IV Anti-Infectives

Question 1

Antibiotics treat

Answer 1

bacterial infections

Question 2

Antifungals treat

Answer 2

fungal infections

Question 3

Antivirals treat

Answer 3

viral infections

Question 4

Common indications for anti-infective: bacterial infections

Answer 4

pneumonia, endocarditis, hardware infections, osteomyelitis, skin/soft tissue infections, sepsis, GI infections, UTI

Question 5

Common indications for anti-infectives: viral infections

Answer 5

influenza, cytomegalovirus (CMV), herpes simplex (HSV), varicella-zoster, meningitis

Question 6

Common indications for anti-infectives: fungal infections

Answer 6

yeast, mold

Question 7

Considerations relative to IV formulations

Answer 7

verify allergies, consider diluent in HF/DM, dosing in organ dysfunction, volume in HF, weigth based dosing, rate of administration, conc.-related med errors, compatibility, continuous vs. intermittent vs. bolus, hypersensitivity, extravasation, storage (refrigeration, room temp, protection from light)

Question 8

IV penicillins

Answer 8

nafcillin
penicillin G
ampicillin/sulbactam (Unasyn)
piperacillin/tazobactam (Zosyn)

Question 9

Nafcillin

Answer 9

fixed dosing, stable in many diluents, continuous infusion or intermittent dosing, avoid in pcn allergy
Caution: 66mg Na/g Nafcillin, extravasation, neurotoxicity w/ large doses especially in renal/hepatic dysfunction

Question 10

Penicillin G

Answer 10

fixed dosing (million units, Na+ and K+ salts), stable in many diluents, CI or intermittent dosing
avoid in pcn allergy
caution: high doses can alter serum Na+ and K+ levels- give at slower rate

Question 11

Piperacillin/Tazobactam

Answer 11

Zosyn
intermittent and extended infusions
dose adjust in renal dysfunction
avoid in pcn allergy
Caution: 54-64mg Na/g piperacillin
Incompatible w/ certain aminoglycosides

Question 12

Ampicillin/Sulbactam

Answer 12

Unasyn
Administer ATC
Avoid in pcn allergy
Caution: 115mg Na/1.5g Unasyn
Incompatible w/ aminoglycosides
adjust dose in renal dysfunction

Question 13

Cepalosporins

Answer 13

Cefazolin
Cefepime (Maxipime)
Ceftriaxone (Rocephin)

Question 14

Cefazolin

Answer 14

1st gen
fixed dosing intermittent infusion
contains 48mg Na/g cefazolin
Use cautiously in pcn allergy (cross sensitivity)
Adjust dose in renal dysfunction

Question 15

Cefepime

Answer 15

Maxipime
intermittent and extended infusions
Use cautiously in pcn allergy (cross sensitivity)
Adjust dose in renal dysfunction
Caution: 83mg Na/g Cefepime
Caution: neurotoxicity

Question 16

Ceftriaxone

Answer 16

Rocephin
fixed dosing
intermittent infusion
Renal and hepatic impairment max daily dose shouldn’t exceed 2g
Caution w/ pcn allergy
Incompatible w/ calcium containing soln
Contraindicated in: hyperbilirubinemic neonates, concomittant IV calcium-containing solns/products in neonates (<28 days old)

Question 17

Aminoglycosides

Answer 17

Intermittent infusions
weight based dosing
Caution: nephrotoxicity (adjust dose in renal dysfunction), neurotoxicity/ototoxicity
Avoid in pregnancy
Monitor serum trough and peak conc.
Amikacin
Gentamycin
Tobramycin

Question 18

Vancomycin

Answer 18

weight based dosing
dose adjust in renal dysfunction
Monitor serum trough conc. to prevent toxicity
Caution: extravasation, avoid rapid infusion (Red Man Syndrome)

Question 19

Daptomycin

Answer 19

Cubicin or Cubicin RF
incompatible w/ dextrose soln
Verify pt’s weight
Dose adjust in renal dysfunction

Question 20

Anti-Viral products

Answer 20

Acyclovir (Zovirax)
Ganciclovir (Cytovene)
Cidofovir (Vistide)

Question 21

Acyclovir

Answer 21

Zovirax
verify pt weight
Use w/ caution in pts w/ underlying neurologic abnormalities, serious hepatic/electrolyte abnormalities or substantial hypoxia
Adjust dose in renal dysfunction
Infuse over 1hr to reduce risk of renal tubular damage and make sure pt is hydrated (crystaluria)

Question 22

Gancyclovir

Answer 22

Cytovene
Verify pt’s weight
Slow infusion into veins w/ good blood flow
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep

Question 23

Cidofovir

Answer 23

Vistide
Infuse over 1 hr
Hydrate w/ 1L NS IV over 1-2hrs immediately prior to infusion. A 2nd liter can be given over a 1-3hr period at the start of or immediately following infusion. To reduce risk of renal impairment.
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep

Question 24

Antifungal products

Answer 24

Eichinocandins
Fluconazole (Diflucan)
Voriconazole (Vfend)

Question 25

Voriconazole

Answer 25

Vfend
Weight based dosing
Drug-drug interactions
May need to change to oral form in specific stages of renal impairment
Dose adjust in hepatic impairment
Monitor electrolytes (K+)
Monitor serum trough concentrations
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep

Question 26

Fluconazole

Answer 26

Diflucan
Don't use if cloudy/precipitated
Infuse slowly, don't exceed 200mg/hr
Dose adjust in renal impairment
Monitor hepatic function
Drug-drug interactions (CYP3A4)
Monitor K+ and Mg++
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep

Question 27

Eichinocandins

Answer 27

Micafungin (Mycamine)
Caspofungin (Cancidas)
Anidulafungin (Eraxis)
Infuse slowly
-if high doses are used infuse through a central catheter to minimize infusion related reactions