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Infectious Disease Flashcards

1
Q

What’s Gram-negative organism?

A

Thin cell wall

Take up safranin counterstain

Stain pink or reddish in color

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2
Q

Gram-positive bacteria consist of mainly what species?

A

SSLEC

Staphylococcus

Streptococcus

Listeria

Enterococcus

Clostridium

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3
Q

Organisms under gram-positive Cocci?

A

Ending in “cocccus”

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4
Q

Organisms under gram-positive Rods?

A

Propionibacterium acnes

Bacillus anthracis

Clostridium difficle, Clostridium perfringens,
Corynebacterium diphtheriae, Corynebacterium jeikeium

Listeria monocytogenes

Nocardia asteroids (branched)

Actinomyces israelii (branched)

Mycobacterium species (acid-fast)

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5
Q

Organisms under gram-negative Cocci?

A

Neisseria gonorrhoeae

Neisseria meningitidis

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6
Q

Organisms under Spirochetes?

A

Borrelia burgdorferi; Borrelia recurrentis

Leptospira interrogans

Treponema pallidum

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7
Q

Organisms under Atypicals?

A

Chlamydia/Chlamydophilia

Mycoplasma hominis; Mycoplasma pneumoniae

Ureaplasma urealyticum

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8
Q

Organisms under gram-negative Coccobacillary?

A

Acinetobactor sp.

Bartonella henselae; Bordetella pertussis

Family rickettsiaceae; Francisella tularensis

Moraxella catarrhallis

Pasteurella multocida

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9
Q

Organisms under gram-negative rod?

A

All others

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10
Q

Whats Minimum Inhibitory Conc (MIC)?

A

Lowest drug conc that prevents visible microbial growth in 24 hrs

(Gen in practice, the MIC used is to prevent growth of 90% of microorganisms MIC90)

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11
Q

What’s breakpoint?

A

Level of MIC at which a bacterium is deemed either susceptible or resistant to an antibiotic

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12
Q

What’s Minimum Bactericidal Conc (MBC)?

A

Lowest drug conc that reduces bacterial density by 99.9% in 24 hrs (kills bacteria)

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13
Q

What’s Synergy?

A

Effect of 2 or more agents produces a greater effect than each agent alone

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14
Q

Purpose of Antimicrobial Stewardship Programs (ASP)?

A

Reduce emergence of resistance

Limiting drug-related adverse events

Minimizing risk of unintentional consequences associated with Antimicrobial use

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15
Q

Factors to consider when selecting a drug regimen?

A

Etiology/epidemiology (community V. Hospital-acquired inf) of inf

Site/ severity of inf

Patient xteristic (age, body wt, renal/liver fxn, allergies, pregnancy status, immune fxn)

Spectrum of activity and pharmacodynamics/pharmacokinetics of the drug regimen

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16
Q

Factors to consider when monitoring for therapeutic effectiveness?

A

Fever curve

WBC count

Radiographic findings

Pain/inflammation

Reduction in s/sx of inf

Gram stain, cultures and Antimicrobial susceptibilities

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17
Q

List Hydrophilic agents

A

DC BAG

Daptomycin

Colistimethate

Beta-lactams

Aminoglycosides

Glycopeptides

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18
Q

Xtics of hydrophilic agents? (Beta-lactams, Aminoglycosides,
Glycopeptides, Daptomycin, Colistimethate)

A

Small volume of distribution

Renal elimination

Doesn’t achieve intracellular conc

Increased clearance and/or distribution in sepsis

Poor-moderate bioavailability

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19
Q

Effects of hydrophilic agents? (Beta-lactams, Aminoglycosides,
Glycopeptides, Daptomycin, Colistimethate)

A

Poor tissue penetration

Nephrotoxicity (ATN- Acute tubular necrosis, AIN- Acute interstitial nephritis)

Not active against atypical (intracellular) pathogens

Consider loading doses and aggressive dosing in sepsis

< 1:1 with PO to IV ratio

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20
Q

List Lipophilic agents

A

Fluoroquinolones

Macrolides

Rifampin

Linezolid

Tetracyclines

Chloramphenicol

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21
Q

Xtics of Lipohilic agents (Fluoroquinolones, Macrolides, Rifampin,
Linezolid, Tetracyclines, Chloramphenicol)

A

Large vol of distribution

Hepatic metabolism

Achieves intracellular conc

Clearance/distribution has minimal change in sepsis

Excellent bioavailability

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22
Q

Effects of Lipohilic agents (Fluoroquinolones, Macrolides, Rifampin,
Linezolid, Tetracyclines, Chloramphenicol)

A

Excellent tissue penetration

Hepatoxicity and DDI (drug-drug interaction)

Active against atypical (intracellular) pathogens

Dose adjustment generally not needed in sepsis

1:1 with PO to IV ratio

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23
Q

How’s the dose of Beta-lactam maximized?

A

By extending the infusion time (such as over 4 hrs)

Or

Given as a continuous infusion which can lead to a greater time above the MIC

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24
Q

Which drugs are listed under Cmax:MIC (Max plasma conc:Min inh conc)?

