Viro exam 1 Flashcards

1
Q

Gram + aerobic organism associated with:

A

-Skin and soft tissue infections
-Community acquired pneumonia
-Catheter related bacteremia

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2
Q

Gram + aerobic bacteria that have cluster shape staphylococcus if coagulate positive

A

Staphyloccus aureus

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3
Q

Gram + aerobic bacteria that have cluster shape staphylococcus
Coagulase -

A

Staphylococcus epidermis

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4
Q

MRSA

A

Methicillin resistant to staphyloccoccus and wont work

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5
Q

ORSA

A

Oxacillin resistant to staphyloccoccus and wont work

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6
Q

MSSA

A

Methiccilin sensitive to staphyloccucus will work

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7
Q

OSSA

A

oxacillin sensitive to staphyloccoccus will work

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8
Q

Gram + aerobic bacteria with bacilli shape are:

A

Streptococcus–>Streptococcus pneumonie (S.pneumonie) –> A hemolytic
Streptococcus pyrogen (S.pyrogen)–> B-hemolytic

and enterococcus sp –> Group D streptococci–> Y hemolytic

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9
Q

Diferentiation of gram + aeorobic bacteria with bacilli shape are based on

A

hemolysis test and penicillin resistant s.pneumoniae

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10
Q

Differentiation of enterococcus 2 major types

A

-They behave differently to antibiotics
E.faecalis
E.Faecium
problem is Vancomycin Resistant Enterococcus (VRE)

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11
Q

Other Gram +

A

Listeria meningitis (Rod)
Coynebacterium spp (bacilli)

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12
Q

Gram + anaerobes cocci

A

Peptococcus and Peptostreptococcus
-They are in the mouth and if aspirate pneumonia contents is a problem

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13
Q

Gram + anaerobes baccili

A

Clostridiodides difficile–>C.deff –> in the GIT causes GI problems
Clostridium Sp. –> in the GIT

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14
Q

Gram + bacterias in the skin

A

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)

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15
Q

Gram + bacterias in the oropharynx
in mouth, upper respt tract or lower

A

Gram + aerobic: Streptococcus sp–> Streptococcus pyrogen and Streptococcus pneumonia
Gram + anerobic cocci–> peptococcus and peptostreptococcus

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16
Q

Gram + bacterias in the GIT:

A

Gram + aerobic with chain or paris –> Enterococcus: E.Faecalis, E.Faecium

Gram + anaerobic baccili–> Clostridioides difficile (C.deff.) and Clostridium sp

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17
Q

Gram (-) aerobic bacterias are associated with

A

Urinary tract infections
Intra-abdominal and gastrointestinal tract infections
Bacteremia–> infection of blood
Nosocomal pneumonia–> hospital acquired pneumonia

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18
Q

Gram (-) aerobic cocci bacteria

A

Neisseria species–> N.meningitis and N.gonorrhoeae

Moraxella catarrhalis–> Respiratory pathogens

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19
Q

Gram (-) aerobic baccili lactose fermentating

A

Enterobacteriales:
E.Coli
Enterobacter
Klebsiella
Citrobacter
-They are in the GIT and urinary tract –> So they cause urinary tract infections

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20
Q

Gram (-) aerobic baccili non fermentating

A

Proteus
Salmonella
Shingella
Pseudomonas

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21
Q

Other Gram (-) aerobe that is in the oropharynx is:

A

Hemophilus influenzae

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22
Q

Gram (-) anaerobe:
Where does is located?

A

Bacteroides fagilis group
In the GIT

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23
Q

What Gram (-) bacterias are in the skin?

A

pseudomonas
Acinetobacter sp

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24
Q

What are the gram (-) aerobic bacterias in the oropharynx?

A

H.influenzae
N.meningitis

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25
Q

What are gram (-) aerobic bacilli bacterias that are positive lactose fermentating found in the GIT?

A

Enterobacteriales:
E.coli
Klebsiella
Citrobacter, Serratia

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26
Q

What are the gram (-) aerobic bacili lactose fermentating bacterias in the urinary tract?

