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InfectiousDiseasesFC Flashcards

1
Q

Aminoglycosides are ______ dependent killers and exhibit a _______. Therefore they are normally dosed _____ daily

A

concentration-dependent
post-antibiotic effect (continued suppression of bacterial growth when antibiotic levels are below the MIC of the organism
once daily

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2
Q

Which drugs are in the class aminoglycosides

A

gentamycin, tobramycin, and amikacin, streptomycin

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3
Q

Which aminoglycosides can be given IV/IM and which can only be given IM

A

Iv/IM: gentamycin, tobramycin and amikacin
IM: streptomycin

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4
Q

Tobramycin comes IV, IM and _____ for the treatment of _____

A

inhaled formulation
CF

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5
Q

You dose aminoglycosides on _______

A

Ideal body weight

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6
Q

What black box warning do aminoglycosides come with

A

may cause neurotoxicity (vertigo, ataxia) and nephrotoxicity

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7
Q

What side effect are common for aminoglycosides

A

nephrotoxicity (ATN) and ototoxicity

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8
Q

Which patients should aminoglycosides be used in caution with

A

elderly, impaired renal function, and those on other nephrotoxic drugs (amphoteracin B, cisplatin, NSAIDs, vancomycin, contrast dyes, cyclosporine)

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9
Q

What are some common nephrotoxic drugs

A

aminoglycosides, amphoteracin B, cisplatin, NSAIDs, vancomycin, contrast dyes, cyclosporine

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10
Q

What monitoring parameters are important for aminoglycosides

A

renal function, hearing tests, and peak/troughs with traditional dosing and random level with extended dosing

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11
Q

What pregnancy category are aminoglycosides

A

D

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12
Q

What is something important to know about aminoglycosides effect on neuromuscular blocking agents

A

they increase levels of those agents

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13
Q

What are doses of aminoglycosides in traditional dosing

A

traditional
gent/tobra: 1-2.5mg/kg/dose
amikacin: 5-7.5mg/kg/dose

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14
Q

What are doses of aminoglycosides in extended interval dosing

A

extended interval
gent/tobra: 4-7 mg/kg
amikacin: 15-20 mg/kg

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15
Q

In traditional dosing of aminoglycosides how do dosing intervals change based on renal function

A

crcl>60 q 8 hr; crcl 40-60 q 12 h; crcl 20-40 q 24 h, crcl <20 give loading dose and monitor levels

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16
Q

When should trough and peak levels be taken for traditional aminoglycoside dosing

A

trough level right before next dose and peak level 1/2 hour after the end of the dosing interval

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17
Q

How are dosing frequency determined using extended interval dosing and when are levels taken

A

draw random level 6-16 hours post dose (depends on nomogram) and place level on nomogram to find out how frequently the dose should be given

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18
Q

What are the peak and trough levels that should be obtained with aminoglycosides using traditional dosing

A

gent/tobramycin: peak 5-10 and trough <5

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19
Q

penicillins exhibit ______ dependent killing and are bactericidal except against _______ where aminoglycosides are needed for ________ activity

A

time dependent killing
enterococci species
bactericidal

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20
Q

Aminopenicillins include which drugs

A

amoxicillin (amoxil, moxatag), amoxicillin + clavulanate (augmentin), ampicillin (principen), and ampicillin + sulbactam (unasyn)

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21
Q

ampicillin + sulbactam brand name is

A

unasyn

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22
Q

brand name of ampicillin is

A

principen

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23
Q

what drugs are referred to as natural penicillins

A

penicillin (penG and pen VK)

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24
Q

What drugs are referred to as ureidopenicillins

A

piperacillin + tazobactam (zosyn)

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25
Q

What is the generic name for zosyn

A

piperacillin + tazobactam

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26
Q

What is a carboxypenicillin

A

ticarcillin + clavulonic acid (timentin)

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27
Q

what are antistaphylococcal penicillins

A

nafcillin, oxacillin, and dicloxacillin

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28
Q

Which penicillin is hepatically cleared and which ones are renally cleared

A

hepatically- nafcillin
renally- all others

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29
Q

Amoxicillin is the doc for which conditions

A

acute otitis media, h. pylori regimen, pregnancy, prophylaxis for endocarditis

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30
Q

piperacillin and ticarcillin are the only penicillins with activity against

A

pseudomonas

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31
Q

penicillins combined with a beta-lactamase inhibitor have a broader spectrum of activity and are often used against ______ infections

A

mixed (intra-abdominal, aspiration pneumonia, diabetic foot ulcers, etc)

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32
Q

reduced dose and/or extended intervals are needed in renal impairment for all penicillins except

A

nafcillin, oxacillin, and dicloxacillin

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33
Q

side effect of penicillins are

A

allergic reactions (including anaphylaxis), rash, pruritis, gi upset, diarrhea, seizures with accumulation, acute interstitial nephritis (AIN), colitis, agranulocytosis, inc LFTs, bone marrow suppression with prolonged use

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34
Q

What are monitoring parameters for penicillins

A

renal function, signs of anaphylaxis with 1st dose

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35
Q

What pregnancy category are penicillins

A

B

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36
Q

penicillins can cause false ____ for both urinary glucose tests and galactomannan test for aspergillosis

A

positive

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37
Q

Which penicillin suspensions must be refrigerated?