A

C FAD

Colistin

Fluroquinolones

Aminoglycosides

Daptomycin

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25
Which drugs are listed under AUC:MIC (Area under curve:Min inh conc)?
VMT Vancomycin Macrolides Tetratcyclines
26
Which drugs occur under T>MIC?
Beta-lactams (penicillins, cephalosporins etc) Dose: more freq dosing, extended, continuous infusions
27
Which antibiotics are Cell Wall Inhibitors: bactericidal?
PCC VMF Penicillins Cephalosporins Carbapenems Vancomycin Monobactams Fosfomycin
28
Which antibiotics are DNA/RNA Inhibitors: bactericidal?
Q RMT Quinolones (DNA gyrase/Topoisomerase) Rifampin Metronidazole Tinidazole
29
Which antibiotics are Folic Acid Synthesis Inhibitors: bacterioSTATIC alone; bactericidal (in combo)?
Sulfonamides Trimethoprim
30
Which antibiotics are Protein Synthesis inhibitors: bacterioSTATIC?
BacterioSTATIC | Except Aminoglycosides and some pathogens for Streptogramnis
31
Which antibiotics are Protein Synthesis inhibitors: 50S?
COMS Clindamycin Oxazolidinones (Linezolid) Macrolides Streptogramins (Quinupristin, Dalfopristin)
32
Which antibiotics are Protein Synthesis inhibitors: 30S?
AT Aminoglycosides Tetracyclines
33
Which antibiotics are Cell Membrane Inhibitors:Bactericidal?
PD Polymyxins (Colistin) Daptomycin
34
What warning comes with all antibacterial agents?
Risk of superinfection with prolonged use including C. difficle-associated diarrhea (CDAD) and Pseudomembranous colitis
35
MOA of Aminoglycosides (AMGs)?
Binds to 30s and 50s ribosomal subunits Exhibit conc-dependent killing Have a post-antibiotic effect (PAE)
36
Advantage of extended interval dosing v. Traditional dosing?
Extended interval dosing may decrease nephrotoxicity
37
Coverage of Aminoglycosides (AMG)?
Gram-negative bacteria (e.g. Pseudomonas) In combo with beta-lactam or vanco: Gram-tve cocci e.g. Staphylococci and Enterococcus endocarditis
38
Drugs under AMGs
TAGS Tobramycin Amikacin Gentamicin Streptomycin
39
How do u dose AMGs?
Using IBW
40
Black box warning of AMGs (TAGS)?
Neurotoxicity (hearing loss, vertigo ataxia) Nephrotoxicity (esp in renal impairment or concurrent use with other nephrotoxic drugs)
41
SEs of AMGs (TAGS)?
Nephrotoxicity (acute tubular necrosis - ATN) Hearing loss (early toxicity associated with high-pitched sounds)
42
Adv of extended interval dosing of AMGs?
Less nephrotoxic and more cost-effective
43
Which has the broadest spectrum of activity?
Amikacin
44
What's the peak and trough of Gentamicin for gm-negative infection?
Peak - 5-10mcg/mL Trough - < 2 mcg/mL
45
What's the peak and trough of Gentamicin for gm-tve infection?
Peak - 3-4mcg/mL Trough - < 1mcg/mL
46
What's the peak and trough of Tobramycin?
Peak - 5-10mcg/mL Trough - < 2mcg/mL
47
What's the peak and trough of Amikacin?
Peak - 20-30 mcg/mL Trough - < 5mcg/mL
48
MOA of penicillins (PCNs)?
PCNs are beta-lactam that inhibit bacterial cell wall synthesis
49
Xtics of PCNs?
PCNs exhibit time-dependent killing Bactericidal, except against Enterococci species (AMGs, gentamicin and streptomycin are needed for bacterial activity)
50
Coverage of PCNs?
Mainly active against Gram-tve cocci (Streptococcus) Some gram-nag entire bacilli coverage
51
Which PCNs have activity against Enterococci?
PAA Piperacillin Ampicillin Amoxicillin
52
``` Which PCNs have activyt against methicillin susceptible Staphylococcus aureus (MSSA)? ```
Nafcillin
53
Effect of addition of beta-lactamase inhibitor to PCNs?
Adds gram-negative coverage (Proteus, E.coli, Klebsiella), H.influenza, MSSA and Anaerobic coverage
54
List PCNs under Aminopenicillins
Amoxicillin (Amoxil) Amoxicillin + Clavulanate (Augmentin, Augmentin ES-600, Augmentin XR, Amocian) Amoxicillin + Sulbactam (Unasyn)
55
Brand name of Amoxicillin (Aminopenicllins)?
Amoxil
56
Brand name of Amoxicillin + Clavulanate (Aminopenicllins)?
Augmentin Augmentin ES-600 Augmentin XR Amocian
57
Brand name of Amoxicillin + Sulbactam (Aminopenicllins)?
Unasyn
58
List PCNs under Natural penicillins
Penicillin (Pen VK) Penicillin G Benzathine (Bicillin L-A) Penicillins G Aqueous (Pfizerpen-G) Pen G Benzathine and Pen G Procaine (Bicillin C-R)
59
What's the brand name of Penicillin (Natural Penicillins)?
Pen VK
60
What's the brand name of Penicillin G Benzathine (Natural Penicillins)?
Bicillin L-A
61
List PCNs under Ureidopenicillins
Piperacillin + Tazobactam (Zosyn)
62
Brand name of Piperacillin + Tazobactam (Ureidopenicillins)?
Zosyn
63
List PCNs under Carboxypencillins
Ticarcillin + Clavulanic acid (Timentin)
64
List PCNs insider Antistaphylococcal penicillins
NAFCILLIN Oxacillin Dicloxacillin
65
Which PCN must be refrigerated?
Augmentin (Amox + Clavulanate) oral SUSPENSION must be refrigerated
66
Which PCN is refrigerated to improve taste?
Amoxil (amoxicillin) oral suspension, stable for 14 days at room temp
67
How do u take Pen VK (Penicillin)? Storage after reconstitution?
On an empty stomach Refrigerate after reconstitution
68
What diluent is Ampicillin IV compatible with? Stability at room temp?
NS only Stable for 8 hrs at room temp
69
Which PCN is a vesicant? How can one mitigate SE?
Nafcillin Use cold packs and hyaluronidase injections (admin thru central line is preferred)
70
In what case is amoxicillin (Amox) DOC for?
Acute otitis media H.pylori regimen Pregnancy Prophylaxis for endocarditis
71
Which PCNs have activity against Pseudomonas?
Piperacillin and Ticarcillin
72
Effects of tetracycline & other bacterioSTATIC on PCNs?
Tetracycline may decrease the effectiveness of PCN, by slowing bacterial growth (PCNs work best against actively growing bacteria)
73
MOA of Cephlosporins?
Inhibit bacterial cell wall
74
Xtics of Cephalosporins?
Time- dependent killing with bactericidal activity Spectrum of activity is dependent upon gen. of cephalosporin, eg activyt against staphy gen decreases with each generation, while activity against Strep and Gm-negative pathogens increases
75
List agents under 1st generation Cephalosporins
Cefadroxil Cefazolin (Kefzol) Cephalexin (Keflex)
76
Xtics of 1st generation Cephalosporins (Cefadroxil; Cefazolin (Kefzol); Cephalexin (Keflex))
Staphylococci activity Covers - Proteus mirabilis, E. coli and Klebsiella species Lower - Streptococci and Gm-negative activity (compared to 2nd/3rd generation)
77
Brand name of Cefazolin (1st generation Cephalosporin)?
Kefzol
78
Brand name of Cephalexin (1st generation Cephalosporin)?
Keflex
79
List agents under 2nd generation Cephalosporins
Cefaclor Cefotetan Cefoxitin Cefprozil Cefuroxime (Ceftin, Zinacef)
80
Xtics of 2nd generation Cephalosporins (Cefaclor; Cefotetan; Cefoxitin; Cefprozil; Cefuroxime (Ceftin, Zinacef))
Better gm-negative activity than 1st gen Similar gm-tve activity including PEK, Haemophilus & Neisseria species (HNPEK)
81
Which 2nd generation cephalosporin have anaerobic activity (Bacteroides fragilis), but less gm-tve activity?
Cefotetan Cefoxitin
82
Brand name of Cefuroxime (2nd generation cephalosporin)?
Ceftin Zinacef
83
List 3rd generation cephalosporin agents
CEFDINIR Cefditoren (Spectracef) Cefixime (Suprax) Cefotaxime (Claforan) Cefpodoxime Ceftazidime (Fortaz, Tazicef) Ceftibuten (Cedax) Ceftriaxone (Rocephin)
84
Xtics of Ceftazidime (Fortaz, Tazicef) 3rd generation cephalosporin?