A

Enterobacterias
E.coli
Klebsiella
Citrobacter, Serratia

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27
Q

What are the atypical organism>

A

Mycoplasma pneumoniae–> Walking pneumoniae
Chlamydia pneumoniae
Ligionella pneumonie

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28
Q

What is Penicillin G?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

A

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

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29
Q

What is Penicillin G Procaine?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

A

-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

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30
Q

What is Penicillin G Benzathine?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

A

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

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31
Q

What is Nafcillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

u-

A

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

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32
Q

What is Oxacillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

the 5-member ring is a thiazolidine

B-

A

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

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33
Q

What is Dicloxacillin?
When should it be use?
Coverage against what bacterias?
Does it requires Dose adjustment?

d-

A

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

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34
Q

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?

A

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

35
Q

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?

A

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

36
Q

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-

A

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

37
Q

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?

A

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

38
Q

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-

A

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

39
Q

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

A

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

40
Q

What is Cefazolin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?

An-, Ke-

good leaving groop not aqueus stable but metabolic stable cause is not a ester
A

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

41
Q

What is Cephalexin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?

bad leaving group: Increase aqueus stability Increase metabolic stability cause not ester Increase oral stability

K-

A

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

42
Q

What is Cefadroxil and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK
What are some AE?

Dar-

Bad leaving group increases oral stabiliy, metabolic stability and aqueus stability
A

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

43
Q

What is Cefuroxime and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?

Kefu-, Zina-

The oxime group will increase stability. It pulls electrons to prevent internal carbonyl attack and also provide B-lactamase resistance
A

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)

44
Q

What is Cefonocid and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?

mon-

Good leaving group Poor aqueous stability Poor oral stability Good metabolic stability
A

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

45
Q

What is Cefuroxime axetil and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?

cef-

A

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

45
Q

What is Cefaclor and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?

cec-

bad leaving group increase aq stabiliy increase metabolic stability increase oral stability
A

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

46
Q

What is Cefprozil and what gen?
When should it be use?
Coverage against what bacterias? thinck HNM-SPEcK
What are some AE?

Cefz-

Alkene bad leaving group Increase oral stability increase metabolic stability increase aq stability
A

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

47
Q

What is Cefoxitin and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK-BF
What are some AE?

mefox-

Good leaving group The ether group increase bulky and prevent attack from B-lactamase
A

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

48
Q

What is Cefotetan and what gen?
When should it be use?
Coverage against what bacterias? thinck SPEcK-BF
What are some AE?

the ether group increase bulky and protect against B-lactamase MTT group
A

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

49
Q

What are the 2nd generation cephalosporins that have MTT
I MET a MAN with a PERfect TAN

A

Cefotetan
Cemetazole
Cefomandole
Cefoperazole

50
Q

What is Cefotaxime and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

clar-

aminothiazole ring allow to enter to the periplasmic space of gram (-) oxime group provde aq stability and greater B-lactamase resistance because pulls electrons away and prevent intramolecular attack
A

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

51
Q

What is Ceftriaxone and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

Roce-

The aminothiazole ring allows penetration to the gram (-) periplasmic space and has affinity to transpeptidase The oxime group increases electronegativity because pulls electrons away --> less likely for intramolecular attack and improve stability against B-lactamase
A

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

52
Q

What is Ceftazidine and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

For-

The aminothiazole ring allow penetration to the gram (-) periplasmic space and inhibit transpeptidase Oxime group provide acid stability --> increase electronegativity so prevent intramolecular attack and provide stabillity against b-lactamase -Zwitter ion can be neutral an pass through the membrane
A

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

53
Q

What is Ceftazidine -Avibactam and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

A

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

54
Q

What is Cefpodoxime proxetil and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?
What are DDi?

Van-

aminothiazole ring allow penetration of gram (-) periplasmic space Oxime provide acid stability by pulling electrons away and preventing intramoleucular attack and protect against b-lactamase
A

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

55
Q

What is Cefdinir and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

aminothiazole ring --> allow penetration to gram (-) periplasmic space Oxime--> increase acid stability and B-lactamase resistant
A

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

56
Q

What is Ceftolozane-tazobactam and what gen?
When should it be use?
Coverage against what bacterias?
What are some AE?