A

augmentin must be refrigerated and amoxicillin suspension is refrigerated only to improve taste but stable 14 days at room temp, pen VK suspension should be refrigerated after reconstitution

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38
Q

how should you take Moxatag

A

Amoxicillin (Amoxil, Moxatag) should be taken within an hour of finishing a meal

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39
Q

How should pen VK be taken

A

penicillin should be taken on an empty stomach

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40
Q

Amoxicillin IV is only compatible with what solvent and stable for only ___ hours at room temp

A

Normal saline only
8 hours at room temp

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41
Q

Nafcillin is a _______ so if extravasation occurs use cold packs and hyaluronidase injections

A

vesicant

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42
Q

______ agents can increase levels of pcns by interfering with renal excretion

A

uricosuric agents (probenacid, allopurinol

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43
Q

Penicillins may decrease the effectiveness of what other drug

A

oral contraceptives

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44
Q

Cephalosporins mechanism of action

A

inhibit bacterial wall synthesis

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45
Q

Cephalosporins are ______ dependent killers with bacteriacidal activity

A

time

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46
Q

First generation cephalosporins include (brand and generic)

A

cefadroxil, cefazolin (kefzol), cephalexin (keflex)

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47
Q

keflex is the brand name for

A

cephalexin (first generation)

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48
Q

kefzol is the brand name for

A

cefazolin first generation

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49
Q

what is the normal dose of cefadroxil and what generation of cephalosporin is it

A

500 to 1000mg q 12 hr (po)
first generation

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50
Q

what is the normal dose of cefazolin, brand name and what generation of cephalosporin is it

A

kefzol
250 to 2000mg po q 8hr (iv)
first generation

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51
Q

what is the normal dose of keflex, what is the generic name and what generation of cephalosporin is it

A

cephalexin
250 to 500 mg q 6 hr (po)
first generation

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52
Q

in which time increments are first generation cephalosporins dosed

A

cefadroxil p 12 hr (po)
cefazolin (kefzol) q 8 hrs (iv)
cephalexin (keflex) q 6 hrs (po)

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53
Q

what drugs are second generation cephalosporins

A

cefactor
cefotetan
cefoxitin (mefoxin)
cefprozil
cefuroxime (ceftin, zinacef)
Cefuroxime

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54
Q

what is the generic name of mefoxin, what generation is it

A

cefoxitin 2nd generation cephalosporin

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55
Q

what is the generic name of ceftin, zinacef? what generation is it?

A

cefuroxime
2nd generation cephalosporin

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56
Q

what is the normal dose of cefotetan and cefoxitin (mefoxin)?

A

cefotetan 1-2 grams q 12 hrs (iv)
cefoxitin 1-2 grams q 6-8 hrs (iv)
both are second generation cephalosporins

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57
Q

what is the normal dose of cefprozil and cefactor

A

Cefaclor 250- 500mg q 8 hrs (po) to 12 h for ER
cefprozil 250 - 500mg q 12-24 hrs (po)

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58
Q

what is the normal dose of cefuroxime (ceftin, zinacef)

A

250- 1,500mg q8 hrs (po/iv)

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59
Q

3rd generation cephalosporins include

A

cefdinir, cefditoren (spectracef), cefixime (suprax), cefotaxime (claforan), cefopodoxime , ceftazidime (fortaz, tazicef), ceftibuten, ceftriaxone (rocephin)

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60
Q

what is the normal dose of ceftoxamine (claforan), ceftazidime (fortaz, tazicef) and ceftriaxone (rocephin)?

A

cefotaxime (claforan) 1-2 grams q 8-12 hr (iv/im)
ceftazidime (fortaz, tazicef) 1-2 grams q 8-12 hr (iv)
ceftriaxone (rocephin) `1-2 grams q 12-24 hrs (iv/im)

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61
Q

what is the normal dose of cefixime (suprax), cefditoren (spectracef) and ceftibuten (cedax)?

A

cefixime (suprax) 400 mg divided q 12 to 24 hr (po
cefditoren ( spectracef) 200-400mg q12 hr (po)
ceftibuten (cedax) 400mg qd (po))

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62
Q

what is the normal dose of cefdinir?

A

300mg q 12 hr or 600mg daily (po)

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63
Q

what is the generic name for fortaz, tazicef)?