Less gm-tve activity, but enhanced gm-negative activity, including Pseudomonas
85
Brand name of Ceftazidime (3rd generation cephalosporin)?
Fortaz Tazicef
86
Brand name of Ceftriaxone (3rd generation cephalosporin)?
Rocephin
87
List 4th generation cephalosporin agent
Cefepime (Maxipime)
88
Xtics of 4th generation cephalosporin (Cefepime - Maxipime)?
Best gm-negative activity, including HNPEKS, Citrobacter, Acinetobacter, Pseudomonas, Enterobacter and Serratia species (CAPES) and Gm-tve activity similar to 3rd gen
89
What's the brand name of Cefepime? (4th generation cephalosporin agent)?
Maxipime
90
List 5th generation cephalosporin agent
Ceftaroline fosamil (Teflaro)
91
Xtics of Ceftaroline fosamil (Teflaro) 5th generation cephalosporin agent?
Best Gm-tve activity Covers MRSA Some gm-negative activity (no Pseudomonas coverage)
92
What's the brand name of Ceftaroline? 5th generation cephalosporin agent
Teflaro
93
Is there cross-sensitivity btw Cephlosporins and PCNs?
Cross sensitivity (< 10%) with PCN allergy Don't use in pts who have a type 1 mediated PCN allergy (swelling, angioedema, anaphylaxis
94
Which cephalosporin shouldn't be given via Y-site or mixed with calcium-containing solns or used in neonates? Which is preferred?
Ceftriaxone (Rocephin) Preferred-Cefotaxime (Claforan)
95
Which cephalosporin contains N-methylthiotetrazole (NMTT or 1-MTT) side-chain? Effect of this?
Cefotetan Can increase the risk of hypoprothrombinemia (bleeding) and a disulfiram-like rxn with alcohol ingestion
96
Effect of Probenecid on all Beta-lactams?
Increase beta-lactam levels by interfering with renal excretion
97
MOA of Carbapenems?
They inhibit bacterial cell wall synthesis They exhibit time-dependent killing with bactericidal activity
98
Coverage of Carbapenems?
Very Broad spectrum (gm-tve, gm-negative and anaerobic pathogens)
99
What don't Carbapenems cover?
Atypical pathogens MRSA VRE C.difficle Stenotrophomonas
100
What does Ertapenem (Carbapenem) not cover?
Psuedomonas Acinetobacter
101
List agents under Carbapenems?
Imipenem/Cilastatin (Primaxin) Meropenem (Merrem) Ertapenem (Invanz) Doripenem (Doribax)
102
Brand name of Imipenem/Cilastatin (Carbapenems)?
Primaxin
103
Brand name of Meropenem (Carbapenems)?
Merrem
104
Brand name of Ertapenem (Carbapenems)?
Invanz
105
Brand name of Doripenems (Carbapenems)?
Doribax
106
Main SE of Carbapenems?
Seizures
107
MOA of Fluoroquinolones (FQs)?
Fluoroquinolones inhibit bacterial DNA Topoisomerase IV and inhibit DNA gyrase (Topoisomerase II) Exhibit conc-dependent killing
108
Which FQs have gm-negative activity, including Pseudomonas?
Ciprofloxacin Levofloxacin
109
Which FQs are referred to as respiratory FQs? Why?
Gemifloxacin Levofloxacin Moxifloxacin Due to enhanced coverage of Stretococcus pneumoniae and atypical coverage
110
List FQs agents
OFLOXACIN Norfloxacin (Norozin) Ciprofloxacin (Cipro, Cipro XR) Levofloxacin (Levaquin) Gatifloxacin (ophthalmic only) Moxifloxacin (Avelox) Gemifloxacin (Factive)
111
What's the brand name of Ciprofloxacin? FQs
Cipro Cipro XR
112
What's the brand name of Levofloxacin? FQs
Levaquin
113
What's the brand name of Otic Ciprofloxacin? FQs
Ciprodex
114
What's the brand name of Moxifloxacin? FQs
Avelox
115
What's the brand name of Ophthalmic Moxifloxacin? FQs
Vigamox
116
What's the dosing of Ciprofloxacin (IV/PO)?
250-750mg PO 200-400mg IV Q8-12H
117
What's the dosing interval of Ciprofloxacin if CrCl = 30-50ml/min?
Q12H
118
What's the dosing interval of Ciprofloxacin if CrCl < 30ml/min?
Q18-24H
119
What's the dosing of Levofloxacin (IV/PO)?
250-720mg daily 500mg, them 250mg daily or 250mg daily
120
What's the dosing of Moxifloxacin (IV/PO)?
400mg Q24H
121
What's the dosing of Gemifloxacin (PO)?
320mg daily
122
Black box warning of FQs?
Tendon inflammation and/or rupture (most often in Achilles' tendon)
123
Warnings to FQs use?
May prolong QT interval (avoid with class Ia and III antiarrhythmics) Peripheral neuropathy (with both oral and IV formulations) CNS effects e.g. Seizures Hypoglycemia (may be severe and sometimes fatal) Photosensitivity
124
Can FQs be used in children?
Avoid in children - risk of arthropathy
125
FQs SEs?
GI upset/diarrhea
126
How should Cipro oral suspension NOT be given?
Through a NG or other feeding tube Don't refrigerate oral suspension
127
Which Cipro formulation can be fed through feeding tube?
Cipro IR - crush, mix with water
128
How should Levofloxacin oral soln be taken? Storage?
On an empty stomach At room temp
129
List agents that can chelate FQs
``` Antacids Didanosine Sucralfate Bile acid resins Mg Al Ca Fe Zn Multivitamin ```
130
When do u give Cipro before and after cheating agents?
Cipro - 2hrs b4 or 6hrs after agents
131
When do u give Levo before and after cheating agents?
2hrs b4 or after
132
When do u give moxi before and after cheating agents?
4hrs b4 or 8hrs after
133
List Macrolides agents
Azithromycin (Zithromax, Z-Pak) Clarithromycin (Biaxin, Biaxin XL, Biaxin XL Pac) Erythromycin (E.E.S, Ery-Tab, EryPed, Erythrocin)
134
What's the brand name of Azithromycin? Macrolide
Zithromax Z-Pak
135
What's the brand name of Clarithromycin? Macrolide
Biaxin Biaxin XL Biaxin XL Pac
136
What's the brand name of Erythromycin? Macrolide
E.E.S Ery-Tab EryPed Erythrocin
137
Warning of Macrolides?
QT prolongation (like FQs) Hepatoxicity
138
SEs of Macrolide?
GI upset (diarrhea, abdominal pain and cramping esp with Erythromycin)
139
Storage of Azithromycin oral suspension (Zmax)?
Don't refrigerate
140
How do u take Biaxin XL (Clarithromycin)?
With food
141
Storage of Biaxin (Clarithromycin) oral suspension?
Don't refrigerate (can gel)
142
Which Macrolide must be refrigerated? Expiration?
Erythromycin ethylsuccinate (E.E.S) oral granule suspension Use w/in 10 days
143
Stability of Erythromycin powder suspension?
Stable at room temp x 35 days
144
Which Macrolide doesn't have many clinically significant drug interactions?
Azithromycin
145
What must be avoided with ALL Macrolides?
With agents that can prolong QT interval
146
List tetracycline agents
Doxycycline Minocycline Tetracycline
147
How should Oracea (Doxycycline) be taken?
On empty stomach (1hr before or 2hrs after meals) Take other forms with food to reduce GI irritation
148
Warnings ass with Tetracycline agents?
Children 8 yrs and under Pregnancy Breastfeeding
149
SEs of Tetracycline agents
GI upset Photosensitivity
150
What's Doxycycline IV to PO conversion ratio?
1:1
151
Storage of Doxycycline oral suspension
Not to be refrigerated
152
MOA of Sulfonamides?
Inhibit enzymes of the Folic acid pathway Individually, they are bacterioSTATIC, but collectively they are bactericidal
153
List agent under Sulfonamides?
Sulfamethoxazole and Trimethoprim (Bactrim, Septra, Sulfatrim)
154
What's the brand name of Sulfamethoxazole and Trimethoprim?
Bactrim Septra Sulfatrim
155
What's always the ratio of Sulfamethoxazole and Trimethoprim?
5:1 ratio Eg SMX/TMP 400/80
156
Indication for Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?
Adult female uncomplicated UTI - 1 DS tab bid x 3 days PCP prophylaxis - 1 DS or SS tab daily
157
CI to Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?
Sulfa allergy
158
SEs of Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?