Zer-

A

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

57
Q

What is Cefepime and what gen?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?

Max-

Aminothiazole ring allow penetration Gram (-) periplasmic space -Oxime increase acid stability and B-lactamase resistant -Is neutral because the carboxylic acid exist as COO- or CO2H --> If the pH is greater than 4 it will be COO- Forms zwitter ion and can cross the membrane
A

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

58
Q

What is Ceftaroline fosamil and what gen?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?

A

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

59
Q

What is Aztreonam IV?
When should it be use?
Coverage against what bacterias?
Dose?
What are some AE?

azac-

amino thiazole ring enhance penetration through Gram (-) outer membrane periplasmic space -Oxime group provide acid stability pulls electrons and provide b-lactamase stability -Sulfonic acid will bind to the lysine residue of transpeptidase like the carboxylic acid in penicillins and carbapens and cepha and will allow it to move
A

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

60
Q

What is Imipenem-Cilastin?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

prima-

5 member ring b-lactam highly reactive the replace S with C increases ring strain the alkene increases ring strain Give cilastin to prevent hydrolysis by renal-dehydropeptidase
A

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

61
Q

What is Meropenem?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

A

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

62
Q

What is Ertapenem ?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

inv-

A

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

63
Q

What is gentamicin and tobramycin?
How is bacteriacidal?
Coverage against?
AE? TANGS do NOT kill ANAEROBES
Dosing? Peak and trough

A

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

64
Q

What is amikacin?
How is bacteriacidal?
Coverage against?
AE? TANGS do NOT kill ANAEROBES
Dosing? Peak and trough

A

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

65
Q

Televancin

Vibac-

A

Improved vancomycins
Gram +
MRSA also
and also for hospital acquired pneumonia and ventilator associated pneumonia

Vibactiv

66
Q

What is Linezolid?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDILinezolid

Zy

A

Oxazolidone class
Is bacteriostatic
For Gram + complicated skin and skin structure infections, nosocomial pnemonia and VRE

Coverage:
Gram +
Staphylococcus –> S.aureus coag +, S. epidermis Coag- and MRSA
Streptococcus–> S.pnemonia, S.pyrogen
Enterococcus–> E.faecalis and VRE

No dose adjustment
IV / PO

AE:
-Myelosupression: Anemia, leukopenia, thrombocytopenia
-HA
-Peripheral neuropathy
-N/V/ diarrhea

DDI:
-SSRI, SNRI, MAOi, TCA, amphetamines, tyramine food –> increase risk of serotonin syndrome

Zyvox

67
Q

What is Tedizolid?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

S

A

Oxazolidine class
Bacteriostatic
Coverage against GRAM +
Staphylococcus–> S. aureus coag +, S.epidermis, MRSA , MSSA
Streptococcus–> S.pneumonia, S.pyrogen
Enterococcus–> E.faecalis

No dose adjustment is IV or PO and once daily

AE:
-Much lower neutropenia

DDI:
SNRI, SSRI, amphetamines, tyramine cheese, –> increase risk of Serotonin syndrome

Sivextro

68
Q

What is Quinupristin/Dafopristin 30:70?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

sy

A

Bacteriostatic member of streptogramins
-Should be use for severe life threating skin reactions, bacteremia, VRE,

Coverage against GRAM +
-Staphylococcus–> S.aureus (Coag+), S.epidermis (Coag-), MRSA
-Streptococcus–> S.pyrogen, S.pneumonia,
-Enterococcus–> E.faecium, VRE

Dose:
-Is hepatic metabolize so yes renal dose adjustment
-IV and need to dilute in D5W and sterile water

AE:
-Inflammation injection site rxn
-Athralgia
-Myalgia
-HA
-N/V, Diarrhea
-Piritus –> increase bilirubin
-Cost $$$

DDI:
-Is a 3A4 inhibitor –> so avoid statins, benzos, carbazepine, amlodipine, nifedipine, apixaban, rivoroxaban

