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Pharm 2 > Antifungals lecture > Flashcards

Antifungals lecture Flashcards

1
Q

Narrow spectrum meds

A

Penicillin
Erythromycin
Nitrofurantoin
Clindamycin

PEN C

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2
Q

Broad spectrum meds

A

Ampicillin
Cephalopsporins
Aminoglyocosides
Tetracyclines
FQs

A CAT FQs (Fucks)

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3
Q

Concentration-dependent ABX

A

Aminoglycosides and FQs

“concentrate as Ami FuQs”

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4
Q

Time-dependent ABX

A

Beta-lactams
Monobactams
Macrolides

BMM

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5
Q

Post Antibiotic Effect can be _______ in an ________ media.

A

decreased
acidic (infected)

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6
Q

ABX resistance is due to….

A

Broad Spectrum

Overuse for inappropriate indications

Poor infection control

Inappropriate dose, duration

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7
Q

Example of Intrinsic Antimicrobial Resistance….

A

Vanc cannot treat gram (-)
Only gram (+)

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8
Q

How do bacteria create Acquired Resistance

A
  • Decreased cell permeability
    -Increased efflux pumps
    -Inactivation
    -Modify antimicrobial target
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9
Q

What does an Antibiogram communicate?

A

Tells about susceptibility rates

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10
Q

Major Nosocomial Infections are?

A

Urinary
Respiratory
Blood

“URB”

Highly associated with the use of DEVICES

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11
Q

Catheter related infections position risk

A

Femoral > IJ > Subclavian

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12
Q

What organism are non-tunneled caths usually colonized with?

A

Gram (+)
Candida, enterococcus, Staph,

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13
Q

Cause of C-Diff and which drug?

A

Antibiotic Therapy
CLINDAMYCIN!!!!!
(2nd place is betalactams)

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14
Q

Pathogenesis is toxin-mediated by which toxins?

A

-Enterotoxin A
-Cytotoxin B

Diagnosis is confirmed through detection of these.

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15
Q

Other risk factors for C-Diff

A

-PPIs and H-2 inhibitors (Acid suppression therapy)
-Handwashing!

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16
Q

Tx of C-Diff?

A

-Oral Vanco (won’t leave GI)
Tx course = 10-14 days
-Dificid
-GI lab (fecal microbiata transplant, 99% cure)

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17
Q

______ of SSIs are preventable when using EBP strategies.

A

HALF

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18
Q

SSI prophylaxis depends on?

A

-Risk of infection (wound classification)
-Patient-related factors
-Bacterial milieu
-Hospital infection rate for procedure
-Factors relating to wound itself

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19
Q

SSI not necessary to continue past ________.

A

Post-op day 1

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20
Q

SSI prophylaxis ABX is usually…..

A

1st gen Cephalosporin (Ancef)

-low cost
-broad spectrum
-low drug interactions

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21
Q

Is there a need for SSI prophylaxis for Class 1 wound?

A

NO!

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22
Q

SSI prophylaxis rec for infected tissue or receiving prosthetic cardiac valves?

A

Include antistaphylococcal ABX for cellulitis and osteomyelitis

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23
Q

SSI prophylaxis timing for Ancef and Vanco?

A

Ancef = 30-60 minutes
Vanco = 60-120 minutes

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24
Q

When to redose Ancef?

A

At 2 half-lives! (1.8 hours)

= 3.6 hours for redose!!!

Redose for 1.5L of blood loss or > 3 hours procedure

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25
Q

Does extended duration of ABX reduce SSI?

A

NO!

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26
Q

What are the Beta-lactams?

A

-Penicillins
-Cephalopsporins
-Monobactams
-Carbapenems

“People Can Make Cars”

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27
Q

What is Beta-lactamase?

A

Bacteria will use this enzyme to break apart betalactam ring of penicillin.

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28
Q

What do beta-lactamase inhibitors do? “bactams”

A

-Sacrifice themselves to betalactamase

-They have NO antibiotic effect (Sulbactam, Tazobactam)

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29
Q

Penicillin coverage

A

Strep A and B

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30
Q

Beta-lactams ADRs?

A

Hypersensitivity, GI upset, and AKI

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31
Q

Amoxicillin Vs Augmentin?

A

Augmentin overcomes beta-lactamse!
-It covers MSSA

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32
Q

What does Amoxicillin/Clavulanate (Augmentin) add on that Amoxicillin (Amoxil) does not?

