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NAPLEX!!!!! > Infectious Disease I > Flashcards

Infectious Disease I Flashcards

1
Q

Penicillins MOA

A

beta-lactams that inhibit bacterial cell wall synthesis

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2
Q

Penicillins exhibit ______ dependent killing

A

time

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3
Q

Penicillins are bacterio_______

A

bactericidal except against enterococci species (requires aminoglycosides for cidal activity)

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4
Q

Boxed warning of Penicillin G benzathine

A

Not for IV use, can cause cardiorespiratory arrest and death

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5
Q

Penicillin brand name

A

Pen VK

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6
Q

Penicillin dosing

A

125-500 mg PO Q6-12H on an empty stomach

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7
Q

Penicillin G Benzathine brand name

A

Bicillin LA

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8
Q

Penicillin G Benzathine dosing

A

1.2-2.4 million units IM x 1 (frequency varies)

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9
Q

Pen G Procaine brand name

A

Bicillin CR

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10
Q

Pen G Procaine dosing

A

1.2-2.4 million units IM x 1 (frequency varies)

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11
Q

Penicillin G aqueous brand name

A

Pfizerpen-G

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12
Q

Penicillin G aqueous dosing

A

2-4 million units IV Q4-6H

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13
Q

Augmentin contraindication

A

history of cholestatic jaundice of hepatic dysfunction associated with previous use; severe renal impairment (CrCl

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14
Q

Unasyn contraindications

A

history of cholestatic jaundice or hepatic dysfunction associated with previous use; severe renal impairment (CrCl

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15
Q

Warnings for all penicillins

A

Anaphylaxis/hypersensitivity reactions. Do not use in penicillin allergic patients

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16
Q

Side effects of all penicillins

A

GI upset, diarrhea, rash, allergic reactions, anaphylaxis, acute interstitial nephritis, myelosupression with prolonged use, increased LFTs, seizures with accumulation

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17
Q

Monitoring for all penicillins

A

Renal function, symptoms of anaphylaxis with 1st dose, CBC and LFTs with prolonged courses

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18
Q

Natural penicillins spectrum of activity

A

Streptococci, Enterococci, gram positive anaerobes (mouth flora)

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19
Q

Aminopenicillins spectrum of activity

A

streptococci, enterococci, HNPEK, gram positive anaerobes (mouth flora)

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20
Q

Aminopenicillins/beta-lactamase inhibitor combos spectrum of activity

A

MSSA, more resistant HPNEK, gram negative anaerobes (B. fragilis)

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21
Q

Amoxicillin brand names

A

Amoxil, Moxatag

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22
Q

Amoxicillin/calvulanate brand name

A

Augmentin, Augmentin ES 600, Augmentin XR, Amoclan

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23
Q

Amoxicillin dosing

A

250-500mg PO Q8H or 500-875 mg PO Q12H, or 775 m XR (moxatag) PO daily

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24
Q

Amox/clav dosing

A

Use 14:1 ratio to reduce diarrhea, 500 mg PO TID, 875 mg PO BID, or 2000 XR PO BID with food

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25
Q

Ampicillin dosing

A

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

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26
Q

ampicillin/sulbactam brand

A

Unasyn

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27
Q

amount of each component in unasyn 3 g

A

2 g ampicillin / 1 g sulbactam

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28
Q

ampicillin/sulbactam dosing

A

1.5-3 grams IV Q6H

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29
Q

Extended spectrum penicillins spectrum of activity

A

streptococci, MSSA, enterococci, more resistant strains of HPNEK, CAPES, gram positive anaerobes (mouth flora), and gram negative anaerobes (B. fragilis), Pseudomonas

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30
Q

Piperacillin/tazobactam brand name

A

Zosyn

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31
Q

piperacillin/tazobactam dosing

A

3.375 grams IV Q6H or 4.5 grams IV Q6-8H

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32
Q

amount of each component in Zosyn 3.375g

A

3 g piperacillin / 0.375 g tazobactam

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33
Q

amount of each component in Zosyn 4.5g

A

4 g piperacillin / 0.5 g tazobactam

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34
Q

piperacillin/tazobactam dosing for prolonged or extended infusion regimens

A

3.375-4.5 g IV Q8H (each dose infused over 4 hours)

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35
Q

Ticarcillin/clavulanate brand name

A

Timentin

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36
Q

amount of each component in Timentin 3.1g

A

3 g ticarcillin / 0.1 g clavulanic acid

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37
Q

ticarcillin/clavulanate dosing

A

3.1 g IV Q4-6H

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38
Q

Antistaphylococcal Penicillins spectrum of activity

A

Streptococci, staphylococci (MSSA only); no coverage of enterococcus or gram-negative

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39
Q

Nafcillin dosing

A

1-2 grams IV/IM Q4-6H

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40
Q

Oxacillin dosing

A

250-2000mg IV Q4-6H

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41
Q

Dicloxacillin dosing

A

125-500 mg PO Q6H

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42
Q

Which penicillins do not require renal adjustments

A

nafcillin, oxacillin, dicloxacillin

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43
Q

which penicillin is a vesicant

A

nafcillin

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44
Q

Penicillin drug interaction with probenecid and management

A

probenecid can increase levels of penicillins by interferring with renal excretion. can be used to increase penicillin levels for severe infections

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45
Q

penicillin drug interaction with tetracyclines and other bacteriostatic agents

A

tetracyclines and other bacteriostatic agents can decrease the effectiveness of penicillins by slowing bacterial growth (penicillins work best against rapidly growing bacteria)

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46
Q

penicillin drug interaction with methotrexate

A

penicillins can increase the serum concentration of methotrexate

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47
Q

penicillin drug interaction with mycophenolate

A

penicillins can decrease serum concentrations of the active metabolites of mycophenolate due to impaired enterohepatic recirculation

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48
Q

Naficillin CYP interaction

A

Nafcillin is a moderate 3A4 inducer

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49
Q

Penicillins drug interaction with warfarin

A

dicloxacillin and nafcillin can decrease INR through increased warfarin metabolism. Other penicillins may increase INR

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50
Q

cephalosporins MOA

A

beta-lactams that inhibit bacterial cell wall synthesis

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51
Q

cephalosporins exhibit _____ dependent killing

A

time

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52
Q

cephalosporins have bacteri_____ activity

A

bactericidal activity

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53
Q

Ceftriaxone contraindications

A

hyperbilirubinemic neonates (causes biliary sludging), concurrent use with calcium containing IV products in neonates