Synercid

69
Q

What is Daptomycin?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

Cubi

A

-Daptomycin (Cubicin) is from the lipopeptides antibiotics
-Use for complicated skin infections, skin structure infections, Staph.Aureus bacteremia, Right sided endocarditis

Coverage: Braod Gram +
Staphylococcus–> S.aureus (Coag+), S.epidermis (Coag-), MRSA
Streptococcus–> S.pyrogen, S.pnemonia. Penicillin resistant strep.pnemonia
Enterococcus–> E.faecalis

Dose adjustment:
Yes is 80% renally excreted
-Need dose adjustment if CrCl <30

AE:
-Injection site rxn
-Neuropathy
-Increase transaminase
-Myopathy, increase CK levels if combine with statins

DDI:
-Is highly protein bound so DDI with other drugs that are highly protein bound

Cubicin

70
Q

What is Clindamycin IV PO?
When should it be use?
Coverage against what bacterias? think + and anaerobes
Dose adjustment?
What are some AE?
DDI

Cleo

A

Is a lincomycin related antibiotic class
Alternative for antistaph penicillins (Naficilin(unipen), Oxacillin (Bactoci), Dixocillin (Dynapen) and 1st gen cepha fa-pha SPEcK Cefazolin (Ancef, Kecof IV), Cephalexin (Keflex PO), Cefadroxil (Duricef PO)
-Topically can treat rosacea and acne
-Can treat aspiration pneumonia
-Can use with other gram - coverage agents for polymicrobial infections

Coverage think Gram + and anaerobes is bacteriostatic
-Staphylococcus–> S.epidermis, S.aureus and community acquired MRSA
-Streptococcus–> S.pneumonia, S.pyrogen

Mouth anaerobe: Peptostreptococcus
Gut anaerobes: Bacteriodes fragilis

-Hepatic metabolize no need renal dose adjustment

AE:
-Diarrhea–> can lead to C.diff
-Hypersensitive rxn
-Bitter taste

Cleocin

71
Q

What is Metronidazole IV/PO?
When should it be use?
Coverage against what bacterias? think anarobes
Dose adjustment?
What are some AE?
DDI

Fla

A

Think Anaerobes is bacteriocidal
-Is use for C.diff
-Can be use topically for acne
-Can also be use for crohns and vaginitis
-Can also be use for in combo for polymicrobial infections

Coverage:
Mouth anaerobes –> peptococcus some mild coverage
Gut anaerobes mainly–> Bacteroides fragilis, C.diff
Miscelleneus–> helicobacter pylori, giardia lambia, trichomonas vaginalis

No dose adjustment is hepatic metabolize

AE:
-Metallic taste –> counsel pt you chew gum
-GI upset
-Dry mouth
-CNS–> peripheral neuropathy, seizure, encephalopathy
-Dilsufram rection–> so avoid alcohol

DDI:
Metronidazole (Flagyl) is a CYP 3A4 and 2C9 inhibitor –> so avoid warfarin because metronidazole (flagyl) will inhibit the metabolims of warfarin and the warfarin concentration in the blood will increase and increase the risk of toxicity and increase INR

Flagyl

72
Q

What is tetracycline PO?
When should it be use?
Coverage against what bacterias? think respiratory pathogens and sexual transmitted
Dose adjustment?
What are some AE?
DDI

A

Bacteriostatic
Use for atypical pneumonia, sexually transmitted chlamydia, UTI, skin and soft tissue infections

Coverage: Think respiratory pathogens
Gram +
Streptococcus –> S.pneumonia
Staphylococcus–> S.aureus, S.epidermis and community acquired MRSA

gram -
H.influenzae

Miscellaneus
Atypical: Mycoplasma pneumonia, chlamydia pneumonia, legionella pneumonia
chlamydia trichomatis
Lyme disease

No dose adjustment –> has a shorter T1/2 and renally excreted

AE:
Photosensitive –> pt should wear sunscreen
Tooth discoloration and bone deposition–> avoid in pregnatn and kids
Gi disturbance

