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NAPLEX Prep > Infectious Disease pt 1 > Flashcards

Infectious Disease pt 1 Flashcards

1
Q

Gram + bugs will stain ______

Gram - bugs will stain ______

A 
\+ = purple/blue
- = red/pink
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2
Q

what are some mechanisms of resistance?

A 
intrinsic (natural)
selection pressure (resistant bacteria remain behind)
enzyme inactivation
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3
Q

examples of beta lactamase inhibitors?

A

clavulanate
sulbactam
tazobactam
avibactam

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4
Q

what bug is the most common CRE (carbapenem resistant enterobactieracae)

A

klebsiella

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5
Q

T or F: All abx have risk for C.Diff infection

A

true

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6
Q

what abx are folic acid synthesis inhibitors

A

sulfonamides
trimethoprim
dapsone

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7
Q

what abx are cell wall inhibitors

A

beta lactams (PCNs, cephalosporins, carbapenems)
Monobactams
Vancomyocin, dalbavancin, telavancin, oritavancin

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8
Q

what abx are DNA/RNA inhibitors

A

quinolones
metronidazole/tinidazole
Rifampin

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9
Q

what abx are cell membrane inhibitors

A

polymyxin
daptomycin
telavancin
oritavancin

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10
Q

what abx are protein synthesis inhibitors

A 
aminoglycosides
macrolides
tetracyclines
clindamycin
linezolid/tedizolid
quinupristin/dalfopristin
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11
Q

(Lipophillic or hydrophilic) drugs usually have enhanced penetration of bone, lung, and brain tissue

A

lipophillic

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12
Q

(Lipophillic or hydrophilic) is renal eliminated and thus can be nephrotoxic

A

hydrophilic

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13
Q

(Lipophillic or hydrophilic) has hepatic metabolism and thus can be hepatoxic/has drug drug interactions

A

lipophilic

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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

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15
Q

(Lipophillic or hydrophilic) has excellent bioavailability and thus PO:IV ratio is 1:1

A

lipophilic

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16
Q

(Lipophillic or hydrophilic) has small volume of distribution and thus poor tissue penetration

A

hydrophilic

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17
Q

(Lipophillic or hydrophilic) gets intracellularly and thus is active against atypical pathogens

A

hydrophilic

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18
Q

what drugs are hydrophilic

A 
beta lactam
aminoglycosides
glycopeptides
daptomyocin
colistimethate
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19
Q

what drugs are lipophilic

A 
quinolones
macrolides
rifampin
linezolid
tetracyclines
chloramphenicol
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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

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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

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22
Q

what drugs’ PD is AUC:MIC?

what what is the PD goal?

A

vancomycoin, macrolides, tetracyclines, colistimethate

Goal: exposure over time

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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

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24
Q

beta lactamase inhibitors add ______ and _____ coverage

A

gram - and anaerobe

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25
Q

what bug does PCN notably cover

A

streptococci

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26
Q

what is the IM form of PCN?

A

PCN benzathine

PCN procaine

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27
Q

ADEs of PCN?

A

GI upset
rash
Seizure with accumulation

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28
Q

Amoxicillin and Augmentin can come in ______ dosage forms (that others do not)

A

chewable

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29
Q

Pip/tazo usually administered over what amount of time to increase time > MIC?

A

4 hours

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30
Q

What is oral PCN used for the most?

A

strep throat
or
mild (non purulent) skin infections

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31
Q

What is oral Amoxicillin commonly used for?

A

otitis media (80 - 90 mg/kg/day)

infective endocarditis prophylaxis before dental procedures

Used in H.pylori infections

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32
Q

What is oral Amoxicillin/Clavulanate commonly used for?

A

otitis media/sinus infection (90 mg/kg/day)

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33
Q

important dosing consideration for amox/clav

A

use product with the least amount of clavulanate to decrease diarrhea side effects

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34
Q

what is IM PCN benzathine commonly used for?

A

drug of choice for syphillis - IM for one dose

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35
Q

PCN benzathine should NOT be given via _____ because it can cause death

A

IV

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36
Q

Pip/tazo is able to cover _____ unlike most other PCNs

A

pseudomonas

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37
Q

What PCNs cover MSSA but not MRSA?

A

nafcillin
oxacillin
dicloxacillin

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38
Q

Which PCNs do NOT need renally adjusted?

