Infectious Disease Pt 2 Flashcards
+Fluoroquinolones
(3)
Routes
Ciprofloxacin (Cipro) IV, PO
Levofloxacin (Levaquin) IV, PO
Moxifloxacin (Avelox) IV, PO
+Fluroquinolones
MOA
Interferes with normal DNA processes by inhibiting DNA topoisomerases -> leading to cell death
+Fluoroquinolones
Spectrum
- B___ coverage including gram-_____ (not _____) and gram _____
- Broad, positive (not MRSA), negative
+Fluoroquinolones
Spectrum
Which Fluoroquinolone has poor Streptococcus coverage and NOT empirically used for CAP?
ONLY _____ and ______ covers Pseudomonas (NOT _____)
Ciprofloxacin
Ciprofloxacin, Levofloxacin, NOT Moxifloxacin
Only Moxifloxacin does not cover pseudomonas*** important!
+Fluoroquinolones PK
- ______ distribution used for nearly ___ infection types
- Bioavailability
- Very _____ used which has led to _____ development
- 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)
+Fluoroquinolones
AE (4)
QTC prolongation
Peripheral Neuropathy
Tendonitis
Hyperglycemia
AEE**** -> QTC, Hyperglycemia in DM
+Fluoroquinolones
Contraindications (1)
Black Box Warning
Pregnancy
Exacerbates Myasthenia Gravis, Peripheral Neuropathy, Tendinitis
many boxed warnings, XXX pregnancy
+Tetracyclines
(3)
Routes
Doxycycline (Vibramycin) PO
Minocycline (Minocin) IV, PO
Tigecycline (Tygacil) IV
Like fluoroquinolones very well absorbed PO
+Tetracyclines
MOA
**Inhibits Protein Synthesis***
+Tetracyclines
Spectrum
- Extensive gram-_____ coverage (including _____) and gram-_____ (____ pseudomonas)
- ______ - also has _____ activity and covers ___*
Positive + MRSA, Negative - Not Pseudomonas
Tigecycline - anaerobic, VRE*
Tigecycline is the broadest (TIGER ON A BICYCLE a ferocious abx) - can cover VRE
+Tetracyclines
Indications
- Very ____ volume of distribution (good for ___ and ___ infections)
- Bad for (2)
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**
+Tetracyclines
AE
- Tigecycline - ___/___ in 40% of patients
- Minocycline - higher _______ toxicities (_____)
- Do not use in ______ and ______ < __ years of age
- ____ deformity and teeth ______
- ____sensitivity (avoid ______)
- 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*
+Macrolides
(2)
Routes
Azithromycin (Zithromax) IV, PO
Clarithromycin (Biaxin) PO
+Macrolides
MOA
Inhibits Protein Synthesis
+Macrolides
Spectrum
- V______: (3), otherwise ____ gram-negative coverage
- ______ pathogens that may cause ___ and other respiratory infections
- Including ‘_____’ - (2)
- ______ also used for (1)
- ______ pathogens that may cause ___ and other respiratory infections
- Anti _______ properties seen with ______
- Great debate: Benefit in preventing _____ exacerbations
- Variable: Streptococcus spp, H. influenzae, Moraxella catarrhalis, weak
- Respiratory, CAP
- atypicals - Mycoplasma pneumoniae, Chlamydophilia pneuomoniae
- Azithromycin, Chlamydia trachomitis
- Respiratory, CAP
- 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…*
+Macrolides
Unique characteristic
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)
+Macrolides
AE
GI Upset (Take with food to minimize GI upset)
QTC prolongation
+Macrolides
Drug Interactions
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*
+Miscellaneous Agents
(2)
Routes
Sulfamethoxazole-Trimethoprim (Bactrim) PO, IV
Metronidazole (Flagyl) PO, IV
+Sulfamethoxazole-trimethoprim (Bactrim)
MOA
Inhibits DNA synthesis via inhibiton of folic acid synthesis (synergistic activity as each component works in a different step)
+Bactrim
Spectrum
- Very _____, gram-_____ including (1) and gram-______ NOT (1)
Broad
Gram + including MRSA
Gram - NOT including Pseudomonas aeruginosa
+Bactrim
- Bioavailability ______ ~__% (IV and PO _______)
- Dose based on?
- Must adjust in _____ dysfunction!!!
