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NAPLEX review 2024 RXPrep Book > Infectious Diseases I: background and ABX by drug class > Flashcards

Infectious Diseases I: background and ABX by drug class Flashcards

1
Q

how to determine if infection present?

A

fever, elevated WBC, site specific stuff
Diagnostic findings such as culture results, X-rays, etc

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2
Q

ABX selection based on…..

A

infection site and likely organisms
infection severity and risk of MDR
abx spectrum of activity & ability to penetrate site of infection
pt characteristics = age, allergies, renal/hepatic function etc
Txm guidelines

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3
Q

Gram + organisms stain…

A

purple or bluish from crystal violet stain and have a thick cell wall

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4
Q

Gram - organisms stain…

A

pink or reddish and have thin cell wall

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5
Q

Gram + clusters

A

Staph

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6
Q

Gram + pairs/chains

A

Strep or Enterococcus

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7
Q

Gram + rods

A

Listeria monocytogenes
Corynebacterim

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8
Q

Gram + anaerobes

A

Clostridium, C.Dif, P. Strep, P. acnes

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9
Q

Atypicals that won’t stain

A

Chlamydia
Legionella
Mycoplasma pneumo
Mycobacterium tuberculosis

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10
Q

Gram - Cocci

A

Neisseria

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11
Q

Gram - Rods, colonize gut “Enteric”

A

Proteus mirabilis
E. coli
Klebsiella
Serratia
Enterobacter
Citrobacter

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12
Q

Gram - Rods, dont colonize gut

A

Psuedomonoas
H influ
Providencia

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13
Q

Gram - Coccobacilli

A

Acinetobacter
Bordetella pertussis
M.Catarrhalis

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14
Q

Gram - Anaerobes

A

B. fragilis
Prevotella

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15
Q

Example of antibiotic synergy

A

Beta-lactams and aminoglycosides, used for certain gram + invasive infections

A + B > A alone + B alone

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16
Q

Intrinsic resistance

A

natural resistance

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17
Q

Selection pressure resistance

A

occurs when abx kills susceptible bacteria, leaving behind more resistant bacteria

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18
Q

Acquired resistance

A

DNA containing resistance transferred between bacteria

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19
Q

Enzyme inactivation resistance

A

bacteria produces enzymes that will break down the antibiotics

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20
Q

Overgrowth of C.diff can occur when….

A

abx kills too much of healthy gut flora

leading to CDI = C.diff infection

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21
Q

Highest risk ABX for C.diff?

A

broad-spectrum penicillins
cephalosporins
quinolones
carbapenems
Clindamycin**

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22
Q

How do beta-lactams work?

A

inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins.
prevents final step of peptidoglycan synthesis

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23
Q

What can increase levels of beta-lactams?

A

Probenecid, sometimes used intentionally for severe infections

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24
Q

Beta-latams effect on warfarin?

A

can inc anticoagulant effect, except nafcillin/dicloxacillin

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25
Q

Pen G benzathine boxed warning?

A

dont use IV

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26
Q

Which penicillins should not be used in CrCl < 30ml/min?

A

extended release oral forms, like Augmenting XR or Amox/clav 875mg

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27
Q

Side effects with penicillins?

A

Seizures (w/ accumulation & incorrect dose), GI upset, diarrhea, rash, allergic reactions

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28
Q

Why isn’t oral ampicillin used?

A

poor bioavailability

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29
Q

ampicillin and ampicillin/sulbactam (Unasyn) should only be diluted in….

A

NS

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30
Q

Penicillin VK is first line for…

A

strep and mild nonpurluent skin infections

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31
Q

Amoxicillin is first line for….

A

acute Otis media
drug of choice for infective endocarditis prophylaxis before dental procedure

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32
Q

amox/clav is first line for….

A

for acute Otis media and bacterial sinusitis

use lowest dose of clavulanate to dec diarrhea

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33
Q

which penicillin is active against pseudomonas?

A

pip/tazo (zosyn)

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34
Q

which penicillin is drug of choice for syphilis?

A

penicillin G benzathine

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35
Q

1st gen cephalosporin spectrum of activity

A

good against gram + cocci
MSSA
dec gram - activity compared to 2/3/4th gen

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36
Q

2nd gen cephalosporin spectrum of activity

A

gram + and increased gram - activity over previous generations

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37
Q

Which beta-lactam covers MRSA?

A

Ceftaroline (5th gen)

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38
Q

which cephalosporin should be separated from drugs that decrease stomach acid

A

Cefuroxime
cefpodoxime
cefdinir

should be operated by 2 hours from short-acting antacids
H2RAs and PPIs should be avoided

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39
Q

Ceftriaxone should be avoided when using the same line as….

A

calcium containing IV fluids

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40
Q

Carbapenems provide no coverage against….

A

atypical pathogens
MRSA
VRE
C.dif
Stenotrophomonas

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41
Q

Ertapenem is different from other carbapenems as it has no activity against….

