Viro exam 1 Flashcards
Gram + aerobic organism associated with:
-Skin and soft tissue infections
-Community acquired pneumonia
-Catheter related bacteremia
Gram + aerobic bacteria that have cluster shape staphylococcus if coagulate positive
Staphyloccus aureus
Gram + aerobic bacteria that have cluster shape staphylococcus
Coagulase -
Staphylococcus epidermis
MRSA
Methicillin resistant to staphyloccoccus and wont work
ORSA
Oxacillin resistant to staphyloccoccus and wont work
MSSA
Methiccilin sensitive to staphyloccucus will work
OSSA
oxacillin sensitive to staphyloccoccus will work
Gram + aerobic bacteria with bacilli shape are:
Streptococcus–>Streptococcus pneumonie (S.pneumonie) –> A hemolytic
Streptococcus pyrogen (S.pyrogen)–> B-hemolytic
and enterococcus sp –> Group D streptococci–> Y hemolytic
Diferentiation of gram + aeorobic bacteria with bacilli shape are based on
hemolysis test and penicillin resistant s.pneumoniae
Differentiation of enterococcus 2 major types
-They behave differently to antibiotics
E.faecalis
E.Faecium
problem is Vancomycin Resistant Enterococcus (VRE)
Other Gram +
Listeria meningitis (Rod)
Coynebacterium spp (bacilli)
Gram + anaerobes cocci
Peptococcus and Peptostreptococcus
-They are in the mouth and if aspirate pneumonia contents is a problem
Gram + anaerobes baccili
Clostridiodides difficile–>C.deff –> in the GIT causes GI problems
Clostridium Sp. –> in the GIT
Gram + bacterias in the skin
Staphylococcus sp.–> Gram + aerobic cluster –> If + coag test is staphylococcus aureus . –> if - coag test staphylococcus epidermis
Streptococcus sp.–> Gram + aerobic chains or pairs form–> S.pneumonia and S.pyrogen (strep throat)
Gram + bacterias in the oropharynx
in mouth, upper respt tract or lower
Gram + aerobic: Streptococcus sp–> Streptococcus pyrogen and Streptococcus pneumonia
Gram + anerobic cocci–> peptococcus and peptostreptococcus
Gram + bacterias in the GIT:
Gram + aerobic with chain or paris –> Enterococcus: E.Faecalis, E.Faecium
Gram + anaerobic baccili–> Clostridioides difficile (C.deff.) and Clostridium sp
Gram (-) aerobic bacterias are associated with
Urinary tract infections
Intra-abdominal and gastrointestinal tract infections
Bacteremia–> infection of blood
Nosocomal pneumonia–> hospital acquired pneumonia
Gram (-) aerobic cocci bacteria
Neisseria species–> N.meningitis and N.gonorrhoeae
Moraxella catarrhalis–> Respiratory pathogens
Gram (-) aerobic baccili lactose fermentating
Enterobacteriales:
E.Coli
Enterobacter
Klebsiella
Citrobacter
-They are in the GIT and urinary tract –> So they cause urinary tract infections
Gram (-) aerobic baccili non fermentating
Proteus
Salmonella
Shingella
Pseudomonas
Other Gram (-) aerobe that is in the oropharynx is:
Hemophilus influenzae
Gram (-) anaerobe:
Where does is located?
Bacteroides fagilis group
In the GIT
What Gram (-) bacterias are in the skin?
pseudomonas
Acinetobacter sp
What are the gram (-) aerobic bacterias in the oropharynx?
H.influenzae
N.meningitis
What are gram (-) aerobic bacilli bacterias that are positive lactose fermentating found in the GIT?
Enterobacteriales:
E.coli
Klebsiella
Citrobacter, Serratia
What are the gram (-) aerobic bacili lactose fermentating bacterias in the urinary tract?
