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Board Review > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

what color do gram + orgs stain?

A

purple, blue

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2
Q

what color do gram - orgs stain?

A

pink from safranin

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3
Q

what is the MIC?

A

the lowest drug concentration to stop growth w/in 24 hours. MIC90: mic needed to inhibit growth of 90% of isolate

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4
Q

what is the breakpoint?

A

the level of MIC at which the bacterium is considered susceptible or resistant

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5
Q

whats the MBC

A

minimum bactericidal concentration : lowest drug [ ] that kills 99.99% of bacteria in 24 hours

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6
Q

which antibiotics typically do not have good concentration in the urine (generally)

A

those that are hepatically cleared

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7
Q

what are the top 5 most common Gram + bacteria?

A 
staphylococcus
streptococcus
enterococcus
clostridium
listeria
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8
Q

Gram + cocci

A

streptococcus

staphylococcus

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9
Q

gram + rods

A 
propionipacterium
bacillus
clorstirdum 
corynebacterium
listeria
nocardia
actinomyces
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10
Q

gram - cocci

A

neisseria

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11
Q

spirochetes

A

borrelia
leptosipra
treponema pallidum

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12
Q

atypicals

A

chlamydia
mycoplasma
ureaplasma

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13
Q

which are the hydrophillic antibiotics

A 
ABCDG
aminoglycosides
Beta lactams
Colistin
Daptomycin
Glycopeptides (vancomycin)
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14
Q

which are the lipophillic antibiotics?

A 
FQ
Macrolides
rifampin
tetracyclines
linezolid
chloramphenicol
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15
Q

how are the hydorphillic compounds typically cleared

A

renally

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16
Q

how are the lipophillic compounds cleared?

A

hepatically

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17
Q

which drug classes have nearly 100% oral bioavailability

A 
fluroquinolones
doxycycline
metronidazole
fluconazole, voriconazole
SMX/TMP
RIfampin
Linezolid

FLM DiVRS = Flame Divers

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18
Q

which FQ does not penetrate into urine?

A

moxifloxacin

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19
Q

which antibiotics have good bone penetration?

A

tetracyclines & fluroquinolones & rifampin

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20
Q

which of the penicillins is not renally cleared?

A

nafcillin

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21
Q

which of the AMGs is not renally cleared?

A

none

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22
Q

which of the cephalosporins is not renally cleared?

A

ceftriaxone! :)

cefotaxime some renal but more heaptic

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23
Q

which of the FQ is not renally cleared?

A

moxifloxacin

cipro R= H

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24
Q

which of the macrolides is not renally cleared?

A

ALL, clarithry H>R

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25
Q

how is doxycycline cleared?

A

H>R

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26
Q

is vancomycin renanally cleared?

A

YES

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27
Q

is linezolid renally cleared

A

NO, hepatic

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28
Q

is clindamycin renally cleared?

A

no, hepatic

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29
Q

is rifampin renally cleared?

A

no hepatic

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30
Q

is daptomycin renally cleared?

A

R>H

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31
Q

is metronidazole reanally cleared?

A

H>R

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32
Q

is SMX/TMP renally cleared

A

S = hepatically
T = Renally
so R= H

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33
Q

B lactams, time dependent or concentration dependent?

A

time dependent

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34
Q

Aminoglycosides, time dependent or concentration dependent?

A

concentration dependent

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35
Q

define time dependent?

A

killing depends on how much time is spent above the MIC so more frequent dosing is desireable

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36
Q

define concentration dependent?

A

killing depends on achieving higher peaks to maximize concentration of drug

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37
Q

Vancomycin, time dependent or concentration dependent?

A

concentration

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38
Q

macrolides, time dependent or concentration dependent?

A

concentration

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39
Q

tetracyclines, time dependent or concentration dependent?

A

concentration

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40
Q

which antibiotics are bacteriocidal vs bacteriostatic?

A

all are bacteriocidal except: Macrolides, Clindamycin, Linezolid, quinaprisitin/dalforisint, tetracyclines

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41
Q

what is so special about how AMGs kill bacteria?

A

they have a post-antibiotic effect

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42
Q

spectrum of activity for AMGs?

A

most all gram negatives

used for syndergy in treating gram + cocci (staph and enterococcus endocarditis)

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43
Q

of all the AMG’s which has the broadest spectrum?

A

Amikacin

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44
Q

which weight do you used to does AMGs

A

Ideal body weight
unless their actual weight is less
OR they are > 30% IBW, then use adjusted body weight

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45
Q

what is the BBW in AMGs?

A

can cause neurotoxicity and nephrotoxcity

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46
Q

what are the main SE os AMGS?

A

nephrotoxicity : acute tubular necrosis, Avoid other nephrotoxins
ototoxicity

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47
Q

when should you take a peak for an AMG?

A

1/2 hour after the end of the infusion

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48
Q

when should you take a trough level for a AMG?

