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
2
Q
Penicillin V Potassium
A
tablet and suspension
- Penicillin (natural penicillin)
3
Q
Penicillin G Aqueous
A
pfizerpen- injection
- Penicillin (natural penicillin)
4
Q
Penicillin G Benzathine
A
Bicillin L-A
-not for IV use, can cause cardio-respiratory arrest and death
- Penicillin (natural penicillin)
5
Q
Penicillin G Benzathine + penicillin G procaine
A
Bicillin C-R
- Penicillin (natural penicillin)
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
7
Q
Nafcillin
A
injection
- nafcillin is vesicant- admin through centeral line- if extravasation occurs, use cold packs and hyaluronidase injection
- Penicillin (antistaphylococcal penicillin)
8
Q
Oxacillin
A
injection
- Penicillin (antistaphylococcal penicillin)
9
Q
Amoxicillin
A
tablet, capsule, chewable!, suspension
- Penicillin (aminopenicillins penicillin)
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)
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)
12
Q
Ampicillin/sulbactam
A
Unasyn- injection
- IV ampicillin and ampicillin/sulbactam must be diluted in NS only
- Penicillin (aminopenicillins penicillin)
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)
14
Q
cefazolin
A
IV/IM 1-2 grams q8h
- 1st generation cephalosporins
15
Q
cephalexin
A
keflex PO
- 1st generation cephalosporins
16
Q
cefadroxil
A
PO 1-2 gram q12-24h
- 1st generation cephalosporins
17
Q
cefuroxime
A
Zinacef
PO/IV/IM
- 2nd generation cephalosporins
18
Q
cefotetan
A
cefotan- IV/IM
- contains side chain- can increase risk of bleed and disulfiram-like reaction with alcohol
- 2nd generation cephalosporins
19
Q
cefaclor
A
- 2nd generation cephalosporins
20
Q
cefoxitin
A
- 2nd generation cephalosporins
21
Q
cefprozil
A
- 2nd generation cephalosporins
22
Q
cefdinir
A
omnicef, PO
- 3rd generation cephalosporins
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
24
Q
cefotaxime
A
IV/IM
- neonates better…
- 3rd generation cephalosporins
25
cefditoren
PO
- 3rd generation cephalosporins
26
cefixime
suprax
available chewable tablets!
PO
- 3rd generation cephalosporins
27
cefpodoxime
PO
- 3rd generation cephalosporins
28
ceftibuten
PO- on empty stomach 400mg daily
- 3rd generation cephalosporins
29
ceftazidime
Fortaz, tazicef
IV/IM
- 3rd generation cephalosporins
30
Cefepime
IV/IM
- 4th generation cephalosporins
31
ceftaroline fosamil
Teflaro
IV
- 5th generation cephalosporins
32
ceftazidime/avibactam
avycaz
IV
activity against some carbapenem-resistant enterobacteriaceae (CRE)
- cephalosporin combinations
33
ceftolozane/tazobactam
Zerbaxa
- cephalosporin combinations
34
cefiderocol
fetroja
IV
- siderophore cephalosporin
35
Doripenem
Injection IV
- carbapenems
36
Imipenem/cilastatin
primaxin I.V.
- carbapenems
37
Imipenem/cilastatin/relebactam
Recarbrio
Injection IV
- carbapenems
38
Meropenem
IV 500-1,000 mg q8h
- carbapenems
39
meropenem/ vaborbactam
vabomere
injection IV, 4 grams q8h, each dose infused over 3 hours
- carbapenems
40
ertapenem
Invanz
- stable in NS only
- no coverage of pseudomonas, acinetobacter, or enterococcus
- carbapenems
41
Aztreonam
azactam
cayston- inhaled for cystic fibrosis
IV
CrCl <30 dose adjusment requred
- aztreonam
- avoid in penicillin allergy
42
gentamicin
IV, IM, Ophthalmic topical
- aminoglycosides
43
tobramycin
IV, IM, ophthalmic, inhaled
tobramycin inhalation for CF (Tobi, Tobi Podhaler, Bethkis, Kitabis Pak)
- aminoglycosides
44
Amikacin
IV, IM
- aminoglycosides
45
Streptomycin
IM
- aminoglycosides
46
Plazomicin
Zemdril
IV
for complicated UTI only
- aminoglycosides
47
Ciprofloxacin
Cipro, Cilaxan eye drops, cetraxal, and Otiprio ear drops
tablet, suspension, injection, ointment, ophtalmic, otic
- quinolones
48
ciprofloxacin + dexamethasone
ciprodex
- quinolones
49
ciprofloxacin + fluocinolone
Otovel
- quinolones
50
ciprofloxacin + hydrocortisone
Cipro HC
- quinolones
51
levofloxacin
levaquin
tablet, solution, injection, ophthalmic
- quinolones
52
moxifloxacin
Avelox, Moxeza, and Vegamox eye drops
tablet, injection, ophtalmic
- quinolones
53
Delafloxacin
Baxdela
tablet, injection
- quinolones
54
Gatifloxacin
Zymaxid eye drops