A

MSSA!!!!

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33
Q

Is Staph susceptible to Augmentin or Amoxicil?

A

Augmentin!!!!

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34
Q

Ampicillin is similar to Amoxil but adds ________ and ________. (not the same!)

A

Enterococci and L. monocytogenes

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35
Q

What are the Antistaphylococcal PCNs?

A

-Oxacillin, Nafcillin, Dicloxacillin

Do not need beta-lactamse inhibitor !!!!!!

NOT MRSA THOUGH

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36
Q

Patients who report PCN allergy had ____ odds of SSI.

A

50%
-Vanc only covers gram (+)!

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37
Q

_____ and _____ rates are higher in patients with reported PCN allergy.

A

MRSA and C-Diff

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38
Q

Will Amoxicillin/Clavulanate overcome beta-lactamase?

A

YES!

39
Q

Antistaphylococcal PCNs don’t need_______.

A

beta-lactamase inhibitor
still covers staph

40
Q

Risk for Piperacillin/Tazo (Zosyn)?

A

Hypokalemia

Zosyn adds on gram (-)

41
Q

MOST Beta-lactams are what?

A

CEPHALOSPORINS

42
Q

ESBLs are resistant to

A

Penicillins plus Cephalosporins up until 3rd gen!

43
Q

Cephalosporin MOA?

A

Same as PCNs, Bactericidal

-less susceptible to penicillinases

44
Q

Cephalosporin coverage from 1st gen to 5th gen?

A

Gram (+) to (-)

45
Q

Which Cephalosporin covers for MRSA?

A

Only 5th Gen!
-broad spectrum against gram (-)

-Ceftaroline (Teflaro)
-Fetroja

46
Q

Example of 1st Gen Cephalosporin?

A

(Cephazolin) Ancef (IV)
Keflex (PO)

47
Q

2nd gen Cephalopsporins add _______? (Cefoxitin, Cefaclor)

A

Respiratory coverage

48
Q

Can you use Cephalosporins interchangeably?

A

Nope

49
Q

Example of good 3rd gen Cephalosporin?

A

Ceftazidime (Fortaz)

TAZMANIAN DEVIL more destructive

50
Q

What does Ceftazidime (Fortaz) cover for?

A

-Staph and most strep
-MOST gram (-) with GOOD PSEUDOMONAL COVERAGE!
-less gram (+) than other 3rd gens.

51
Q

What is more broad spectrum? Ceftriaxone (Rocephin) or Ceftazidime (Fortaz)?

A

Fortaz is more broad spectrum!

Rocephin has NO Pseudomonal coverage

52
Q

Ceftriaxone (Rocephin) specific side effect?

A

-Diarrhea and biliary sludging

-Precipitates with Ca++

53
Q

4th Gen Cephalopsorin?

A

Cefepime
-still resistant to ESBLs

54
Q

What 4th gen Cephalosporins are reserved for ESBL profilers?

A

-Cefepime

Ceftolozane/tazobactam (Zerbexa)

55
Q

5th Gen Cephalosporin example? Coverage?

A

Ceftaroline (Teflaro)
-1st beta-lacatam to cover MRSA!

56
Q

What does Cefiderocol (Fetroja) cover?
(5th Gen Ceph)

A

1st to cover A. baumanni complex
-Covers Acenobacter!!!

57
Q

1st Gen names?

A

Ceph “A”

except Cefaclor (2nd)

58
Q

4th Gen names?

A

Have “pi” in name!

No “a” after Ceph

59
Q

5th gen names?

A

if “rol” is in name!

60
Q

3rd gen names?

A

Ends with Me, One, or Ten!

except cefuroxime

61
Q

Carbapenems action and coverage?

A

throw grenade, destroy everything
-covers most aerobic and anaerobic gram (+) and (-) including pseudomonas

62
Q

Carbapenems ADR risk?
Risk on all package inserts?

A

SEIZURES!

63
Q

Carbapenem with HIGHEST seizure risk?

A

Primaxin! (Imipenem/Cilastatin)

64
Q

Which Carabapenem has lower incidence for seizures?

A

Meropenem (Meronem) / Vaborbactam

65
Q

Treatment of choice for ESBLs?

A

CARBAPENEMS!

66
Q

How does Vanco work? what what type of dependence?

A

Inhibits the peptidoglycan formation, disrupts cell wall synthesis, BACTERICIDAL!