A

right before the 4th dose (steady state)

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49
Q

what is the goal peak an trought for gent/tobra?

A

peak 5-10, trough < 2

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50
Q

what is the traditional dosing for gent/tobra?

A

1-2.5mg/kg/dose

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51
Q

how do you determine how frequently to give the get/ tobra?

A

clcr <20: give loading dose, mx levels
Clcr 20-40 : q24h
40-60 : q12h
Clcr: q8H

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52
Q

what is the Adjusted body weight equation?

A

IBW + 0.4 x (ACtual minus ideal)

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53
Q

amoxil

A

amoxicillin

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54
Q

amoxicillin brand

A

amoxil

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55
Q

augmentin

A

amox/clave

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56
Q

amox/clav brand

A

aumentin

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57
Q

unasyn

A

amp/sulbactam

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58
Q

amp/sulbactam brand

A

Unasyn

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59
Q

Pen VK

A

penicillin

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60
Q

penicillin brand

A

Pen VK

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61
Q

piperacillin/tazo brand

A

Zosyn

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62
Q

zosyn

A

pip/tazo

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63
Q

which of the penicillins has enhanced activity against MSSA?

A

nafcillin

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64
Q

which of the penicillins has activity against pseudomonas?

A

piperacillin/tazo

ticarcillin

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65
Q

which penicillins do not need to be renal dose adjusted?

A

nafcillin
oxacillin
dicloxacillin

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66
Q

which penicillin is DOC in pregnancy ?

A

amoxicillin

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67
Q

pregnancy category for penicillins

A

category B

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68
Q

for how long must augmentin be refrigerated?

A

always

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69
Q

for how long should amoxil be refrigerated?

A

can be stable for 14 days, but can be refrigerated to improve taste

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70
Q

how should you take the Pen VK tablets

A

on an empty stomach

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71
Q

how long should your refrigerate the pen VK suspension?

A

always

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72
Q

with what is Ampicllin IV compatible w/ for diluents?

A

normal saline only and it is stables only for 8 hours at room temperature

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73
Q

what do you do if you have extravasation of nafcillin?

A

use cold packs and hyaluronidase injections

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74
Q

what are the side effects of penicillins:

A

Diarrhea, Gi upset
allergic reactions: rash, anaphylaxis, pruritis
-if accumulation: seizures
-Acute interstitial nephritis
-bone marrow suppression w/ long term use

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75
Q

main DDis w/ penicillins?

A

May decrease effectiveness of oral contraceptives ; check package insert for each agent
-probenecid/allopurinol can increase levels of PCNs by interfering w/ renal excretion

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76
Q

first generation cephalosporins:

A

cefazolin

cephalexin

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77
Q

brand cephalexin

A

keflex

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78
Q

brand cefazolin

A

kefzol

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79
Q

kefzol

A

cefazolin

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80
Q

keflex

A

cephalexin

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81
Q

typical cephalexin doseing

A

250-500 q 6 h

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82
Q

typical cefazolin dose

A

250-2000 q 8 hours

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83
Q

what do the 1st generation cephalosporins cover?

A

staph> strept

PEK

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84
Q

2nd genration cephalosporins

A

cefprozil
cefuroxime
cefactor
cefotetan
cefoxitin (mefoxin)

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85
Q

spectrum of activity 2nd gen ceph

A

HNPEK

cefotetan , cefuroxime,cefoxitin also cover Bfrag

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86
Q

typical cefurxime dose

A

250-1500 q 8 h

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87
Q

typical cefprozil dose

A

250-500 q 12-24h

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88
Q

3rd generation cephalosporin

A

ceftriaxone
cefdinir
ceftazidime
ceftoaxime

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89
Q

brand ceftriaxone

A

rocephin

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90
Q

brand ceftazidime

A

Fortaz

Tazicef

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91
Q

typical ceftriaxone dose

A

1-2 rams q12 h-24h

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92
Q

typical ceftazidime dose

A

1-2 g q 8 / 12h

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93
Q

what is the advantage of ceftazidime over other 3rd gen cephalosporins?

A

it covers pseudomonas

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94
Q

what is the spectrum of activity of 3rd gen ceph?

A

HNPEKS

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95
Q

spectrum of cefepime?

A

HNPEKS

+ CAPES

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96
Q

typical dose of cefepime

A

1-2 grams q8-12h

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97
Q

brand cefepime

A

maxipime

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98
Q

maxipime

A

cefepime

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99
Q

what is special about cetaroline?

A

covers MRSA and has gram - coverage like ceftriaxone (HNPEK)

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100
Q

typical dose of ceftaroline

A

600mg q 12h

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101
Q

what is the cross reactivity in allergic reactions w/ cephalosprins and PCN?

A

< 10%

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102
Q

which pts that have a PCN allergic reaction should avoid cepalosporins?

