Infectious Disease I Flashcards
1
Q
Penicillins MOA
A
beta-lactams that inhibit bacterial cell wall synthesis
2
Q
Penicillins exhibit ______ dependent killing
A
time
3
Q
Penicillins are bacterio_______
A
bactericidal except against enterococci species (requires aminoglycosides for cidal activity)
4
Q
Boxed warning of Penicillin G benzathine
A
Not for IV use, can cause cardiorespiratory arrest and death
5
Q
Penicillin brand name
A
Pen VK
6
Q
Penicillin dosing
A
125-500 mg PO Q6-12H on an empty stomach
7
Q
Penicillin G Benzathine brand name
A
Bicillin LA
8
Q
Penicillin G Benzathine dosing
A
1.2-2.4 million units IM x 1 (frequency varies)
9
Q
Pen G Procaine brand name
A
Bicillin CR
10
Q
Pen G Procaine dosing
A
1.2-2.4 million units IM x 1 (frequency varies)
11
Q
Penicillin G aqueous brand name
A
Pfizerpen-G
12
Q
Penicillin G aqueous dosing
A
2-4 million units IV Q4-6H
13
Q
Augmentin contraindication
A
history of cholestatic jaundice of hepatic dysfunction associated with previous use; severe renal impairment (CrCl
14
Q
Unasyn contraindications
A
history of cholestatic jaundice or hepatic dysfunction associated with previous use; severe renal impairment (CrCl
15
Q
Warnings for all penicillins
A
Anaphylaxis/hypersensitivity reactions. Do not use in penicillin allergic patients
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
17
Q
Monitoring for all penicillins
A
Renal function, symptoms of anaphylaxis with 1st dose, CBC and LFTs with prolonged courses
18
Q
Natural penicillins spectrum of activity
A
Streptococci, Enterococci, gram positive anaerobes (mouth flora)
19
Q
Aminopenicillins spectrum of activity
A
streptococci, enterococci, HNPEK, gram positive anaerobes (mouth flora)
20
Q
Aminopenicillins/beta-lactamase inhibitor combos spectrum of activity
A
MSSA, more resistant HPNEK, gram negative anaerobes (B. fragilis)
21
Q
Amoxicillin brand names
A
Amoxil, Moxatag
22
Q
Amoxicillin/calvulanate brand name
A
Augmentin, Augmentin ES 600, Augmentin XR, Amoclan
23
Q
Amoxicillin dosing
A
250-500mg PO Q8H or 500-875 mg PO Q12H, or 775 m XR (moxatag) PO daily
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
25
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
26
ampicillin/sulbactam brand
Unasyn
27
amount of each component in unasyn 3 g
2 g ampicillin / 1 g sulbactam
28
ampicillin/sulbactam dosing
1.5-3 grams IV Q6H
29
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
30
Piperacillin/tazobactam brand name
Zosyn
31
piperacillin/tazobactam dosing
3.375 grams IV Q6H or 4.5 grams IV Q6-8H
32
amount of each component in Zosyn 3.375g
3 g piperacillin / 0.375 g tazobactam
33
amount of each component in Zosyn 4.5g
4 g piperacillin / 0.5 g tazobactam
34
piperacillin/tazobactam dosing for prolonged or extended infusion regimens
3.375-4.5 g IV Q8H (each dose infused over 4 hours)
35
Ticarcillin/clavulanate brand name
Timentin
36
amount of each component in Timentin 3.1g
3 g ticarcillin / 0.1 g clavulanic acid
37
ticarcillin/clavulanate dosing
3.1 g IV Q4-6H
38
Antistaphylococcal Penicillins spectrum of activity
Streptococci, staphylococci (MSSA only); no coverage of enterococcus or gram-negative
39
Nafcillin dosing
1-2 grams IV/IM Q4-6H
40
Oxacillin dosing
250-2000mg IV Q4-6H
41
Dicloxacillin dosing
125-500 mg PO Q6H
42
Which penicillins do not require renal adjustments
nafcillin, oxacillin, dicloxacillin
43
which penicillin is a vesicant
nafcillin
44
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
45
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)
46
penicillin drug interaction with methotrexate
penicillins can increase the serum concentration of methotrexate
47
penicillin drug interaction with mycophenolate
penicillins can decrease serum concentrations of the active metabolites of mycophenolate due to impaired enterohepatic recirculation
48
Naficillin CYP interaction
Nafcillin is a moderate 3A4 inducer
49
Penicillins drug interaction with warfarin
dicloxacillin and nafcillin can decrease INR through increased warfarin metabolism. Other penicillins may increase INR
50
cephalosporins MOA
beta-lactams that inhibit bacterial cell wall synthesis
51
cephalosporins exhibit _____ dependent killing
time
52
cephalosporins have bacteri_____ activity
bactericidal activity
53
Ceftriaxone contraindications
hyperbilirubinemic neonates (causes biliary sludging), concurrent use with calcium containing IV products in neonates
54
Cephalosporins warnings
Anaphylaxis/hypersensitivity reactions, may increase INR with warfarin, Cross sensitivity with PCN allergy
