Infectious Disease I Flashcards
Penicillins MOA
beta-lactams that inhibit bacterial cell wall synthesis
Penicillins exhibit ______ dependent killing
time
Penicillins are bacterio_______
bactericidal except against enterococci species (requires aminoglycosides for cidal activity)
Boxed warning of Penicillin G benzathine
Not for IV use, can cause cardiorespiratory arrest and death
Penicillin brand name
Pen VK
Penicillin dosing
125-500 mg PO Q6-12H on an empty stomach
Penicillin G Benzathine brand name
Bicillin LA
Penicillin G Benzathine dosing
1.2-2.4 million units IM x 1 (frequency varies)
Pen G Procaine brand name
Bicillin CR
Pen G Procaine dosing
1.2-2.4 million units IM x 1 (frequency varies)
Penicillin G aqueous brand name
Pfizerpen-G
Penicillin G aqueous dosing
2-4 million units IV Q4-6H
Augmentin contraindication
history of cholestatic jaundice of hepatic dysfunction associated with previous use; severe renal impairment (CrCl
Unasyn contraindications
history of cholestatic jaundice or hepatic dysfunction associated with previous use; severe renal impairment (CrCl
Warnings for all penicillins
Anaphylaxis/hypersensitivity reactions. Do not use in penicillin allergic patients
Side effects of all penicillins
GI upset, diarrhea, rash, allergic reactions, anaphylaxis, acute interstitial nephritis, myelosupression with prolonged use, increased LFTs, seizures with accumulation
Monitoring for all penicillins
Renal function, symptoms of anaphylaxis with 1st dose, CBC and LFTs with prolonged courses
Natural penicillins spectrum of activity
Streptococci, Enterococci, gram positive anaerobes (mouth flora)
Aminopenicillins spectrum of activity
streptococci, enterococci, HNPEK, gram positive anaerobes (mouth flora)
Aminopenicillins/beta-lactamase inhibitor combos spectrum of activity
MSSA, more resistant HPNEK, gram negative anaerobes (B. fragilis)
Amoxicillin brand names
Amoxil, Moxatag
Amoxicillin/calvulanate brand name
Augmentin, Augmentin ES 600, Augmentin XR, Amoclan
Amoxicillin dosing
250-500mg PO Q8H or 500-875 mg PO Q12H, or 775 m XR (moxatag) PO daily
Amox/clav dosing
Use 14:1 ratio to reduce diarrhea, 500 mg PO TID, 875 mg PO BID, or 2000 XR PO BID with food
Ampicillin dosing
250-500 mg PO Q6H on an empty stomach 1 hour before or 2 hours after meals or 1-2 grams IV/IM Q4-6H
ampicillin/sulbactam brand
Unasyn
amount of each component in unasyn 3 g
2 g ampicillin / 1 g sulbactam
ampicillin/sulbactam dosing
1.5-3 grams IV Q6H
Extended spectrum penicillins spectrum of activity
streptococci, MSSA, enterococci, more resistant strains of HPNEK, CAPES, gram positive anaerobes (mouth flora), and gram negative anaerobes (B. fragilis), Pseudomonas
Piperacillin/tazobactam brand name
Zosyn
piperacillin/tazobactam dosing
3.375 grams IV Q6H or 4.5 grams IV Q6-8H
amount of each component in Zosyn 3.375g
3 g piperacillin / 0.375 g tazobactam
amount of each component in Zosyn 4.5g
4 g piperacillin / 0.5 g tazobactam
piperacillin/tazobactam dosing for prolonged or extended infusion regimens
3.375-4.5 g IV Q8H (each dose infused over 4 hours)
Ticarcillin/clavulanate brand name
Timentin
amount of each component in Timentin 3.1g
3 g ticarcillin / 0.1 g clavulanic acid
ticarcillin/clavulanate dosing
3.1 g IV Q4-6H
Antistaphylococcal Penicillins spectrum of activity
Streptococci, staphylococci (MSSA only); no coverage of enterococcus or gram-negative
Nafcillin dosing
1-2 grams IV/IM Q4-6H
Oxacillin dosing
250-2000mg IV Q4-6H
Dicloxacillin dosing
125-500 mg PO Q6H
Which penicillins do not require renal adjustments
nafcillin, oxacillin, dicloxacillin
which penicillin is a vesicant
nafcillin
Penicillin drug interaction with probenecid and management
probenecid can increase levels of penicillins by interferring with renal excretion. can be used to increase penicillin levels for severe infections