A

if they have a type 1 sensivity: swelling, angioedema, anaphylaxis

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103
Q

cephalosporins pregnancy category

A

B

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104
Q

special side effects of cefotetan

A

cotnains NMTT side chain that can lead to bleeding and a disulfiram like reaction w/ alcohol ingestion

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105
Q

which three cephalosporins must be taken w/ food

A

cefaclor, cefpodoxime, cefurxoime

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106
Q

DDIs cephalosporins

A

probeneicid/allopurinol increase levels through renal secretion inhibitions
-decrease effectiveness of OCs

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107
Q

brand name imipenem

A

primaxin

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108
Q

typical dose of imipeneme

A

250-100mg VI q 6-8h

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109
Q

brand meropenem

A

Merrem

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110
Q

Primaxin

A

imipenem

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111
Q

Merrem

A

meropenem

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112
Q

brand ertapenem

A

Invanz

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113
Q

invanz

A

ertapenem

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114
Q

doribax

A

doripenem

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115
Q

typical meropenem dose

A

500-100mg iv q 6-8h

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116
Q

tipical ertapenem dose

A

1000mg IV/ IM q d

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117
Q

typical dose of doripenem

A

500 iv q 8h

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118
Q

which is the only carbapenem that does not have activity against pseudomonas or acenitobacter?

A

ertapenem

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119
Q

what is the spectrum of the carbopenemems

A

cover almost everything except : MRSA, VRE, C. diff, stenotorphomonas or naocardia

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120
Q

DDIs carbapenems

A

same as PCN/cephalosporins

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121
Q

why does imipenem come w/ cilastin?

A

because cilastin inhibits a renal dehydropeptidase from degrading imimpenem

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122
Q

main SEs carbapenems?

A

Diarrhea
rash
seisures at higher doses (esp. imipenem)

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123
Q

what is the MOA of fluroquinolones?

A

they inhibit bacterial cell DNA toposiomerase IV and inhibit DNA gyrase: leads to breaking of the double stranded DNA

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124
Q

fluroquinolones bacterisstatic or bacteriocidal?

A

bacteriocidal

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125
Q

what is the typical cipro PO dose/

A

250-750 po

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126
Q

what si the typical cipro dose IV

A

200-400 IV

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127
Q

how do you dose frequency for cipro based on clcd?

A

> 50 q8-12
30-50: q12
<30: q18-24

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128
Q

typical moxifloxacin dose?

A

400mg po q 24

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129
Q

typical levofloxacin dose

A

250-750mg po IV q 24 h if crcl > 50

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130
Q

what is the spectrum of activity of FQs

A

great gram +
great gram -
excellent atypical coverage

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131
Q

which of the FQs have pseudomonal coverage?

A

cipro

levo

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132
Q

what is the BBW of FQs

A

tendon inflammation and/ or rupture esp w/ concurrent corticosteroid use , if > 60 or organ transplant patient

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133
Q

comon SEs FQs

A

photosensisitivity and hyperglycemia
QT prolongation
GI- NVD
HA, rash

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134
Q

can u use FQs in pregnancy

A

do not use due to cartilage damage in immature animals : preg C

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135
Q

DDIs of FQs

A 
Antacids , divalent ations: Ca, Fe, ZN, Al, MG, MVIs
Bile acid bindingg resins
- Warfarin 
-QT prolonging rugs  (esp moxi)
-SUs, Warfarin, NSAIDs
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136
Q

how much should you separate your FQs from other meds

A

Cipro: if you take the cipro first, you have to wait 6 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your cipro
Levo: if you take the cipro first, you have to wait 2 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your Levo
Moxi: if you take the cipro first, you have to wait 8 hours to give the other meds. If you take the other meds first, you have to wait 4 hours to take your Moxi

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137
Q

what is the MOA of macrolides?

A

bind to 50S ribosome leading to inhibition of protein synthesis

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138
Q

brand azithromycin

A

zithromax

z-pack

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139
Q

macrolides spectrum of activity

A

streptococus
Heamophilus, neisseria, moraxella
Atypicals

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140
Q

SEs of macrolides

A

GI upset: D, abd pain/cramping esp erythro,
liver dysfucntion,
QT prolongation

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141
Q

brand of clarithromycin

A

biaxin

biaxin XL

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142
Q

dosing of aztithro

A

500 x 1 , then 250mg x 4 days

or 500mg qd x 3 days

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143
Q

refrigerate aztithromycinn oral suspension?

A

NO

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144
Q

referiatgerate biaxin oral suspension?

A

NO

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145
Q

how should you take biaxin XL

A

w/ food!

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146
Q

typical clarithromycin dose

A

250-500mg po BID to 1 g daily

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147
Q

erythormycin brand

A

erythorcin
ery-tab
eryped
EES

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148
Q

typical erythomycin dose

A

EES 400mg QID

others 250-500mg po QID

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149
Q

refrigerated erythromycin ?