A

ceftazidime
3rd generation cephalosporin

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64
Q

what is the generic name for rocephin

A

ceftriaxone

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65
Q

what are the names of fourth generation cephalosporins

A

cefepime (maxipime)

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66
Q

what is the generic name for maxipime

A

cefepime
4th generation cephalosporin

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67
Q

what is the generic name for teflaro

A

ceftaroline fosamil
5th generation cephalosporin

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68
Q

what is the normal dose of maxipime

A

cefepime (maxipime) 1-2 grams q 8-12 hr (iv)

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69
Q

what is the normal dose of teflaro

A

ceftaraline(teflaro) 600mg q 12 hr (iv)

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70
Q

what are common side effects of cephalosporins

A

allergic reactions (anaphylaxis), rash, gi upset, diarrhea, colitis, increased LFTS, bone marrow suppression with prolonged use

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71
Q

what should be monitored in cephalosporins, what other drug class is this like?

A

renal function, signs of allergic reaction (anaphylaxis) with first dose
penicillins

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72
Q

cross sensitivity of cephalosporins with pCNs is _____

A

<10%

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73
Q

cephalosporins should not be used in pts with type ___ reaction to pcns

A

1

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74
Q

cephalosporins are pregnancy category ___

A

B

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75
Q

___________ have test interactions with positive direct coomb’s test and false positive urinary glucose tests

A

cephalosporins

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76
Q

reduced doses and extended intervals are needed in cephalosporins except for ________

A

ceftriaxone

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77
Q

______________ cephalosporin can cause biliary sludging and should not be given via y-site or mixed with ca-containing solutions

A

ceftriaxone

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78
Q

cefotetan contains NMTT or 1-MTT side chain and can leasd to risk of ______________________ and a disulfram-like reaction with _____ ingestion

A

hypoprothrombinemia (bleeding)
alcohol

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79
Q

ceftibuten should be taken _________food

A

without (on an empty stomach)

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80
Q

how should cefpodoxime, cefaclor, cefuroxime, and cefdiltoren tablets all should be taken how in regards to food

A

with food

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81
Q

probenecid and allopurinol as well as other urosurgic agents can ____levels of cephalosporins by interfering with renal excretion

A

increase

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82
Q

cephalosporins can ____ levels of oral contraceptives

A

decrease

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83
Q

Which carbapenems are given q 6-8 hrs and which daily?

A

q6-8 hrs–> imipenem/cilastin (primaxin) 250-1000mg iv q6-8hr
meropenem (merrem) 500-1000mg iv q 6-8hrs
–q8hrs doripenem (doribax) 500mg iv q8hrs
q24hrs ertapenem (invanz) 1000mg iv/im daily

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84
Q

which carbapenem is not active against pseudomonas?

A

ertapenem (invanz)
note: also the only one dosed daily as wel (iv/im)

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85
Q

what is the generic name for primaxin

A

imipenem/cilastin
carbapenem

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86
Q

what is the generic name for merrem

A

meropenem
carbopenem

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87
Q

what is the generic name for invanz

A

ertapenem
carbapenem

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88
Q

what is the generic name for doribax

A

doripenem

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89
Q

what are common side effects of carbapenems

A

diarrhea, rash, and seizures with higher doses and patients with decreased renal function (mostly imipenem)

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90
Q

who is at risk for a seizure with carbapenems, which one is worst?

A

patients on higher doses with impaired renal function
–primarily with imipenem (primaxin)

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91
Q

what category are carbapenems, which is a different category

A

b
c- imipenem

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92
Q

why is imipenem combined with cilastin?

A

to prevent degradation by renal tubular dehydropeptidase

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93
Q

which carbapenems need reduced dose or extended intervals with renal impairment

A

all

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94
Q

it is ok to use carbapenems in a patient with a pcn allergy

A

no cross sensitivity between 50-<10%

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95
Q

uricosurgic agents (probenacid, allopurinol) can ___levels of carbapenems

A

increase

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96
Q

which drugs are affected by uricosurgic agents (probenacid, allopurinol)

A

PCN, cephalosporins, carbapenems

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97
Q

carbapenems can _____ serum conc of valproic acid

A

decrease which can lead to a loss of seizure control

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98
Q

imipenem is ok to take with ganciclovir

A

FALSE
avoid use due to increased risk of seizures

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99
Q

ciprodex

A

ciprofloxacin otic

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100
Q

carbapenems are ok to use in patients at risk for seizures

A

FALSE
do not use

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101
Q

cetraxal

A

ciprofloxacin

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102
Q

what is MOA of FQ’s and they exhibit _____ dependent killing with bactericidal activity

A

inhibit bacterial DNA topoisomerase IV and inhibit DNA gyrase (topoisomerase II).
Concentration

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103
Q

ciloxan

A

cipro opthalmic

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104
Q

what drugs are considered FQ’s

A

ofloxacin (floxin otic), norfloxacin, cipro, levo, gati, gemi

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105
Q

Noroxin

A

nofloxacin

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106
Q

Cipro

A

ciprofloxacin (cipro, cipro XR, ciloxan ophthalmic, cetraxal, and ciprodex otic)

