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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
Q

Which penicillin covers Pseudomonas?

A

piperacillin/tazobactam

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26
Q

Which cephalosporins cover Pseudomonas?

A

ceftazidime
ceftazidime/avibactam
cefepime

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27
Q

Which cephalosporins cover MRSA?

A

ceftaroline

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28
Q

cefiderocol (Fetroja) mechanism of action, indication, and coverage

A
  • Uses iron transport system to enter the Gram-negative cell wall
  • Approved for complicated UTI/pyelonephritis
  • Covers E. coli, Klebsiella, Proteus and Pseudomonas
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29
Q

First-generation cephalosporins

A

cefazolin (Ancef) - IV/IM

cephalexin (Keflex) - PO

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30
Q

Dosing for cephalexin

A

250-500 mg PO Q6-12 hours

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31
Q

Second-generation cephalosporins

A

cefuroxime (Ceftin) - IV/IM/PO

cefotetan (Cefotan) - IV/IM

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32
Q

third-generation cephalosporins

A

cefdinir (Omnicef) - PO
ceftriaxone (Recephin) - IV/IM
cefotaxime - IV/IM

ceftrazidime (Fortaz) - IV/IM
ceftazidime/avibactam (Avycaz) - IV
ceftolozane/tazobactam (Zerbraxa) - IV

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33
Q

Fourth-generation cephalosporin

A

cefepime (Maxipime)

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34
Q

Fifth-generation cephalosporin

A

ceftaroline (Teflaro)

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35
Q

Which cephalosporin is contraindicated in neonates?

A

ceftriaxone

causes biliary sludging; kernicterus

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36
Q

Which cephalosporin can cause a disulfiram-like reaction?

A

cefotetan

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37
Q

What are carbapenems reserved for?

A

MDR gram-negative infections

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38
Q

Which organisms are not covered by carbapenems?

A 
atypical pathogens
MRSA
VRE
C. difficile
Stenotrophomonas
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39
Q

ertapenem (Invanz) is only stable in __.

A

Normal saline

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40
Q

Which carbapenem has the highest seizure risk?

A

imipenem/cilastatin

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41
Q

aztreonam (Azactam) coverage

A

only gram-negative; including pseudomonas

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42
Q

Boxed warning for aminoglycosides

A

nephrotoxicity

ototoxicity

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43
Q

Traditional IV dosing for gentamicin and tobramycin

A

1 - 2.5 mg/kg/dose

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44
Q

Renal dose adjustment for aminoglycosides

A

CrCl >/= 60 mL/min : Q8 hours

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45
Q

Extended interval IV dosing for gentamicin and tobramycin

A

4-7 mg/kg/dose

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46
Q

Target peak and trough for gentamicin and tobramycin

A

5-10 mcg/mL

<2 mcg/mL

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47
Q

respiratory quinolones

A

gemifloxacin
levofloxacin
moxifloxacin

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48
Q

Which quinolones cover Pseudomonas?

A

ciprofloxacin

levofloxacin

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49
Q

Delafloxacin coverage

50
Q

Safety notes for quinolones

A
  • tendon inflammation and rupture
  • peripheral neuropathy
  • CNS effects (seizure, tremor, confusion, hallucination)
  • QTc prolongation
  • hypoglycemia
  • psychiatric disturbances
  • photosensitivity
  • avoid in children
51
Q

Cipro oral suspension

A

Do not put through NG or feeding tube

52
Q

Quinolones must be separated from ___.

53
Q

Which macrolides increases mortality in patients with CAD?

A

clarithromycin

54
Q

Which macrolides are CYP3A4 inhibitors?

A

erythromycin

clarithromycin

55
Q

Safety notes for macrolides

A 
QTc prolongation
hepatotoxicity
GI upset
taste perversion
SJS/TEN/DRESS
56
Q

macrolide coverage

A

atypicals

used for treatment of chlamydia, gonorrhea

57
Q

Dosing for Z-Pak

A

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

58
Q

Dosing for Tri-Pak

A

500 mg daily for 3 days

59
Q

__ is a macrolide that has better gram-positive coverage than azithromycin which has better gram- __ coverage than erythromycin.

