Infectious Diseases - PART 2 Flashcards
AMINOGLYCOSIDE AGENTS
GENTAMICIN
TOBRAMYCIN
AMIKACIN
AMINOGLYCOSIDE TOXICITIES
NEPHROTOXICITY
OTOTOXICITY
NEUROMUSCULAR BLOCKADE
AMINOGLYCOSIDE COVERAGE
GN (INCLUDING PSEUDOMONAS)
AMINOGLYCOSIDES ARE COMMONLY USED IN COMBINATION WITH WHICH AGENTS AND WHY?
BETA LACTAMS OR VANCOMYCIN
FOR SYNERGY AND TO COVER GP
AMINOGLYCOSIDE DOSING: UNDERWEIGHT PATIENT
USE TOTAL BODY WEIGHT
AMINOGLYCOSIDE DOSING: OBESE PATIENT
ADJUSTED BODY WEIGHT
AMINOGLYCOSIDE DOSING: GENTAMICIN AND TOBRAMYCIN TRADITIONAL DOSING
1-2.5 MG/KG/DOSE Q8H
AMINOGLYCOSIDE DOSING: GENTAMICIN AND TOBRAMYCIN EXTENDED INTERVAL DOSING
4-7 MG/KG/DAY Q24H
AMINOGLYCOSIDE MONITORING: DRUG LEVEL FOR TRADITIONAL DOSING
NEED TROUGH LEVEL RIGHT BEFORE 4TH DOSE AND PEAK 30 MIN AFTER 4TH DOSE
GOAL TROUGH <2
GOAL PEAK 5-10
AMINOGLYCOSIDE MONITORING: DRUG LEVEL FOR EXTENDED DOSING
RANDOM LEVEL TO DETERMINE DOSING FREQUENCY
NOMOGRAM BASED ON DRUG LEVEL AND TIME BETWEEN START AND RANDOM DRAW
QUINOLONE AGENTS
CIRPOFLOXACIN
LEVOFLOXACIN
MOXIFLOXACIN
GEMIFLOXACIN
QUINOLONE COVERAGE
GN AND GP
ATYPICALS
RESPIRATORY QUINOLONES
LEVOFLOXACIN
MOXIFLOXACIN
GEMIFLOXACIN
HAVE ENHANCED COVERAGE TO S.PNEUMO AND ATYPICAL
WHICH QUINOLONES HAVE ENHANCED GN ACTIVITY (INCLUDING TO PSEUDOMONAS)
CIPROFLOXACIN
LEVOFLOXACIN
WHICH QUINOLONE CAN NOT BE USED FOR UTIS?
MOXIFLOXACIN
WHICH FLUOROQUINOLONE HAS ENHANCED GP AND ANAEROBIC COVERAGE
MOXIFLOXACIN
WHICH FLUOROQUINOLONE HAS MRSA COVERAGE?
DELAFLOXACIN
OTHER QUINOLONES ARE AVOIDED DUE TO RESISTANCE
WHICH FLUOROQUINOLONE DOES NOT REQUIRE RENAL DOSE ADJUSTMENT?
MOXIFLOXACIN
WHICH QUINOLONES HAVE IV:PO RATIO OF 1:1?
LEVOFLOXACIN AND MOXIFLOXACIN
CAUTION FLUOROQUINOLONE USE IN THESE DISEASE STATES
CVD
LOW K OR MG
USE WITH OTHER QT PROLONGING
SEIZURE HISTORY
DIABETES
PSYCHIATRIC CONDITIONS
WHICH ORAL SUSPENSION SHOULD AVOID ADMINISTRATION WITH NG TUBE OR OTHER FEEDING TUBE?
