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IPT: ID > Block 1 > Flashcards

Block 1 Flashcards

1
Q

Natural PCN coverage

A

No G-

G+, strep except enterococcus

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2
Q

What is DOC for T. pallidum?

A

PCN G

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3
Q

What is the DOC for MSSA?

A

Anti-staphyl. PCN + 1st Gen cephalosporins

Nafcillin

Oxacillin

Dicloxacillin

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4
Q

Anti-staph PCN coverage

A

No G-

G+: MSSA, MSSE, some strep except enterococcus

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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

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6
Q

What is the DOC for Enterococcus?

A

Amino PCN (ampicillin and amoxicillin)

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7
Q

Ureido PCN + BLI (Zosyn) coverage?

A

Strep and Enterococcus

Some G- likes enterobacteriaceae, non enterics like P. aeruginosa

Oral and enteric anaerobes

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8
Q

1st Gen cephalosporin coverage

A

G+: MSSA, strep except enterococcus

G-: Ancef for PEK, Proteus, E. coli, Klebsiella

Some oral anaerobes

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9
Q

2nd Gen cephalosporin coverage

A

G+: Strep except enterococcus

G-: PEK; Proteus, E. coli, Klebsiella

Some oral anaerobes

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10
Q

3rd Gen cephalosporin coverage

A

G+: Strep and S. pneumoniae

G-: Enterobacteriaceae, Kingella, H. influenzae, Neisseria

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11
Q

What is the DOC for S. pneumoniae?

A

3rd Gen cephalosporins

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12
Q

What is the DOC for KIN (Kingella, H. influenzae, Neisseria)

A

3rd Gen cephalosporins

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13
Q

What cephalosporins begin to lose G+ coverage?

A

“3.5” Gen

Ceftazidime

Cefiderocol

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14
Q

Coverage for 3.5 and 4th Gen Cephalosporin

A

G+: 4th only, MSSA + strep except enterococcus

G-: All, Enterobacteriaceae including P. aeruginosa

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15
Q

Which fluoroquinolone covers MRSA and MRSE?

A

Delafloxacin

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16
Q

Do fluoroquinolones cover Atypicals?

A

Yes

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17
Q

Which fluoroquinolones cover staph infections?

A

Only delafloxacin

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18
Q

Which fluoroquinolones cover strep infections?

A

All do except cipro

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19
Q

Which fluoroquinolones cover S. pneumoniae?

A

All do except cipro

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20
Q

What does cipro cover?

A

Enteric and nonenterics, P. aeruginosa + atypicals

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21
Q

Which fluoroquinolones do NOT cover P. aeruginosa?

A

Moxifloxacin

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22
Q

Which fluoroquinolones cover oral anaerobes?

A

All, but cipro is limited

Delafloxacin and Moxifloxacin have some gut targets as well

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23
Q

Do carbapenems cover Atypicals?

A

No

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24
Q

Do PCNs cover Atypicals?

A

No

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25
Q

Do Macrolides cover Atypicals?

A

Yes

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26
Q

Do Tetracyclines cover Atypicals?

A

Yes

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27
Q

Carbapenem coverage?

A

Broad spectrum, but CAN’T cover:

G+: MRSA, enterococci, L. monocytogenes

G-: Vibrio, P. aeruginosa

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28
Q

Aztreonam coverage?

A

ONLY G-

Except CIA

M. catarrhalis
H. influenzae
P. aeruginosa

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29
Q

Aminoglycoside coverage?

A

Used for G- and G+ (synergy required for G+)

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30
Q

Macrolide coverage?

A

Atypicals

Some G- coverage:

C. jejuni
Salmonella
Shigella

H. influenzae
M. catarrhalis
N. gonorrhoeae

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31
Q

What are the 1st Gen Tetracyclines?

A

Tetracycline

Doxycycline

Minocycline

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32
Q

What are the 2nd Gen Tetracyclines?

A

Tigecycline

Omadacycline

Eravacycline

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33
Q

BBW for Tigecycline?

A

Mortality

Omadacycline just has a warning

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34
Q

Tetracycline general coverage?

A

G+ and Atypicals

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35
Q

Glycopeptide/Lipopeptide general coverage?

A

G+

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36
Q

Oxazolidinone general coverage?

A

G+

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37
Q

Fosfomycin general coverage?

