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NAPLEX 2021 (select RxPrep&PNN) > Infectious Disease 1: Background & Antibacterials by Drug Class > Flashcards

Infectious Disease 1: Background & Antibacterials by Drug Class Flashcards

1
Q

Folic acid synthesis inhibitors

A

sulfonamides
trimethoprim
dapsone

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2
Q

Cell wall inhibitors

A

penicillins, cephalosporins, carbapenems
monobactams
vancomycin, dalbavancin, telavancin, oritavancin

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3
Q

Protein synthesis inhibitors

A 
aminoglycosides
macrolides
tetracyclines
clindamycin
linezolid, tedizolid
quinupristin/dalfopristin
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4
Q

DNA/RNA inhibitors

A

quinolones (DNA gyrase, topoisomerase IV)
metronidazole, tinidazole
rifampin

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5
Q

Cell membrane inhibitors

A

polymyxins
daptomycin
telavancin
oritavancin

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6
Q

hydrophilic agents

A 
beta-lactams
aminoglycosides
glycopeptides
daptomycin
polymyxins
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7
Q

hydrophilic PK parameters

A 
small volume of distribution
renal elimination
low intracellular concentrations
increased clearance and/or distribution in sepsis
poor-moderate bioavailility
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8
Q

lipophilic agents

A 
quinolones
macrolides
rifampin
linezolid
tetracyclines
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9
Q

lipophilic PK parameters

A 
large volume of distribution
hepatic metabolism
achieve intracellular concentration
clearance/distribution is changed minimally in sepsis
Excellent bioavailability
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10
Q

Concentration-dependent agents

A

aminoglycosides
quinolones
daptomycin

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11
Q

AUC:MIC agents

A

vancomycin
macrolides
tetracyclines
polymyxins

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12
Q

time-dependent agents

A

penicillins, cephalosporins, carbapenems

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13
Q

beta-lactam mechanism of action

A

inhibit bacterial cell wall synthesis by binding to penicillin-binding protein (PBPs) preventing the final step of peptidoglycan synthesis in bacterial cell walls.

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14
Q

Which organisms are not covered by penicillins?

A

MRSA

atypical organism

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15
Q

Side effects of the penicillin class

A 
seizures
GI upset
diarrhea
rash
hemolytic anemia
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16
Q

Boxed warning for penicillin G benzathine

A

do NOT use IV

can cause cardio-respiratory arrest and death

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17
Q

Dosing for penicillin G benzathine

A

1.2-2.4 million units x 1

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18
Q

IV ampicillin and ampicillin/sulbactam must be diuted in __ only

A

normal saline

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19
Q

Preferred penicillin for MSSA soft tissue, bone and joint, endocarditis and bloodstream infections

A

antistaphylococcal penicillins

  • dicloxacillin
  • nafcillin
  • oxacillin
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20
Q

Extended infusion dosing and timing for Zosyn

A

3.375 - 4.5 grams IV Q8H infused over 4 hours

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21
Q

Which penicillin is a vesicant and how is extravasation treated?

A

nafcillin

use cold packs and hyaluronidase

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22
Q

When should penicillin be used even if the patient has an allergy?