Enterobacterias
E.coli
Klebsiella
Citrobacter, Serratia
What are the atypical organism>
Mycoplasma pneumoniae–> Walking pneumoniae
Chlamydia pneumoniae
Ligionella pneumonie
What is Penicillin G?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
IV or IM is natural penicillin
-Can use it for emergency situations also
-Gram + –>Streptococcus (S.pneumonia, S.pyrogen), Enterococcus (E.faecalis), Mouth anaerobes (Peptocpoccus, pepsistreptococcus), N.meningitis, syphilis, Pasteurella Multocida dog or cat bite
-Yes renal and heart failure ptd
What is Penicillin G Procaine?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
-Only IM
-Natural penicillin
Coverage against: Gram + –> Only Streptococcus (S.pneumonia, S.pyrogen), Enterococcus (E.facalis, E.faceium) in the GIT, Mouth anarobes peptococcus, pepstreptococcus, n.meningitis, syphilis, pasteurella multocida - dog/cat bite
Yes–> For renal dysfuction pt and for heart failure pt
What is Penicillin G Benzathine?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
Natural penicillin
Only IM x 1 dose
Coverage against Gram + = Streptococcus S.pneumonia, S.pyrogen, Enterococcus (E.faecalis, E.Faecium), mouth anaerobes Peptococcus, pepstreptococccus. Syphilis, N.meningitis, pasteurella multocida
Yes: Renal dysfunction and heart failure pts
What is Nafcillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
u-
Nafcillin (Unipen) is a penicillinase resistant penicillin also known as antistaphyloccus
-Inhibits bacteria cell wall synthesis and the bulky group prevent destruction from B-lactamase
-Use IV for skin and soft tissue infections
-Coverage against Gram + –> Staphylococcus S.aureus (Coug+) S.epidermis (coag -) BUT NO MRSA , Streptococcus (S.pyrogen, S.pneumonia)
-No dose adjustment is metabolize by the liver
-May elevate liver enzymes –> Pontential risk for hepatitis
-Avoid extravasation –> fluid leaks from IV line into interstitial
-DDI with warfarin
-Do not administer in same IV line of Aminoglycosides
What is Oxacillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
B-
Oxacillin (bactocilli) IV
Is a penicillinase resistant penicillin
Also refered as antistaphylococcus
-Use for skin and soft tissue infections
-Inhibits bacteria cell wall synthesis prevent transpeptidase from linking Glycine + alanine
-The bulky group prevent destruction by B-lactamase
Coverage against Gram + = Staphylococcus coug + S.aureus Coug - S.epidermis, Streptococcus
-No dose adjustment needed because is metabolize by the livers
-Can increase liver enzymes–> Potential risk for hepatitis
-Do not administer in the same IV line with aminoglycosides
What is Dicloxacillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
d-
Dicloxacillin (Dynapen) only PO
Is a penicillinase resistant penicillin antibiotic also known as ANTISTAPH
Use for skin and soft tissue infections
Coverage against Gram + –> Staphylococcus if coug + S.aureus if coag - S.epidermis no MRSA
-Does not require renal dose adjustment
-Need to give 1-2 hrs after meal
-Can increase LFT –> potential risk for hepatitis
-DDi–> Warfarin –> Dicloxacilin (Dynapen) will enhance metabolism of warfarin and decrease the effects of warfarin
What is Ampicillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
Ampicillin is a amino-penicillin IV or PO QID
-Is use for upper respiratory tract infections: otitis media, sinus, bronchitis. Can also be use for neserria and enterococcal infections (intraabdominal infections)
-It has coverage against:
Gram + –> Streptococcus S.pneumonia, Enterococcus E.Faecalis, E.Faecium and may be use for VRE
Gram +mouth anaerobes –> Peptococcus, peptostreptococcus
Gram (-)–>
Enterobacteriales –> E.coli and proteus if lactose fermentating
