Block 1 Flashcards
1
Q
Natural PCN coverage
A
No G-
G+, strep except enterococcus
2
Q
What is DOC for T. pallidum?
A
PCN G
3
Q
What is the DOC for MSSA?
A
Anti-staphyl. PCN + 1st Gen cephalosporins
Nafcillin
Oxacillin
Dicloxacillin
4
Q
Anti-staph PCN coverage
A
No G-
G+: MSSA, MSSE, some strep except enterococcus
5
Q
AminoPCN (ampicillin and amoxicillin) coverage
A
No G-
Strep, enterococcus, listeria spp.
Some oral anaerobes
AminoPCN + BLI can treat many G- enterobacteriaceae, and some non-enteric as well as enteric anaerobes
6
Q
What is the DOC for Enterococcus?
A
Amino PCN (ampicillin and amoxicillin)
7
Q
Ureido PCN + BLI (Zosyn) coverage?
A
Strep and Enterococcus
Some G- likes enterobacteriaceae, non enterics like P. aeruginosa
Oral and enteric anaerobes
8
Q
1st Gen cephalosporin coverage
A
G+: MSSA, strep except enterococcus
G-: Ancef for PEK, Proteus, E. coli, Klebsiella
Some oral anaerobes
9
Q
2nd Gen cephalosporin coverage
A
G+: Strep except enterococcus
G-: PEK; Proteus, E. coli, Klebsiella
Some oral anaerobes
10
Q
3rd Gen cephalosporin coverage
A
G+: Strep and S. pneumoniae
G-: Enterobacteriaceae, Kingella, H. influenzae, Neisseria
11
Q
What is the DOC for S. pneumoniae?
A
3rd Gen cephalosporins
12
Q
What is the DOC for KIN (Kingella, H. influenzae, Neisseria)
A
3rd Gen cephalosporins
13
Q
What cephalosporins begin to lose G+ coverage?
A
“3.5” Gen
Ceftazidime
Cefiderocol
14
Q
Coverage for 3.5 and 4th Gen Cephalosporin
A
G+: 4th only, MSSA + strep except enterococcus
G-: All, Enterobacteriaceae including P. aeruginosa
15
Q
Which fluoroquinolone covers MRSA and MRSE?
A
Delafloxacin
16
Q
Do fluoroquinolones cover Atypicals?
A
Yes
17
Q
Which fluoroquinolones cover staph infections?
A
Only delafloxacin
18
Q
Which fluoroquinolones cover strep infections?
A
All do except cipro
19
Q
Which fluoroquinolones cover S. pneumoniae?
A
All do except cipro
20
Q
What does cipro cover?
A
Enteric and nonenterics, P. aeruginosa + atypicals
21
Q
Which fluoroquinolones do NOT cover P. aeruginosa?
A
Moxifloxacin
22
Q
Which fluoroquinolones cover oral anaerobes?
A
All, but cipro is limited
Delafloxacin and Moxifloxacin have some gut targets as well
23
Q
Do carbapenems cover Atypicals?
A
No
24
Q
Do PCNs cover Atypicals?
A
No
25
Do Macrolides cover Atypicals?
Yes
26
Do Tetracyclines cover Atypicals?
Yes
27
Carbapenem coverage?
Broad spectrum, but CAN'T cover:
G+: MRSA, enterococci, L. monocytogenes
G-: Vibrio, P. aeruginosa
28
Aztreonam coverage?
ONLY G-
Except CIA
M. catarrhalis
H. influenzae
P. aeruginosa
29
Aminoglycoside coverage?
Used for G- and G+ (synergy required for G+)
30
Macrolide coverage?
Atypicals
Some G- coverage:
C. jejuni
Salmonella
Shigella
H. influenzae
M. catarrhalis
N. gonorrhoeae
31
What are the 1st Gen Tetracyclines?
Tetracycline
Doxycycline
Minocycline
32
What are the 2nd Gen Tetracyclines?
Tigecycline
Omadacycline
Eravacycline
33
BBW for Tigecycline?
Mortality
Omadacycline just has a warning
34
Tetracycline general coverage?
G+ and Atypicals
35
Glycopeptide/Lipopeptide general coverage?
G+
36
Oxazolidinone general coverage?
G+
37
Fosfomycin general coverage?
G-
38
Clindamycin general coverage?
G+
39
Lefamulin general coverage?
