACUTE EXACERBATION
PUD
DOSAGE: 250-500mg PO QID ON EMPTY STOM.
250-500mg PO BID for ACNE vulgaris
103
Tetracycline
COUNSELING POINTS:
Doxy/ Minocycline: May give w/ food to decrease GI upset. GIVE W/ FULL glass of WATER!
Doxy: Have pat. SIT UPRIGHT FOR 30 minutes.
Oracea(Doxycycline): low dose doxy which has ANTI-IMFLAMMATORY RESPONSE.
Solodyn(Minocycline): for mod/severe ACNE
(LESS DIZZINESS because XR)
```
Ximino(Minocycline) - ER caps
(FOR IMFLAMMATORY, ACNE)
————————————————
- PHOTOSENSITIVITY
- INTERACT W/ milk/ antacids,
```
-DECREASE EFFECTS OF COC; ^ INR w/ Warfarin
————————————————-
-children < 8yo
- Pregnancy: TEETH STAINING
- RENAL patients should not be treated with any tetracycline besides DOXY.
104
Chloramphenicol
MOA: Binds to 50s ribosomal SUBUNIT.
BROAD SPECTRUM:
Gram(+), Gram(-), anaerobes
SE: 1) Hemolytic anemi
2) BINE MARROW SUPP
3) Leukemia
4) **GRAY BABY SYNDROME**
105
Cleocin
Clindamycin
MOA: Inhibits 50S RIBOSOME
SPECTRUM: gram(+); ANAEROBES
(NO GRAM(-) AT ALL)
Forms: caps; solution
SE: #1 cause of C.DIFF
PSEUDOMEMBRANOUS COLITIS: REPORT SEVERE DIARRHEA
106
Linocin
Lincomycin(similar to CLINDA)
SERIOUS GRAM(+)
- DO NOT USE IN CLINDAMYCIN HYPERSENT
- DO NOT USE W/ ERYTHROMYCIN DUE TO ANTAGONISTIC EFFECT
107
Flagyl
Metronidazole
MOA: disrupts bacterial DNA syntheSIS
SPECTRUM: ANAEROBES (DOC: c.diff/ b. Frag)
Contraindicated in 1st TRiMESTER - then PREGNANCY CATEGORY B
SE: Disulfiram reaction (Avoid alcohol)
1) Darkens URine
2) Metallic Taste, GI upset
3) Neuro: Seizures/ Peripheral/ optic neuropathy
DI: ^ INR w/ Warfarin
- Flagyl is a CYP2C19 Inhibitor thus ^ WARFARIN
- if a patient is on it for BACTERIAL vaginosis recommend vaginal CLINDAMYCIN
———————————————-
Dosage forms: - IV
May be Refrigerated; redissolve if
Crystals form using WATER
DILUTE W/ NS
- Tabs TID
- Caps TID
- ER: 750mg QD (EMPTY STOMACHE)
108
Macrobid; MacroDantin; Furadantin (Susp)
NitrofuranToin
Spectrum: ALL UTi gram (-) except for PSEUDOMONAS & Proteus
DOSE- Furadantin, Macrodantin: 50-100mg Q6H W FOOD
- Macrobid: 100mg po BID w/ FOOD X7d
———————————————————
Caution—>
- Dont use if crCL < 60ml
- Pregnancy > 38 weeks
- DO NOT use jn infant < 1 month
- Discoloration of urine (BROWN)
- Heoatic rxns, Peripheral neuropathy; pulm tox!
109
Monurol
Fosfomycin
-Simple uncomplicated UTi
- One 3 gram packet, single dose
- Dissolve in 1/2 cup of water
* Metoclopramide decreases urinary excretion
* Single dose is less effective than cipro/ bactrim
110
Oxazolidinones, are which ABX and what is this MOA?
MOA: Inhibit the 50S. Ribosome subunit and Gram (+) ONLY!!
