Infectious disease I Flashcards

1
Q

What is collateral damage?

A

unintended consequences of antibiotic use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

common resistant pathogens

A
  • Kill Each And Every Strong Pathogen
  • Klebsiella (ESBL, CRE)
  • E.coli (ESBL, CRE)
  • Acinetobacter
  • Enterococcus (VRE)
  • S.aureus (MRSA)
  • Pseudomonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hydrophilic drugs

A
  • beta-lactams
  • aminoglycosides
  • glycopeptides
  • daptomycin
  • polymyxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

lipophilic drugs

A
  • quinolones
  • macrolides
  • rifampin
  • linezolid
  • tetracyclines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

hydrophilic drugs PK parameter

A
  • small Vd -> poor tissue penetration
  • renal elimination -> nephrotoxicity possibility
  • low intracellular concentration -> not effective against atypical infections which is mostly intracellular
  • increased Cl and/or distribution in sepsis
  • poor/moderate bioavailability -> either no PO or IV:PO not 1:1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

lipophilic drugs PK parameter

A
  • large Vd -> good issue penetration
  • hepatic metabolism -> hepatotoxicity possibility
  • good intracellular concentrations -> yes for atyipicals
  • Cl/distribution not changes in sepsis
  • good bioavailability -> IV:PO 1:1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

beta-lactam MOA

A

bind to PCN-binding proteins (PBPs) -> inhibit bacterial wall synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PCN coverage

A
  • gram positive cocci

- Streptococci, Enterococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

aminopenicillins coverage

A

PCN coverage + HNPEK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HNPEK

A
  • Haemophilus
  • Neisseria
  • Proteus
  • E.coli
  • Klebsiella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

aminopenicillins + beta lactamase inhibitors coverage

A

same as aminopenicillins plus:

  • MSSA
  • more resistant HNPEK
  • anaerobe (B.fragilis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Zosyn coverage

A

same as aminopenicillins + beta lactamase inhibitors plus:

  • CAPES
  • Pseudomonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CAPES

A
  • Citrobacter
  • Acinetobacter
  • Providencia
  • Enterpbacter
  • Serratia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

antistaph PCN

A
  • strep

- staph (MSSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PCN pearls

A
  • PCN G benzathine IM only; NOT for IV (can cause cardioresp arrest and death)
  • do not use extended forms of amox or augmentin or augmentin 875 in patients w/ CrCl < 30
  • ADE: seizure with accumulation, GI upset, diarrhea, rash
  • amox has chewable forms available
  • IV amp diluted in NS only
  • zosyn can be given via extended infusion (4h)
  • sodium in zosyn
  • no renal dose adjustments in antistaph pcn
  • nafcillin is vesicant; risk of extravasation; if happens, use cold packs and hyaluronidase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PCN drug interactions

A
  • probenecid can increase beta-lactams (interfere with renal excretion)
  • beta-lactams (except naf and dicloxacillin) enhance warfarin
  • PCNs increase methotrexate
  • PCNs decrease mycophenolate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Key: PCN VK

A

1st line for strep throat and mild nonpurulent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Key: amoxicillin

A
  • first line treatment for acute otitis media (80-90mg/kg/day)
  • 1st choice for infective endocarditis prophylaxis before dental procedure (2g 30-60 min before procedure)
  • used in H.pylori treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Key: augmentin

A
  • 1st line for acute otitis media (90mg/kg/day) and sinus infection if indicated
  • use lowest dose of clav to decrease diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Key: PCN G benzathine

A
  • 1st line for syphilis (2.4 millions units IM once)

- not for IV use; can cause death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Key: zosyn

A
  • active against psuedomonas

- can be used with extended infusion (4h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Key: antistaph PCN

A
  • cover MSSA only

- no renal dose adjustments needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T/F: cephalosporin not active against Enterococcus

