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NAPLEX 2022 > Infectious Disease Part 1: Background & ABX by Class > Flashcards

Infectious Disease Part 1: Background & ABX by Class Flashcards

1
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

CNS/Meningitis

A

Neisseria meningitidis
Group B Streptococcus/E. coli (young)
Streptococcus pneumoniae
Haemophilus influenzae
Listeria (young/old)

“No Girl Should Have Lice”

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2
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Upper Respiratory

A

Moraxella catarrhalis
Streptococcus pyogenes
Haemophilus influenzae
Streptococcus pneumoniae

“My Son Has Strep”

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3
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Heart/Endocarditis

A

Staphylococcus aureus, including MRSA
Enterococci
Staphylococcus epidermidis
Streptococci

“Souls ‘Must’ Enter SomewhEre Sacred”

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4
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Skin/Soft Tissue

A

Pasteurella multocida +/- aerobic/anaerobic GNR (in DM)
Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis

“Pale, skin scream sunlight”

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5
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Bone/Joint

A

Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus
Neisseria gonorrhoeae GNR

“Strong Skeleton Support Nerves”

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6
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Urinary Tract

A

Klebsiella
Proteus
E. coli
Enterococci
Staphylococcus saprophyticus

K.P.E.E.S

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7
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Intra-abdominal

A

Bacteroides species
Enteric GNR
Enterococci
Streptococci

B.E.E.S

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8
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Lower Respiratory (Hospital)

A

Enteric GNR (ESBL, MDR)
Pseudomonas aeruginosa
Acinetobacter baumannii
Streptococcus pneumoniae
Staphylococcus aureus, MRSA

E.P.A.S.S *M

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9
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Mouth

A

Mouth flora (Peptostreptococcus)
Anaerobic GNR (Prevotella)
Viridans group Streptococci

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10
Q

Common Bacterial Pathogens for Select Sites of Infections pg. 345

Lower Respiratory (Community)

A

Chlamydophila
Haemophilus influenzae
Atypicals: Legionella, Mycoplasma
Streptococcus pneumoniae
Enteric GNR (alcoholics)

C.H.A.S.E.

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11
Q

Common Resistant Pathogens pg. 349

A

Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, E. faecium (VRE)
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa

“Kill Each And Every Strong Pathogen”

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12
Q

What does ESBL stand for?

A

Extended-spectrum beta-lactamase

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13
Q

What does CRE stand for?

A

Carbapenem-resistant Enterobacteriaceae

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14
Q

What does VRE stand for?

A

Vancomycin-resistant Enterococcus

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15
Q

Enzyme Activation pg. 349

ESBL Treatment of Choice

A

Carbapenems or newer Cephalosporin/Beta-lactamase inhibitors

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16
Q

Enzyme Activation pg. 349

CRE Treatment of Choice

A

Combination of ABX that include Polymyxins or ceftazidime/avibactam (Avycaz)

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17
Q

Antibiotics MOA pg. 350

Cell Wall Inhibitors

A

Beta-lactams (PCNs, Cephs, Carbapenems)
Monobactams (Aztreonam)
Vancomycin, Dalbavancin, Telavancin, Oritavancin

“DOT. V MB”

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18
Q

Antibiotics MOA pg. 350

DNA/RNA Inhibitors

A

Quinolones (DNA gyrase, topoisomerase IV)
Metronidazole, tinidazole
Rifampin

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19
Q

Antibiotics MOA pg. 350

Folic Acid Synthesis Inhibitors

A

Sulfonamides
Trimethoprim*
Dapsone

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20
Q

Antibiotics MOA pg. 350

Cell Membrane Inhibitors

A

Polymyxins
Daptomycin
Telavancin
Oritavancin

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21
Q

Antibiotics MOA pg. 350

Protein Synthesis Inhibitors

A

Quinupristin/Dalfopristin (Synercid)
Tetracyclines
Clindamycin
Linezolid, tedizolid
Aminoglycosides
Macrolides

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22
Q

Hydrophilic Agents

*Read section for description (pg. 350)

A

Beta-lactams
Aminoglycosides
Daptomycin
Glycopeptides
Polymyxins

“BAD GrandPa”

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23
Q

Lipophilic Agents

*Read section for description (pg. 350)