GI upset (n/v/d) Skin rxns (rash, SJS, TEN) Crystalluria (take with 8oz of water) Photosensitivity Hyperkalemia Hypoglycemia
159
Storage of Bactrim IV? Diluent?
Store at room temp (Bactrim susp too) Dilute with D5W
160
Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) IV to PO?
1:1
161
Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) are strong inh of 2C8/9. What med should caution be used with?
Warfarin
162
MOA of Vancomycin?
Blocks Glycopeptides Exhibits time-dependent killing and is bacticidal
163
What's Vancomycin (Vancocin) DOC for? Dose?
MRSA inf 15-20mg/kg Q8-12H IV
164
What's oral Vancomycin used for? Dosing?
C.diff 125-500mg QID Z 10-14 days
165
SEs of vancomycin?
Infusion rxn/red man syndrome Nephrotoxicity
166
What's Vanco trough (after 4th dose) for Pneumonia, Endocarditis, Osteomyelitis, Menigitis, Bacteremia?
15-20 mcg/mL
167
What's Vanco trough (after 4th dose) for other infections?
10-15 mcg/mL
168
What the max infusion rate for peripheral IV vanco?
Don't exceed 5 mg/mL
169
When is an alternative agent considered instead of vanco?
When MIC of organism >= 2 mcg/mL
170
Coverage of Linezolid?
Most gm-tve bacteria, including MRSA, VRE faecium and faecalis Approved for pneumonia and uncomplicated/complicated skin and soft-tissue infections including diabetic foot inf and inf caused by Staphylococcus aureus and Strep species and for VRE inf
171
What's the brand name of Linezolid?
Zyvox
172
CI to Linezolid (Zyvox) use?
Concurrent use or w/in 2 wks of MAO inh
173
Warnings to Linezolid (Zyvox) use?
It's a weak MAO inh
174
SEs to Linezolid (Zyvox) use?
Headaches Diarrhea
175
What's the IV to PO conversion of Linezolid (Zyvox)?
1:1
176
Does Linezolid (Zyvox) req adjustment in renal impairment?
NO!
177
Storage of Linezolid (Zyvox)?
Room temp
178
What's brand name of Quinupristin/Dalfopristin?
Synercid
179
Whats Quinupristin/Dalfopristin (Synercid) approved for?
Complicated skin and soft-tissue inf caused by Staphylococcus aureus and Streptococcus pyogenes
180
SEs of Quinupristin/Dalfopristin (Synercid)?
Arthralgias/myalgias (up to 47%) Infusion rxn, including edema and pain at infusion site (up to 44%) Phlebitis (40%) Hyperbilirubinemia (up to 35%)
181
How should Quinupristin/Dalfopristin (Synercid) be given peripherally?
Must be in a vol of >= 250ml Mixed with D5W ONLY
182
What's Daptomycin brand name?
Cubicin
183
What's Daptomycin (Cubicin) approved for?
Complicated skin and soft-tissue inf and staphylococcus aureus bloodstream infections, including right-sided endocarditis
184
SEs of Daptomycin (Cubicin)?
GI upset (constipation, diarrhea, vomiting) Increased CPK and myopathy
185
Monitoring of Daptomycin (Cubicin)?
CPK level weekly
186
What indication is Daptomycin (Cubicin) not used for?
Pneumonia (as it's inactivated by surfactant)
187
What diluent is Daptomycin (Cubicin) compatible with?
NS (not D5W)
188
Daptomycin (Cubicin) and PT/INR?
Can cause false elevations in PT/INR (but no increase in bleeding risk)
189
What's Telavancin (Vibativ)?
Lipoglycopeptide and derivative of vancomycin
190
What's Telavancin (Vibativ) approved for
Complicated skin and soft-tissue inf caused by Gm-tve org Hospital acquired pneumonia (HAP) due to gm-.tve pathogens, including MRSA, when alt tx are not appropriate
191
Black box warning of Telavancin (Vibativ)?
Nephrotoxicity
192
Warnings of Telavancin (Vibativ) use?
May prolong QT interval Red man syndrome
193
SEs of Telavancin (Vibativ)?
Metallic taste N/v
194
Additional agents to treat gm-negative inf
Aztreonam Colistimethate
195
Aztreonam and cross-allergenicity with beta-lactams?
Monobactams structure makes cross-allergenicity with beta-lactams unlikely
196
What's the brand name of Aztreonam?
Azactam iv
197
Coverage of Aztreonam (Azactam IV)?
Gm-negative org, including Pseudomonas NO gm-tve activity
198
Effect of lack of cross-allergenicity of Aztreonam (Azactam IV) with beta-lactams?
Can be used in PCN-allergic pts
199
Brand name of Colistimethate?
Colistin Coly-Mycin M
200
Moa of Colistimethate (Colistin; Coly-Mycin M)?
Conc-dependent killing Bactericidal
201
Coverage of Colistimethate (Colistin; Coly-Mycin M)?
Used primarily in multidrug resistant Gm-negative pathogens
202
Warnings of Colistimethate (Colistin; Coly-Mycin M)?
Nephrotoxicity (dose-dependent)
203
SEs of Colistimethate (Colistin; Coly-Mycin M)?
Nephrotoxicity (Proteinuria, increased SCr) Neurologic disturbance (dizziness, tingling, numbness, parasthesia, vertigo)
204
List other nephrotoxic antibacterial agents
Colistimethate (Colistin; Coly-Mycin M) Amphotericin B AMGs
205
Warnings ass with Chloramphenicol use?
Gray syndrome - xterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma and death, associated with high serum levels
206
What's Telithromycin (Ketek) structurally related to?
Macrolides
207
Warnings of Telithromycin (Ketek) use?
Acute hepatic failure QT prolongation
208
Monitoring of Telithromycin (Ketek) use?
LFTs
209
What class is Tigecycline (Tygacil) structurally related to?
Tetratcyclines BacterioSTATIC
210
Tigecycline (Tygacil) are Gm-tve and Gm-negative. Which gm-negative does it have no effect against?
The 3 P's Pseudomonas Proteus Providencia
211
What's the recent FDA warning about the use of Tigecycline (Tygacil)?
Only when other alternatives are not possible
212
Black box warning of Tigecycline (Tygacil)?
Increased risk of death
213
When should the use of Tigecycline (Tygacil) be avoided?
In bloodstream infections
214
Black box warning of Clindamycin (Cleocin)?
Severe and possibly fatal colitis
215
SEs of Clindamycin (Cleocin)?
GI upset (n/v/d)
216
Brand name of Metronidazole?
Flagyl
217
Dosing of Metronidazole (Flagyl) for mild-to-moderate C. diff inf?
500mg TID for 10-15 days
218
CI to Metronidazole (Flagyl) and Tinidazole (Tindamax)?
Use of alcohol during therapy or w/in 3 days of therapy d/c Can increase INR if used with warfarin
219
SEs to Metronidazole (Flagyl) and Tinidazole (Tindamax)?
GI upset Metallic taste CNS (peripheral neuropathy)
220
IV to oral ratio of Metronidazole (Flagyl)?
1:1
221
Storage of Metronidazole IV?
Don't refrigerate
222
Indication of Rifaximin (Xifaxan)?
Traveller's diarrhea caused by non-invasive E.cole And Prevention of hepatic encephalopathy
223
Indication of Fosfomycin (Monurol)?
Single dose for uncomplicated UTI (cystitis only) due to E.coli and E.faecalis (active against VRE)
224
Indication of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?
Uncomplicated UTI (cystitis only) due to E.coli, S.aureus, Enterococcus, Klebsiella and Enterobacter
225
CI of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?
Pts with renal impairment (CrCl < 60 mL/min)
226
Coverage of Fidaxomicin (Dificid)?
C. difficile associated diarrhea
227
Limitation to Fidaxomicin (Dificid) use?
Not effective for systemic inf
228
List the main antibiotics that need to be refrigerated
Amox/Clavulanate (Augmentin) Cefprozil Cefuroxime (Ceftin) Cephalexin (Keflex) Erythromycin ethylsuccinate/sulfisoxazole Penicillin VK
229
Which AB is recommended to be stored in the fridge? Why?
Amoxicillin (Amoxil) - improves taste
230
List Antiobiotic that should NOT be refrigerated
