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NAPLEX > Infectious Disease (ID) > Flashcards

Infectious Disease (ID) Flashcards

1
Q

Cmax: MIC (concentration-dependent)

A

aminoglycosides, quinolones, daptomycin

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2
Q

AUC: MIC

A

vancomycin, macrolides, tetracyclines, polymyxins

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3
Q

Time> MIC (time-dependent)

A

beta-lactams (penicillins, cephalosporins, carbapenems)

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4
Q

Natural penicillins (Penicillin G)

A

Cover gram-positive cocci (Streptococci and Enterococci), gram-positive anaerobes (mouth flora)

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5
Q

Aminopencillins (PO: amoxicillin (Moxatag), IV:ampicillin)

A

Adds gram-negative coverage (HNPE)

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6
Q

Aminopenicillin + beta-lactamase inhibitor (clavulanate, sulbactam, tazobactam)

A

Adds MSSA, more resistant strains of Gram-negative bacteria (HNPEK), and Gram-negative anaerobes (B. fagilis)

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7
Q

Extended-spectrum penicillin + beta-lactamase inhibitor (piperacillin/tazobactam)

A

Adds expanded coverage of other gram-negative bacteria (CAPES), Pseudomonas.

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8
Q

Antistaphylococcal penicillins (IV: nafcillin, oxacillin; PO: dicloxacillin)

A
  • Only covers Streptococci and MSSA

* No renal dose adjustment

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9
Q

HNPEK

A 
H. influenzae (gram-negative bacilli or coccobacilli)
Neisseria sp. (gram-negative cocci) 
Proteus mirabilis (gram-negative rods)
E. coli (gram-negative rods)
Klebsiella spp. (gram-negative rods)
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10
Q

CAPES (all gram-negative)

A 
Citrobacter 
Acinetobacter 
Providencia 
Enterobacter
Serratia 
Pseudomonas
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11
Q

Atypicals (have no cell wall)

A

Chlamydia spp.
Legionella spp.
Mycoplasma pneumoniae
Mycobacterium tuberculosis

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12
Q

Penicillin class trends

A
  • All cover Enterococcus (except antistaph PNCs)

- Do not cover atypicals or MRSA

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13
Q

Natural penicillins

A

PO: Penicillin V Potassium
IV: Penicillin G aqueous
IM: Penicillin G Benzathine (Bicillin L-A)

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14
Q

1st gen cephalosporins (IV: cefazolin; PO: cephalexin)

A

Cover Staph, Strep, PEK, mouth anaerobes
PO Keflex: good for outpatient tx of strep throat, MSSA skin infections
IV Cefazolin: commonly used for surgical ppx

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15
Q

2nd gen: IV/IM/PO cefuroxime (Ceftin)

A

Better gram-negative coverage (HNPEK)

Cefotetan and cefoxitin have anaerobic activity (B. fragilis)

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16
Q

3rd gen: PO cefdinir; IV/IM ceftriaxone; IV/IM cefotaxime; PO cefpodoxime, IV/IM ceftazidime, IV ceftazidime/avibactam

A

Group 1: IV ceftriaxone, PO cefdinir (less Staph coverage, but better Strep coverage)
Group 2: ceftazidime, ceftazidime/avibactam (cover Pseudomonas)

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17
Q

4th gen: IV/IM cefepime

A

Broad-spectrum: Gram-positives, HNPEK, CAPES, Pseudomonas

18
Q

5th gen: IV ceftaroline (Teflaro)

A

Similar to ceftriaxone, but with MRSA coverage

19
Q

siderophore cephalosporin (IV)

A

cefiderocol (Fetroja): 2g IV Q8 hrs

20
Q

cephalosporin class trends

A
  • No Enterococcus or atypical coverage
21
Q

Carbapenems: class effects. (commonly used for polymicrobial infections, empiric therapy when resistance is suspected, and resistant Pseudomonas or Acinetobacter infections)

A
  • Drug of choice for ESBL-producing organisms
  • All cover Pseudomonas (except ertapenem)
  • Avoid in beta-lactam allergy & or seizure risk
  • All IV; ertapenem is stable in NS only
  • Do not cover atypicals, VRE, MRSA
22
Q

ertapenem (Invanz)

A
  • IV/IM: 1 gram daily
  • CrCl ≤ 30 mL/min: dose adjustment required
  • Stable in NS only
  • No coverage of Pseudomonas, Acinetobacter or Enterococcus
23
Q

Common Resistant Pathogens

A 
Klebsiella pneumoniae (ESBL, CRE) 
E.coli (ESBL, CRE) 
Acinetobacter baumannii 
Enterococcus faecalis, Enterococcus facecium (VRE) 
Staph aureus (MRSA) 
Pseudomonas aeruginosa
24
Q

monobactam (aztreonam)

A

Drug of choice for patients with beta-lactam allergy

Covers many Gram-negatives, including Pseudomonas. Has no Gram-positive or anaerobic activity.