A

clarithromycin

negative

60
Q

tetracycline coverage

A

gram-positive
gram-negative
atypicals
spirochetes, Rickettsiae, Bacillus anthracis, Treponema pallidum

61
Q

Doxycycline coverage

A

broader indications:
CAP, tick-borne/rickettsial diseases, chlamydia, gonorrhea
mild SSTI (CA-MRSA)
UTI (VRE)

62
Q

Safety notes for tetracyclines

A

Do NOT use in children < 8 yo, pregnancy, breastfeeding
photosensitivity
DRESS/SJS/TENS

63
Q

Which tetracycline can cause DILE?

A

minocycline

64
Q

tetracyclines should be separated from ___, __, __, __, and __.

A 
antacids
cations
sucralfate
bismuth subsalicylate
bile acid reside
65
Q

Bactrim double strength dose

A

800 mg SMX / 160 mg TMP

66
Q

Safety notes for sulfamethoxazole/trimethoprim

A 
avoid in sulfa allergy
SJS/TENS
TTP
hemolysis in G6PD deficiency
hypoglycemia
thrombocytopenia
photosensitivity
Increased K
crystalluria
67
Q

Effect of SMX/TMP on warfarin

A

CYP2C9 inhibitor; increase INR

68
Q

Bactrim dosing for uncomplicated UTI

A

1 DS tablet PO BID for 3 days

69
Q

Bactrim dosing for PCP prophylaxis

A

1 DS or SS tablet daily

70
Q

First-line agent for MRSA

A

vancomycin

71
Q

Vancomycin dosing for C. dif infection

A

125-500 mg PO QID x 10d ays

72
Q

Safety notes for vancomycin

A

ototoxicity
nephrotoxicity
infusion reaction

73
Q

Maximum vancomycin infusion rate

A

1000 mg/hour

74
Q

Lipoglycopeptides (generic/brand) agents

A

telavancin (Vibativ)
oritavancin (Orbactiv)
dalbavancin (Dalvance)

75
Q

Safety notes for telavancin

A 
fetal risk 
nephrotoxicity
concurrent use of IV UFH
infusion reaction
QTc prolongation
metallic taste
76
Q

Which labs are affected by lipoglycopeptides?

A

coagulation test (aPTT/PT/INR)

77
Q

lipoglycopeptide contraindications

A

IV UFH for 5 days

78
Q

Which agents are dosed once for SSTI?

A

oritavancin

dalbavancin

79
Q

Which agent should not be used in pneumonia because it is inactivated by lung surfactant?

A

daptomycin

80
Q

Safety notes for daptomycin

A

myopathy and rhabdomyolysis
falsely increase PT/INR (no bleed risk)
peripheral neuropathy

81
Q

Daptomycin in only compatible in __

A

normal saline

82
Q

Safety notes for linezolid

A 
Do not use with or within 2 weeks of MAOI
Duration related myelosuppression
optic neuropathy
serotonin syndrome
hypoglycemia
83
Q

Linezolid suspension __ __ __

A

Do Not Shake

84
Q

Oxazolidinone agents

A

linezolid (Zyvox)

tedizolid (Sivextro)

85
Q

Safety noes for quinupristin/dalfopristin

A

arthalgias, myalgias
infusion reactions
hyperbilirubinema

86
Q

Synercid coverage

A

MRSA
Enterococcus faecium (VRE)
- not E. faecalis

87
Q

Synercid is only diluted in ___ and is given through a ___.

A

D5W

central line

88
Q

Safety notes for tigecycline (Tygacil)

A

increase risk of death, use alternative if possible

89
Q

Do not use Synercid for ____ infections.

A

bloodstream

It does not achieve adequate concentrations in the blood.

90
Q

Synercid is ___ colored; discard if not this color.

A

yellow-orange

91
Q

indication for polymyxins

A

MDR gram-negative pathogens

92
Q

Safety notes for colistimethate sodium

A

dose-dependent nephrotoxicity

neurotoxicity

93
Q

Safety notes for polymyxin b sulfate

A

nephrotoxicity

neurotoxicity (may result in respiratory paralysis from neuromuscular blockade)

94
Q

Safety notes for chloramphenicol

A

fatal blood dyscrasias

Gray syndrome

95
Q

Safety notes for clindamycin

A

colitis
SJS/TEN/DRESS
N/V/D

96
Q

Safety notes for metronidazole

A

pregnancy
disulfirm reaction (avoid alcohol during treatment and 3 days after discontinuation)
Seizure, peripheral neuropathy
metallic taste

97
Q

Indication for secnidazole (Solosec)

