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Pharm Exam 3 > infectious diseases, part 2 > Flashcards

infectious diseases, part 2 Flashcards

1
Q

Tx for acute bacterial skin and skin structure infections, outpatient

A

Cephalexin

  • great for MSSA and strep (Not MRSA)
  • dosed 4x a day: compliance issue
  • cannot use in PCN allergy pts

Tetracyclines (doxycycline, minocycyline)

Bactrim

Clindamycin - use as last nine b/c of C. diff

Linezolid

  • IV and PO, very $$
  • toxicities if used longer than 2 weeks
  • reserved for resistant MRSA

Dalbavancin or Oritavancin

  • one injection , one time dose
  • very long 1/2 life, similar to vanco
  • useful for non-compliant pts
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2
Q

Tx for acute bacterial skin and skin structure infections , inpatient

A 
pharm agents for inpatient (wanna cover for MRSA): 
Vancomycin
Linezolid
Ceftaroline
Daptomycin
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3
Q

acute uncomplicated cystitis

A

usually casued by E. coli (75-95% of cases)

urgency, increased frequency, dysuria, suprapubic pain or tenderness

diagnostics! get UA first, then urine culture
only get urine culture if UA is abnormal
urine culture may show bacteria but if the patient is asymptomatic, shouldn’t treat

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4
Q

Antifungals

A

tx disease causing yeast and molds

common classes

  • Polyenes
  • Triazoles
  • Echinocandins

Common pathogens: Candida and aspergillus

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5
Q

triazoles spectrum of activity

A

————————————————->
increasing spectrum of activity

fluconazole
itraconazole
voriconazole
posaconazole
isavuconazole

fluconazole is the least broad
candida glubra is 30% resistant to fluconazole

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6
Q

URI tx

A 
avoid antibiotics, treat symptoms
nasal discharge - antihistamine
nasal congestion - decogenstant / saline
sore throat - lozenges
headache etc - acetaminophen
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7
Q

Isavuconzole (Cresemba)

A

BIG GUN
available IV and PO
metabolized primarily by liver
very broad spectrum of activity including yeast and mold

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8
Q

URI work up

A

bacterial versus viral

fever
rapid throat swab - rule out strep
nasal viral swab - rule out flu

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9
Q

CURB-65

A 
CONFUSION
BUN > 20
RR > 30 
BP systolic < 90 or diastolic < 60 
Age > 65

one point for each

0-1 –> outpatient
2 - discretion / either short inpatient or supervised out
3 - inpatient
4-5 - inpatient / icu

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10
Q

when to tx a URI with antibiotics

A

strep throat
-amoxicillin or augmentin

otitis externa

otitis media with pus draining

worsening URI

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11
Q

community acquired pneumonia diagnosis

A 
fever
tachypnea
cough
sputum production
confusion
fatigue
CXR showing infiltrate
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12
Q

Other agents for UTI

A

Bactrim - not in pregnancy
Fluroquinolones (Levofloxacin, Ciprofloxacin)
use in allergic or severe/refractory case
DO NOT USE MOXIFLOXACIN FOR UTI
Beta-lactams (definitive therapy)
amoxicillin clauvanate (Augmentin)
oral cephalosporins ie cefpodoxime (Vantin)

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13
Q

Fluconazole (Diflucan)

A

Excellent oral bioavailability
Good distribution in CSF, vitreous, urine
Renal elimination -adjust dose in renal failure
Think: C. albicans injections - thrush, UTI, blood

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14
Q

empiric therapy

A

no culture data to guide antibiotic selection
takes into account common pathogens
takes into account pt hx and local resistance

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15
Q

Fosfomycin (Monurol) PO

A

MOA: interferes with cell wall synthesis
broad spectrum , covering - and +
Reserved for refractory cases***
Given as a one time dose in uncomplicated disease
Many will complain of diarrhea, nausea.. sometimes dizziness
Patients develop resistance so only should use empirically once or twice, need to base it on cultures after that

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16
Q

treatment of CAP outpatient

A

first line: for outpatient, uncomplicated
Doxycycline or azithromycin

first line (oupatient, complicated)
same as above or
levofloxacin or moxifloxacin

complicated = patient has multiple comorbidities including COPD, diabetes, CHF, OR they have recent antibx use

tx about 5-7 days

17
Q

indications for antifungal disease

A

invasive candidiasis

  • mucocutaenous disease
  • candiduria
  • candidemia (4th most common blood stream infection)
  • intra-abdominal infections
  • meningitis
  • endocarditis

invasive mold infections (lung, skin, sinus, CNS)

  • aspergillosis
  • other mold species
18
Q

community acquired pneumonia

A

similar symptoms to structural lung disease and CHF exacerbations

in elderly, confusion may be only initial symptom

chest x-ray not always sensitive

19
Q

Voriconazole (VFEND)

A

drug of choice for invasive pulmonary aspergillis
excellent distribution including CSF, and CNS BUT NOT URINE
iv and oral option - great bioavailability
requires monitoring, goal is 2 - 5.5 mcg/ml

side effects include visual disturbances and hallucinations!! can develop tolerance tho

20
Q

Azole ADE / Monitoring

A 
LFTs
Renal Function
QTc interval
Drug Interactions
GI Intolerance
Agent Specific
21
Q

Itraconazole (Sporonax)

A 
less common
-inotropic effects
Contraindicated with class 3 and 4 heart failure
metabolized extensively by liver
requires monitoring of drug levels
22
Q

treatment of acute uncomplicated cystitis

A

Fluoroquinolones no longer recommended as first line therapy - reserve for allergy / severe
Resistance is huge concern
typical duration is just 3-5 days

preferred agents: 
nitrofurantoin (Macrobid)
Bactrim
Fosfomycin
Fluoroquinolones
Beta-lactams (amoxicillin-clauvanate, cefpodoxime)
23
Q

treatment of CAP inpatient

A

Ceftriaxone PLUS Azithromycin
(PCN allergy: levofloxacin or moxifloxacin)

concern for pseudomonas :
anti-pseudomonal agent + Levofloxacin

concern for MRSA: add vanco or linezolid

tx about 7-10 days

24
Q

Nitrofurantoin (Macrobid) PO

A

MOA: works intracellularly to damage bacterial RNA and DNA
requires patients to have CrCl > 50
Requires minimum of 5 days treatment
Safe in pregnancy
Well tolerated
-diarrhea, hypersensitivity, rash, anemia (rare), peripheral neuropathy (rare, long term use)
Covers many gram-negative organims (E. coli)
also coveres Enterococcus, VRE

DO NOT USE IN COMPLICATED DISEASE
poor GU tissue concentrations
need to rule out upper GU involvement

25
Q

Posaconazole (Noxafil)

A

expanded spectrum including rare molds
IV and po options
therapeutic drug monitroing
prophylaxis in neutropenic patients tx for AML

Pharm Exam 3 (5 decks)

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