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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
Q

Which drugs are listed under AUC:MIC (Area under curve:Min inh conc)?

A

VMT

Vancomycin

Macrolides

Tetratcyclines

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26
Q

Which drugs occur under T>MIC?

A

Beta-lactams (penicillins, cephalosporins etc)

Dose: more freq dosing, extended, continuous infusions

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27
Q

Which antibiotics are Cell Wall Inhibitors: bactericidal?

A

PCC VMF

Penicillins

Cephalosporins

Carbapenems

Vancomycin

Monobactams

Fosfomycin

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28
Q

Which antibiotics are DNA/RNA Inhibitors: bactericidal?

A

Q RMT

Quinolones (DNA gyrase/Topoisomerase)

Rifampin

Metronidazole

Tinidazole

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29
Q

Which antibiotics are Folic Acid Synthesis Inhibitors: bacterioSTATIC alone; bactericidal (in combo)?

A

Sulfonamides

Trimethoprim

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30
Q

Which antibiotics are Protein Synthesis inhibitors: bacterioSTATIC?

A

BacterioSTATIC

Except Aminoglycosides and some pathogens for Streptogramnis

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31
Q

Which antibiotics are Protein Synthesis inhibitors: 50S?

A

COMS

Clindamycin

Oxazolidinones (Linezolid)

Macrolides

Streptogramins (Quinupristin, Dalfopristin)

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32
Q

Which antibiotics are Protein Synthesis inhibitors: 30S?

A

AT

Aminoglycosides

Tetracyclines

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33
Q

Which antibiotics are Cell Membrane Inhibitors:Bactericidal?

A

PD

Polymyxins (Colistin)

Daptomycin

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34
Q

What warning comes with all antibacterial agents?

A

Risk of superinfection with prolonged use including C. difficle-associated diarrhea (CDAD) and Pseudomembranous colitis

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35
Q

MOA of Aminoglycosides (AMGs)?

A

Binds to 30s and 50s ribosomal subunits

Exhibit conc-dependent killing

Have a post-antibiotic effect (PAE)

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36
Q

Advantage of extended interval dosing v. Traditional dosing?

A

Extended interval dosing may decrease nephrotoxicity

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37
Q

Coverage of Aminoglycosides (AMG)?

A

Gram-negative bacteria (e.g. Pseudomonas)

In combo with beta-lactam or vanco: Gram-tve cocci e.g. Staphylococci and Enterococcus endocarditis

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38
Q

Drugs under AMGs

A

TAGS

Tobramycin

Amikacin

Gentamicin

Streptomycin

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39
Q

How do u dose AMGs?

A

Using IBW

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40
Q

Black box warning of AMGs (TAGS)?

A

Neurotoxicity (hearing loss, vertigo ataxia)

Nephrotoxicity (esp in renal impairment or concurrent use with other nephrotoxic drugs)

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41
Q

SEs of AMGs (TAGS)?

A

Nephrotoxicity (acute tubular necrosis - ATN)

Hearing loss (early toxicity associated with high-pitched sounds)

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42
Q

Adv of extended interval dosing of AMGs?

A

Less nephrotoxic and more cost-effective

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43
Q

Which has the broadest spectrum of activity?

A

Amikacin

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44
Q

What’s the peak and trough of Gentamicin for gm-negative infection?

A

Peak - 5-10mcg/mL

Trough - < 2 mcg/mL

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45
Q

What’s the peak and trough of Gentamicin for gm-tve infection?

A

Peak - 3-4mcg/mL

Trough - < 1mcg/mL

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46
Q

What’s the peak and trough of Tobramycin?

A

Peak - 5-10mcg/mL

Trough - < 2mcg/mL

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47
Q

What’s the peak and trough of Amikacin?

A

Peak - 20-30 mcg/mL

Trough - < 5mcg/mL

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48
Q

MOA of penicillins (PCNs)?

A

PCNs are beta-lactam that inhibit bacterial cell wall synthesis

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49
Q

Xtics of PCNs?

A

PCNs exhibit time-dependent killing

Bactericidal, except against Enterococci species (AMGs, gentamicin and streptomycin are needed for bacterial activity)

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50
Q

Coverage of PCNs?

A

Mainly active against

Gram-tve cocci (Streptococcus)

Some gram-nag entire bacilli coverage

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51
Q

Which PCNs have activity against Enterococci?

A

PAA

Piperacillin

Ampicillin

Amoxicillin

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52
Q 
Which PCNs have activyt against methicillin susceptible
Staphylococcus aureus (MSSA)?
A

Nafcillin

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53
Q

Effect of addition of beta-lactamase inhibitor to PCNs?

A

Adds gram-negative coverage (Proteus, E.coli, Klebsiella), H.influenza, MSSA and Anaerobic coverage

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54
Q

List PCNs under Aminopenicillins

A

Amoxicillin (Amoxil)

Amoxicillin + Clavulanate (Augmentin, Augmentin ES-600, Augmentin XR, Amocian)

Amoxicillin + Sulbactam (Unasyn)

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55
Q

Brand name of Amoxicillin (Aminopenicllins)?

A

Amoxil

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56
Q

Brand name of Amoxicillin + Clavulanate (Aminopenicllins)?

A

Augmentin

Augmentin ES-600

Augmentin XR

Amocian

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57
Q

Brand name of Amoxicillin + Sulbactam (Aminopenicllins)?

A

Unasyn

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58
Q

List PCNs under Natural penicillins

A

Penicillin (Pen VK)

Penicillin G Benzathine (Bicillin L-A)

Penicillins G Aqueous (Pfizerpen-G)

Pen G Benzathine and Pen G Procaine (Bicillin C-R)

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59
Q

What’s the brand name of Penicillin (Natural Penicillins)?

A

Pen VK

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60
Q

What’s the brand name of Penicillin G Benzathine (Natural Penicillins)?

A

Bicillin L-A

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61
Q

List PCNs under Ureidopenicillins

A

Piperacillin + Tazobactam (Zosyn)

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62
Q

Brand name of Piperacillin + Tazobactam (Ureidopenicillins)?

A

Zosyn

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63
Q

List PCNs under Carboxypencillins

A

Ticarcillin + Clavulanic acid (Timentin)

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64
Q

List PCNs insider Antistaphylococcal penicillins

A

NAFCILLIN

Oxacillin

Dicloxacillin

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65
Q

Which PCN must be refrigerated?

A

Augmentin (Amox + Clavulanate) oral SUSPENSION must be refrigerated

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66
Q

Which PCN is refrigerated to improve taste?

A

Amoxil (amoxicillin) oral suspension, stable for 14 days at room temp

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67
Q

How do u take Pen VK (Penicillin)? Storage after reconstitution?

A

On an empty stomach

Refrigerate after reconstitution

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68
Q

What diluent is Ampicillin IV compatible with? Stability at room temp?

A

NS only

Stable for 8 hrs at room temp

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69
Q

Which PCN is a vesicant? How can one mitigate SE?

A

Nafcillin

Use cold packs and hyaluronidase injections (admin thru central line is preferred)

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70
Q

In what case is amoxicillin (Amox) DOC for?

A

Acute otitis media

H.pylori regimen

Pregnancy

Prophylaxis for endocarditis

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71
Q

Which PCNs have activity against Pseudomonas?

A

Piperacillin and Ticarcillin

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72
Q

Effects of tetracycline & other bacterioSTATIC on PCNs?

A

Tetracycline may decrease the effectiveness of PCN, by slowing bacterial growth (PCNs work best against actively growing bacteria)

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73
Q

MOA of Cephlosporins?

A

Inhibit bacterial cell wall

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74
Q

Xtics of Cephalosporins?