A

Quinolones
Macrolides
Rifampin
Linezolid
Tetracyclines

“Little Quincy Ran Thru Manhattan”

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24
Q

Dose Optimization Graph (pg. 351)

“CMAX:MIC”

Concentration - Dependent Classes

A

Aminoglycosides
Quinolones
Daptomycin

Goal: high peak = incr. killing | low trough = dec. toxicity
Dosing strategies: Large doses, long intervals

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25
Q

Dose Optimization Graph (pg. 351)

“AUC:MIC”

Exposure - Dependent Classes

A

Vancomycin
Macrolides
Tetracyclines
Polymyxins

Goal: exposure over time
Dosing strategies: variable

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26
Q

Dose Optimization Graph (pg. 351)

“Time > MIC”

Time - Dependent Classes

A

Beta-lactams (PCNs, Cephs, Carbapenems)

Goal: maintain drug level > MIC for most of the dosing interval

Dosing strategies: shorter dosing interval, extended or continuous infusions

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27
Q

Beta-Lactam Antibiotics

Name the Classes & MOA

A

Classes: PCNs, Cephs, Carbapenems

MOA: Inhibit bacterial cell wall synthesis and prevent peptidoglycan synthesis

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28
Q

Beta-Lactam Antibiotics - PCNs (pg. 352)

Natural Penicillins

A

Penicillin G & Penicillin VK

Gram positive cocci, Gram positive anaerobes

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29
Q

Beta-Lactam Antibiotics - PCNs

Aminopenicillins

A

Amoxicillin, Ampicillin

Adds Gram negative coverage (HNPEK)

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30
Q

Beta-Lactam Antibiotics - PCNs

Aminopenicillins + Beta Lactamase Inhibitors

A

Amoxicillin/clavulanate, Ampicillin/sulbactam

Adds MSSA, more resistant strains of HNPEK, Gram negative anaerobes (B. fragilis)

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31
Q

Beta-Lactam Antibiotics - PCNs

Extended Spectrum + Beta-Lactamase Inhibitors

A

Piperacillin/tazobactam

Adds CAPES, Pseudomonas

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32
Q

Beta-Lactam Antibiotics - PCNs

Antistaphylococcal

A

Nafcillin, Oxacillin

Covers MSSA and Streptococci only

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33
Q

When should you NOT use Beta-Lactams?

A
  1. Beta-lactam allergy
  2. Risk of seizures
  3. CrCl <30 mL/min
  4. Pen G not IV use
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34
Q

PCNs - Outpatient (PO) treat what infections?

Penicillin VK

A

Strep throat & mild skin infections

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35
Q

PCNs - Outpatient (PO) treat what infections?

Amoxicillin - Brand?

A

Brand: Moxatag

Acute Otitis Media (AOM)
Infective endocarditis prophylaxis
H. pylori

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36
Q

PCNs - Outpatient (PO) treat what infections?

Amoxicillin/Clavulanate - Brand?

A

Brand: Augmentin

AOM
Lowest dose of clavulanate

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37
Q

PCNs - Inpatient (Parenteral) treat what infections?

Penicillin G Benzathine - Brand?

A

Brand: Bicillin L-A

Syphilis
Never use IV

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38
Q

PCNs - Inpatient (Parenteral) effective against what pathogen?

Zosyn - Generic?

A

Generic: piperacillin/tazobactam

ONLY penicillin active against Pseudomonas
Extended-infusion common

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39
Q

PCNs - Inpatient (Parenteral) effective against what pathogen(s)?

Nafcillin, Oxacillin, Dicloxacillin

A

MSSA and Streptococcus (no MRSA)

No renal dose adjustments*

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40
Q

Beta-Lactam Antibiotics - Cephalosporins

First Generation

Route of Administration(s) & Coverage

A

IV: Cefazolin
PO: Cephalexin (Keflex)

Staphylococci, Streptococci, PEK, mouth anaerobes (Peptostreptococci)

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41
Q

Beta-Lactam Antibiotics - Cephalosporins

Second Generation

Route of Administration(s) & Coverage

A

IV/IM/PO: Cefuroxime (Ceftin)

Better Gram-negative activity “HNPEK”