55
Cefotetan warning
NMTT side chain which can increase risk of hypoprothrombinemia (bleeding) and a disulfiram-like reaction with alcohol ingestion
56
cephalosporin side effects
GI upset, diarrhea, rash/allergic reaction/anaphylaxis, acute interstitial nephritis, myelosuppression with prolonged use, increased LFTs, seizures with accumulation, drug fever
57
cephalosporin monitoring
renal function, signs of anaphylaxis with 1st dose, CBC, LFTs
58
Which cephalosporin dose not require renal adjustment
ceftriaxone
59
Which cephalosporin covers some carbapenem-resistant Enterobacteriaceae (CRE)
ceftazidime/avibactam
60
1st generation cephalosporin spectrum of activity
streptococci, staphylococci (MSSA), PEK, gram positive anaerobes (mouth flora). [Preferred for MSSA]
61
cefadroxil is a ____ generation cephalosporin
first
62
cefazolin is a _____ generation cephalosporin
first
63
cephalexin is a _____ generation cephalosporin
first
64
cefazolin brand name
ancef, kefzol
65
cephalexin brand name
keflex
66
Cefadroxil dosing
500-1000 mg PO Q12H
67
cefazolin dosing
1-1.5 grams IV/IM Q8H
68
cephalexin dosing
250-1000 mg PO Q6H
69
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)
70
cefaclor is a _____ generation cephalosporin
2nd
71
cefprozil is a _______ generation cephalosporin
2nd
72
cefuroxime is a _______ generation cephalosporin
2nd
73
cefotetan is a ________ generation cephalosporin
2nd
74
cefoxitin is a _________ generation cephalosporin
2nd
75
cefaclor brand name
ceclor
76
cefprozil brand name
cefzil
77
cefuroxime brand name
ceftin, zinacef
78
cefotetan brand name
cefotan
79
cefoxitin brand name
mefoxin
80
cefaclor dosing
250-500 mg PO Q8H
81
cefprozil dosing
250-500 mg PO Q12-24H
82
Cefuroxime dosing
250-1500 mg PO/IV/IM Q8-12H, take suspension with food
83
Cefotetan dosing
1-2 grams IV/IM Q12H
84
Cefoxitin dosing
1-2 grams IV/IM Q6-8H
85
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)
86
Cefdinir is a ____ generation cephalosporin
third, group 1
87
cefdinir brand name
omnicef
88
cefditoren brand name
spectracef
89
cefditoren is a ___ generation cephalosporin
third, group 1
90
Cefixime is a ____ generation cephalosporin
third, group 1
91
cefpodoxime is a ____ generation cephalosporin
third, group 1
92
ceftibuten is a _____ generation cephalosporin
third, group 1
93
ceftriaxone is a ____ generation cephalosporin
third, group 1
94
cefotaxime is a ____ generation cephalosporin
third, group 1
95
cefixime brand name
suprax
96
cefpodoxime brand name
vantin
97
ceftibutan brand name
cedax
98
ceftriaxone brand name
rocephin
99
cefotaxime brand name
claforan
100
cefdinir dosing
300 mg PO Q12H or 600 mg PO daily
101
cefditoran dosing
200-400 mg PO Q12H with food
102
cefixime dosing
400 mg PO divided Q12-24H
103
cefpodoxime dosing
100-400 mg PO Q12H
104
Ceftibuten dosing
400 mg PO daily on an empty stomach
105
ceftriaxone dosing
1-2 grams IV/IM Q12-24H
106
cefotaxime dosing
1-2 grams IV/IM Q4-12H
107
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
108
ceftazidime is a ____ generation cephalosporin
3rd generation group 2
109
ceftolozane is a _____ generation cephalosporin
3rd generation group 2
110
Ceftaxidime brand name
Fortaz, Tazicef
111
Ceftazidime/avibactam brand name
avycaz
112
amount of each component in avycaz 2.5 grams
2 g ceftrazidime / 0.5 g avibactam
113
ceftazidime dosing
1-2 grams IV/IM Q8-12H
114
Ceftazidime/avibactam dosing
2.5 grams IV Q8H
115
ceftolozane/tazobactam brand name
Zerbaxa
116
amount of each component in Zerbaxa 1.5 grams
1 g ceftolozane / 0.5 g tazobactam
117
dosing of ceftolozane/tazobactam
1.5 grams IV Q8H
118
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
119
Cefepime is a ____ generation cephalosporin
4th
120
Cefepime brand name
Maxipime
121
Cefepime dosing
1-2 grams IV/IM Q8-12H
122
5th generation cephalosporin spectrum of activity
Broadest gram positive activity, staphylococci (MRSA), gram negative activity similar to ceftriaxone (no pseudomonas coverage)
123
ceftaroline fosamil is a _____ generation cephalosporin
5th
124
ceftaroline fosamil brand name
teflaro
125
ceftaroline fosamil dosing
600 mg IV Q12H
126
cephalosporin drug interaction with probenecid
probenecid can increase levels of cephalosporins by interfering with renal excretion. Can be used to increase cephalosporin levels
127
Cephalosporin drug interaction with warfarin
cephalosporins may increase the INR by inhibiting the production of vitamin K dependent clotting factors