A

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

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75
Q

List agents under 1st generation Cephalosporins

A

Cefadroxil

Cefazolin (Kefzol)

Cephalexin (Keflex)

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76
Q

Xtics of 1st generation Cephalosporins (Cefadroxil; Cefazolin (Kefzol); Cephalexin (Keflex))

A

Staphylococci activity

Covers - Proteus mirabilis, E. coli and Klebsiella species

Lower - Streptococci and Gm-negative activity (compared to 2nd/3rd generation)

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77
Q

Brand name of Cefazolin (1st generation Cephalosporin)?

A

Kefzol

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78
Q

Brand name of Cephalexin (1st generation Cephalosporin)?

A

Keflex

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79
Q

List agents under 2nd generation Cephalosporins

A

Cefaclor

Cefotetan

Cefoxitin

Cefprozil

Cefuroxime (Ceftin, Zinacef)

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80
Q

Xtics of 2nd generation Cephalosporins (Cefaclor; Cefotetan; Cefoxitin; Cefprozil; Cefuroxime (Ceftin, Zinacef))

A

Better gm-negative activity than 1st gen

Similar gm-tve activity including PEK, Haemophilus & Neisseria species (HNPEK)

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81
Q

Which 2nd generation cephalosporin have anaerobic activity (Bacteroides fragilis), but less gm-tve activity?

A

Cefotetan

Cefoxitin

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82
Q

Brand name of Cefuroxime (2nd generation cephalosporin)?

A

Ceftin

Zinacef

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83
Q

List 3rd generation cephalosporin agents

A

CEFDINIR

Cefditoren (Spectracef)

Cefixime (Suprax)

Cefotaxime (Claforan)

Cefpodoxime

Ceftazidime (Fortaz, Tazicef)

Ceftibuten (Cedax)

Ceftriaxone (Rocephin)

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84
Q

Xtics of Ceftazidime (Fortaz, Tazicef) 3rd generation cephalosporin?

A

Less gm-tve activity, but enhanced gm-negative activity, including Pseudomonas

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85
Q

Brand name of Ceftazidime (3rd generation cephalosporin)?

A

Fortaz

Tazicef

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86
Q

Brand name of Ceftriaxone (3rd generation cephalosporin)?

A

Rocephin

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87
Q

List 4th generation cephalosporin agent

A

Cefepime (Maxipime)

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88
Q

Xtics of 4th generation cephalosporin (Cefepime - Maxipime)?

A

Best gm-negative activity, including HNPEKS, Citrobacter, Acinetobacter, Pseudomonas, Enterobacter and Serratia species (CAPES)

and

Gm-tve activity similar to 3rd gen

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89
Q

What’s the brand name of Cefepime? (4th generation cephalosporin agent)?

A

Maxipime

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90
Q

List 5th generation cephalosporin agent

A

Ceftaroline fosamil (Teflaro)

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91
Q

Xtics of Ceftaroline fosamil (Teflaro) 5th generation cephalosporin agent?

A

Best Gm-tve activity

Covers MRSA

Some gm-negative activity (no Pseudomonas coverage)

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92
Q

What’s the brand name of Ceftaroline? 5th generation cephalosporin agent

A

Teflaro

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93
Q

Is there cross-sensitivity btw Cephlosporins and PCNs?

A

Cross sensitivity (< 10%) with PCN allergy

Don’t use in pts who have a type 1 mediated PCN allergy (swelling, angioedema, anaphylaxis

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94
Q

Which cephalosporin shouldn’t be given via Y-site or mixed with calcium-containing solns or used in neonates? Which is preferred?

A

Ceftriaxone (Rocephin)

Preferred-Cefotaxime (Claforan)

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95
Q

Which cephalosporin contains N-methylthiotetrazole (NMTT or 1-MTT) side-chain? Effect of this?

A

Cefotetan

Can increase the risk of hypoprothrombinemia (bleeding) and a disulfiram-like rxn with alcohol ingestion

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96
Q

Effect of Probenecid on all Beta-lactams?

A

Increase beta-lactam levels by interfering with renal excretion

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97
Q

MOA of Carbapenems?

A

They inhibit bacterial cell wall synthesis

They exhibit time-dependent killing with bactericidal activity

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98
Q

Coverage of Carbapenems?

A

Very Broad spectrum (gm-tve, gm-negative and anaerobic pathogens)

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99
Q

What don’t Carbapenems cover?

A

Atypical pathogens

MRSA

VRE

C.difficle

Stenotrophomonas

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100
Q

What does Ertapenem (Carbapenem) not cover?

A

Psuedomonas

Acinetobacter

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101
Q

List agents under Carbapenems?

A

Imipenem/Cilastatin (Primaxin)

Meropenem (Merrem)

Ertapenem (Invanz)

Doripenem (Doribax)

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102
Q

Brand name of Imipenem/Cilastatin (Carbapenems)?

A

Primaxin

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103
Q

Brand name of Meropenem (Carbapenems)?

A

Merrem

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104
Q

Brand name of Ertapenem (Carbapenems)?

A

Invanz

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105
Q

Brand name of Doripenems (Carbapenems)?

A

Doribax

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106
Q

Main SE of Carbapenems?

A

Seizures

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107
Q

MOA of Fluoroquinolones (FQs)?

A

Fluoroquinolones inhibit bacterial DNA Topoisomerase IV and inhibit DNA gyrase (Topoisomerase II)

Exhibit conc-dependent killing

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108
Q

Which FQs have gm-negative activity, including Pseudomonas?

A

Ciprofloxacin

Levofloxacin

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109
Q

Which FQs are referred to as respiratory FQs? Why?

A

Gemifloxacin

Levofloxacin

Moxifloxacin

Due to enhanced coverage of Stretococcus pneumoniae and atypical coverage

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110
Q

List FQs agents

A

OFLOXACIN

Norfloxacin (Norozin)

Ciprofloxacin (Cipro, Cipro XR)

Levofloxacin (Levaquin)

Gatifloxacin (ophthalmic only)

Moxifloxacin (Avelox)

Gemifloxacin (Factive)

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111
Q

What’s the brand name of Ciprofloxacin? FQs

A

Cipro

Cipro XR

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112
Q

What’s the brand name of Levofloxacin? FQs

A

Levaquin

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113
Q

What’s the brand name of Otic Ciprofloxacin? FQs

A

Ciprodex

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114
Q

What’s the brand name of Moxifloxacin? FQs

A

Avelox

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115
Q

What’s the brand name of Ophthalmic Moxifloxacin? FQs

A

Vigamox

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116
Q

What’s the dosing of Ciprofloxacin (IV/PO)?

A

250-750mg PO

200-400mg IV Q8-12H

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117
Q

What’s the dosing interval of Ciprofloxacin if CrCl = 30-50ml/min?

A

Q12H

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118
Q

What’s the dosing interval of Ciprofloxacin if CrCl < 30ml/min?

A

Q18-24H

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119
Q

What’s the dosing of Levofloxacin (IV/PO)?

A

250-720mg daily

500mg, them 250mg daily or 250mg daily

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120
Q

What’s the dosing of Moxifloxacin (IV/PO)?

A

400mg Q24H

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121
Q

What’s the dosing of Gemifloxacin (PO)?

A

320mg daily

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122
Q

Black box warning of FQs?

A

Tendon inflammation and/or rupture (most often in Achilles’ tendon)

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123
Q

Warnings to FQs use?

A

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

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124
Q

Can FQs be used in children?

A

Avoid in children - risk of arthropathy

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125
Q

FQs SEs?

A

GI upset/diarrhea

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126
Q

How should Cipro oral suspension NOT be given?

A

Through a NG or other feeding tube

Don’t refrigerate oral suspension

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127
Q

Which Cipro formulation can be fed through feeding tube?

A

Cipro IR - crush, mix with water

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128
Q

How should Levofloxacin oral soln be taken? Storage?