**Cef-o-tetan and Cef-o-xitin have anaer-o-bic activity (B. fragilis)

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42
Q

Beta-Lactam Antibiotics - Cephalosporins

Third Generation

Route of Administration(s) & Coverage

A

——Group 1——
IV: Ceftriaxone no renal dose adjustments
PO: Cefdinir
Coverage: Staphylococci < Streptococci

——Group 2——
IV: Ceftazidime, Ceftazidime/Avibactam (Avycaz)
Coverage: Pseudomonas

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43
Q

Beta-Lactam Antibiotics - Cephalosporins

Fourth Generation

Route of Administration(s) & Coverage

A

IV: Cefepime

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

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44
Q

Beta-Lactam Antibiotics - Cephalosporins

Fifth Generation

Route of Administration(s) & Coverage

A

IV: Ceftaroline (Teflaro)

Similar to Ceftriaxone but with MRSA coverage

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45
Q

What pathogens are HNPEK?

A

Haemophilus
Neisseria
Proteus
E. coli
Klebsiella

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46
Q

What pathogens are CAPES or SPACE?

A

Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia

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47
Q

Penicillin are NOT active against what pathogens?

A

MRSA (except Ceftaroline)
Atypicals

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48
Q

Cephalosporins - Inpatient (Parenteral) used when?

1st Generation: Cefazolin

A

Surgical Prophylaxis

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49
Q

Cephalosporins - Inpatient (Parenteral) used when?

2nd Generation: Cefotetan & Cefoxitin

A

Surgical Prophylaxis (GI Procedures)

**Cefotetan: disulfiram-like rxn

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50
Q

Cephalosporins - Inpatient (Parenteral) used when?

3rd Generation: Ceftriaxone & Cefotaxime

A

CAP, meningitis, SBP, pyelonephritis

Ceftriaxone: no renal dose adjustments, DO NOT use in neonates*

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51
Q

Cephalosporins - Inpatient (Parenteral) used when?

Ceftazidime (3rd Gen) & Cefepime (4th Gen)

A

Pseudomonas

52
Q

Cephalosporins - Inpatient (Parenteral) used when?

5th Generation: Ceftaroline

A

MRSA

53
Q

Cephalosporins - Outpatient (PO) used when?

1st Generation: Cephalexin (Keflex)

A

Strep throat & MSSA skin infections

54
Q

Cephalosporins - Inpatient (Parenteral) used when?

2nd Generation: Cefuroxime

A

AOM
CAP
Sinus infections

55
Q

Cephalosporins - Inpatient (Parenteral) used when?

3rd Generation: Cefdinir

A

CAP
Sinus infections

56
Q

What is the dosing of oral Keflex?

A

250 - 500 mg Q6-12H

57
Q

Why is Ceftriaxone contraindicated in neonates?

A

Causes hyperbilirubinemia (AKA biliary sludging, kernicterus)

58
Q

Which two cephalosporins cover anaerobes?

A

2nd generation: Cefotetan and Cefoxitin

59
Q

Beta-Lactamase Antibiotics - Carbapenems

Class Effects

A

All active against ESBL-producing organisms and
Pseudomonas (except ertapenem)

Beta-lactam allergy and seizures, monitor renal function

All are IV only* (ertapenem only stable in normal saline)

60
Q

Beta-Lactamase Antibiotics - Carbapenems

Does NOT cover

A

Atypicals
VRE
MRSA

ErtAPenem does NOT cover “PEA” Pseudomonas, Enterococcus, Acinetobacter*

61
Q

Monobactam

Drug & Coverage

A

Drug: Aztreonam (Azactam)

Coverage: many Gram-negatives, Pseudomonas but NO Gram-positives or anaerobic activity

62
Q

Aminoglycosides (pg. 358)

Coverage, Dosing, & Monitoring

A

Coverage: Gram-negative + Pseudomonas; Synergy for Gram-positives (Staphylococci/Enterococci)

Dosing (Gentamicin/Tobramycin):
Traditional: 1-2.5 mg/kg IV Q8H (peaks & troughs)
Extended-interval: 4-7 mg/kg IV Q24H (random level, use nomogram)

Monitoring: renal function & serum levels

63
Q

What weight is used for Aminoglycoside dosing?