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107
Q

levaquin

A

levofloxacin

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108
Q

zymar and zymaxid

A

gatifloxacin (zymar and zymaxid ophthalmic)

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109
Q

avelox, moxeza, vigamox

A

moxifloxacin (avelox, moxeza, and vigamox ophthalmic)

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110
Q

factive

A

gemfloxacin

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111
Q

what is the generic name of cipro or cipro XR

A

ciprofloxacin FQ

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112
Q

what is the generic name of levaquin

A

levofloxacin

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113
Q

what is the generic name of avelox

A

moxifloxacin

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114
Q

what is the normal dose of ciprofloxacin (iv/po); crcl>50, 30-50, and <30

A

250-750mg po or 200-400iv
crcl>50 q8-12hr
30-50: q12 hr
<30: q 18-24 hr

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115
Q

levofloxacin dosing iv/po; crcl>50, 20-49, <20

A

250-750
crcl>50 qd
20-49: 750 q 48hr, 500, then 250 daily, or 250 daily
<20: 750 then 500 q48hr, or 500 then 250 q48hr or 250 q 48hr

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116
Q

moxifloxacin dosing (iv/po)

A

400mg q 24 hrs

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117
Q

Which FQ are renally excreted and which are hepatic

A

moxifloxacin is hepatic others are renal
cipro is mixed r=h

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118
Q

what is black box warning for FQ

A

tendon inflammation and/or rupture

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119
Q

what puts pts at risk for tendon inflammation and/or rupture with fQs

A

concurrent corticosteroid use, organ transplant patients, and patients >60years old

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120
Q

what are common side effects of fQ

A

photosensitivity, glycemia issues (hypo normally), arthropathy in children, QT prolongation, gi upset (n/v/d), headache rash

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121
Q

FQ use should be avoided if possible in what patient pop

A

children due to arthropathy and concerns of increased mx toxicity may use if risk outweighs benefits

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122
Q

what agents should be avoided with FQ due to increased risk of QT prolongation

A

class 1a and class III antiarrhythmics

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123
Q

are FQ safe in pregnancy?

A

class C
may cause cartilage damage in young animals

124
Q

cipro oral suspension is ok to give NG

A

no because oil based suspension adheres to tubing

125
Q

what are counseling points on cipro oral suspension

A

shake vigorously for 15sec before admin
no chew the microcapsules

126
Q

can cipro IR be crushed?

A

yes, and it can be mixed with water and given via NG tube

127
Q

which version of cipro should be given NG and are there any other recommendations?

A

hold tube feedings 1 hour before and 2 hours after the dosecipro IR mixed with water ok (cipro susp not ok)

128
Q

which FQ need to have reduced doses or extended intervals in renal impairment

A

all but moxifloxacin

129
Q

can FQ be used in PCN allergic pts?

130
Q

which agents cannot be given with FQ due to being multivalent cations

A

antacids, didanosine, sucralfate, bile acid resins, mg, al, ca, fe, zn, multivitamins

131
Q

how long should each type of FQ be seperated from multivalent cations?

A

cipro 2 hrs before/ 6 hrs after
levo 2 hrs before/2 hrs after
moxi 4 hrs before/8hrs after

132
Q

FQ can increase the levels of …..(3)

A

warfarin, sulfonylureas, and QT prolonging drusg

133
Q

which FQ has the most prominent effect on QT prolonging drugs

A

moxifloxacin

134
Q

probenacid and NSAIDs can ____ FQ levels

135
Q

ciprofloxacin is a strong ____ inhibitor and a weak _____ inhibitor

A

1A2, weak 3A4

136
Q

Macrolides MOA, have bacteriostatic activity and related to __________

A

bind to 50S ribosomal subunit –> inhibit RNA dpdt protein synthesis
total exposure of the drug (AUC/MIC)

137
Q

what drugs are considered macrolides (brand/generic)

A

zithromax, zpack (azithromycin)
biaxin, biaxin XL (clarithromycin)
EES, erytab, eryped, erthrocin (erythromycin)

138
Q

what is the generic name for zithromax, z pack

A

azithromycin macrolide

139
Q

what is the generic name for biaxin, biaxin xl

A

clarithromycin

140
Q

what is the generic name for EES, erytab, eryped, erythrocin

A

erythromycin

141
Q

what are common doses of azithromycin

A

500mg on day 1, then 250 days 2-5
OR 500mg daily x 3 days

142
Q

should you refrigerate azithromycin oral suspension (zmax)?

143
Q

common dose of biaxin

A

clarithromycin (biaxin)
250-500mg bid or
1 gram qd

144
Q

should you take biaxin xl with food?

145
Q

should you refrigerate biaxin oral suspension

146
Q

which macrolide suspensions do you refrigerate?

A

only erythromycin (ees)
no fridge: clarithromycin and azithromycin

147
Q

what is the only macrolide that needs to be renally adjusted?

A

clarithromycin

148
Q

what is the normal dose of erythromycin?

