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NAPLEx > Micro-background I > Flashcards

Micro-background I Flashcards

1
Q

Common resistant pathogens
Kill Each And Every Strong Pathogen

A

Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, enterococcus faecium (VRE)
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa

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2
Q

Penicillin V Potassium

A

tablet and suspension
- Penicillin (natural penicillin)

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3
Q

Penicillin G Aqueous

A

pfizerpen- injection
- Penicillin (natural penicillin)

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4
Q

Penicillin G Benzathine

A

Bicillin L-A
-not for IV use, can cause cardio-respiratory arrest and death
- Penicillin (natural penicillin)

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5
Q

Penicillin G Benzathine + penicillin G procaine

A

Bicillin C-R
- Penicillin (natural penicillin)

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6
Q

Dicloxacillin

A

Capsule
- Penicillin (antistaphylococcal penicillin)
- antistaphyloccal:
— preferred for MSSA soft tissue, bone and joint, endocarditis and bloodstream infections
— and no renal dose adjustment

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7
Q

Nafcillin

A

injection
- nafcillin is vesicant- admin through centeral line- if extravasation occurs, use cold packs and hyaluronidase injection
- Penicillin (antistaphylococcal penicillin)

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8
Q

Oxacillin

A

injection
- Penicillin (antistaphylococcal penicillin)

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9
Q

Amoxicillin

A

tablet, capsule, chewable!, suspension
- Penicillin (aminopenicillins penicillin)

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10
Q

amoxicillin/clavulanate

A

Augmentin, Augmentin ES 600
-tablet, chewable!, suspension
- use 14:1 ration to decrease diarrhea caused by clavulanate
- Penicillin (aminopenicillins penicillin)

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11
Q

Ampicillin

A

injection!, capsule, suspension
- ampicillin PO is rarely used due to poor bioavailability (only preferred when switching to PO from IV ampicillin)
- Penicillin (aminopenicillins penicillin)

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12
Q

Ampicillin/sulbactam

A

Unasyn- injection
- IV ampicillin and ampicillin/sulbactam must be diluted in NS only
- Penicillin (aminopenicillins penicillin)

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13
Q

Piperacillin/tazobactam

A

zosyn- injection
-contains 65mg NA per 1 gram of piperacillin
- 0.375grams/3grams of piper/tazo respectively, dosing…
- Penicillin (Extended- Spectrum penicillin)

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14
Q

cefazolin

A

IV/IM 1-2 grams q8h
- 1st generation cephalosporins

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15
Q

cephalexin

A

keflex PO
- 1st generation cephalosporins

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16
Q

cefadroxil

A

PO 1-2 gram q12-24h
- 1st generation cephalosporins

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17
Q

cefuroxime

A

Zinacef
PO/IV/IM
- 2nd generation cephalosporins

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18
Q

cefotetan

A

cefotan- IV/IM
- contains side chain- can increase risk of bleed and disulfiram-like reaction with alcohol
- 2nd generation cephalosporins

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19
Q

cefaclor

A
  • 2nd generation cephalosporins
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20
Q

cefoxitin

A
  • 2nd generation cephalosporins
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21
Q

cefprozil

A
  • 2nd generation cephalosporins
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22
Q

cefdinir

A

omnicef, PO
- 3rd generation cephalosporins

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23
Q

ceftriaxone

A

Rocephin
- IV/IM
- avoid in neonates, causes hyperbilirubinemic
- avoid use with calcium-containing IV products in neonates <28 days old, forms insoluble precipitates
- no renal dose adjustment, CNS penetration at high dose
- 3rd generation cephalosporins