penicillin drug interaction with tetracyclines and other bacteriostatic agents
tetracyclines and other bacteriostatic agents can decrease the effectiveness of penicillins by slowing bacterial growth (penicillins work best against rapidly growing bacteria)
penicillin drug interaction with methotrexate
penicillins can increase the serum concentration of methotrexate
penicillin drug interaction with mycophenolate
penicillins can decrease serum concentrations of the active metabolites of mycophenolate due to impaired enterohepatic recirculation
Naficillin CYP interaction
Nafcillin is a moderate 3A4 inducer
Penicillins drug interaction with warfarin
dicloxacillin and nafcillin can decrease INR through increased warfarin metabolism. Other penicillins may increase INR
cephalosporins MOA
beta-lactams that inhibit bacterial cell wall synthesis
cephalosporins exhibit _____ dependent killing
time
cephalosporins have bacteri_____ activity
bactericidal activity
Ceftriaxone contraindications
hyperbilirubinemic neonates (causes biliary sludging), concurrent use with calcium containing IV products in neonates
Cephalosporins warnings
Anaphylaxis/hypersensitivity reactions, may increase INR with warfarin, Cross sensitivity with PCN allergy
Cefotetan warning
NMTT side chain which can increase risk of hypoprothrombinemia (bleeding) and a disulfiram-like reaction with alcohol ingestion
cephalosporin side effects
GI upset, diarrhea, rash/allergic reaction/anaphylaxis, acute interstitial nephritis, myelosuppression with prolonged use, increased LFTs, seizures with accumulation, drug fever
cephalosporin monitoring
renal function, signs of anaphylaxis with 1st dose, CBC, LFTs
Which cephalosporin dose not require renal adjustment
ceftriaxone
Which cephalosporin covers some carbapenem-resistant Enterobacteriaceae (CRE)
ceftazidime/avibactam
1st generation cephalosporin spectrum of activity
streptococci, staphylococci (MSSA), PEK, gram positive anaerobes (mouth flora). [Preferred for MSSA]
cefadroxil is a ____ generation cephalosporin
first
cefazolin is a _____ generation cephalosporin
first
cephalexin is a _____ generation cephalosporin
first
cefazolin brand name
ancef, kefzol
cephalexin brand name
keflex
Cefadroxil dosing
500-1000 mg PO Q12H
cefazolin dosing
1-1.5 grams IV/IM Q8H
cephalexin dosing
250-1000 mg PO Q6H
2nd generation cephalosporin spectrum of activity
1st generation plus Haemophilus, Neisseria (HNPEK), cephamycin group (cefotetan and cefoxitin) have activity against Gram negative anaerobes (Bacteroides fragilis)
cefaclor is a _____ generation cephalosporin
2nd
cefprozil is a _______ generation cephalosporin
2nd
cefuroxime is a _______ generation cephalosporin
2nd
cefotetan is a ________ generation cephalosporin
2nd
cefoxitin is a _________ generation cephalosporin
2nd
cefaclor brand name
ceclor
cefprozil brand name
cefzil
cefuroxime brand name
ceftin, zinacef
cefotetan brand name
cefotan
cefoxitin brand name
mefoxin
cefaclor dosing
250-500 mg PO Q8H
cefprozil dosing
250-500 mg PO Q12-24H
Cefuroxime dosing
250-1500 mg PO/IV/IM Q8-12H, take suspension with food
Cefotetan dosing
1-2 grams IV/IM Q12H
Cefoxitin dosing
1-2 grams IV/IM Q6-8H
3rd generation cephalosporin group 1 spectrum of activity
streptococci (more resistant S. pneumoniae and viridans group strep), staphylococci (MSSA), more resistant strains of HNPEK, gram positive anaerobes (mouth flora)
Cefdinir is a ____ generation cephalosporin
third, group 1
cefdinir brand name
omnicef
cefditoren brand name
spectracef
cefditoren is a ___ generation cephalosporin
third, group 1
Cefixime is a ____ generation cephalosporin
third, group 1
cefpodoxime is a ____ generation cephalosporin
third, group 1
ceftibuten is a _____ generation cephalosporin
third, group 1
ceftriaxone is a ____ generation cephalosporin