A

EES 400mg qid
erythromycin base/stearate: 250-500mg qid

149
Q

which macrolide is dosed qd, bid, and which is qid

A

qd- azithromycin
bid- clarithromycin (unless 1gm daily)
qid- erythromycin

150
Q

do you need to refrigerate erythromycin suspension?

A

yes EES (erythromycin ethylsuccinate) oral granule suspension and use within 10 days
erythromycin powder suspension stable at room temp x 35 days

151
Q

what are common side effects of macrolides

A

gi upset (diarrhea, abdominal pain/cramping, esp with erythromycin), liver dysfunction, QT prolongation

152
Q

which macrolide has the most gi upset

A

erythromycin

153
Q

what is the pregnancy categories of macrolides, which is the exception?

A

b
c- clarithromycin

154
Q

azasite is an ophthalmic formulation of

A

azithromycin

155
Q

azasite is a viscous solution for ophthalmic use and how must it be stored?

A

room temp as in fridge it becomes more viscous

156
Q

can macrolides be used in a pt allergic to PCN?

157
Q

which macrolides do not require dose adjustments in renally impaired pts

A

azithromycin and erythromycin
clarithromycin—>req dose adj

158
Q

azithromycin ER suspension (zmax) is bioequivalent with zithromax and should be interchanged? T/F

A

F
not bioequivalent, they should NOT be interchanged

159
Q

zmax must be consumed within ____ hours of reconstitution and must be taken how with regards to food?

A

12 hours on empty stomach

160
Q

which macrolides are moderate to strong 3A4 inhibitors?

A

erythromycin and clarithromycin

161
Q

______ prolongation agents should not be taken with erythromycin and clarithromycin

162
Q

tetracyclines MOA, have bacteriostatic activity related to _____

A

moa- bind to 30S ribosomal subunit inhibiting bacterial protein synthesis
total exposure of the drug (AUC/MIC)

163
Q

which drugs are in the class tetracyclines

A

doxycycline (vibramycin, oracea, doryx)
minocycline (minocin, dynacin, solodyn, ximino)
tetracycline

164
Q

what is the generic name for vibramycin

A

doxycycline

165
Q

what is the generic name for minocin

A

minocycline

166
Q

what is a common dose of doxycycline

A

100mg q 12 hrs

167
Q

oracea should be taken how in regards to food

A

doxycycline
1 hr before or 2 hrs after meal

168
Q

how should doxycycline be taken?

A

with food to decrease gi upset unless oracea which is taken on empty stomach 1 hr before or 2 hrs after meal

169
Q

what is the normal dose of minocin

A

minocycline
40-100mg qd-BID

170
Q

what is the normal dose of tetracycline

A

250-500 bid-qid

171
Q

what are 2 pt groups that should not take tetracyclines

A

children </=8
pregnant women category D due to suppressing bone growth and skeletal development and stains teeth

172
Q

what pregnancy category are tetracyclines?

A

d
due to suppressing bone growth and skeletal development and stains teeth

173
Q

how should tetracyclines be taken?

A

with water and food to decrease gi irritation
unless oracea (doxycycline) which is on empty stomach 1 hr before or 2 hrs after food

174
Q

which tetracyclines should be dose adjusted in renal impairment

A

not doxycycline and minocycline
tetracycline should be dose adjusted in renal impairment

175
Q

antacids con mg,al, or ca should be avoided with which tetracyclines

176
Q

tetracyclines can be taken with divalent cations such as fe-containing preparations sucralfate, bile acid resins, and subsalicylate

A

no
seperate doses (1-2 hrs before and 4 hrs after)

177
Q

tetracyclines have what effect on INR

A

increase INR on pts taking warfarin

178
Q

tetracyclines have what effect on oral contraceptives

179
Q

pseudotumor cerebri can be caused by taking tetracyclines with ___________

A

retinoic acid derivatives

180
Q

what is the MOA of SMX and TMP? together they are ______, but individually they are ______

A

SMX- interferes with bacterial folic acid synthesis via inhibition of dihydrofolic acid formation from para-aminobenzoic acid
TMP inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in inhibition of ezymes in folic acid pathway
bactericidal, seperate are bacteriostatic

181
Q

Which drugs are considered sulfonamides

A

sulfamethoxazole and trimethoprim (bactrim, septra)

182
Q

generic name of septra

A

sulfamethoxazole and trimethoprim

183
Q

generic name of bactrim

A

sulfamethoxazole and trimethoprim

184
Q

single strength (ss) bactrim/septra is _ vs ds

A

sulfamethoxazole and trimethoprim
SS:400mg SMX/ 80mg TMP
DS: 800mg SMX/160mg TMP
always a 5:1 ratio

185
Q

in sulfamethoxazole and trimethoprim, when dosing always a _____ ratio of SMX to TMP