-Hemophilus influenzae
Dose adjustment:
Yes requires dose adjustment for renal
Only dilute ampicillin IV and ampicillin/sulbactam in NS
Do not administer together in same IV line
DDi:
Allopurinol–> Can cause rash if take ampicillin + allopurinol
Warfarin–> It will decrease the effects of warfarin –> Increases risk of bleeding because increases the INR
AE:
-Nausea
-Skin rahs because of allergie to penicillin
-Problem increase bacteria resistance
What is Amoxicillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
Amoxicillin (Amoxil, trimox)–> is aminopenicillins
-Is primarily use for upper respiratory tract infections : otitis media, sinus, bronchitis
Coverage against:
Gram (+) :
–> Streptococcus–> S.pneumonia
–> Enterococcus –> E.faecalis
Mouth anaerobes–> peptococcus, pepsistreptococcus
Gram (-):
-Enterobacteriales–> E.coli (lactose fermentating), proteous
-H.Influenzae
-neseria meningitis , listeria meningitis
Dose: 500-875mg BID
Dose adjustment:
-For renal and if the CrCl <30 DONT USE IT
DDi:
Allopurinol–> Increase risk of rash
Warfarin–> Decreases effects of warfarin so increase INR increases risk of bleeding
AE:
-Nausea
-Diarrhea
-Allergic rxn to the amino group
What is Piperacillin IV?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
Pip-
Piperacillin IV (Pipracil) is a extended spectrum penicillin
-Use for Gram (-) infections such as UTI, pneumonia, pseudomonas
-Coverage against:
Gram (+)
-Streptococcus –> S.pneumonia
-Enterococcus -E. faecalis
-Mouth anaerobes –> Peptococcus, pepsistreptococcus
-Gut anaerobes –> C.diff
Gram (-):
-Enterobacteriales–> E.coli (lactose fermentating), klebisella, Enterobacter, serratia
-Pseudomonas aeroginosa
-H.influenzae
Dose:
-Not require dose adjustment
-Piperacillin (pipracil) has high levels of Na+ 65mg Na+/gram or 1.85 MEQ Na+ /gram so need to monitor Na+ levels in pt
-Can also give with aminoglycosides and fluoroquinolones but do not give the aminoglycoside in the same IV line
AE:
-Thrombophletis
-Injection site rxn
-Can cause renal toxicity if administer with vancomycin
What is Amoxicillin/Clavunate?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
Amoxicillin/Clavunate -Augmentin XR , augmentin
-Is a penicillin + b-lactamase inhibitor a suicide
-The suicide will cause hydrolyisis bind to the b-lactamase attack it twice irriversible and prevents the hydrolysis of penicillin
-THe suicide can increase the antimicrobial activity of the penicillin but on their own no antimicrobial activity
-Coverage against:
Gram (+):
-Staphylococcus aureus coag + –> MSSA
Gram -
-Enterobacteriales –> Lactose fermentating E.coli, klebsiella, proteus
Pseudomonas
Moraxella catarrhalis
H.influenzae
Anaerobes in the GIT –> bacteroides fragilis
Renal dose adjustment and avoid givingg 875mg if CrCl <30
Ratio is 2:1, 4:1, 7:1
AE:
-N/V
-Anemia
-Seizure, coma–> at high doses
-Allergic rxn
What is Ampicillin/Sulbactam?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
una-
Ampicillin/Sulbactam (Unasyn) IV
-Is use primarly for upper and lower respiratory tract infections and for Intra-abdominal infections
Coverage against:
Gram (+)–> Staphylococcus areus (Coag +) and MSSA and Enterococcus
Gram (-):
Enterobacteriales baccili lactose fermentating–> E.coli, klebisella, proteus
Moraxella catarhalis –> Resp pathogen
H.Influenza
Pseudomonas
Gram (-) anaerobic–> Bacteroides fragilis in GIT
No dose adjustment
DDI:
-Warfarin
AE:
-Nausea
-Vomiting
-Diarrhea
-Hemolytic anemia and plalet dysfunction
-Interstitial nephritis
-Seizure / coma –> High doses
-Skin rash allergic rxn
What is Piperacillin/Tazobactam?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?