128
Which cephalosporins should be seperated from short acting antacids and avoided with H2RAs/PPIs due to decreased bioavailability
cefuroxime, cefpodoxime, cefdinir, cefditoren
129
Carbapenems MOA
beta lactams that inhibit bacterial cell wall synthesis
130
carbapenems exhibit _____ dependent killing
time
131
carbapenems are bacteri_____
bactericidal
132
Carbapenem spectrum of activity
most gram positive, gram negative (ESBL producing bacteria) and anaerobic pathogens
133
Ertapenem does not cover which pathogens that other carbapenems do
Pseudomonas, acinetobacter or enterococcus
134
Doripenem brand name
doribax
135
doripenem dosing
500 mg IV Q8H
136
imipenem/cilastatin brand name
Primaxin
137
imipenem/cilastatin dosing
250-1000 mg IV Q6-8H
138
Meropenem brand name
Merrem
139
Meropenem dosing
500-1000 mg IV Q8H (dilute with SWFI, stable 3 hours at room temp)
140
Ertapenem brand name
Invanz
141
ertapenem dosing
1 gram IV/IM daily (stable in NS)
142
Common uses for ertapenem
ESBL-producing bacteria, diabetic foot infections
143
Common uses for carbapenems
ESBL-producing bacteria, Pseudomonas, broad spectrum empiric coverage
144
Why is imipenem combined with cilastatin
to prevent drug degredation by renal tubular dehydropeptidase
145
contraindications to carbapenems
anaphylactic reactions to beta-lactam antibiotics
146
warnings for carbapenems
associated with CNS adverse effects (confusional states, seizures), Do not use in PCN allergy due to chance of cross reactivity
147
warnings for doripenem
Do not use for the treatment of pneumonia including HAP and VAP
148
Side effects of carbapenems
diarrhea, rash, seizures (higher doses, impaired renal function [more with imipenem]), bone marrow suppression with prolonged use, increased LFTs
149
carbapenem monitoring
Renal function, symptoms of anaphylaxis with 1st dose, CBC, LFTs
150
Carbapenem drug interaction with probenecid
probenecid may increase carbapenem levels through interference with renal excretion
151
carbapenem drug interaction with valproic acid
carbapenems can decrease serum concentrations of valproic acid leading to a loss of seizure control
152
What does PEK stand for
proteus, E.coli, Klebsiella
153
What does HNPEK stand for
Haemophillus, Neisseria, Proteus, E.coli, Klebsiella
154
What does CAPES stand for
Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia
155
Drugs that are active against CA-MRSA SSTI (mild outpatient)
SMX/TMP, doxycycline, minocycline, clindamycin (must preform D-test before use)
156
Drugs that are active against CA-MRSA SSTI (more severe requiring hospitalization)
Vancomycin, Linezolid, tedizolid, daptomycin, ceftaroline, telavancin, oritavancin, dalbavancin, quinupristin/dalfopristin, tigecycline
157
drugs that are active against Nosocomial MRSA
Vancomycin (use an alternative if MIC is 2 or higher), Linezolid, telavancin, daptomycin, rifampin (combination only)
158
Drugs that are active against VRE (e. faecalis)
Pen G or ampicillin, Linezolid, daptomycin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]
159
drugs that are active against VRE (e. faecium)
daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, [for cystitis only: nitrofurantoin, fosfomycin, doxycycline]
160
drugs that are active against pseudomonas
ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, cefepime, piperacillin/tazobactam, ticarcillin/clavulanate, cabapenems (except ertapenem), ciprofloxacin, levofloxacin, aztreonam, aminoglycosides, colistimethate
161
Drugs that are active against acinetobacter
carbapenems (except ertapenem), ampicillin/sulbactam, minocycline, tigecycline, quinolones, SMX/TMP, colistimethate
162
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
163
Drugs that are active against carbapenem resistant gram negative rods (CRE, KPC)
ceftazidime/avibactam, colistimethate
164
drugs that are active against bacteroides fragilis
metronidazole, beta-lactam/beta lactamase inhibitor combos, cefotetan,cefoxitin, carbapenems, tigecycline, others (reduced activity: clindamycin, moxifloxacin)
165
drugs that are active against C. diff infection
metronidazole, vancomycin (oral), Fidaxomicin
166
drugs that are active against atypical organisms
Azithromycin, clarithromycin, doxycycline, minocycline, quinolones
167
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
168
aztreonam MOA
inhibits cell wall synthesis
169
When is aztreonam primarily used
when beta-lactam allergy is present
170
aztreonam is bacteri_____