DDI:
separate 2hrs from Ca2+, mg2+, antacids, milk, cholestyramine, colestipol –> chelation rxn

73
Q

What is Minocycline IV/Po?
When should it be use?
Coverage against what bacterias? think respiratory pathogens and sexual transmistted
Dose adjustment?
What are some AE?
DDI

m

A

-Bacteristatic
-For atypical pneumonia, sexually transmitted chlamidia, UTI, skin and soft tissue infection

Coverage againts: Think Respt pathogens
Gram +
Streptococcus–> S.pneumonia
Staphylococcus–> S.aureus, S.epidermis and Community acquired MRSA

Gram -
H.influenza

miscelleneous:
Atypical: Mycoplasma pneumonia, chlamydia pneumonia, legionella pneumonia
-Chlamydia trichomatis
-Lyme disease

No dose adjustment

AE:
-Photosensitive–> need to wear sunscreen
-Tooth discoloration and bone deposition–> CI kids and pregnat
-Gi disturbance

DDI:
Mg2+ , Ca2+, Fe, milk, antacids, cholestyramine, colestipol–> chelation rxn so need to separate 2hrs before or 2hrs after

Minocin

74
Q

What is Doxycycline (IV/PO)?
When should it be use?
Coverage against what bacterias? think respiratory pathogens and sexual transmitted
Dose adjustment?
What are some AE?
DDI

vibra

A

Bacteriostatic
-Use for atypical pneumonia, chlamydia, UTI, skin and soft tissue infections

Coverage:
Gram +
Streptococcus –> S.pneumonia
Staphylococcus–> S.aureus and S.epidermis and community acquired MRSA

Gram -
H.influenzae

Miscellenous:
Atypical: Mycoplasma pneumonia, chlamidia pneumonia, ligonella pneumonia
Chlamydia trichomatis
Lyme disease

No dose adjustment –> Has a longer half life and in less renally excreted

AE:
Photosensitive–> need sunscreen
Tooth discoloration and bone deposition–> CI kids and pregnant
Gi disturbance

DDI:
-Mg, Ca,Fe, milk, antiacids, cholestyramine, colestipol–> chelation rxn so separate 2hrs

Vibramycin

75
Q

What is Tigecycline IV?
When should it be use? broad spectrum gram+ , gram - and anerobic
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

Tiga

A

-Bacteriostatic
-For complicated skin/skin structure and intraabdominal infections

Coverage:
Gram +
Staphylococcus –> S.aureus, S.epidermis, MRSA
Streptococcus–> S.pneumonia, Spyroned, Penicillin Resistant Streptococcus
Enterococcus–> E.faecalis, E.faecium andd VSE

Anaerobes:
Mouth anaerobes: peptostreptococcus
Gut anaerobes–> Bacteriodes fragilis, C.diff

Dose adjustment:
-Is billiary/fecal elimination–> dose adjustment if severe hepatic impairment

AE:
-Photosensitive –> wear sunscreen
-Tooth discoloration
-N/V/D

DDI:
-Mg, Ca, Fe, milk, antiacids, cholestyramine, colestipol –Chelation rxn so need to separate dose by 2hrs before or 2hrs after

Tigacil

76
Q

What is Sulfamethoxazole-Trimethoprim?
When should it be use? Think Respiratory tract, GIT, and urinary tract
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

B and S

A

Is bacteriostatic

-Use for UTI, Skin and structure infections, respiratory tract infections, PCP HIV, travelers diarrhe

Coverage:
Gram +
Streptococcus S.pneumonia
Community acquired MRSA

Gram -
Enterobacteriales –L> E.coli
H.influenzae
Moxella catarrhs

Miscelleneous
Gi pathogens –> Shigella, salmonella
Listeria monocytogenesis
Stenetrophomans maltophilia
Pneumocytosis Juvenili (PCJ)

Dose adjustment:
Yes renall dose adjustment
Is liver metabolize and renal excreted

AE:
Photosenstive
Bone marrow supression–> drop WBC, hemolytic anemia
Hypersenstive rxn–> rash, Steven johnson syndrome
Crystalluria
Hyperkalemai