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24
Q

cefotaxime

A

IV/IM
- neonates better…
- 3rd generation cephalosporins

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25
Q

cefditoren

A

PO
- 3rd generation cephalosporins

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26
Q

cefixime

A

suprax
available chewable tablets!
PO
- 3rd generation cephalosporins

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27
Q

cefpodoxime

A

PO
- 3rd generation cephalosporins

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28
Q

ceftibuten

A

PO- on empty stomach 400mg daily
- 3rd generation cephalosporins

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29
Q

ceftazidime

A

Fortaz, tazicef
IV/IM
- 3rd generation cephalosporins

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30
Q

Cefepime

A

IV/IM
- 4th generation cephalosporins

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31
Q

ceftaroline fosamil

A

Teflaro
IV
- 5th generation cephalosporins

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32
Q

ceftazidime/avibactam

A

avycaz
IV
activity against some carbapenem-resistant enterobacteriaceae (CRE)
- cephalosporin combinations

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33
Q

ceftolozane/tazobactam

A

Zerbaxa
- cephalosporin combinations

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34
Q

cefiderocol

A

fetroja
IV
- siderophore cephalosporin

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35
Q

Doripenem

A

Injection IV
- carbapenems

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36
Q

Imipenem/cilastatin

A

primaxin I.V.
- carbapenems

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37
Q

Imipenem/cilastatin/relebactam

A

Recarbrio
Injection IV
- carbapenems

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38
Q

Meropenem

A

IV 500-1,000 mg q8h
- carbapenems

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39
Q

meropenem/ vaborbactam

A

vabomere
injection IV, 4 grams q8h, each dose infused over 3 hours
- carbapenems

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40
Q

ertapenem

A

Invanz
- stable in NS only
- no coverage of pseudomonas, acinetobacter, or enterococcus
- carbapenems

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41
Q

Aztreonam

A

azactam
cayston- inhaled for cystic fibrosis
IV
CrCl <30 dose adjusment requred
- aztreonam
- avoid in penicillin allergy

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42
Q

gentamicin

A

IV, IM, Ophthalmic topical
- aminoglycosides

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43
Q

tobramycin

A

IV, IM, ophthalmic, inhaled
tobramycin inhalation for CF (Tobi, Tobi Podhaler, Bethkis, Kitabis Pak)

  • aminoglycosides
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44
Q

Amikacin

A

IV, IM
- aminoglycosides

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45
Q

Streptomycin

A

IM
- aminoglycosides

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46
Q

Plazomicin

A

Zemdril
IV
for complicated UTI only
- aminoglycosides

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47
Q

Ciprofloxacin

A

Cipro, Cilaxan eye drops, cetraxal, and Otiprio ear drops

tablet, suspension, injection, ointment, ophtalmic, otic
- quinolones

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48
Q

ciprofloxacin + dexamethasone

A

ciprodex
- quinolones

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49
Q

ciprofloxacin + fluocinolone

A

Otovel
- quinolones

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50
Q

ciprofloxacin + hydrocortisone

A

Cipro HC
- quinolones

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51
Q

levofloxacin

A

levaquin
tablet, solution, injection, ophthalmic
- quinolones

52
Q

moxifloxacin

A

Avelox, Moxeza, and Vegamox eye drops
tablet, injection, ophtalmic
- quinolones

53
Q

Delafloxacin

A

Baxdela
tablet, injection
- quinolones

54
Q

Gatifloxacin

A

Zymaxid eye drops
- quinolones

55
Q

Gemifloxacin

A

tablets
- quinolones

56
Q

Ofloxacin

A

Ocuflox eye drops
tablet, ophthalmic, otic
- quinolones

57
Q

Azithromycin

A

Zithromax, Z-Pak, Zithromax Tri-Pak, AzaSite eye drops
tablet, suspension, injection, ophthalmic
better gram negative activity than erythromycin
can be used for traveler’s diarrhea
- macrolides

58
Q

Clarithromycin

A

tablet, ER tablet, suspension
better gram -positive activity
- macrolides

59
Q

erythromycin

A

E.E.S, Ery-tab, Erythrocin, EryPed, Ery and Erygel topical

E.E.S= erythromycin ethylsuccinate
- macrolides

60
Q

Doxycycline

A

Vibramycin, Doryx, Oracea, Acticlate, others
- no renal dose required
- tetracyclines