Linezolid (Zyvox) oral/ IV : BID
TEDIZOLID (Sivextro) - oral/ IV: QD
111
Zyvox
LineZOLID
MOA: Inhibits translation PROCESS
SPECTRUM: VRE/MRSA/GRAM(+)
Dose: 600mg PO BID
FORMS: tabs, susp, IV(D5W)
———————————————-
- Thromocytopenia
- MAO INHIBITOR (interacts w/ serotonergic agents and TYRAMINE food/ 3 MONTHS OF TREATMENT
RENALLY CLEARED: NO ADJUSTMENT NEEDED
PREGANCY CATEGORY C
112
Sivextro
Tedizolid
GRAM(+), skin infections, MES, strep, and ENTEROCOCCUS FAECALIS
DOSE: 200mg QD IV OR ORAL
NO DOSE ADJUSMENTS Needed in HEPATIC/ RENAL
CAUTION: MyeloSUPP
* NOT RECOMMENDED IF ANC < 1000
- MAOI
COMMON SE: n/v/ diarrhea/ dizziness
113
Synercid
Quinupristine/ Dalfopristin
IV ONLY
GRAM(+) ONLY
SPECTRUM: VRE/ MRSA
SE: Venous irritation, Arthalgia/ Myalgia
CYP3A4 inhibitor
- COVERS E. Faecium ONLY
114
Tygacil
Tigecycline
MOA: works on 30S RIBOSOME Inhibits protein synthesis
BROAD SPECTRUM ACTIVITY
GRAM(+) pathogens, SSTI, intraABDOMINAL, but NOT FOR CAP CAUSED BY MRSA, VRE; faecium/faecalis
Gram(-) pathogens
Anaerobic
*INCREASE RISK OF DEATH* BBW
————————————————
Similar ti TETRACYCLINES thus has similar SE
- N/V: Photosensitivity: Pancreatitis
Cautions: Pregnancy CAT
DO NOT GIVE LESS THAN 8 yrs OLD
DECREASE EFFICACY OF OCP
MONITOR INR
115
Lipoglycopeptides
VERY SIMILAR TO VANCO
Vibativ : Telavancin (QD)
Dalvance: Dalbavancin (WEEKLY)
Orbactiv: Ortavancin (Single Dose)
Spectrum: GRAM(+)
MOA: Inhibit CELL WALL SYNTHESIS
116
Vibativ
- TelavAncin (LIKE VAnco)
Complicated SSTI (MSSA/MRSA)
- Qt prolongation
* Nephrotoxicity
* TASTE DIST/ Foamy URINE!!**
————————————————
- IV QD w/ no monitoring
————————————————
Dose adjustments < 50
- CrCL of 30-50 is 7.5mg/kg every 24h
- CrCl 10-30: 10mg/kg every 48h
*OVER 69 minutes because of RED-MAN syndrome*
117
Dalvance
Dalbivancin
VERY LONG HALF LIFE
D5W
Infuse over 30 minutes.
GIVE ONE DOSE WEEKLY
118
Orbactiv
OritaVANCIN
*SINGLE DOSE OVER 3 HOURS*
D5W ONLY!!
LONG T1/2 10 days
ONLY GOOD FOR 6 HOURS AT ROOM TEMP!!!
Contraindicated: USE OF IV HEPARIN for 120 hours after ORBACTIV; falsely ELEVATED aPTT test for 120 hours.
- Orbactiv my increase risk of BLEEDING w/ Warfarin.