- quinolones
55
Gemifloxacin
tablets
- quinolones
56
Ofloxacin
Ocuflox eye drops
tablet, ophthalmic, otic
- quinolones
57
Azithromycin
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
Clarithromycin
tablet, ER tablet, suspension
better gram -positive activity
- macrolides
59
erythromycin
E.E.S, Ery-tab, Erythrocin, EryPed, Ery and Erygel topical
E.E.S= erythromycin ethylsuccinate
- macrolides
60
Doxycycline
Vibramycin, Doryx, Oracea, Acticlate, others
- no renal dose required
- tetracyclines
61
Minocycline
Minocin, Solodyn, CoreMino, Minolira, Ximino
- associated with drug induced lupus
- tetracyclines
62
Eravacycline
Xerava
injection
- tetracyclines
63
Omadacycline
Nuzyra
tablet, injection
- tetracyclines
64
Sarecycline
Seysara
tablet
- tetracyclines
65
Tetracycline
capsule
- tetracycline
66
Sulfamethoxazole/Trimethoprim
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
Vancomycin
Vancocin, Firvanq oral solution
first line for moderate to severe MRSA
if MIC >=2 consider alternative
68
telavancin
vibativ
approved for SSTI (soft tissue infections, hospital acquired and ventilator associated pneumonia
- Lipoglycopeptides
69
Oritavancin
Orbactive
approved for SSTI (soft tissue infections)
- Lipoglycopeptides
70
Dalbavancin
Dalvance
approved for SSTI (soft tissue infections
- Lipoglycopeptides
71
Daptomycin
cubicin and cubicin RF
do not use to tx pneumonia (inactivated in the lungs by surfactants)
- daptomycin - cyclic lipopeptide
72
Linezolid
zyvox
is a MAO inhibitor
- oxazolidinones
73
tedizolid
sivextro
is a MOA inhibitor
- oxazolidinones
74
quinupristin/ dalofpristin
synercid
injection
dilute in D5W only
75
Tigecyclin
tygacil
injection
derivative of minocycline
boxed warning- increased risk of death, use only when alternative tx are not suitable
76
Colistimethate
Coly-Mycin M
- Polymyxins
77
Polymyxin B
injection
prodrug- hydrolyzed to colistin
1mg=10,000units of polymyxin B
- Polymyxins
78
Chloramphenicol
injection
rarely used due to adverse effects
79
Clindamycin
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
Metronidazole
Flagyl
tablet capsule, injection
topical: MetroCream, Merolotion, Metrogel, Noritate, Rosadan
Vaginal: Nuvessa, Vandazole
- metronidazole and related drugs
81
Tinidazole
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
Secnidazole
solosec
granule packet
approved only for bacterial vaginosis
- metronidazole and related drugs
83
lefamulin
xenlata
tablet, injection
- first in class pleuromutilin, inhibits bacterial protein synthesis
84
fidaxomicin
dificid
tablet, suspension
used for C. difficile infection
-inhibits RNA polymerase
85
rifaximin
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
fosfomycin
monurol
- inhibits bacterial wall synthesis by inactivating the enzyme pyruval transferase.
- packet granules- 3mg per packet
87
Nitrofurantoin
macrobid, macrodantin
capsule and suspension
- uncomplicated UTI
- avoid crcl <60ml/min
SE= brown urine discoloration
macroBID= given BID
- bacterial cell wall inhibitor
88
mupirocin
bactroban
- topical decolonization
89
Methylcillin- sensitive staphylococcus aureus (MSSA)
**- Dicloxacillin, nafcillin, oxacillin
- Cefazolin, cephalexin (and other 1st and 2nd generation cephalosporins) **
- Amoxicillin/clavulanate, ampicillin/sulbactam
- doxycycline, minocyclin
- SMX/TMP
90
Community- associated methicillin-resistant staphylococcus aureus (CA-MRSA) skin & soft tissue infection (SSTIs)
**- SMX/TMP
- Doxycycline, minocycline
- clindamycin
- linezolid**
91
Severe SSTIs requiring IV treatment or hospitalization (cover MRSA and Streptococci)
**- Vanco (if MIC>=2 consider alternative
- Linezolid, tedizolid
- daptomycin
- ceftaroline**
- telavancin
- oritavancin
- dalbavancin
- quinupristin/dalfopristin
- tigecyclin
92
Nosocomial MRSA
**- Vanco (if MIC>=2 consider alternative
- linezolid
- daptomycin (not in pneumonia)**
- telavancin
93
VRE (E. faecalis)
**- Pen G or ampicillin
- Linezolid
- Daptomycin**
- Tigecycline
- **Cystitis** only: nitrofurantoin, Fosfomycin, doxycycline
94
Acineobacter baummanni
**- carbapenems (except ertapenem)
**- ampicillin/sulbactam
- minocycline