G+, G-, Atypicals
40
Metronidazole coverage?
B. fragilis
41
Nitrofurantoin coverage?
G+: enterococcus
G-: E. coli + K.pneumoniae
42
Polymyxins coverage?
P. aeruginosa
43
Bactrim general coverage?
G+, G-, only Legionella Atypical species
44
What are the Anti-MRSA (IV) Rx?
Dapto
Vanco (w/ other "vancs")
Ceftaroline
Tetracyclines
Linezolid (w/ other Rx)
Pleuromutilins
Delafloxacine
Chloramphenicol
Synercid (streptogramin)
45
What are the anti-MRSA (PO) Rx?
Clindamycin
Pleuromutilins
Delafloxacin
Bactrim
Linezolid (w/ other Rx)
Tetracycline
46
What are the anti-MSSA Rx?
Dicloxacillin (PO)
Oxacillin
Cefazolin/Cephelexin
Cefipime
Any anti MRSA agent
Nafcillin
47
What are the common Rx against enterococcus?
Vanco
Ampicillin
Linezolid
Dapto
**remember that cephalosporins cant fix this one
48
What are the anti-pseudomonal Rx?
Carbapenems (except ertapenem)
Aminoglycosides (except plazo)
Monobactam (aztreonam)
Polymixins
Fluroquinolones (except Moxi)
thIRd/Fourth Gen ceph
Extended spectrum B-lactams
**CAMP FIRE
49
What are the anti-Atypical Rx?
Fluoroquinolones
Macrolides
Tetracyclines
Pleuromutilin (Lefamulin)
50
What are the peak:MIC rx?
Aminoglycosides
Fluoroquinolones
Flagyl
51
What are the AUC:MIC rx?
Macrolides
Tetracycline
Vanco
52
What are the Time>MIC rx?
Beta-lactams
Oxazolidinones
53
What are the bacteriostatic RX?
Linezolid
Tetracyclines
Vanco (for enterococcus spp.)
54
What are the bactericidal Rx?
Beta-lactams
Vanco (staph and strep spp.)
55
Which anti-MRSA rx are 1:1 IV:PO?
Linezolid
Doxycycline
Bactrim
56
Which anti-typical rx are 1:1 IV:PO?
Fluoroquinolones (levo, moxi)
Doxycycline
Azithromycin
57
Which anti-anaerobe rx are 1:1 IV:PO?
Flagyl
58
Which other rx that doesnt cover MRSA, typicals, or anaerobes are 1:1 IV:PO?
Rifampin
-azoles (flu, vori)
59
Which Abx are weight based by TBW?
Vanco + Dapto
Bactrim but only on the trimethoprim part
**adjBW if obese
60
Which Abx are weight based by IBW
Aminoglycosides and Polymixins
61
Which Abx should NOT be used to treat lung infections?
Dapto due to it being inactivated by surfactants
Aminoglycosides because it has poor penetration
Abx must be able to cross both hydrophobic and hydrophilic barriers
62
In the urine/kidney, how does nitrofurantoin and moxifloxacin behave?
Nitro doesnt penetrate kidneys
Moxi doesnt concentrate in the kidneys
63
Which Abx increase INR?
FAB5
Flagyl/Fluoroquinolones
Azoles
Bactrim/Biaxin
64
What DDI exist with linezolid?
SSRIs/MAOIs risk of serotonin syndrome
65
Using SSRIs/MAOIs with what Abx increases risk of serotonin syndrome?
Linezolid
66
What DDI exist with meropenem?
Valproic acid; decreases the amount of valproic acid
67
Using valproic acid and this Abx should NOT be used together...
Meropenem
68
Which Abx cause altered mental status?
Imipenem/cilastin combo
Fluoroquinolones
69
Which Abx causes neutropenia?
Beta-lactams
70
Which Abx causes kernicterus?
Ceftriaxone
71
What Abx class causes hyper/hypo glycemia?
Fluoroquinolones
72
What Abx class causes increased risk of MSK disorders in pediatrics?
Fluoroquinolones
73
BBW of lipopeptides?
Increased mortality when used for pneumonia
Also has metallic taste Sx
74
Increased mortality when used for pneumonia is a BBW for which Abx class?
Lipopeptides
75
Vanco uses (zero/first) order kinetics. What does that mean?