- Excellent ~85% (interchangeable)
- Trimethoprim* component
- Renal*
- We dose it based on the Trimethoprim component (FOCUSED ON TRIMETHOPRIM)*
- Nephrotoxicity if not dosed properly*
+Bactrim
AE (4)
Contraindications (1)
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!*
+Bactrim
Indications
Useful for variety of indications including (4)
Pneumonia
UTI
Skin infections
Bone infections
V important drug, commonly prescribed for lots of things -> skin infections dt MRSA coverage
+When Prescribing Bactrim
- The following mental checklist should always be used when you consider prescribing Bactrim
- Is the pt ______ or of child-bearing age? - ____, can be harmful
- Is the pt on ______? Interacts causing significant increase in ___
- Does the pt have a ________ allergy? ______**
- Does the pt have any _____ disease? Must renally _____/potentially ____
- Does the pt have issues with their ______ levels? - Can cause ______, avoid
- Does the pt have any _________ issues? - Can cause _______, use caution
- Has the pt had Bactrim before? ~20% of _____ are resistant in the community
- Pregnany -> avoid
- Warfarin -> increases INR
- Sulfonamide -> Contraindicated**
- Renal -> adjust, potentially avoid
- Potassium -> hyperkalemia -> avoid
- Hematological -> Neutropenia -> caution
- E.coli
For pts w recurrent UTI’s - keep in mind drug resistance
+Metronidazole (Flagyl)
MOA
Damages DNA of the organism and leads to cell death
+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
- No longer a ____ line recommendation for mild. C.diff
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
+Metronidazole PK
Bioavailability
Excellent bioavailability
IV and PO interchangeable
+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
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
+Metronidazole (Flagyl)
Indications (3)
Bacterial vaginosis
Trichomonas infections
GI related illness
Really just reserved for intraabdominal infections/aspiration PNA
+Gram Positive Agents
(3)
Routes
Vancomycin (Vancocin) - PO, IV
Linezolid (Zyvox) - PO, IV
Daptomycin (Cubicin) IV
+Vancomycin (Vancocin)
MOA
Inhibits cell wall synthesis
+Vancomycin
Spectrum
Drug of choice for?
Gram-positive only
Drug of choice for MRSA
+Vancomycin
Indications
- IV for _____ infections including (5)
- PO for (1)
Systemic - PNA, CNS, UTI, bone, blood
- C.diff* (PO not absorbed systemically)
- Bc PO not systemically absorbed -> less toxicities when given for C.diff*
+Vancomycin PK
Dose based on?
MUST ______ drug levels for efficacy and toxicity (when given __)
Weight, Age, Renal function
Monitor, IV
A lot of PROS if used properly -> therefore dosed by weight
+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)
- Nephrotoxicity
- Ototoxicity
- Red Man’s - histamine, rapid
- NOT an allergy, slow (60 min)
60 by 60 rule
+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 =
- 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
Example of MRSA
+Linezolid (Zyvox)
MOA
Inhibits Protein Synthesis
+Linezolid
Spectrum
VERY broad gram ____ coverage including (2)
No gram-____ coverage
- Bioavailability?
Positive - MRSA and VRE
NO Negative
- Excellent (100%)
+Linezolid
Indications
Reserved for treatment of? (3)
VRE - Drug resistant enterococcus
Staphylococcal infections of lungs
Pts with Vancomycin intolerance
+Linezolid
AE
- Use > 14 days =
- Use > 28 days =
- Drug interaction (1)
- Contraindication (1)
- Thrombocytopenia
- Optic neuritis
- SSRIs (may cause serotonin syndrome)
- MAOI
We tend not to use it long term > 2 wks -> thrombocytopenia
+Daptomycin (Cubicin)
MOA
Causes rapid depolarization leading to inhibition of protein, DNA and RNA synthesis
+Daptomycin
Spectrum
Same as _____
Linezolid
VERY broad gram + coverage including MRSA and VRE
No gram negative
+Daptomycin
Indications
- ______ agent to linezolid for (2)
- NOT used to treat?
Alternative: resistant gram + infections, linezolid intolerance
NOT to treat pneumonia (inactivated by lung surfactant)
We do not use dapto for PNA
+Daptomycin
AE (1)
Monitor what?
Associated with myopathy
CPK
Rhabdo bc can cause elevated CPK - esp when dehydrated
+Applicable to ALL Antibiotics
(2)
-
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)
+NEED TO KNOW
Which medications work on Pseudomonas aeruginosa
(6)
- Piperacillin/tazobactam (Zosyn)
- Ceftazidime
- Cefepime
- All Carbapenems EXEPT Ertapenem
- Levofloxacin
- Ciprofloxacin
PCC, AL Come
+NEED TO KNOW
Which meds work on Methicillin-resistant Staphylococcus aeurus (MRSA)?
(6)
- Vancomycin
- Linezolid
- Daptomycin
- Tetracyclines
- Sulfamethoxazole trimethoprim (Bactrim)
- Ceftaroline
Very Long Days, To See Crap
+Example of Antibiogram
On exam: might have to interpret one
Shows the % ______
Resistant profiles based on hospital stats from?
Susceptible
last years pts in different areas
+Antiobiotic Resistance
How does it happen?