- tigecycline
- quinolones
- SMX/TMP
- amikacin
- colistimethate, polymyxin B
95
VRE (E. Faecium)
**- Daptomycin
- Linezolid**
- Quinupristin/Dalfopristin
- Tigecycline
- Cystitis only: nitrofurantoin, fosfomycin, doxycycline
96
Extended-spectrum beta-lactamase producing gram-negative rods (ESBL GNR) - E.coli, K.pneumoniae, P. mirabills
**- carbapenems
- ceftazidime/avibactam
- ceftolozane/tazobactam**
- aminoglycosides
- cystitis only: fosfomycin
97
HPNEK
**- beta-lactam/beta-lactamase inhibitor
**- Amoxicillin (if beta-lactamase negative)
- Cephalosporins (except 1st generation)
- Carbapenems
- SMX/TMP
- aminoglycosides
- Quinolones
98
Carbapenem-resistant gram-negative rods (CRE)
**- ceftazidime/avibactam
- colistimethate, polymyxin B**
- Meropenem/vaborbactam
- Imipenem/cilastatin/ relebactam
99
Atypical organisms
**- azithromycin, clarithromycin
- doxycycline, minocycline
- quinolones**
100
Bacteroides fragilis
**- metronidazole
- beta-lactam/beta-lactamase inhibitor
- cefotetan, cefoxitin
- carbapenems**
- tigecycline
- other (reduced activity): moxifloxacin
101
C. Diff
**- oral vanco
- fidaxomicin **
- metronidazole
102
Pseudomonas aeruginosa
**- Piperacillin/tazobactam
- Cefepime
- Ceftazidime
- Ceftazidime/avibactam
- ceftolozane/tazobactam
- carbapenems (except ertapenem)
- cipro, levo
- aztreonam
- aminoglycosides
- colistimethate, polymyxin B**
103
Refrigeration after reconstitution required
**Penicillin VK
Ampicillin, Amoxicillin/Clavulanate, **
Cephalexin,
Cefadroxil,
Cefpodoxime,
Cefprozil,
Cefuroxime,
Cefaclor,
Ceftibuten,
Vanco Oral,
Valganciclovir
104
Refrigeration recommended
amoxicillin- improves taste
105
Do not refrigerate
**cefdinir**,
azithro,
clarithromycin (bitter taste, thickens/gels),
doxycycline,
cipro,
levofloaxcin,
clindamycin (thickens, may crystallize),
Linezolid
sulfamethoxazole/trimethprim
acyclovir
fluconazole
pasoconazole
virconazole
nystatin
106
storage requirements: IV antibiotics
do not refrigerate
**metronidazole
moxifloxacin
sulfamethoxazole/trimethoprim**
acyclovir- (refrigeration causes crystallization)
107
Take with/without food
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
IV to oral 1:1
levofloxacin, moxifloxacin
doxycycline, minocycline
linezolid, tedizolid
metronidazole
sulfamethoxazole/trimethoprim
fluconazole, isavuconazonium, posaconazole, voriconazole
109
light protection during admin
**doxycycline
micafungin**
pentamidine
110
compatible with dextrose only
diluent compatibility
**quinopristine/dalfopristin
sulfamethoxazole/trimethoprim
amphotericine b**
dalbavancin, oritavancin
pentamidine
111
compatible with saline only
diluent compatibility
**ampicillin
ampicillin/sulbactam
ertapenem
daptomycin (cubicin RF)**
112
compatible with NS/LR only
diluent compatibility
**caspofungin
daptomycin (cubicin)**
113
what are atypical organisms
**chlamydia ssp, legionella spp., mycoplasma pneumoniae, mycobacterium tuberculosis**
114
tetracyclines and quinolones have in common
**avoid multivitamins**- separated for divalent cations
115
Escherichia coli- pyelonephritis
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
empiric tx for accute cystitis, most likely pathogen is E. Coli
bactrim, nitrofurantoin, or fosfomycin
if bactrim was used 2 months ago, avoid reuse...
117
prophylaxis of Pneumoncystis Pneumonia
SMX/TMP!
118
kissing virus
epstein-barr virus
119
prego and HIV
zidovudine to prevent HIV transmission to infant
- NRTI
120
interfere with coagulation assays
dapto, ortivancin, telavancin
121
no renal dose adjustment
antistaphylococcal penicillins
ceftriaxone
clinda
doxy
macrolides (only azithro and erythromycin
metronidazole
moxifloxacin
linezolid
122
key features of nitrofurantoin
- 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
bactrim and warfarin
INR increases, use alternative when possible
124
key features of tetracycline
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
key features of macrolides
all macro: CAP, and alternative to beta-lactam for strep throat
clarithromycin and erythromycin are strong cyp 3A4 inhibitors, lova and simva are contraindicated