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54
Q

Cephalosporins warnings

A

Anaphylaxis/hypersensitivity reactions, may increase INR with warfarin, Cross sensitivity with PCN allergy

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55
Q

Cefotetan warning

A

NMTT side chain which can increase risk of hypoprothrombinemia (bleeding) and a disulfiram-like reaction with alcohol ingestion

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56
Q

cephalosporin side effects

A

GI upset, diarrhea, rash/allergic reaction/anaphylaxis, acute interstitial nephritis, myelosuppression with prolonged use, increased LFTs, seizures with accumulation, drug fever

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57
Q

cephalosporin monitoring

A

renal function, signs of anaphylaxis with 1st dose, CBC, LFTs

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58
Q

Which cephalosporin dose not require renal adjustment

A

ceftriaxone

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59
Q

Which cephalosporin covers some carbapenem-resistant Enterobacteriaceae (CRE)

A

ceftazidime/avibactam

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60
Q

1st generation cephalosporin spectrum of activity

A

streptococci, staphylococci (MSSA), PEK, gram positive anaerobes (mouth flora). [Preferred for MSSA]

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61
Q

cefadroxil is a ____ generation cephalosporin

A

first

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62
Q

cefazolin is a _____ generation cephalosporin

A

first

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63
Q

cephalexin is a _____ generation cephalosporin

A

first

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64
Q

cefazolin brand name

A

ancef, kefzol

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65
Q

cephalexin brand name

A

keflex

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66
Q

Cefadroxil dosing

A

500-1000 mg PO Q12H

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67
Q

cefazolin dosing

A

1-1.5 grams IV/IM Q8H

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68
Q

cephalexin dosing

A

250-1000 mg PO Q6H

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69
Q

2nd generation cephalosporin spectrum of activity

A

1st generation plus Haemophilus, Neisseria (HNPEK), cephamycin group (cefotetan and cefoxitin) have activity against Gram negative anaerobes (Bacteroides fragilis)

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70
Q

cefaclor is a _____ generation cephalosporin

A

2nd

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71
Q

cefprozil is a _______ generation cephalosporin

A

2nd

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72
Q

cefuroxime is a _______ generation cephalosporin

A

2nd

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73
Q

cefotetan is a ________ generation cephalosporin

A

2nd

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74
Q

cefoxitin is a _________ generation cephalosporin

A

2nd

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75
Q

cefaclor brand name

A

ceclor

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76
Q

cefprozil brand name

A

cefzil

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77
Q

cefuroxime brand name

A

ceftin, zinacef

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78
Q

cefotetan brand name

A

cefotan

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79
Q

cefoxitin brand name

A

mefoxin

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80
Q

cefaclor dosing

A

250-500 mg PO Q8H

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81
Q

cefprozil dosing

A

250-500 mg PO Q12-24H

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82
Q

Cefuroxime dosing

A

250-1500 mg PO/IV/IM Q8-12H, take suspension with food

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83
Q

Cefotetan dosing

A

1-2 grams IV/IM Q12H

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84
Q

Cefoxitin dosing

A

1-2 grams IV/IM Q6-8H

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85
Q

3rd generation cephalosporin group 1 spectrum of activity

A

streptococci (more resistant S. pneumoniae and viridans group strep), staphylococci (MSSA), more resistant strains of HNPEK, gram positive anaerobes (mouth flora)

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86
Q

Cefdinir is a ____ generation cephalosporin

A

third, group 1

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87
Q

cefdinir brand name

A

omnicef

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88
Q

cefditoren brand name

A

spectracef

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89
Q

cefditoren is a ___ generation cephalosporin

A

third, group 1

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90
Q

Cefixime is a ____ generation cephalosporin

A

third, group 1

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91
Q

cefpodoxime is a ____ generation cephalosporin

A

third, group 1

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92
Q

ceftibuten is a _____ generation cephalosporin

A

third, group 1

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93
Q

ceftriaxone is a ____ generation cephalosporin

A

third, group 1

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94
Q

cefotaxime is a ____ generation cephalosporin

A

third, group 1

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95
Q

cefixime brand name

A

suprax

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96
Q

cefpodoxime brand name

A

vantin

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97
Q

ceftibutan brand name

A

cedax

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98
Q

ceftriaxone brand name

A

rocephin

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99
Q

cefotaxime brand name

A

claforan

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100
Q

cefdinir dosing

A

300 mg PO Q12H or 600 mg PO daily

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101
Q

cefditoran dosing

A

200-400 mg PO Q12H with food

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102
Q

cefixime dosing

A

400 mg PO divided Q12-24H

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103
Q

cefpodoxime dosing

A

100-400 mg PO Q12H

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104
Q

Ceftibuten dosing

A

400 mg PO daily on an empty stomach

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105
Q

ceftriaxone dosing

A

1-2 grams IV/IM Q12-24H

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106
Q

cefotaxime dosing

A

1-2 grams IV/IM Q4-12H

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107
Q

3rd generation group 2 cephalosporin spectrum of activity

A

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

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108
Q

ceftazidime is a ____ generation cephalosporin

A

3rd generation group 2

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109
Q

ceftolozane is a _____ generation cephalosporin

A

3rd generation group 2

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110
Q

Ceftaxidime brand name

A

Fortaz, Tazicef

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111
Q

Ceftazidime/avibactam brand name

A

avycaz

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112
Q

amount of each component in avycaz 2.5 grams

A

2 g ceftrazidime / 0.5 g avibactam

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113
Q

ceftazidime dosing

A

1-2 grams IV/IM Q8-12H

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114
Q

Ceftazidime/avibactam dosing

A

2.5 grams IV Q8H

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115
Q

ceftolozane/tazobactam brand name

A

Zerbaxa

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116
Q

amount of each component in Zerbaxa 1.5 grams

A

1 g ceftolozane / 0.5 g tazobactam

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117
Q

dosing of ceftolozane/tazobactam

A

1.5 grams IV Q8H

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118
Q

4th generation cephalosporin spectrum of activity

A

gram negative activity includes HNPEK, citrobacter, acinetobacter, providencia, Entrobacter and serratia species (CAPES), and Pseudomonas. Gram positive similar to 3rd generation

