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NAPLEX Prep > ID-I: Background and ABX by Drug Class > Flashcards

ID-I: Background and ABX by Drug Class Flashcards

1
Q

What are the treatment guidelines for ID

A

IDSA, CDC

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2
Q

Appearance of G+ stain

A

Thick cell wall and stain is dark purple or blue from crystal violet

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3
Q
A
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4
Q

Appearance of G- stain

A

Thin cell wall and stain that takes up safranin (pink)

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5
Q

G+ pairs and chains

A

Strep
Enterococcus

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6
Q

G+ Rods

A

Listeria
Corynebacterium

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7
Q

G+ Anaerobes

A

Peptostreptococcus
Propionibacterium
C. diff

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8
Q

Atypical pathogens

A

Chlamydia
Legionella
Mycoplasma pneumoniae
Mycobacterium

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9
Q

G- cocci

A

Neisseria

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10
Q

G- rods enteric

A

Proteus
E coli
Klebsiella
Serratia
Enterobacter
Citrobacter

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10
Q

G- rods not in gut

A

Pseudomonas
Kaemophilus
Providencia

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11
Q

G- curved or spiral

A

H. pylori
Campylobacter
Treponema
Borrelia
Leptospira

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12
Q

G- coccobacilli

A

Acinetobacter
Bordetella
Moraxella

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13
Q

G- Anaerobes

A

Bacteroides
Provotella

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14
Q

What is intrinsic resistance

A

The resistance is natural to organism (Stenotrophomonas)

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15
Q

What is selection pressure?

A

Resistance occurs when ABX kill susceptible bacteria leaving behind more resistant strains to multiply

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16
Q

What is acquired resistance?

A

Bacterial DNA containing resistant genes can be transferred between species or picked up from fragments

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17
Q

Common resistant pathogens?

A

E coli (ESBL, CRE)
Staph aureus (MRSA)
Klebsiella pneumoniae (ESBL, CRE)
Acinetobacter
Pseudomonas
Enterococcus (VRE)

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18
Q

Folic acid synthesis inhibitors

A

Sulfonamides
Trimethoprim
Dapsone

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19
Q

Cell wall inhibitors

A

Beta lactase
Monobactams
Vancomycin, dalbavancin, telavancin, oritavancin

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20
Q

Protein synthesis inhibitors

A

AG
Macorlides
Tetracyclines
Clindamycin
Linezolid, tedizolid

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21
Q

Cell membrane inhibitors

A

Polymixins
Daptomycin
Telavancin
Oritavancin

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22
Q

DNA/RNA inhibitors

A

Quinolones
Metronidazole, tinidazole
Rifampin

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23
Q

Hydrophilic drugs

A

Beta-lactam
AG
Vanc
Daptomycin
Polymixins

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24
Q

Lipophillic drugs

A

Quinolones
Macrolides
Rifampin
Linezolid
Tetracyclines

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25
Q

Properties of hydrophilic drugs

A
  1. Small Vd → less tissue penetration
  2. Renally eliminated
  3. Low intracellular concentrations → not good for atypical
  4. Poor F → IV:PO is not 1:1
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26
Q

Properties of lipophilic drugs

A
  1. Large Vd → good tissue penetration
  2. Hepatically metabolized
  3. Higher intracellular concentrations → good for atypicals
  4. Excellent F IV:PO is 1:1`
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27
Q

Properties of concentration dependent

A

Cmax:MIC

AG, quinolones, daptomycin
Goal: high peak (↑ killing), low trough (↓ toxicity)
Dosing: large dose, long interval

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28
Q

Properties of exposure-dependent

A

AUC:MIC

Vance, macrolides, tetracyclines, polymyxins
Goal: exposure over time
Dosing: Varies

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29
Q

Properties of time-dependent

A

Time > MIC

Beta-lactams
Goal: maintain drug level >MIC for most dosing intervals
Dosing: shorter dosing intervals, extended or continuous infusions

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30
Q

BBW for Pen G benzathine

A

Not for IV use → cardio respiratory arrest

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31
Q

ADRs of penicillins

A

Seizures due to accumulation, GI upset, diarrhea, rash (SJS/TEN), allergic reaction, hemolytic anemia

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32
Q

What penicillin does not require renal adjustment

A

Antistaph

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33
Q

How to administer naficillin

A

Is a vesicant, if extravasation occurs use cold packs and hyaluronidase injections

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34
Q

How should IV ampicillin and unasyn be prepared

A

Diluted in NS

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35
Q

First line for strep throat

A

Penicillin VK

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36
Q

First line for acute otitis media? Dosing?