A

On an empty stomach

At room temp

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129
Q

List agents that can chelate FQs

A 
Antacids 
Didanosine
Sucralfate
Bile acid resins
Mg
Al
Ca
Fe
Zn
Multivitamin
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130
Q

When do u give Cipro before and after cheating agents?

A

Cipro - 2hrs b4 or 6hrs after agents

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131
Q

When do u give Levo before and after cheating agents?

A

2hrs b4 or after

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132
Q

When do u give moxi before and after cheating agents?

A

4hrs b4 or 8hrs after

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133
Q

List Macrolides agents

A

Azithromycin (Zithromax, Z-Pak)

Clarithromycin (Biaxin, Biaxin XL, Biaxin XL Pac)

Erythromycin (E.E.S, Ery-Tab, EryPed, Erythrocin)

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134
Q

What’s the brand name of Azithromycin? Macrolide

A

Zithromax

Z-Pak

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135
Q

What’s the brand name of Clarithromycin? Macrolide

A

Biaxin

Biaxin XL

Biaxin XL Pac

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136
Q

What’s the brand name of Erythromycin? Macrolide

A

E.E.S

Ery-Tab

EryPed

Erythrocin

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137
Q

Warning of Macrolides?

A

QT prolongation (like FQs)

Hepatoxicity

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138
Q

SEs of Macrolide?

A

GI upset (diarrhea, abdominal pain and cramping esp with Erythromycin)

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139
Q

Storage of Azithromycin oral suspension (Zmax)?

A

Don’t refrigerate

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140
Q

How do u take Biaxin XL (Clarithromycin)?

A

With food

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141
Q

Storage of Biaxin (Clarithromycin) oral suspension?

A

Don’t refrigerate (can gel)

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142
Q

Which Macrolide must be refrigerated? Expiration?

A

Erythromycin ethylsuccinate (E.E.S) oral granule suspension

Use w/in 10 days

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143
Q

Stability of Erythromycin powder suspension?

A

Stable at room temp x 35 days

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144
Q

Which Macrolide doesn’t have many clinically significant drug interactions?

A

Azithromycin

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145
Q

What must be avoided with ALL Macrolides?

A

With agents that can prolong QT interval

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146
Q

List tetracycline agents

A

Doxycycline

Minocycline

Tetracycline

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147
Q

How should Oracea (Doxycycline) be taken?

A

On empty stomach (1hr before or 2hrs after meals)

Take other forms with food to reduce GI irritation

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148
Q

Warnings ass with Tetracycline agents?

A

Children 8 yrs and under

Pregnancy

Breastfeeding

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149
Q

SEs of Tetracycline agents

A

GI upset

Photosensitivity

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150
Q

What’s Doxycycline IV to PO conversion ratio?

A

1:1

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151
Q

Storage of Doxycycline oral suspension

A

Not to be refrigerated

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152
Q

MOA of Sulfonamides?

A

Inhibit enzymes of the Folic acid pathway

Individually, they are bacterioSTATIC, but collectively they are bactericidal

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153
Q

List agent under Sulfonamides?

A

Sulfamethoxazole and Trimethoprim (Bactrim, Septra, Sulfatrim)

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154
Q

What’s the brand name of Sulfamethoxazole and Trimethoprim?

A

Bactrim

Septra

Sulfatrim

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155
Q

What’s always the ratio of Sulfamethoxazole and Trimethoprim?

A

5:1 ratio

Eg SMX/TMP 400/80

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156
Q

Indication for Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

A

Adult female uncomplicated UTI - 1 DS tab bid x 3 days

PCP prophylaxis - 1 DS or SS tab daily

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157
Q

CI to Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

A

Sulfa allergy

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158
Q

SEs of Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

A

GI upset (n/v/d)

Skin rxns (rash, SJS, TEN)

Crystalluria (take with 8oz of water)

Photosensitivity

Hyperkalemia

Hypoglycemia

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159
Q

Storage of Bactrim IV? Diluent?

A

Store at room temp (Bactrim susp too)

Dilute with D5W

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160
Q

Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) IV to PO?

A

1:1

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161
Q

Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) are strong inh of 2C8/9. What med should caution be used with?

A

Warfarin

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162
Q

MOA of Vancomycin?

A

Blocks Glycopeptides

Exhibits time-dependent killing and is bacticidal

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163
Q

What’s Vancomycin (Vancocin) DOC for? Dose?

A

MRSA inf

15-20mg/kg Q8-12H IV

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164
Q

What’s oral Vancomycin used for? Dosing?

A

C.diff

125-500mg QID Z 10-14 days

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165
Q

SEs of vancomycin?

A

Infusion rxn/red man syndrome

Nephrotoxicity

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166
Q

What’s Vanco trough (after 4th dose) for Pneumonia, Endocarditis, Osteomyelitis, Menigitis, Bacteremia?

A

15-20 mcg/mL

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167
Q

What’s Vanco trough (after 4th dose) for other infections?

A

10-15 mcg/mL

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168
Q

What the max infusion rate for peripheral IV vanco?

A

Don’t exceed 5 mg/mL

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169
Q

When is an alternative agent considered instead of vanco?

A

When MIC of organism >= 2 mcg/mL

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170
Q

Coverage of Linezolid?

A

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

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171
Q

What’s the brand name of Linezolid?

A

Zyvox

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172
Q

CI to Linezolid (Zyvox) use?

A

Concurrent use or w/in 2 wks of MAO inh

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173
Q

Warnings to Linezolid (Zyvox) use?

A

It’s a weak MAO inh

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174
Q

SEs to Linezolid (Zyvox) use?

A

Headaches

Diarrhea

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175
Q

What’s the IV to PO conversion of Linezolid (Zyvox)?

A

1:1

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176
Q

Does Linezolid (Zyvox) req adjustment in renal impairment?

A

NO!

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177
Q

Storage of Linezolid (Zyvox)?

A

Room temp

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178
Q

What’s brand name of Quinupristin/Dalfopristin?

A

Synercid

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179
Q

Whats Quinupristin/Dalfopristin (Synercid) approved for?

A

Complicated skin and soft-tissue inf caused by Staphylococcus aureus and Streptococcus pyogenes

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180
Q

SEs of Quinupristin/Dalfopristin (Synercid)?

A

Arthralgias/myalgias (up to 47%)

Infusion rxn, including edema and pain at infusion site (up to 44%)

Phlebitis (40%)

Hyperbilirubinemia (up to 35%)

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181
Q

How should Quinupristin/Dalfopristin (Synercid) be given peripherally?

A

Must be in a vol of >= 250ml

Mixed with D5W ONLY

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182
Q

What’s Daptomycin brand name?

A

Cubicin

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183
Q

What’s Daptomycin (Cubicin) approved for?

A

Complicated skin and soft-tissue inf and staphylococcus aureus bloodstream infections, including right-sided endocarditis

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184
Q

SEs of Daptomycin (Cubicin)?

A

GI upset (constipation, diarrhea, vomiting)

Increased CPK and myopathy

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185
Q

Monitoring of Daptomycin (Cubicin)?

A

CPK level weekly

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186
Q

What indication is Daptomycin (Cubicin) not used for?

A

Pneumonia (as it’s inactivated by surfactant)

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187
Q

What diluent is Daptomycin (Cubicin) compatible with?

A

NS (not D5W)

188
Q

Daptomycin (Cubicin) and PT/INR?

A

Can cause false elevations in PT/INR (but no increase in bleeding risk)

189
Q

What’s Telavancin (Vibativ)?

A

Lipoglycopeptide and derivative of vancomycin

190
Q

What’s Telavancin (Vibativ) approved for

A

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
Q

Black box warning of Telavancin (Vibativ)?

A

Nephrotoxicity

192
Q

Warnings of Telavancin (Vibativ) use?

A

May prolong QT interval

Red man syndrome

193
Q

SEs of Telavancin (Vibativ)?