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

first generation cephalosporins

A
  • *cefazolin (Ancef)
  • *cephalexin (Keflex)
  • cefadroxil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
second generation cephalosporins
- *cefuroxime (Ceftin) - *cefotetan (Cefotan) - cefaclor - cefoxitin - cefprozil
26
third generation cephalosporins
- *cefdinir (Omnicef) - *ceftriaxone (Rocephin) - *cefotaxime - cefditoren (Spectracef) - cefixime (Suprax) - cefpodoxime - ceftibuten - *ceftazidime (Fortax, Tazicef) / avibactam (Avycaz) - ceftolozane/taxobactam (Zerbaxa)
27
fourth generation cephalosporins
*cefepime (Maxipime)
28
fifth generation cephalosporins
*ceftaroline fosamil (Teflaro)
29
first generation cephalosporins coverage
- gram + cocci (strep, staph esp MSSA) | - a little gram -: PEK
30
second generation cephalosporins coverage
- Staph - more resistant S.pneumoniae - HNPEK - cefotetan and cefoxitin: same plus anaerobes (B.fragilis)
31
third generation cephalosporins coverage
+ Group 1: - more resistant Strep, HNPEK, and also gram + anaerobes and MSSA + Group 2: - no gram + but covers psuedomonas; with beta lactamase inhibitor, can also cover MDR gram -'s
32
fourth generation cephalosporins coverage
- HNPEK - CAPES - pseudomonas - staph, strep
33
fifth generation cephalosporins coverage
- MRSA - HNPEK - broad gram +
34
cephalexin dosing
250-500mg Q6-12h
35
cephalosporin pearls
- ceftriaxone CI in neonates due to biliary sludging and kernicterus and in neonates 28 days or younger who are also receiving Ca products - 10% cross sensitivity with PCN allergy - cefotetan has side chain which can increase risk of bleeding and disulfiram-like reaction with etoh - ADE: seizure with accumulation, GI upset, diarrhea, rash - cefixime has chewable tablet - ceftaz/avibactam covers some CRE
36
cephalosporin pearls
- ceftriaxone CI in neonates due to biliary sludging and kernicterus and in neonates 28 days or younger who are also receiving Ca products - 10% cross sensitivity with PCN allergy - cefotetan has side chain which can increase risk of bleeding and disulfiram-like reaction with etoh - ADE: seizure with accumulation, GI upset, diarrhea, rash - cefixime has chewable tablet - ceftaz/avibactam covers some CRE
37
cephalosporin drug interactions
- decrease stomach acid can decrease bioavailability of some cephalosporins -> avoid H2RA and PPI - cefuroxime and cefpodoxime separated from short-acting antacids
38
Key: outpatient cephalosporins
- cephalexin: common for MSSA skin infections or strep throat - cefuroxime: common for acute otitis media, CAP, sinus infection - cefdinir: common for CAP, sinus infection
39
Key: inpatient cephalosporins
ceftriaxone and cefotaxime used in CAP, meningitis, spontaneous bacterial peritonitis, pyelonephritis
40
carbepenem coverage
- gram + and - (including ESBL) - anaerobes - DO NOT COVER: atypical, MRSA, VRE, C.diff, Stenotrophomonas - ertapenem DOES NOT COVER: pseudo, acinetobacter, enterococcus
41
carbepenem pearls
- warning: in pts with seizures - do not use in pts with PCN allergy - ertapenem DOES NOT COVER: pseudo, acinetobacter, enterococcus
42
carbepenem drug interactions
decrease valproic acid
43
Key: carbepenems
commonly used for: - polymicrobial infections (like diabetic foot infection) - empiric when resistant organisms are suspected (pseudo and acinetobacter)
44
monobactam MOA
bind to PCN-binding proteins (PBPs) -> inhibit bacterial wall synthesis
45
monobactam coverage
- gram - including pseudomonas | - NO gram positive
46
aminoglycoside MOA
bind to ribosome -> interferes with protein synthesis -> defective bacterial cell membrane
47
aminoglycoside coverage
gram - including pseudomonas
48
aminoglycoside pearls