First
First = constant FRACTION of drug eliminated per unit time; rate of rx elimination is PROPORTIONAL to Rx plasma concentration
Zero = constant AMOUNT of drug eliminated per unit time
76
As MIC increases, the effect of vanco (increases/decreases)
Decreases
77
What DDI exist with vanco?
Zosyn, increased nephrotoxicity
78
Vd of vanco?
0.7L/kg
79
Half life of vanco?
Adults = 6-7 hrs
80
LD, MD of Vanco (initally)
LD = 20-35mg/kg via TBW
MD = 15-20mg/kg via TBW every 8-12hrs
If obese (>130% IBW), LD = 20-25mg/kg
81
What is the AUC:MIC goal of Vanco?
400-600
82
What levels should be collected for Vanco using the bayesian model?
2 levels after 1st or 2nd dose
Peak: 1-2 hr after infusion
Trough: prior to next dose
83
What levels should be collected for Vanco using the 2 level PK approximation?
2 levels after the 4th dose
84
Just know that vanco MIC is assumed to be 1mg/L
and that if MIC >1, probability of achieving AUC/MIC goal of ≥400 is low
If MIC <1 mg/L, dont decrease dose
kay kay
85
Spectrum of activity on aminoglycosides?
G-
G+ w/ beta-lactams or vanco for synergy
86
Vd of aminoglycosides?
0.25L/kg
87
Half life of aminoglyosides?
2-3hrs unless anephric, then its 30-60hrs
88
What is the desired peak and trough of genta and tobramycin?
Peak = 4-10
Trough = 1-2
89
What is the desired peak and trough of amikacin?
Peak = 15-30
Trough = 5-10
90
Attainment of adequate peak in aminoglycosides shows what?
Efficacy and minimizes risk of ototoxicity
91
Attainment of adequate trough in aminoglycosides shows what?
Minimizes risk of nephrotoxicity and ototoxicity
92
What are the peak/trough levels that must be maintained with gentamicin and synergy dosing?
Peak = 3-4
Trough = <1
93
When should you collect peaks and troughs for aminoglycosides?
If given over 30min, get the peak 30min after the end of the infusion
If given over 1hr, get it at the end of infusion
Troughs are collected 30min to 1hr prior to next dose
Collect repeat levels every 3-7 days
94
AE to watch out for in aminoglycosides?
Nephro, Ototoxicity
Neuromuscular blockade
Limit the use because of accumulation
95
When should you not use extended interval dosing of aminoglycosides?
CrCl <20
Burns >20% of body
Pregnant
Ascites
Significant third spacing
96
What are some advantages of extended interval dosing of aminoglycosides?
Achieves higher peaks
Decreases troughs to nearly undetectable levels
Takes advantage of aminoglycosides post-Abx effect
Reduces adaptive resistance
97
Hartford Nomogram for gentamicin, tobramycin and amikacin
≥60 = q24hr
40-59 = q36hr
20-39 = q48hr
<20 = monitor and administer a dose when below 1mcg/mL
With first dose, get a 6 to 14 hr post infusion level and plot
***Amikacin, divide by 2
***Gentamicin/tobra = 7mg/kg
***Amikacin = 15mg/kg
98
Limitations of Hartford Nomogram?
Do NOT allow clinicians or even yourself to individualize dosing regimens
Based on average PK parameters
99
What clues are given to notate ESBL?
3rd Gen ceph = R
Cephamycin = S
100
What clues are given to notate Amp-C?
3rd Gen ceph = S
Cephamycin = R
101
What clues are given to notate Carbapenemase?
Carbapenems = R
102
How do you treat ESBL?
Low inoculum (UT or skin) = zosyn
High inoculum = fluoroquinolones or carbapenem
103
How do you treat Amp-C?
Low inoculum (UT or skin) = cefepime
High inoculum = carbapenem or fluoroquinolones
104
How do you treat Carbapenemases?
New = combo meds or cefiderocol
Old = Fosfomycins or fluoroquinolones
***must be genetically tested, not common in Texas
105
What does mecA alter?
PBP2 to PBP2a
Confers resistance to anti-staph PCN (MSSA to MRSA
106
If MRSA becomes resistant, what else could it be?
VISA (thicker cell wall) or VRSA (via vanA)
107
What are some risk factors for resistance?
Previous infection or prior Abx within 90 days
For hospital acquired MRSA, an addition of positive nasal carriage