A

0.209027778

186
Q

what is the adult uti dosage of Bactrim

A

sulfamethoxazole and trimethoprim
1DS tab BID x 3 days
DS: 800mg SMX/ 160mg TMP

187
Q

what is the PCP prophylaxis dose of Septra

A

sulfamethoxazole and trimethoprim
1 DS or SS tab daily
DS: 800mg SMX/ 160mg TMP; SS: 400mg SMX/ 80mg TMP

188
Q

in more severe infections, what is the dose of sulfamethoxazole and trimethoprim

A

10-20 TMP mg/kg/day

189
Q

in PCP treatment what is teh dose of sulfamethoxazole and trimethoprim

A

15-20 mg/kg TMP iv/po divided in 3-4 doses
i.e. 2DS tabs TID

190
Q

what is the dose of sulfamethoxazole and trimethoprim in uti/aom

A

40mg/kg SMX and 8mg/kg TMP, divided BID x 10days

191
Q

what are 5 contraindications to using sulfamethoxazole and trimethoprim

A

sulfa allergy
pregnancy (at term)
breastfeeding
anemia due to folate deficiency
marked renal or hepatic disease

192
Q

How is sulfamethoxazole and trimethoprim excreted?

A

TMP= R; SMX=H

193
Q

what are common side effects to using sulfamethoxazole and trimethoprim

A

gi upset (N/V/D), skin reactions (rash, urticaria, SJS, TENS), crystalluria (take with 8 oz of water), photosensitivity, false elevations in Scr (pseudoazotemia), hyperkalemia

194
Q

A pt taking sulfamethoxazole and trimethoprim can develop stephens johnson syndrome or TENS?

195
Q

if a patient taking sulfamethoxazole and trimethoprim with 8 oz of water, why should they do this

A

bc risk of crystalluria

196
Q

if a pt taking sulfamethoxazole and trimethoprim has elevated Scr should you be worried

A

maybe, can cause false elevations–> pseudoazotemia

197
Q

What pregnancy category is sulfamethoxazole and trimethoprim

A

C and D (at term)
risk for kernicterus and spinal cord defects

198
Q

Bactrim IV should be stored ______ and has a ______ stability, however the more concentrated the soln the shorter teh half life.

A

at room temp
short stability (6 hrs)

199
Q

Bactrim IV should be protected from _____ and diluted with _____

200
Q

bactrim suspension should be refrigerated? T/F

A

F– at room temp
protect from light too!!

201
Q

The dose of bactrim should be unchanged during renal impairment? T/F

A

F should be reduced

202
Q

sulfonamides are mod-strong inhibitors of ______ and should be avoided with __________

A

2C8/9
warfarin

203
Q

SMX/TMP can ____ levels of sulfonylureas, phenytoin, dofetilide, azatioprine, MTX

204
Q

Levels of SMX/TMP may be ____ by 2C9/9 inhibitors

205
Q

what effect does leucovorin/levoleucovorin have on SMX/TMP

A

decreased therapeutic effectiveness

206
Q

5 agents that treat gram positives, not in an antibiotic class

A

vancomycin (vancocin)
Linezolin (zyvox)
Quinupristin and dalfopristin (synercid)
daptomycin (cubicin)
telavancin (vibativ)

207
Q

generic name of vancocin and spectrum

A

vancomycin gram positives

208
Q

generic name of linezolid and spectrum

A

zyvox gram positives

209
Q

generic name of synercid) and spectrum

A

Quinupristin and dalfopristin gram positives

210
Q

generic name of cubicin and spectrum

A

daptomycin gram positives

211
Q

generic name of vibativ and spectrum

A

telavancin gram positives

212
Q

drug of choice for MRSA infections

A

vancomycin (vancocin) dosed 15-20mg/kg q 8-12 hrs iv

213
Q

what is the MOA of vancomycin

A

inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization by binding to D-alanyl-D-alanine portion

214
Q

what type of killing does vancomycin exhibit and it is slowly _____

A

time-dependent killing bacteriacidal

215
Q

side effects of vancomycin

A

nephrotoxicity, ototoxicity, red man syndrome, hypotension, flushing, neutropenia,

216
Q

vancomycin is infused at what rate to avoid red man syndrome (rash)

A

30 min for each 500mg of drug given

217
Q

how is vancomycin monitored, what levels for infections

A

trough 15-20 mcg/ml for pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia
trough 10-15mcg/ml for other infections
monitor: renal func

218
Q

what category is vancomycin (pregnancy)

A

po b where as iv c

219
Q

vancomycin should be used with caution with what other nephrotoxic agents

A

AMGs, and cisplatin

220
Q

how is vancomycin dosed in crcl 20-49 ml/min, and crcl <20

A

20-49: q 24 hrs
<20: give loading dose and monitor levels

221
Q

what concentration of vancomycin cannot be exceeded when given via peripheral iv

A

no exceed 5mg/ml

222
Q

oral vancomycin is used to treat ______, and is dosed how

A

c diff
125-500 mg qid for severe cc diff infections or recurrent infections

223
Q

when the mic of vancomycin is > _____ mcg/ml then another agent should be considered