bactericidal
171
Aztreonam coverage
similar to cefotazidime; may gram negative organisms (Pseudomonas). no gram positive coverage
172
aztreonam side effects
similar to penicillins, rash, N/V/d, increased LFTs
173
aztreonam brand name
Azactam IV, inhaled - Cayston
174
Aztreonam dosing
500-2000 mg IV Q6-12H
175
Aztreonam dose adjustments
CrCl 10-30: decrease dose by 50% after 1st dose; CrCl
176
Aminoglycosides MOA
bind to 30S and 50S subunits to interfere with membrane protein synthesis
177
Aminoglycosides exhiit _____ dependent killing
concentration
178
Aminoglycoside coverage
Gram negative (Pseudomonas)
179
Which two aminoglycosides are used for synergy with a beta-lactam or vancomycin when treating gram positive cocci
gentamicin and streptomycin
180
Which two aminoglycosides are considered second line therapy for Mycobactrial infections
streptomycin and amikacin
181
boxed warnings for aminoglycosides
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
aminoglycoside warnings
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
aminoglycoside side effects
nephrotoxicity (acute tubular necrosis), hearing loss (early toxicity associated with high pitched sounds), vestibular toxicity (resulting in balance deficits)
184
Aminoglycoside monitoring
renal function, urine output, hearing tests, drug levels
185
When to drawn aminoglycoside levels in traditional dosing
trough right before 4th dose, peak 1/2 hour after the end of drug infusion of the 4th dose
186
When to drawn aminoglycoside level in extended interval dosing
draw random level per timing of the nomogram
187
Which aminoglycoside has the broadest spectrum of activity
amikacin
188
When should extended interval aminoglycoside regimens not be used
pregnancy, ascites, burns, cystic fibrosis, CrCl
189
gentamycin dosing (traditional)
1-2.5 mg/kg/dose
190
tobramycin dosing (traditional)
1-2.5 mg/kg/dose
191
amikacin dosing (traditional)
5-7.5 mg/kg/dose
192
Traditional aminoglycoside dosing frequency
CrCl > 60: Q8H, CrCl 40-60: Q12H, CrCl 20-40: Q24H, CrCl
193
gentamycin dosing (extended interval)
4-7 mg/kg/dose
194
tobramycin dosing (extended interval)
4-7 mg/kg/dose
195
Amikacin dosing (extended interval)
15-20 mg/kg/dose
196
gentamicin peak (gram negative infection)
5-10 mcg/ml
197
gentamicin peak (gram positive infection)
3-4 mcg/ml
198
gentamicin trough (gram negative infection)
199
gentamicin trough (gram positive infection)
200
tobramcyin peak
5-10 mcg/ml
201
tobramycin trough
202
amikacin peak
20-30 mcg/ml
203
amikacin trough
204
quinolones MOA
inhibit bacterial DNA topoisomerase IV and inhibit DNA gyrase (topoisomerase II) - prevents supercoiling and leads to breakage of double strand DNA
205
quinolones exhibit ____ dependent killing
concentration-dependent
206
quinolones are bacteri______
bactericidal
207
Which are the respiratory quinolones
gemifloxacin, levofloxacin, moxifloxacin
208
The respiratory quinolones have enhanced coverage of
S. pneumonia and atypical coverage
209
Cipro and levofloxacin have enhanced activity against
gram negatives (pseudomonas used in combination)
210
Moxifloxacin has enhanced activity against
gram positive and anaerobes
211
quinolones should not be used to treat ____ infections
MRSA
212
quinolone boxed warnings
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
ciprofloxacin contraindications
concurrent administration with tizanidine
214
which quinolone carries most risk for QT prolongatin
moxifloxacin
215
Quinolone warnings
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
quinolone side effects
GI upset/diarrhea, headache, dizziness, insomnia, crystalluria, and interstitial nephritis
217
Administration of ciprofloxacin through feeding tubes
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
Which quinolone should not be used in UTI
moxifloxacin
219
Which quinolone does not require renal dose adjustments
moxifloxacin
220
Storage of ciprofloxacin suspension
Room temp. DO NOT REFRIGERATE
221
Ofloxacin dosing
200-400 mg PO Q12H
222
ofloxacin dose adjustments
CrCl
223
Norfloxacin brand name
Noroxin
224
Norfloxacin dosing
400 mg PO BID or 800 mg PO daily
225
Norfloxacin dose adjustments
CrCl 30 or less: 400 mg daily
226
Ciprofloxacin brand name
Cipro, Cipro XR, Ciloxin eye drops, Cetraxal ear drops
227
Ciprofloxacin dosing
250-750 PO or 200-400 mg IV Q8-12H
228
ciprofloxacin dose adjustments
CrCl 30-50: Q12H, CrCl
229
Levofloxacin brand name
Levaquin, Quixin eye drops
230
Levofloxacin dosing
250-750 mg IV/PO daily