What are the DDI?
What are some AE?
Zo
Piperacillin/Tazobactam (Zosyn) IV
-Is use for Upper / lower respiratory tract infections and for intraabdominal infections
Coverage against:
Gram (+)–> Staphylococcus aereus (coag +) , MSSA and enterococci
Gram (-):
Enterobacteriales lactose fermentating–> E.coli, klebesilla, proteus
H. Influenzae
Morazella catarrhs
pseudomonas
Gram (-) anerobes–> Bacteroides
Dose adjustment:
Yes for renal if CrCl <40ml/min
AE:
-N,V, diarrhea
-Skin rxn
-Hemolytic anemia
-Seizure, coma
What is Cefazolin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?
An-, Ke-
Cefazolin (Ancef, Kefzol) IV 1st gen cephalosporine
-Is a bacteriocidal inhibit bacteria cell wall synthesis
-Use for Gram + skin infections and for surgical prophylaxis
Coverage against: SPEcK
Gram (+)–> Staphylococcus S.aureus, S.epidermis . Streptococcus S.pneumonia, S.pyrogen
Gram (-)
Proteus –> non lactose ferm
E.coli–> lactose ferm
Klebisella –> lactose ferm
AE:
-Thrombophlebitis
-Hypersensitive rxn
-Injectiin site rxn
-Cross sensistive with penicillin osea si pt fue allergico a penicillin there is 5% also that is allergic to 1st gen cephalosporin
-Eosonophilia
-Thrombocytopenia
What is Cephalexin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?
K-
Cephalexin (Keflec) PO 1st gen cephalosporins
-Is bacteriacidal inhibits bacteria cell wall synthesis
-Use it for Gram + skin infections
Coverage against: SPEcK
Gram (+)–>
Staphylococcus S.auereus coag + , S.epidermis coag -
Streptococcus S,pneumonia, S.pyrogen
Gram (-):
Proteus –> non lactose ferm
E.coli–> lactose ferm
klebisella –> lactose ferm
AE:
-N,V, diarrheaa
-Possible C.diff
-Hypersensitive rxn
-Thrombocytopenia
-Eosonophilia
-Cross reactivity–> pt is allergic to penicillin there is 5% que tambien also allergic to 1st gen cephalosporins
What is Cefadroxil and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?
Dar-
Cefadroxil (Daricef) PO 1st gen cephalosporin
MOA: Bacteriocidal inhibit bacteria cell wall synthesis
-Use it for Gram + skin infections
-Coverage against SPEcK
Gram (+)–> Staphylococcus S.aureus (coag+) S.epidermis (Coag-). Streptococcus S.pneumonia, S.pyrogen
Gram (-): Proteus, E.coli, Klebisella
AE:
-N,V, D, c.Diff
-Hypersensitive rxn
-Eosinophilia
-Thrombocytopenia
-Cross reactivity with penicillin can be 5% chance that is also allergic to cepha 1st gen
What is Cefuroxime and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?
Kefu-, Zina-
Cefuroxime (Kefurox, Zinacef) IV 2nd Generation group A
-Use primarly for upper and lower respiratory tract infections
Coverage against:
Gram (+) Streptococcus–> S.pyrogen, S.pneumonia
Gram (-): cocci
H.Influenzae
N.meningitis
Moxarella catarrhs–> resp
Gram (-) baccili
Proteaus
E.coli
Klebesella
AE:
-Thrombophlebitis
-Hypersensitive rxn
-Cross-reactivity with penicillins –> osea si ot es allergic a penicillin there is 5% that also a cefuroxime (Kefurox, zinacef)
What is Cefonocid and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?