``` Azithromycin (Zmax) Cefdinir Cefixime (Suprax) Clarithromycin (Biaxin) - bitter taste and thickening/gels Clindamycin (Cleocin) - thickening and may crystallize Ciprofloxacin (Cipro) Doxycycline (Vibramycin) Fluconazole (Diflucan) Levofloxacin (Levaquin) Linezolid (Zyvox) SMX/TMP (Septra, Sulfatrim) Voriconazole (VFEND) ```
231
Antiobiotic that DO NOT need renal dose adjustment
Azithromycin Ceftriaxone Chloramphenicol Clindamycin Dicloxacillin Doxycycline Erythromycin Fidaxomicin Linezolid Metronidazole Minocycline Moxifloxacin Nafcillin Oxacillin Quinupristin/Dalfopristin Rifaximin Rifampin Tigecycline Tinidazole
232
Main Antiobiotic used for skin and skin structure inf caused by community- associated methicillin-resistant staphylococcus aureus (CA-MRSA)?
SMX/TMP (Bactrim DS) 1-2 DS tab Q12H
233
Main agent used for Nosocomial-Associated MRSA?
Vancomycin
234
Main agents used to treat VRE faecalis?
Pen G or Ampicillin
235
Main agents used to treat VRE faecium?
Daptomycin
236
Main agents used to treat Pseudomonas aeruginosa?
Imipenem; Meropenem; Doripenem Cefepime; Ceftazidime Ciprofloxacin; Levofloxacin Aztreonam Ticarcillin/Clavulanic acid; Piperacillin; Piperacillin/Tazobactam Colistimethate (Colistin) Amikacin; Tobramycin; gentamicin
237
Main agent used to treat Extended spectrum beta-lactamase producing Enteric gram-negative rods (ESBL GNR) - E.coli, Klebsiella pneumoniae, P.mirabili
Carbapenems
238
Agents used to treat Acinetobacter baumannii
Imipenem Meropenem Doripenem
239
Agents used to treat Bacteroides fragilis?
Metronidazole Carbepenems Beta-lactam/ beta-lactamase inh for combos Tigecycline Cefoxitin Cefotetan
240
Agents used to treat C. difficile?
Metronidazole Vancomycin (PO) Fidaxomicin
241
List antibiotics that may cause Hepatotoxicity
Rifampin Macrolides (Azithromycin, Clarithromycin, erythromycin) ``` Clindamycin Fluconazole FQs (Ofloxacin, norfloxacin, Cipro, Levo, Gatifloxacin, Moxi, Gemi) Quinupristin/Dalfopristin Tetracycline ```
242
List antibiotics that may cause renal toxicity
AMGs (acute tubular necrosis - ATN) Colistin (ATN) Acyclovir SMX/TMP Beta-lactams (acute interstitial nephritis - AIN) Vanco (AIN)
243
Which Antibiotics increase Neuromuscular blockers, ototoxic?
AMGs
244
Which Antibiotics may cause seizure with accumulations; allergic rxns?
Beta-lactams
245
Which Antibiotics has a BBW of Colitis?
Clindamycin
246
Which Antibiotics should CPK levels be monitored in and should only be mixed with NS?
Daptomycin
247
Which Antibiotics is QT prolongation a concern in?
Fluconazole Macrolides (Azithromycin, Clarithromycin, erythromycin) FQs SMX/TMP
248
Which Antibiotics is serotonin syndrome if used with SSRI or MAO-I and HTN crisis, BMS
Linezolid
249
Which Antibiotics results in metallic taste, darkened urine, PN, no EtOH?
Metronidazole
250
Which Antibiotics is CI in CrCl < 60ml/min
Nitrofurantoin
251
Which Antibiotics has BBW of tendonitis, additive QT, photosensitivity, cations (dosed 1-2 hr b4 or 4-6 hr after di/trivalent cations eg Mg, Ca, Fe), PN?
Quinolones
252
Which Antibiotics causes muscle toxicity, phlebitis, and must be diluted with D5W only?
Quinupristin/Dalfopristin
253
Which Antibiotics causes Red urine and a strong 450 inducers?
Rifampin
254
Which Antibiotics causes allergic rxns, photosensitivity, additive QT, diluted with D5W only, stored at room temp?
SMX/TMP
255
Which Antibiotics must be separated from cations (dosed 1-2 hr b4 or 4-6 hr after di/trivalent cations eg Mg, Ca, Fe), cause photosensitivity and is preg class D (affects the bone)?
Tetracyclines
256
Which antibiotics causes ototoxic, infusion rxns?
Vancomycin
257
Common bacterial pathogens for selected sites of infection (CNS/Meningitis)?
Stretococcus pneumoniae Neisseria gonorrhoeae H. influenza Stretococci/E.coli (young) Listeria (young/old)
258
Common bacterial pathogens for selected sites of infection (Upper Respiratory)?
M. catarrhallis H. influenza Streptococci
259
Common bacterial pathogens for selected sites of infection (Bone and Joint)?
Staphylococcus aureus Staphylococcus epidermidis Streptococci Neisseria gonorrhea +/- GNR
260
Common bacterial pathogens for selected sites of infection (Mouth/ENT)?
Peptostreptococcus Actinomyces Anaerobic GNRs +/- H. influenza and aerobic GNR
261
Common bacterial pathogens for selected sites of infection (Skin/Soft Tissue)?
Staphylococcus aureus Streptococcus pyogenes Staphylococcus epidermidis Pasteurella +/- aerobic/anaerobic GNR (diabetics)
262
Common bacterial pathogens for selected sites of infection (Intra-abdominal Tract)?
E. coli, Proteus, Klebsiella Enterococci/Streptococci Bacteroides species
263
Common bacterial pathogens for selected sites of infection (Lower Respiratory - Community)?
Streptococcus pneumoniae H. influenza Atypicals: Legionella, Mycoplasma Enteric GNRs (Alcoholics, IC, HCA)
264
Common bacterial pathogens for selected sites of infection (Lower Respiratory - Hospital)?
Enteric GNRs (E. coli, Klebsiella, Proteus) Streptococcus pneumoniae Pseudomonas aeruginosa Enterobacter species S. aureus, including MRSA
265
Common bacterial pathogens for selected sites of infection (Urinary Tract)?
E. coli, Proteus, Klebsiella Staphylococcus saprophyticus Enterococci/Streptococci
266
What's surgical antibiotic prophylaxis?
Brief course of AB initiated w/in 60mins before incision | 120 mins before incision if using FQs or Vancomycin
267
When's a second dose of AB needed surgical antibiotic prophylaxis?
Longer procedures (>= 3-4 hrs) If there's a major blood loss (>= 1.5L of blood)
268
Drug of choice as surgical antibiotic prophylaxis?
1st or 2nd generation Cephalosporin e.g. Cefazolin/ Cefuroxime Given 1 hr (60mins) before
269
Alternative to DOC of surgical antibiotic prophylaxis?
In PCN-allergic pts Vancomycin - given 2 hrs prior to surgical incision
270
When is AB with broader spectrum used? Name the AB used?
In surgeries that involve parts of the bowel or put patients at risk of an anaerobic infection Cefotetan, Ertapenem or Ceftriaxone with Metronidazole
271
What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in CABG, other cardiac or vascular surgeries? Hip fracture repair/total joint replacement?
Cefazolin, Cefuroxime Vancomycin or Clindamycin
272
What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in Colon (colorectal)?
Cefotetan, Cefoxitin, Ampicillin/Sulbactam or Ertapenem Or Cefazolin or Ceftriaxone + Metronidazole Alternative: Clindamycin + (Aminoglycoside or Quinolone or Aztreonam) Or Metronidazole + (Aminoglycoside or Quinolone)
273
What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in Hysterectomy?
Cefotetan, Cefazolin, Cefoxitin or Ampicillin/Sulbactam Alternative: Clindamycin or Vanco + (Aminoglycoside or Quinolone or Aztreonam) Or Metronidazole + (Aminoglycoside or Quinolone)
274
What's the most likely organism to cause bacterial meningitis?
Streptococcus pneumonia Neisseria meningitidis Haemophilus influenzae Listeria monocytogenes
275
What's empiric therapy of Acute Bacterial Meningitis, in pts 2-50 yrs (primarily S. pneumoniae and N. meningitidis)?
Cefotaxime 2 Gm IV Q4-6H or Q12H Meropenem 2Gm IV Q8H + Vancomycin 30-45mg/kg per day in divided doses +/- Dexamethasone 0.15 mg/kg IV Q6H x 2-4 days
276
Empiric tx of Acute Bacterial Meningitis in Immunocompromised Pts or those > 50 yrs old (S. pneumoniae, N. meningitidis, L. monocytogenes )?