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119
Q

Cefepime is a ____ generation cephalosporin

A

4th

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120
Q

Cefepime brand name

A

Maxipime

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121
Q

Cefepime dosing

A

1-2 grams IV/IM Q8-12H

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122
Q

5th generation cephalosporin spectrum of activity

A

Broadest gram positive activity, staphylococci (MRSA), gram negative activity similar to ceftriaxone (no pseudomonas coverage)

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123
Q

ceftaroline fosamil is a _____ generation cephalosporin

A

5th

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124
Q

ceftaroline fosamil brand name

A

teflaro

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125
Q

ceftaroline fosamil dosing

A

600 mg IV Q12H

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126
Q

cephalosporin drug interaction with probenecid

A

probenecid can increase levels of cephalosporins by interfering with renal excretion. Can be used to increase cephalosporin levels

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127
Q

Cephalosporin drug interaction with warfarin

A

cephalosporins may increase the INR by inhibiting the production of vitamin K dependent clotting factors

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128
Q

Which cephalosporins should be seperated from short acting antacids and avoided with H2RAs/PPIs due to decreased bioavailability

A

cefuroxime, cefpodoxime, cefdinir, cefditoren

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129
Q

Carbapenems MOA

A

beta lactams that inhibit bacterial cell wall synthesis

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130
Q

carbapenems exhibit _____ dependent killing

A

time

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131
Q

carbapenems are bacteri_____

A

bactericidal

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132
Q

Carbapenem spectrum of activity

A

most gram positive, gram negative (ESBL producing bacteria) and anaerobic pathogens

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133
Q

Ertapenem does not cover which pathogens that other carbapenems do

A

Pseudomonas, acinetobacter or enterococcus

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134
Q

Doripenem brand name

A

doribax

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135
Q

doripenem dosing

A

500 mg IV Q8H

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136
Q

imipenem/cilastatin brand name

A

Primaxin

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137
Q

imipenem/cilastatin dosing

A

250-1000 mg IV Q6-8H

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138
Q

Meropenem brand name

A

Merrem

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139
Q

Meropenem dosing

A

500-1000 mg IV Q8H (dilute with SWFI, stable 3 hours at room temp)

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140
Q

Ertapenem brand name

A

Invanz

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141
Q

ertapenem dosing

A

1 gram IV/IM daily (stable in NS)

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142
Q

Common uses for ertapenem

A

ESBL-producing bacteria, diabetic foot infections

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143
Q

Common uses for carbapenems

A

ESBL-producing bacteria, Pseudomonas, broad spectrum empiric coverage

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144
Q

Why is imipenem combined with cilastatin

A

to prevent drug degredation by renal tubular dehydropeptidase

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145
Q

contraindications to carbapenems

A

anaphylactic reactions to beta-lactam antibiotics

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146
Q

warnings for carbapenems

A

associated with CNS adverse effects (confusional states, seizures), Do not use in PCN allergy due to chance of cross reactivity

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147
Q

warnings for doripenem

A

Do not use for the treatment of pneumonia including HAP and VAP

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148
Q

Side effects of carbapenems

A

diarrhea, rash, seizures (higher doses, impaired renal function [more with imipenem]), bone marrow suppression with prolonged use, increased LFTs

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149
Q

carbapenem monitoring

A

Renal function, symptoms of anaphylaxis with 1st dose, CBC, LFTs

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150
Q

Carbapenem drug interaction with probenecid

A

probenecid may increase carbapenem levels through interference with renal excretion

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151
Q

carbapenem drug interaction with valproic acid

A

carbapenems can decrease serum concentrations of valproic acid leading to a loss of seizure control

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152
Q

What does PEK stand for

A

proteus, E.coli, Klebsiella

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153
Q

What does HNPEK stand for

A

Haemophillus, Neisseria, Proteus, E.coli, Klebsiella

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154
Q

What does CAPES stand for

A

Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia

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155
Q

Drugs that are active against CA-MRSA SSTI (mild outpatient)

A

SMX/TMP, doxycycline, minocycline, clindamycin (must preform D-test before use)

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156
Q

Drugs that are active against CA-MRSA SSTI (more severe requiring hospitalization)

A

Vancomycin, Linezolid, tedizolid, daptomycin, ceftaroline, telavancin, oritavancin, dalbavancin, quinupristin/dalfopristin, tigecycline

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157
Q

drugs that are active against Nosocomial MRSA

A

Vancomycin (use an alternative if MIC is 2 or higher), Linezolid, telavancin, daptomycin, rifampin (combination only)

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158
Q

Drugs that are active against VRE (e. faecalis)

A

Pen G or ampicillin, Linezolid, daptomycin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]

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159
Q

drugs that are active against VRE (e. faecium)

A

daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]

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160
Q

drugs that are active against pseudomonas

A

ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, cefepime, piperacillin/tazobactam, ticarcillin/clavulanate, cabapenems (except ertapenem), ciprofloxacin, levofloxacin, aztreonam, aminoglycosides, colistimethate

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161
Q

Drugs that are active against acinetobacter

A

carbapenems (except ertapenem), ampicillin/sulbactam, minocycline, tigecycline, quinolones, SMX/TMP, colistimethate

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162
Q

Drugs that are active against ESBL gram negative rods (E. coli, Klebsiella pneumoniae, P. mirabilis)

A

Carbapenems, ceftolozane/tazobactam, ceftazidime/avibactam, cefepime (high dose), quinolones, aminoglycosides

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163
Q

Drugs that are active against carbapenem resistant gram negative rods (CRE, KPC)

A

ceftazidime/avibactam, colistimethate

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164
Q

drugs that are active against bacteroides fragilis

A

metronidazole, beta-lactam/beta lactamase inhibitor combos, cefotetan,cefoxitin, carbapenems, tigecycline, others (reduced activity: clindamycin, moxifloxacin)

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165
Q

drugs that are active against C. diff infection

A

metronidazole, vancomycin (oral), Fidaxomicin

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166
Q

drugs that are active against atypical organisms

A

Azithromycin, clarithromycin, doxycycline, minocycline, quinolones

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167
Q

drugs that are active against HNPEK

A

amoxicillin (if beta-lactamase negative), beta-lactam/beta lactamase inhibitor combo, cephalosporins (except 1st generations), carbapenems, SMX/TMP, aminoglycosides, quinolones