A

Metallic taste

N/v

194
Q

Additional agents to treat gm-negative inf

A

Aztreonam

Colistimethate

195
Q

Aztreonam and cross-allergenicity with beta-lactams?

A

Monobactams structure makes cross-allergenicity with beta-lactams unlikely

196
Q

What’s the brand name of Aztreonam?

A

Azactam iv

197
Q

Coverage of Aztreonam (Azactam IV)?

A

Gm-negative org, including Pseudomonas

NO gm-tve activity

198
Q

Effect of lack of cross-allergenicity of Aztreonam (Azactam IV) with beta-lactams?

A

Can be used in PCN-allergic pts

199
Q

Brand name of Colistimethate?

A

Colistin

Coly-Mycin M

200
Q

Moa of Colistimethate (Colistin; Coly-Mycin M)?

A

Conc-dependent killing

Bactericidal

201
Q

Coverage of Colistimethate (Colistin; Coly-Mycin M)?

A

Used primarily in multidrug resistant Gm-negative pathogens

202
Q

Warnings of Colistimethate (Colistin; Coly-Mycin M)?

A

Nephrotoxicity (dose-dependent)

203
Q

SEs of Colistimethate (Colistin; Coly-Mycin M)?

A

Nephrotoxicity (Proteinuria, increased SCr)

Neurologic disturbance (dizziness, tingling, numbness, parasthesia, vertigo)

204
Q

List other nephrotoxic antibacterial agents

A

Colistimethate (Colistin; Coly-Mycin M)

Amphotericin B

AMGs

205
Q

Warnings ass with Chloramphenicol use?

A

Gray syndrome - xterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma and death, associated with high serum levels

206
Q

What’s Telithromycin (Ketek) structurally related to?

A

Macrolides

207
Q

Warnings of Telithromycin (Ketek) use?

A

Acute hepatic failure

QT prolongation

208
Q

Monitoring of Telithromycin (Ketek) use?

A

LFTs

209
Q

What class is Tigecycline (Tygacil) structurally related to?

A

Tetratcyclines

BacterioSTATIC

210
Q

Tigecycline (Tygacil) are Gm-tve and Gm-negative. Which gm-negative does it have no effect against?

A

The 3 P’s

Pseudomonas
Proteus
Providencia

211
Q

What’s the recent FDA warning about the use of Tigecycline (Tygacil)?

A

Only when other alternatives are not possible

212
Q

Black box warning of Tigecycline (Tygacil)?

A

Increased risk of death

213
Q

When should the use of Tigecycline (Tygacil) be avoided?

A

In bloodstream infections

214
Q

Black box warning of Clindamycin (Cleocin)?

A

Severe and possibly fatal colitis

215
Q

SEs of Clindamycin (Cleocin)?

A

GI upset (n/v/d)

216
Q

Brand name of Metronidazole?

A

Flagyl

217
Q

Dosing of Metronidazole (Flagyl) for mild-to-moderate C. diff inf?

A

500mg TID for 10-15 days

218
Q

CI to Metronidazole (Flagyl) and Tinidazole (Tindamax)?

A

Use of alcohol during therapy or w/in 3 days of therapy d/c

Can increase INR if used with warfarin

219
Q

SEs to Metronidazole (Flagyl) and Tinidazole (Tindamax)?

A

GI upset

Metallic taste

CNS (peripheral neuropathy)

220
Q

IV to oral ratio of Metronidazole (Flagyl)?

A

1:1

221
Q

Storage of Metronidazole IV?

A

Don’t refrigerate

222
Q

Indication of Rifaximin (Xifaxan)?

A

Traveller’s diarrhea caused by non-invasive E.cole

And

Prevention of hepatic encephalopathy

223
Q

Indication of Fosfomycin (Monurol)?

A

Single dose for uncomplicated UTI (cystitis only) due to E.coli and E.faecalis (active against VRE)

224
Q

Indication of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?

A

Uncomplicated UTI (cystitis only) due to E.coli, S.aureus, Enterococcus, Klebsiella and Enterobacter

225
Q

CI of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?

A

Pts with renal impairment (CrCl < 60 mL/min)

226
Q

Coverage of Fidaxomicin (Dificid)?

A

C. difficile associated diarrhea

227
Q

Limitation to Fidaxomicin (Dificid) use?

A

Not effective for systemic inf

228
Q

List the main antibiotics that need to be refrigerated

A

Amox/Clavulanate (Augmentin)

Cefprozil

Cefuroxime (Ceftin)

Cephalexin (Keflex)

Erythromycin ethylsuccinate/sulfisoxazole

Penicillin VK

229
Q

Which AB is recommended to be stored in the fridge? Why?

A

Amoxicillin (Amoxil) - improves taste

230
Q

List Antiobiotic that should NOT be refrigerated

A 
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
Q

Antiobiotic that DO NOT need renal dose adjustment

A

Azithromycin

Ceftriaxone
Chloramphenicol
Clindamycin

Dicloxacillin
Doxycycline

Erythromycin

Fidaxomicin

Linezolid

Metronidazole
Minocycline
Moxifloxacin

Nafcillin

Oxacillin

Quinupristin/Dalfopristin

Rifaximin
Rifampin

Tigecycline
Tinidazole

232
Q

Main Antiobiotic used for skin and skin structure inf caused by community- associated methicillin-resistant staphylococcus aureus (CA-MRSA)?

A

SMX/TMP (Bactrim DS) 1-2 DS tab Q12H

233
Q

Main agent used for Nosocomial-Associated MRSA?

A

Vancomycin

234
Q

Main agents used to treat VRE faecalis?

A

Pen G or Ampicillin

235
Q

Main agents used to treat VRE faecium?

A

Daptomycin

236
Q

Main agents used to treat Pseudomonas aeruginosa?

A

Imipenem; Meropenem; Doripenem

Cefepime; Ceftazidime

Ciprofloxacin; Levofloxacin

Aztreonam

Ticarcillin/Clavulanic acid; Piperacillin; Piperacillin/Tazobactam

Colistimethate (Colistin)

Amikacin; Tobramycin; gentamicin

237
Q

Main agent used to treat Extended spectrum beta-lactamase producing Enteric gram-negative rods (ESBL GNR) - E.coli, Klebsiella pneumoniae, P.mirabili

A

Carbapenems

238
Q

Agents used to treat Acinetobacter baumannii

A

Imipenem

Meropenem

Doripenem

239
Q

Agents used to treat Bacteroides fragilis?

A

Metronidazole

Carbepenems

Beta-lactam/ beta-lactamase inh for combos

Tigecycline

Cefoxitin

Cefotetan

240
Q

Agents used to treat C. difficile?

A

Metronidazole

Vancomycin (PO)

Fidaxomicin

241
Q

List antibiotics that may cause Hepatotoxicity

A

Rifampin

Macrolides (Azithromycin, Clarithromycin, erythromycin)

Clindamycin
Fluconazole
FQs (Ofloxacin, norfloxacin, Cipro, Levo, Gatifloxacin, Moxi, Gemi)
Quinupristin/Dalfopristin
Tetracycline
242
Q

List antibiotics that may cause renal toxicity

A

AMGs (acute tubular necrosis - ATN)
Colistin (ATN)

Acyclovir
SMX/TMP
Beta-lactams (acute interstitial nephritis - AIN)
Vanco (AIN)

243
Q

Which Antibiotics increase Neuromuscular blockers, ototoxic?

A

AMGs

244
Q

Which Antibiotics may cause seizure with accumulations; allergic rxns?

A

Beta-lactams

245
Q

Which Antibiotics has a BBW of Colitis?

A

Clindamycin

246
Q

Which Antibiotics should CPK levels be monitored in and should only be mixed with NS?

A

Daptomycin

247
Q

Which Antibiotics is QT prolongation a concern in?