- if actual body weight < IBW, use actual body weight for dosing - if obese, use adjusted body weight for dosing - traditional: gentamicin and tobramycin: 1-2.5 mg/kg/dose - extended: gentamicin and tobramycin: 4-7 mg/kg/dose - traditional renal dose adjustments: CrCl >= 60 -> Q8h - extended interval frequency determined by nomogram - teratogenic - neuromuscular blockade - levels: for traditional, draw trough 30 min before 4th dose and peak 30 min after infusion of 4th dose; for extended, draw random level per timing on nomogram - goal trough for gent gram - infection and tobramycin: <2 mcg/mL
49
quinolone MOA
- inhibit bacterial DNA topisomerase IV and DNA gyrase (topisomerase II) - concentration dependent antibacterial activity
50
quinolone coverage
- gemi, levo, moxi are resp quinolones: enhanced coverage of S.pneumoniae - cipro and levo: enhanced gram - including pseudomonas; commonly used in combo with beta lactams when treating psuedomonas empirically - moxi: enhanced gram + and anaerobic - dela: MRSA
51
quinolone pearls
- warning: peipheral neuropathy, hypo- and hyperglycemia, psychiatric disturbances, avoid in children and pregnant/breastfeeding due to musculoskeletal toxicity, photosensitivity - caution: seizures - QT prolongation (highest risk with moxi) - cipro oral suspension: shake vigorously 15 min, NO NG tube - moxi: no urine concnetration, no UTI, no renal dose adjustments
52
quinolone drug interactions
- antacids and polyvalent cations chelate and inhibit quinolone absorption - lanthanum carbonate (Fosrenol) and sevelamer decrease concentration of oral quinolone; separate administration - quinolone increase effect of sylfonylureas, insulin, and hypoglycemic drugs - probenicid and NSAIDS can increase quinolone - levo and moxi: IV:PO 1:1
53
What are the atypicals?
- Legionella - Chlamydia - Mycoplasma - Mycobacterium
54
macrolide MOA
bind to 50S ribosomal subunit -> inhibit RNA-dependent protein synthesis
55
macrolide coverage
atypicals
56
macrolide uses
- CAP, LRTI | - STD (chlamydia, gonorrhea)
57
macrolide pearls
- Tri Pak: 500mg daily for 3 days - do not use clarithro or erythro with lovastatin or simvastatin - warning: QT prolongation, hepatotoxicity - clarithro: caution in pts with CAD (increased mortality) - ADE: GI upset
58
macrolide drug interactions
- erythro and clarithro are CYP3A4 inhibitors; close monitoring with colchicine, apixaban, dabigatran, rivaroxaban, theophylline, WARFARIN - azithro: fewer drug interactions
59
Key: macrolides
- used as alternative to beta-lactam for strep throat - azithro: monotherapy for chlamydia, combo therapy for gonorrhea, prophylaxis for MAC, choice for travelers' diarrhea - clarithro: tx of H.pylori - erythro causes most GI upset
60
tetracyclines MOA
bind to 30S ribosomal -> inhibit protein synthesis
61
tetracyclines coverage
- Gram positive: staph, strep, enterococci, nocardia, bacillus, propionibacterium - Gram negative: haemophilus, moraxella - Other: atypicals, rickettsiae, bacillus anthracis, treponema
62
doxycycline
- has broader coverage compared to other tetracyclines | - used for: CAP, tick/rickettesial diseases, STD (chlamydia and gonorrhea), CA-MRSA skin infections, VRE UTIs
63
tetracycline pearls
- no renal dose adjustments for doxycyline - minocycline: drug-induced lupus erythematosus (DILE) - mino and docy IV:PO 1:1
64
tetracycline drug interactions
- antacids, polyvalent cations, multivitamins, sucralfate, bismuth subsalicylate, bile acid resins can chelate and inhibit tetracycline absorption; separate administration - docy and mino taken with food to decrease GI upset - lanthanum carbonate (Fosrenol) decrease tetracyclines; separate administration - tetracyclines enhance effect of warfarin and neuromuscular blocking drugs
