Drugs

Question 0

Zosyn (Pipercillin/Tazobactam)

Answer 0

Coverage: gram positives, some gram negatives and anaerobes

Dosage: 3.375g IV q 6 hours
*Most common broad spectrum IV drug used in diabetic infections today.

Question 1

Augmentin (Amoxicillin/Clavulonic Acid)

Answer 1

Coverage: gram positives, some gram negatives and some anaerobes (bacteroides)
Dosage: 875mg PO BID
*each tab contains 125mg clavulonic acid

*DOC for dog and cat bites (Pasturella multocida).

Question 3

Penicillin G

Answer 3

Coverage: pure streptococcal infections, anaerobes including clostridia (not bacteroides), and enterococcus.

Dosage: 10-20 million units IM/IV divided daily q 4 hours.
*Gustilo and Anderson farm or soil injuries.

Question 4

Ancef (Kefzol/Cefazolin)

Answer 4

Coverage: Staphylococcus, streptococcus, gram negatives (E. Coli, Shigella, Salmonella, P. mirabilis), and anaerobes other than bacteroides.
Dosage: .5g - 2g IV q 8 hours

*Great bone penetration with long half-life – great surgical prophylaxis

Question 5

Keflex (Cephalexin)

Answer 5

Coverage: Staphylococcus, streptococcus, gram negatives (E. Coli, Shigella, Salmonella, P. mirabilis), and anaerobes other than bacteroides.

Dosage: 250mg – 500mg PO bid -qid

Question 6

Duricef (Cefadroxil)

Answer 6

Coverage: Staphylococcus, streptococcus, gram negatives (E. Coli, Shigella, Salmonella, P. mirabilis), and anaerobes other than bacteroides.

Dosage: 500mg – 1g PO daily

Question 7

Gentamicin

Answer 7

Coverage: Aerobic gram negatives, staphylococcus, streptococcus, and anaerobe coverage. 
Dosage:    2mg/kg loading dose
            1 mg/kg divided q 8h
            5 mg/kg q 24h
            Peak: 6-10 µg/ml. 
            Trough: 2µg/ml

Question 8

Clindamycin

Answer 8

Coverage: gram positives and anaerobes (no C. difficile)
Dosage: 900mg IV/IM q 8 hours or
300mg PO tid
*Some MRSA effectiveness, watch for C. difficile.

Question 9

Ciprofloxacin (Cipro)

Answer 9

Coverage: Most all gram negatives, pseudomonas, and have gram positive resistance (great with clindamycin).

Dosage: 500mg PO bid for mild to moderate infections and 750mg PO bid for severe infections and osteomyelitis.

Question 10

Levofloxacin (Levaquin)

Answer 10

Coverage: Gram negatives and less pseudomonas coverage, but greater susceptibility for staphylococcus and streptococcus.
Dosage: 500 mg PO or IV for mild to moderate infections or 750mg PO or IV for complicated skin and skin structure infections (IV and PO dosing fairly equivalent).

Question 11

Trimethoprim/Sulfamethaxazole (Bactrim DS)

Answer 11

Coverage: Bacteriostatic against all organisms, staphylococcus, MRSA, gram negatives (except pseudomonas), and limited activity against streptococcus.
Dosage: 60mg Trimethoprim/800mg
Sulfamethaxazole PO bid or tid for
severe infections.

Question 12

Vancomycin

Answer 12

Vancomycin is a bactericidal antibiotic that inhibits cell wall mucopeptide formation.
Coverage: Bactericidal against all gram positive organisms, MRSA, MRSE, enterococcus, gram positive anaerobes (clostridia, corynebacteria) and has no gram negative coverage.
Dosage: 1g IV q 12 hours (max dose 2g/day)
Peak: 20-30µg/ml
Trough: 10µg/ml
* Beware: Red man syndrome! Administer over 45 - 60 min. Nephrotoxicity, Ototoxicity
**May use in oral form ONLY for pseudomembranous colitis (125mg PO qid) and only after flagyl fails.
**Used alongside Zosyn for IV antibiotic coverage in diabetic infections for coverage of MRSA

Question 13

Zyvox (Linezolid)

Answer 13

Coverage: All gram positives including enterococcus and MRSA

Dosage: 600mg PO/IV bid.

*100% bioavailability and hence reserved in IV form only for those who cannot tolerate PO.

Question 14

Lamisil (terbinafine)

Answer 14

Dosage: 250mg PO daily
Inhibits the fungal enzyme squalene epoxidase

*Liver metabolism so must monitor liver functions

Question 15

Lotrimin (Clotrimazole)

Answer 15

Dosage: cream/solution apply bid

Inhibits fungal steroid synthesis

Question 16

Naftin

Answer 16

Dosage: 1 % cream apply daily or gel apply BID

Question 17

Loprox (Ciclopirox)

Answer 17

Dosage: .77% cream/gel apply bid

Question 18

Ciclopirox (Penlac)

Answer 18

Dosage: 8% lacquer apply daily

Question 19

Griseofulvin (Gris-Peg)

Answer 19

Dosage: 500mg PO daily

Interferes with microtubule function disrupting mitosis

Question 20

Fluconozole (Diflucan)

Answer 20

Dosage: 300mg PO weekly

Inhibits fungal steroid synthesis

Question 21

Itraconazole (Spronox)

Answer 21

Dosage: 100mg PO bid with fatty meal

Inhibits fungal steroid synthesis

Question 22

Percocet (Oxycodone/Acetaminophen)

Answer 22

Dosage: 5/325 1-2 PO q 4-6 hours PRN pain

Question 23

Vicodin (Hydrocodone/Acetaminophen)

Answer 23

Dosage: 5/300 1-2 PO q 4-6 hours PRN pain

Question 24

Morphine Sulfate

Answer 24

Dosage: 4mg IV q 4 hours PRN severe pain

PCA: dose/lockout/basal/max dose per hour
Morphine PCA: 1mg/6minutes/0 basal/10mg/hour

Question 26

Unasyn (Ampicillin/Sulbactam)

Answer 26

Coverage: gram positives, some gram negatives and some anaerobes (bacteroides)

Dosage: 1.5g - 3.0g IV q 6-8 hours

*DOC for presumed anaerobic and aerobic infections.