231
Levofloxacin dose adjustments
CrCl
232
Gatifloxacin brand name
Zymaxid eye drops
233
Moxifloxacin brand name
Avelox, Avelox ABC pack, Moxeza eye drops, Vigamox eye drops
234
Moxifloxacin dosing
400 mg IV/PO Q24H
235
Gemifloxacin brand name
Factive
236
Gemifloxacin dosing
320 mg PO daily
237
Gemifloxacin dose adjustments
CrCl
238
Finafloxacin brand name
Xtoro otic suspension
239
Finafloxacin dosing
swimmer's ear (acute otitis externa): 4 drops BID x 7 days
240
When to give quinolones (Cipro/Levo/Moxi) after agents containing multivalent cations
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
quinolone drug interaction with lanthanum
Lanthanum (Fosrenal), can decrease the concentration of quinolones. separate by at least 2 hours before or after
242
quinolone drug interaction with sevelamer
Sevelamer (Renagel) can decrease the concentration of quinolones. take quinolones 2 hours before or 6 hours after sevelamer
243
Which medications can have increased effects due to quinolones
warfarin, sulfonylureas/insuline, QT prolonging drugs
244
Which medications can increase quinolone levels
NSAIDs, probenecid
245
Ciprofloxacin drug interaction with theophylline
cipro can increase levels of caffeine and theophylline by reducing metabolism
246
Macrolides MOA
bind to 50S subunit, inhibiting RNA dependent protein synthesis
247
Macrolides have bacteri_______ activity
bacteriostatic
248
Macrolide spectrum of activity
good atypical coverage (legionella, chlamydia, mycoplasma, and some mycobacteremia) and haemophilus
249
Macrolides contraindications
history of cholestatic jaundice/hepatic dysfunction with prior use;
250
contraindications for clarithromycin:
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
erythromycin contraindications
concomitant use with pimozide, ergotamine, dihydroergotamine, lovastatin, or simvastatin
252
Which macrolide has the highest risk of QT prolongation
erythromycin
253
macrolide warnings
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
macrolide side effects
GI upset (diarrhea, abdominal pain and cramping [erythromycin esp]) taste perversion, increased LFTs, ototoxicity (reversible and rare)
255
Azithromycin brand names
Zithromax, Z-Pak, Zmax, Zithromax tri-pak, Azasite opthalamic
256
Azithromycin dosing (PO)
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
Azithromycin prophylaxis dosing
600 mg daily or 1200 mg PO weekly
258
Azithromycin dosing (IV)
250-500 mg IV daily
259
Clarithromycin brand name
Biaxin, Biaxin XL, Biaxin XL Pac
260
Clarithromycin dosing
250-500 mg PO Q12H or 1 gram (Biaxin XL) PO daily
261
Clarithromycin dose adjustments
CrCl
262
Erythromycin brand name
EES, Erytab, Erypred, Erythrocin, PCE
263
EES dosing
400-800 mg PO Q6-12H
264
Erythromycin base/stearate dosing
250-500 mg PO Q6-12H
265
Erythromycin lactobionate dosing
12-20 mg/kd/day IV 6H (max 4 grams/day) (stable in NS)
266
400 mg EES = _____ base or stearate
250 mg
267
Which macrolides are substrates of 3A4 and moderate strong 3A4 inhibitors
erythromycin, clarithromycin
268
Tetracyclines MOA
reversibly binding to 30S subunit
269
tertracyclines have bacteri______ activity
bacteriostatic
270
Tetracyclines spectrum of activity
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
Tetracyclines warnings
children
272
tetracyclines side effects
N/V/d rash
273
tetracyclines monitoring
LFTs, renal function, CBC
274
Doxycycline brand name
Adoxa, Atridox, Doryx, Monodox, Oracea, Vibramycin
275
Doxycycline dosing
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
Minocycline brand names
Minocin, Solodyn
277
Minocycline dosing
200 mg PO/IV x 1, then 100 mg PO/IV Q12H
278
Tetracycline dosing
250-500 mg PO Q6H on an empty stomach
279
Tetracycline dosing adjustment
CrCl
280
tetracyclines drug interaction with warfarin
can increase INR
281
tetracclines drug intraction with neuromuscular blocking agents
can enhance effects of neuromuscular blocking agents
282
tetracyclines drug interaction with retinoic acid derivatives
avoid concomitant use of tetracyclines with retinoic acid derivatives due to increased risk of pseudotumor cerebri
283
SMX/TMP MOA
SMX - inhibits folic acid synthesis through inhibition of dihyrofolic acid formation; TMP inhibits dihydrofolic acid reduction to tetrahydrofolate
284
SMX/TMP are bacteri______
static alone. cidal in combination
285
SMZ:TMP ratio
5:1
286
SMX/TMP brand name
Bactrim, Bactrim DS, Septra DS, Sulfatrim
287
SMX/TMP contraindications