A

must ref E.E.Es : erythromycin ethylsuccinate and use w/ 10 days
the powder suspension is table at room temp x 35 days

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150
Q

renal dose adjustment for azithro/erythro

A

NONE!

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151
Q

bioequivalency of zithromax & azithromycin ER suspention (ZMAX)

A

none and should not be interchanged

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152
Q

how to take the Zmax oral suspension:

A

w/in 12 hours of reconstitution on an empty stomach

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153
Q

which macrolides are QT polongers

154
Q

which macrocodes are mod-strogn cup 3a4 inhibitors

155
Q

macrolides bacteriostatic or cidal?

156
Q

tetracyclines static or cidal?

157
Q

MOA of tetracyclines

A

inhibiitonof 30s ribosomal subunit

158
Q

brand doxycycline

A

Vibramycin
Oracea
doryx

159
Q

typical dose of doxy

A

100mg po q 12h

160
Q

brand minocylcine

A

minocin
dynacin
soldyn
ximino

161
Q

typical dose of minocycline

A

50-100mg qd -bid

162
Q

Spectrum of activity of doxy

A

mild skin infix w/ mesa
VRE UTIS
staph strep, enterococcus, nocardi, propio, bacillus
atypicals, HI, moraxella

163
Q

how should you take your tetracyclines?

A

w/ 8 oz better to minimize go irritation

best on empty stomach (avoid DDIs)

164
Q

SE of tetracyclines:

A 
GI upset 
photosensitivity
tooth discoloration in children
DRESS
lupus like syndrome 
inc in LFTs
165
Q

renal adjustment in tetracylines?

A

not for doxy or mino yes for tetra

166
Q

Tetracycline DDs

A 
divalent cations 
sucralfate 
bile acid b resins 
-warfrain 
-OCs
167
Q

who should you separate your tetracyclines

A

take your tetra, then wait 1-2 hours for your other meds

or take your other meds and wait 4 hours to take your doxy

168
Q

what is the MOA of SMX /TMP

A

interfferes w/ folic acid synthesis via inhibition of dihydroflic acid formation

169
Q

SMX/TMP dosing for most common indications

A

adult UTI: 1 ds tab bid x 3 days
PCP ppx: 1 ds or ss tab daily
and other doses: depends

170
Q

what is the SS strength of smx/tmp

A

400 smx/ 80tmp 5:1 ratio

171
Q

what is the DS strength of Smx/tmp

A

800 smx/ 160 tmp 5:1 ratio

172
Q

contraindications for SMx/TMP

A 
pregnancy (at term)
breastfeeding
anemia due to folate deficinecy
marked hepatic/renal disease 
sulfa allergy
173
Q

SE smx/ tmp

A 
hyperkalemia
go upset
skin reactions
photosensitivity 
false inc in scr
174
Q

bactrim susp refrigerate?

A

no, keep at room temp and protect from light

175
Q

DDIs SMX/tmp

A

warfarin

any cup 2c9 inducers

176
Q

what is the MRSA dose for vancomycin

A

15-20mg/kg q8-12h

177
Q

concetration or time dependent killing?

A

time dependent killin

178
Q

side effects vancomycin

A

nephrotoxicity
ototoxicity
redman syndrome if infused too quickly (500mg 30 min each

179
Q

what are the sx of redman syndrome

A

maculopapular rash
hypotensio
flushing
neutropenia

180
Q

when should you target trough 15-20

A 
pneumonia
endocarditis
osteomyelitis
meningitis
bactermia
181
Q

when should you target 10-15

A

all other infections or decreased renal funciton

182
Q

brand vancomycin

183
Q

how do you determine the dosing interval for vancomycin

A

Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels

183
Q

how do you determine the dosing interval for vancomycin

A

Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels

184
Q

max perifpher iv vancomcing concentration

184
Q

max perifpher iv vancomcing concentration

185
Q

whats the dose for C diff infections for vancomycin

A

125-250mg po QID

186
Q

brand name of linezolid

187
Q

MOA of lniezolid

A

binding the 23 s risomaal ran of the 50s subunit inhibition bacterial translation and protein synthesis

188
Q

linezolid bacteriostatic or cidal

189
Q

what to avoid to avoid serotonin syndrome w/ linezolid?

A

tyramine containing foods: wine and feremtend foods

ssris, maox, tcas, pusparione

190
Q

contraindication of linezolid

A

concurrent use or w/in 2 weeks of MAOIs
uncontrolled HTN
sympathomimetics

191
Q

what to avoid to avoid serotonin syndrome w/ linezolid?

A

tyramine containing foods: wine and feremtend foods

ssris, maox, tcas, pusparione

192
Q

main side effects of linezolid

A

myelosuppression (> 14 days ) , thrombocytopenia
diarrrhea
incease pancreatic ezymes

193
Q

renal dose adj linezolid

194
Q

refrigerate linezolid?

A

keep oral suspension at room temp

195
Q

quinuprisitin/dalfopristin brand

196
Q

diluent for synercid

197
Q

renal dose adj for syndercid

198
Q

diluent for synercid

199
Q

brand daptomycin

200
Q

why use dap to?