mon-
Cefonocid (Monocid) 2nd generation Cephalosporin Group A only IV
-Use it for Upper-lower respiratory tract infections
-Coverage: HNM-SPEcK
Gram (+)= Streptococcus S.pneumonia, S.pyrogen
Gram (-): cocci
H.influenzae
N.meningitis
Moxarella catarrhs–> resp pathogen
Gram (-) baccili:
Proteus–> non lactose
E.coli–> lactose
Klebisella–> lactose
AE:
Thrombophlebitis
Eosonophilia
Thrombocytopenia
-Cross reactivity if pt is allergic to penicillins
What is Cefuroxime axetil and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?
cef-
Cefuroxime axetil (Ceftin) PO 2nd generation cephalosporin group A
-Use for upper and lower respiratory trac infections
Coverage: HNM-SPEcK
Gram (+)–> Streptococcus S.pneumonia, S.pyrogen
Gram (-) cocci:
H.influenzae
Moxarella catarrhs–. resp pathogen
N. Meningitis
gram (-) baccili:
Proteus–> non lactose
E.coli–> lactose
Klebisella–> lactose
AE:
-Eosonophilia
-Thrombocytopenia
-Hyper sensitive rxn
-N,V,D
-C.diff
-cross reaction si es tambien penicillin allergic
What is Cefaclor and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?
cec-
Cefaclor (Ceclor, Ceclor CD) PO 2nd gen cephalosporine group A
-Use for upper and lower respiratory tract infections
Coverage: HNM-SPEcK
Gram (+)–> Streptococcus S.pneumonia, S.pyrogen
Gram (-) cocci:
H.influenzae
N.meningitis
Moxarella catarrs–> resp pathogen
Gram (-) baccili:
Proteus
E.coli
Klebesilla
AE:
-Thrombocytopenia
-Eosonophilia
-N,V,D
-C.diff
-Hypersensitive rxn
-Cross -reactivity with penicilllin if also allergic 5% chance also allergic to 2n gen
What is Cefprozil and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?
Cefz-
Cefprozil (cefzil) PO 2n generation cephalosporines group A HNM-SPEcK
-Use for upper and lower respiratory tract infections
Coverage against HNM-SPEcK
Gram (+) –> Streptococcus –> S.pneumonia, S.pyrogen
Gram (-) cocci:
H.influenzae
N.meningitis
Moxarella catarrs–> resp pathogen
Gram (-) baccili:
Proteaus–> non lactose
E.coli–> lactose
Klebesilla–> lactose
AE:
-Eosonophilia
-Thrombocytopenia
-N,V,D
-C.diff
-Hypersensitive rxn
-Cross reactivity with penicillin –> si es alergico no le des 2nd gen
What is Cefoxitin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK-BF
What are some AE?
mefox-
Cefoxitin (Mefoxin) only IV and is 2nd gen cephalosporine group B cephamycin subgroup
-Use for aerobi and anerobic bacteria infections –> intraabdominal and pelvic infections
Coverage against SPEcK-BF
Gram (+) –> Streptococcus –> S.pneumonia, S.pyrogen
Gram - baccili
Proteus–> non lactose
E.Coli–> lactose
Kebisella–> lactose
Gram (-) anerobe:
Bacteriodes fragilis
AE:
-Thromobophebilitis
-Eosonophilia
-Thrombocytopenia
-Hypersensitive rxn
-Cross reactivtiy
What is Cefotetan and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK-BF
What are some AE?