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168
Q

aztreonam MOA

A

inhibits cell wall synthesis

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169
Q

When is aztreonam primarily used

A

when beta-lactam allergy is present

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170
Q

aztreonam is bacteri_____

A

bactericidal

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171
Q

Aztreonam coverage

A

similar to cefotazidime; may gram negative organisms (Pseudomonas). no gram positive coverage

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172
Q

aztreonam side effects

A

similar to penicillins, rash, N/V/d, increased LFTs

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173
Q

aztreonam brand name

A

Azactam IV, inhaled - Cayston

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174
Q

Aztreonam dosing

A

500-2000 mg IV Q6-12H

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175
Q

Aztreonam dose adjustments

A

CrCl 10-30: decrease dose by 50% after 1st dose; CrCl

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176
Q

Aminoglycosides MOA

A

bind to 30S and 50S subunits to interfere with membrane protein synthesis

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177
Q

Aminoglycosides exhiit _____ dependent killing

A

concentration

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178
Q

Aminoglycoside coverage

A

Gram negative (Pseudomonas)

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179
Q

Which two aminoglycosides are used for synergy with a beta-lactam or vancomycin when treating gram positive cocci

A

gentamicin and streptomycin

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180
Q

Which two aminoglycosides are considered second line therapy for Mycobactrial infections

A

streptomycin and amikacin

181
Q

boxed warnings for aminoglycosides

A

nephrotoxicity, ototoxicity (hearing loss, vertigo, ataxia), neuromuscular blockage and respiratory paralysis, fetal harm if given during pregnancy (tobramycin). Avoid concurrent therapy with other nephrotoxic/neurotoxic drugs

182
Q

aminoglycoside warnings

A

caution in patients with impaired renal function, the elderly, and those on other nephrotoxic drugs (amphotericin B, cisplatin, colisthimethate, cyclosporine, loop diuretics, NSAIDs, radiocontrast dye, tacrolimus, vancomycin)

183
Q

aminoglycoside side effects

A

nephrotoxicity (acute tubular necrosis), hearing loss (early toxicity associated with high pitched sounds), vestibular toxicity (resulting in balance deficits)

184
Q

Aminoglycoside monitoring

A

renal function, urine output, hearing tests, drug levels

185
Q

When to drawn aminoglycoside levels in traditional dosing

A

trough right before 4th dose, peak 1/2 hour after the end of drug infusion of the 4th dose

186
Q

When to drawn aminoglycoside level in extended interval dosing

A

draw random level per timing of the nomogram

187
Q

Which aminoglycoside has the broadest spectrum of activity

188
Q

When should extended interval aminoglycoside regimens not be used

A

pregnancy, ascites, burns, cystic fibrosis, CrCl

189
Q

gentamycin dosing (traditional)

A

1-2.5 mg/kg/dose

190
Q

tobramycin dosing (traditional)

A

1-2.5 mg/kg/dose

191
Q

amikacin dosing (traditional)

A

5-7.5 mg/kg/dose

192
Q

Traditional aminoglycoside dosing frequency

A

CrCl > 60: Q8H, CrCl 40-60: Q12H, CrCl 20-40: Q24H, CrCl

193
Q

gentamycin dosing (extended interval)

A

4-7 mg/kg/dose

194
Q

tobramycin dosing (extended interval)

A

4-7 mg/kg/dose

195
Q

Amikacin dosing (extended interval)

A

15-20 mg/kg/dose

196
Q

gentamicin peak (gram negative infection)

A

5-10 mcg/ml

197
Q

gentamicin peak (gram positive infection)

A

3-4 mcg/ml

198
Q

gentamicin trough (gram negative infection)

199
Q

gentamicin trough (gram positive infection)

200
Q

tobramcyin peak

A

5-10 mcg/ml

201
Q

tobramycin trough

202
Q

amikacin peak

A

20-30 mcg/ml

203
Q

amikacin trough

204
Q

quinolones MOA

A

inhibit bacterial DNA topoisomerase IV and inhibit DNA gyrase (topoisomerase II) - prevents supercoiling and leads to breakage of double strand DNA

205
Q

quinolones exhibit ____ dependent killing

A

concentration-dependent

206
Q

quinolones are bacteri______

A

bactericidal

207
Q

Which are the respiratory quinolones

A

gemifloxacin, levofloxacin, moxifloxacin

208
Q

The respiratory quinolones have enhanced coverage of

A

S. pneumonia and atypical coverage

209
Q

Cipro and levofloxacin have enhanced activity against

A

gram negatives (pseudomonas used in combination)

210
Q

Moxifloxacin has enhanced activity against

A

gram positive and anaerobes

211
Q

quinolones should not be used to treat ____ infections

212
Q

quinolone boxed warnings

A

tendon inflammation and/or rupture (achilles tendon), increased risk with concurrent systemic steroids, organ transplant pts, >60 years of age. May exacerbate muscle weakness related to myasthenia gravis

213
Q

ciprofloxacin contraindications

A

concurrent administration with tizanidine

214
Q

which quinolone carries most risk for QT prolongatin

A

moxifloxacin

215
Q

Quinolone warnings

A

QT prolongation (avoid use in high risk patients, caution with other QT prolonging drugs [class Ia and III antiarrhythmics]), peripheral neuropathy (can last months to years after discontinuation, maybe permanent), CNS effects (tremor, restlessness, confusion, and rarely hallucinations, increased intracranial pressure, seizures), caution in known CNS disorder, hypo/hyperglycemia, increased LFTs, Photosensitivity/phototoxicity, risk of arthropathy (avoid use in children)

216
Q

quinolone side effects

A

GI upset/diarrhea, headache, dizziness, insomnia, crystalluria, and interstitial nephritis

217
Q

Administration of ciprofloxacin through feeding tubes

A

DO NOT GIVE SUSPENSIONN THROUGH FEEDING TUBE. crush IR tablet and mix with water. seperate from tube feeds 1 hour before and 2 hours after