Vancomycin + Ampicillin + Ceftriaxone Or Vanco + ampicillin + Cefotaxime
277
Empiric tx of Acute Bacterial Meningitis for severe PCN allergy?
Chloramphenicol 4,000-6,000 mg/ day in 4 doses + Vancomycin 30-45 mg/kg per day in divided doses +/- SMX/TMP 5mg/kg IV Q6H
278
In kids 6 months - 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except this one)?
Unilateral AOM without Otorrhea (middle ear effusion/fluid) AB / observation
279
In kids >= 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except)?
Bilateral and Unilateral AOM without Otorrhea (middle ear effusion/fluid) AB / observation
280
What's recommended 1st line tx in AOM?
Amoxicillin 80-90 mg/kg/d in 2 divided dose Or Amox/Clav 90 mg/kg/d in 2 divided doses
281
What's recommended tx after 48-72 hrs of failure of initial tx in AOM?
Amox/Clav 90 mg/kg/day of Amox in 2 divided doses Or Ceftriaxone 50mg IM/IV x 3 days
282
Duration of tx recommended in < 2 yrs; 2-5 yrs; >= 6 yrs in AOM?
< 2 yrs = 10 days 2-5 yrs = 7 days >= 6 yrs = 5-7 days
283
Main pathogen responsible for Pharyngitis (upper respiratory tract inf)?
S. pyogenes
284
Tx of Acute Bronchitis - except cough to last 2 weeks?
Usually viral - antibiotics not indicated Recommend anti-tussive +/- inhaled bronchodilators
285
Tx of Acute Bacterial Exacerbation of chronic bronchitis (ABECB) with 2 or more of the ff: increased dyspnea, increased sputum pdt and increased sputum purulence?
Inhaled anticholinergic bronchodilator + oral corticosteroid
286
What's preferred outpatient tx of CAP?
Macrolide (Azithromycin, Clarithromycin, erythromycin)
287
What's preferred inpatient (non-ICU) tx of CAP?
Beta-lactam + Macrolide | Preferred b-lactam agents include Ceftriaxone, Cefotaxime, Ampicillin, Doxycycline
288
Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) < 5 days?
Enteric gm-negative bacteria
289
Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) > 5 days?
Nosocomial pathogens (MRSA, Pseudomonas)
290
Howz TB diagnosed?
Tuberculin skin test (TST), also called a PPD test Look for induration (raised area) w/in 48-72 hrs after injection
291
Name the categories of TB?
Latent and active dx
292
Latent dx tx?
Isoniazid (INH) 300mg daily (or twice weekly) for 9 months (typical regimen, preferred for HIV+ or children) Rifampin 400mg daily x 4 months INH + Rifapentine once weekly for 12wks (not for HIV+ or on children)
293
Tx of active TB dx?
4-drug regimen Rifampin, Isoniazid, Pyrazinamide and Ethambutol (RIPE)
294
T/F? Use direct observed therapy (DOT), if possible? When's DOT preferred?
T Preferred for regimen dosed 2 or 3 times per wk instead of daily
295
Which is the preferred TB dosing freq?
Daily (unless DOT is possible)
296
Where should pts with active TB be in hospital?
Isolated, single negative pressure rooms
297
What's recommended to adding to INH (Isoniazide)? Why?
Pyridoxine (Vit. B6) 25-50mg PO daily To reduce risk of neuropathy
298
List agents used in TB?
Whats the pr
299
Preferred initial tx Regimen for initial phase (~ 8 wks) in TB?
Rifampin (RIF) + Isoniazid (INH) + Pyrazinamide + Ethambutol (RIPE) for 56 daily doses (8 wks)
300
Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If sensitive to INH + RIF?
Continue INH + RIF daily or twice weekly (18 wks) Total duration of therapy = 26 wks (6 months)
301
Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to INH?
RIF + Pyrazinamide + Ethambutol +/- Moxifloxacin Total duration of therapy = 26 wks (6 months)
302
Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to RIF?
INH + Ethambutol + FQ + (Pyrazinamide x 2 months) Total duration of therapy = 12-18 months
303
Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to MDR-TB (resistance to 2 or more drugs including INH and RIF)?
FQ + Pyrazinamide + Ethambutol + AMG (Streptomycin/Amikacin/Kanamycin) +/- alt. agents (Cycloserine, Capreomycin, Ethioamide) Total duration of therapy = 18-24 months
304
Howz Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater) taken?
On empty stomach
305
SEs of Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater)?
Increased LFTs GI upset Rash/pruritus Orange-red discoloration of body secretions Flu-like syndrome
306
What should be added to Isoniazid (Rifamate) + Rifampin (Rifadin) + Pyrazinamide/Rifampin (Rifater) to reduce risk of peripheral neuropathy?
Pyridoxine 25-50mg/day
307
SEs of Pyrazinamide + Rifampin + Isoniazid (Rifater)?
GI upset Malaise Hyperuricemia
308
SEs of Ethambutol (Myambutol)?
Optic neuritis
309
Which TB agent is a very potent inducer?
Rifampin
310
What's the main cause of Prosthetic valve infective endocarditis? What's added to tx?
Staphylococci species Req addition of Rifampin
311
What's usually added to primary Antimicrobial therapy for synergy?
Gentamicin
312
What's the target peak and trough levels when Gentamicin is used for synergy?
3-4 mcg/mL < 1 mcg/mL
313
What AB should not be used for endocarditis?
Don't use extended interval dosing of AMG
314
What's the preferred oral prophylactic regimens before dental procedure (take a single dose 30-60 mins before dental procedure)?
Amoxicillin 2 gms
315
What's the preferred prophylactic regimens before dental procedure when pt can't take PO (take a single dose 30-60 mins before dental procedure)?
Ampicillin 2 Gm IM/IV Or Cefazolin or Ceftriaxone 1 Gm IM/IV
316
What's the preferred prophylactic regimens before dental procedure in a pt allergic to PCN + can take PO (take a single dose 30-60 mins before dental procedure)?
Clindamycin 600mg Or Azithromycin or Clarithromycin 500mg
317
What's the preferred prophylactic regimens before dental procedure in a pt allergic to PCN + can't take PO (take a single dose 30-60 mins before dental procedure)?
Cefazolin or Ceftriaxone Or Clindamycin
318
What's primary peritonitis?
Infection of peritoneal space and gen occurs in pts with liver dx
319
DOC of primary peritonitis?
Ceftriaxone for 5-7 days
320
Whats Cellulitis?
Affects all layers of the skin and is a serous SSTI
321
For outpt SSTI (skin & soft tissue inf), whats the primary tx for cutaneous abscess?
Incisions and drainage (I & D)
322
What's used for severe SSTI inf, rapid progression, systemic illness etc?
IV antibiotics
323
What's the empiric therapy options for complicate SSTI?
Vancomycin 15 mg/kg IV Q12H (goal trough 10-15 mg/L)
324
Typical s/sx of lower urinary tract infections (cystitis)?
Dysuria Urgency Freq Burning Nocturia Suprapubic heaviness Hematuria (fever is uncommon)
325
What indicates positive urinalysis?
Pyuria (positive leukocyte esterase or >= 10 WBC/mL) Bacteriuria (>= 10^5 bacteria/mL in uncomplicated pts and 10^3 bacteria/mL in complicated pts and men)
326
In what grp MUST bacteriuria be treated even if asymptomatic with negative urinalysis?
Pregnant women x 7 days
327
What should be avoided in pregnant to treat bacteriuria?
Quinolones (cartilage toxicity and arthropathies) Tetracyclines (teratogenic) SMX/TMP (Hyperbilirubinemia and Kernicterus)
328
Preferred tx for bacteriuria ?
Amox-Clav, Amoxicillin, Cephalosporin
329
What may be added to DOC of acute uncomplicated cystitis in females of child bearing age (~ 15-45 yrs of age)? Why?
Phenazopyridine 200mg PO TID x 2 days to relieve dysuria?
330
When is prophylaxis used in UTI inf? What's used?
>= 3 episodes in 1 yr 1 SMX/TMP SS daily Nitrofurantoin 50mg PO daily