61
Q

Minocycline

A

Minocin, Solodyn, CoreMino, Minolira, Ximino
- associated with drug induced lupus

  • tetracyclines
62
Q

Eravacycline

A

Xerava
injection
- tetracyclines

63
Q

Omadacycline

A

Nuzyra
tablet, injection
- tetracyclines

64
Q

Sarecycline

A

Seysara
tablet
- tetracyclines

65
Q

Tetracycline

A

capsule
- tetracycline

66
Q

Sulfamethoxazole/Trimethoprim

A

Bactrim, Bactrim DS, Sulfatrim Pediatric
- single strength 400/80
- double strength 800/160
all product 5:1 ratio
- avoided in pt with G6PD deficiency
- suolfonamides

67
Q

Vancomycin

A

Vancocin, Firvanq oral solution
first line for moderate to severe MRSA
if MIC >=2 consider alternative

68
Q

telavancin

A

vibativ
approved for SSTI (soft tissue infections, hospital acquired and ventilator associated pneumonia
- Lipoglycopeptides

69
Q

Oritavancin

A

Orbactive
approved for SSTI (soft tissue infections)
- Lipoglycopeptides

70
Q

Dalbavancin

A

Dalvance
approved for SSTI (soft tissue infections
- Lipoglycopeptides

71
Q

Daptomycin

A

cubicin and cubicin RF
do not use to tx pneumonia (inactivated in the lungs by surfactants)
- daptomycin - cyclic lipopeptide

72
Q

Linezolid

A

zyvox
is a MAO inhibitor
- oxazolidinones

73
Q

tedizolid

A

sivextro
is a MOA inhibitor
- oxazolidinones

74
Q

quinupristin/ dalofpristin

A

synercid
injection
dilute in D5W only

75
Q

Tigecyclin

A

tygacil
injection
derivative of minocycline
boxed warning- increased risk of death, use only when alternative tx are not suitable

76
Q

Colistimethate

A

Coly-Mycin M
- Polymyxins

77
Q

Polymyxin B

A

injection
prodrug- hydrolyzed to colistin
1mg=10,000units of polymyxin B
- Polymyxins

78
Q

Chloramphenicol

A

injection
rarely used due to adverse effects

79
Q

Clindamycin

A

Cleocin
injection, capsule, suspension
topical formulation: Cleocin-T, clindagel, clindacin ETZ, clindacin Pac, Clindacin- P, evoclin,

foam, gel, lotion, kit, solution, swab
clindesse, cleocin
vaginal cream and suppository

common uses: purulent and non-purulent skin infections, beta-lactam alternative for dental abscess, surgery prophylaxis and infective endocarditis prophylaxis

-lincosamide antibiotic

80
Q

Metronidazole

A

Flagyl
tablet capsule, injection
topical: MetroCream, Merolotion, Metrogel, Noritate, Rosadan
Vaginal: Nuvessa, Vandazole

  • metronidazole and related drugs
81
Q

Tinidazole

A

tablet
like metronidazole, alcohol should not be used with or after 3 days of med d/c due to disulfiram-like reaction

  • metronidazole and related drugs
82
Q

Secnidazole

A

solosec
granule packet
approved only for bacterial vaginosis
- metronidazole and related drugs

83
Q

lefamulin

A

xenlata
tablet, injection
- first in class pleuromutilin, inhibits bacterial protein synthesis

84
Q

fidaxomicin

A

dificid
tablet, suspension
used for C. difficile infection
-inhibits RNA polymerase

85
Q

rifaximin

A

xifaxan

think of traveler’s diarrhea
- DNA/RNA inhibitor
- not effective for systemic infections
of label use for c. diff (second recurrence)
tx- hepatic encephalopathy
- inhibits bacterial RNA synthesis

86
Q

fosfomycin

A

monurol
- inhibits bacterial wall synthesis by inactivating the enzyme pyruval transferase.
- packet granules- 3mg per packet