65
Key: tetracyclines
- doxy and mino used for CA-MRSA skin infections - doxy first line for lyme disease, rock mountain spotted fever, CAP, COPD exacerbations, sinusitis, VRE UTI - tetracycline used in H.pylori treatment
66
sulfonamide MOA
inhibit bacterial folic acid production
67
sulfonamide coverage
- Staph (MRSA and CA-MRSA) - broad gram -: haemophilus, proteus, E.coli, klebsiella, enterobacter, **shigella, salmonella, stenotrophomonas** - opportunistic pathogens: nocardia, **pneumocystis, toxoplasmosis** - does NOT cover pseudo, entercocci, atypicals, anaerobes
68
sulfonamide pearls
- dose based on TMP component - DS: 800/160 - uncomplicated UTI: 1 DS tab PO BID x 3d - warnings: SJS/TEN, thrombotic purpura (TTP), do not use if pt has G6PD deficiency - ADE: photosensitivity, increased K, hemolytic anemia (positive coombs test), crystalluria
69
sulfonamide drug interactions
- Bactrim is CYP2C9 inhibitor -> can increase INR - do not use with CYP2C9 inducers; levels can decrease - Bactrim therapeutic effects can decrease with use of leucovorin
70
vancomycin MOA
bind to D-alanyl-D-alanine cell wall precursor -> inhibit bacterial wall synthesis
71
vancomycin pearls
- systemic infections: 15-20 mg/kg Q8-12h - dose based on actual body weight - CrCl 20-49: Q24H - C.Diff: 125-500mg QID x 10d - ototoxicity and nephrotoxicity - goal trough 15-20 mcg/mL for pneumonia, endocarditis, osteo, mening, bacteremia
72
lipoglycopeptide MOA
- bind to D-alanyl-D-alanine cell wall precursor -> inhibit bacterial wall synthesis - disrupt bacterial membrane potential
73
lipoglycopeptide pearls
- concentration dependent antibacterial activity - televancin approved for use of SSTI; boxed warning: fetal risk, nephrotoxicity - oritavancin & dalbavancin: do not use IV UFH 5 days after administration due to falsely elevated aPTT; long half life -> single dose regimen - can falsely increase caogulation tests; red man syndrome
74
lipoglycopeptide drug interactions
- televancin: use caution in QT prolongation or HF | - oritavancin: has effect on CYP2C9, CYP2C19, CYP3A4, CYP2D6
75
daptomycin MOA
bind to cell membrane -> depolarization
76
daptomycin pearls
- concentration dependent antibacterial activity - falsely elevated PT/INR - check CPK weekly - use NS
77
oxazolidinones MOA
bind to 50s subunit -> inhibit protein synthesis
78
oxazolidinones pearls
- no renal dose adjustments - Iv to PO 1:1 - do not use within 2 weeks of MAOi - longer duration = higher risk for myelosuppression (common thrombocytopenia) - other warnings: peripheral and optic neuropathy, serotonin syndrome, hypoglycemia - ADE: low platelets - don't shake suspension
79
oxazolidinones coverage
like vanc + VRE
80
quinupristin/dalfopristin MOA
bind to 50s subunit -> inhibit protein synthesis
81
quinupristin/dalfopristin coverage
- gram + - MRSA - VRE.faecium
82
quinupristin/dalfopristin pearls
- ADE: arthralgias/myalgias, infusion reactions, hyperbilirubinemia - D5W only - central line
83
tigecycline MOA
bind to 30s subunit -> inhibit protein synthesis
84
tigecycline coverage
- gram + - MRSA - VRE - gram - - anaerobes - atypical
85
tigecycline pearls
- related to tetracyclines - increase risk of death - do not use for bloodstream infections - reconstituted solution should be yellow-orange
86
polymyxin coverage
- Enterobacter - E.coli - Klebsiella pneumoniae - Pseudomonas
87
polymyxin pearls
- MDR gram - pathogens - colistimethate prodrug converted to colistin - inhalations: mixed right before administration - nephro and neurotoxicity - resp paralysis from neuromuscular blockade
88
chloramphenicol MOA
bind to 50s subunit -> inhibit protein synthesis
89