A

mrsa, vre, faecium and faecalis

gram + coverage

201
Q

what to monitor for dapto

A

CPK esp if w/ statin

202
Q

what diluent to use w/ dapto

A

normal sailine

203
Q

what to monitor for dapto

A

cpk esp if w/ statin

204
Q

what is the MOA of aztreonam?

A

nhibits cell wall synthesis by binding to PBPs

205
Q

spectrum of activity of aztreonam

A

gram - inc pseudomonas

206
Q

SE aztreonam

A

NVD
inc LFTs
rash

207
Q

dose adjust renal imp? Afternoon

208
Q

why use tigecycline?

A

MRSA
VRE (both f’s)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia

209
Q

max chloramphenicol per day

210
Q

why use tigecycline?

A

MRSA
VRE (both f’s)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia

211
Q

brand clindamycin

212
Q

bbw of clinda

A

can cause sever and possible fatal colitis

213
Q

activity of clinda

A

most gram + aerobes but not enterococcus

anaerobic gram - and gram +

214
Q

contraindications of flgayl

A

pregnancy in 1st trimester

215
Q

metronidazole brand

216
Q

contraindications of flgayl

A

pregnancy in 1st trimester

217
Q

how to take ur metronidazole

A

IR: w/ or w/o food

ER; on an empty stomach

218
Q

macrobid dose vs macrodantin dose

A

macrobid 100 po bid

macrodanti 50-100mg po QID

219
Q

how to take ur metronidazole

A

IR: w/ or w/o food

ER; on an empty stomach

220
Q

macrobid dose vs macrodantin dose

A

macrobid 100 po bid

macrodanti 50-100mg po QID

221
Q

Suspensions that must be refrigerated

A 
Augemntin
cefprozil
cefuroxime
cephalexin
erythormycin ethylsuccinate
penicillin VK
Amoxil recommneded
224
Q

agets for CA-MRSA skin infectiosn

A

SMX tmp ds 1-2 ds tab q 12

225
Q

what are the organisms commonly found in the upper respiratory tract?

A

streptococccus
H. Influenzae
M. catarrhalis

226
Q

what are common organisms found in Lungs for infections

A

strept. pneumoniae
H. influenza
Atypicals: legionella, mycoplasma
Enteric Grame Negative Rods

227
Q

what are the common organism found in lungs esp if patient has been in the hospital?

A 
Enteric gram - rods (PEK)
Strep penumo
Pseudomonas 
Enterobacter
S. A (inc MRSA)
228
Q

what are common CNS/Mengingitis pathogens?

A 
Strep Pneumo 
Neisseria gonnorhea
H. I
Strept/ ecoli (young)
listeria (young/old)
229
Q

what organisms are found in the mouth and ENT?

A 
peptostreptoccous
actinomycines
anaerobic GNRs
Aerobic GNRS
H.I
230
Q

what organisms are found in the skin?

A 
strep. pyogennes 
S.A 
S. Epi
Pasturellea
aerobi/anaerobic GNR if diabetics
231
Q

what organisms are found in the bone/joints?

A 
S. A
S. Epi
Streptococcus
Nesseria Gonnorrhe
\+/- GNRs
232
Q

what organisms are found in the intrabdominal tract

A

PEK
Enterococcus
streptococcus
bacteroides

233
Q

what organisms are found in the urnitary tract?

A

PEK
S. Saprophyticus
enteroccocs/
streptococus

234
Q

which patients in the hospital should undergo contact precautions?

A

those w/ mrsa and VRE

235
Q

when do you give antibiotics before surgery?

A

1 hour before

236
Q

what are the DOC for surgical PPX?

A

cefazolin
cefuroxime
Vanc w/ 2 hours before surgery if PCN allergic
or Clinda if PCN allergic

237
Q

what do you use if patient is undergoing surgery that involves the bowel?

A

broader coverage fro anaerobes: cefotetan, ertapenem, CTX + Metronidazole

238
Q

what is the classic triad of meningitis?

A

fever
nuchal rigidity
altered mental status

239
Q

most common meningitis pathogesn

A

S. pneumo
N. menigiditis
H. Influezae
L. Monocytogenes

240
Q

What is a common cause of otitis media? should you just observe?

A

can be viral

appropriate to observe 48-72 hours if not < 6months, not severe, certain diagnosis is viral

241
Q

which age group must get abx for otitis media no matter what?

A

< 6 months

242
Q

if > 6months, should children get abx?

A

only if severe illness or you are certain they have bacteria otherwise observe

243
Q

what do you treat the pain in otitis media?

A

APAP or ibuprofen

If > 5 yo, topical benzocaine: auraglan, americaine otic OK

244
Q

DOC otitis media and dose

A

amox 90mg/kg/day divided q12 or q 8h

245
Q

2nd choic otitis media if severe or failure?