A

for the treatment of syphilis during pregnancy

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23
Q

First-line treatment for strep throat and mild nonpurulent skin infections

A

penicillin VK

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24
Q

Dosing for amoxicillin/clavulanate and amoxicillin

A

90 mg/kg/day

80-90 mg/kg/day

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25
Which penicillin covers Pseudomonas?
piperacillin/tazobactam
26
Which cephalosporins cover Pseudomonas?
ceftazidime ceftazidime/avibactam cefepime
27
Which cephalosporins cover MRSA?
ceftaroline
28
cefiderocol (Fetroja) mechanism of action, indication, and coverage
- Uses iron transport system to enter the Gram-negative cell wall - Approved for complicated UTI/pyelonephritis - Covers E. coli, Klebsiella, Proteus and Pseudomonas
29
First-generation cephalosporins
cefazolin (Ancef) - IV/IM | cephalexin (Keflex) - PO
30
Dosing for cephalexin
250-500 mg PO Q6-12 hours
31
Second-generation cephalosporins
cefuroxime (Ceftin) - IV/IM/PO | cefotetan (Cefotan) - IV/IM
32
third-generation cephalosporins
cefdinir (Omnicef) - PO ceftriaxone (Recephin) - IV/IM cefotaxime - IV/IM ceftrazidime (Fortaz) - IV/IM ceftazidime/avibactam (Avycaz) - IV ceftolozane/tazobactam (Zerbraxa) - IV
33
Fourth-generation cephalosporin
cefepime (Maxipime)
34
Fifth-generation cephalosporin
ceftaroline (Teflaro)
35
Which cephalosporin is contraindicated in neonates?
ceftriaxone | causes biliary sludging; kernicterus
36
Which cephalosporin can cause a disulfiram-like reaction?
cefotetan
37
What are carbapenems reserved for?
MDR gram-negative infections
38
Which organisms are not covered by carbapenems?
``` atypical pathogens MRSA VRE C. difficile Stenotrophomonas ```
39
ertapenem (Invanz) is only stable in __.
Normal saline
40
Which carbapenem has the highest seizure risk?
imipenem/cilastatin
41
aztreonam (Azactam) coverage
only gram-negative; including pseudomonas
42
Boxed warning for aminoglycosides
nephrotoxicity | ototoxicity
43
Traditional IV dosing for gentamicin and tobramycin
1 - 2.5 mg/kg/dose
44
Renal dose adjustment for aminoglycosides
CrCl >/= 60 mL/min : Q8 hours
45
Extended interval IV dosing for gentamicin and tobramycin
4-7 mg/kg/dose
46
Target peak and trough for gentamicin and tobramycin
5-10 mcg/mL | <2 mcg/mL
47
respiratory quinolones
gemifloxacin levofloxacin moxifloxacin
48
Which quinolones cover Pseudomonas?
ciprofloxacin | levofloxacin
49
Delafloxacin coverage
MRSA
50
Safety notes for quinolones
- tendon inflammation and rupture - peripheral neuropathy - CNS effects (seizure, tremor, confusion, hallucination) - QTc prolongation - hypoglycemia - psychiatric disturbances - photosensitivity - avoid in children
51
Cipro oral suspension
Do not put through NG or feeding tube
52
Quinolones must be separated from ___.
cations
53
Which macrolides increases mortality in patients with CAD?
clarithromycin
54
Which macrolides are CYP3A4 inhibitors?
erythromycin | clarithromycin
55
Safety notes for macrolides
``` QTc prolongation hepatotoxicity GI upset taste perversion SJS/TEN/DRESS ```
56
macrolide coverage
atypicals | used for treatment of chlamydia, gonorrhea
57
Dosing for Z-Pak
500 mg PO on day 1, then 250 mg PO on days 2-5
58
Dosing for Tri-Pak
500 mg daily for 3 days
59
__ is a macrolide that has better gram-positive coverage than azithromycin which has better gram- __ coverage than erythromycin.
clarithromycin negative
60
tetracycline coverage
gram-positive gram-negative atypicals spirochetes, Rickettsiae, Bacillus anthracis, Treponema pallidum
61
Doxycycline coverage
broader indications: CAP, tick-borne/rickettsial diseases, chlamydia, gonorrhea mild SSTI (CA-MRSA) UTI (VRE)
62
Safety notes for tetracyclines
Do NOT use in children < 8 yo, pregnancy, breastfeeding photosensitivity DRESS/SJS/TENS
63
Which tetracycline can cause DILE?
minocycline
64
tetracyclines should be separated from ___, __, __, __, and __.
``` antacids cations sucralfate bismuth subsalicylate bile acid reside ```
65
Bactrim double strength dose
800 mg SMX / 160 mg TMP
66
Safety notes for sulfamethoxazole/trimethoprim
``` avoid in sulfa allergy SJS/TENS TTP hemolysis in G6PD deficiency hypoglycemia thrombocytopenia photosensitivity Increased K crystalluria ```
67
Effect of SMX/TMP on warfarin
CYP2C9 inhibitor; increase INR
68
Bactrim dosing for uncomplicated UTI
1 DS tablet PO BID for 3 days
69
Bactrim dosing for PCP prophylaxis
1 DS or SS tablet daily
70
First-line agent for MRSA
vancomycin
71
Vancomycin dosing for C. dif infection
125-500 mg PO QID x 10d ays
72
Safety notes for vancomycin
ototoxicity nephrotoxicity infusion reaction
73
Maximum vancomycin infusion rate
1000 mg/hour
74
Lipoglycopeptides (generic/brand) agents
telavancin (Vibativ) oritavancin (Orbactiv) dalbavancin (Dalvance)
75
Safety notes for telavancin
``` fetal risk nephrotoxicity concurrent use of IV UFH infusion reaction QTc prolongation metallic taste ```
76
Which labs are affected by lipoglycopeptides?
coagulation test (aPTT/PT/INR)
77
lipoglycopeptide contraindications
IV UFH for 5 days