A

Amoxicillin
Pediatric: 80-90 mg/kg/day

Augmentin
Pediatric: 90 mg /kg/day

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37
Q

Drug of choice of infective endocarditis prophylaxis?

A

Amoxicillin 2 g PO once 30-60 min before procedure
* Amoxicillin is used used due to oral flora coverage

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38
Q

Indications for Pen G (Bicillin LA)

A

Syphillis

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39
Q

How long is Zosyn extended infusions?

A

4 hrs

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40
Q

What causes diarrhea in Augmentin?

A

Clavlanate

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41
Q

Cephalosporin don’t have coverage against what?

A

Enterococcus

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42
Q

Why is Ceftriaxone CI in neonates?

A

Biliary slugging and kernicterus especially with calcium-containing IV products

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43
Q

What are typ1 allergy

A

Swelling, angioedema, anaphylaxis

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44
Q

What ABX cause disulfiram like reactions

A

Metronidazole and Cefotetan

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45
Q

ADRs of cephalosporins

A

Seizures, GI upset, diarrhea, rash (SJS/TEN), allergic reactions, hemolytic anemia

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46
Q

What cephalosporins require no renal adjustments

A

Ceftriaxone

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47
Q

What cephalosporin comes in chewable tablets

A

Cefixime (3rd gen)

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48
Q

Cephalosporins with Anaerobic coverage

A

Cefotetan and Cefoxitin

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49
Q

Cephalosporins with Pseudomonas coverage

A

Ceftazidime and Cefepime

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50
Q

What is not covered by carbapenems

A

Atypicals, MRSA, VRE, C diff, Steno

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51
Q

What is the difference between ertapenem and other carbapenems in terms of coverage?

A

Meropenem and Imipenem/Cilastatin covers Acinetobcter, Pseudomonas, Enterococcus

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52
Q

Ertapenem is only stable in what solution?

53
Q

ADRs of carbapenems

A

Seizures: Imipenme/cilastatin > Ertapenem > Meropenem
- failure to renally adjust, higher doses

54
Q

When is Aztreonam used?

A

Penicillin allergy

CAPES and Pseudomonas

55
Q

What is not covered by Aztreonam

A

G+ and anaerobes

56
Q

Beta lactams that don’t require renal adjustmnts

A

Ceftriaxone
Antistaph

57
Q

What is the difference between traditional and extended AG dosing

A

Traditional: uses lower doses more frequently (normal real function)
Extended: higher doses less frequently → less accumulation of drug, lower risk of nephrotox, and decreased cost

58
Q

Coverage of AG

A

G- and Pseudomonas
G+ as synergy

59
Q

How do you dose AG

A

<IBW: use TBW
Normal BW: use IBW
Obese (TBW >120% IBW): use AdjBW

60
Q

What is the dosing of traditional for AG

A

Tobra and Gent: 1-2.5mg/kg/dose
- 1 is for G+ synergy
- 2.5 is for G- infections

Amikacin: 5-7.5 mg/kg/dose

61
Q

What is the extended dose for AG?

A

Tobra and gent: 4-7 mg/kg/dose (7 is most common)

62
Q

What are the peak targets of AG in trad dosing

A

Gent G+ synergy: 3-4
Gent G- and Tobra: 5-10
Amikacin: 20-30

mcg/mL

63
Q

What are the trough targets of AG in trad dosing

A

Gent G+ synergy: <1
Gent G- and Tobra: <2
Amikacin: <5

mcg/mL

64
Q

When should troughs and peaks be drawn for AGs

A

Trough: 30 min before 4th dose
Peak: 30 min after 4th dose

65
Q

What is drawn for extended interval using of AG

A

Random between 6-14 hrs

66
Q

BBW of AGs

A

Nephro and ototoxicity
Neuromuscular blockade
Avoid with other neurotoxic drugs

Fetal harm

Caution in really impaired, older adults, and those taking nephrotoxic drugs

67
Q

MOA of FQ

A

Inhibit bacterial topoisomerase IV and DNA gyrase

68
Q

What are responsible FQ? why?