A

Augmentin 90mg/kg/day divided BID or TID

cefdinier, cefpodoxime, cefprozil, cefurxime

246
Q

what if otitis media and PCN allergy?

A

azithro 10mg/kg/day x 1 then 5mg/kg/day x 4 days, clarithro, erythro sulfisoxazole
SMX/TMP
Clinda

247
Q

duration of tx meningitis

248
Q

duration tx for otitis media

A

= 2 5-7 days

249
Q

what if otitis media and cannot take anything orally?

A

ctx IM/IV 50mg/kg x 3 days

250
Q

rocephin

A

ceftriaxone

251
Q

which people should get the Prevnar 13 pneumococcal vaccine?

A

people 2-23 months old

252
Q

when can you give the antivirals for FLU?

A

< 48 hours after symptoms

  • if severe
  • outbreak scenario
253
Q

what is the treatment duration for antivirals for flu?

254
Q

when should you give ABX for pharyngitis

A

they have fever
they have a no cough
tonsil swelling or lymph node
+RADT, cx

255
Q

what is the tx duration for abx for pharyngitis?

256
Q

tx agents of phryngitis

A

amox
pen
cephalexin
macrolides

257
Q

common bacteria or pharyngitis?

A

s. pyogenes

258
Q

common bacteria for sinusitis?

A

s. pneumo
H. I
moraxell

259
Q

tx sinusitis

A 
amox
augmentin
cephalosporins
azithro
FQ
260
Q

when should you treat sinusitis w/ abx?

A

> 7 days sx
tooth face pain
discharge
worsening sx

261
Q

tx for otitis media agents

A

same as sinusitis , except CTX instead of FQ

262
Q

tx for acute bronchitis

A

symptomatic tx, NO ABX as its caused by viruses

263
Q

sx of acute bronchitis

A 
cough > 2 weeks
sore throat
coryza
malaise 
HA
low-grad fever 
\+/- purulent sputum
264
Q

whooping cough

A

> 14 days cough w/ whoop

265
Q

tx for whooping cough

A

azithromycin zpack
erythormycin 500 QID x 14 days
bactrim ds 1 BID x 14 days
clarithr 500 bid , or 1g ER daily x 7 days

266
Q

when to treat w/ abx for AECB?

A

inc dyspnea
inc sputum production
inc purulence

267
Q

tx for AECB

A

debated
mild/mod: amox, doxy, bactim, cephalo
sever: aug, azith, clari,cephalo
FQ

268
Q

which FQ does not work in the lungs?

269
Q

which FQ does not work in the bladder

270
Q

CAP outpatient tx

A

ABx in last 3 mo/HF/DM/immussupression
Resp FQ: moxi/levo
B lactam + macrolide

Otherwise:
macrolide or (can consider FQ instead)
doxy
271
Q

CAP inpatient Medical ward TX

A

Beta lactam + macrolide OR

just a resp FQ

272
Q

CAP tx in ICU and no pseudomonas risk

A

B lactam +
( Azithromycin or resp FQ)

If allergic to to BL
Resp FQ + Aztreonam

273
Q

CAP tx ICU ww pseudomonal risk

A 
beta lactam (AP) +
(cipro/levo) OR AMG+ azithro

Allergy BL
Aztreonam +
(cipro/levo) OR AZTh

274
Q

cefpodoxime dose for cap

A

200mg po q12h

275
Q

cefuroxime dose for cap

A

500mg q12h

276
Q

ceftin

A

cefuroxime

277
Q

azithromycin dose for cap

A

z pack dose

278
Q

clarithrymicin dose for cap

A

250-500mg q 12

or 1000mg daily

279
Q

erythromycin dose for CAP

A

250-500 q 6h

280
Q

Levoloxacin dose for CAP

A

750mh po qd

281
Q

moxifloxacin dose for CAP

A

400mg po qd

282
Q

avelox

A

moxifloxacin

283
Q

docy dose for cap

A

100mg po q12h

284
Q

amoxicillin dose for cap

285
Q

augmentid dose fro cap, which augmentin

A

Augmentin XR

2g q 12h

286
Q

treatment duration for CAP

A

at leas 5 days and afebrile 48-72 hours and <= one sign of clinical instability

287
Q

duration of treatment for HAP

A

7 days

unless pseudomonas/acenitobacter or bloodstream infix = 14 days

288
Q

early onset HAP tx

A

CTX OR levo/mox OR Unysn OR ertapenem

289
Q

what is early onset HAP

A

when it occurs and you have been in the hops for < = 5 days

290
Q

treatment for late onset HAP tx

A

2 antipseudomonal agents + anti MRSA

291
Q

for late onset HAP, AP agent 1 and AP agent 2

A

AP 1 :
cefepime/ ceftazidime
imip/mero
pip/tazo

AP2:
gent/ tobra/amikacin
Levo/cipro

292
Q

what three tests can you do to test for TB

A

PPD skin test
sputum smear and culture
PCR for acid fast bacillus

293
Q

what is the tx for latent TB?