A

Fluconazole

Macrolides (Azithromycin, Clarithromycin, erythromycin)

FQs

SMX/TMP

248
Q

Which Antibiotics is serotonin syndrome if used with SSRI or MAO-I and HTN crisis, BMS

A

Linezolid

249
Q

Which Antibiotics results in metallic taste, darkened urine, PN, no EtOH?

A

Metronidazole

250
Q

Which Antibiotics is CI in CrCl < 60ml/min

A

Nitrofurantoin

251
Q

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?

A

Quinolones

252
Q

Which Antibiotics causes muscle toxicity, phlebitis, and must be diluted with D5W only?

A

Quinupristin/Dalfopristin

253
Q

Which Antibiotics causes Red urine and a strong 450 inducers?

A

Rifampin

254
Q

Which Antibiotics causes allergic rxns, photosensitivity, additive QT, diluted with D5W only, stored at room temp?

A

SMX/TMP

255
Q

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)?

A

Tetracyclines

256
Q

Which antibiotics causes ototoxic, infusion rxns?

A

Vancomycin

257
Q

Common bacterial pathogens for selected sites of infection (CNS/Meningitis)?

A

Stretococcus pneumoniae

Neisseria gonorrhoeae

H. influenza

Stretococci/E.coli (young)

Listeria (young/old)

258
Q

Common bacterial pathogens for selected sites of infection (Upper Respiratory)?

A

M. catarrhallis

H. influenza

Streptococci

259
Q

Common bacterial pathogens for selected sites of infection (Bone and Joint)?

A

Staphylococcus aureus

Staphylococcus epidermidis

Streptococci

Neisseria gonorrhea

+/- GNR

260
Q

Common bacterial pathogens for selected sites of infection (Mouth/ENT)?

A

Peptostreptococcus

Actinomyces

Anaerobic GNRs

+/- H. influenza and aerobic GNR

261
Q

Common bacterial pathogens for selected sites of infection (Skin/Soft Tissue)?

A

Staphylococcus aureus

Streptococcus pyogenes

Staphylococcus epidermidis

Pasteurella

+/- aerobic/anaerobic GNR (diabetics)

262
Q

Common bacterial pathogens for selected sites of infection (Intra-abdominal Tract)?

A

E. coli, Proteus, Klebsiella

Enterococci/Streptococci

Bacteroides species

263
Q

Common bacterial pathogens for selected sites of infection (Lower
Respiratory - Community)?

A

Streptococcus pneumoniae

H. influenza

Atypicals: Legionella, Mycoplasma

Enteric GNRs (Alcoholics, IC, HCA)

264
Q

Common bacterial pathogens for selected sites of infection (Lower
Respiratory - Hospital)?

A

Enteric GNRs (E. coli, Klebsiella, Proteus)

Streptococcus pneumoniae

Pseudomonas aeruginosa

Enterobacter species

S. aureus, including MRSA

265
Q

Common bacterial pathogens for selected sites of infection (Urinary Tract)?

A

E. coli, Proteus, Klebsiella

Staphylococcus saprophyticus

Enterococci/Streptococci

266
Q

What’s surgical antibiotic prophylaxis?

A

Brief course of AB initiated w/in 60mins before incision

120 mins before incision if using FQs or Vancomycin

267
Q

When’s a second dose of AB needed surgical antibiotic prophylaxis?

A

Longer procedures (>= 3-4 hrs)

If there’s a major blood loss (>= 1.5L of blood)

268
Q

Drug of choice as surgical antibiotic prophylaxis?

A

1st or 2nd generation Cephalosporin e.g. Cefazolin/ Cefuroxime

Given 1 hr (60mins) before

269
Q

Alternative to DOC of surgical antibiotic prophylaxis?

A

In PCN-allergic pts

Vancomycin - given 2 hrs prior to surgical incision

270
Q

When is AB with broader spectrum used? Name the AB used?

A

In surgeries that involve parts of the bowel or put patients at risk of an anaerobic infection

Cefotetan, Ertapenem or Ceftriaxone with Metronidazole

271
Q

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?

A

Cefazolin, Cefuroxime

Vancomycin or Clindamycin

272
Q

What’s the recommended AB (and Alt. if pt has Beta-lactam allergy) in Colon (colorectal)?

A

Cefotetan, Cefoxitin, Ampicillin/Sulbactam or Ertapenem

Or

Cefazolin or Ceftriaxone + Metronidazole

Alternative:
Clindamycin + (Aminoglycoside or Quinolone or Aztreonam)
Or
Metronidazole + (Aminoglycoside or Quinolone)

273
Q

What’s the recommended AB (and Alt. if pt has Beta-lactam allergy) in Hysterectomy?

A

Cefotetan, Cefazolin, Cefoxitin or Ampicillin/Sulbactam

Alternative:
Clindamycin or Vanco + (Aminoglycoside or Quinolone or Aztreonam)
Or
Metronidazole + (Aminoglycoside or Quinolone)

274
Q

What’s the most likely organism to cause bacterial meningitis?

A

Streptococcus pneumonia

Neisseria meningitidis

Haemophilus influenzae

Listeria monocytogenes

275
Q

What’s empiric therapy of Acute Bacterial Meningitis, in pts 2-50 yrs (primarily S. pneumoniae and N. meningitidis)?

A

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
Q

Empiric tx of Acute Bacterial Meningitis in Immunocompromised Pts or those > 50 yrs old (S. pneumoniae, N. meningitidis, L. monocytogenes )?

A

Vancomycin + Ampicillin + Ceftriaxone

Or

Vanco + ampicillin + Cefotaxime

277
Q

Empiric tx of Acute Bacterial Meningitis for severe PCN allergy?

A

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
Q

In kids 6 months - 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except this one)?

A

Unilateral AOM without Otorrhea (middle ear effusion/fluid)

AB / observation

279
Q

In kids >= 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except)?

A

Bilateral and Unilateral AOM without Otorrhea (middle ear effusion/fluid)

AB / observation

280
Q

What’s recommended 1st line tx in AOM?

A

Amoxicillin 80-90 mg/kg/d in 2 divided dose

Or

Amox/Clav 90 mg/kg/d in 2 divided doses

281
Q

What’s recommended tx after 48-72 hrs of failure of initial tx in AOM?

A

Amox/Clav 90 mg/kg/day of Amox in 2 divided doses

Or

Ceftriaxone 50mg IM/IV x 3 days

282
Q

Duration of tx recommended in < 2 yrs; 2-5 yrs; >= 6 yrs in AOM?

A

< 2 yrs = 10 days

2-5 yrs = 7 days

> = 6 yrs = 5-7 days

283
Q

Main pathogen responsible for Pharyngitis (upper respiratory tract inf)?

A

S. pyogenes

284
Q

Tx of Acute Bronchitis - except cough to last 2 weeks?

A

Usually viral - antibiotics not indicated

Recommend anti-tussive +/- inhaled bronchodilators

285
Q

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?

A

Inhaled anticholinergic bronchodilator + oral corticosteroid

286
Q

What’s preferred outpatient tx of CAP?

A

Macrolide (Azithromycin, Clarithromycin, erythromycin)

287
Q

What’s preferred inpatient (non-ICU) tx of CAP?

A

Beta-lactam + Macrolide

Preferred b-lactam agents include Ceftriaxone, Cefotaxime, Ampicillin, Doxycycline

288
Q

Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) < 5 days?

A

Enteric gm-negative bacteria

289
Q

Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) > 5 days?

A

Nosocomial pathogens (MRSA, Pseudomonas)

290
Q

Howz TB diagnosed?

A

Tuberculin skin test (TST), also called a PPD test

Look for induration (raised area) w/in 48-72 hrs after injection

291
Q

Name the categories of TB?

A

Latent and active dx

292
Q

Latent dx tx?

A

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
Q

Tx of active TB dx?