A

Levo and Moxi due to Strep pneumo coverage

69
Q

Pseudomonas FQ

A

Cipro and Levo

70
Q

What is good about Moxifloxacin coverage

A

Enhanced G+ and anaerobic coverage, but can’t treat UTIs due to inadequate renal penetration

71
Q

FQ with MRSA coverage

A

Delafloxacin

72
Q

FQ that requires no renal adjustment

A

Moxifloxacin

73
Q

BBW of FQ

A

Tendon rupture
Peripheral neuropathy
CNS (seizures, caution with patient with CNS disorders)

Terotogenic

74
Q

ADRs of FQ

A

QTc prolongation: Moxi > Levo > Cipro

Hypoglycemia and hyper
Psychiatric disturbances
Photosensitivity

75
Q

Counseling of Cipro PO suspension

A

Shake before ingestion

Due not put in NG or feeding tube due to oil-based suspension

However, Cipro tablets can be crushed and mixed with water and given via feeding tube

76
Q

MOA of macrolides

A

Binds to 50S ribosomal hsubunit

77
Q

Coverage of macrolides

A

Atypicals, Strep pneumonia, Haemophilus, and Morxella

78
Q

Ci of Macrolides

A

Clarithro and Erythromycin should not be on lovastatin or simvastatin

79
Q

ADR of macrolides

A

QTc prolongation

Clarithormycin: caution in CAD → ↑ mortality

GI upset, taste perversion, skin reaction, ototoxicity
Hepatotoxicity

80
Q

Dosing of a ZPak

A

500 mg on day 1, then 250 mg days 2-5

81
Q

MOA of tetracyclines

A

Reversibly bind to 30S ribosomal subunits

82
Q

Warning of tetracyclines

A

Children <8
Photosensitive
Minocycline: DILE

83
Q

Tetracyclines that don’t need renal adjustment

A

Doxy and Mino

84
Q

Counseling of tetracycline

A

IV:PO is 1:1

Take with 8oz of water
Doxy: sit up for 30 minutes after

Avoid antacids and polyvalent cations

85
Q

Coverage of tetracycline

A

Resp flora: H flu, Morexella, Atypicals

MRSA, VRE

86
Q

MOA of Sulfonamides

A

SMX: inhibits DHA formation
TMP: inhibits DHA reduction to THF → inhibiting folic acid pathway

87
Q

Coverage of Bactrim

A

MRSA
HPEK
Enterobacter
Shigella, Steno, Salmonella
Opportunistic (Nocardia, Pneumocystis, Toxoplasmosis)

88
Q

What is not covered by Bactrim

A

Pseudomonas, enterococci, atypicals, and anaerobes

89
Q

Describe dosing of Bactrim

A

Based on TMP component

SMX:TMP 5:1

90
Q

CI of Bactrim

A

Sulfa allergy

91
Q

ADR of Bactrim

A

Skin reactions (SJS/TEN/TTP)
Hemolytic anemia
Photosensitivity
Crystalluria
Increased K

92
Q

Strength of SS and DS Bactrim

A

SS: 400/80
DS: 800/160

93
Q

DDI of Bactrim

A

Can ↑ INR if combined with warfarin

94
Q

What is first line of MRSA

95
Q

When should an alternative be used for MRSA

A

Vanc MIC is ≥2

96
Q

Coverage of Vanc

97
Q

How is Vanc dosed

A

Systemic infection: 15-20 mg/kg Q8-12H
CrCl 20-49: Q24H
CrCl <20: pulse dosing

C diff: 125 mg PO QID

98
Q

ADR of Vanc

A

Ototoxicity, nephrotoxicity
Vanc infusion reactions: do not infuse >1g/hr

99
Q

How to monitor vanc

A

AUC/MIC and SS trough should be drawn 30 min before 4th or 5th dose

Serious infection: 15-20 mcg/mL or AUC 400-600
Other infection: 10-15

100
Q

BBW of lipoglycopeptides

A

Fetal risk
Nephrotoxicity

101
Q

CI of lipoglycopeptides

A

Telavancin and Ortivance: Avoid IV UFH
Ortivancin: avoid for 120 fr (5days) due to interference with aPPT (false elevation)