A

nafcillin/oxacillin

dicloxacillin

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39
Q

1st generation cephalosporins cover gram ____ cocci well and are best for _____ infections

A

gram + cocci

MSSA infections

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40
Q

1st gen cephs cover what gram - rods

A

PEK

proteus, E.coli klebsiella

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41
Q

2nd gen cephs are split into two groups
Drugs like cefuroxime cover ________

The cephamycin drugs like cefotetan and cefoxitin have added ______ coverage

A

HNPEK (Haemophilus, Neiserria, proteus, E.coli klebsiella)

have added anaerobe coverage

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42
Q

3rd gen cephs are more resistant to _______ but have enhanced _______ coverage

A

resistant to streptococci

more gram - coverage

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43
Q

3rd gen ceph drug ceftazidime does not have any _____ coverage but is able to cover ________

A

no gram + coverage

is able to cover pseudomonas

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44
Q

3rd gen ceph + beta lactamase inhibitor combinations (ex: ceftazidime/avibactam and ceftolozane/tazobactam) are us able to cover what?

A

MDR pseudomonas

and more gram negative rods

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45
Q

what is the name of the 4th drug ceph?

A

cefepime

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46
Q

what is the only cephalosporin with MRSA coverage?

A

ceftaroline

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47
Q

Generally for the class of cephalosporins: they do not cover _______ or _________

A

enterobacteriacae or atypicals

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48
Q

What is oral cephalexin commonly used for?

A

MSSA skin infections

strep throat

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49
Q

What is oral Cefuroxime commonly used for?

A

otitis media
Community acquired pneumonia (CAP)
sinus infection

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50
Q

What is oral Cefdinir commonly used for?

A

Community acquired pneumonia (CAP)

sinus infection

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51
Q

What is IV cefazolin commonly used for?

A

surgical prophylaxis

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52
Q

What is IV cefotetan/cefoxitin commonly used for?

A

anaerobe coverage - B. fragilis

thus good for surgical prophylaxis (COLORECTAL surgeries)

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53
Q

what cephalosporin can cause disulfiram like reactions with alcohol

A

the cephamycins – ex: cefotetan

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54
Q

what age population should not use ceftriaxone?

A

neonates (0 - 28 days)

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55
Q

What is IV ceftriaxone/cefotaxime commonly used for?

A

CAP
meningitis
spontaneous bacterial peritonitis
pyleonephritis

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56
Q

which cephalosporin does not need renal adjustment

A

ceftriaxone

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57
Q

Ceftazidime and Cefepime are able to cover _______ infections

A

pseudomonas

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58
Q

common 1st gen cephs?

A

cefazolin

cephalexin

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59
Q

common 2nd gen cephs?

A

cefuroxime

cefoTEtan

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60
Q

Cefotetan has a ______ that causes disulfiram reactions and ________

A

NMTT side chain

and hypoprothrombinemia (bleeding)

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61
Q

main side effects of cephalosporins?

A

GI upset
rash
seizures with accumulation

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62
Q

common 3rd gen cephs?

A

cefdinir
ceftriaxone
cefotaxime

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63
Q

______ is available in a chewable tablet

A

cefixime

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64
Q

what cephalosporin/beta lactamase inhibitor combo is used for some CRE (carbapenem reistnant enterobacteriacae)

A

ceftazidime/avibactam

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65
Q

brand name for cefdinir?

A

omnicef

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66
Q

brand name for cefazolin?

A

Ancef

Kefzol

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67
Q

brand name for cefotetan?

A

Cefotan

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68
Q

brand for ceftriaxone?

A

Rocephin

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69
Q

brand name for cefotaxime?

A

Claforan

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70
Q

brand name for ceftazidime/avibactam?

A

Avycaz

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71
Q

brand name for ceftolozane/tazobactam?

A

Zerbaxa

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72
Q

brand name for ceftaroline?

A

Teflaro

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73
Q

what is the 4th gen ceph

A

cefepime

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74
Q

what carbapenem is give with cilastatin? and why?

A

imipenem

to prevent the drugs degradation by renal tubular dehydropeptidase

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75
Q

what carbapenem does not cover pseudomonas?

A

ertapenem

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76
Q

T or F:

Carbapenems do NOT cover what?

A 
Atypials
MRSA
VRE
C.Diff
stenotrophomonas
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77
Q

Ertapenem does not cover pseudomonas or what other bugs?

A

acinetobacter

enterococcus

78
Q

common uses for carbapenems?

A
  • polymicrobial infections (ex mod-severe diabetic foot infections)
  • empiric therapy when resistant organisms are suspected
  • resistant pseudomonas or acinetinobacter
79
Q

Carbapenem Warnings:
Avoid use in patients with ______
And there is a risk of ______

A

w/ PCN allergy

risk of seizures

80
Q

what increases the risk of seizures with carbapenems?