A

pseudomonas
acinetobacter
enterococcus

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42
Q

Aztreonam info

A

no cross reactivity with beta-lactam, used when allergy present

doesnt cover gram +/anaerobes but does cover many gram -/pseudomonas

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43
Q

Aminoglycoside info

A

usually used for synergy

2 dosing strategies

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44
Q

2 Dosing strategies for Aminoglycosides

A

traditional = lower dose, more frequent
Extended interval = higher dose for higher peak, less frequent

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45
Q

Benefits of using extended dosing interval aminoglycosides

A

lower risk of nephrotoxicity
less accumulation
decreased cost

hasn’t been shown to be clinically superior tho

46
Q

Aminoglycoside Boxed warnings

A

Nephrotoxicity, ototoxicity, neuromuscular blockade n respiratory paralysis. avoid with other nephrotoxic drugs

47
Q

Aminoglycoside warnings

A

caution in impaired renal function and elderly patients

48
Q

Dosing for aminoglycosides?

A

use TBW if < IDW, use TBW if weight normal and use ABW if obese

Genta/tobra = lower doses for gram +, higher dose for gram neg infection

49
Q

Quinolone MOA

A

inhibit bacterial DNA topoisomerase IV and DNA gyrase

50
Q

Do quinolones have concentration dependent activity?

A

Yes

51
Q

Which quinolones are “respiratory”?

A

Levofloxacin and Moxifloxacin due to enhanced coverage of S.pneumoniae and atypical pathogens

52
Q

Which quinolones have enhanced gram - activity?

A

ciprofloaxin and levofloxacin, also coverage against pseudomonas (can be used in combo w/ beta-lactam or as mono if susceptible)

53
Q

Which quinolone cant be used for UTI?

A

Moxifloxacin = doesnt conc in urine

but can be used for polymicrobial infections (intra-ab), no renal adjustment req

54
Q

Which quinolone is active against MRSA?

A

Delafloxacin

preferred if treating skin infections suspected to be caused by MRSA

55
Q

Quinolone boxed warnings

A

Tendon inflammation/rupture
Peripheral neuropathy
CNS effects

56
Q

CI of ciprofloxacin

A

dont take with tizanidine

57
Q

Quinolone QT prolongation risk

A

Highest = moxi > levo > cipro

dont use in pts with known prolongation

58
Q

Warnings for quinolones

A

Dont use kids/pregnant/breastfeeding
Hypo/Hyperglycemia
Psychiatric disturbances
photosensitivity

59
Q

Quinolone side effects

A

N/D
HA
dizziness
SJS/TEN

60
Q

Quinolone drug interactions

A

Antacids n other polyvalent cations = can chelate, dont take together
phosphate binders = separate by 2hrs before/after
inc effect of warfarin, diabetes drugs

61
Q

Macrolide MOA

A

bind to 50S ribosomal subunits, inhibit RNA-dependent protein synthesis

62
Q

Macrolides excellent coverage of….

A

atypical
used for community acquired RTI and some STI

63
Q

Clarithromycin/Erythromycin CI

A

lovastatin n simvastatin

caution with warfarin other blood thinners

64
Q

Macrolide warnings

A

QT prolongation
Hepatotoxicity

65
Q

Macrolide SE?

A

GI upset (erythromycin used specifically for motility), rare but SJS/TEN

66
Q

Tetracycline MOA

A

inhibit protein synthesis by reversibly binding to 30S ribosomal subunit

67
Q

Which tetracycline has broadest indications?

A

Doxy - RTI, ticks, STI, mild CA-MRSA skin and VRE UTI

68
Q

Tetracycline warnings

A

Photosensitivity
Children < 8, preg/breastfeeding = teeth/bones

** Minocycline = DILE = drug-induced lupus **

69
Q

Doxycycline notes

A

sit atleast for 30min after, take w/ 8oz water for all tetracyclines

70
Q

Tetracycline SE/Monitoring

A

N/V/D

monitor LFT, renal function, CBC

71
Q

Tetracycline DI

A

Antacids n polyvalent cations separate by 2hr before or 4hrs after

72
Q

SMX/TMP MOA

A

SMX = inhibits dihydrofolic acid formation, interfere with bacteria folic acid synthesis
TMP = inhibits dihydrogolic acid reduction, interfere with folic acid pathway

73
Q

SMX/TMP CI

A

sulfa allergy

74
Q

SMX/TMP warnings

A

Skin reaction = SJS/TEN, TTP
Hemolytic anemia = dont use G6PD deficiency
dont use preg unless benefit> risk

75
Q

SMX/TMP side effects

A

photosensitivity
inc potassium
crystalluria = take w/ 8oz water

76
Q

SMX/TMP drug interactions

A

inc INR if used w/ warfarin
risk of hyperkalemia inc if on ACE/ARB
can inc toxic effects of methotrexate