102
Q

ADR of lipoglycopeptides

A

Infusion reactions
Ortivancin and telavancin: falsely elevated aPTT/PT/INR but doesn’t ↑ bleeding risk
Telvancin: Etc prolongation
Dalvance: ↑ ALT

103
Q

Dosing of lipoglycpeptides

A

Oritavancin and Dalvance: 1 single doses

104
Q

ADR of Daptomycin

A

Myopathy and rhabdo (DC is CPK is >1000, hold statins)

Falsely elevate PT/INR and ↑ CPK

Monitor weekly

105
Q

Why is Cubicin not indicated for pneumonia

A

Inactivates by lung surfactant

106
Q

How is Cubicin prepared

A

Compatible with LR and NS

107
Q

CI of linezolid

A

MOAI within 2 week

108
Q

ADR and warning of linezolid

A

Myelosuppression (thrombocytopenia)
Optic neuropathy >28 days
Serotonin syndrome (Avoid tyramine foods or serotonin drugs)
Hypoglycemia

Monitor CBC weekly

109
Q

Dosing of linezolid

A

No renal adjustment

IV:PO is 1:1

Do not shake suspension

110
Q

What is tigecycline

A

Broad spectrum: MRSA, VRE, G- bacteria, anaerobes, and atypicals

No activity against: Pseudomonas, Proteus, Providncia

111
Q

BBW of tigecycline

A

Increased risk of death

Don’t use for blood stream infections du to lipophillicity

Solution should be yellow-orange

112
Q

BBW of polymixins

A

Dose-dependent nephrotoxicity
Neurotoxicity
Respiratory paralysis from neuromuscular blockade

113
Q

Nephrotoxic drgs

A

Aminoglycosides
Amp B
Cisplatin
Cyclosporine
Loops
NSAIDs
Contrast dyes
Tacrolimus
Vanc

114
Q

Activity of clindamycin

A

MRSA and aerobes and most G+

115
Q

BBW of Clinda

116
Q

ADR and Dosing of Clinda

A

ADR: N/V/D

D-test to confirm S. aureus resistance: flattened zone is positive

Not renally adjusted

117
Q

Activity of metronidazole

A

Anaerobes and protozoal oganisms

118
Q

CI of Flagyl

A

Pregnant (1st trimester)
Alcohol or PEG during or within 3 days of tx discontinuation

119
Q

ADR of Metronidzole

A

Metallic taste, peripheral neuropathy

120
Q

DDI of metronidzole

A

↑ INR with warfarin

121
Q

ADR of Lefamulin

A

QTc prolongation

122
Q

What is fidaxomicin

123
Q

What is fosfomycin

A

Uncomplicated UTI

124
Q

CI of Nitrofurantoin

125
Q

ADR of Nitrofurantoin

A

Hemolytic anemia
GI upset (take with food)
Brown urine

126
Q

Difference between Macrobid and Macrodantin

A

Macrobid: BID
Macrodantin: QID

127
Q

ABX that can cause hemolytic anemia

A

Penicillin, cephalosporins, Bactrim, Nitrofurantoin

128
Q

ABX that should be rfrigerated

A

Pen VK
Augmentin

129
Q

ABX where refrigeration is recmmended

A

Amoxicillin: improves taste
Tamiflu: Improves shelf life

130
Q

Do not fridge ABX

A

Cefdinir
Metronidazole
Moxifloxacin
Bactrim

131
Q

Non-renal adjusted ABX

A

Antistaph penicillins
Azithromycin and erythomycin
Ceftriaxone
Clindamycin
Doxycline
Metronidazole
Moxifloxacin
Linezolid

NAPLEX Prep (16 decks)

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