218
Q

Which quinolone should not be used in UTI

A

moxifloxacin

219
Q

Which quinolone does not require renal dose adjustments

A

moxifloxacin

220
Q

Storage of ciprofloxacin suspension

A

Room temp. DO NOT REFRIGERATE

221
Q

Ofloxacin dosing

A

200-400 mg PO Q12H

222
Q

ofloxacin dose adjustments

223
Q

Norfloxacin brand name

224
Q

Norfloxacin dosing

A

400 mg PO BID or 800 mg PO daily

225
Q

Norfloxacin dose adjustments

A

CrCl 30 or less: 400 mg daily

226
Q

Ciprofloxacin brand name

A

Cipro, Cipro XR, Ciloxin eye drops, Cetraxal ear drops

227
Q

Ciprofloxacin dosing

A

250-750 PO or 200-400 mg IV Q8-12H

228
Q

ciprofloxacin dose adjustments

A

CrCl 30-50: Q12H, CrCl

229
Q

Levofloxacin brand name

A

Levaquin, Quixin eye drops

230
Q

Levofloxacin dosing

A

250-750 mg IV/PO daily

231
Q

Levofloxacin dose adjustments

232
Q

Gatifloxacin brand name

A

Zymaxid eye drops

233
Q

Moxifloxacin brand name

A

Avelox, Avelox ABC pack, Moxeza eye drops, Vigamox eye drops

234
Q

Moxifloxacin dosing

A

400 mg IV/PO Q24H

235
Q

Gemifloxacin brand name

236
Q

Gemifloxacin dosing

A

320 mg PO daily

237
Q

Gemifloxacin dose adjustments

238
Q

Finafloxacin brand name

A

Xtoro otic suspension

239
Q

Finafloxacin dosing

A

swimmer’s ear (acute otitis externa): 4 drops BID x 7 days

240
Q

When to give quinolones (Cipro/Levo/Moxi) after agents containing multivalent cations

A

Cipro 2 hours before or 6 hours after; levo 2 hours before or 2 hours after; moxi 4 hours before or 8 hours after

241
Q

quinolone drug interaction with lanthanum

A

Lanthanum (Fosrenal), can decrease the concentration of quinolones. separate by at least 2 hours before or after

242
Q

quinolone drug interaction with sevelamer

A

Sevelamer (Renagel) can decrease the concentration of quinolones. take quinolones 2 hours before or 6 hours after sevelamer

243
Q

Which medications can have increased effects due to quinolones

A

warfarin, sulfonylureas/insuline, QT prolonging drugs

244
Q

Which medications can increase quinolone levels

A

NSAIDs, probenecid

245
Q

Ciprofloxacin drug interaction with theophylline

A

cipro can increase levels of caffeine and theophylline by reducing metabolism

246
Q

Macrolides MOA

A

bind to 50S subunit, inhibiting RNA dependent protein synthesis

247
Q

Macrolides have bacteri_______ activity

A

bacteriostatic

248
Q

Macrolide spectrum of activity

A

good atypical coverage (legionella, chlamydia, mycoplasma, and some mycobacteremia) and haemophilus

249
Q

Macrolides contraindications

A

history of cholestatic jaundice/hepatic dysfunction with prior use;

250
Q

contraindications for clarithromycin:

A

concomitant use with pimozide, ergotamine, dihydroergotamine, lovastatin, or simvastatin; concurrent use with colchicine in patients with renal or hepatic impairment, history of QT prolongation, or ventricular arrhthmia

251
Q

erythromycin contraindications

A

concomitant use with pimozide, ergotamine, dihydroergotamine, lovastatin, or simvastatin

252
Q

Which macrolide has the highest risk of QT prolongation

A

erythromycin

253
Q

macrolide warnings

A

QT prolongation (caution in patient at risk, avoid use in uncorrected hypokalemia or hypomagnesemia, significant bradycardia, and those receiving class Ia or III antiarrhythmics), hepatotoxicity (caution in liver disease)

254
Q

macrolide side effects

A

GI upset (diarrhea, abdominal pain and cramping [erythromycin esp]) taste perversion, increased LFTs, ototoxicity (reversible and rare)

255
Q

Azithromycin brand names

A

Zithromax, Z-Pak, Zmax, Zithromax tri-pak, Azasite opthalamic

256
Q

Azithromycin dosing (PO)

A

500 mg on day 1, 250 mg days 2-5, 500 mg daily x 3 days, 1-2 grams x 1 (Zmax), or 600 mg daily

257
Q

Azithromycin prophylaxis dosing

A

600 mg daily or 1200 mg PO weekly

258
Q

Azithromycin dosing (IV)

A

250-500 mg IV daily

259
Q

Clarithromycin brand name

A

Biaxin, Biaxin XL, Biaxin XL Pac

260
Q

Clarithromycin dosing

A

250-500 mg PO Q12H or 1 gram (Biaxin XL) PO daily

261
Q

Clarithromycin dose adjustments

262
Q

Erythromycin brand name

A

EES, Erytab, Erypred, Erythrocin, PCE

263
Q

EES dosing

A

400-800 mg PO Q6-12H

264
Q

Erythromycin base/stearate dosing

A

250-500 mg PO Q6-12H

265
Q

Erythromycin lactobionate dosing

A

12-20 mg/kd/day IV 6H (max 4 grams/day) (stable in NS)

266
Q

400 mg EES = _____ base or stearate

267
Q

Which macrolides are substrates of 3A4 and moderate strong 3A4 inhibitors

A

erythromycin, clarithromycin

268
Q

Tetracyclines MOA

A

reversibly binding to 30S subunit

269
Q

tertracyclines have bacteri______ activity

A

bacteriostatic

270
Q

Tetracyclines spectrum of activity

A

gram positive bacteria (staphylococci, streptococci, enteococci, nocardia, bacillus, propionibacterium), gram negative bacteria (respiratory flora, Haemophilus, moraxella, atypicals), unique pathogens (spirochetes, Rickettsiae, Bacills anthracis, Treponema pallidum)

271
Q

Tetracyclines warnings

272
Q

tetracyclines side effects

A

N/V/d rash

273
Q

tetracyclines monitoring

A

LFTs, renal function, CBC

274
Q

Doxycycline brand name

A

Adoxa, Atridox, Doryx, Monodox, Oracea, Vibramycin

275
Q

Doxycycline dosing

A

100-200 mg PO/IV in 1-2 divided doses. Take with food {ORACEA should be on an empty stomach 1 hour before or 2 hours after meals)