119
Treatment of MRSA - IV
- Vanco
- Daptomycin
- Linezolid
- Tedizolid
- Ceftaroline
- Telavancin
- Dalbavancin
- OritaVancin
120
TREATMENT OF MRSA- PO
- Clindamycin
- Bactrim
- Doxycyline
- Minocycline
- Linezolid/ Tedizolid
121
Which drugs TREAT VRE
- Linezolid (WORKS BOTH)
- Daptomycin
- Tigecycline
- synecid (faecium only)
- Tedizolid/ TelVancin/ Oritavancin( Faecalis)
122
BacTRIM/ SepTRA/Sulfatrim/
Cotrimoxazole
Trimethoprim-Sulfamethoxazole
Trimethoprim MOA: Inhibit bacterial dihydrofolATE. SULFONAMIDE IS FOR SYNERGY
SE: BONE MARROW SUPRESSION
- Anemia, Leukopenia, Thrombocytopenia- GIVE FOLIC ACID TO REVERSE
- HYPERKALEMIA
- RASH**/ crystalURIA
- PHOTOSENSITIVITY W THE RASH
Renal CL
USE 50% of dose for crcl 15-30
- DONT USE IF CrCL< 15
PREGANCY CATEGORY C
—————————————-
Spectrum: gram(-), PCP, MRSA
Clinical use: UTI/ PCP/ MRSA
DI: -Warfarin
- Rifampin
Counseling pts: SULFA ALLERGY
REPORT RASH(AVOID SUN)
DRINK A LOT OF WATER
————————————————
Contraindicated in MEGALOBLASTIC ANEMIA
PREGNANT PATIENTS AND NURSING MOTHERS and can cause kernicturs
Infants< 2 months
- Hepatic damage or severe renal insufficiency
123
Bactrim dosing
400(s)-80; DS 800-160mg (5-1) RATIO
- Store away from heat, moisture, Light
UTI: 800-160mg q12
- Uncomplicated UTI: 3-5 days
- complicated 7-10 days: pyelo 10-14 days
PCP: 15/20 mg/kg TMP every 24 HOURS
PCP PPX: 1 DS Qd
MRSA: 1DS BID or 2DS BID
CRCL< 15 DO NOT GIVE
—————————————-
Bactrim IV infusion must be diluted in D5W
- EACH 5mL should be ADDED to 125mL of D5W
- DO NOT REFRIGERATE AND USE W/I 6 HRS
- If cloudiness happens, DISCARD!!
124
Xifaxan
Rifaximin
- Travelers diarrhea
Prevention of HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS
- Kills bacteria in the gut that PRODUCES AMMONIA
- IBS-D
125
Mepron
Atovaquone
Indication: PCP treatment ; ppx in HIV patients w/ SULFA ALLERGY
DOSE-
Treatment: 750mg po BID X21 days
Prevention: 1500mg PO DAILY
126
ABX SAFE TO USE IN PREGNANCY!!
Penicillins/ cephalosporins
ERYTHROMYCIN/ Azithromycin (B)
Clindamycin (alt to metronidazole in first trimester for anaerobic coverage)
Nitrofurantoin
Daptomycin
127
ABX NOT REFRIGERATED?
- Biaxin
- cleocin
- omnicef
128
Which ABX CANNOT be left at ROOM TEMP?
- Augmentin
129
Fungizone
Ampho B (Conventional)
MOA: binding to ergosterol (part of cell wall/Membrane)
SE: Infusion related shaking/CHILLS, Hypotension, NEPHROTOX, Hypomag/ hypokalemia.
*PREMediCATE w/ APAP, diphenhydramine, HYDROCORTISONE, Meperidine(for SHAKING/CHILLS)*
Ampho B(IV): Give IV test dose of 1mg**
———————————————————
D5W (ONLY)
1mg/10mL
130
Abelcet/ AmBisone/ Amphotec
Ampho-B LIPID Formulations
-Less toxic but more EXPENSIVE than CONVENTIONAL
—————————————————-
MUST meet at least one of the following criteria:
1) Significant Renal Impairment : Scr> 2.4 or CrCL < 50ml/min, or a rise in Scr 1mg/dL over BASELINE
2) Patient is unable to tolerate regular AMPHO-B
3) Transplant PATIENTS, generally exempt.
131
Azole AntiFungals
GENERAL INFO
MOA: Inhibit cyp450 DEPENDENT ERGOSTEROL SYNTHESIS*
SE: Hepatotoxicity
DI: CYP3A4 (Ketoconazole/ itraconazole), ^ INR
Counseling points:
1) Itra/keto- conazole NEED ACIDIC ENVIRONMENT, Avoid giving with ANTACIDS!! (W/ FOOD)
2) Fluconazole/Itraconazole penetrate BBB and thus can cause HA AND VERTIGO
132
Diflucan
Fluconazole
Forms: tabs/ susp/ IV
TREATS: 1) Vaginal candidiasis
2) Oropharynge CANDIDIASIS (Thrush)
3) Systemic Candiasis (400mg/d)
4) Coccidiomycosis
5) Cryptococcus Meningitis
SE: Hepatoxicity, HA, NAUSEA, abd pain, pruritis
Pregnancy: Single 150mg dose CAT C, all other CAT D.