A

G-

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38
Q

Clindamycin general coverage?

A

G+

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39
Q

Lefamulin general coverage?

A

G+, G-, Atypicals

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40
Q

Metronidazole coverage?

A

B. fragilis

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41
Q

Nitrofurantoin coverage?

A

G+: enterococcus

G-: E. coli + K.pneumoniae

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42
Q

Polymyxins coverage?

A

P. aeruginosa

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43
Q

Bactrim general coverage?

A

G+, G-, only Legionella Atypical species

44
Q

What are the Anti-MRSA (IV) Rx?

A

Dapto
Vanco (w/ other “vancs”)
Ceftaroline
Tetracyclines

Linezolid (w/ other Rx)
Pleuromutilins
Delafloxacine

Chloramphenicol
Synercid (streptogramin)

45
Q

What are the anti-MRSA (PO) Rx?

A

Clindamycin
Pleuromutilins
Delafloxacin

Bactrim
Linezolid (w/ other Rx)
Tetracycline

46
Q

What are the anti-MSSA Rx?

A

Dicloxacillin (PO)
Oxacillin
Cefazolin/Cephelexin

Cefipime
Any anti MRSA agent
Nafcillin

47
Q

What are the common Rx against enterococcus?

A

Vanco
Ampicillin
Linezolid
Dapto

**remember that cephalosporins cant fix this one

48
Q

What are the anti-pseudomonal Rx?

A

Carbapenems (except ertapenem)

Aminoglycosides (except plazo)

Monobactam (aztreonam)

Polymixins

Fluroquinolones (except Moxi)

thIRd/Fourth Gen ceph

Extended spectrum B-lactams

**CAMP FIRE

49
Q

What are the anti-Atypical Rx?

A

Fluoroquinolones

Macrolides

Tetracyclines

Pleuromutilin (Lefamulin)

50
Q

What are the peak:MIC rx?

A

Aminoglycosides

Fluoroquinolones

Flagyl

51
Q

What are the AUC:MIC rx?

A

Macrolides

Tetracycline

Vanco

52
Q

What are the Time>MIC rx?

A

Beta-lactams

Oxazolidinones

53
Q

What are the bacteriostatic RX?

A

Linezolid

Tetracyclines

Vanco (for enterococcus spp.)

54
Q

What are the bactericidal Rx?

A

Beta-lactams

Vanco (staph and strep spp.)

55
Q

Which anti-MRSA rx are 1:1 IV:PO?

A

Linezolid

Doxycycline

Bactrim

56
Q

Which anti-typical rx are 1:1 IV:PO?

A

Fluoroquinolones (levo, moxi)

Doxycycline

Azithromycin

57
Q

Which anti-anaerobe rx are 1:1 IV:PO?

A

Flagyl

58
Q

Which other rx that doesnt cover MRSA, typicals, or anaerobes are 1:1 IV:PO?

A

Rifampin

-azoles (flu, vori)

59
Q

Which Abx are weight based by TBW?

A

Vanco + Dapto

Bactrim but only on the trimethoprim part

**adjBW if obese

60
Q

Which Abx are weight based by IBW

A

Aminoglycosides and Polymixins

61
Q

Which Abx should NOT be used to treat lung infections?

A

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
Q

In the urine/kidney, how does nitrofurantoin and moxifloxacin behave?

A

Nitro doesnt penetrate kidneys

Moxi doesnt concentrate in the kidneys

63
Q

Which Abx increase INR?

A

FAB5

Flagyl/Fluoroquinolones
Azoles
Bactrim/Biaxin

64
Q

What DDI exist with linezolid?

A

SSRIs/MAOIs risk of serotonin syndrome

65
Q

Using SSRIs/MAOIs with what Abx increases risk of serotonin syndrome?

A

Linezolid

66
Q

What DDI exist with meropenem?

A

Valproic acid; decreases the amount of valproic acid

67
Q

Using valproic acid and this Abx should NOT be used together…

A

Meropenem

68
Q

Which Abx cause altered mental status?

A

Imipenem/cilastin combo

Fluoroquinolones

69
Q

Which Abx causes neutropenia?

A

Beta-lactams

70
Q

Which Abx causes kernicterus?

A

Ceftriaxone

71
Q

What Abx class causes hyper/hypo glycemia?

A

Fluoroquinolones

72
Q

What Abx class causes increased risk of MSK disorders in pediatrics?