A

4-drug regimen

Rifampin, Isoniazid, Pyrazinamide and Ethambutol (RIPE)

294
Q

T/F? Use direct observed therapy (DOT), if possible? When’s DOT preferred?

A

T

Preferred for regimen dosed 2 or 3 times per wk instead of daily

295
Q

Which is the preferred TB dosing freq?

A

Daily (unless DOT is possible)

296
Q

Where should pts with active TB be in hospital?

A

Isolated, single negative pressure rooms

297
Q

What’s recommended to adding to INH (Isoniazide)? Why?

A

Pyridoxine (Vit. B6) 25-50mg PO daily

To reduce risk of neuropathy

298
Q

List agents used in TB?

A

Whats the pr

299
Q

Preferred initial tx Regimen for initial phase (~ 8 wks) in TB?

A

Rifampin (RIF) + Isoniazid (INH) + Pyrazinamide + Ethambutol (RIPE) for 56 daily doses (8 wks)

300
Q

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If sensitive to INH + RIF?

A

Continue INH + RIF daily or twice weekly (18 wks)

Total duration of therapy = 26 wks (6 months)

301
Q

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to INH?

A

RIF + Pyrazinamide + Ethambutol +/- Moxifloxacin

Total duration of therapy = 26 wks (6 months)

302
Q

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to RIF?

A

INH + Ethambutol + FQ + (Pyrazinamide x 2 months)

Total duration of therapy = 12-18 months

303
Q

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)?

A

FQ + Pyrazinamide + Ethambutol + AMG (Streptomycin/Amikacin/Kanamycin) +/- alt. agents (Cycloserine, Capreomycin, Ethioamide)

Total duration of therapy = 18-24 months

304
Q

Howz Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater) taken?

A

On empty stomach

305
Q

SEs of Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater)?

A

Increased LFTs

GI upset

Rash/pruritus

Orange-red discoloration of body secretions

Flu-like syndrome

306
Q

What should be added to Isoniazid (Rifamate) + Rifampin (Rifadin) + Pyrazinamide/Rifampin (Rifater) to reduce risk of peripheral neuropathy?

A

Pyridoxine 25-50mg/day

307
Q

SEs of Pyrazinamide + Rifampin + Isoniazid (Rifater)?

A

GI upset

Malaise

Hyperuricemia

308
Q

SEs of Ethambutol (Myambutol)?

A

Optic neuritis

309
Q

Which TB agent is a very potent inducer?

A

Rifampin

310
Q

What’s the main cause of Prosthetic valve infective endocarditis? What’s added to tx?

A

Staphylococci species

Req addition of Rifampin

311
Q

What’s usually added to primary Antimicrobial therapy for synergy?

A

Gentamicin

312
Q

What’s the target peak and trough levels when Gentamicin is used for synergy?

A

3-4 mcg/mL

< 1 mcg/mL

313
Q

What AB should not be used for endocarditis?

A

Don’t use extended interval dosing of AMG

314
Q

What’s the preferred oral prophylactic regimens before dental procedure (take a single dose 30-60 mins before dental procedure)?

A

Amoxicillin 2 gms

315
Q

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)?

A

Ampicillin 2 Gm IM/IV

Or

Cefazolin or Ceftriaxone 1 Gm IM/IV

316
Q

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)?

A

Clindamycin 600mg

Or

Azithromycin or Clarithromycin 500mg

317
Q

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)?

A

Cefazolin or Ceftriaxone

Or

Clindamycin

318
Q

What’s primary peritonitis?

A

Infection of peritoneal space and gen occurs in pts with liver dx

319
Q

DOC of primary peritonitis?

A

Ceftriaxone for 5-7 days

320
Q

Whats Cellulitis?

A

Affects all layers of the skin and is a serous SSTI

321
Q

For outpt SSTI (skin & soft tissue inf), whats the primary tx for cutaneous abscess?

A

Incisions and drainage (I & D)

322
Q

What’s used for severe SSTI inf, rapid progression, systemic illness etc?

A

IV antibiotics

323
Q

What’s the empiric therapy options for complicate SSTI?

A

Vancomycin 15 mg/kg IV Q12H (goal trough 10-15 mg/L)

324
Q

Typical s/sx of lower urinary tract infections (cystitis)?

A

Dysuria

Urgency

Freq

Burning

Nocturia

Suprapubic heaviness

Hematuria (fever is uncommon)

325
Q

What indicates positive urinalysis?

A

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
Q

In what grp MUST bacteriuria be treated even if asymptomatic with negative urinalysis?

A

Pregnant women x 7 days

327
Q

What should be avoided in pregnant to treat bacteriuria?

A

Quinolones (cartilage toxicity and arthropathies)

Tetracyclines (teratogenic)

SMX/TMP (Hyperbilirubinemia and Kernicterus)

328
Q

Preferred tx for bacteriuria ?

A

Amox-Clav, Amoxicillin, Cephalosporin

329
Q

What may be added to DOC of acute uncomplicated cystitis in females of child bearing age (~ 15-45 yrs of age)? Why?

A

Phenazopyridine 200mg PO TID x 2 days to relieve dysuria?

330
Q

When is prophylaxis used in UTI inf? What’s used?

A

> = 3 episodes in 1 yr

1 SMX/TMP SS daily
Nitrofurantoin 50mg PO daily

331
Q

What’s used as urinary analgesic (to reduce sx of pain or burning with urination)?

A

Phenazopyridine (Azo, Uristat, Pyridium)

332
Q

SEs of Phenazopyridine (Azo, Uristat, Pyridium) - urinary analgesic?

A

Headache

Dizziness

Stomach cramps

Body secretion discoloration

333
Q

How to minimize stomach upset from using Phenazopyridine (Azo, Uristat, Pyridium) in urinary analgesic?

A

Take with or without food + 8oz water to minimize stomach upset

334
Q

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

A

T

335
Q

What should be avoided in C. difficle Infection (CDI)?

A

Anti motility agents (due to risk of toxic megacolon)

336
Q

Tx of CDI (3rd infection of mild-mod; 1st, 2nd & 3rd CDI sever dx and severe, complicated dx)?

A

Vanco

337
Q

Tx of CDI (1st inf and 2nd inf (1st recurrence))?

A

Metronidazole 500mg PO TID X 10-14 days

338
Q

Are prophylactic AB recommended in Traveller’s dx (TD)?

A

No!

339
Q

What’s the most important tx in Traveller’s diarrhea (TD)?

A

Oral rehydration therapy, esp in young children, elderly

340
Q

DOC, dosing and duration for Syphilis caused by Treponema pallium, a spirochete (primary, secondary or early latent < 1 yr duration)?

A

Penicillin G benzathine (Bicillin LA - don’t substitute with Bicillin CR) 2.4 million units IM x 1

341
Q

DOC, dosing and duration for Syphilis - late latent ( > 1 yr duration)?

A

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
Q

DOC for Gonorrhea? Dosing?

A

Ceftriaxone (Rocephin) 250mg IM x 1

343
Q

DOC for Chlamydia inf? Dosing?

A

Azithromycin 1 gm PO x 1

344
Q

DOC for Bacterial Vaginosis? Dosing?

A

Metronidazole 500mg PO BID x 7 days

Metronidazole 0.75% gel

345
Q

T/F? All sexual partners must also be treated concurrently to prevent re-infection?

A

T

346
Q

MOA of Terbinafine?

A

Blocks Squalene to Squalene epoxide

347
Q

MOA of Azole?

A

Blocks action of Lanosterol (decrease ergosterol synthesis)

Typically fungistatic, but may be fungicidal for select fungal pathogens

348
Q

MOA of Echinocandins?

A

Inhibits B-glucan synthase

349
Q

SEs of Amphotericin B (conventional)?