Cefotetan (Cefotan) IV 2nd generation Cephalosporine group B cephamycin subgroup
-Use for aerobic/anaerobic infections–> intrabdominal and pelvic infections
Coverage against SPEcK -BF
Gram (+) cocci–> Streptococci S.pneumonia, S.pyrogen
Gram (-) bacili:
-Proteus–> non lactose
E.coli–> lactose
Klebisella–> lactose
Gram (-) anaerobe:
-Bacteriodes fragilis
AE:
-n-methyl-5-thiotetrazole (MTT) –> Disulfiram like rxns increase aceta aldehyde –> hangover symptoms and bleeding because inhibit pro-thrombin synthesis
-Thrombophlebitis
-Eosonophilia
-Thrombocytopenia
What are the 2nd generation cephalosporins that have MTT
I MET a MAN with a PERfect TAN
Cefotetan
Cemetazole
Cefomandole
Cefoperazole
What is Cefotaxime and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
clar-
Cefotaxime (Claforan) IV 3rd generation cephalosporin
-Use for severe gram (-) infections like UTI, intraabdominal infections, pelvic infection and for pneumonia
Coverage against:
-Looses some Gram (+) coverage
-More gram (-) coverage due to the aminothiazole ring that allows to enter to the gram (-) periplasmic space
Gram (-) cocci: N.meningitis, moxarella catarrhs
Gram (-) baccili: Enterobacteriales E.coli, klebesilla
AE:
-Thromboplebitis
-Eosonophilia
-Thrombocytopenia
What is Ceftriaxone and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
Roce-
Ceftriaxone (Rocephin) IV 3rd generation cephalosporine
Use for severe gram (-) infections like UTI, intraabdominal, pelvic infections
-It can penetrate the CSF and treat n.meningitis
-Can also treat lyme disease and gnorrhea
-IV q24h
Coverage against:
looses Gram (+) but can treat streptococcal pneumonia
Gram (-):
Cocci–> n.meningitis
Baccili–> Enterobacteriales E.coli, klebisella
AE:
-Increase liver transaminase —> Can cause cholestasis (gall stone) because is not renally excreted
DDI:
Do not administer ceftriaxone (rocephin) with IV calcium, ringer solution, parental nutrition
Because it will form Ceftriaxone+ Calcium complex and centriaxone wont work
What is Ceftazidine and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
For-
Ceftazidine (Fortaz) IV 3rd gen cephalosporine
-Use for gram (-) infections like: UTI, intraadominal and pelvic infections
-Can also treat pnemonia from gram +
Coverage against:
Looses some Gram (+)–> streptococci
Gram (-)–> Psedomonas
Gram (-) enterobacteriales –> E.coli, klebisella
AE:
-Hypersensitive rxn
-Thrombophlebitis
-Thrombocytopenia
-Eosonophilia
What is Ceftazidine -Avibactam and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
Ceftazidine-Alvibactam (Avicaz) third gen cepha
For Gram (-)
Complicated uti, intraabdominal and pelvic infections , severe nosocomial pneumonia
And has activity againse ESBL (Extended Spectrum Beta-lactamase) like E.coli, klebisella
What is Cefpodoxime proxetil and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
What are DDi?
Van-
Cefpodoxime proxetil (Vantin) 3rd gen cephalosporine
Dose is PO BID
-Give with food to enhace absorbtion
-Use it for severe Gram (-) infections like UTI, nosocomal pnemonia, intraabdominal and pelvic infection
-Looses some Gram (+) coverage
Moree Gram - coverage
Gram (-) Enterobacteriales –> E.coli, klebesella
AE:
Eosonophilia
-N,V,D
-Thrombocytopenia
DDI:
Antiacids, Calcium, magnisium, H2 blockers–> because they decrease absorption of vantin
What is Cefdinir and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
Cefidinir (Omnicef) PO Once a day 3rd gen cephalosporine
