Infectious Disease pt 1 Flashcards
1
Q
Gram + bugs will stain ______
Gram - bugs will stain ______
A
\+ = purple/blue - = red/pink
2
Q
what are some mechanisms of resistance?
A
intrinsic (natural) selection pressure (resistant bacteria remain behind) enzyme inactivation
3
Q
examples of beta lactamase inhibitors?
A
clavulanate
sulbactam
tazobactam
avibactam
4
Q
what bug is the most common CRE (carbapenem resistant enterobactieracae)
A
klebsiella
5
Q
T or F: All abx have risk for C.Diff infection
A
true
6
Q
what abx are folic acid synthesis inhibitors
A
sulfonamides
trimethoprim
dapsone
7
Q
what abx are cell wall inhibitors
A
beta lactams (PCNs, cephalosporins, carbapenems)
Monobactams
Vancomyocin, dalbavancin, telavancin, oritavancin
8
Q
what abx are DNA/RNA inhibitors
A
quinolones
metronidazole/tinidazole
Rifampin
9
Q
what abx are cell membrane inhibitors
A
polymyxin
daptomycin
telavancin
oritavancin
10
Q
what abx are protein synthesis inhibitors
A
aminoglycosides macrolides tetracyclines clindamycin linezolid/tedizolid quinupristin/dalfopristin
11
Q
(Lipophillic or hydrophilic) drugs usually have enhanced penetration of bone, lung, and brain tissue
A
lipophillic
12
Q
(Lipophillic or hydrophilic) is renal eliminated and thus can be nephrotoxic
A
hydrophilic
13
Q
(Lipophillic or hydrophilic) has hepatic metabolism and thus can be hepatoxic/has drug drug interactions
A
lipophilic
14
Q
(Lipophillic or hydrophilic) has increased clearance and/or distribution in sepsis and will probably need to do larger doses during sepsis
A
hydrophilic
15
Q
(Lipophillic or hydrophilic) has excellent bioavailability and thus PO:IV ratio is 1:1
A
lipophilic
16
Q
(Lipophillic or hydrophilic) has small volume of distribution and thus poor tissue penetration
A
hydrophilic
17
Q
(Lipophillic or hydrophilic) gets intracellularly and thus is active against atypical pathogens
A
hydrophilic
18
Q
what drugs are hydrophilic
A
beta lactam aminoglycosides glycopeptides daptomyocin colistimethate
19
Q
what drugs are lipophilic
A
quinolones macrolides rifampin linezolid tetracyclines chloramphenicol
20
Q
what ways can you maximize the pharmacodynamics of beta lactam abx
A
more frequent dosing/shorter drug interval
extending the infusion time
give as a continuous infusion
21
Q
what drugs are time dependent (time>MIC) and what is the PD goal?
A
beta lactams (PCNs, cephalosporins, carbapenems)
Goal: keep drug level above the MIC for most of the dosing interval
22
Q
what drugs’ PD is AUC:MIC?
what what is the PD goal?
A
vancomycoin, macrolides, tetracyclines, colistimethate
Goal: exposure over time
23
Q
what drugs PD is Cmax: MIC (concentration dependent)
and what is the PD goal?
A
aminoglycosides, quinolones, daptomyocin
Goal: high peak = killing and low trough = less toxicity
24
Q
beta lactamase inhibitors add ______ and _____ coverage
A
gram - and anaerobe
25
what bug does PCN notably cover
streptococci
26
what is the IM form of PCN?
PCN benzathine
| PCN procaine
27
ADEs of PCN?
GI upset
rash
Seizure with accumulation
28
Amoxicillin and Augmentin can come in ______ dosage forms (that others do not)
chewable
29
Pip/tazo usually administered over what amount of time to increase time > MIC?