A

Fever

Chills

Headache

Malaise

Rigors

Hypokalemia

Hypomagnesemia

Nephrotoxicity

350
Q

Brand Name of Amphotericin B Lipid formulations?

Amphotericin B Lipid?
Liposomal Amphotericin B?

A

Amphotericin B Lipid (Abelcet)

Liposomal Amphotericin B (AmBisome)

351
Q

What diluent is Amphotericin B formulations compatible with?

A

D5W

352
Q

Advantage of Amphotericin B Lipid formulations?

A

Reduce risk for infusion rxns and nephrotoxicity

353
Q

What’s used to pre-mediate Amphotericin B Conventional formulations? Why?

A

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
Q

SEs of Flucytosine (Ancobon, 5-FC)?

A

Bone marrow suppression

Hepatitis

Increased SCr and GUN

355
Q

What’s Fluconazole DOC for?

A

Oropharyngeal candidiasis (thrush) in HIV pts

Or

Moderate dx in non-HIV infected pt

356
Q

What’s Voriconazole DOC for?

A

Aspergillus inf

357
Q

List Azoles Antifungals

A

Itraconazole (Sporanox, Sporanox PulsePak, Onmel)

Ketoconazole (Nizoral, Nizoral AD, Ketodan, Extina, Xolegel)

Fluconazole (Diflucan)

Voriconazole (VFEND)

Posaconazole (Noxafil)

358
Q

Brand name of Fluconazole (Azoles Antifungals)?

A

Diflucan

359
Q

Brand name of Voriconazole (Azoles Antifungals)?

A

VFEND

360
Q

Brand name of Posaconazole (Azoles Antifungals)?

A

Noxafil

361
Q

When should oral Ketoconazole tablets be used?

A

Only when other effective antifungal therapy is unavailable or not tolerated

362
Q

Main SE of Ketoconazole?

A

Increased LFTs

363
Q

Are Itraconazole capsules and oral solutions interchangeable?

A

No! They are not interchangeable

364
Q

Storage of Fluconazole IV?

A

Should NOT be refrigerated

365
Q

Fluconazole IV to PO conversion?

A

1:1

366
Q

How should Voriconazole (VFEND) be taken?

A

1 hr b4 or after meals (empty stomach)

367
Q

CI Voriconazole (VFEND) use?

A

3A4 substrates (Rifampin, Rifabutin, Ergot alkaloids, long-acting barbiturates, CBZ, pimozide, quinidine, Sirolimus, St. John’s wort)

368
Q

Warnings to Voriconazole (VFEND) and Posaconazole (Noxafil) use?

A

QT prolongation - correct Ca, K, and Mg prior to initiating Voriconazole (VFEND) and Posaconazole (Noxafil)

369
Q

Main SEs of Voriconazole (VFEND)?

A

Visual changes

Increased LFTs

370
Q

Monitoring of Voriconazole (VFEND)?

A

LFTs

Renal fxn

Electrolytes (Ca, Mg, K)

Visual fxn

371
Q

Voriconazole (VFEND) and night driving?

A

Caution to driving at night (due to vision changes)

Avoid direct sunlight

372
Q

How should Posaconazole (Noxafil) taken?

A

Must be taken with a full meal (during or w/in 20 mins following a meal)

373
Q

SEs of Posaconazole (Noxafil)?

A

Increased LFTs

374
Q

T/F? All Azoles are 3A4 inhibitors?

A

True (they will increased conc of 3A4 substrates)

375
Q

What type of absorption does Itraconazole and Ketoconazole have?

A

PH-dependent absorption (increase PH reduce absorption, t4 avoid using with antacids, H2RAs, PPIs)

376
Q

Effect of strong inhibitors on Voriconazole (VFEND)?

A

Can increase dangerously when given with drugs that inh Voriconazole’s metabolism or small dose increases

377
Q

What’s the kinetics of Voriconazole (VFEND)?

A

1st order

Followed by

Michaelis-Menten (non-linear) kinetics

378
Q

List drugs that concurrent use with Voriconazole (VFEND) should be avoided

A

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
Q

Role Echinocandins in therapy?

A

DOC for most systemic Candida infection, including strains resistant to Azoles antifungals, hence the name EchinoCANDINS

380
Q

List Echinocandins agents

A

Caspofungin (Cancidas)

Micafungin (Mycamine)

Anidulafugin (Eraxis)

381
Q

Brand name of Caspofungin (Echinocandins)?

A

Cancidas

382
Q

Brand name of Micafungin (Echinocandins)?

A

Mycamine

383
Q

How should Caspofungin (Cancidas) NOT be mixed?

A

Don’t mix with dextrose-containing solution

384
Q

How’s Micafungin (Mycamine) used in Candidemia?

A

Micafungin (Mycamine) 100mg IV daily

385
Q

How’s Micafungin (Mycamine) used in Esophageal Candiasis?

A

Micafungin (Mycamine) 150mg IV daily

386
Q

How’s Anidulafungin (Eraxis) used in Esophageal Candiasis?

A

100mg IV on day 1, then 50mg daily

387
Q

How’s Anidulafungin (Eraxis) used in Candidemia?

A

200mg IV on day 1, then 100mg daily

388
Q

Ses of Echinocandins (Caspofungin, Micafungin, Anidulafungin)?

A

Increased LFTs

Hypotension

Fever

Diarrhea

Hypokalemia

Hypomagnesemia

Rash

389
Q

Main SE of Griseofulvin (Grifulvin, Gris-PEG)?

A

Photosensitivity

390
Q

Preg cat of Griseofulvin (Grifulvin, Gris-PEG)?

A

X

391
Q

What’s the brand name of Terbinafine (antifungal)?

A

Lamisil

392
Q

Main SE of Terbinafine (Lamisil)?

A

Headache

Increased LFTs

393
Q

Griseofulvin and OCPs?

A

Griseofulvin induces OCPs (alternative, nonhormonal form of contraception recommended)

394
Q

Whats DOC for Candida?

A

Fluconazole or Topicals (Clotrimazole or Nystatin) x 7-14 days

395
Q

Whats DOC for Aspergillus?

A

Voriconazole (6-12 wks or indefinite)

396
Q

Whats DOC for Onychomycosis? What must be done b4 initiating DOC?

A

Itraconazole, Terbinafine or Fluconazole (confirm fungal inf prior to tx)

397
Q

What are viruses?

A

Viruses are obligate intracellular parasites: they depend on host cell metabolic processes for survival

398
Q

List steps to viral replication

A

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
Q

Dose & duration of Oseltamivir (Tamiflu) for tx in adults?

A

75mg BID x 5 days

400
Q

Dose & duration of Oseltamivir (Tamiflu) for prevention in adults?

A

75mg BID x 10 days

401
Q

SEs of Oseltamivir (Tamiflu)?

A

Vomiting

Nausea (“tummy flu”)

402
Q

How soon should Oseltamivir (Tamiflu) be started?

A

W/in 48 hrs of sx

403
Q

Warning associated with Zanamivir (Relenza Diskhaler)? Implication?

A

Bronchospasm risk: don’t use if asthma/COPD or with breathing problems

404
Q

List antivirals used for tx of HSV, VZV, and CMV?

A

Acyclovir (Zovirax)

Valacyclovir (Valtrex)

Famciclovir (Famvir)

Ganciclovir (Cytovene IV)

Valganciclovir (Valcyte)

Cidofovir (Vistide)

Foscarnet (Foscavir)

405
Q

Brand name of Acyclovir? (antivirals used for tx of HSV, VZV, and CMV)

A

Zovirax

406
Q

Brand name of Valacyclovir? (antivirals used for tx of HSV, VZV, and CMV)

A

Valtrex

407
Q

Brand name of Valganiciclovir? (antivirals used for tx of HSV, VZV, and CMV)

A

Valcyte

408
Q

How should Acyclovir (Zovirax) be dosed in obese pts?