276
Q

Minocycline brand names

A

Minocin, Solodyn

277
Q

Minocycline dosing

A

200 mg PO/IV x 1, then 100 mg PO/IV Q12H

278
Q

Tetracycline dosing

A

250-500 mg PO Q6H on an empty stomach

279
Q

Tetracycline dosing adjustment

280
Q

tetracyclines drug interaction with warfarin

A

can increase INR

281
Q

tetracclines drug intraction with neuromuscular blocking agents

A

can enhance effects of neuromuscular blocking agents

282
Q

tetracyclines drug interaction with retinoic acid derivatives

A

avoid concomitant use of tetracyclines with retinoic acid derivatives due to increased risk of pseudotumor cerebri

283
Q

SMX/TMP MOA

A

SMX - inhibits folic acid synthesis through inhibition of dihyrofolic acid formation; TMP inhibits dihydrofolic acid reduction to tetrahydrofolate

284
Q

SMX/TMP are bacteri______

A

static alone. cidal in combination

285
Q

SMZ:TMP ratio

286
Q

SMX/TMP brand name

A

Bactrim, Bactrim DS, Septra DS, Sulfatrim

287
Q

SMX/TMP contraindications

A

sulfa allergy, pregnancy (at term), breastfeeding, anemia due to folate deficiency, marked renal or hepatic disease, infants

288
Q

SMX/TMP warnigns

A

bloods dyscrasias including agranulocytosis and aplastic anemia, SJS/TEN, thrombotic thrombcytopenic purpura, other dermalogic reactions, G6PD deficiency - caution and discontinue if hemolysis occurs

289
Q

SMX/TMP side effects

A

N/V/d, anorexia, skin reactions (rash, urticaria, SJS/TEN), crystaluria (take wth 8 oz of water), photosensitivity, increased K, hypoglycemia, decrease folate, positive Coombs test, myelosupression with prolonged use, pseudoazotemia, interstitial nephritis, CNS (confusion, drug fever, seizures), increased LFTs

290
Q

SMX/TMP monitoring

A

REnal function, LFTs, electrolytes, CBC

291
Q

SMX/TMP dosing for severe infections

A

10-20 mg/kd/day TMP divided Q6-8H (2 DS tabs BID-TID)

292
Q

SMX/TMP dosing for adult femal uncomplicated UTI

A

1 DS tab BID x 3 days

293
Q

SMX/TMP dosing for PCP prophylaxis

A

1 DS or SS tab daily

294
Q

SMX/TMP dosing for PCP treatment

A

15-20 mg/kg/day TMP IV/PO divided Q6H

295
Q

SMX/TMP dose adjustments

A

CrCl 15-30 decrease dose by 50%; CrCl

296
Q

SMX/TMP drug interaction with warfarin

A

increase INR. cation with concurrent use

297
Q

SMX/TMP can increase drug levels of which medications

A

sulfonylureas, metformin, fosphenytoin/phenytoin, dofetilide, azathioprine, methotrexate, and mercaptopurine

298
Q

Which medications can diminish the effect of SMX/TMP

A

2C8/9 inducers and leucovorin/levoleucovorin

299
Q

Vancomycin MOA

A

glycopeptide that inhibits cell wall synthesis through peptidoglycan polymerization (D-alanyl-D-alanine portion)

300
Q

Vancomycin spectrum of activity

A

gram positive bacteria (staphylococci (MRSA), streptococci, enterococci (NOT VRE), and C. diff)

301
Q

Vancomycin brand name

302
Q

Vancomycin dosing for MRSA infections

A

15-20 mg/kg IV Q8-12H (Actual body weight)

303
Q

Max infusion concentration of vancomycin in a peripheral IV

304
Q

Vancomycin dose adjustments

A

CrCl 20-49: Q24H, CrCl

305
Q

Vancomcin dosing for C.diff

A

125-500 mg PO QID x 10-14 days

306
Q

Vancomycin warnings

A

caution iwth the use of other nephrotoxic or ototoxic drugs

307
Q

Vancomycin side effects

A

GI upset, infusion reactionred man syndrome (500 mg of drug over 30 minutes), nephrotoxiity, myelosuprresion (neutropenia/thrombocytopenia), drug fever, ototoxicity

308
Q

vancomycin monitoring

A

renal function, WBC, trough concentration as steady state (before 4th dose)

309
Q

vancomycin target troughs

A

15-20 mcg/ml for pneumonia, endocarditis, osteomyelitis, meningitis, and bactermia; 10-15 mcg/ml for other infections

310
Q

Lipoglycopeptides MOA

A

inhibit cell wall synthesis by blocking polymerizaiton and cross linking of peptidoglycan, and disrupting bacterial membrane potential and changing permeability

311
Q

Lipoglycopeotide exhibit _____ dependent killing

A

concentration

312
Q

Lipoglycopeptides are bacteri____ _

313
Q

Telavancin brand name

314
Q

Telavancin indicaitons

A

SSTI, and HAP

315
Q

Lipoglycopeptide spectrum of activity

A

similar to vancomycin

316
Q

Telavancin dosing

A

10 mg/kg IV daily over 60 minutes to prevent infusion reaction

317
Q

Telavancin REMS

A

warning of increase mortality in patient with pre-exisiting renal dysfunction and risk of fetal developmental toxicity

318
Q

Telavncin dose adjustments

319
Q

Telavancin boxed warnings

A

fetal risk - pregnancy test prior to therapy, nephrotoxicity, increase mortality vs vancomycin in CrCl

320
Q

telavancin warnings

A

falsely elevate INR (no increase in bleeding risk) does not interfere with Xa monitoring. Rapid IV infusion can cause red man syndrome

321
Q

Telavancin side effects

A

metallic taste, N/V, increased SCr, QT prolongation, red man syndrome

322
Q

Telavancin monitoring

A

renal function, pregnancy status

323
Q

Oritavancin brand name

324
Q

Ortavancin indication

325
Q

Ortavancin dosing

A

1200 mg IV x 1 infused over 3 hours

326
Q

Ortivacin contrindications

A

use of IV UFH for 48 hours after adminsitration due to interference with aPTT lab results

327
Q

Oritavancin warnings

A

may increase risk of bleeding in patient receiving warfarin, can cause false elevated INR x 24 hours and aPTT x 48 hours after a dose. Osteomyelitis developed more in the oritavancin group

