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Advanced Pharmacology > Infectious Disease Pt 2 > Flashcards

Infectious Disease Pt 2 Flashcards

1
Q

+Fluoroquinolones

(3)

Routes

A

Ciprofloxacin (Cipro) IV, PO

Levofloxacin (Levaquin) IV, PO

Moxifloxacin (Avelox) IV, PO

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2
Q

+Fluroquinolones

MOA

A

Interferes with normal DNA processes by inhibiting DNA topoisomerases -> leading to cell death

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3
Q

+Fluoroquinolones

Spectrum

  • B___ coverage including gram-_____ (not _____) and gram _____
A
  • Broad, positive (not MRSA), negative
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4
Q

+Fluoroquinolones

Spectrum

Which Fluoroquinolone has poor Streptococcus coverage and NOT empirically used for CAP?

ONLY _____ and ______ covers Pseudomonas (NOT _____)

A

Ciprofloxacin

Ciprofloxacin, Levofloxacin, NOT Moxifloxacin

Only Moxifloxacin does not cover pseudomonas*** important!

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5
Q

+Fluoroquinolones PK

  • ______ distribution used for nearly ___ infection types
  • Bioavailability
  • Very _____ used which has led to _____ development
A
  • Excellent, All
  • Excellent (100%) -> can switch from PO -> IV in serious infections
  • Commonly, Resistance

There is PO for all bc excellent bioavailability! (similar concentrations PO and IV form)

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6
Q

+Fluoroquinolones

AE (4)

A

QTC prolongation

Peripheral Neuropathy

Tendonitis

Hyperglycemia

AEE**** -> QTC, Hyperglycemia in DM

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7
Q

+Fluoroquinolones

Contraindications (1)

Black Box Warning

A

Pregnancy

Exacerbates Myasthenia Gravis, Peripheral Neuropathy, Tendinitis

many boxed warnings, XXX pregnancy

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8
Q
A
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10
Q
A
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11
Q

+Tetracyclines

(3)

Routes

A

Doxycycline (Vibramycin) PO

Minocycline (Minocin) IV, PO

Tigecycline (Tygacil) IV

Like fluoroquinolones very well absorbed PO

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12
Q

+Tetracyclines

MOA

A

**Inhibits Protein Synthesis***

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13
Q

+Tetracyclines

Spectrum

  • Extensive gram-_____ coverage (including _____) and gram-_____ (____ pseudomonas)
    • ​______ - also has _____ activity and covers ___*
A

Positive + MRSA, Negative - Not Pseudomonas

Tigecycline - anaerobic, VRE*

Tigecycline is the broadest (TIGER ON A BICYCLE a ferocious abx) - can cover VRE

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14
Q

+Tetracyclines

Indications

  • Very ____ volume of distribution (good for ___ and ___ infections)
    • Bad for (2)
A

high, bone and skin infections

X blood infections (bacteremia) and Urine infections

  • Because most of it distributes to bone and skin -> LOW SERUMM for blood stream -> bad for blood stream infections*
  • TETRACYCLINES SHOULD NOT BE USED FOR TX OF UTIS** Also doesn’t concentrate well in the urine -> worsening UTI -> pyelonephritis**
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15
Q

+Tetracyclines

AE

  • Tigecycline - ___/___ in 40% of patients
  • Minocycline - higher _______ toxicities (_____)
  • Do not use in ______ and ______ < __ years of age
    • ____ deformity and teeth ______
  • ____sensitivity (avoid ______)
A
  • N/V
  • vestibular (vertigo)
  • pregnancy, children, 8
    • bone, staining
  • Photosensitivity, sunlight
  • Highest incidence of N/V than any other abx*
  • Minocycline - AVOID IN PTS WITH HX/WITH VERTIGO*
  • X pregnancy and children -> bone deformities, teeth staining*
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16
Q

+Macrolides

(2)

Routes

A

Azithromycin (Zithromax) IV, PO

Clarithromycin (Biaxin) PO

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17
Q

+Macrolides

MOA

A

Inhibits Protein Synthesis

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18
Q

+Macrolides

Spectrum

  • V______: (3), otherwise ____ gram-negative coverage
    • ______ pathogens that may cause ___ and other respiratory infections
      • Including ‘_____’ - (2)
      • ______ also used for (1)
  • Anti _______ properties seen with ______
    • Great debate: Benefit in preventing _____ exacerbations
A
  • Variable: Streptococcus spp, H. influenzae, Moraxella catarrhalis, weak
    • Respiratory, CAP
      • atypicals - Mycoplasma pneumoniae, Chlamydophilia pneuomoniae
      • Azithromycin, Chlamydia trachomitis
  • inflammatory, Azithromycin
    • ​COPD
  • URI’s like sinusitis*
  • Also given for ATYPICAL” PNA caused by those two organisms*
  • Battle I come across pulmonologists that just give it for the anti-inflammatory effects with acute exacerbations of COPD -> AE > anti-inflam effects…*
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19
Q