77
Q

Vanco MOA

A

inhibit bacterial cell wall synthesis by binding to D-alanyl-D-alanine

covers gram +, including MRSA but not VRE

78
Q

Vanco warnings

A

Oto/nephrotoxicity = caution when used with other agents

PO only used C.diff not systemic infections

Vanc infusion reaction if too fast infusion

79
Q

Vanco monitoring

A

Renal function
Drug lvls
AUC/MIC ratio or steady state troughs

80
Q

Lipoglycopeptides MOA

A

inhibit bacterial cell wall synthesis by binding D-alanyl-D-alanine and disrupting cell membrane/changing permeability

have concentration dependent activity

81
Q

Telavancin boxed warning

A

Fetal risk = preg test before starting
nephrotoxicity = inc mortality CrCl < 50

82
Q

Telavancin and oritavancin CI

A

Tela = dont use UFH same time, dont use in QT prolonged pts
Orit = dont use UFH 120hrs (5 days) after

can affect PT/INR/aPTT falsely

83
Q

Daptomycin MOA

A

inhibits all intracellular replication processes by causing rapid depolarization

concentration dependent activity against most gram +, including MRSA n VRE, no gram - activity

84
Q

Daptomycin warnings

A

myopathy n rhabdo
false inc INR/PT

cant use for pneumonia, inactivated by surfactant in lungs
additive muscle tox when used with statins

85
Q

Daptomycin monitoring

A

CPK weekly (can cause inc)

86
Q

Oxazolidinones MOA (Linezolid and tedizolid)

A

bind to 50S subunit and inhibit translation/protein synthesis

similar to vanc coverage, but also VRE

87
Q

CI for Linezolid/Tedizolid

A

dont use within 2 weeks of MOAi

** avoid tyramine containing foods **

88
Q

Warnings for Linezolid/Tedizolid

A

duration-related myelosuppression when used > 14 days
optic neuropathy when used > 28 days

** dont shake Linezolid suspension **

89
Q

Linezolid/Tedizolid SE

A

dec platelets

monitor weekly CBC/visual function

90
Q

Quinupristin/Dalfopristin (streptogramin) MOA

A

inhibits protein synthesis by binding 50S ribosomal subunit

not well tolerated, used for VRE infections

91
Q

Quinupristin/Dalfopristin (streptogramin) SE/notes

A

** D5W only **

infusion reactions, arthralgia/myalgias, hyperbilirubinemia

92
Q

Tigecycline MOA

A

binds to 30S ribosomal subunit n inhibits protein synthesis

broad spec against gram -/+, no activity against 3 P (pseudo/proteus/providencia)

93
Q

Tigecycline boxed warning

A

inc risk of death, only used when other txm cant

94
Q

Tigecycline Notes

A

dont use blood stream infections
should be yellow-orange when recon**

95
Q

Polymixins generally used for….

A

MDR gram - infection due to risk of toxicities

96
Q

Polymixin B boxed warnings

A

nephrotoxicity = dose dependent
neurotoxicity, can result in respiratory neuromuscular blockade

nephrotoxicity inc if used with other drugs

97
Q

Colistimethate warning/notes

A

prodrug converted to colistin
Dose-dependent nephrotoxicity
neurotoxicity

98
Q

Chloramphenicol MOA

A

reversibly binds 50S subunit of bacterial ribosome, inhibiting protein synthesis

99
Q

Chloramphenicol Boxed warnings

A

Serious and fatal blood dyscrasias

100
Q

Chloramphenicol Warnings

A

Gray syndrome w/ high serum levels

Montior CBC at baseline and Q 2 days during therapy

101
Q

Clindamycin MOA

A

reversibly binds 50S subunit, inhibiting protein synthesis

102
Q

Clindamycin boxed warning

A

C.diff

103
Q

Clindamycin SE and notes

A

N/V/D

induction test (D-test) should be performed

104
Q

Metronidazole MOA

A

cause loss of DNA structure and strand breakage, resulting in inhibition of protein synthesis

105
Q

Metronidazole CI

A

1st trimester pregnancy
alc during or within 3 days of txm stop

106
Q

Metronidazole SE

A

metallic taste, furry tongue, dark urine

107
Q

Metronidazole DI

A

dont use with alc during and 3 days after stopping txm
can inc INR in pts on warfarin

108
Q

Lefamulin (Xenleta) info

A

Avoid in preg, QT prolongation

approved for CAP

109
Q

Rifaximin (Xifaxan) info

A

used off-label C.diff and hepatic encephalopathy

110
Q

Fosfomycin info

A

used for uncomplicated UTI - female

1 dose regimen

111
Q

Nitrofurantoin info

A

used for uncomplicated UTI - covers VRE/E.coli/Klebsiella

CI in CrCl < 60
dont use G6PD deficiency

SE = GI upset - take with food, brown urine,

112
Q

Mupirocin nasal ointment uses

A

to get rid of MRSA colonization

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