CDC recommend ONLY using TOPICAL ANTIFUNGALS (vaginal azoles for 7 days to treat PREGNANT WOMEN WITH VulvoVAGINAL INFECTIONS
133
SporaNOX (L/C)
Itraconazole
Form: 100mg caps
200mg Tabs
Solution
IV
DOSE: 200mg PO QD for Onychomycosis
NEED ACIDIC STOMACHE FOR TABS/CAPS
HOWEVER, soln on EMPTY STOMACHE!!!
* MORE ACTIVE AGAINST ASPERGILLUS THAN OTHER AZOLES*
- ALSO cab be used for THRUSH!!
SE: Hepatoxicity/ Negative inotrope (Avoid in CHF), Edema, HTN, Hypokalemia, CNS, GI
DI: CYP450 3A4 inhibitor and SUBSTRATE
CONTRAINDICATED W/: Felodipine, dofetilide, ergot Alkaloids, Lovastatin, Simvastatin, PO Midazolam, Triazolam, Methadone.
134
Nizoral
Ketoconazole
Forms: Shampoo, 2% Cream, 200mg Tabs
Dose/Indications
1) Tinea versicolor: 2% shampoo
2) dandruff: 1% shampoo
3) Systemic Fungal Infections: 200-400mg QD
CYP3A4 Inhibitor/ Substrate
**SUPRESSES TESTOSTERONE**
- Gynecomastia
**SUPRESSES CORTISOL PRODUCTION—> Cushing SYNDROME
NEEDS ACIDIC STOMACHE, TAKE WITH FOODS, avoid antacids
135
Vfend (L/C)
Voriconazole
```
Indications: DOC- Aspergillosis
Esophageal Cadidiasis (THRUSH)
```
Forms: 1) Injection
2) Tabs
3) Oral SUSP (NOT in FRIDGE)
4) EMPTY STOMACHE(Different!**)
WARNING:
1) Monitor VISION w/ Treatment > 28 days
2) CNS(hallucination)
3) CYP3A4 SUBSTRATE
4) Photosensitivity/ RASH
5) Periostatis (Inflammation of tissue surrounding bone)
6) QT prolongation
136
CresembA
Isavuconazonium
Indication: 1) Aspergillosis
2) Mucormycosis
Form: Caps/ IV
- Oral caps: w or w/o FOOD
- IV: infuse over 1 HOUR
Contraindications:
- MAJOR CYP3A4 SUBSTRATE
- Familial short QT syndrome
Monitoring:
- LFT @ baseline and PERIODICALLY
137
CanciDAS
CapsofunGIN
MOA: Inhibit synthesis of GLUCAN; component of fungal cell wall
Indication: INVASIVE ASPERGILLOSIS
DOSE: 70mg IV first day then 50mg IV qd
- Dilution w/ NS or LACTATED RINGERS
138
Eraxis
AnidulaFuGIN
MOA: Inhibits fungal CELL-WALL
INDICATION: Severe Candida
Form: IV (Dilute w/ NS or D5W)
SE: Histamine rxn, give it slowly
139
NOXAFIL
Posconazole
MOA: Inhibit synthesis of ergosterol
Indications: PREVENTION/ TREATMENT of invasive Aspergillosis and CANDIDA Infections in IMMUNOCOMPRAMISED
Forms: 40mg/mL ORAL SUSP (HIGH FAT MEALS)
100mg delayed-release tabs
IV 18mg/mL - avoid in RENAL Impairment
———————————————————-
SE: N/V- HA/ HEPATOX/ Hypokalemia
DI: CYP3A4 Inhibitor/ substrate
```
Precautions: WATCH LFT
QT PROLONGATION (watch for hypokelamia)
```
**CORRECT ELECTROLYTE ABNORMALITIES** before initiating therapy
140
Lotrimin
ClotrimAZOLE
Forms:
1) Topical cream for ATHLETES FOOT
2) Troche “lozenge” for ORAL THRUSH
3) Gyne-Lotrimin (OTC) for vaginal YEAST INF
- USEFUL IN 1st TRIMESTER
4) Vaginal tablet for VAGINAL YEAST INF
- Insert 100mg/d x7 d or 500mg single DOSE.