4 hours
30
What is oral PCN used for the most?
strep throat
or
mild (non purulent) skin infections
31
What is oral Amoxicillin commonly used for?
otitis media (80 - 90 mg/kg/day)
infective endocarditis prophylaxis before dental procedures
Used in H.pylori infections
32
What is oral Amoxicillin/Clavulanate commonly used for?
otitis media/sinus infection (90 mg/kg/day)
33
important dosing consideration for amox/clav
use product with the least amount of clavulanate to decrease diarrhea side effects
34
what is IM PCN benzathine commonly used for?
drug of choice for syphillis - IM for one dose
35
PCN benzathine should NOT be given via _____ because it can cause death
IV
36
Pip/tazo is able to cover _____ unlike most other PCNs
pseudomonas
37
What PCNs cover MSSA but not MRSA?
nafcillin
oxacillin
dicloxacillin
38
Which PCNs do NOT need renally adjusted?
nafcillin/oxacillin
| dicloxacillin
39
1st generation cephalosporins cover gram ____ cocci well and are best for _____ infections
gram + cocci
| MSSA infections
40
1st gen cephs cover what gram - rods
PEK
| proteus, E.coli klebsiella
41
2nd gen cephs are split into two groups
Drugs like cefuroxime cover ________
The cephamycin drugs like cefotetan and cefoxitin have added ______ coverage
HNPEK (Haemophilus, Neiserria, proteus, E.coli klebsiella)
have added anaerobe coverage
42
3rd gen cephs are more resistant to _______ but have enhanced _______ coverage
resistant to streptococci
| more gram - coverage
43
3rd gen ceph drug ceftazidime does not have any _____ coverage but is able to cover ________
no gram + coverage
| is able to cover pseudomonas
44
3rd gen ceph + beta lactamase inhibitor combinations (ex: ceftazidime/avibactam and ceftolozane/tazobactam) are us able to cover what?
MDR pseudomonas
| and more gram negative rods
45
what is the name of the 4th drug ceph?
cefepime
46
what is the only cephalosporin with MRSA coverage?
ceftaroline
47
Generally for the class of cephalosporins: they do not cover _______ or _________
enterobacteriacae or atypicals
48
What is oral cephalexin commonly used for?
MSSA skin infections
| strep throat
49
What is oral Cefuroxime commonly used for?
otitis media
Community acquired pneumonia (CAP)
sinus infection
50
What is oral Cefdinir commonly used for?
Community acquired pneumonia (CAP)
| sinus infection
51
What is IV cefazolin commonly used for?
surgical prophylaxis
52
What is IV cefotetan/cefoxitin commonly used for?
anaerobe coverage - B. fragilis
| thus good for surgical prophylaxis (COLORECTAL surgeries)
53
what cephalosporin can cause disulfiram like reactions with alcohol
the cephamycins -- ex: cefotetan
54
what age population should not use ceftriaxone?
neonates (0 - 28 days)
55
What is IV ceftriaxone/cefotaxime commonly used for?
CAP
meningitis
spontaneous bacterial peritonitis
pyleonephritis
56
which cephalosporin does not need renal adjustment
ceftriaxone
57
Ceftazidime and Cefepime are able to cover _______ infections
pseudomonas
58
common 1st gen cephs?
cefazolin
| cephalexin
59
common 2nd gen cephs?
cefuroxime
| cefoTEtan
60
Cefotetan has a ______ that causes disulfiram reactions and ________
NMTT side chain
and hypoprothrombinemia (bleeding)
61
main side effects of cephalosporins?
GI upset
rash
seizures with accumulation
62
common 3rd gen cephs?
cefdinir
ceftriaxone
cefotaxime
63
______ is available in a chewable tablet
cefixime
64
what cephalosporin/beta lactamase inhibitor combo is used for some CRE (carbapenem reistnant enterobacteriacae)
ceftazidime/avibactam
65
brand name for cefdinir?
omnicef
66
brand name for cefazolin?
Ancef
| Kefzol
67
brand name for cefotetan?
Cefotan
68
brand for ceftriaxone?
Rocephin
69
brand name for cefotaxime?
Claforan
70
brand name for ceftazidime/avibactam?
Avycaz
71
brand name for ceftolozane/tazobactam?
Zerbaxa
72
brand name for ceftaroline?
Teflaro
73
what is the 4th gen ceph
cefepime
74
what carbapenem is give with cilastatin? and why?
imipenem
| to prevent the drugs degradation by renal tubular dehydropeptidase
75
what carbapenem does not cover pseudomonas?
ertapenem
76
T or F:
| Carbapenems do NOT cover what?
```
Atypials
MRSA
VRE
C.Diff
stenotrophomonas
```
77
Ertapenem does not cover pseudomonas or what other bugs?
acinetobacter
| enterococcus
78
common uses for carbapenems?