224
Q

zyvox is dosed how and what is the moa

A

600 mg q12 h po/iv
oxazolidinone class binds to bacterial 23S ribosomal RNA of 50S subunit

225
Q

zyvox is _____ activity

A

bacteriostatic

226
Q

linezolid iv dose is equivalent to what po dose

A

0.042361111

227
Q

what are contraindications to linezolid (3)

A

concurrent use or within 2 weeks of mao inhibitors
uncontrolled HTN
sympathomimetics

228
Q

linezolid is a _____ so tyramine containing foods should be avoided, serotonergic, and adrenergic drugs, tcas, meperidine, and buspirone should be avoided due to _____

A

weak maoi
serotonin syndrome

229
Q

side effects of linezolid

A

myelosuppression >14 days of use, headaches (11+%), diarrhea, increased pancreatic enzymes

230
Q

linezolid is a pregnancy ____

231
Q

is renal adjustment needed with linezolid

A

no, it’s hepatically cleared

232
Q

the oral suspension of linezolid should be stored in the fridge? T/F

A

F– at room temp

233
Q

dose of synercid

A

quinupristin and dalfopristin (synercid) is dosed at 7.5mg/kg iv q 8-12 hr

234
Q

quinupristin and dalfopristin (synercid) is in the streptogramin class which has what moa and what type of activity

A

binds to diff sites on 50S bacterial ribosomal subunit
bactericidal/static activity

235
Q

side effects of synercid

A

quinupristin and dalfopristin (synercid)
hyperbilirubinemia (up to 35%), phlebitis (40%), inflammation, edema and pain at the infusion site (13-44%), arthralgias and myalgias (up to 47%)

236
Q

side effects are rare with synercid

A

quinupristin and dalfopristin (synercid)
no quite common….hyperbilirubinemia (up to 35%), phlebitis (40%), inflammation, edema and pain at the infusion site (13-44%), arthralgias and myalgias (up to 47%)

237
Q

what pregnancy category is quinupristin and dalfopristin (synercid)

238
Q

is adjustment needed in renal impairment for quinupristin and dalfopristin (synercid)

A

no, hepatically cleared

239
Q

what volume of quinupristin and dalfopristin (synercid) is needed in what diluent to be given peripherally

A

250mL or greater
D5W only

240
Q

cubicin is dosed

A

4-6 mg/kg iv daily (daptomycin)

241
Q

daptoycin is in the cyclic lipopeptide class and what is the moa and has _____ dependent killing and _____ activity

A

binds to cell membrane components causing rapid depolarization inhibiting all ic replication processes including protein synthesis
concentration-dpdt
bactericidal activity

242
Q

what are side effects of daptomycin

A

> 10% diarrhea/constipation, vomiting, anemia, peripheral edema, chest pain, hypo/hyper kalemia, inc CPK and myopathy, eosinophilia pneumonia

243
Q

what monitoring should be done with a pt on cubicin

A

daptomycin
cpk levels weekly (more freq if on statin), muscle pain/weakness

244
Q

what pregnancy category is cubicin

A

daptomycin is b

245
Q

does dose or frequency need to be reduced for pts on cubicin with reduced renal function?

A

reduce freq (q24 h to q48 h)

246
Q

can daptomycin be used to treat pneumonia?

A

no inactivated by lung surfactants

247
Q

is daptomycin compatible with D5W?

A

no with NS

248
Q

telavancin(vibativ) is dosed how

A

10 mg/kg iv daily

249
Q

what is MOA of telavancin (vibativ) (a lipoglycopepetide derivative of vancomycin)

A

inhibits bacterial cell wall synthesis

250
Q

what is the black box warning of telavacin (vibativ)

A

fetal risk, obtain pregnancy test prior to initiating therapy

251
Q

what is the side effects of telavacin (vibativ)

A

taste disturbances (33%), N/V (20%), foamy urine (13%), renal dysfunction, qt prolongation, red man syndrome

252
Q

what monitoring is needed for telavacin (vibativ)

A

renal function, pregnancy status
can inc pt, inr, aptt, act, xa

253
Q

what pregnancy category is telavacin (vibativ)

A

c but bbw of fetal risk, obtain pregnancy test prior to initiating therapy

254
Q

should the dose be reduced or frequency reduced with patients with renal impairment taking telavacin (vibativ)

255
Q

what drugs can cause red man syndrome

A

vancomycin (vancocin) and telavancin (vibativ) a lipoglycopeptide derivativve of vancomycin

256
Q

how can red man syndrome be reduced with telavancin (vibativ)

A

infuse over 60 minutes

257
Q

telavancin (vibativ) can _____ many blood coag levles (pt, inr, aPTT, ACT, Xa

258
Q

what is a common agent to treat gram negatives that is a monobactam

A

aztreonam (azactam iv, cayston inhaled for CF)