141
Nystatin
DOC- THRUSH
Forms: Topical/ Oral
- oral: caps/tabs, powder, susp
- Topical: Cream/Oint/ Powder
Oral THRUSH:
- Use 5mL swish/ swallow for ORAL THRUSH
- 400k-600k units QID; swish in mouth several minutes before SWALLOWING
- **CAN GIVE TO INFANTS**
- Causes DIARRHEA and N/V
- NO SYSTEMIC ABSORPTION!!! So it is okay to SWALLOW!!
Contains alcohol!!
142
Miconazole
| Zeasorb, Moni-STAT
MOA: Inhibits ERGOSTEROL synthesis
(OTC) - COMMONLY SEEN IN MONOSTAT?
Forms: powder/ Liquid spray cream
Tinea corporis
Tinea pedis
VULVOVAGINAL CANDIDIASIS
- **BEST TO USE AT BEDTIME SO IT ISN’T EXCRETED OUT OF VAGINA WHILE WALKING**
DI: decrease effect of progesterone
Increase WARFARIN
143
Lamisil
TerbiNAFINE
MOA: Inhibits fungal ergosterol SYNTHESIS
Dose for Onychomycosis:
- Fingernail: 250mg PO qd for 6 WEEKS
- Toenails: 250mg PO qd for 12 WEEKS
* *MONITOR LFTS WHEN TAKING PO**
Lamisil 1% cream (OTC)
- Apply QD/BID for 1-4 WKS
144
PenLAC
Ciclopirox 8% (6.6mL)
- Topical NAIL lacquer for ONYCHOMYCOSIS of Fingernails/ toenails
- APPLY OVER ENTIRE NAIL PLATE, AND UNDER NAIL PLATE SURFACE, AND SURROUNDING SKIN AT BEDTIME (OR ALLOW 8 HOURS BEFORE WASHING)
- APPLY daily over previous coat for 7 DAYS; after 7 days, REMOVE WITH ALCOHOL and continue cycle.
145
Jublia
Efinaconazole
Indication: Fingernails
RX: Topical
QD for 48 WKS
-Similar to PENLAC, However more effective
For patients who cant or wont use oral therapy
- **RECOMMEND ORAL TERBINAFINE(Lamisil) first line (MORE EFFECTIVE)*
146
Kerydin
Tavaborole
Indication: onychomycosis
Dose: 5% topical SOLUTION
- Apply to affected toenails for QD for 48 wks
- Should be applied to the entire toenail surface and under the TIP
147
Luzu
Luliconazole (RX)
- Cream
————————————
148
OTC FUNGAL TOPICALS
Butenafine - LOTRIMIN ULTRA
Clotrimazole - LOTRIMIN AF
Terbinafine - Lamisil AF
Tinactin - Tolnaftate
149
Ancobon
Flucytosine
Forms: ONLY PO
- synergistic w/ ampho B OR Fluconazole jn cryptococcal MENINGITIS
Caution:
1) Causes myeloSUPP
2) Caution w/ Renal Impairment
150
Zovirax
Acyclovir (K/B)
Forms: Topical/ Oral/ IV
- Herpes
- Zoster (Shingles)
- Varicella (chk pox)
RENAL - Drink A LOT of FLUIDS
SE: (Ha, agitation, confusion), N/V/D
151
Valtrex
Valacyclovir (K/B)
1st episode 1g BID x10
Then: 500mg BID x3d
**MUCH BETTER FOR COMPLIANCE**
**watch for RENAL < 50mL/min**
152
Famvir
FAMCICLOVIR
(K/B)
-converted to penciclovir in intestine and liver
153
Tamiflu
Oseltamivir
MOA: Neurominidase Inhibitor
Treat: Influenza A and B
Treatment
- 75mg BID x 5d w/ FOOD to help N/V
- > 2wks old 3mg/kg BID X5d
- Prevention: 75mg PO QD x 7d
- Oral susp for > 1 yo and 30mg, 45mg caps.
- SUSP expires in 10 days once mixed
154
Relenza
Zanamivir
Neurominidase Inhibitor
Treats Influenza A and B
Treatment 10mg (2 PUFFs) BID X 5 days
Ppx: 2 puff QD x7 d
Caution: In asthma and COPD
155
Rapivab
Peramivir (IV)
- PRESERVATIVE FREE
Dose: 600mg single DOSE
dose adjust in RENAL IMPAIRMENT
CONCERNS: derma rxn, hypersensitivity, neuro events
156
Symmetrel
Amantidine
AntiViral
Reduce dose in RENAL impairment
Can cause CUTANEOUS RXN.