A

Based on IBW in obese pts

409
Q

SEs of Acyclovir, Valacyclovir, Famciclovir?

A

Malaise

Headache

N/v/d

Increased SCr and BUN

410
Q

How should Valganciclovir (Valcyte) be taken?

A

With food

411
Q

BBW of Ganciclovir and Valganciclovir?

A

Myelosuppression

412
Q

Ses of of Ganciclovir and Valganciclovir?

A

Fever

N/v/d

Anorexia

Thrombocytopenia

Neutropenia

Leukopenia

Anemia

413
Q

What’s the DOC for CMV?

A

Ganciclovir and Valganciclovir

414
Q

What’s the BBW that specific to Cidofovir?

A

Dose-dependent nephropathy

415
Q

SEs of Cidofovir?

A

Increased risk of Nephrotoxcity (similar to Ganciclovir)

416
Q

SEs of Foscarnet?

A

Increased SCr

417
Q

How should Foscarnet be handled?

A

Like a chemo agent

418
Q

T/F? Up to 50% of pts with HSV remain asymptomatic?

A

True

419
Q

Whats the definitive sx of HSV? Xtics?

A

Lesions on external genitalia

Lesions are painful

420
Q

When does tx start in HSV?

A

Must start tx during Prodrome

Or

Within 1 day of lesion onset for the pt to experience benefit

421
Q

T/F? If pt is resistant to acyclovir, the pt will be resistant to valacyclovir?

A

T

422
Q

T/F? Strains resistant to acyclovir, will be resistant to famciclovir?

A

T

423
Q

When should therapy be initiated and most effective?

A

At earliest s/sx of shingles

Most effective when started w/in 72hrs of onset of zoster rash

424
Q

List malaria agents (Areas with Chloroquine-resistant Plasmodium falciparum)

A

Atovaquone/Proquanil (Malarone)

Mefloquine (Lariam)

Doxycycline (Vibramycin)

Quinine (Qualaquin)

425
Q

Main SE of Atovaquone/Proquanil (Malarone)?

A

Increased LFTs

426
Q

Adult Prophylaxis Dose of Atovaquone/Proquanil (Malarone)?
Initiation (pre-travel)?
D/C (post travel)?

A

250/100mg PO once daily

Initiate - 1-2 days b4 travel

D/c - 7 days

427
Q

Adult Prophylaxis Dose of Mefloquine (Lariam)?
Initiation (pre-travel)?
D/C (post travel)?

A

250mg PO once weekly

1-3 wks

4 wks

428
Q

Adult Prophylaxis Dose of Doxycycline (Vibramycin)?
Initiation (pre-travel)?
D/C (post travel)?

A

100mg PO daily

1-2 wks

4 wks

429
Q

Main CI of Mefloquine (Lariam)?

A

Hx of seizures or psychiatric disorder

430
Q

Main SE of Mefloquine (Lariam)?

A

Loss of balance/dizziness

GI upset

Chills

Dizziness

Tinnitus

Psychiatric SE

431
Q

Main CI of Quinine (Qualaquin)?

A

Prolonged QT interval

G6PD deficiency

432
Q

Main SE of Quinine (Qualaquin)?

A

QT prolongation

433
Q

List malaria agents (Areas with Chloroquine-sensitive Plasmodium falciparum)

A

Chloroquine (Aralen)

434
Q

Adult Prophylaxis Dose of Chloroquine (Aralen)?
Initiation (pre-travel)?
D/C (post travel)?

A

500mg PO once weekly

1-2 wks

4 wks

435
Q

Warnings ass with Chloroquine (Aralen) use?

A

Retinopathy

QT prolongation

436
Q

SE of Chloroquine (Aralen)?

A

GI upset

Visual disturbance

Photosensitivity

437
Q

List malaria agents (Areas with Plasmodium vivax and P. ovale with or without P. falciparum)

A

Primaquine

438
Q

SE of Primaquine?

A

Agranulocytosis

Anemia

Hemolytic anemia (in pts with G6PD deficiency)

439
Q

What does CDC require b4 initiating Primaquine?

A

G6PD deficiency screening

440
Q

Look at pt counseling pts on pg 308 to 315

A

Look

441
Q

T/F? Cefdinir, Cipro, Clindamycin (Cleocin) and Voriconazole (VFEND) suspension should NOT be refrigerated

A

T

442
Q

Voriconazole (VFEND) should be taken with food?

A

False!

VFEND should be taken on an empty stomach

443
Q

Therapy for outpt community-acquired pneumonia?

A

Zithromax 500mg PO x 1 day

Then 269mg PO daily (days 2-5)

444
Q

Therapy for inpt community-acquired pneumonia?

A

Vanco 1gm IV Q12H + Imipenem 500mg Q6H

445
Q

What’s a choice to treat Pseudomonas caught while in the hospital?

A

Doribax (Doripenem)

446
Q

What SE can Anidulafungin cause?

A

Increase in liver Transaminases

447
Q

What’s a choice to UTI caused by E. coli, sensitive to everything?

A

Nitrofurantoin 100mg PO BID x 5 days

448
Q

List true things about Bactrim wrt to exposure to light, renal impairment and conversion from IV to PO?

A

Bactrim IV should be protected from light

Needs to be dose adjusted in significant renal impairment

1:1 ratio for IV to PO

449
Q

Doc for gonorrheae STDI?

A

Ceftriaxone 250mg IM x 1 + Azithromycin 1Gm PO x 1

450
Q

Info about isoniazid (INH) wrt how to take and role in latent TB?

A

On empty stomach (1 hr b4 or 2 hr after a meal)

Can be used alone to treat latent TB

451
Q

Which med helps prevent peripheral neuropathies in pts on INH?

A

Pyridoxine (Vit B6)

452
Q

A pt taking Amphotericin B is at risk for which electrolyte abnormalities?

A

Hypokalemia and hypomagnesemia

453
Q

UTI tx in pregnant woman allergic to Cephalexin?

A

Nitrofurantoin 100mg PO BID x 7 days

454
Q

VFEND wrt visual SE, how to take, and doc?

A

Visual change can occur

Must be take on empty stomach

Preferred agent for Aspergillosis inf

455
Q

Which AB doesn’t req dose adjustment in renal impairment?

A

Tigecycline

456
Q

Which AB should be refrigerated?

A

Keflex (Cefalexin)

457
Q

Which meds should pt use sunscreen when there are on?

A

Avelox (Moxifloxacin)

VFEND (Voriconazole)

458
Q

Which IV AB should be reconstituted with NS?

A

Ampicillin

459
Q

List AB that must be taken with water

A

Clindamycin

Doxycycline

FQ

Metronidazole

(Val)Acyclovir

460
Q

List AB that must be taken with food

A

Amoxicillin (Clav); Azithromycin

Cefdinir; Cephalexin; Clarithromycin; Clindamycin

Fluconazole

Metronidazole

Nitrofurantoin

Oseltamivir

Terbinafine; TMP/SMX

(Val)Acyclovir

461
Q

List AB that must be taken without food

A

Azithromycin ER suspension

Cefdinir; Cephalexin; Clindamycin

Doxycycline

FQ

Voriconazole

462
Q

List AB that causes sun sensitivity

A

Doxycycline

FQ

TMP/SMX

Voriconazole (VFEND)

463
Q

They all cause GI (n/v/d) to some extent

A

T

464
Q

List AB that cause rash

A

Amoxicillin (Clav)

Cefdinir; Cephalexin

Fluconazole; FQ

TMP/SMX (sulfa)

Voriconazole

465
Q

List AB that cause HA and CNS effects

A

Doxycycline

Fluconazole; FQ

Metronidazole

Nitrofurantoin

(Val)Acyclovir

Voriconazole (VFEND)

466
Q

What’s Gram-positive organism?

A

Thick cell wall

Stain purple/bluish in color

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