87
Q

Nitrofurantoin

A

macrobid, macrodantin
capsule and suspension
- uncomplicated UTI
- avoid crcl <60ml/min
SE= brown urine discoloration
macroBID= given BID

  • bacterial cell wall inhibitor
88
Q

mupirocin

A

bactroban
- topical decolonization

89
Q

Methylcillin- sensitive staphylococcus aureus (MSSA)

A

**- Dicloxacillin, nafcillin, oxacillin
- Cefazolin, cephalexin (and other 1st and 2nd generation cephalosporins) **
- Amoxicillin/clavulanate, ampicillin/sulbactam
- doxycycline, minocyclin
- SMX/TMP

90
Q

Community- associated methicillin-resistant staphylococcus aureus (CA-MRSA) skin & soft tissue infection (SSTIs)

A

- SMX/TMP
- Doxycycline, minocycline
- clindamycin
- linezolid

91
Q

Severe SSTIs requiring IV treatment or hospitalization (cover MRSA and Streptococci)

A

- Vanco (if MIC>=2 consider alternative
- Linezolid, tedizolid
- daptomycin
- ceftaroline
- telavancin
- oritavancin
- dalbavancin
- quinupristin/dalfopristin
- tigecyclin

92
Q

Nosocomial MRSA

A

- Vanco (if MIC>=2 consider alternative
- linezolid
- daptomycin (not in pneumonia)
- telavancin

93
Q

VRE (E. faecalis)

A

- Pen G or ampicillin
- Linezolid
- Daptomycin
- Tigecycline
- Cystitis only: nitrofurantoin, Fosfomycin, doxycycline

94
Q

Acineobacter baummanni

A

**- carbapenems (except ertapenem)
**- ampicillin/sulbactam
- minocycline
- tigecycline
- quinolones
- SMX/TMP
- amikacin
- colistimethate, polymyxin B

95
Q

VRE (E. Faecium)

A

- Daptomycin
- Linezolid
- Quinupristin/Dalfopristin
- Tigecycline
- Cystitis only: nitrofurantoin, fosfomycin, doxycycline

96
Q

Extended-spectrum beta-lactamase producing gram-negative rods (ESBL GNR) - E.coli, K.pneumoniae, P. mirabills

A

- carbapenems
- ceftazidime/avibactam
- ceftolozane/tazobactam
- aminoglycosides
- cystitis only: fosfomycin

97
Q

HPNEK

A

**- beta-lactam/beta-lactamase inhibitor
**- Amoxicillin (if beta-lactamase negative)
- Cephalosporins (except 1st generation)
- Carbapenems
- SMX/TMP
- aminoglycosides
- Quinolones

98
Q

Carbapenem-resistant gram-negative rods (CRE)

A

- ceftazidime/avibactam
- colistimethate, polymyxin B
- Meropenem/vaborbactam
- Imipenem/cilastatin/ relebactam

99
Q

Atypical organisms

A

- azithromycin, clarithromycin
- doxycycline, minocycline
- quinolones

100
Q

Bacteroides fragilis

A

- metronidazole
- beta-lactam/beta-lactamase inhibitor
- cefotetan, cefoxitin
- carbapenems
- tigecycline
- other (reduced activity): moxifloxacin

101
Q

C. Diff

A

**- oral vanco
- fidaxomicin **
- metronidazole

102
Q

Pseudomonas aeruginosa

A

- Piperacillin/tazobactam
- Cefepime
- Ceftazidime
- Ceftazidime/avibactam
- ceftolozane/tazobactam
- carbapenems (except ertapenem)
- cipro, levo
- aztreonam
- aminoglycosides
- colistimethate, polymyxin B

103
Q

Refrigeration after reconstitution required

A

**Penicillin VK
Ampicillin, Amoxicillin/Clavulanate, **
Cephalexin,
Cefadroxil,
Cefpodoxime,
Cefprozil,
Cefuroxime,
Cefaclor,
Ceftibuten,
Vanco Oral,
Valganciclovir