Nausea, anorexia, depression, suicidal ideation, seizure, Orthostatic Hypotension, anti-cholinergic
157
Flumadine
Rimantadine
- LESS CNS SIDE EFFEXTS
158
Cytovene;
Vitrasert;
Zirgan: eye gel
Ganciclovir (IV ONLY)
Treats: CMV
MONITOR: CBC, Seizure
- BONE MARROW SUP**
- NEPHROTOXICITY; SEIZURES!!
Do not use if ANC < 500 or plt< 25,000
159
Valcyte
Valganciclovir
PO Renal
- Forms: 450mg tabs and 50mg/ mL solution
- Refrigerate constituted oral soln
Caution: **NEphroTOXICITY, SEIZURes**
160
Vistide
Cidofovir (IV ONLY)
Renal TOXICITY!!
SE: Eyes, neutropenia
**BONE MARROW SUPP**
Give PROBENECID** for renal toxicity!!
Monitor IOP(EYES)
161
Foscavir
Foscarnet (IV ONLY)
** RENAL TOXICITY**
Seizure due to electrolyte imbalance/ neutropenia
**BONE MARROW SUPP**
Supplied in glass bottles or IV bags!!
162
Baraclude
Entecavir
-nucleotide analog
Form: ORALLY ONLY
0. 5-1mg PO QD
- Generally well TOLERATED/ pregnNcy cat C
163
Tyzeka
Telbivudine
HEP-B
Form: ORAL ONLY
600mg PO QD (PREGNANCY CAT B)
SE: 1) Peripheral Neuropathy
2) **MYOPATHY** (^CPK)
164
HepserA
Adefovir
HEP-B
Form: ORAL ONLY
10mg PO QD
-Generally LESS EFFECTIVE
165
Epivir-HB
Lamivudine
HEP B/ HIV
Form: ORAL ONLY
100mg PO QD (HEP-B ONLY)
166
Viread
Tenofovir (DF)
HEP-B/HIV
300mg PO QD (HB)
- **RENAL TOXICITY** Fanconi SYNDROME**
- DECREASE BONE DENSITY/ osteomalacia
167
Vemlidy
Tenofovir alafenamide (AF)
HEP-B/ HIV
25mg PO QD w/ FOOD
168
Intron-A
Interferon alfa-2B
HEP-B
- **FLU-LIKE* s/s
- monitor for DEPRESSION
- **THYROID ABNORMALITIES**
- **HEPATOTOXICITY**
Pulmonary/ CVD rxns
** RETINAL DAMAGE**
** BONE MARROW SUPP**
——————————————-
Monitor: CBC, LFT, TSH, Electrolytes
169
Pegasys
Pegylated interferon alfa-2a
HEP-B
170
okySio
Simeprevir (Protease Inhibitor)
**Watch for SULFA allergy**
Treats: HCV 1/4
Dose: 150mg w/ FOOD
SE: Rash, Photosensitivity (SULFA DRUG)
DI: Major CYP3A4 Substrate
BBW: HB virus reactivation!!
171
Sovaldi
Sofosbuvir
MOA: Nucleotide analog Polymerase Inhibitor (NS5B NPI)
Dose: 400mg QD + Ribavirin and w or W/o Pegingerferon alfa for 12 WEEKS
SE: **SEVERE BRADYCARDIA** when given w/ AMIODARONE
DI: **dont give w/ AMIODARONE**
Combo: Harvoni (ledipasvir/sofosbuvir)
172
Harvoni
Ledipsavir + Sofosbuvir
(DOES NOT REQUIRE INTERFERON OR RIBAVIRIN)
Spectrum: GENOTYPE 1 (MOST COMMON)
Dose: PO WD w or w/o FOOD
Counseling pt: **AVOID ANTACIDS**
DI: co-admin w/ P-gp inducers such as RIFAMPIN, st. johns wort, can DECREASE Harvoni LEVELS
**Avoid CRESTOR(Rosuvastatin)
Caution: **EXTREME CAUTION WHEN COMBINING AMIODARONE W/ Sofosbuvir due to EXTREME BRADYCARDIA**
173
Viekira pak
Ombitasvir, Paritaprevir, ritonavir , dasabuvir (PORD)
Treats: HCV (GT1a/ GT1b)
Dose: Take w/ FOOD.
