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228 Cards in this Set
- Front
- Back
- 3rd side (hint)
Which ABX inhibit or disrupt cell wall production?
|
Beta-lactams
monobactams Glycopeptides |
|
|
Which drugs are considered beta-lactams?
|
Penicillins, cephalosporins, and carbapenems
|
|
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What drug is a glycopeptide?
|
Vancomycin
|
commonly used for MRSA
|
|
Which drugs inhibit protein synthesis by interfering with bacterial ribosomes?
|
Macrolides
Ketolides Clindamycin Aminogylycosides Tetracycline |
|
|
Which drugs inhibit DNA synthesis?
|
Fluoroquinolones
Metronidazole |
|
|
Which drug inhibits folic acid synthesis?
|
TMP-SMX
|
|
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When are bacteriocidal agents prefered over static?
|
1) host is compromised (e.g. neutropenic)
2) host defenses do not operate well in that area (e.g. endocarditis, meningitis) 3) critical condition |
|
|
Which ABX are generally considered bacteriocidal?
|
Beta lactams
glycopeptides (vanco) Aminoglycosides Fluoroquinolones Metronidazole Cyclic lipopeptides |
wish there was a way to remember this one!
|
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Which ABX are generally considered bacteriostatic?
|
Sulfonamides (TMP-SMX?)
Tetracyclines Macrolides Ketolides Lincosamides |
|
|
3 examples of concentration-dependent ABX.
|
Aminoglycosides
Fluoroquinolones Cyclic lipopeptides |
|
|
3 examples of Time-Dependent ABX.
|
Beta lactams
Monobactams Vancomycin |
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Which drugs will inc -cidal effects when you increase the dosage? C-D or T-D?
|
Concentration Dependent
|
Aminoglycosides
Fluoroquinolones Cyclic lipopeptides (daptomycin) |
|
Which drugs have post ABX effect?
|
Aminoglycosides
Fluoroquinolones Cyclic lipopeptides (daptomycin) |
Concentration dependent
|
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Which ABX are active against Intracellular Organisms?
|
Tetracyclines
TMP-SMX Fluoroquinolones Macrolides/Ketolides Clindamycin Rifampin |
beta lactams are NOT!
|
|
Which organisms are intracellular?
|
Chlamydia pneumoniae
Legionella pneumophila Mycobacteria (TB and others) Rickettsia Erlichiae |
2 are associated w/tick bites
|
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Which ABX achieve equivalent levels PO and IV?
|
Fluoroquinolones
Rifampin TMP-SMX Tetracyclines Metronidazole Linezolid |
4 of them are also active against intracellular MOs
|
|
Which ABX undergo renal excretion?
|
Beta lactams (except two)
Fluoroquinolones (split) Tetracyclines (split) Vanco Aminoglycosides |
|
|
Which Beta lactams are not excreted by the kidney? (2)
|
Ceftriaxone
Nafcillin |
One penicillin and one cephalosporin
|
|
Which ABX are excreted hepatically?
|
Ceftriaxone
Nafcillin Mainly: Clindamycin Metronidazole Others: Sulfamethoxazole Macrolides/Ketolides Rifampin |
|
|
ABX associated with ototoxicity (3)
|
Aminoglycosides
Vancomycin Azithromycin Minocycline |
one tends to be permanent
one tends to be transient and one is actually more vestibular dysfunction |
|
Which ABX are associated with nephrotoxicity?
|
Amphotericin B
Aminoglycosides Nafcillin Tetracycline Vancomycin (historically) |
|
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Which ABX is associated with ATN (acute proximal tubular necrosis)?
|
Aminoglycosides
|
nephrotoxic and excreted by kidney
|
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Which ABX causes AIN (acute interstitial nephritis)?
|
Nafcillin
|
associated with nephrotoxicity but not renally excreted
|
|
Which drug is associated w/Fanconi syndrome?
|
Tetracycline
|
|
|
What are the main ABX associated with psychiatric symptoms?
|
*Fluoroquinolones*(esp levo)
Clarithromycin Isoniazid Metronidazole TMP-SMX |
|
|
Which ABX are associated with chemical phlebitis?