78
Which agents are dosed once for SSTI?
oritavancin | dalbavancin
79
Which agent should not be used in pneumonia because it is inactivated by lung surfactant?
daptomycin
80
Safety notes for daptomycin
myopathy and rhabdomyolysis falsely increase PT/INR (no bleed risk) peripheral neuropathy
81
Daptomycin in only compatible in __
normal saline
82
Safety notes for linezolid
``` Do not use with or within 2 weeks of MAOI Duration related myelosuppression optic neuropathy serotonin syndrome hypoglycemia ```
83
Linezolid suspension __ __ __
Do Not Shake
84
Oxazolidinone agents
linezolid (Zyvox) | tedizolid (Sivextro)
85
Safety noes for quinupristin/dalfopristin
arthalgias, myalgias infusion reactions hyperbilirubinema
86
Synercid coverage
MRSA Enterococcus faecium (VRE) - not E. faecalis
87
Synercid is only diluted in ___ and is given through a ___.
D5W | central line
88
Safety notes for tigecycline (Tygacil)
increase risk of death, use alternative if possible
89
Do not use Synercid for ____ infections.
bloodstream | It does not achieve adequate concentrations in the blood.
90
Synercid is ___ colored; discard if not this color.
yellow-orange
91
indication for polymyxins
MDR gram-negative pathogens
92
Safety notes for colistimethate sodium
dose-dependent nephrotoxicity | neurotoxicity
93
Safety notes for polymyxin b sulfate
nephrotoxicity | neurotoxicity (may result in respiratory paralysis from neuromuscular blockade)
94
Safety notes for chloramphenicol
fatal blood dyscrasias | Gray syndrome
95
Safety notes for clindamycin
colitis SJS/TEN/DRESS N/V/D
96
Safety notes for metronidazole
pregnancy disulfirm reaction (avoid alcohol during treatment and 3 days after discontinuation) Seizure, peripheral neuropathy metallic taste
97
Indication for secnidazole (Solosec)
Single dose for bacterial vaginosis
98
Safety notes for lefamulin (Xenleta)
avoid in pregnancy QTc prolongation C. dif
99
Indication for lefamulin
CAP
100
Indication for fidaxomicin (Dificid)
C. difficile
101
Indications for rifaximin (Xifaxan)
traveler's diarrhea hepatic encephalopathy IBS-D C. difficile infection (off label)
102
Fosfomycin coverage and indication
E. coli (ESBL), E. faecalis (VRE) Single dose for uncomplicated cystitis
103
Dosing for Macrobid
100 mg PO BID for 5 days
104
Renal cut-off for nitrofurantoin
CrCl < 60 mL/min
105
Safety notes for nitrofurantoin
hemolytic anemia in G6PD deficiency | harmless brown urine discoloration
106
drugs of choices for MSSA
``` dicloxacillin, nafcillin, oxacillin cefazolin, cephalexin, cefuroxime, cefotetan Augmentin, Unasyn doxycycline, minocycline Bactrim ```
107
drugs of choice for VRE
linezolid daptomycin tigecycline cystitis only: nitrofurantoin, fosfomycin, doxycycline (E. faecalis): penicillin G ampicillin (E. faecium): quinupristin/dalfopristin
108
drugs of choice for CRE
ceftazidime/avibactam colistimethate polymyxin B
109
drugs of choice for CA-MRSA SSTI
Bactrim doxycycline, minocycline clindamycin linezolid
110
drugs of choice for severe MRSA SSTI
``` vancomycin linezolid, tedizolid daptomycin ceftaroline telavancin oritavancin dalbavancin quinupristin/dalfopristin tigecycline ```
111
drugs of choice for nosocomial MRSA
``` vancomycin linezolid daptomycin rifampin (not monotherapy) televancin ```
112
drugs of choice for Pseudomonas aeruginosa
``` piperacillin/tazobactam cefepime ceftazidime ceftazidime/avibactam ceftolozane/tazobactam carbapenems (except ertapenem) ciprofloxacin, levofloxacin aztreonam aminoglycosides colistimethate, polymyxin B ```
113
drugs of choice for ESBL GNR (E. coli, Klebsiella, Proteus)
``` carbapenems ceftolozane/tazobactam ceftazidime/avibactam cefepime aminoglycosides cystitis only: fosfomycin ```
114
drugs of choice for Acinetobacter baumannii
``` carbapenems (not ertapenem) ampicillin/sulbactam minocycline tigecycline quinolones SMX/TMP colistimethate, polymyxin B ```
115
drugs of choice for HNPEK
``` beta-lactam + beta-lactamase inhibitor amoxicillin cephalosporins (not 1st generation) carbapenems SMX/TMP aminoglycosides quinolones ```
116
drugs of choice for Bacteroides fragillis
``` metronidazole beta-lactam+beta-lactamase inhibitor cefotetan, cefoxitin carbapenems tigecycline ```
117
drugs of choice for C. difficile
vancomycin PO fidaxomicin metronidazole rifaximin
118
drugs of choice for atypical organisms
azithromycin, clarithromycin doxycycline, minocycline quinolones
119
antibiotic oral suspensions requiring refrigeration
``` penicillin VK ampicillin amoxicillin/clavulante cephalexin cefadroxil cefpodoxime cefprozil ceuroxime cefaclor ceftibuten vancomycin oral (Firvanq) valganciclovir (Valcyte) ```
120
antibiotic oral suspensions do NOT refrigerate
``` cefdinir azithromycin clarithromycin doxycycline ciprofloxacin levofloxacin clindamycin linezolid SMX/TMP acyclovir (Zovirax) fluconazole (Diflucan) posaconazole (Noxafil) voriconazole (Vfend) nystatin ```
121
IV antibiotics do NOT refrigerate
metronidazole (Flagyl) moxifloxacin (Avelox) SMX/TMP acyclovir (Zovirax)

NAPLEX 2021 (select RxPrep&PNN) (5 decks)

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