25
Q

Aminoglycosides (inhibit protein synthesis by binding to 30S ribosome)

A

Pros: Cover gram-negatives, synergistic with beta-lactams for Gram-positive infections, low resistance and low cost
Cons: renal and ototoxicity

26
Q

Aminoglycoside: traditional dosing

A
  • Draw trough 30 min before 4th dose
  • Draw peak 30 min after the end of the 4th dose infusion
    Peak: 5-10 mcg/mL
    Trough: < 2 mcg/mL
27
Q

Extended Interval Dosing Nomogram

A
  • Draw random level sometime between 6-14 hours after the start of the infusion
  • Plot on nomogram to determine dosing interval
  • If the level plots on a line, round up to the next dosing interval to avoid potential toxicity
28
Q

Quinolones (inhibit bacterial DNA topoisomerase IV and DNA gyrase)

A
  • Have concentration-dependent activity

- Broad-spectrum of activity against Gram-negative, Gram-positive and atypicals

29
Q

Respiratory quinolones (gemifloxacin, levofloxacin, moxifloxacin)

A

“My Good Lungs”

Enhanced coverage of S. pneumoniae and atypicals.

30
Q

Antipseudomonal quinolones (ciprofloxacin and levofloxacin)

A
  • Have enhanced Gram-negative activity, including Pseudomonas coverage.
  • Commonly used for Pseudomonal infections, UTIs, intra-abdominal infections, traveler’s diarrhea
31
Q

Moxifloxacin

A
  • Has enhanced gram-positive and anaerobic activity. —- Can be used alone for mixed infections (intra-abdominal infections).
  • The only quinolone that cannot be used to treat UTIs. - Has the highest risk of QT prolongation.
  • IV:PO= 1:1
32
Q

Quinolones: class effects

A

Boxed warnings: tendon rupture, peripheral neuropathy, CNS effects (including seizures), use last-line only
Warnings: QT prolongation, hypo and hyperglycemia, psychiatric disturbances, photosensitivity, avoid use in children
Interactions: chelation with divalent cations

33
Q

delafloxacin

A

-Newer quinolone approved for skin infections, active MRSA coverage. Other quinolones are noted to have activity against MRSA, but avoid due to resistance.

34
Q

Quinolone drug interactions

A
  • Antacids and other polyvalent cations, multivitamins, sucralfate, and bile acid resins can chelate and inhibit quinolone absorption
  • Lanthanum carbonate and sevelamer can decrease the [ ] of oral quinolones; separate by at least 2 hours before, and at least 2 hours after (with lanthanum) and 6 hours after (with sevelamer)
  • can increase effects of warfarin
  • can increase effects of sulfonylureas, insulin, and other hypoglycemic drugs
  • caution with CVD, low K and Mg, and use with other QT-prolonging drugs (e.g. azole antifungals, antipsychotics, methadone, macrolides)
  • Probenecid and NSAIDs can increase quinolone levels
  • Ciprofloxacin can increase levels of caffeine, theophylline, and tizanidine
35
Q

Macrolides (inhibit protein synthesis by binding to 50S ribosomal subunit)

A
  • Commonly used for CAP and strep throat
    excellent atypical coverage and H. influenzae
  • azithromycin, clarithromycin, erythromycin
36
Q

Macrolide: drug interactions

A
  • Erythromycin and clarithromycin are major substrates for CYP3A4 and CYP3A4 inhibitors. Avoid medications that are metabolized by CYP3A4 (C/I with simvastatin, lovastatin) or monitor.
  • Use caution with CVD, decreased K and Mg, and when using with other QT-prolonging drugs
37
Q

Erythromycin

A

Increases gastric motility, may be used for gastroparesis

38
Q

Tetracyclines (inhibit bacterial protein synthesis by binding to the 30S subunit)

A
  • Cover many Gram-positives (MRSA), Gram-negative bacteria (Haemophilus, Moraxella, atypicals) and other unique pathogens (spirochetes, Rickesttsiae, Bacillus anthracis, Treponema pallidum)
  • Common uses: CA-MRSA skin infections, acne
39
Q

Tetracycline safety

A
  • Avoid use in children age <8 years, pregnancy, breastfeeding
  • Photosensitivity
  • Interaction with divalent cations
  • IV: PO =1:1 (doxycycline, minocycline)
  • Minocycline: drug-induced lupus erythematosus (DILE)
40
Q

doxycycline

A

First-line for Lyme disease, Rocky Mountain Spotted Fever (tick-borne illnesses), CAP, COPD exacerbations, VRE UTI, monotherapy for chlamydia, combo therapy for gonorrhea

NAPLEX (25 decks)

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