DDI:
Bactrim is a 2C9 inhibitor –> so inhibits metabolism of warfarin so increases INR and increases concentration of warfarin in the serum

Dose
Single dose –>TM 80mg Sulfa 400mg
Double strentg –> TM 160mg Sulfa 800mg

Bactrim, Septra

77
Q

What is Erythromycin?
When should it be use?
Coverage against what bacterias? Think respiratory pathogens and HIV
Dose adjustment?
What are some AE?
DDI

A

Erythromycin IV/PO
Is a macrolide antibiotic –> Bacteriostatic
Think Respiratory pathogens and HIV
-Use for respiratory pathogens, MAC (Mycobacterium avium complex) in HIV, gram + infections

Coverage:
Gram +
Streptococcus–> S.pneumonia but increasing resistance
Staphylococcus–> S.aureus, S.epidermis NO MRSA

Gram -
Respiratory pathogens –> H.influenzae, Moxella catarrhs

Miscellenous
Atypical: Mycoplasmic pneumonia, chlamidia pneumonia, legionella pneumonia, chlamydia trachomatis
HIV pathogens: Mycobacterium avium complex (MAC)

Dose:
-No renal dose adjustment
-If give IV can be irritative to the blood vessels
-If give PO:
E-base will be destroyed by gastric acid contents
E-formulation need to be taken without food to enhance absorption
Bus EES or delayed release formulation–> is not affected by food

AE:
GI: N,V, diarrhea
CNS: Seizure, hearing impairment, tinitus–> is reversible
QT prolongation –> can cause arrythmia
Increase LFT –> can lead to cholestasis jaudince

DDI:
-Erythromycin is a 3A4 inhibitor so avoid giving
3A4 substrates: Warfarin, statins, benzos, cyclosporine, carbazepine
It will increase the serum concentration of warfarin –> increases its effect increase INR increase risk of bleeding

Drugs that prolong QT–> methadone, cyclobenzaprine (TCA), antipsychs

78
Q

What is Azithromycin?
When should it be use? Think respiratory pathogens and HIV
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

A

Is bacteriostatic think Respiratory pathogen and HIV

Coverage:
Gram +
-Streptococcus –> S.pneumonia, S.pyrogen
-Staphylococcus–> S.aureus Coag +, S.epidermis coag- NO MRSA

Gram -
Respiratory pathogens–> Moxella catarrhs, H.influenzae

Miscellenous:
Atypical pathoges: Mycoplasma pneumonia, chlamydia pneumonia, legionella pneumonia, chlamydia trachomatitis

HIV: Mycobacterium Avium Complex (MAC), Toxoplasmosis clyptosporidium

Dose: no renal dose
Zpack: Day 1 take 2 tablets (total 500mg) from day 2-5 take 1 tablet
Tri pack: Take 1 tablet 500mg for 3 days

AE:
-GI: N,V,D
-CNS: Seizure, hearing impairment, tinitus–> reversible
-Prolong Qt–> increase risk of arrythmia
-Increase LFT–> increase risk of cholestasis
-IV injection site rxn

DDI:
-Antacids because it will decrease the absorption of azythromycin

Zithromax, Zpack, Tripack

79
Q

What is Clarithromycin PO?
When should it be use? Think respiratory pathogens and HIV
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

Biax

A

Clarithromycin PO (Biaxin) is bacteriostatic
Use for:
MAC –> Mycobacterium Avium Complex in HIV along with ethambutol and rifabutin
H.pylori

Coverage:
Gram +
Streptococcus chains and pairs–> S.pneumonia
Staphylococcus clusters–> S.aureus coag+, S.epidermis coag- NO MRSA

Gram -
Respiratory pathogens: H.influenza, Moxella catarrhs

Atypical:
Mycoplasmic pneumonia
Chlamydia pneumonia
Legionella pneumonia
Chlamydia trachomatis

HIV pathogens:
MAC–> Mycobacterium avium complex
Toxoplasmosis cryptosporidium
H.pylori