A
  1. If underweight: use total body weight (TBW)
  2. If normal: IBW or TBW
  3. Obese: AdjBW
64
Q

Aminoglycosides (pg. 358)

Boxed Warnings

A

Nephrotoxicity
Ototoxicity
Neuromuscular blockade

65
Q

Aminoglycosides (pg. 358)

When should the peaks and troughs be drawn up for a traditional IV dosing of Gentamicin - /Tobramycin?

A

Trough: drawn up 30 min BEFORE 4th dose (<2 mcg/mL)

Peak: drawn up 30 min AFTER the 4th dose (5-10 mcg/ml)

66
Q

Quinolones (pg. 360)

MOA

A

Inhibit DNA topoisomerase IV and DNA gyrase (topoisomerase II).

Concentration - dependent

67
Q

Quinolones (pg. 360-361)

Which drug(s) cover which pathogen(s)?

A

Respiratory FQs: Levofloxacin, Moxifloxacin and Gemifloxacin (enhance coverage of S. pneumoniae & atypical pathogens)

Cipro & Levo: active against Pseudomonas (synergy w/ another beta-lactam)

Moxi: anaerobic activity when used alone for IAI but NOT UTI

Delafloxacin: active against MRSA preferred in SSTI

68
Q

Quinolones (pg. 360)

Boxed Warnings

A

Tendon Rupture
Peripheral Neuropathy
CNS effects (incl. seizures)
Use Last-line (only if no alternatives)

69
Q

pg. 360

Warnings to monitor while on Quinolones

A

QT Prolongation (Moxi > Levo > Cipro)
Hypo/Hyperglycemia
Psychiatric disturbances
Photosensitivity

Avoid in: children & pregnancy/breastfeeding

70
Q

Quinolones (pg. 360-361)

IV:PO Ratio for Levofloxacin & Moxifloxacin

A

1:1

71
Q

Quinolones (pg. 361)

Respiratory Quinolones

A

Moxifloxacin (IV/PO 1:1; not renally adjusted, NOT for UTIs)
Gemifloxacin
Levofloxacin

“My Good Lungs”

72
Q

Quinolones (pg. 361)

Which FQs are used for Pseudomonas infections, UTIs, IAIs & traveler’s diarrhea?

A

Ciprofloxacin & Levofloxacin

73
Q

Macrolides (pg. 361)

MOA & coverage

A

Bind to 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis

Excellent coverage of “Atypicals,” utility against S. pneumoniae, Haemophilus, Neisseria & Moraxella

74
Q

Name the Atypical Pathogens

A

Legionella, Chlamydia, Mycoplasma, and Mycobacterium avium complex

75
Q

Macrolides (pg. 361-362)

Agents in Class (Brand/Generic) & Common Uses

A

—–General Uses——
CAP & Strep

Azithromycin (Zithromax) - COPD exacerbations, chlamydia, gonorrhea, MAC prophylaxis
Clarithromycin (Biaxin) - H. pylori
Erythromycin (E.E.S) - increase gastric motility

76
Q

Macrolides (pg. 361-362)

Warnings, Side Effects, & DDIs

A

QT Prolongation (Ery > Azith > Clarith)
Hepatotoxicity

SE: GI upset

DDI: Simvastatins/Lovastatins - Clarithromycin

77
Q

Tetracyclines (pg. 362-363)

Agents in Class (Brand/Generic) & Common Uses

A

—-General Uses—-
CA-MRSA skin infections, acne

Doxycycline (Vibramycin) - tick-borne infections, CAP, COPD exacerbations, sinusitis, VRE, UTI, Chlamydia, Gonorrhea
Minocycline (Minocin, Solodyn)
Tetracycline - H. pylori

78
Q

Tetracyclines (pg. 362-363)

Safety Issues

A
  1. Avoid in children <8 yoa, pregnancy/breastfeeding
  2. Photosensitivity
  3. Interaction with divalent cations
  4. IV:PO = 1:1 (doxy & mino)
  5. Minocycline: DILE
79
Q

What is DILE stand for?