- polymicrobial infections (ex mod-severe diabetic foot infections)
- empiric therapy when resistant organisms are suspected
- resistant pseudomonas or acinetinobacter
79
Carbapenem Warnings:
Avoid use in patients with ______
And there is a risk of ______
w/ PCN allergy
| risk of seizures
80
what increases the risk of seizures with carbapenems?
using higher doses
renal impairment
using imipenem/cilastatin
81
Carabepenems are all administered via _____
IV
82
Ertapenem must be diluted with _______ before adminsitration
normal saline
83
T or F:
| Aztreonam is likely safe to use with PCN allergy
true --- cross reactivity is very rare
84
Typical coverage of aztreonam:
covers mainly gram _____
it has NO coverage of gram _____
gram - (even pseudomonas)
NO gram + coverage
85
brand name for aztreonam?
Azactam
86
Aminoglycosides:
exhibit _____ dependent antibacterial activity
and have a ________ effect
concentration dependent
post antibiotic effect
87
what type of dosing is good for aminoglycosides so that you can can get a good peak but less toxicity
extended internal dosing
88
Aminoglycosides:
kill gram _______ fast
and can act synergistically with ________ for some bugs
gram -
| w/ beta lactams
89
Aminoglycosides:
| notable toxicities?
renal damage
| hearing loss/tinnitus/balance problems = ototoxicity
90
T or F:
| Aminoglycosides do not cover pseudomonas
false - they do!
91
If using an extended interval dosing nomogram --- if it falls on the line, round (up or down)
up
92
What is an extended interval dosing nomogram for aminoglycosides used for/ how does it work?
after one dose - draw a random level
| on the nomogram it will help you determine the interval dosing
93
what drugs are aminoglycosides?
gentamicin
tobramycin
amikacin
Streptomycin
94
Dosing Aminoglycosides:
| if the patient is underweight --- use _______ weight
actual body weight
95
Dosing Aminoglycosides:
| if the patient is obese --- use ________ weight
adjusted body weight
96
Dosing Aminoglycosides:
| if the patient is not obese --- use ________ weight
ideal body weight or actual body weight -- look at hospitals protocol
97
Traditional Dosing for Gentamicin/Tobramycin?
1 - 2.5 mg/kg/DOSE
| use lower doses if gram + infection
98
Traditional Dosing for Amikacin?
5 - 7.5 mg/kg/dose
99
in what conditions should you NOT use extended interval dosing for aminoglycosides?
burns
ESRD
pregnancy
ascites
100
Monitor what for aminoglycosides?
renal function
| drug levels
101
Boxed warning for aminoglycosides?
Nephro / oto - toxic
neuromuscular blockade/respiratory paralysis
avoid use with other neuro/nephrotoxic drugs
102
what drugs are known as the respiratory quinonlones and why?
levofloxacin
moxifloxacin
they have enhanced coverage of s. pneumoniae
103
what quinolone covers MRSA?
delafloxacin
104
Ciprofloxacin and levofloxacin have enhanced gram ______ coverage
negative
105
T or F:
| Quinolones are first line for MRSA infections
false --- with resistance being high with quinolones - have to avoid quinlones
106
brand name for moxifloxacin?
Avelox
107
All but one quinolone needs renally adjustment -- which one does not need renal adjustment
moxifloxacin does not need the adjustment
108
Boxed warnings of quinolones?
tendon inflammation/rupture
peripheral neuropathy
seizures
109
what patient age population should not use quinolones
children
110
Quinolone warnings?
QT prolongation
hepatoxicity
photosensitivity
hypo and hyper glycemia problems
111
Cipro oral suspension should not be given via ______ and why?
and what to do instead?
do not give via NG tube or other feeding tubes
crush up IR cipro tablets in water and give via tube
112
which quinolone does not get into the urine enough/should not be used for UTIs?
moxifloxacin
113
which quinolones are good for pseudomonal infections?
cipro and levo
114
delafloxacin is mainly used for what type of infection?
skin infections - MRSA coverage
115
main drug interaction with the quinolones?
multivalent cations can chelate and inhibit absorption
116
what quinolones have a PO:IV ratio of 1:1
levofloxacin and moxifloxacin
117
Quinolone Tips:
- watch for additive toxicity of ________ with other meds
- avoid use in patients with _______
QT prolongation
w/ seizures
118
Quinolone Tips:
watch for tendon rupture (especially in _____ patients and patients using _____)
watch for neuropathy
older patients; and patients using steroids
119
Quinolone Counseling Tips:
- avoid ______ exposure
- separate from _______
- monitor ______
avoid sun exposure
separate from cations
monitor blood sugar - if DM
120
Macrolides:
| have good _______ coverage
atypical
121
what drugs are macrolides?
azithromycin
clarithromycin
erythromycin
122
brand name for clarithromycin
Biaxin
123
Contraindication for Clarithromycin and Erythromycin?
contaminant use of lovastatin and simvastatin
124
ADEs of macrolides ?