CONCENTRATION DEPENDENT - DRAW TROUGH

67
Q

If MRSA is expected then ______ is used.

A

Vanco

68
Q

How is Vanco dosed?

A

Concentration Based Dosing

Skin/soft tissue - 5/10 mcg/ml
Sepsis, endocarditis- 10-15 mcg/ml

Etc….

69
Q

Vanco ADRs?

A

RED-MAN SYNDROME (SLOW DOWN INFUSION RATE!)
-nephrotoxicity, ototoxicity, thrombocytopenia

70
Q

Vanco, Dapto, and Linezolid are gram ()???

A

Positive (+)
Vanco picked first

71
Q

Daptomycin (Cubicin) coverage? and risks?

A

-Broad spectrum gram (+) including VRE

-given for Vanco resistant gram (+)

Choose Vanco more often unless resistant (more side effects with Cubicin)INFUSION REACTIONS!

72
Q

Linezolid (Zyvox) coverage

A

Broad gram (+) including MRSA, VRE, Enterococci faecalis

-ribosomal subunit inhibiting type.

73
Q

Linezolid (Zyvox) ADRs and special considerations

A

ADRs: Anemia, leukopenia, pancytopenia, thrombocytopenia, myelosupression

Special considerations: Drug interactions with MOA w/ potential for Serotonin Syndrome

CHECK CBCs AND DRUG INTERACTIONS!!!!

74
Q

Macrolides suffix and coverage?

A

“Mycins”
-good for LONG TERM Tx, Good gram (-)
-Covers respiratory

75
Q

Macrolides ADRs?

A

-QT prolongation and
-DRUG INTERACTIONS!

76
Q

How do Fluoroquinolones work?

A

inhibit DNA synthesis

77
Q

FQs risks?
FQs suffix?

A

MANY DRUG INTERACTIONS!

“floxacins”

78
Q

FQs ADRs?

A

GI, arthropathies, QT Prolongations, CNS excitement, muscle weakness (MG) ACHILLES TENDON RUPTURE

79
Q

High risk side effects of FQs?

A

-Tendonitis
-Neurologic
-Hypoglycemia
-Morbidity/Mortality

LOTS OF SIDE EFFECTS!

80
Q

Tetracyclines (“cyclines”) things to know…

A

Don’t give to kids!
-inhibits bone growth and can cause YELLOW TEETH!
-LOTS OF ADRs, LFTS
-3rd line for MRSA
-penetrates skin/tissue

81
Q

Tigecycline (TCNs) symptom

A

High incidence of VOMITING

82
Q

Aminoglycosides (Things to Think about?)

A

-Oto and nephrotoxic!
-Can affect NEUROMUSCULAR BLOCKADE!

-Draw troughs and think about KIDNEYS

83
Q

Things to check when taking Bactrim?

A

Check KIDNEYS, CBCs, and SKIN! (Stevens Johnson syndrome)

84
Q

Bactrim uses

A

Alternative to Vanco for MRSA and VRE

85
Q

Nitrofurantoin (Macrobid) Use?

A

Suppression of Chronic UTIs!
-uropathogens

86
Q

Clindamycin (Cleocin) coverage and considerations

A

Covers ANAEROBES
-ADRs = HIGHEST C-Diff risk and neuromuscular blockade issues

87
Q

Metronidazole (Flagyl) coverage and considerations

A

-Covers ALL ANAEROBES (Very Broad)

ADRS- pancreatitis, peripheral neuropathy

VERY TOXIC

88
Q

Rifampin Uses, Interactions and ADRS

A

LOTS OF DRUG INTERACTIONS (last a long time)

-ORANGE-RED BODY FLUIDS!

FOR TB AND PROSTHETICS!

89
Q

ABX to avoid in Pregnancy

A

Metronidazole, Rifampin, Trimethoprim, FQs, Tetracyclines

-POTENTIAL TO INJUR FETUS

90
Q

Side effects from Antivirals (Acyclovir)

A

CNS effects!
-Post-op delirium, tremors

91
Q

What to use for severe fungal infection?

A

Amphoteracin B

-can cause K and Mg wasting

92
Q

What to consider when taking “Azoles” Fluconazole (Diflucan)?

A

DRUG INTERACTIONS!

93
Q

What do Fungin drugs cover?

A

-Candida and non-candida

Pharm 2 (5 decks)

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