third, group 1
cefotaxime is a ____ generation cephalosporin
third, group 1
cefixime brand name
suprax
cefpodoxime brand name
vantin
ceftibutan brand name
cedax
ceftriaxone brand name
rocephin
cefotaxime brand name
claforan
cefdinir dosing
300 mg PO Q12H or 600 mg PO daily
cefditoran dosing
200-400 mg PO Q12H with food
cefixime dosing
400 mg PO divided Q12-24H
cefpodoxime dosing
100-400 mg PO Q12H
Ceftibuten dosing
400 mg PO daily on an empty stomach
ceftriaxone dosing
1-2 grams IV/IM Q12-24H
cefotaxime dosing
1-2 grams IV/IM Q4-12H
3rd generation group 2 cephalosporin spectrum of activity
very little gram positive activity, increase gram negative activity including pseudomonas. with a beta-lactamse inhibitor leads to extended coverage of MDR gram negative rods including pseudomonas
ceftazidime is a ____ generation cephalosporin
3rd generation group 2
ceftolozane is a _____ generation cephalosporin
3rd generation group 2
Ceftaxidime brand name
Fortaz, Tazicef
Ceftazidime/avibactam brand name
avycaz
amount of each component in avycaz 2.5 grams
2 g ceftrazidime / 0.5 g avibactam
ceftazidime dosing
1-2 grams IV/IM Q8-12H
Ceftazidime/avibactam dosing
2.5 grams IV Q8H
ceftolozane/tazobactam brand name
Zerbaxa
amount of each component in Zerbaxa 1.5 grams
1 g ceftolozane / 0.5 g tazobactam
dosing of ceftolozane/tazobactam
1.5 grams IV Q8H
4th generation cephalosporin spectrum of activity
gram negative activity includes HNPEK, citrobacter, acinetobacter, providencia, Entrobacter and serratia species (CAPES), and Pseudomonas. Gram positive similar to 3rd generation
Cefepime is a ____ generation cephalosporin
4th
Cefepime brand name
Maxipime
Cefepime dosing
1-2 grams IV/IM Q8-12H
5th generation cephalosporin spectrum of activity
Broadest gram positive activity, staphylococci (MRSA), gram negative activity similar to ceftriaxone (no pseudomonas coverage)
ceftaroline fosamil is a _____ generation cephalosporin
5th
ceftaroline fosamil brand name
teflaro
ceftaroline fosamil dosing
600 mg IV Q12H
cephalosporin drug interaction with probenecid
probenecid can increase levels of cephalosporins by interfering with renal excretion. Can be used to increase cephalosporin levels
Cephalosporin drug interaction with warfarin
cephalosporins may increase the INR by inhibiting the production of vitamin K dependent clotting factors
Which cephalosporins should be seperated from short acting antacids and avoided with H2RAs/PPIs due to decreased bioavailability
cefuroxime, cefpodoxime, cefdinir, cefditoren
Carbapenems MOA
beta lactams that inhibit bacterial cell wall synthesis
carbapenems exhibit _____ dependent killing
time
carbapenems are bacteri_____
bactericidal
Carbapenem spectrum of activity
most gram positive, gram negative (ESBL producing bacteria) and anaerobic pathogens
Ertapenem does not cover which pathogens that other carbapenems do
Pseudomonas, acinetobacter or enterococcus
Doripenem brand name
doribax
doripenem dosing
500 mg IV Q8H
imipenem/cilastatin brand name
Primaxin
imipenem/cilastatin dosing
250-1000 mg IV Q6-8H
Meropenem brand name
Merrem
Meropenem dosing
500-1000 mg IV Q8H (dilute with SWFI, stable 3 hours at room temp)
Ertapenem brand name
Invanz
ertapenem dosing
1 gram IV/IM daily (stable in NS)
Common uses for ertapenem
ESBL-producing bacteria, diabetic foot infections
Common uses for carbapenems
ESBL-producing bacteria, Pseudomonas, broad spectrum empiric coverage
Why is imipenem combined with cilastatin
to prevent drug degredation by renal tubular dehydropeptidase
contraindications to carbapenems
anaphylactic reactions to beta-lactam antibiotics
warnings for carbapenems
associated with CNS adverse effects (confusional states, seizures), Do not use in PCN allergy due to chance of cross reactivity
warnings for doripenem