A

Drug-induced lupus erythematosus

80
Q

Tetracyclines (pg. 362-363)

Coverage

A

S. aureus including CA-MRSA
H. influenzae, Moraxella, Atypicals +/- S. pneumoniae
Rickettsia
H. pylori
VRE

81
Q

Tetracyclines (pg. 362-363)

MOA

A

Inhibits protein synthesis by reversibly binds to 30S ribosomal subunit

82
Q

Sulfonamides (pg. 363)

MOA & Drug (Brand/Generic)

A

Inhibits bacterial folic acid synthesis

Sulfamethoxazole/Trimethoprim (Bactrim)

83
Q

Sulfonamides - SMX/TMP (pg. 363)

Types of Infection & Dosing

A

Severe infections (CA-MRSA): IV/PO 10-20 mg TMP/kg/day Q6H (Bactrim DS 2 tabs BID-TID)

Uncomplicated UTI: 1 DS tab PO BID x3 days

Pneumocystis Pneumonia Prophylaxis (PCP): 1 DS/SS tab daily

84
Q

Sulfonamides - SMX/TMP (pg. 363)

Single Strength vs Double Strength Dose for each component

A

SS: 400 mg SMX/80 mg TMP

DS: 800 mg SMX/160 mg TMP

85
Q

Sulfonamides - SMX/TMP (pg. 363)

SMX:TMP ratio

A

5:1

86
Q

Sulfonamides - SMX/TMP (pg. 363)

When NOT to use, Warnings, & Side effects

A
  1. Sulfa allergy or pregnant/breastfeeding
  2. Warnings: SJS/TENs, thrombotic thrombocytopenic purpura (TTP), G6PD deficiency (hemolysis risk)
  3. SE: Photosensitivity, incr. K, hemolytic anemia (positive Coombs test), crystalluria (drink 8 oz of water), increase INR when used with warfarin
87
Q

ABX for Gram-positive infections - Vancomycin

MOA

A

Inhibit bacterial cell wall synthesis by binding to D-alanyl-D-alanine

88
Q

ABX for Gram-positive infections - Vancomycin

Coverage, Dosing, Monitoring, & Side Effect

A

Coverage: Gram-positive (MRSA), Streptococci, Enterococci, C. difficile

Dosing: IV: 15-20 mg/kg Q8-12H using TBW (**need renal dose adj); CrCl 20-49: Q24H

Monitoring: SCr and avoid other nephrotoxic/ototoxic drugs (Lasix, AMG, Cisplatin)

SE: Red Man Syndrome (w/ rapid infusion)

89
Q

ABX for Gram-positive infections - Vancomycin

First Line Treatment in what infections?

A

Meningitis
Some SSTIs
Bacteremia
Pneumonia

“My Shitty Bitchy Person!”

90
Q

ABX for Gram-positive infections - Vancomycin

Target Trough for Severe Infections

A

15-20 mcg/mL

91
Q

ABX for Gram-positive infections - Vancomycin

Oral Dosing and Indication

A

Indication: C. difficile infections

Dosing: PO 125 mg QID x 10 days

92
Q

ABX for Gram-positive infections - Lipoglycopeptides

Drugs (Brand/Generic)

A

Telavancin (Vibativ)
Oritavancin (Orbactiv)
Dalbavancin (Dalvance)

93
Q

ABX for Gram-positive infections - Lipoglycopeptides

MOA

A

Inhibit cell wall synthesis

94
Q

ABX for Gram-positive infections - Lipoglycopeptides

Which agent is approved for skin infections and HAP/VAP?

A

Telavancin

95
Q

ABX for Gram-positive infections - Lipoglycopeptides

Boxed Warnings, Contraindications, & Warnings

A

BW (Telavancin): Fetal risk, nephrotoxicity, increase mortality compared to Vancomycin in Pneumonia

——Contraindications—–
Telavancin: concurrent use of IV UFH
Oritavancin: use of IV UFH for 5 days after

——-Warnings——–
Telavancin: falsely increased aPTT/PT/INR
Oritavancin: increase PT/INR (~12H) and increase aPTT (~120H)

96
Q

Daptomycin

MOA, Brand, Coverage, Indications, Warnings, & Monitoring

A

Brand: Cubicin —> Scroll down <—–

MOA: inhibits intracellular replication process (binds to cell membrane)

Coverage: MRSA + VRE (E. faecium/faecalis)