A

Fluoroquinolones

73
Q

BBW of lipopeptides?

A

Increased mortality when used for pneumonia

Also has metallic taste Sx

74
Q

Increased mortality when used for pneumonia is a BBW for which Abx class?

A

Lipopeptides

75
Q

Vanco uses (zero/first) order kinetics. What does that mean?

A

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
Q

As MIC increases, the effect of vanco (increases/decreases)

A

Decreases

77
Q

What DDI exist with vanco?

A

Zosyn, increased nephrotoxicity

78
Q

Vd of vanco?

A

0.7L/kg

79
Q

Half life of vanco?

A

Adults = 6-7 hrs

80
Q

LD, MD of Vanco (initally)

A

LD = 20-35mg/kg via TBW

MD = 15-20mg/kg via TBW every 8-12hrs

If obese (>130% IBW), LD = 20-25mg/kg

81
Q

What is the AUC:MIC goal of Vanco?

A

400-600

82
Q

What levels should be collected for Vanco using the bayesian model?

A

2 levels after 1st or 2nd dose

Peak: 1-2 hr after infusion

Trough: prior to next dose

83
Q

What levels should be collected for Vanco using the 2 level PK approximation?

A

2 levels after the 4th dose

84
Q

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

A

kay kay

85
Q

Spectrum of activity on aminoglycosides?

A

G-

G+ w/ beta-lactams or vanco for synergy

86
Q

Vd of aminoglycosides?

A

0.25L/kg

87
Q

Half life of aminoglyosides?

A

2-3hrs unless anephric, then its 30-60hrs

88
Q

What is the desired peak and trough of genta and tobramycin?

A

Peak = 4-10

Trough = 1-2

89
Q

What is the desired peak and trough of amikacin?

A

Peak = 15-30

Trough = 5-10

90
Q

Attainment of adequate peak in aminoglycosides shows what?

A

Efficacy and minimizes risk of ototoxicity

91
Q

Attainment of adequate trough in aminoglycosides shows what?

A

Minimizes risk of nephrotoxicity and ototoxicity

92
Q

What are the peak/trough levels that must be maintained with gentamicin and synergy dosing?

A

Peak = 3-4

Trough = <1

93
Q

When should you collect peaks and troughs for aminoglycosides?

A

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
Q

AE to watch out for in aminoglycosides?

A

Nephro, Ototoxicity

Neuromuscular blockade

Limit the use because of accumulation

95
Q

When should you not use extended interval dosing of aminoglycosides?

A

CrCl <20

Burns >20% of body

Pregnant

Ascites

Significant third spacing

96
Q

What are some advantages of extended interval dosing of aminoglycosides?

A

Achieves higher peaks

Decreases troughs to nearly undetectable levels

Takes advantage of aminoglycosides post-Abx effect

Reduces adaptive resistance

97
Q

Hartford Nomogram for gentamicin, tobramycin and amikacin

A

≥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
Q

Limitations of Hartford Nomogram?

A

Do NOT allow clinicians or even yourself to individualize dosing regimens

Based on average PK parameters

99
Q

What clues are given to notate ESBL?

A

3rd Gen ceph = R

Cephamycin = S

100
Q

What clues are given to notate Amp-C?

A

3rd Gen ceph = S

Cephamycin = R

101
Q

What clues are given to notate Carbapenemase?

A

Carbapenems = R

102
Q

How do you treat ESBL?

A

Low inoculum (UT or skin) = zosyn

High inoculum = fluoroquinolones or carbapenem

103
Q

How do you treat Amp-C?

A

Low inoculum (UT or skin) = cefepime

High inoculum = carbapenem or fluoroquinolones

104
Q

How do you treat Carbapenemases?

A

New = combo meds or cefiderocol

Old = Fosfomycins or fluoroquinolones

***must be genetically tested, not common in Texas

105
Q

What does mecA alter?

A

PBP2 to PBP2a

Confers resistance to anti-staph PCN (MSSA to MRSA

106
Q

If MRSA becomes resistant, what else could it be?

A

VISA (thicker cell wall) or VRSA (via vanA)

107
Q

What are some risk factors for resistance?

A

Previous infection or prior Abx within 90 days

For hospital acquired MRSA, an addition of positive nasal carriage

IPT: ID (11 decks)

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