|
Nafcillin
Cefepime Vancomycin Clindamycin |
|
|
Which ABX is associated w/a disulfiram like rxn?
|
Metronidazole
|
Gold standard anti-anaerobic oral drug
can have metallic taste if give too much |
|
What should you educate a patient about if you prescribe Metronidazole?
|
No ETOH for 3 days after they complete therapy
|
|
|
Associated with yellow babies
|
Sulfonamides
|
|
|
Which drugs are sulfonamides?
|
Trimethoprim
Sulfamethoxazole (e.g. TMP-SMX) |
|
|
What are sulfonamides often used to treat?
|
Urinary tract infections
|
|
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What ABX are associated with gray babies?
|
Chloramphenicol
|
|
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What is red man syndrome associated with?
|
Vancomycin
|
|
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How can you decrease the chance of a person developing "red neck syndrome" from vancomycin?
|
Slow infusion
give diphenhydramine to tx |
|
|
What drug is associated with Red Lobster syndrome? And what IS red lobster syndrome?
|
Rifampin --> red-orange discoloration or urine, tears, and sweat
|
|
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What drug causes discolored teeth?
|
tetracyclines
|
|
|
What drugs may cause pt to lose red/green color perception?
|
Ethambutol
Amiodarone |
causes neuritis
|
|
What ABX may cause Hyperkalemia?
|
Trimethoprim (usually TMP-SMX)
|
Think of a woman with uncomplicated cystitis
|
|
What ABX may cause hypokalemia?
|
especially:
Nafcillin Piperacillin |
They are penicillins
|
|
Associated with causing C. dif?
|
Aminopenicillins (amox, augmentin, ampicillin, amp/sulfabactam)
Cephalosporins Clindamycin (classic) |
classic = highest incidence
other two = highest prevalence |
|
Main drugs associated with rash when used in Infectious Mono?
|
Ampicillin
|
IV aminopenicillin
|
|
When else might a rash occur when taking ampicillin?
|
CLL
coadministration of allopurinol |
|
|
What drugs does a true penicllin allergy apply to?
|
penicillins
cephalosporins carbapenems |
|
|
Can you use aztreonam (a monobactam) if pt had anaphylactic rxn to penicillin?
|
Yes - but no carbapenems
|
|
|
If pt had rash from penicillin what could you use?
|
possibly cephalosporins, carbapenems, if necessary
definitely aztreonam |
|
|
What Oral ABX are effective against pseudomonas?
|
Ciprofloxacin
Levofloxacin |
(2) fluoroquinolones
|
|
What oral ABX is gold standard to treat Methicillin susceptible Staph aureus?
|
Dicloxacillin
|
|
|
What IV ABX should be used for MSSA?
|
Nafcillin
|
|
|
What other IV drug can be used for MSSA if gold standard (naf) isn't used?
|
Cephazolin (2nd choice)
Vanco (3rd choice) |
|
|
What oral drug should be used for MRSA?
|
**Linezolid
Minocycline/doxycycline maybe TMP-SMX (not good choice) |
|
|
What oral ABX work for MSSA but are not gold standard? (dicloxacillin)
|
cephalexin (2nd choice)
Minocycline/doxycycline >TMP/SMX |
|
|
What oral ABX can be used if enterococcus is resistant to vanco?
|
linezolid
|
|
|
What are the 2 best anti-anaerobic oral ABX?
|
Metronidazole
Augmentin (amox/clav) |
|
|
What is the silver standard to tx of anaerobic infxn w/oral ABX?
|
Clindamycin
|
|
|
If cephalexin is less active against MSSA than dicloxacillin then shy is it used often?
|
better absorbed, don't need emty stomach
|
|
|
What is the problem with using minocycline and TMP-SMX for MSSA?