A

Single dose for bacterial vaginosis

98
Q

Safety notes for lefamulin (Xenleta)

A

avoid in pregnancy
QTc prolongation
C. dif

99
Q

Indication for lefamulin

100
Q

Indication for fidaxomicin (Dificid)

A

C. difficile

101
Q

Indications for rifaximin (Xifaxan)

A

traveler’s diarrhea
hepatic encephalopathy
IBS-D
C. difficile infection (off label)

102
Q

Fosfomycin coverage and indication

A

E. coli (ESBL), E. faecalis (VRE)

Single dose for uncomplicated cystitis

103
Q

Dosing for Macrobid

A

100 mg PO BID for 5 days

104
Q

Renal cut-off for nitrofurantoin

A

CrCl < 60 mL/min

105
Q

Safety notes for nitrofurantoin

A

hemolytic anemia in G6PD deficiency

harmless brown urine discoloration

106
Q

drugs of choices for MSSA

A 
dicloxacillin, nafcillin, oxacillin
cefazolin, cephalexin, cefuroxime,
cefotetan
Augmentin, Unasyn
doxycycline, minocycline
Bactrim
107
Q

drugs of choice for VRE

A

linezolid
daptomycin
tigecycline
cystitis only: nitrofurantoin, fosfomycin, doxycycline

(E. faecalis):
penicillin G
ampicillin

(E. faecium):
quinupristin/dalfopristin

108
Q

drugs of choice for CRE

A

ceftazidime/avibactam
colistimethate
polymyxin B

109
Q

drugs of choice for CA-MRSA SSTI

A

Bactrim
doxycycline, minocycline
clindamycin
linezolid

110
Q

drugs of choice for severe MRSA SSTI

A 
vancomycin
linezolid, tedizolid
daptomycin
ceftaroline
telavancin
oritavancin
dalbavancin
quinupristin/dalfopristin
tigecycline
111
Q

drugs of choice for nosocomial MRSA

A 
vancomycin
linezolid
daptomycin
rifampin (not monotherapy)
televancin
112
Q

drugs of choice for Pseudomonas aeruginosa

A 
piperacillin/tazobactam
cefepime
ceftazidime
ceftazidime/avibactam
ceftolozane/tazobactam
carbapenems (except ertapenem)
ciprofloxacin, levofloxacin
aztreonam
aminoglycosides
colistimethate, polymyxin B
113
Q

drugs of choice for ESBL GNR (E. coli, Klebsiella, Proteus)

A 
carbapenems
ceftolozane/tazobactam
ceftazidime/avibactam
cefepime
aminoglycosides
cystitis only: fosfomycin
114
Q

drugs of choice for Acinetobacter baumannii

A 
carbapenems (not ertapenem)
ampicillin/sulbactam
minocycline
tigecycline
quinolones
SMX/TMP
colistimethate, polymyxin B
115
Q

drugs of choice for HNPEK

A 
beta-lactam + beta-lactamase inhibitor
amoxicillin
cephalosporins (not 1st generation)
carbapenems
SMX/TMP
aminoglycosides
quinolones
116
Q

drugs of choice for Bacteroides fragillis

A 
metronidazole
beta-lactam+beta-lactamase inhibitor
cefotetan, cefoxitin
carbapenems
tigecycline
117
Q

drugs of choice for C. difficile

A

vancomycin PO
fidaxomicin
metronidazole
rifaximin

118
Q

drugs of choice for atypical organisms

A

azithromycin, clarithromycin
doxycycline, minocycline
quinolones

119
Q

antibiotic oral suspensions requiring refrigeration

A 
penicillin VK
ampicillin
amoxicillin/clavulante
cephalexin
cefadroxil
cefpodoxime
cefprozil
ceuroxime
cefaclor
ceftibuten
vancomycin oral (Firvanq)
valganciclovir (Valcyte)
120
Q

antibiotic oral suspensions do NOT refrigerate

A 
cefdinir
azithromycin
clarithromycin
doxycycline
ciprofloxacin
levofloxacin
clindamycin
linezolid
SMX/TMP
acyclovir (Zovirax)
fluconazole (Diflucan)
posaconazole (Noxafil)
voriconazole (Vfend)
nystatin
121
Q

IV antibiotics do NOT refrigerate

A

metronidazole (Flagyl)
moxifloxacin (Avelox)
SMX/TMP
acyclovir (Zovirax)

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

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