-Use for severe gram (-) infections: UTI, nosocomal pneumonia, intraabdominal, pelvic infections
-Looses gram +
More gram -
Enterobacteriales–> E.coli, klebesilla
AE:
-N,V,D
-Thrombocytopenia
-Eosonophelia
What is Ceftolozane-tazobactam and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
Zer-
Ceftolozane-tazobactam (Zerbaxa) gen 3 or 4 cephalosporin
-For complicated gram (-) infections: Complicated UTI x7days, complicated intraabdominal infections 7-14 days and give along with metronidazole, ventilator associated pnemomia
Coverage against:
Gram (-)–> E.coli, klebesella
Gram (-)–> Pseudomonas
Expanded spectrum beta lactamase (ESBL) or multidrug resistance pathogens
What is Cefepime and what gen?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
Max-
Cefepime (Maxipime) IV 1 g PO q 12h is 4th gen cephalosporine
-Use for severe infections septic shock
Coverage against:
Gram (+)–> Streptococcus S.pneumonia like Ceftriaxone (Roceptin)
Gram (-) –> Pseudomonas like Ceftazidine (Forzaz)
Gram (-) –> Enterobacteriales E.coli, klebisella
Dose:
-Renal dose adjustment
-Also even if CrCl<60ml/min need to adjust dose because it can cause seizure
-Renal dose adjustment for elderly and compromise renal function
What is Ceftaroline fosamil and what gen?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
Ceftaroline Fosamil (Teflaro) IV BID Gen 5 cephalosrporine
-Use for: MRSA, community acquired pneumonia, bacteremia, skin infections
Coverage against:
GRAM (+)–> Streptococcus
Gram (+) –> Staphylococcus aureus and MRSA
Gram (-):
H.influenzae
Enterobacteriales–> E.coli, klebisella
Dose adjustment:
Renal dose and if CrCl <50ml/min
What is Aztreonam IV?
When should it be use?
Coverage against what bacterias?
Dose?
What are some AE?
azac-
Aztreonam IV (Azactam)
Is a monobactam
Use for Gram (-) infections : UTI, bacteremia, intraabdominal pelvic infections
Coverage:
Gram (-) baccili lactose ferm–> Enterobacteriales E.coli, Klebisella
Gram (-) baccili non lactose ferm–> pseudomonas
Gram (-) H.influenza
Dose: no cross reactivity with penicillin allergic pt
IV
Inhalation for cystic fibrosis pt
AE:
-Rash
-Diarrhe
-Local rxn
What is Imipenem-Cilastin?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI
prima-
Imipenem-cilastin (Primaxin) is a carbapenem
-Ihibits bacteria cell wall synthesis
-Is use for severe life threating polymicrobial infections and infections due to pseudomonas and ESBL (ex. pt has E.coli + Septic)
Coverage against:
Gram (-)
Staphylococcus but NO MRSA
Streptococcus –> S.pneumonia, S.pyrogen
Enterococcus–> Only E.faecalis
Mouth anaerobes–> Pepstreptococcus, Peptococcus
Gram (-):
Gram (-) baccil
i–> Enterobacterialis E.coli, Klebesilla
-Pseudomonas
Gram (-) cocci:
N.meningitis, N.gonorrhea
Moraxella catarrhs
AlsonH.influenzae
Gram (-) anaerobic–> Bacteriodes flagelli
Renal dose adjustment
AE:
-Seizure –> risk factors are: renal dysfunction, high dose, CNS lession, history of seizure
-Allergy rash, drug fever –> Can give if pt is allergic to penicillin
-N, V
-Phlebitis
DDI:
-Avoid giving it if the pt is taking Valproic acid (T-type ca2+ blocker, NMDA blocker, GABA T inhibitor) becase it will change the ADME and the pt will suffer from seizure
What is Meropenem?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI
Meropenem (Merem) IV is a Carbapenem
Inhibits bacteria cell wall synthesis
-Use for N.meningitis
Coverage:
Has More coverage against gram (-) and less for gram (+)
Gram (-):
Gram (-) cocci–> N.meningitis, N. gonorrhea, moraxella catarrhs