No dose adjustment required

AE:
-GI: N, V, diarrhea
CNS: seizure, hearing loss, tinnitus–> reversible
-QT prolongation –> can cause arrythmia
-Increase LFT –> increase risk of cholestasis

DDI:
Clarithromycin (Biaxin) is a 3A4 and 2C9 inhibitor –> so it will inhibit metabolism of Warfarin –> so increase warfarin concentration in blood so increase the effects of warfarin and increases INR and increases risk of bleeding.
Also inhibit metabolism of benzos, carbamazepine, cyclosporine, statins

DDI with other drugs that prolonged the QT:
Methadone, cyclobenzaprine (Flexeril, Amrix), antipsych

Biaxin

80
Q

What is Cirpofloxacin IV/PO?
When should it be use?
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

A

Is bacteriocidal
MOA: inhibits DNA gyrase and topiosimerase IV
Use for UTI, respiratory pathogens

Coverage:
More Gram -
Pseudomonas
Enterobacteriales: E.coli lactose ferm, Klebesella, Proteus
Respiratory pathogens: H.influenza, Moxella catarrhs

Some Gram +
Staphylococcus –> No MRSA
Streptococcus–> S.pneumonia, S.pyrogen

Need renall dose adjustment

AE:
GI: N, V, diarrhea and taste perverssion
Neurotoxicity: HA, dizziness, seizure, worsening myasthenia gravis, peripheral neuropathy, confusion, psychiatric issues
Allergies–> skin rash
Photosensitive
Musculoskeletal—> Tendon rupture –> increase risk in elderly, renal dysfunction pt and pt on corticosteroids
QT prolongation
Hypoglycemia
Increase LFT

CI:
-Pregnant pt
-Elderly pt

DDI
Ciprofloxacin is a 1A2 inhibitor so it will incrase the levels of caffeine therefore causing increase nervousness and excitation
-QT prolongation drugs like: Cyclobenzaprine, methadone, haldol, risperidone, Class 1A antiarrythmic: Procainamide, Disopyramide, Class 3 antiarrythmic: Sotalol, Ibutillide, Dofetilide, amiodarone, dronedarone
-It can increase concentration of warfarin by: Inhibiting metabolism of warfarin, disrupt normal GI flora so no vitamin K synthesis, displace warfarin from protein binding

-Need to separate dose when taking Ca, Mg, multivatimes, K, Fe, milk, yogurt

Cipro

81
Q

What is Levofloxacin IV/PO 250-500mg daily and for complicated 750mg daily?
When should it be use? Think broad spectrum emphasize on gram -
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

A

Quinolone is bacteriocidal
MOA: inhibit bacteria DNA synthesis and replication by inhibiting DNA gyrase and topoisomerase IV

Use for respiratory tract infections and UTI

Coverage:
Gram +
Streptococcus –> s.pneumonia, s.pyrogen
Staphylococcus–> S.aureus, S.epidermis NO MRSA
Enterococcus

Gram -
Enterobacteriales–> E.coli
Pseudomonas
Respiratory pathogen: Moxella catarrhs, h.influenza

Atypical: Mycoplasmac pneumonia, chlamydia pneumonia, limogella pneumonia

Yes renal dose adjustment

AE:
GI: N, V, diarrhea, taste perversion
Neurotoxicity: Seizure, psychiatric, confusion, dizziness, worsening myasthenia gravis, periphery neuropathy, HA
Photosensitivity
Tendon rupture–> increase risk in elderly, renal dysfunction and if using corticosteroids
Hypoglycemia
Increase LFT
Prolong QT

DDI:
-Need to separate dose when taking Fe, Ca, Mg, Zn, Al,sulcrafate, multivit, milk, cheese
-NSAID –> increase CNS activation
-Class 1 antiarrthmic-_> disopyrimidine, procainamide
-Class 3 antiarrthmic–> ilbutillide, dofetillide, sotalol, amiodarone, dronedarone
-QT prolong drugs: methadone, cyclobenzaprine, risperidone (risperdal), haldol

