Exam 2 - specific Qs Flashcards
drugs that may cause interstitial nephritis
penicillins
-especially nafcillin and methicillin
-leads to abrupt increase in SCr and possibly renal failure
drugs to consider with sodium content
- Piperacillin - 1.85 mEq per gram
- Pen G - 2 mEq per 1 million units
- Nafcillin - 2.9 mEq per gram
- Carbenicillin - 4.7 mEq per gram
- Ticarcillin - 5.2 mEq per gram
what B-lactam can you use in penicillin allergic pts?
aztreonam
list the agents with N-methylthiotetrazole (MTT) side chain and its clinical significance
cefamandole
cefotetan
cefmatazole
cefoperazone
moxalactam
-ethanol intolerance
-hypoprothrombinemia (low prothrombin –> low blood coagulation –> more bleeding risk)
Which of the carbapenems and monobactams can penetrate the CSF
- meropenem is best
- aztreonam does in the presence of inflamed meninges
purpose of cilistatin
given in combo with imipenem to inhibit DHP, an enzyme that makes a nephrotoxic metabolite of imipenem
CNS (seizure) risk factors for carbapenems
risk factors for seizures include:
-CNS disorder
-high doses
-renal insufficiency
FQs considerations in terms of risk for torsades
use with caution in pts w/:
-QT prolongation
-hypokalemia
-concomitant anti-arrhythmic drugs
4 PK advantages of FQs
fluorinated quinolones (FQs) provide:
-broadened spectrum of activity
-better oral bioavailability
-better tissue penetration
-longer half lives
AE of macrolides - common and rare
common:
-GI (more common w erythro, less with clarithro and azithro)
rare:
-cholestatic hepatitis
-thrombophlebitis (to avoid: dilute dose, slow admin, large vein)
-ototoxicity
-QTc prolongation
macrolide that does not inhibit CYP3A4/2C9
azithromycin
DNA gyrase (topo II)
gram (-)
-blocks DNA replication by blocking the supercoil relief system
topo IV
gram (+)
-separation of daughter cells
telithromycin
-community acquired pneumonia
-inhibits CYP3A4
cannot use aminoglycosides (gent, tobra, amikacin) alone in which infection type (gram - or +)
gram +
ABx class that requires serum monitoring and why?
aminoglycosides due to variability in Vd and Cl, narrow TP index
considerations for aminoglycoside dosing pt by pt
-renal fxn (determines 1/2 life)
-Vd (conc. dependent killers)
-age
-gender
-weight
-infection type
-severity of infection
aminoglycoside risk factors for nephrotoxicity and ototoxicity
-prolonged high troughs
-long duration of therapy
-underlying renal dysfxn
-elderly
-hypovolemia
-use of other nephrotoxic agents
C. diff drug of choice
Oral Vancomycin
drug of choice for MRSA
vancomycin
specifics regarding red man syndrome with vancomycin
-happens within 5-15 mins of start of infusion
-related to RATE of infusion (too fast, doses should be 60 mins or more)
-resolves after d/c
other vanco AE
-nephro and ototoxicity
-thrombophlebitis
-interstitial nephritis
agents developed and used for VRE (among other things)
-synercid (faecium only, not faecalis)
-linezolid
-tedizolid
-daptomycin
-telavancin
-dalbavancin
-oritavancin
daptomycin should be avoided in what infection type
pneumonia