A

using higher doses
renal impairment
using imipenem/cilastatin

81
Q

Carabepenems are all administered via _____

A

IV

82
Q

Ertapenem must be diluted with _______ before adminsitration

A

normal saline

83
Q

T or F:

Aztreonam is likely safe to use with PCN allergy

A

true — cross reactivity is very rare

84
Q

Typical coverage of aztreonam:
covers mainly gram _____
it has NO coverage of gram _____

A

gram - (even pseudomonas)

NO gram + coverage

85
Q

brand name for aztreonam?

A

Azactam

86
Q

Aminoglycosides:
exhibit _____ dependent antibacterial activity
and have a ________ effect

A

concentration dependent

post antibiotic effect

87
Q

what type of dosing is good for aminoglycosides so that you can can get a good peak but less toxicity

A

extended internal dosing

88
Q

Aminoglycosides:
kill gram _______ fast
and can act synergistically with ________ for some bugs

A

gram -

w/ beta lactams

89
Q

Aminoglycosides:

notable toxicities?

A

renal damage

hearing loss/tinnitus/balance problems = ototoxicity

90
Q

T or F:

Aminoglycosides do not cover pseudomonas

A

false - they do!

91
Q

If using an extended interval dosing nomogram — if it falls on the line, round (up or down)

A

up

92
Q

What is an extended interval dosing nomogram for aminoglycosides used for/ how does it work?

A

after one dose - draw a random level

on the nomogram it will help you determine the interval dosing

93
Q

what drugs are aminoglycosides?

A

gentamicin
tobramycin
amikacin
Streptomycin

94
Q

Dosing Aminoglycosides:

if the patient is underweight — use _______ weight

A

actual body weight

95
Q

Dosing Aminoglycosides:

if the patient is obese — use ________ weight

A

adjusted body weight

96
Q

Dosing Aminoglycosides:

if the patient is not obese — use ________ weight

A

ideal body weight or actual body weight – look at hospitals protocol

97
Q

Traditional Dosing for Gentamicin/Tobramycin?

A

1 - 2.5 mg/kg/DOSE

use lower doses if gram + infection

98
Q

Traditional Dosing for Amikacin?

A

5 - 7.5 mg/kg/dose

99
Q

in what conditions should you NOT use extended interval dosing for aminoglycosides?

A

burns
ESRD
pregnancy
ascites

100
Q

Monitor what for aminoglycosides?

A

renal function

drug levels

101
Q

Boxed warning for aminoglycosides?

A

Nephro / oto - toxic
neuromuscular blockade/respiratory paralysis
avoid use with other neuro/nephrotoxic drugs

102
Q

what drugs are known as the respiratory quinonlones and why?

A

levofloxacin
moxifloxacin

they have enhanced coverage of s. pneumoniae

103
Q

what quinolone covers MRSA?

A

delafloxacin

104
Q

Ciprofloxacin and levofloxacin have enhanced gram ______ coverage

A

negative

105
Q

T or F:

Quinolones are first line for MRSA infections

A

false — with resistance being high with quinolones - have to avoid quinlones

106
Q

brand name for moxifloxacin?

A

Avelox

107
Q

All but one quinolone needs renally adjustment – which one does not need renal adjustment

A

moxifloxacin does not need the adjustment

108
Q

Boxed warnings of quinolones?

A

tendon inflammation/rupture
peripheral neuropathy
seizures

109
Q

what patient age population should not use quinolones

A

children

110
Q

Quinolone warnings?

A

QT prolongation
hepatoxicity
photosensitivity
hypo and hyper glycemia problems

111
Q

Cipro oral suspension should not be given via ______ and why?

and what to do instead?

A

do not give via NG tube or other feeding tubes

crush up IR cipro tablets in water and give via tube

112
Q

which quinolone does not get into the urine enough/should not be used for UTIs?

A

moxifloxacin

113
Q

which quinolones are good for pseudomonal infections?

A

cipro and levo

114
Q

delafloxacin is mainly used for what type of infection?

A

skin infections - MRSA coverage

115
Q

main drug interaction with the quinolones?

A

multivalent cations can chelate and inhibit absorption

116
Q

what quinolones have a PO:IV ratio of 1:1

A

levofloxacin and moxifloxacin

117
Q

Quinolone Tips:

  • watch for additive toxicity of ________ with other meds
  • avoid use in patients with _______
A

QT prolongation

w/ seizures

118
Q

Quinolone Tips:
watch for tendon rupture (especially in _____ patients and patients using _____)
watch for neuropathy

A

older patients; and patients using steroids

119
Q

Quinolone Counseling Tips:

  • avoid ______ exposure
  • separate from _______
  • monitor ______
A

avoid sun exposure
separate from cations
monitor blood sugar - if DM

120
Q

Macrolides:

have good _______ coverage

A

atypical

121
Q

what drugs are macrolides?