Indications: SSTIs, bloodstream infections/endocarditis (NOT for Pneumonia)

Warnings: Myopathy/rhabdomyolysis; falsely increase PT/INR

Compatible with NS or LR ONLY (No Dextrose)

Monitor: CPK weekly (if taking a statin or renal impaired)

97
Q

Oxazolidinones

Agents (Brand/Generic), MOA, Coverage, Indications, & IV/PO ratio

A

MOA: inhibits translation and protein synthesis by binding to 50S subunit

Linezolid (Zyvox) - SSTIs, VRE infections, pneumonia, & bloodstream infections
Tedizolid (Sivextro) - SSTI only

Coverage: similar to vanc + VRE

IV/PO Ratio = 1:1

98
Q

Oxazolidinones - Linezolid (pg. 366)

Contraindications & Warnings

A

CI: MAOI use within 14 days

——Warnings——-
1. Duration related myelosuppression (thrombocytopenia) - monitor CBC weekly
2. Optic neuropathy
3. Serotonin Syndrome:
~both weak MAOI inhibitors
~caution with serotonergic drugs (SSRIs, SNRIs, TCAs)
~avoid tyramine-containing foods

99
Q

Quinupristin/Dalfopristin

Brand, MOA, Coverage, Indications, Side Effects, & Compatibility

A

Brand: Synercid

MOA: Inhibit protein synthesis (50S subunit)

Coverage: Gram-positive including MRSA, VRE (E. faecium only)

Indications: SSTIs

Side Effects: Arthralgia/myalgias, infusion rxn, hyperbilirubinemia, phlebitis (admin central line)

Compatible with D5W only

100
Q

Additional Broad-Spectrum Antibiotics - Tigecycline (pg. 367)

Brand, MOA, Coverage, Indications, Boxed Warning, & Notes

A

Brand: Tygacil

MOA: Inhibit protein synthesis - 30S

Coverage: Gram-positive (MRSA/VRE), Gram-negatives, Anaerobes & Atypicals

Indications: complicated SSTIs, IAIs, & CAP

BW: Increase risk of death

——Notes—–
1. Do not use in bloodstream infections
2. No activity against “3Ps” (Pseudomonas, Proteus, Providencia)
3. Solution should be yellow-orange in color “like a tiger!”
4. No renal dose adjustments

101
Q

Additional Broad-Spectrum Antibiotics - Polymyxin (pg. 368)

Formulations, Coverage/uses & Toxicities

A

Formulations: Colistimethate sodium (prodrug of colistin) & polymyxin B sulfate “assess dose carefully”

Coverage/Uses: MDR Gram-negative infections

Toxicities: Nephrotoxicity (dose-dependent) & Neurotoxicity

102
Q

What are the 3Ps?

A

Pseudomonas, Proteus. Providencia

103
Q

Chloramphenicol Antibiotic

A

Broad-spectrum
Serious blood dyscrasias
Causes gray syndrome - high serum levels, cyanotic, coma –> death

104
Q

Cleocin Generic & Facts

A

Generic: Clindamycin

—–Facts——–
1. Multiple formulations
2. Covers Staphylococci, Streptococci and anaerobes
3. No renal dose adjustments
4. Boxed warning: C. difficile colitis
5. Do Induction (D-test) - “If sensitive to clindamycin but resistant to erythromycin” –> if Positive test do NOT use Clindamycin

105
Q

Flagyl Generic & Facts

A

Generic: Metronidazole – 2C9 inhibitor

—–Facts——–
1. Anaerobic and protozoal infections
2. Multiple formulations
3. IV/PO ratio = 1:1
4. CI: Pregnancy (1st trimester), alcohol/propylene glycol (disulfiram rxn) |3 day window|
5. SE: Metallic taste & vulvovaginal candidiasis
6. Increase INR with warfarin

106
Q

What is the first line treatment for C. difficile infection?

Name (Brand/Generic) & Formulation

A

Fidaxomicin (Dificid)

PO only

107
Q

Rifaximin

Coverage, Formulation & Indications

A

E. coli
PO only
Indications: Traveler’s diarrhea, prevention of hepatic encephalopathy, IBS-D
Off-label: C. diff

108
Q

Urinary Agents (pg. 371)

Agents (Brand/Generic) & which is the drug of choice?

