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Neuro Round 2 wk 2+ > Pharm CNS infections > Flashcards

Pharm CNS infections Flashcards

1
Q

What is the exception to giving abx IV for bacterial meningitis?

A

Rifampin

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2
Q

Why would you add dexamethasone to tx of bacterial meningitis?

A

to control CNS inflammation and limit neurological deficits

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3
Q

If a pt >50 yo has a beta lactam allergy, what should you tx the pt with for community acquired bacterial meningitis?

A

Vanc + Moxifloxacin + TMP-SMX

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4
Q

What can be used to replace Vanc if the pt has a beta lactam allergy?

A

Linezolid

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5
Q

What is the down side to adding dexamethasone to tx of bacterial meningitis?

What can we do to assist coverage?

A

may impair CNS entry of some abx (eg vanc)

add oral Rifampin to assist Vanc coverage

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6
Q

What carbapenems are used or not used for meningitis and why?

A

imipenem is not used bc the sz risk is too high

meropenem is used bc it has the lowest sz risk

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7
Q

What drug drug interaction do you need to be aware of when rx’ing most penicillins for meningitis?

A

probenecid - gout drug - inhibits tubular transport

doses should be reduced for pt, or pt with renal disease

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8
Q

How is Nafcillin excreted?

A

via liver into bile

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9
Q

No dosing adjustment are required for what two drugs if renal disease is present and you are tx’ing meningitis with penicillins?

A

nafcillin and oxacillin

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10
Q

What two cephalosporins cover Pseudomonas?

A

3rd gen ceftazidime

4th gen cefepime

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11
Q

What cephalosporin does not require dosing adjustments if the pt is on probenecid or has renal dz?

A

ceftriaxone

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12
Q

What drug has the broadest spectrum of activity of any beta-lactam abx and is good for ESBL producing g- bacteria?

A

meropenem

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13
Q

You should decrease drug dose of meropenem if the pt is also taking…

A

probenecid

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14
Q

How do carbapenems interact with valproic acid?

A

decrease plasma levels, should consider alternative tx

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15
Q

What is the only beta-lactam with NO gram positive bacteria coverage?

A

aztreonam

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16
Q

aztreonam is only active against…

A

aerobic gram negative bacteria

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17
Q

Is aztreonam sensitive to probenecid? Do you ever have to change dosage?

A

No interaction with probenecid

decrease drug dose for pt with impaired renal function

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18
Q

What could be a croos-allergy risk with aztreonam?

A

ceftazidime

19
Q

Vanc covers most gram positive bacteria including MRSA, but does not cover

A

Listeria

20
Q

decrease Vanc dose if the pt has…

A

renal dz

21
Q

How does Red man syndrome occur as an AE of Vanc?

A

high IV infusion rate

d/t histamine release

pre-medicate with antihistamine

22
Q

What is the only way to administer polymixin abx?

What are examples of polymixins?

A

intrathecal or intraventricular

Polymixin B or Colistin (Polymixin E)

23
Q

How does chloramphenicol work as an abx?

A

binds 50S subunit, inhibiting protein synthesis

inhibits peptidyl transferase to prevent the addition of new aa to the polypeptide

24
Q

Who is chloramphenicol indicated to use in?

A

serious beta lactam abx allergy

25
Q

What is an AE of chloramphenicol in premature infants?

Why does this happen?

A

gray baby syndrome - cyanosis, weakness, resp depression

poor metabolism d/t lack of glucuronidation enzyme: UDP glucuronosyltransferase

26
Q

What are the top three AE of Chloramphenicol?

A

anemia

aplastic anemia

gray baby syndrome

27
Q

What is the MOA of Linezolid?

A

blocks 50S subunit from joinging up with 30S subunit, no complex formation, inhibiting protein synthesis by blocking initiation complex formation

28
Q

What are three AE of Linezolid?

A

bone marrow suppression

risk for severe HTN, inhibition of MOA

serotonin syndrome

29
Q

What is a drug interaction of Linezolid?

A

MOA

contraindicated with MOAIs

30
Q

What is the MOA of TMP-SMX?

A

bactericidal when used together

inhibit folate

31
Q

What g negatives does bactrim not cover?

A

N. meningitidis and Pseudomonas

32
Q

What CYP enzymes go with bactrim?

A

Inhibitors of CYP2C8 (TMP) and CYP2C9 (SMX)

33
Q

You should lower bactrim dose in pt with…

A

renal disease

34
Q

What AEs go with TMP-SMX?

A

hypersensitivity rxn, hemolytic anemia, crystalluria with SMX

megaloblastic anemia with TMP

both - Steven Johnsons

Prego - avoid in last month (kernicterus)

35
Q

MOA of Fluoroquinolones?

target in g + and g-??

A

DNA synthesis inhibitors

Topoisomerase IV in g+

DNA gyrase in g-

36
Q

What fluoroquinolone covers Pseudomonas?

A

Cipro

37
Q

What fluoroquinolone covers strep, staph, and listeria?

A

moxifloxicin

38
Q

What is the exception to most fluoroquinolones excreted by the kidney?

A

moxi excreted by liver

39
Q

What are the major AEs of fluoroquinolones?

A

tendon rupture, QT prolongation

cartilage damage

40
Q

Cipro inhibits CYP1A2 and should be cautioned with

A

caffeine and warfarin

41
Q

What is the least likely fluoroquinolone to induce QT prolongation?

A

cipro

42
Q

What drug can be used as prophylaxis for individuals exposed to meningitis caused by H influ and N meningitidis?

A

Rifampin

43
Q

What is MOA of Rifampin?

A

binds to DNA dependent RNA polymerase to prevent RNA synthesis

Neuro Round 2 wk 2+ (16 decks)

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