sulfa allergy, pregnancy (at term), breastfeeding, anemia due to folate deficiency, marked renal or hepatic disease, infants
288
SMX/TMP warnigns
bloods dyscrasias including agranulocytosis and aplastic anemia, SJS/TEN, thrombotic thrombcytopenic purpura, other dermalogic reactions, G6PD deficiency - caution and discontinue if hemolysis occurs
289
SMX/TMP side effects
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
SMX/TMP monitoring
REnal function, LFTs, electrolytes, CBC
291
SMX/TMP dosing for severe infections
10-20 mg/kd/day TMP divided Q6-8H (2 DS tabs BID-TID)
292
SMX/TMP dosing for adult femal uncomplicated UTI
1 DS tab BID x 3 days
293
SMX/TMP dosing for PCP prophylaxis
1 DS or SS tab daily
294
SMX/TMP dosing for PCP treatment
15-20 mg/kg/day TMP IV/PO divided Q6H
295
SMX/TMP dose adjustments
CrCl 15-30 decrease dose by 50%; CrCl
296
SMX/TMP drug interaction with warfarin
increase INR. cation with concurrent use
297
SMX/TMP can increase drug levels of which medications
sulfonylureas, metformin, fosphenytoin/phenytoin, dofetilide, azathioprine, methotrexate, and mercaptopurine
298
Which medications can diminish the effect of SMX/TMP
2C8/9 inducers and leucovorin/levoleucovorin
299
Vancomycin MOA
glycopeptide that inhibits cell wall synthesis through peptidoglycan polymerization (D-alanyl-D-alanine portion)
300
Vancomycin spectrum of activity
gram positive bacteria (staphylococci (MRSA), streptococci, enterococci (NOT VRE), and C. diff)
301
Vancomycin brand name
Vancocin
302
Vancomycin dosing for MRSA infections
15-20 mg/kg IV Q8-12H (Actual body weight)
303
Max infusion concentration of vancomycin in a peripheral IV
5 mg/ml
304
Vancomycin dose adjustments
CrCl 20-49: Q24H, CrCl
305
Vancomcin dosing for C.diff
125-500 mg PO QID x 10-14 days
306
Vancomycin warnings
caution iwth the use of other nephrotoxic or ototoxic drugs
307
Vancomycin side effects
GI upset, infusion reactionred man syndrome (500 mg of drug over 30 minutes), nephrotoxiity, myelosuprresion (neutropenia/thrombocytopenia), drug fever, ototoxicity
308
vancomycin monitoring
renal function, WBC, trough concentration as steady state (before 4th dose)
309
vancomycin target troughs
15-20 mcg/ml for pneumonia, endocarditis, osteomyelitis, meningitis, and bactermia; 10-15 mcg/ml for other infections
310
Lipoglycopeptides MOA
inhibit cell wall synthesis by blocking polymerizaiton and cross linking of peptidoglycan, and disrupting bacterial membrane potential and changing permeability
311
Lipoglycopeotide exhibit _____ dependent killing
concentration
312
Lipoglycopeptides are bacteri____ _
cidal
313
Telavancin brand name
Vibativ
314
Telavancin indicaitons
SSTI, and HAP
315
Lipoglycopeptide spectrum of activity
similar to vancomycin
316
Telavancin dosing
10 mg/kg IV daily over 60 minutes to prevent infusion reaction
317
Telavancin REMS
warning of increase mortality in patient with pre-exisiting renal dysfunction and risk of fetal developmental toxicity
318
Telavncin dose adjustments
CrCl
319
Telavancin boxed warnings
fetal risk - pregnancy test prior to therapy, nephrotoxicity, increase mortality vs vancomycin in CrCl
320
telavancin warnings
falsely elevate INR (no increase in bleeding risk) does not interfere with Xa monitoring. Rapid IV infusion can cause red man syndrome
321
Telavancin side effects
metallic taste, N/V, increased SCr, QT prolongation, red man syndrome
322
Telavancin monitoring
renal function, pregnancy status
323
Oritavancin brand name
Orbactiv
324
Ortavancin indication
SSTI
325
Ortavancin dosing
1200 mg IV x 1 infused over 3 hours
326
Ortivacin contrindications
use of IV UFH for 48 hours after adminsitration due to interference with aPTT lab results
327
Oritavancin warnings
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
Dalbavancin warnings
infusion reactions (infuse over 30 minutes to avoid red man syndrome) increase ALT > 3x ULN
329
Lipoglycopeptide side effects
N/V/d, rash, infusion ractions (red man syndrome)
330
Lipoglycopeptide monitoring
signs of osteomyelitis (oritavancin), LFTs, renal function
331
Oritavancin dose adjustments
CrCl
332
Dalbavancin brand name
Dalvance
333
Dalbavancin indication
SSTI
334
Dalbavnacin dosing
1000 mg IV x 1, then 500 mg IV one week later infused over 30 minutes
335
Dalbavancin dose adjustments
CrCl
336
Telavancin drug interactions
prolongs QT interval. avoid in patients at risk (long QT syndrome, known QT prolongation uncompensated HF, other QT prolonging medications)
337
Daptomycin brand name