|
They are static drugs while the first and second choice (dicloxacillin and cephalexin) are cidal
|
|
|
IV drugs for pseudomonas
|
piperacillin/tazobactam
aztreonam ceftazidime cefepime cipro levo tobra carbapenems (mero moreso than imipenem) |
|
|
Top choices (in order) for IV drug against MSSA
|
#1) nafcillin
#2) cefazolin #3) vancomycin |
there are many others
|
|
What is the gold standard parenteral ABX for anaerobes? (there are three)
|
beta-lactam/beta-lactamase inhibitor
Carbapenems Metronidazole |
one is the same as oral top choice
|
|
What are the silver and bronze standard anti-anaerobes (IV form)
|
2nd choice - clindamycin
3rd choice - cefotetan, or cefoxitin |
|
|
Are penicillins excreted by kidney or liver?
|
kidney
|
nafcillin is the exception
but all other beta lactams are excreted this way |
|
What is the difference between penicillin G and VK? what MO(s) do they cover?
|
VK is PO
G is IV |
strep pyogenes
|
|
What is the difference between penicillin G and penicillin G benzathine?
|
benzathine is IM and long acting. . . also it covers treponema pallidum
|
|
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When might penicillin V be used?
|
strep pharyngitis
|
only one instance
|
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Which penicillin is associated with Hoignes syndrome?
|
penicillin C procaine (IM)
|
|
|
What drugs are considered anti-staph penicillins?
|
Nafcillin
Dicloxacillin |
|
|
Which anti-staph penicillin is PO?
|
dicloxacillin
|
|
|
What MOs do aminopenicillins cover?
|
s. pyogenes
s. aureus Enterococci B. burgorferi P. multocida Proteus Listeria SOME h.flu and e.coli |
anti-staph pen + others
|
|
In what situations might you use an anti-staph penicillin?
|
cellulitis
staph aureus meningitis endocarditis |
only when you think staph may be causing ifxn or you cannot rule out its presence
|
|
What MOs are added by "augmenting" aminopenicillins?
|
h.flu and m.cat (even amox resistant strains)
most anaerobes some e.coli and klebsiella group B strep (agalactiae) |
good for URIs, otitis, sinusitis, etc
|
|
Name two augmented aminoPCNs
|
amoxicillin/clavulanate
ampicillin/sulfabactam |
amox is still PO
amp is still IV |
|
What drug is a Ureidopenicillin?
|
piperacillin = ureido
|
beta-lactam that is used primarily in combination with a betalactamase inhibitor
|
|
what organisms do augmented extended-spectrum penicillins cover that other penicillins do not?
|
Pseudomonas
Klebsiella Enterobacter Serratia |
bad anaerobes!
|
|
is piperacillin-tazobactam (extended-spectrum penicillin) IV or PO?
|
IV - only used in hospitals
|
active against pseudomonas!
|
|
Are cephalosporins excreted by the liver or kidney?
|
kidney
|
like all beta lactams (except nafcillin)
|
|
Name two 1st generation cephalosporins and whether they are IV or PO
|
Cefazolin (IV)
Cephalexin (PO) |
same drug, different formulations - ancef and keflex
|
|
What MOs do the 1st generation cephalosporins (like cefazolin and cefalexin) cover?
|
s. pyogenes
s. aureus e. coli klebsiella proteus |
good gram + activity
|
|
what might a 1st generation cephalosporin be used for?
|
strep pharyngitis
bone infection UTI? |
|
|
Name a 2nd generation cephalosporin
|
Cefuroxime
|
|
|
What formulations is cefuroxime available in?
|
IV
PO suspension |
|
|
What are possible indications for the use of a second generation cephalosporin?
|
otitis, sinus infections, pneumonia
|
gram + mostly
|
|
What is the big difference between first and second generation cephalosporins?
|
2nd generation get pneumococcus
- but also m. cat, h.flu, and pasteurella |
think URI
|
|
Name 4 3rd generation cephalosporins
|
Ceftriaxone (IV) - rocephen
Ceftazidime (IV) Cefpodoxime (PO) Cefotaxime (IM/IV) |
|
|
What would make you use Ceftazidime instead of Ceftriaxone (IV Rocephen)?
|
Ceftazidime covers resistant gram negatives like pseudomonas, enterobacter, and serratia but Ceftriaxone does not.