A

azithromycin
clarithromycin
erythromycin

122
Q

brand name for clarithromycin

A

Biaxin

123
Q

Contraindication for Clarithromycin and Erythromycin?

A

contaminant use of lovastatin and simvastatin

124
Q

ADEs of macrolides ?

A

GI upset (diarrhea, abdominal pain, cramping - especially erythromycin)

125
Q

warnings of macrolides?

A

QT prolongation

hepatoxicity

126
Q

which macrolide has the highest risk of QT prolongation?

A

erythromycin

127
Q

T or F:

Azithromycin ER suspension is bioequivalent with Zithromax

A

false —-they are NOT interchangeable

128
Q

which macrolides are 3A4 inhibitors?

A

erythromycin and clarithromycin

azithromycin - is a MINOR substrate - very few clinically significant drug interactions

129
Q

With all macrolides do use other drugs that also ______

A

prolong the QT interval

130
Q

Common uses for macrolides:

All can be used for ______ and as a beta lactam alternative for _______

A

used for CAP; alternative for strep throat

131
Q

Azithromycin Uses:

  • can be used for _________
  • or as monotherapy for which STD?
  • or combo therapy for which STD?
  • prophylaxis for ______
  • drug of choice for ________
A 
used for COPD exacerbations
mono: chlamydia
combo: gonorrhea
proph: MAC
DOC for dysentery (travelers diarrhea with blood stools)
132
Q

Doxycycline can be used for:
________ (mild infections)
and
even ______ in UTIs

A

CA-MRSA skin infections

VRE in UTIs

133
Q

Tetracycline drug examples?

A

doxycycline

minocycline

134
Q

Oracea 40 mg (a low dose of doxycycline) should be given how in relation to food?

A

on empty stomach (1 hr before food or 2 hours after)

135
Q

Warnings of tetracyclines:

What groups of people should not use them?

A

Children under 8
pregnant
breastfeeding
(because of bone growth issues and permanently discolors teeth)

136
Q

Warnings of tetracyclines:

can cause what two different kinds of skin issues?

A

DILE - drug induce lupus erythematosus (mainly minocycline)
and
photosensitivity

137
Q

ADEs of tetracyclines?

A

N/V/D

138
Q

IV: PO conversion for doxycyline and minocycline?

A

1:1

139
Q

main drug interaction for tetracyclines?

A

divalent cations (Mg, Al, Ca)
iron containing preparations
sucralfate
bismuth salicylate

(separate 1 hr before; 2 hr after)

140
Q

Doxycycline and minocycline commonly used for

________ infections and ______

A

CA-MRSA

and acne

141
Q

Doxycycline is first line for ________ and _______ (tick borne diseases)

A

lyme disease

rocky mountain spotted fever

142
Q

Doxycycline:

  • or as monotherapy for which STD?
  • or combo therapy for which STD?
A

mono: chlamydia
combo: gonorrhea

143
Q

Tetracyline:

used in _______ treatment

A

H.pylori

144
Q

Sulfamethoxazole/TMP:

dose is based on which component?

A

TMP componentn

145
Q

Sulfamethoxazole/TMP dosing if uncomplicated UTI?

A

1 DS tab BID x 3 days

146
Q

Contraindications of Sulfamethoxazole/TMP?

A 
Sulfa allergy...
and pregnant (at term)
147
Q

ADEs of Sulfamethoxazole/TMP?

A 
N/V/D
Anorexia
skin reactions
crystalluria (thus take with water)
photosensitivity
increased K+
hypoglycemia
decreased folate
\+ coombs test
148
Q

main drug interaction with sulfonamide abx?

A

they are inhibitors of 2C9 - aka interact with warfarin and can increase INR

149
Q

common uses of Sulfamethoxazole/TMP?

A

CA-MRSA skin infections
UTI
PCP (pneumocystis pneumonia)

150
Q

the Sulfamethoxazole/TMP ratio is always ___: ___

A

sulfa 5 : 1 TMP

ex: (400 / 80 )

151
Q

common dosing for C. Diff for vancomycoin?

A

125 - 500 mg PO!! QID x 10 - 14 days

152
Q

dosing for systemic infections for vanc?

A

15 - 20 mg/kg IV Q 8 - 12H

153
Q

warnings for vancomyocin?