GI upset (diarrhea, abdominal pain, cramping - especially erythromycin)
125
warnings of macrolides?
QT prolongation
| hepatoxicity
126
which macrolide has the highest risk of QT prolongation?
erythromycin
127
T or F:
| Azithromycin ER suspension is bioequivalent with Zithromax
false ----they are NOT interchangeable
128
which macrolides are 3A4 inhibitors?
erythromycin and clarithromycin
| azithromycin - is a MINOR substrate - very few clinically significant drug interactions
129
With all macrolides do use other drugs that also ______
prolong the QT interval
130
Common uses for macrolides:
| All can be used for ______ and as a beta lactam alternative for _______
used for CAP; alternative for strep throat
131
Azithromycin Uses:
- can be used for _________
- or as monotherapy for which STD?
- or combo therapy for which STD?
- prophylaxis for ______
- drug of choice for ________
```
used for COPD exacerbations
mono: chlamydia
combo: gonorrhea
proph: MAC
DOC for dysentery (travelers diarrhea with blood stools)
```
132
Doxycycline can be used for:
________ (mild infections)
and
even ______ in UTIs
CA-MRSA skin infections
VRE in UTIs
133
Tetracycline drug examples?
doxycycline
| minocycline
134
Oracea 40 mg (a low dose of doxycycline) should be given how in relation to food?
on empty stomach (1 hr before food or 2 hours after)
135
Warnings of tetracyclines:
| What groups of people should not use them?
Children under 8
pregnant
breastfeeding
(because of bone growth issues and permanently discolors teeth)
136
Warnings of tetracyclines:
| can cause what two different kinds of skin issues?
DILE - drug induce lupus erythematosus (mainly minocycline)
and
photosensitivity
137
ADEs of tetracyclines?
N/V/D
138
IV: PO conversion for doxycyline and minocycline?
1:1
139
main drug interaction for tetracyclines?
divalent cations (Mg, Al, Ca)
iron containing preparations
sucralfate
bismuth salicylate
(separate 1 hr before; 2 hr after)
140
Doxycycline and minocycline commonly used for
| ________ infections and ______
CA-MRSA
| and acne
141
Doxycycline is first line for ________ and _______ (tick borne diseases)
lyme disease
| rocky mountain spotted fever
142
Doxycycline:
- or as monotherapy for which STD?
- or combo therapy for which STD?
mono: chlamydia
combo: gonorrhea
143
Tetracyline:
| used in _______ treatment
H.pylori
144
Sulfamethoxazole/TMP:
| dose is based on which component?
TMP componentn
145
Sulfamethoxazole/TMP dosing if uncomplicated UTI?
1 DS tab BID x 3 days
146
Contraindications of Sulfamethoxazole/TMP?
```
Sulfa allergy...
and pregnant (at term)
```
147
ADEs of Sulfamethoxazole/TMP?
```
N/V/D
Anorexia
skin reactions
crystalluria (thus take with water)
photosensitivity
increased K+
hypoglycemia
decreased folate
+ coombs test
```
148
main drug interaction with sulfonamide abx?
they are inhibitors of 2C9 - aka interact with warfarin and can increase INR
149
common uses of Sulfamethoxazole/TMP?
CA-MRSA skin infections
UTI
PCP (pneumocystis pneumonia)
150
the Sulfamethoxazole/TMP ratio is always ___: ___
sulfa 5 : 1 TMP
| ex: (400 / 80 )
151
common dosing for C. Diff for vancomycoin?
125 - 500 mg PO!! QID x 10 - 14 days
152
dosing for systemic infections for vanc?
15 - 20 mg/kg IV Q 8 - 12H
153
warnings for vancomyocin?