Gram (-) baccili:
Enterobacteriales–> E.coli lactose ferm, Klebisella lactose ferm
Non lactose ferm–> pseudomonas
Renal dose adjustment
AE:
-Drug fever
-Rash
-Phlebetis
-Less risk of seizure
DDI:
-Avoid giving it to pt that is on valproic acid (depakote, depakene) valproic acid will block T-type Ca2+ in the post synaptic neuron, also inhibits GABA transaminase so prevent metabolism of GABA, also blocks NMDA receptors and is use for convulsion
So if you give meropenem to the pt taking Valproic acid it will cause seizure in the pt
What is Ertapenem ?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI
inv-
Ertapenem (Invaz) IV once daily is a carbapenem and will inhibit synthesis of bacteria cell wall
-For severe life threating polymicrobial infections
Coverage against:
Gram (+)
Staphylococcus –> S.aureus, S.epidermis NO MRSA
Streptococcus–> S.pnemonia, S.pyrogen
Enterococcus–> E.faecalis
Mouth anaerobes–> peptococcus, pepstreptococcos
Gram (-)
Cocci
-N.meningitis, Moraxella catarrhs
Baccili
Lactose ferm–> enterobacteriales E,coli, klebisella
but NO Pseudomonas for Ertapenem (Invaz)
-H.influenzae
-Gram (-) anaerobes–> bacteriodes fagelli
Dose adjustmet for renal
AE:
-Skin rxn
-Drug fever
-N,V, D
-Phlebitis –> infusion rxn
DDI:
-Valproic acid (T-type Ca2+ channel blocker in the post synaptic, GABA T inhibitor, NMDA antagonist) and ertapenem (invaz) will disrupt the ADME of valproate and causes seizure to the pt taking valproate
What is gentamicin and tobramycin?
How is bacteriacidal?
Coverage against?
AE? TANGS do NOT kill ANAEROBES
Dosing? Peak and trough
Gentamicin will bind to the 30s ribosomal unit to the subunit A and will cause a mismatch of the AA so the protein that is going to code it wont work
-Is for UTI, burns, psudomonas, skin infections, nosocomal pnemonia and endocarditis infections
Coverage against:
Mostly Gram (-):
Baccili–> E.coli (lactose), Kebesilla (lactose), Pseudomonas (non lactose)
Cocci–> N.meningitis, Moraxella catarrhs , H.influenzae
Gram (+) —> Staphylococcus–> S.areus, S.epidermis no MRSA
Gram (+) –> Streptococcus S.pnemonia, S.pyrogen
Gram (+) —> Enterococcus –> endocarditis use also b-lactam but not in the same IV line
AE:
Nephrotoxicity –> reversible, the risk factors are: elderly, duration of dose, unstable renal function
Ototoxicity–> irriversible due to damage to the 8 cranial nerve causes vestibular disturbance and auditory loss
Teratogen
Dosing:
Need CrCl = (140-age) x BW / 72 x SCr (0.85 if female)
IBW= 50kg
Peak –> 30 min after 4th dose 3-4mcg/mL
Trough–> 30min before 4th dose <1mcg/mL
What is amikacin?
How is bacteriacidal?
Coverage against?
AE? TANGS do NOT kill ANAEROBES
Dosing? Peak and trough
Binds to the 30s ribosomal to the A subunit and insert the wrong amino acid and causes a misreading –> the protein that is produce is useless is a bacteriocidal
IS FOR MULTIDRUG RESISTANCE TB and fro ESBL Klebesilla
Gram (-):
Baccili lactose–> E.coli, ESBL Klebisella
Baccili non lactose–> PSEUDOMONAS
Gram (+):
Streptococccus–> S.pneumonia , S.pyrogen
Enterococcus–> Endocarditis
AE:
Nephrotoxicity
Otoxicity
Teratogenic
Dosing base on CrCl, BW
Traditional
Peak–> 30min after 4th dose 15-30mcg/ml
Trought–> 30min before 4th dose <10mcg/dl
Once a day 15mg/kg/d
base on CDK –> Above the MIC
and on PAE–> below the MIC
Televancin
Vibac-
Improved vancomycins
Gram +
MRSA also
and also for hospital acquired pneumonia and ventilator associated pneumonia
Vibactiv