Pregnancy CATEGORY B (Safe in pregnancy)
174
Technivie
Ombitasvir/ paritaprevir/ ritonavir (POR)
Treats: HCV (GT-4)
Dose: TAKE W/ FOOD
PREGNANY CAT B
175
Daklinza
Daclatasvir
PO QD W/ sofosbuvir (GT3)
Dose: 60mg WD + SOFOSBUVIR
DI: Substrate of CYP3A4
Caution: bradycardia w/ Sofosbuvir + Amiodarone
176
Zepatier
GraZoprevir + elbasvir
Treats: HCV (Ns5A)/ HCV NS3/4A
Dose: 1 tab QD w/o regard to meals
SE: Fatigue, HA, nausea, insomnia. Dizziness,
BBW: risk of HEP B reactivation
COUNSELING POINT:
1) Recommend Zepatier in DIALYSIS
2) RECOMMEND ZEPATIER OR VIEKIRA in SEVERE RENAL IMPAIRMENT
177
Epclusa
Sofosbuvir + velpatasvir
PAN-genotype (can be used for ALL)
DI: DONT USE PPI’s (NEED ACIDIC pH)
Caution:
- Amiodarone
- Atorvastatin, Colchicine,
BBW: Hepatitis B reactivation
178
Mavyret
Glecaprevir + pibrentasvir
QD w/ food x 8 WEEKS
179
Copegus; Rabetrol; Ribasphere
Ribavirin
Treats: Oral (HCV); Inhaled used for RSV infection (off-label)
MOA: Inhibits RNA/DNA synthesis
Caution: Pregancy CATEGORY X
TWO RELIABLE CONTRACEPTIVES!!
Hemolytic ANEMI!!
180
SYnagjs
Palivizumab
- prevention of RSV in HIGH RISK PATIENTS
Preservative FREE
15mg/kg IM QMONTH during RSV season (November-April)
181
Emverm
Mebendazole
Dose: 100mg SINGLE DOSE (Pinworm), REPEAT IN 3 weeks
182
Albenza
Albendazole
400mg PO Single DOSE
183
Pin-x, Pin-RID
Pyrantel (OTC)
> 2 YO
- Capsules/Liquid taken as a SINGLE DOSE for pinworm/ roundworm and 3 days QD for hook worms
- REPEAT IN 2Weeks. Treat entire family
184
Impavido
Miltefosine
Treats: leishmaniasis
PREGnancy CATEGORY D
185
Aralen
Chloroquine
Malaria PPX
Dose: 500mg qwk start 1-2 weeks prior to departure and continue for FOUR WEEKS
186
Lariam
Mefloquine
- Malaria PPX for Chloroquine RESIST
Dose: 250mg qWK
Start 1-2 WKS prior to departure and continue 4 wks after return
CNS: **Contraindicated in psych, epilepsy, CVD**
187
Doxycycline
| As an anti-malarial
100mg Qd for adults.
Begin 1-2 d prior to travel, Continued for 4 WEEKS after
- Avoid in children < 8 YO/ photosensitivity
188
Malarone
Atovaquone/Proguanil
Dose: QD 2 days prior, then continue for SEVEN(7) days afterwards
SE: HA, insomnia, GI, mouth ulcers, SJS, hepatitis
Avoid in cL< 30ml/min
189
Plaquenil
Hydroxychloroquine SulFATE
Qwk, start 2 weeks prior to departure and 8 weeks after return
SE: **VISUAL CHANGES** (EYE EXAM/ CBC)
190
VSL#3
High potency probiotic with 450 Billion live bacteria per packet
Approved for:
1) Ulverative colitis
2) ileal pouch
3) Irritable bowel syndrome (IBS)
191
Hiprex
Methenamine
Treats: PPX for patients w/ RECURRENT UTi
**CONTRAINDICATED W/ SULFONAMIDES**
Antacids/PPI’s or anything that RAISES urinary pH may DECREASE LEVELS OF METHENAMINE