Do not use for the treatment of pneumonia including HAP and VAP
Side effects of carbapenems
diarrhea, rash, seizures (higher doses, impaired renal function [more with imipenem]), bone marrow suppression with prolonged use, increased LFTs
carbapenem monitoring
Renal function, symptoms of anaphylaxis with 1st dose, CBC, LFTs
Carbapenem drug interaction with probenecid
probenecid may increase carbapenem levels through interference with renal excretion
carbapenem drug interaction with valproic acid
carbapenems can decrease serum concentrations of valproic acid leading to a loss of seizure control
What does PEK stand for
proteus, E.coli, Klebsiella
What does HNPEK stand for
Haemophillus, Neisseria, Proteus, E.coli, Klebsiella
What does CAPES stand for
Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia
Drugs that are active against CA-MRSA SSTI (mild outpatient)
SMX/TMP, doxycycline, minocycline, clindamycin (must preform D-test before use)
Drugs that are active against CA-MRSA SSTI (more severe requiring hospitalization)
Vancomycin, Linezolid, tedizolid, daptomycin, ceftaroline, telavancin, oritavancin, dalbavancin, quinupristin/dalfopristin, tigecycline
drugs that are active against Nosocomial MRSA
Vancomycin (use an alternative if MIC is 2 or higher), Linezolid, telavancin, daptomycin, rifampin (combination only)
Drugs that are active against VRE (e. faecalis)
Pen G or ampicillin, Linezolid, daptomycin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]
drugs that are active against VRE (e. faecium)
daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]
drugs that are active against pseudomonas
ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, cefepime, piperacillin/tazobactam, ticarcillin/clavulanate, cabapenems (except ertapenem), ciprofloxacin, levofloxacin, aztreonam, aminoglycosides, colistimethate
Drugs that are active against acinetobacter
carbapenems (except ertapenem), ampicillin/sulbactam, minocycline, tigecycline, quinolones, SMX/TMP, colistimethate
Drugs that are active against ESBL gram negative rods (E. coli, Klebsiella pneumoniae, P. mirabilis)
Carbapenems, ceftolozane/tazobactam, ceftazidime/avibactam, cefepime (high dose), quinolones, aminoglycosides
Drugs that are active against carbapenem resistant gram negative rods (CRE, KPC)
ceftazidime/avibactam, colistimethate
drugs that are active against bacteroides fragilis
metronidazole, beta-lactam/beta lactamase inhibitor combos, cefotetan,cefoxitin, carbapenems, tigecycline, others (reduced activity: clindamycin, moxifloxacin)
drugs that are active against C. diff infection
metronidazole, vancomycin (oral), Fidaxomicin
drugs that are active against atypical organisms
Azithromycin, clarithromycin, doxycycline, minocycline, quinolones
drugs that are active against HNPEK
amoxicillin (if beta-lactamase negative), beta-lactam/beta lactamase inhibitor combo, cephalosporins (except 1st generations), carbapenems, SMX/TMP, aminoglycosides, quinolones
aztreonam MOA
inhibits cell wall synthesis
When is aztreonam primarily used
when beta-lactam allergy is present
aztreonam is bacteri_____
bactericidal
Aztreonam coverage
similar to cefotazidime; may gram negative organisms (Pseudomonas). no gram positive coverage
aztreonam side effects
similar to penicillins, rash, N/V/d, increased LFTs
aztreonam brand name
Azactam IV, inhaled - Cayston
Aztreonam dosing
500-2000 mg IV Q6-12H
Aztreonam dose adjustments
CrCl 10-30: decrease dose by 50% after 1st dose; CrCl
Aminoglycosides MOA
bind to 30S and 50S subunits to interfere with membrane protein synthesis
Aminoglycosides exhiit _____ dependent killing
concentration
Aminoglycoside coverage
Gram negative (Pseudomonas)
Which two aminoglycosides are used for synergy with a beta-lactam or vancomycin when treating gram positive cocci
gentamicin and streptomycin