331
What's used as urinary analgesic (to reduce sx of pain or burning with urination)?
Phenazopyridine (Azo, Uristat, Pyridium)
332
SEs of Phenazopyridine (Azo, Uristat, Pyridium) - urinary analgesic?
Headache Dizziness Stomach cramps Body secretion discoloration
333
How to minimize stomach upset from using Phenazopyridine (Azo, Uristat, Pyridium) in urinary analgesic?
Take with or without food + 8oz water to minimize stomach upset
334
T/F? Phenazopyridine (Azo, Uristat, Pyridium) may cause red-orange coloring of the urine and other body fluids. Contact lenses and clothes can be stained
T
335
What should be avoided in C. difficle Infection (CDI)?
Anti motility agents (due to risk of toxic megacolon)
336
Tx of CDI (3rd infection of mild-mod; 1st, 2nd & 3rd CDI sever dx and severe, complicated dx)?
Vanco
337
Tx of CDI (1st inf and 2nd inf (1st recurrence))?
Metronidazole 500mg PO TID X 10-14 days
338
Are prophylactic AB recommended in Traveller's dx (TD)?
No!
339
What's the most important tx in Traveller's diarrhea (TD)?
Oral rehydration therapy, esp in young children, elderly
340
DOC, dosing and duration for Syphilis caused by Treponema pallium, a spirochete (primary, secondary or early latent < 1 yr duration)?
Penicillin G benzathine (Bicillin LA - don't substitute with Bicillin CR) 2.4 million units IM x 1
341
DOC, dosing and duration for Syphilis - late latent ( > 1 yr duration)?
Penicillin G benzathine (Bicillin LA - don't substitute with Bicillin CR) 2.4 million units IM weekly x 3 wks (7.2 MU total)
342
DOC for Gonorrhea? Dosing?
Ceftriaxone (Rocephin) 250mg IM x 1
343
DOC for Chlamydia inf? Dosing?
Azithromycin 1 gm PO x 1
344
DOC for Bacterial Vaginosis? Dosing?
Metronidazole 500mg PO BID x 7 days Metronidazole 0.75% gel
345
T/F? All sexual partners must also be treated concurrently to prevent re-infection?
T
346
MOA of Terbinafine?
Blocks Squalene to Squalene epoxide
347
MOA of Azole?
Blocks action of Lanosterol (decrease ergosterol synthesis) Typically fungistatic, but may be fungicidal for select fungal pathogens
348
MOA of Echinocandins?
Inhibits B-glucan synthase
349
SEs of Amphotericin B (conventional)?
Fever Chills Headache Malaise Rigors Hypokalemia Hypomagnesemia Nephrotoxicity
350
Brand Name of Amphotericin B Lipid formulations? Amphotericin B Lipid? Liposomal Amphotericin B?
Amphotericin B Lipid (Abelcet) Liposomal Amphotericin B (AmBisome)
351
What diluent is Amphotericin B formulations compatible with?
D5W
352
Advantage of Amphotericin B Lipid formulations?
Reduce risk for infusion rxns and nephrotoxicity
353
What's used to pre-mediate Amphotericin B Conventional formulations? Why?
Acetaminophen or NSAID Diphenhydramine 25 mg IV and/or Hydrocortisone 50-100mg IV Meperidine 25-50mg IV for reducing duration of sever rigors Fluid boluses (500-1,000mL) to reduce the risk of nephrotoxicity To prevent infusion-related rxns
354
SEs of Flucytosine (Ancobon, 5-FC)?
Bone marrow suppression Hepatitis Increased SCr and GUN
355
What's Fluconazole DOC for?
Oropharyngeal candidiasis (thrush) in HIV pts Or Moderate dx in non-HIV infected pt
356
What's Voriconazole DOC for?
Aspergillus inf
357
List Azoles Antifungals
Itraconazole (Sporanox, Sporanox PulsePak, Onmel) Ketoconazole (Nizoral, Nizoral AD, Ketodan, Extina, Xolegel) Fluconazole (Diflucan) Voriconazole (VFEND) Posaconazole (Noxafil)
358
Brand name of Fluconazole (Azoles Antifungals)?
Diflucan
359
Brand name of Voriconazole (Azoles Antifungals)?
VFEND
360
Brand name of Posaconazole (Azoles Antifungals)?
Noxafil
361
When should oral Ketoconazole tablets be used?
Only when other effective antifungal therapy is unavailable or not tolerated
362
Main SE of Ketoconazole?
Increased LFTs
363
Are Itraconazole capsules and oral solutions interchangeable?
No! They are not interchangeable
364
Storage of Fluconazole IV?
Should NOT be refrigerated
365
Fluconazole IV to PO conversion?
1:1
366
How should Voriconazole (VFEND) be taken?
1 hr b4 or after meals (empty stomach)
367
CI Voriconazole (VFEND) use?
3A4 substrates (Rifampin, Rifabutin, Ergot alkaloids, long-acting barbiturates, CBZ, pimozide, quinidine, Sirolimus, St. John's wort)
368
Warnings to Voriconazole (VFEND) and Posaconazole (Noxafil) use?
QT prolongation - correct Ca, K, and Mg prior to initiating Voriconazole (VFEND) and Posaconazole (Noxafil)
369
Main SEs of Voriconazole (VFEND)?
Visual changes Increased LFTs
370
Monitoring of Voriconazole (VFEND)?
LFTs Renal fxn Electrolytes (Ca, Mg, K) Visual fxn
371
Voriconazole (VFEND) and night driving?
Caution to driving at night (due to vision changes) Avoid direct sunlight
372
How should Posaconazole (Noxafil) taken?
Must be taken with a full meal (during or w/in 20 mins following a meal)
373
SEs of Posaconazole (Noxafil)?
Increased LFTs
374
T/F? All Azoles are 3A4 inhibitors?
True (they will increased conc of 3A4 substrates)
375
What type of absorption does Itraconazole and Ketoconazole have?
PH-dependent absorption (increase PH reduce absorption, t4 avoid using with antacids, H2RAs, PPIs)
376
Effect of strong inhibitors on Voriconazole (VFEND)?
Can increase dangerously when given with drugs that inh Voriconazole's metabolism or small dose increases
377
What's the kinetics of Voriconazole (VFEND)?
1st order Followed by Michaelis-Menten (non-linear) kinetics
378
List drugs that concurrent use with Voriconazole (VFEND) should be avoided
Alfuzosin, Apixaban, Barbiturates CBZ, Copaxone Darunavir, Dofetilide, Dronedarone Eplerenone, Ergot derivatives Lopinavir, Lovastatin, Lurasidone Nilotinib Pimozide Quinidine Ranolazine, Rifampin, Rifabutin, Ritonavir, Rivaroxaban Simvastatin, St. John's wort Ticagrelor Thioridazine
379
Role Echinocandins in therapy?
DOC for most systemic Candida infection, including strains resistant to Azoles antifungals, hence the name EchinoCANDINS
380
List Echinocandins agents
Caspofungin (Cancidas) Micafungin (Mycamine) Anidulafugin (Eraxis)
381
Brand name of Caspofungin (Echinocandins)?
Cancidas
382
Brand name of Micafungin (Echinocandins)?
Mycamine
383
How should Caspofungin (Cancidas) NOT be mixed?
Don't mix with dextrose-containing solution
384
How's Micafungin (Mycamine) used in Candidemia?
Micafungin (Mycamine) 100mg IV daily
385
How's Micafungin (Mycamine) used in Esophageal Candiasis?
Micafungin (Mycamine) 150mg IV daily
386
How's Anidulafungin (Eraxis) used in Esophageal Candiasis?
100mg IV on day 1, then 50mg daily
387
How's Anidulafungin (Eraxis) used in Candidemia?
200mg IV on day 1, then 100mg daily
388
Ses of Echinocandins (Caspofungin, Micafungin, Anidulafungin)?
Increased LFTs Hypotension Fever Diarrhea Hypokalemia Hypomagnesemia Rash
389
Main SE of Griseofulvin (Grifulvin, Gris-PEG)?
Photosensitivity
390
Preg cat of Griseofulvin (Grifulvin, Gris-PEG)?
X
391
What's the brand name of Terbinafine (antifungal)?
Lamisil
392
Main SE of Terbinafine (Lamisil)?
Headache Increased LFTs
393
Griseofulvin and OCPs?
Griseofulvin induces OCPs (alternative, nonhormonal form of contraception recommended)
394
Whats DOC for Candida?
Fluconazole or Topicals (Clotrimazole or Nystatin) x 7-14 days
395
Whats DOC for Aspergillus?
Voriconazole (6-12 wks or indefinite)
396
Whats DOC for Onychomycosis? What must be done b4 initiating DOC?