328
Q

Dalbavancin warnings

A

infusion reactions (infuse over 30 minutes to avoid red man syndrome) increase ALT > 3x ULN

329
Q

Lipoglycopeptide side effects

A

N/V/d, rash, infusion ractions (red man syndrome)

330
Q

Lipoglycopeptide monitoring

A

signs of osteomyelitis (oritavancin), LFTs, renal function

331
Q

Oritavancin dose adjustments

332
Q

Dalbavancin brand name

333
Q

Dalbavancin indication

334
Q

Dalbavnacin dosing

A

1000 mg IV x 1, then 500 mg IV one week later infused over 30 minutes

335
Q

Dalbavancin dose adjustments

336
Q

Telavancin drug interactions

A

prolongs QT interval. avoid in patients at risk (long QT syndrome, known QT prolongation uncompensated HF, other QT prolonging medications)

337
Q

Daptomycin brand name

338
Q

Daptomycin MOA

A

cyclic lipopeptide that binds to cell membranes causing rapid depolariztion

339
Q

Daptomcyin has ____ dependent killing

A

concentration

340
Q

Daptomycin is bacteri_____

341
Q

Daptomycin coverage

A

most gram positive, staphylococci (MRSA) and enterococci (VRE (e. faecium and E. faecalis)

342
Q

Daptomycin indications

A

SSTI, MRSA bloodstream infections (right sided endocarditis)

343
Q

Daptomycin dosing in SSTI

A

4 mg/kg IV daily

344
Q

Daptomycin dosing in bactermia/right sided endocarditis

A

6 mg/kg IV daily

345
Q

Daptomycin dose adjustments

346
Q

Daptomycin warnings

A

Eosinophilic pneumonia (2-4 weeks after initiations), Myopathy (d/c is s/s and increase in CPK > 1000 [5xULN] or in asymptomatic patient with a CPK >2000 [10xULN]

347
Q

Daptomycin side effects

A

N/V/d constipation, anemia, headache, dizziness, increase CPK and myopathy, dyspnea, hypo/hyperkalemia, hyperphosphatemia, increase LFTs

348
Q

Daptomycin monitoring

A

CPK level weekly (more frequently if on a statin); muscle pain/weakness

349
Q

Daptomycin compatability with IV fluids

A

NS and LR only

350
Q

Daptomycin and anticoagulants

A

can flase increase PT/INR readings without increase in bleeding risk

351
Q

Oxazolidinones MOA

A

bind to 50S subunit inhibiting translation and protein synthesis

352
Q

Oxazolidinonesare bacteri_____

353
Q

Oxazolidinones spectrum of activity

A

similar to vancomycin but also cover VRE

354
Q

Linezolid brand name

355
Q

Linezolid dosing

A

600 mg PO/IV Q12H

356
Q

Tedizolid brand name

357
Q

Tedizolid indication

358
Q

Tedizolid dosing

A

200 mg IV/PO daily x 6 days. Infuse over 1 hour. stable in NS

359
Q

Contraindications to linezolid

A

concurrent or use within 2 weeks of MAOI

360
Q

Linezolid warnigs

A

duration related myelosuppression, peripheral and optic neuropathy (treatment >28 days), serotonin syndrome, hypoglycemia

361
Q

Tedizolid warnings

A

Consider alternative therapy in patients with neutropenia

362
Q

Oxazolidinones side effects

A

myelosuppression, anemia, thrombocytopenia, headache, nausea, diarrhea, dizziness, insomnia, increase pancreatic enzymes, increase LFTs, neuropathy

363
Q

Oxazolidinones monitoring

A

Weekly CBC, visual function

364
Q

Administration of linezolid suspension

A

DO NOT SHAKE

365
Q

Quinupristin/dalfopristin brand name

366
Q

Streptogramin MOA

A

bind to 50S subunit inhibiting protein synthesis

367
Q

Streptogramins are bacteri____

368
Q

Streptogramin spectrum of activity

A

Gram positive including staphylococci (MRSA), enterococcus faecium (VRE). Approved for SSTI

369
Q

Quinupristin/dalfopristin dosing

A

7.5 mg/kg IV Q8-12H

370
Q

Quinupristin/dalfopristin side effects

A

arthralgias/myagias, infusion reactions (edema, pain) phlebitis, hyperbilirubinemia, CPK elevations, GI upset, increase LFTs

371
Q

Quinupristin/dalfopristin can increase levels of which medications

A

CCBs, cyclosporine, dofetilide

372
Q

Tigecycline brand name

373
Q

Glycylcycline MOA

A

bind to 30S subunit to inhibit protein synthesis

374
Q

Glycycycline are bacteri_____

375
Q

Tigecycline spectrum of activity

A

gram positive (staphylococci [MRSA], Enterococci [VRE]) gram negative, anaerobic, atypicals.

376
Q

Tigecycline has no coverage against which 3 Ps

A

Pseudomonas, Proteus, and Providencia

377
Q

When is tigecycline used

A

when other alternatives are not possible

378
Q

Tigecycline indications

A

SSTI, intraabdominal infections, CAP. AVOID USE N BLOODSTREAM INFECTIONS

379
Q

Tigecycline dosing

A

100 mg IV x 1 then 50 mg IV Q12H

380
Q

Tigecycline dose adjustmnts

A

sever hepatic impairment 100mg IV x 1, then 25 mg IV Q12H

381
Q

tigecycline boxed warnign

A

increased risk of death, use only when alternatives are no suitable

382
Q

tigecycline warnigns

A

hepatotoxicity, pancreatitis, photosensitivty, teeth discoloartion in children

383
Q

tigecycline side effects

A

N/V/d, headache, dizziness, increased LFTs, rash

384
Q

Tigecycline adminstraiton

A

solution should be yellow-orange. discard if not this color

385
Q

Tigecycline drug interaction with warfarin

A

increase INR

386
Q

Polymyxins MOA

A

cationic detergent and damages cell membrane

387
Q

Polymyxins exhibit ___ dependent killing

A

concentration

388
Q

Polymyxins are bacteri_____

389
Q

Polymyxins should be used as _____ therpay

A

combination due to emergence of resistance

390
Q

Polymyxins spectrum of activity

A

gram negative (Enterobacter, E. coli, Klebsiella pneumoniae, Pseudomonas). Used for MDR gram negative pathogens [NOT PROTEUS]