CIPROFLOXACIN
AVOID SYSTEMIC FLUOROQUINOLONES IN THESE POPULATIONS
- PTS WITH SEIZURE HX
- PEDIATRICS (MUSCULOTOXICITY)
- PREGNANCY (MUSCULOTOXICITY)
MACROLIDE AGENTS
AZITHROMYCIN
CLARITHROMYCN
ERYTHROMYCIN
Z-PAK DOSING
500 MG DAY 1
250 MG DAY 2-5
MACROLIDE COVERAGE
ATYPICALS
H FLU
MACROLIDE COMMON USE
COMMUNITY ACQUIRED RESPIRATORY INFECTIONS
STI (CHLAMYDIA AND GONORRHEA)
MACROLIDE WARNING
QT PROLONGATION
HEPATOTOXICITY
WHICH MACROLID SHOULD BE CAUTIONED IN CAD
CLARITHROMYCIN CAN INCREASE RISK OF DEATH
THESE MACROLIDES HAVE HIGH POTENTIAL FOR DDIS BECAUSE THEY DO THIS
CLARITHOMYCIN AND ERYTHROMYCIN
STRONG CYP3A4 INHIBITORS
TETRACYCLINE AGENTS
DOXYCYCLINE
MINOCYCLINE
TETRACYCLINE
TETRACYCLINE COVERAGE
GPC
GN AND ATYPICALS
DOXYCYCLINE HAS BROADER INDICATIONS
CAP
TICK-BORNE DISEASES
STIS (CHLAMYDIA AND GONORRHEA)
CA-MRSA SKIN INFECTION
VRE UTI
WHICH TETRACYCLINE DOES NOT NEED RENAL DOSE ADJUSTMENTS
DOXYCYCLINE
TETRACYCLINE WARNINGS
BONE GROWTH AND TEETH DISCOLORATION (CHILDREN < 8 YO, PREGNANCY)
PHOTOSENSITIVITY
MINOCYCLINE HAS THIS UNIQUE WARNING
DRUG INDUCED LUPUS ERYTHEMATOSUS (DILE)
TETRACYCLINE BIOAVAILABILITY (IV:PO RATIO)
GOOD
1:1 FOR DOXY AND MINOCYCLINE
SMX/TMP COVERAGE
MRSA
UNRELIABLE STREP
BROAD GN BACTERIA (SHIGELLA, SALMONELLA, HNPEK)
OPPORTUNISTIC PATHOGENS
NO PSEUDOMONAS, ENTEROCOCCI, ATYPICAL, OR ANAEROBE COVERAGE
WHICH OPPORTUNISTIC PATHOGENS DOES SMX/TMP HAVE COVERAGE?
PNEUMOCYSTUS
TOXOPLASMOSIS
SMX TMP DOSE IS BASED ON WHICH COMPONENT?
TMP COMPONENT
SMX/TMP FORMULATION RATIO
SMX:TMP = 5:1
SMX/TMP SS
400 MG SMX
80 MG TMP
SMX/TMP DS
800 MG SMX
160 MG TMP
SMX/TMP UTI DOSING
1 DS TAB PO BID X 3 DAYS
SMX/TMP PCP PROPHYLAXIS DOSING
1 DS OR SS DAILY
SMX/TMP WARNINGS
SULFA ALLERGY
THROMBOCYTPENIC PURPURA (TTP)
G6PD DEFICIENCY (HEMOLYSIS RISK)
SMX/TMP SIDE EFFECTS
PHOTOSENSITIVITY
↑ K
HEMOLYTIC ANEMIA (POS COOMBS)
CRYSTALLURIA
SMX/TMP DDI WITH WARFARIN
CAN INCREASE INR
SMX/TMP IS A CYP2C9 INHIBITOR
VANCOMYCIN COVERAGE
GP BACTERIA (INCLUDING MRSA)
C.DIF (PO VANCO)
NO VRE
VANCOMYCIN IS FIRST LINE IN WHICH INFECTIONS?
MODERATE-SEVERE SYSTEMIC MRSA INFECTION
WHEN SHOULD YOU CONSIDER AN ALTERNATIVE AGENT OF VANCOMYCIN?
MRSA MIC ≥ 2
VANCOMYCIN IV DOSING FOR SYSTEMIC INFECTION
15 - 20 MG/KG Q8-12H
VANCOMYCIN DOSING BASED ON WHAT WEIGHT
TOTAL BODY WEIGHT
WHEN TO RENAL DOSE ADJUST VANCOMYCIN AND TO WHAT ADJUSTMENT?
CRCL 20-49
CHANGE TO Q24H
VANCOMYCIN C.DIF DOSE
125 MG QID X 10 DAYS
VANCOMYCIN WARNINGS
OTOTOXICITY
NEPHROTOXICITY
FOR SERIOUS MRSA INFECTIONS, WHAT ARE THE THERAPEUTIC DRUG LEVEL GOALS FOR VANCOMYCIN?
AUC/MIC RATIO 400-600 OR
GOAL TROUGH 15 - 20 MCG/ML (NORMALLY JUST 10-15 MCG/ML)
LIPOGLYCOPEPTIDE AGENTS
TELAVANCIN
ORITAVANCIN
LIPOGLYCOPEPTIDE APPROVED FOR WHAT INDICATIONS
TELA: SSTI AND HA-VAP
ORITA: SSTI
TELAVANCIN BOXED WARNINGS
FETAL RISK
NEPHROTOXICITY (CRCL ≤ 50)
LIPOGLYCOPEPTIDE CONTRAINDICATIONS
CONCURRENT USE OF IV UFH
ORITA: DONT USE UFH FOR 120H AFTER ORITA ADMIN
CAN INTERFERE WITH aPTT LAB RESULTS
LIPOGLYCOPEPTIDE WARNINGS
FALSELY ↑ PT/INR AND OTHER COAGULATION TESTS
RED MAN SYNDROME
ORITAVANCIN DOSING
ONLY A SINGLE DOSE IS NEEDED DUE TO EXTREMELY LONG HALF-LIFE