+Macrolides

Unique characteristic

A

Post Antibiotic Effect

Continues to work despite subtherapeutic concentrations

POST ABX EFFECT/RESIDUAL EFFECT for about 4-5 days after** this class is notorious for this (some other ones have this quality but this is the main one)

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20
Q

+Macrolides

AE

A

GI Upset (Take with food to minimize GI upset)

QTC prolongation

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21
Q

+Macrolides

Drug Interactions

A

Inhibits CYP 450 enzymes

Clarithromycin rarely used dt to this DI -> increased GI intolerance and more frequent dosing

  • EXAM QUESTION: You have a pt with a cyp substrate which macrolide to prescribe? - Azithro***
  • Clarithromycin less favored bc of DI*
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22
Q
A
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23
Q
A
24
Q

+Miscellaneous Agents

(2)

Routes

A

Sulfamethoxazole-Trimethoprim (Bactrim) PO, IV

Metronidazole (Flagyl) PO, IV

25
Q

+Sulfamethoxazole-trimethoprim (Bactrim)

MOA

A

Inhibits DNA synthesis via inhibiton of folic acid synthesis (synergistic activity as each component works in a different step)

26
Q

+Bactrim

Spectrum

  • Very _____, gram-_____ including (1) and gram-______ NOT (1)
A

Broad

Gram + including MRSA

Gram - NOT including Pseudomonas aeruginosa

27
Q

+Bactrim

  • Bioavailability ______ ~__% (IV and PO _______)
  • Dose based on?
  • Must adjust in _____ dysfunction!!!
A
  • Excellent ~85% (interchangeable)
  • Trimethoprim* component
  • Renal*
  • We dose it based on the Trimethoprim component (FOCUSED ON TRIMETHOPRIM)*
  • Nephrotoxicity if not dosed properly*
28
Q

+Bactrim

AE (4)

Contraindications (1)

A

Skin reactions (can be very severe) Stevens-Johnsons Syndrome

Neutropenia

Nephrotoxicity

Hyperkalemia

**SULFA ALLERGIES**

  • In no way shape or form - absolutely contraindicated in sulfa allergies no matter what reaction*
  • Issues -> high risk of skin reaction!*
29
Q

+Bactrim

Indications

Useful for variety of indications including (4)

A

Pneumonia

UTI

Skin infections

Bone infections

V important drug, commonly prescribed for lots of things -> skin infections dt MRSA coverage

30
Q

+When Prescribing Bactrim

  • The following mental checklist should always be used when you consider prescribing Bactrim
    1. Is the pt ______ or of child-bearing age? - ____, can be harmful
    2. Is the pt on ______? Interacts causing significant increase in ___
    3. Does the pt have a ________ allergy? ______**
    4. Does the pt have any _____ disease? Must renally _____/potentially ____
    5. Does the pt have issues with their ______ levels? - Can cause ______, avoid
    6. Does the pt have any _________ issues? - Can cause _______, use caution
    7. Has the pt had Bactrim before? ~20% of _____ are resistant in the community
A
  1. Pregnany -> avoid
  2. Warfarin -> increases INR
  3. Sulfonamide -> Contraindicated**
  4. Renal -> adjust, potentially avoid
  5. Potassium -> hyperkalemia -> avoid
  6. Hematological -> Neutropenia -> caution
  7. E.coli

For pts w recurrent UTI’s - keep in mind drug resistance

31
Q

+Metronidazole (Flagyl)

MOA

A

Damages DNA of the organism and leads to cell death

32
Q

+Metronidazole (Flagyl)

Spectrum

  • _______ gram-negative organisms, (1) which is a gram-positive anaerobic organism
    • No longer a ____ line recommendation for mild. C.diff
      • Used in combo with (1) for severe C.diff
A

Anaerobic gram negatives, C. diff anaerobic gram positives

X first line

Oral Vanco

Covers both anearobic gram + and -

Bc anearobes require a lack of oxygen -> deeper in the GI tract have higher numbers - Used to be first line for c.diff -> lack of efficacy/reoccurence

33
Q

+Metronidazole PK

Bioavailability

A

Excellent bioavailability

IV and PO interchangeable

34
Q

+Metronidazole (Flagyl)

AE

___ upset

______ taste

H______

Dark _____

Peripheral _____

  • Exhibits a ______-like reaction - do not take with _____ -> will cause extreme ______
    • Must inform pts to _____ alcohol for up to ___ hrs after ____ dose
A

GI upset

Metallic taste

Headache

Dark urine

Peripheral Neuropathy

  • disulfiram, alcohol, vomiting
    • avoid, 24 hrs, after last dose

DI with ALCOHOLL - inhibits the metabolism/excretion of alcohol/its metabolites -> alcohol toxicity

35
Q

+Metronidazole (Flagyl)

Indications (3)

A

Bacterial vaginosis

Trichomonas infections

GI related illness

Really just reserved for intraabdominal infections/aspiration PNA

36
Q

+Gram Positive Agents

(3)

Routes

A

Vancomycin (Vancocin) - PO, IV

Linezolid (Zyvox) - PO, IV

Daptomycin (Cubicin) IV

37
Q

+Vancomycin (Vancocin)

MOA

A

Inhibits cell wall synthesis

38
Q

+Vancomycin

Spectrum

Drug of choice for?