259
Q

generic name for azactam iv

260
Q

aztreonam dosing

A

500- 2000mg iv q 6-12 hr

261
Q

moa of azactam

A

aztreonam (azactam) inhibits bacterial cell wall synthesis by binding to pbps

262
Q

side effects of azactam

A

aztreonam (azactam)
rash, diarrhea, nausea, vomiting, increased lfts

263
Q

what pregnancy category is aztreonam

264
Q

does aztreonam need dose adjustment in renal impairment

265
Q

can aztreonam be used in pcn allergic patients

266
Q

What are 3 broad spectrum agents that do not belong to an antibiotic class

A

chloramphenicol, telithromycin (ketek), tigecycline (tygacil)

267
Q

Generic name for ketek

A

telithromycin

268
Q

generic name for tigecycline

269
Q

How is chloramphenicol dosed and is it used

A

4gm/day
rarely used do to Ses

270
Q

MOA of chloramphenicol, and what is its activity

A

reversibly binds to 50S ribosomal subunit
bactericidal against some pathogens

271
Q

Chloramphenicol black box warning

A

serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia) must monitor cbc weekly

272
Q

due to black box warning on chloramphenicol what must be monitored weekly

A

cbc
bbw=serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia)

273
Q

side effects of chloramphenicol

A

myelosuppression (pancytopenia) grey syndrome (circulatory collapse, acidosis, coma, death), cns

274
Q

what syndrome can chloramphenicol cause which is circulatory collapse, acidosis, coma and death

A

grey syndrome

275
Q

what should be monitored for chloramphenicol

A

cbc, liver and renal function

276
Q

does chloramphenicol need to be adjusted in patients with impaired renal function

A

no but use with caution

277
Q

how is ketek dosed

A

800 mg po daily
telithromycin

278
Q

telithromycin is in the ketolide class and what is MOA, ______ dpdt, and _____ activity

A

inhibits protein synthesis by binding to 2 sites on 50S ribosomal subunit
concentration dpdt
bactericidal

279
Q

black box warning of telithromycin (ketek)

A

do not use in myasthenia gravis due to respiratory failure

280
Q

contraindications to telithromycin use (4)

A

allergy to macrolides
hx of hepatitis or jaundice from macrolides
myasthenia gravis
concurrent use of colchicine, lovastatin or simvastatin

281
Q

which 3 drugs cannot be used with telithromycin

A

colchicine, lovastatin, or simvastatin

282
Q

what warnings does telithromycin have (5)

A

acute hepatic failure (can be fatal)
qt prolongation
visual disturbances (blurry vision, diplopia)
loss of consciousness
colitis

283
Q

side effects of telithromycin

A

diarrhea, ha, n/v

284
Q

what should be monitored with telithromycin

A

lfts and visual acuity

285
Q

what pregnancy category is telithromycin

286
Q

should dose be reduced in renal impairment with telithromycin (ketek)

A

yes but drug is hepatically cleared

287
Q

Tygacil is a derivative of what drug

A

tigecycline is a derivative of minocycline

288
Q

how is tygacil dosed?

A

tigecycline is dosed 100mg iv x 1 dose, then 50mg iv q 12 hrs

289
Q

tigecycline (tygacil) is of glycylcyclines class and what is moa, and has _____ activity

A

binds to 30s ribosomal subunit inhibiting protein synthesis
bacteriostatic activity

290
Q

what are common se’s of tigecycline

A

n/v (20%), diarrhea, inc lfts, photosensitivity,

291
Q

what drugs cannot be used in children <8

A

tetracyclines + tigecycline (tygacil)

292
Q

what pregnancy category is tygacil

A

tigecycline is a category d

293
Q

are adjustments needed during renal impairment for tigecycline

A

no, is hepatically eliminated

294
Q

_____ cure rates for VAP when using tigecycline

295
Q

tygacil can be used for bloodstream infections

A

tigecycline cannot be used during blood stream infections as it does not achieve adequate conc in central compartment (blood) due to its lipophiliciy

296
Q

tigecycline is not active against which 3p’s

A

pseudomonas, proteus, providencia species

297
Q

Generic name for cleocin

A

clindamycin

298
Q

Generic name for flagyl, metrogel topical

A

metronidazole

299
Q

Generic name for tindamax

A

tinidazole

300
Q

Generic name for xifaxan

301
Q

Dosing of clindamycin (cleocin)

A

150-450 mg po 3-4 times daily

302
Q

Dosing of metronidazole (flagyl) and for c diff

A

250-750 mg q 6-8 hrs (iv,po)
use 500 mg tid for 10-14 days c diff mild to mod infections

303
Q

Dosing of tinidazole (tindamax)

A

2 grams po daily up to 5 days

304
Q

Dosing of rifaximin (xifaxan)

A

200 mg tid x 3 days

305
Q

dose of metronidazole in c diff

A

500 mg tid for 10-14 days c diff mild to mod infections

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