A

Fosfomycin (Monurol)

Nitrofurantoin (Macrobid, Macrodantin)*****

109
Q

Urinary Agents - Nitrofurantoin

Dosing, Warnings, & Counseling

A

——Dosing——
Macrobid 100 mg BID x 5 days***
Macrodantin is QID
Avoid if CrCl < 60 mL/min

Warnings: Avoid in G6PD deficiency, can cause hemolytic anemia (positive Coombs test)

Counseling: take with food, discolor urine (brown)

110
Q

Urinary Agents - Fosfomycin

Coverage & Dose Regimen

A

Coverage: E. coli (including ESBL), E. faecalis (incl. VRE)

Single-dose regimen

111
Q

Topical Decolonization - Drug of Choice (Brand/Generic)

A

Mupirocin (Bactroban) Nasal ointment x 5 days

eliminates Staphylococci MRSA colonization*

112
Q

Drugs of Choice/Active Drugs for Specific Pathogens (pg. 372)

Nosocomial MRSA

A

Vancomycin (consider using alternative if MIC >2)

Linezolid
Daptomycin (not in pneumonia)

113
Q

Drugs of Choice/Active Drugs for Specific Pathogens

C. difficile infections

A

Fosfomycin & Vancomycin

114
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Community-acquired methicillin-resistant S. aureus (CA-MRSA) and skin & soft tissue infections “SSTIs”

A

SMX/TMP (Bactrim)
Linezolid
Doxycycline/Minocycline
Clindamycin (D-test must be performed before using)

“Bad Lungs Do More Coughing”

115
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Methicillin-sensitive S. aureus (MSSA)

A

Nafcillin, Oxacillin, Dicloxacillin
Cefazolin, Cephalexin

116
Q

Drugs of Choice/Active Drugs for Specific Pathogens

VRE (E. faecalis)

A

Pen G or Ampicillin
Linezolid
Daptomycin

—Cystis only—–
Nitrofurantoin, fosfomycin or doxycycline

117
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Acinetobacter baumannii

A

Carbapenems (except ertapenem)

118
Q

Drugs of Choice/Active Drugs for Specific Pathogens

VRE (E. faecium)

A

Daptomycin
Linezolid

—Cystic only——
Nitrofurantoin, fosfomycin or doxycycline

119
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Bacteroides fragilis

A

Metronidazole
Beta-lactam/beta-lactamase inhibitors
Cefotetan, Cefoxitin
Carbapenems

120
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Carbapenem-resistant Gram-negative rods (CRE)

A

Ceftazidime/avibactam (Avycaz)
Colistimethate, polymyxin B sulfate

121
Q

Drugs of Choice/Active Drugs for Specific Pathogens

HNPEK

A

Beta-lactam/Beta-lactamase inhibitors

122
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Extended-spectrum beta-lactamase producing Gram-negative rods (ESBL GNR) - E. coli, K. pneumoniae, P. mirabilis

A

Carbapenems
Ceftazidime/avibactam (Avycaz)
Ceftolozane/tazobactam (Zerbaxa)

123
Q

Drugs of Choice/Active Drugs for Specific Pathogens

Atypical Organisms

A

Azithromycin
Doxycycline
Quinolones

124
Q

Storage Requirements - Liquid Oral ABX (pg. 373)

Refrigeration Required after Reconstitution

A

Pen VK
Ampicillin
Augmentin
Keflex

125
Q

Storage Requirements - Liquid Oral ABX

Which drug should NOT Refrigerated? Which drug is recommended for taste?

A

NOT: Cefdinir

Taste Enhancement: Amoxicillin

126
Q

Storage Requirements - IV Antibiotics

DO NOT Refrigerate!

A

Metronidazole
Moxifloxacin (Avelox)
SMX/TMP

127
Q

Key Drugs That do NOT require renal adjustments

A

Anti Staphylococcus PCNs (Naf, Oxa, Diclox)
Ceftriaxone
Clindamycin
Doxycycline
Macrolides (EES & Zithromax only)
Metronidazole
Moxifloxacin
Linezolid
Vancomycin (PO only)

NAPLEX 2022 (25 decks)

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