Cubicin
338
Daptomycin MOA
cyclic lipopeptide that binds to cell membranes causing rapid depolariztion
339
Daptomcyin has ____ dependent killing
concentration
340
Daptomycin is bacteri_____
cidal
341
Daptomycin coverage
most gram positive, staphylococci (MRSA) and enterococci (VRE (e. faecium and E. faecalis)
342
Daptomycin indications
SSTI, MRSA bloodstream infections (right sided endocarditis)
343
Daptomycin dosing in SSTI
4 mg/kg IV daily
344
Daptomycin dosing in bactermia/right sided endocarditis
6 mg/kg IV daily
345
Daptomycin dose adjustments
CrCL
346
Daptomycin warnings
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
Daptomycin side effects
N/V/d constipation, anemia, headache, dizziness, increase CPK and myopathy, dyspnea, hypo/hyperkalemia, hyperphosphatemia, increase LFTs
348
Daptomycin monitoring
CPK level weekly (more frequently if on a statin); muscle pain/weakness
349
Daptomycin compatability with IV fluids
NS and LR only
350
Daptomycin and anticoagulants
can flase increase PT/INR readings without increase in bleeding risk
351
Oxazolidinones MOA
bind to 50S subunit inhibiting translation and protein synthesis
352
Oxazolidinonesare bacteri_____
static
353
Oxazolidinones spectrum of activity
similar to vancomycin but also cover VRE
354
Linezolid brand name
Zyvox
355
Linezolid dosing
600 mg PO/IV Q12H
356
Tedizolid brand name
Sivextro
357
Tedizolid indication
SSTI
358
Tedizolid dosing
200 mg IV/PO daily x 6 days. Infuse over 1 hour. stable in NS
359
Contraindications to linezolid
concurrent or use within 2 weeks of MAOI
360
Linezolid warnigs
duration related myelosuppression, peripheral and optic neuropathy (treatment >28 days), serotonin syndrome, hypoglycemia
361
Tedizolid warnings
Consider alternative therapy in patients with neutropenia
362
Oxazolidinones side effects
myelosuppression, anemia, thrombocytopenia, headache, nausea, diarrhea, dizziness, insomnia, increase pancreatic enzymes, increase LFTs, neuropathy
363
Oxazolidinones monitoring
Weekly CBC, visual function
364
Administration of linezolid suspension
DO NOT SHAKE
365
Quinupristin/dalfopristin brand name
Synecid
366
Streptogramin MOA
bind to 50S subunit inhibiting protein synthesis
367
Streptogramins are bacteri____
cidal
368
Streptogramin spectrum of activity
Gram positive including staphylococci (MRSA), enterococcus faecium (VRE). Approved for SSTI
369
Quinupristin/dalfopristin dosing
7.5 mg/kg IV Q8-12H
370
Quinupristin/dalfopristin side effects
arthralgias/myagias, infusion reactions (edema, pain) phlebitis, hyperbilirubinemia, CPK elevations, GI upset, increase LFTs
371
Quinupristin/dalfopristin can increase levels of which medications
CCBs, cyclosporine, dofetilide
372
Tigecycline brand name
Tygacil
373
Glycylcycline MOA
bind to 30S subunit to inhibit protein synthesis
374
Glycycycline are bacteri_____
static
375
Tigecycline spectrum of activity
gram positive (staphylococci [MRSA], Enterococci [VRE]) gram negative, anaerobic, atypicals.
376
Tigecycline has no coverage against which 3 Ps
Pseudomonas, Proteus, and Providencia
377
When is tigecycline used
when other alternatives are not possible
378
Tigecycline indications
SSTI, intraabdominal infections, CAP. AVOID USE N BLOODSTREAM INFECTIONS
379
Tigecycline dosing
100 mg IV x 1 then 50 mg IV Q12H
380
Tigecycline dose adjustmnts
sever hepatic impairment 100mg IV x 1, then 25 mg IV Q12H
381
tigecycline boxed warnign
increased risk of death, use only when alternatives are no suitable
382
tigecycline warnigns
hepatotoxicity, pancreatitis, photosensitivty, teeth discoloartion in children
383
tigecycline side effects
N/V/d, headache, dizziness, increased LFTs, rash
384
Tigecycline adminstraiton
solution should be yellow-orange. discard if not this color
385
Tigecycline drug interaction with warfarin
increase INR
386
Polymyxins MOA
cationic detergent and damages cell membrane
387
Polymyxins exhibit ___ dependent killing
concentration
388
Polymyxins are bacteri_____
cidal
389
Polymyxins should be used as _____ therpay
combination due to emergence of resistance
390
Polymyxins spectrum of activity
gram negative (Enterobacter, E. coli, Klebsiella pneumoniae, Pseudomonas). Used for MDR gram negative pathogens [NOT PROTEUS]
391
Colistimethat sodium or colistin brand name
Coly-Mycin M
392
Colistimethate dosing
2.5-5 mg/kg/day IV/IM in 2-4 divided doses
393
Colistimethat dose adjustments
CrCl
394
Colistimethate warnigns
dose dependent nephrotoxicity (monitor renal function and electrolytes), neurotoxiity