Itraconazole, Terbinafine or Fluconazole (confirm fungal inf prior to tx)
397
What are viruses?
Viruses are obligate intracellular parasites: they depend on host cell metabolic processes for survival
398
List steps to viral replication
1) Attachment of virus to cell membrane 2) Penetration into the host cell 3) Uncoating of viral RNA/DNA 4) Transcription of viral proteins 5) Assembly of new virions (the infective form of the virus) 6) Budding of new, immature virions 7) Release of new virus
399
Dose & duration of Oseltamivir (Tamiflu) for tx in adults?
75mg BID x 5 days
400
Dose & duration of Oseltamivir (Tamiflu) for prevention in adults?
75mg BID x 10 days
401
SEs of Oseltamivir (Tamiflu)?
Vomiting Nausea ("tummy flu")
402
How soon should Oseltamivir (Tamiflu) be started?
W/in 48 hrs of sx
403
Warning associated with Zanamivir (Relenza Diskhaler)? Implication?
Bronchospasm risk: don't use if asthma/COPD or with breathing problems
404
List antivirals used for tx of HSV, VZV, and CMV?
Acyclovir (Zovirax) Valacyclovir (Valtrex) Famciclovir (Famvir) Ganciclovir (Cytovene IV) Valganciclovir (Valcyte) Cidofovir (Vistide) Foscarnet (Foscavir)
405
Brand name of Acyclovir? (antivirals used for tx of HSV, VZV, and CMV)
Zovirax
406
Brand name of Valacyclovir? (antivirals used for tx of HSV, VZV, and CMV)
Valtrex
407
Brand name of Valganiciclovir? (antivirals used for tx of HSV, VZV, and CMV)
Valcyte
408
How should Acyclovir (Zovirax) be dosed in obese pts?
Based on IBW in obese pts
409
SEs of Acyclovir, Valacyclovir, Famciclovir?
Malaise Headache N/v/d Increased SCr and BUN
410
How should Valganciclovir (Valcyte) be taken?
With food
411
BBW of Ganciclovir and Valganciclovir?
Myelosuppression
412
Ses of of Ganciclovir and Valganciclovir?
Fever N/v/d Anorexia Thrombocytopenia Neutropenia Leukopenia Anemia
413
What's the DOC for CMV?
Ganciclovir and Valganciclovir
414
What's the BBW that specific to Cidofovir?
Dose-dependent nephropathy
415
SEs of Cidofovir?
Increased risk of Nephrotoxcity (similar to Ganciclovir)
416
SEs of Foscarnet?
Increased SCr
417
How should Foscarnet be handled?
Like a chemo agent
418
T/F? Up to 50% of pts with HSV remain asymptomatic?
True
419
Whats the definitive sx of HSV? Xtics?
Lesions on external genitalia Lesions are painful
420
When does tx start in HSV?
Must start tx during Prodrome Or Within 1 day of lesion onset for the pt to experience benefit
421
T/F? If pt is resistant to acyclovir, the pt will be resistant to valacyclovir?
T
422
T/F? Strains resistant to acyclovir, will be resistant to famciclovir?
T
423
When should therapy be initiated and most effective?
At earliest s/sx of shingles Most effective when started w/in 72hrs of onset of zoster rash
424
List malaria agents (Areas with Chloroquine-resistant Plasmodium falciparum)
Atovaquone/Proquanil (Malarone) Mefloquine (Lariam) Doxycycline (Vibramycin) Quinine (Qualaquin)
425
Main SE of Atovaquone/Proquanil (Malarone)?
Increased LFTs
426
Adult Prophylaxis Dose of Atovaquone/Proquanil (Malarone)? Initiation (pre-travel)? D/C (post travel)?
250/100mg PO once daily Initiate - 1-2 days b4 travel D/c - 7 days
427
Adult Prophylaxis Dose of Mefloquine (Lariam)? Initiation (pre-travel)? D/C (post travel)?
250mg PO once weekly 1-3 wks 4 wks
428
Adult Prophylaxis Dose of Doxycycline (Vibramycin)? Initiation (pre-travel)? D/C (post travel)?
100mg PO daily 1-2 wks 4 wks
429
Main CI of Mefloquine (Lariam)?
Hx of seizures or psychiatric disorder
430
Main SE of Mefloquine (Lariam)?
Loss of balance/dizziness GI upset Chills Dizziness Tinnitus Psychiatric SE
431
Main CI of Quinine (Qualaquin)?
Prolonged QT interval G6PD deficiency
432
Main SE of Quinine (Qualaquin)?
QT prolongation
433
List malaria agents (Areas with Chloroquine-sensitive Plasmodium falciparum)
Chloroquine (Aralen)
434
Adult Prophylaxis Dose of Chloroquine (Aralen)? Initiation (pre-travel)? D/C (post travel)?
500mg PO once weekly 1-2 wks 4 wks
435
Warnings ass with Chloroquine (Aralen) use?
Retinopathy QT prolongation
436
SE of Chloroquine (Aralen)?
GI upset Visual disturbance Photosensitivity
437
List malaria agents (Areas with Plasmodium vivax and P. ovale with or without P. falciparum)
Primaquine
438
SE of Primaquine?
Agranulocytosis Anemia Hemolytic anemia (in pts with G6PD deficiency)
439
What does CDC require b4 initiating Primaquine?
G6PD deficiency screening
440
Look at pt counseling pts on pg 308 to 315
Look
441
T/F? Cefdinir, Cipro, Clindamycin (Cleocin) and Voriconazole (VFEND) suspension should NOT be refrigerated
T
442
Voriconazole (VFEND) should be taken with food?
False! VFEND should be taken on an empty stomach
443
Therapy for outpt community-acquired pneumonia?
Zithromax 500mg PO x 1 day Then 269mg PO daily (days 2-5)
444
Therapy for inpt community-acquired pneumonia?
Vanco 1gm IV Q12H + Imipenem 500mg Q6H
445
What's a choice to treat Pseudomonas caught while in the hospital?
Doribax (Doripenem)
446
What SE can Anidulafungin cause?
Increase in liver Transaminases
447
What's a choice to UTI caused by E. coli, sensitive to everything?
Nitrofurantoin 100mg PO BID x 5 days
448
List true things about Bactrim wrt to exposure to light, renal impairment and conversion from IV to PO?
Bactrim IV should be protected from light Needs to be dose adjusted in significant renal impairment 1:1 ratio for IV to PO
449
Doc for gonorrheae STDI?
Ceftriaxone 250mg IM x 1 + Azithromycin 1Gm PO x 1
450
Info about isoniazid (INH) wrt how to take and role in latent TB?
On empty stomach (1 hr b4 or 2 hr after a meal) Can be used alone to treat latent TB
451
Which med helps prevent peripheral neuropathies in pts on INH?
Pyridoxine (Vit B6)
452
A pt taking Amphotericin B is at risk for which electrolyte abnormalities?
Hypokalemia and hypomagnesemia
453
UTI tx in pregnant woman allergic to Cephalexin?
Nitrofurantoin 100mg PO BID x 7 days
454
VFEND wrt visual SE, how to take, and doc?
Visual change can occur Must be take on empty stomach Preferred agent for Aspergillosis inf
455
Which AB doesn't req dose adjustment in renal impairment?
Tigecycline
456
Which AB should be refrigerated?
Keflex (Cefalexin)
457
Which meds should pt use sunscreen when there are on?
Avelox (Moxifloxacin) VFEND (Voriconazole)
458
Which IV AB should be reconstituted with NS?
Ampicillin
459
List AB that must be taken with water
Clindamycin Doxycycline FQ Metronidazole (Val)Acyclovir
460
List AB that must be taken with food
Amoxicillin (Clav); Azithromycin Cefdinir; Cephalexin; Clarithromycin; Clindamycin Fluconazole Metronidazole Nitrofurantoin Oseltamivir Terbinafine; TMP/SMX (Val)Acyclovir
461
List AB that must be taken without food
Azithromycin ER suspension Cefdinir; Cephalexin; Clindamycin Doxycycline FQ Voriconazole
462
List AB that causes sun sensitivity
Doxycycline FQ TMP/SMX Voriconazole (VFEND)
463
They all cause GI (n/v/d) to some extent
T
464
List AB that cause rash
Amoxicillin (Clav) Cefdinir; Cephalexin Fluconazole; FQ TMP/SMX (sulfa) Voriconazole
465
List AB that cause HA and CNS effects
Doxycycline Fluconazole; FQ Metronidazole Nitrofurantoin (Val)Acyclovir Voriconazole (VFEND)
466
What's Gram-positive organism?
Thick cell wall Stain purple/bluish in color

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