A

Neprhotoxicity and ototoxicity

Infusion/Red man syndrome

154
Q

Vanc is 1st line treatment for ______ infections

A

MRSA infections

155
Q

Monitor what when using vancomyocin

A

renal function

trough concentration

156
Q

Goals for vanc trough?

A

15 - 20 for pneumonia, endocarditis, meningitis, osteo

10 - 15 for other infections

157
Q

Consider a different drug than vancomyocin when MRSA MIC is > ___

A

2

158
Q

examples of lipoglycopeptides

A

telavancin
oritavancin
dalbavancin

159
Q

lipoglycopeptides have coverage similar to what other antibiotic

A

vancomyocin

160
Q

which glycopeptides need to only be given once because of very long half lives?

A

oritavancin

dalbavancin

161
Q

the lipoglycopeptides can falsely elevate ______

A

PT/INR

162
Q

contraindication for oritavancin?

A

use of IV Unfractionated Heparin for 5 days after use because of interference of aPTT lab results

163
Q

Side effects seen with lipoglycopeptides?

A

Red man syndrome

N/V

164
Q

which lipoglycopeptide causes metallic taste

A

telavancin

165
Q

infuse telavancin for how long to prevent red man syndrome?

A

OVER 60 minutes

166
Q

boxed warnings for telavancin

A
  • fetal risk
  • nephrotoxicity
  • increased mortality (vs vanc in some pts treated for pneumonia esp with renal impairment)
167
Q

Daptomyocin Warnings:
can cause _______ and _______
and can falsely elevate ______

A
  • myopathy and rhabdomyolysis

- elevate PT/INR

168
Q

Daptomyocin Side effects and monitoring

A

increased CPK

check CPK levels weekly

169
Q

Daptomyocin

is compatible with ______ but not _____

A

good with NS (not dextrose)

170
Q

Do not use daptomyocin to treat what type of infection??

A

pneumonia (drug is inactivated in the lungs by surfactant)

171
Q

what drugs are oxazolidinones?

A

linezolid

tedizolid

172
Q

Contraindication for linezolid?

A

w/in 2 weeks of MAO inhibitor use

173
Q

warning and side effects for linezolid?

A

duration related myleosuppression (thrombocytopenia)

can decrease platelets and cause HA/nausea/diarrhea

174
Q

Counseling/administration point about linezolid suspension

A

DO NOT shake it!!

175
Q

Use linezolid with caution what drugs?

A

serotonergic or adrenergic drugs

176
Q

Synercid (quinapristin/dalfopristin) is not tolerated well and thus not used a lot – what kind of infections would it maybe be used?

A

for VRE infections (but NOT active against faecalis infections; just faecium)

177
Q

Side effects of synercid?

A 
arhralgias/myalgias (V COMMON)
infusion reactions
edema/pain
phlebitis
hyperbilirubinemia
CPK elevations
178
Q

Tigecycline: covers what bugs?

A

VRE, MRSA, gram negative, anaerobes and atypical

179
Q

Tigecycline does not cover the 3 “___’s”

A

3 P’s = pseudomonas; proteus, providencia

180
Q

Tigecycline:

T or F: Needs renal adjustment

A

FALSE

it does not need renal adjustment

181
Q

Tigecycline:
Increased risk of _______

Side effects seen?

A

risk of death

N/V/D

182
Q

Tigecycline

Avoid use in ______ infections

A

bloodstream

183
Q

Tigecycline

When reconstitued it should be _________ - if it is not - throw it away

A

yellow/orange

184
Q

Polymyxins: best as mono or combo therapy?

A

best as combo b/c of emerging resistance

185
Q

Examples of polymyxin?

A

colistimethate or colistin

and polymyxin B….

186
Q

main side effects warning with the polymyxins?

A

neuro (dizzy, HA, vertigo) and nephro toxic

187
Q

you need to ASSESS THE DOSE carefully for colistimethate… why?

A

the dosing can be based off units of colistimethate sodium or mg of colistimethate sodium or mg of colistin base

188
Q

what abx can cause Gray syndrome? (and what is gray syndrome)

A

chloramphenicol

gray syndrome = circulatory collapse/cyanosis

189
Q

Chloramphenicol side effects

A

gray syndrome and myleosuppression

190
Q

what abx needs a D test?

A

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
Q

boxed warning for Clindamycin?

A

C.diff

192
Q

Rifaximin can it NOT be used for Spontaneous bacterial peritonitis or travelers diarrhea? and why?

A

SBP – it does not absorb well (stays in the gut!)

it CAN be used also for IBS with diarrhea, hepatic encephalopthy, refractory c.diff

NAPLEX Prep (19 decks)

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