A

Gram-positive only

Drug of choice for MRSA

39
Q

+Vancomycin

Indications

  • IV for _____ infections including (5)
  • PO for (1)
A

Systemic - PNA, CNS, UTI, bone, blood

  • C.diff* (PO not absorbed systemically)
  • Bc PO not systemically absorbed -> less toxicities when given for C.diff*
40
Q

+Vancomycin PK

Dose based on?

MUST ______ drug levels for efficacy and toxicity (when given __)

A

Weight, Age, Renal function

Monitor, IV

A lot of PROS if used properly -> therefore dosed by weight

41
Q

+Vancomycin

AE

  • _______ with elevated levels
  • Rare: ______ - very high levels for long periods can be irreversible
  • ___ ___ Syndrome* - ______ mediated reaction secondary to _____ infusions
    • NOT an ____ reaction, simply ___ the infusion (min. __ min)
A
  • Nephrotoxicity
  • Ototoxicity
  • Red Man’s - histamine, rapid
    • NOT an allergy, slow (60 min)

60 by 60 rule

42
Q

+Vancomycin Serum Concentration Monitoring

  • Trough: collected when? prior to what dose?
  • Correlates with ____ and ____
  • _____ marker for total exposure
  • Desired concentrations for
    • serious infections (CNS, blood, lung) =
    • mild skin, UTI infections =
A
  • 30 min before 4th dose (steady state for pts with normal renal function)
  • Efficacy and toxicity
  • Surrogate
  • Desired concentrations
    • 15-20 mcg/ml
    • 10-15 mcg/ml
43
Q

Example of MRSA

A
44
Q

+Linezolid (Zyvox)

MOA

A

Inhibits Protein Synthesis

45
Q

+Linezolid

Spectrum

VERY broad gram ____ coverage including (2)

No gram-____ coverage

  • Bioavailability?
A

Positive - MRSA and VRE

NO Negative

  • Excellent (100%)
46
Q

+Linezolid

Indications

Reserved for treatment of? (3)

A

VRE - Drug resistant enterococcus

Staphylococcal infections of lungs

Pts with Vancomycin intolerance

47
Q

+Linezolid

AE

  • Use > 14 days =
  • Use > 28 days =
  • Drug interaction (1)
  • Contraindication (1)
A
  • Thrombocytopenia
  • Optic neuritis
  • SSRIs (may cause serotonin syndrome)
  • MAOI

We tend not to use it long term > 2 wks -> thrombocytopenia

48
Q

+Daptomycin (Cubicin)

MOA

A

Causes rapid depolarization leading to inhibition of protein, DNA and RNA synthesis

49
Q

+Daptomycin

Spectrum

Same as _____

A

Linezolid

VERY broad gram + coverage including MRSA and VRE

No gram negative

50
Q

+Daptomycin

Indications

  • ______ agent to linezolid for (2)
  • NOT used to treat?
A

Alternative: resistant gram + infections, linezolid intolerance

NOT to treat pneumonia (inactivated by lung surfactant)

We do not use dapto for PNA

51
Q

+Daptomycin

AE (1)

Monitor what?

A

Associated with myopathy

CPK

Rhabdo bc can cause elevated CPK - esp when dehydrated

52
Q
A
53
Q

+Applicable to ALL Antibiotics

(2)

A
  • Clostridium Difficule infection
    • Normally colonized by C.diff
    • By giving abx - we kill everything BUT the c.diff which then allows for overgrowth (disease)
  • Resistance development
    • Organisms are VERY smart, will adapt, tries to kill them -> various mechanisms of resistance (ie. beta-lactamase)
54
Q

+NEED TO KNOW

Which medications work on Pseudomonas aeruginosa

(6)

A
  1. Piperacillin/tazobactam (Zosyn)
  2. Ceftazidime
  3. Cefepime
  4. All Carbapenems EXEPT Ertapenem
  5. Levofloxacin
  6. Ciprofloxacin

PCC, AL Come

55
Q

+NEED TO KNOW

Which meds work on Methicillin-resistant Staphylococcus aeurus (MRSA)?

(6)

A
  1. Vancomycin
  2. Linezolid
  3. Daptomycin
  4. Tetracyclines
  5. Sulfamethoxazole trimethoprim (Bactrim)
  6. Ceftaroline

Very Long Days, To See Crap

56
Q

+Example of Antibiogram

On exam: might have to interpret one

Shows the % ______

Resistant profiles based on hospital stats from?

A

Susceptible

last years pts in different areas

57
Q

+Antiobiotic Resistance

How does it happen?

A

Advanced Pharmacology (14 decks)

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