Increase concentration of warfarin by:
-Inhibiting metabolism
-Disrupting normal GI flora so no vitamin K
-Displacement from PPB

Ofloxacin

82
Q

What is Moxifloxacin IV/PO daily?
When should it be use? Think broadspectrum some gram - but also anaerobes
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

Ave

A

Is a quinolone Bacteriocidal–> it will inhibit DNA gyrase and Topoisomerase IV so inhibit bacteria DNA synthesis and replication

-Use for respiratory tract infections and UTI

Coverage:
Gram +
Streptococcus–> S.pneumonia, S.pyrogen
Staphylococcus–> S.aureus, S.epidermis NO MRSA
Enterococcus

Gram -
Enterobacteriales–> E.coli
Respiratory pathogens–> H.influenzae, Moxella catarrhs

Anaerobic:
Mouth anerobes–> Peptostreptococcus
Gut anaerobes–> C.diff, Bacteriodes fragelli

Atypical pathogens:
Mycoplasmic pneumonia, Chlamydia pneumonia, limogella pneumonia

-Is hepatic excreted so no need renal dose adjustment
-Can take it with or without food

AE:
GI: N,V,D, taste perversion
Neurotoxicity: Seizure, dizziness, HA, confusion, peripheral neuropathy, worsening of myasthenia gravis, psychiatric
Tendon rupture–> increase risk in elderly and in renal dysfunction pt and pt on corticosteroids\
Photosensitive
Hypoglycemia
Prolong QT–> increase risk if pt has low Mg or K, cardiac conditions, on other meds that prolong QT
Increase LFT

Ci:
-Avoid in pregnancy and elderly pt

DDI:
-Need to separate dose when taking Ca, Mg, Fe, Zn, Al, milk, sulcrafate, yogurt
-NSAID –> Increase CNS activation
-Class 1 antiarrythmic–> procainamide, disopyrimide
Class 3 antiarrthmic–> ilbutillide, dofetillide, sotalol, amiodarone, dronedarone
Other drugs that prolong qt–> cyclobenzaprine, haldol, methadone

Warfarin:
-It will increase the levels of warfarin because:
Inhibits metabolism
Disrupt GI flora so no Vitamin K
Displacement from PPB

Avelox

83
Q

What is Delafloxacin ?
When should it be use? Think broad spectrum emphasis on gram -
Coverage against what bacterias?
Dose adjustment?
What are some AE?
DDI

Baxi

A

Quinolone Bacteriocidal
Use it for skin and skin structure infections
Coverage against
Gram +
Staphylococcus –> Yes MRSA, S.aureus, Se.epideris
Streptococcus–> S.pneumonia, S.pyrogen
Enterococci

Gram -
Enterobacteriales–> E.coli
Pseudomonas
Resp pathogens–> H.influenzae, moxella catarrhs

Atypical: Chlamydia pneumonia, mycoplasmic pneumonia, limogella pneumonia

Yes renal dose adjustment
-Has good bioavailabily
-Has difference in IV and PO dosing

AE:
AE:
GI: N,V,D, taste perversion
Neurotoxicity: Seizure, dizziness, HA, confusion, peripheral neuropathy, worsening of myasthenia gravis, psychiatric
Tendon rupture–> increase risk in elderly and in renal dysfunction pt and pt on corticosteroids\
Photosensitive
Hypoglycemia
Prolong QT–> increase risk if pt has low Mg or K, cardiac conditions, on other meds that prolong QT
Increase LFT

Ci:
-Avoid in pregnancy and elderly pt

DDI:
-Need to separate dose when taking Ca, Mg, Fe, Zn, Al, milk, sulcrafate, yogurt
-NSAID –> Increase CNS activation
-Class 1 antiarrythmic–> procainamide, disopyrimide
Class 3 antiarrthmic–> ilbutillide, dofetillide, sotalol, amiodarone, dronedarone
Other drugs that prolong qt–> cyclobenzaprine, haldol, methadone

Warfarin:
-It will increase the levels of warfarin because:
Inhibits metabolism
Disrupt GI flora so no Vitamin K
Displacement from PPB

Baxidella