391
Q

Colistimethat sodium or colistin brand name

A

Coly-Mycin M

392
Q

Colistimethate dosing

A

2.5-5 mg/kg/day IV/IM in 2-4 divided doses

393
Q

Colistimethat dose adjustments

394
Q

Colistimethate warnigns

A

dose dependent nephrotoxicity (monitor renal function and electrolytes), neurotoxiity

395
Q

colistimethate side effects

A

nephrotoxicity (proteiinuria, increased SCr), neurologic disturbances (dizziness, headache, tingling, oral paresthesia, verigo)

396
Q

Polymyxin B sulfate dosing

A

15,000 - 25,000 units/kg/day IV divided Q12H

397
Q

Polymyxin B dose adjustments

398
Q

Polymyxin B boxed warnigns

A

Nephrotoxicity, neurotoxicity, IM/intrathecal only to hospitalized patients, acoid neurotoxic/nephrotoxi drugs, resiratory paralysis

399
Q

Polymyxin B side effects

A

nephrotoxicity, neurologic disturbances (dizziness, tingling, numbness, paresthesia, vertigo) fever, urticariea

400
Q

1 mg = ____ units of polymyxin B

A

10,000 units

401
Q

Chloraphenicol MOA

A

binds to 50S subunit inhibiting protein synthesis

402
Q

Chloramphenicol exhibits bacteri____

403
Q

Chloramphenicol spectrum of activity

A

Gram positive, gram negative, anaerobes, and atypicals

404
Q

Chloramphenicol dosing

A

50-100 mg/kg/day IV in divided doses Q6H (max 4g/day)

405
Q

Chloramphenicol boxed waring

A

serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia, granulocytopenia)

406
Q

Chloramphenicol warnings

A

gray syndrome - characterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma, and death

407
Q

Chloramphenicol side effects

A

myelosuppression (pancytopenia), aplastic anemia, dermatologic (angioedema, rash, urticaria)

408
Q

Chloramphenicol mnitoring

A

CBC at baseline and every 2 days during therapy, LFTs and renal function, serum drug concentrations

409
Q

Telithromycin brand name

410
Q

Telithromycin MOA

A

binds to 50S subunit inhibiting protein sythesis

411
Q

Telithromcyin _____ dependent killing

A

concentration

412
Q

Telithromycin is bacteri_____

413
Q

Telithromycin coverage

A

gram positive (Streptococci [ macrolide resistant strains]) gram negative, some anaerobic, atypical

414
Q

telithromycin indication

415
Q

Telithromycin dosing

A

800 mg PO daily

416
Q

Telithromycin dose adjustments

417
Q

Telithromycin boxed warning

A

contraindicated in patients with mysathenia gravis due to respiratory failure

418
Q

telithromycin contraindications

A

allergy to macrolides, history of hepatitis jaundice from macrolides, myasthenia gravis, concurrent use with colchicine (if patient has renal or liver impairment), lovastatin, simvastatin, or pimozide

419
Q

telithromycin warnings

A

acute hepatic failure (can be fatal), QT prolongation, visual disturbances (blurry vision, diplopia), syncope

420
Q

telithromycin side effects

A

N/V/d, dizziness, headache, increase LFTs, rash

421
Q

Telithromycin montiroing

A

LFTs, and visual acuity

422
Q

Clindamycin brand name

A

Cleocin, Evoclin, Cindagel, Clindamax, Clindacin, Clindesse

423
Q

Lincosamides MOA

A

binds to 50S subunit inhibiting protein synthesis

424
Q

Lincosamides are bacteri______

425
Q

Clindamycin spectrum of activity

A

aerobic and anaerobic gram positive bacteria (CA-MRSA) DOES NOT COVER ENTEROCOCCUS

426
Q

Clindamycin dosing (PO)

A

150-450 mg PO Q6H

427
Q

Clindamycin dosing (IV)

A

600-900 mg IV Q8H

428
Q

Clindamycin boxed warning

A

colitis (C.diff)

429
Q

Clindamycin warning

A

severe or fatal skin reactions (SJS/TEN)

430
Q

Clindamycin side effects

A

N/V/d, rash, urticaria, increase LFTs

431
Q

Meaning of a positive D-test

A

inducible clindamycin resitance - do not use clindamycin

432
Q

Metronidazole brand name

A

Flagyl, metro

433
Q

Tinidazole brand name

434
Q

Metronidazole MOA

A

loss of helical DNA structure and strand breakage

435
Q

Tinidazole MOA

A

loss of helical DNA structure and strand breakage

436
Q

Metronidazole is bacteri_____

437
Q

Tinidazole is bacteri ______

438
Q

Metronidazole spectrum of activity

A

anaerobes and protozoal infections (bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, c.diff, combinations for intraabdominal infections)

439
Q

Tinidazole spectrum of acitivity

A

protozoa (giardiasis, amebiasis), trichomniasis, and bacterial vaginosis

440
Q

Metronidazole dosing

A

500-750 mg IV/PO Q8-12H or 250-500 mg IV/Po Q6-8H

441
Q

Metronidazole dosing for mild to moderate C.diff

A

500 mg IV/PO TID x 10-14 days

442
Q

Metronidazole administrations

A

take IR with food. Take ER on empty stomach

443
Q

Metronidazole/Tinidazole boxed waring

A

possible carcinogenic based on animal data

444
Q

metronidazole/tinidazole contraindications

A

pregnancy (1st trimester), breastfeeding (tinidazole) use of disulfiram in past 2 weeks (metronidazole), use of alcohol or propylene glycol containing products during therapy or within 3 days of therapy discontinuation

445
Q

metronidazole/tinidazole warnings

A

CNS effects - seizures, peripheral/optic neuropathies, aseptic meningitis (metronidazole), encephalopathy (metronidazole)

446
Q

Metronidazole/tinidazole side effects

A

N/V/d, metallic taste, furry tongue, darkened urine, rash, headache, dizziness

447
Q

Tinidazole brand name

448
Q

Tinidazole dosing

A

2 grams PO daily with food

449
Q

Metronidazole/tinidazole drug interaction with warfarin

A

can increase INR

NAPLEX!!!!! (8 decks)

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