104
Q

Refrigeration recommended

A

amoxicillin- improves taste

105
Q

Do not refrigerate

A

cefdinir,
azithro,
clarithromycin (bitter taste, thickens/gels),
doxycycline,
cipro,
levofloaxcin,
clindamycin (thickens, may crystallize),
Linezolid
sulfamethoxazole/trimethprim
acyclovir
fluconazole
pasoconazole
virconazole
nystatin

106
Q

storage requirements: IV antibiotics
do not refrigerate

A

metronidazole
moxifloxacin
sulfamethoxazole/trimethoprim
acyclovir- (refrigeration causes crystallization)

107
Q

Take with/without food

A

most antibiotics can be taken with food to decrease GI upset

except: take on empty stomach-
- ampicillin oral capsules and suspension
- ceftibuten suspension
- levofloxacin oral solution
- penicillin VK
- rifampin
- isoniazid
- itraconazole solution
- voriconazole

take within one hour of finishing meal- amoxicillin ER

108
Q

IV to oral 1:1

A

levofloxacin, moxifloxacin
doxycycline, minocycline
linezolid, tedizolid
metronidazole
sulfamethoxazole/trimethoprim
fluconazole, isavuconazonium, posaconazole, voriconazole

109
Q

light protection during admin

A

doxycycline
micafungin
pentamidine

110
Q

compatible with dextrose only
diluent compatibility

A

quinopristine/dalfopristin
sulfamethoxazole/trimethoprim
amphotericine b
dalbavancin, oritavancin
pentamidine

111
Q

compatible with saline only
diluent compatibility

A

ampicillin
ampicillin/sulbactam
ertapenem
daptomycin (cubicin RF)

112
Q

compatible with NS/LR only
diluent compatibility

A

caspofungin
daptomycin (cubicin)

113
Q

what are atypical organisms

A

chlamydia ssp, legionella spp., mycoplasma pneumoniae, mycobacterium tuberculosis

114
Q

tetracyclines and quinolones have in common

A

avoid multivitamins- separated for divalent cations

115
Q

Escherichia coli- pyelonephritis

A

most common cause of pyelonephritis
healthy pt. empiric therapy while waiting on culture results go for
- fluoroquinolone (cipro or levo) for 5-7 days or
- SMX/TMP for 7-10 days

116
Q

empiric tx for accute cystitis, most likely pathogen is E. Coli

A

bactrim, nitrofurantoin, or fosfomycin

if bactrim was used 2 months ago, avoid reuse…

117
Q

prophylaxis of Pneumoncystis Pneumonia

A

SMX/TMP!

118
Q

kissing virus

A

epstein-barr virus

119
Q

prego and HIV

A

zidovudine to prevent HIV transmission to infant
- NRTI

120
Q

interfere with coagulation assays

A

dapto, ortivancin, telavancin

121
Q

no renal dose adjustment

A

antistaphylococcal penicillins
ceftriaxone
clinda
doxy
macrolides (only azithro and erythromycin
metronidazole
moxifloxacin
linezolid

122
Q

key features of nitrofurantoin

A
  • review prego use
  • avoid in renal <60 ml/min
  • MacroBID= BID
  • macrodantin= QID
  • counseling: take with food to avoid nausea and cramping
  • can discolor urine to brown
123
Q

bactrim and warfarin

A

INR increases, use alternative when possible

124
Q

key features of tetracycline

A

doxy and minocycline- CA- MRSA skin infections and acne
doxy= 1st line tx for lyme disease and rocky mt spotted fever, CAP, COPD exacerbations, VRE UTI, chlamydia

Do not use in prego, breastfeeding or children <8 years old

125
Q

key features of macrolides

A

all macro: CAP, and alternative to beta-lactam for strep throat
clarithromycin and erythromycin are strong cyp 3A4 inhibitors, lova and simva are contraindicated

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