395
colistimethate side effects
nephrotoxicity (proteiinuria, increased SCr), neurologic disturbances (dizziness, headache, tingling, oral paresthesia, verigo)
396
Polymyxin B sulfate dosing
15,000 - 25,000 units/kg/day IV divided Q12H
397
Polymyxin B dose adjustments
CrCl
398
Polymyxin B boxed warnigns
Nephrotoxicity, neurotoxicity, IM/intrathecal only to hospitalized patients, acoid neurotoxic/nephrotoxi drugs, resiratory paralysis
399
Polymyxin B side effects
nephrotoxicity, neurologic disturbances (dizziness, tingling, numbness, paresthesia, vertigo) fever, urticariea
400
1 mg = ____ units of polymyxin B
10,000 units
401
Chloraphenicol MOA
binds to 50S subunit inhibiting protein synthesis
402
Chloramphenicol exhibits bacteri____
cidal
403
Chloramphenicol spectrum of activity
Gram positive, gram negative, anaerobes, and atypicals
404
Chloramphenicol dosing
50-100 mg/kg/day IV in divided doses Q6H (max 4g/day)
405
Chloramphenicol boxed waring
serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia, granulocytopenia)
406
Chloramphenicol warnings
gray syndrome - characterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma, and death
407
Chloramphenicol side effects
myelosuppression (pancytopenia), aplastic anemia, dermatologic (angioedema, rash, urticaria)
408
Chloramphenicol mnitoring
CBC at baseline and every 2 days during therapy, LFTs and renal function, serum drug concentrations
409
Telithromycin brand name
Ketek
410
Telithromycin MOA
binds to 50S subunit inhibiting protein sythesis
411
Telithromcyin _____ dependent killing
concentration
412
Telithromycin is bacteri_____
cidal
413
Telithromycin coverage
gram positive (Streptococci [ macrolide resistant strains]) gram negative, some anaerobic, atypical
414
telithromycin indication
CAP only
415
Telithromycin dosing
800 mg PO daily
416
Telithromycin dose adjustments
CrCl
417
Telithromycin boxed warning
contraindicated in patients with mysathenia gravis due to respiratory failure
418
telithromycin contraindications
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
telithromycin warnings
acute hepatic failure (can be fatal), QT prolongation, visual disturbances (blurry vision, diplopia), syncope
420
telithromycin side effects
N/V/d, dizziness, headache, increase LFTs, rash
421
Telithromycin montiroing
LFTs, and visual acuity
422
Clindamycin brand name
Cleocin, Evoclin, Cindagel, Clindamax, Clindacin, Clindesse
423
Lincosamides MOA
binds to 50S subunit inhibiting protein synthesis
424
Lincosamides are bacteri______
static
425
Clindamycin spectrum of activity
aerobic and anaerobic gram positive bacteria (CA-MRSA) DOES NOT COVER ENTEROCOCCUS
426
Clindamycin dosing (PO)
150-450 mg PO Q6H
427
Clindamycin dosing (IV)
600-900 mg IV Q8H
428
Clindamycin boxed warning
colitis (C.diff)
429
Clindamycin warning
severe or fatal skin reactions (SJS/TEN)
430
Clindamycin side effects
N/V/d, rash, urticaria, increase LFTs
431
Meaning of a positive D-test
inducible clindamycin resitance - do not use clindamycin
432
Metronidazole brand name
Flagyl, metro
433
Tinidazole brand name
Tindamax
434
Metronidazole MOA
loss of helical DNA structure and strand breakage
435
Tinidazole MOA
loss of helical DNA structure and strand breakage
436
Metronidazole is bacteri_____
cidal
437
Tinidazole is bacteri ______
cidal
438
Metronidazole spectrum of activity
anaerobes and protozoal infections (bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, c.diff, combinations for intraabdominal infections)
439
Tinidazole spectrum of acitivity
protozoa (giardiasis, amebiasis), trichomniasis, and bacterial vaginosis
440
Metronidazole dosing
500-750 mg IV/PO Q8-12H or 250-500 mg IV/Po Q6-8H
441
Metronidazole dosing for mild to moderate C.diff
500 mg IV/PO TID x 10-14 days
442
Metronidazole administrations
take IR with food. Take ER on empty stomach
443
Metronidazole/Tinidazole boxed waring
possible carcinogenic based on animal data
444
metronidazole/tinidazole contraindications
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
metronidazole/tinidazole warnings
CNS effects - seizures, peripheral/optic neuropathies, aseptic meningitis (metronidazole), encephalopathy (metronidazole)
446
Metronidazole/tinidazole side effects
N/V/d, metallic taste, furry tongue, darkened urine, rash, headache, dizziness
447
Tinidazole brand name
Tindamax
448
Tinidazole dosing
2 grams PO daily with food
449
Metronidazole/tinidazole drug interaction with warfarin
can increase INR