Neprhotoxicity and ototoxicity
| Infusion/Red man syndrome
154
Vanc is 1st line treatment for ______ infections
MRSA infections
155
Monitor what when using vancomyocin
renal function
| trough concentration
156
Goals for vanc trough?
15 - 20 for pneumonia, endocarditis, meningitis, osteo
10 - 15 for other infections
157
Consider a different drug than vancomyocin when MRSA MIC is > ___
2
158
examples of lipoglycopeptides
telavancin
oritavancin
dalbavancin
159
lipoglycopeptides have coverage similar to what other antibiotic
vancomyocin
160
which glycopeptides need to only be given once because of very long half lives?
oritavancin
| dalbavancin
161
the lipoglycopeptides can falsely elevate ______
PT/INR
162
contraindication for oritavancin?
use of IV Unfractionated Heparin for 5 days after use because of interference of aPTT lab results
163
Side effects seen with lipoglycopeptides?
Red man syndrome
| N/V
164
which lipoglycopeptide causes metallic taste
telavancin
165
infuse telavancin for how long to prevent red man syndrome?
OVER 60 minutes
166
boxed warnings for telavancin
- fetal risk
- nephrotoxicity
- increased mortality (vs vanc in some pts treated for pneumonia esp with renal impairment)
167
Daptomyocin Warnings:
can cause _______ and _______
and can falsely elevate ______
- myopathy and rhabdomyolysis
| - elevate PT/INR
168
Daptomyocin Side effects and monitoring
increased CPK
| check CPK levels weekly
169
Daptomyocin
| is compatible with ______ but not _____
good with NS (not dextrose)
170
Do not use daptomyocin to treat what type of infection??
pneumonia (drug is inactivated in the lungs by surfactant)
171
what drugs are oxazolidinones?
linezolid
| tedizolid
172
Contraindication for linezolid?
w/in 2 weeks of MAO inhibitor use
173
warning and side effects for linezolid?
duration related myleosuppression (thrombocytopenia)
| can decrease platelets and cause HA/nausea/diarrhea
174
Counseling/administration point about linezolid suspension
DO NOT shake it!!
175
Use linezolid with caution what drugs?
serotonergic or adrenergic drugs
176
Synercid (quinapristin/dalfopristin) is not tolerated well and thus not used a lot -- what kind of infections would it maybe be used?
for VRE infections (but NOT active against faecalis infections; just faecium)
177
Side effects of synercid?
```
arhralgias/myalgias (V COMMON)
infusion reactions
edema/pain
phlebitis
hyperbilirubinemia
CPK elevations
```
178
Tigecycline: covers what bugs?
VRE, MRSA, gram negative, anaerobes and atypical
179
Tigecycline does not cover the 3 "___'s"
3 P's = pseudomonas; proteus, providencia
180
Tigecycline:
| T or F: Needs renal adjustment
FALSE
| it does not need renal adjustment
181
Tigecycline:
Increased risk of _______
Side effects seen?
risk of death
N/V/D
182
Tigecycline
| Avoid use in ______ infections
bloodstream
183
Tigecycline
| When reconstitued it should be _________ - if it is not - throw it away
yellow/orange
184
Polymyxins: best as mono or combo therapy?
best as combo b/c of emerging resistance
185
Examples of polymyxin?
colistimethate or colistin
| and polymyxin B....
186
main side effects warning with the polymyxins?
neuro (dizzy, HA, vertigo) and nephro toxic
187
you need to ASSESS THE DOSE carefully for colistimethate... why?
the dosing can be based off units of colistimethate sodium or mg of colistimethate sodium or mg of colistin base
188
what abx can cause Gray syndrome? (and what is gray syndrome)
chloramphenicol
| gray syndrome = circulatory collapse/cyanosis
189
Chloramphenicol side effects
gray syndrome and myleosuppression
190
what abx needs a D test?
Clindamycin
(D test = test done if resistant to erythromycin but not clindamycin --- may need to do this test to make sure that is correct)
191
boxed warning for Clindamycin?
C.diff
192
Rifaximin can it NOT be used for Spontaneous bacterial peritonitis or travelers diarrhea? and why?
SBP -- it does not absorb well (stays in the gut!)
| it CAN be used also for IBS with diarrhea, hepatic encephalopthy, refractory c.diff