A

INH 300mg po daily q 9mos

alt 15m/kg BIW

294
Q

what does RIPE therapy consist of in terms of agents?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

295
Q

typical course for a typical active infection?

A

take 4 drugs x 8 weeks, then check cultures and susceptibilities. If fully susceptible then only take the INH/rifampin for the next 18 weeks

296
Q

what do you do if the patient is resistant to INH?

A

continue RPE +/- a fluroquinolone for a total of 6 months now

297
Q

what do you do if they are resistant to rifampin?

A

do IPE + FQ but only do the pyrazinamide for 2 months and the total duration is 1 year - 1.5 years

298
Q

what can you add to INH to reduce neuropathy?

A

25-50mg vitamin b 6 (pyridoxine) po daily

299
Q

what can you use instead of rifampin to avoid DDIs?

300
Q

what is the MOA of rifampin

A

inhibits RNA synthesis

301
Q

how should you take your rifampin?

A

on an empty stomach

1 hour before or 2 hours after a meal

302
Q

dose for rifampin

A

10mg/kg per day max 600mg (or 2-3 x /week)

303
Q

brand name rifampin

304
Q

when is rifampin contraindicated?

A

when used with Protease inhibitors, switch to rifabutin

305
Q

SEs of rifampin

A 
Flu like syndrome 
rash
itchiness 
hepatotoxy
** stains secretions orange: tears, urine etc
306
Q

INH for TB?

A

5mg/kg qd max 300mg

or 15m/kg 2-3x/ week max 900mg

307
Q

contraindications for isoniazid therapy?

A

active liver disease or previous adverse rection to INH

308
Q

SE of INH?

A

increased LFTs, Hepatitis
peripheral neuropathy
lupus-like sydnrome

309
Q

pyrazinamide dosing

A

15-20mg/kg QD max 2 G

310
Q

SE pyrazinamide

A

hepatoxicity
hyperuricemia, gout
NV
arthralgias, myagias

311
Q

CI pyrazinamide

A

acute gout

severe hepatic damage

312
Q

ethambutol brand

313
Q

ethambutol dose?

A

15-25 mg/kg QD max 1.5g

314
Q

main SE of ethambutol?

A

optic neuritis therefore routine vision tests every month

315
Q

who should get pox for endocarditis?

A

Prosthetic valve
previous IE
congenital heard disease
cardiac transplant who got valvulopathy

316
Q

ppx for dental procedures?

A

axmo 2g 30-60 minutes before the procdure

317
Q

ppx for dental procedures?

A

clindamycin 600mg 30-60min before procedure

azithro or clarithro 500mg before procedure

318
Q

what are the most common bugs for primary peritonitis?

A

streptococcus
enteric gram - PEK
rare anaerobes

319
Q

what is the the DOC is SBP?

A

ctx x 5-7 days

320
Q

what is cholecytitis?

A

infection of the gallbladder

321
Q

what is cholangitis?

A

infection of the biliary ductal system

322
Q

what are the bugs in secondary peritonitis? MILDE to mdoerate

A

strept
enteric gram - PEK
anaerobes +/- enterococcus

323
Q

what are the bugs in high severe secondary peritonitis?

A

strept
PEK
CAPES
+/- enterococcus

324
Q

high-severity Secondary peritonitis tx?

A

imi/mero/dori

325
Q

mild-mod severity secondary peritonitis tx?

A 
Ticarcillin/clav
erta
cefoxitin
tigecycline
moxi
326
Q

what its the dose fro the tx of ricketsial diseases?

A

dox 100 po/IV BID x ate least 7 days mostly. For ly at least 14 days

327
Q

which are the rickettsial diseases?

A 
lyme disease
rocky mountain spotted fever 
typhus
ehrlichiosis
tularemia
328
Q

what are the most common agents that cause cellulitis?

A

S. pyogenes

S. aureus

329
Q

typicla treatmetn for non-purulent cellulitis?

A

beta lactam : cephalexi n

330
Q

typical tx for purulent cellulitis?

A 
clinda 300-450 TID
bactim 1-2 ds BID
doxy 100mg bid 
minocyline 200mg x1 then 100 id 
linezolid 600 bid
331
Q

what duration of tx for purulent cellulitis?

332
Q

inpatient SSTI

A 
Vanco
linezolid
dapto
telvancin
clinda 600mg IV q 8h/ 300-450po q6h
333
Q

duration of tx for inpatient cellutlis?

334
Q

what is uncomplicated cystitis?

A

women of child bearing age 15-45 w/ a UTI

335
Q

what are the common organisms in uncomplicated cystitis?

A

e. coli
s. saprophyticus
enterococcus

336
Q

what is the DOC for uncomplicated cystitis?