chloramphenicol pearls
warning: Gray syndrome
90
lincosamide MOA
bind to 50s subunit -> inhibit protein synthesis
91
lincosamide coverage
- anaerobes | - Gram + (ex. CA-MRSA)
92
lincosamide pearls
- no renal dose adjustments - warning: c.diff - induction test (D-test) on S.aureus -> flattened zone = resistance
93
metronidazole MOA
loss of helical DNA structure and strand breakage -> inhibit protein synthesis
94
metronidazole coverage
- anaerobes | - protozoal infections
95
metronidazole uses
- bacterial vagionosis - trichomoniasis - IAI
96
metronidazole pearls
- IV:PO 1:1 - CI in: 1st trimester, use of alcohol within 3 days after tx course - secnidazole can be taken as 2g single dose and can treat vulvovaginal candidiasis
97
metronidazole drug interactions
- disulfiram rxn: abd cramping, N/V, headaches, flushing | - can increase INR
98
fidaxomicin MOA
inhibit RNA polymerase -> inhibit protein synthesis
99
rifaximin MOA
inhibit RNA polymerase -> inhibit protein synthesis
100
rifaximin uses
- traveler's diarrhea - reduce hepatic enceph. occurrence - IBS - not for systemic infections
101
fosfomycin coverage
- E.coli (+ ESBL) | - E.faecalis (+VRE)
102
nitrofurantoin MOA
bacterial cell wall inhibitor
103
nitrofurantoin coverage
uncomplicated UTI only - E.coli - Klebsiella - Enterobacter - S.aureus - Entreococcus (VRE)
104
nitrofurantoin pearls
- Macrobid: 100mg BID x 5 days - do NOT use if CrCl < 60 - warning: hemolytic anemia, caution in pts with G6PD deficiency - ADE: GI upset (take with food to help with GI upset), brown urine discoloration
105
Key: nitrofurantoin
- drug of choice for uncomplicated UTI - Macrodantin is QID - take with food to avoid GI side effects
106
drug of choice for CA-MRSA SSTI
- Bactrim - doxy / mino - clindamycin - linezolid
107
drug of choice for severe MRSA SSTI
- vanc - dapto - linezolid - ceftaroline
108
drug of choice for nosocomial MRSA
- vanc - linezolid - dapto
109
drug of choice for VRE.faecalis
- PenG or ampicillin - linezolid - dapto - cystitis: nitroduran, fosfo, doxy
110
drug of choice for VRE.faecium
- dapto - linezolid - cystitis: nitroduran, fosfo, doxy
111
drug of choice for pseudomonas
- Zosyn - cefepime - ceftazidime +/- avibactam - ceftolozane/tazobactam - carbapenem (but not ertapenem) - cipro, levo - aztreonam - aminoglycosides - polymyxins
112
drug of choice for acinetobacter baumannii
carbapenem (but not ertapenem)
113
drug of choice for ESBL
- carbapenems - ceftazidime/avibactam - ceftolozane/tazobactam
114
drug of choice for CRE
- ceftazidime/avibactam | - polymyxins
115
drug of choice for bacteroides fragillis
- metronidazole - beta-lactam +/- beta-lactamase inhibitor - cefotetan, cefoxitin - carbapenems
116
drug of choice for atypical organisms
- azithromycin - doxycyline - quinolones
117
drug of choice for HNPEK
beta-lactam +/- beta-lactamase inhibitor
118
Which oral suspensions require refrigeration after reconstitution?
- PCN VK - ampicillin - Augmentin - recommend for amoxicillin to improve taste but not required
119
Which oral suspensions does not require refrigeration after reconstitution?
- cefdinir - cipro - azithromycin, clarithromycin - doxycycline - Bactrim - clinda
120
Which medications make you more sensitive to the sun?
- quinolones - tetracycline - bactrim
121
Which medications should you take with food?
- Biaxin XL - Augmentin - nitorfuran
122
Which medications should you take with a full glass of water?
- quinolones (crystal formation) - tetracycline (GI irritation) - bactrim (crystal formation) - clinda (GI irritation)
123
Which key drugs do not have renal dose adjustments?
- antistaph beta-lactam - clinda - doxy - macrolides (azithro and erythro) - metronidazole - moxifloxacin - linezolid