A

SMX/TMP ds tab BID x 3 days

if < 20% of local ecoli is resistant to bactrime and no sulfa allergy

337
Q

alternative tx for acute uncomplicated cystitis?

A 
cipro 250 bid x 3d
cipro ER 500 daily x 3 d
levo 250mg daily x 3 da
nitrofurantoin 100mg bid x 5 days 
fosfomycin 3g x 1 (w/ 4oz)
338
Q

when do you use for PPX for UTI (uncomplicated cystitis)?

A

> = 3 episodes in one year

339
Q

What ppx to use for UTI (uncomplicated cystitis)?

A

1 SS daily bactrime
macrodanting 50mg po daily
or 1 DS post coitus

340
Q

uncomplicated pyelonephritis organisms

A

PEK
Enterococus
PA

341
Q

uncomplicated pyelonephritis moderate Out pt PO tx

A

cipro 500mg po bid
cipro ER, 1000 daily
Levo 750 daily all tx 5-7days

FQ-R: augmentin, cefaclor, cefpodosime, cefdinir and tx 14 days

342
Q

uncomplicated pyelonephritis severe IV tx

A

FQ, Amp/gent, pip/tazo, ctx x 14 days

343
Q

tx for complicated UTI?

A

Amp/gent
Pip/tazo
Ticar/clav
CTX/ ceftaxime +/- FQ

344
Q

tx duration of complicated UTI?

345
Q

what if you have a pregnant women w/ a UTI?

A

must treat x 7 days even if asymptomatic

346
Q

brand phenazopyrdine

A

pyridium
Azo
Uristat

347
Q

dose for phenazopyridine

A

200mg PO TID x 2 days

100mg po TID (OTC) x 2 days

348
Q

How should patients take their phenazopyridine?

A

w/ food to dec stomach upset
no longer that 2 days cuz can mask sx of worsening n
can cause red-orange secretions= staining of lenses and clothes

349
Q

mild-mod tx for c. diff

A

metronidazole 500mg po TID x 10-14days

350
Q

tx for severe c.diff

A

vanco 125mg po QID x 10-14 days

351
Q

what is Vanco pulse therapy? and when do you use it?

A 
use it on the third Cdiff infection
vanc 125mg po QID x 14 days
BID x 1 week
daily x 1 week
then q 2-3 days for 2-8 weeks
352
Q

tx for SEVERE (w/ shock, megacolon, ileus) cdiff

A

vanc 500 po QID + metro 500 IV Q8h

353
Q

Syphilis TX primary, secondary or early latent (<1 year) tx dose

A 
Penicillin Benzathine (Bicillin LA NOT CR)
2.4 Million Units IM x 1
354
Q

Syphilis TX late latetnt > 1 year, tertiary, or unknown duration) tx dose

A

Bicillin LA

2.4 Million Units IM q Week x 3 doses

355
Q

neurosyphillis tx

A

pen G aqueous 3-4 million units IV q 4h x 10-14 days

356
Q

gonorrhea tx

A

CTX IM x 1

357
Q

chlamydia tx

A

azithromycin 1g po X 1

358
Q

bacterial vaginosis

A

metronidazole 500mg po bid x 7 days

metro gel 0.75% 5g intravaginall daily x 5 days

359
Q

trichomoniais

A

metronidazole 2g po x 1

tinidazole 2g po x 1

360
Q

which is the conventional amphotericin?

A

amphotericin desoxycholate

361
Q

brands of liposomal amphotericin

A

Abelcet
AmBisome
Aphotec

362
Q

main Side effects of ampho

A

hypokalemia
hypomagnesimea
nephrotoxicity

363
Q

fluconazole brand

364
Q

coverage of fluconzole

A

candida

cryptococcus

365
Q

why not use ketoconazole?

A

hepatoxiicity

366
Q

can you interchange oral capsule and oral solution of itraconazole?

367
Q

how should you take your itracolzole capsule?

A

w/ food for acidity

368
Q

brand name for voriconazole?

369
Q

spectrum of activity vori

A

Candida, Aspergillus but not nucor (zygomycosis)

370
Q

how should you take your voriconazole?

A

1 hour before or 1 hour after meals (empty stomach)

371
Q

contraindications for voriconazole

A

CYP3a4 inhibitors

372
Q

SE vori

A

visual changes
must correct K/Ca/mg abnormalities before starting therapy
caution driving at night due to vision changes
avoid direct sunlight

373
Q

DDIs for all azoles

A

CYP3A4 inhibitors

374
Q

which two azoles require acidity for absorption?

375
Q

DOC for aspergillus?

376
Q

brand caspofungin

377
Q

brand mycafungin

378
Q

main SE of caspo

A

increased LFTS

379
Q

capo dose

A

IV lD 70mg x1 then 50mg daily

380
Q

mycafungin candidemai dos

A

100mg Iv daily

381
Q

mycafungin dose for esophageal candidiasis

A

150mg IV daily over 60 minutes

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