|
|
|
Name the only 4th generation cephalosporin we discussed
|
Cefepime (IV)
|
|
|
What is the difference between cefepime (4th gen) and 3rd generation cephalosporin?
|
Cefepime, like 3rd generation cephalosporins cover gram negatives, like ceftazidime it covers the "nasty" gram negatives (pseudomonas, enterobacter, serratia)
but. . . it ALSO has better staph aureus and s. pneumo coverage than 3rd generation cephalosporins |
compare to ceftriaxone and ceftazidime
|
|
What drug class is aztreonam?
|
Monobactam
|
|
|
What should monobactams be used for?
|
Pseudomonas
other resistant gram neg. (enterobacter, serratia) |
Only 2 things. . .
only gram negative! only aerobes! |
|
What are 3 Carbapenems?
|
Imipenem
Meropenem Ertapenem |
|
|
What MOs do carbapenems cover?
|
MDR Gram negatives
Extended spectrum beta lactase gram negatives |
complicated/nosocomial infxns
|
|
How are monobactams excreted?
|
renal excretion
|
|
|
How are carbapenems excreted?
|
renal excretion
|
same as beta lactams
|
|
Which carbapenem is available only IV, not IM?
|
Meropenem
|
|
|
What is the difference between ertapenem and the other two carbapemens (Imi and Mero)?
|
Ertapenem does not cover pseudomonas, Enterococci, or Acinetobacter
|
Don't use for empiric nosocomial therapy!
|
|
What ABX is a glycopeptide?
What formulations are avail? |
Vancomycin
PO, IV, suspension |
|
|
What should oral or suspension vanco be used for?
|
refractory c. dif
|
(no oral absorption) vancomycin is a large molecule that cannot leave the intestine
|
|
MOs covered by vancomycin
|
MSSA
MRSA MRCNS strep enterococci (in PCN allergic pts) clostridial species (perfringens and dif) coagulase negative staph |
|
|
What gram neg organisms does vanco cover?
|
none!
only G+ aerobes and anaerobes |
|
|
Is vancomycin time-dependent or concentration-dependent?
|
time-dependent (measure troughs)
|
|
|
do tetracyclines have a long or short half life?
|
long
|
usually dosed qd-bid
|
|
What decreases the absorption of tetracyclines?
|
Ca, Fe, Mg, Zn (di and trivalent cations)
|
don't take with antacids, dairy products, etc
|
|
What side effects of tetracycline is seen with minocycline in particular?
|
1) vestibular
2) purple/blue hyperpigmentation of skin 3) drug-induced lupus |
|
|
What are the three tetracyclines?
|
doxycycline
tetracycline minocycline (only PO) |
|
|
What organisms are covered by tetracyclines?
|
strep pneumo
m cat h flu chlamydia legionella mycoplasma rickettsia erlichia borrelia burdorferi pasteurella most staph aureus (+MRSA) |
|
|
What might you prescribe a tetracycline for?
|
works just as well as azithromycin for otitis, sinusitis
can use for walking pneumonia, dog/cat bite, tick bite |
URIs and atypicals + bites
|
|
Where are the macrolides metabolized?
|
liver
|
|
|
Which macrolide does not have P450 interactions?
|
azithromycin
|
|
|
Are macrolides static or cidal?
|
static
(interferes w/ribosome) |
|
|
Why wouldn't a macrolide work well for a bacteremia from pneumonia?
|
high tissue levels but low serum levels
|
|
|
What unpleasant characteristic is associated with clarithromycin?
|
metallic taste
|
same as high dose metronidazole
|
|
Rank the 3 macrolides in order of potency
|
clarithro > azithro > erythro
|
|
|
Which macrolide is only available PO?
|
clarithromycin (Biaxin)
|
|
|
What MOs are covered by macrolides
|
s. pneumo
h. flu m. cat chlamydia legionella mycoplasma strep pyogenes |
Think ears, sinuses, lungs, throat!
|
|
What drug is like a "supercharged biaxin"?
biaxin = clarithromycin |
Ketolides
|
|
|
An example of a ketolide.
|
telithromycin
|
|
|
What is covered by ketolides but not by macrolides?
|
s. pneumo (even macrolide resistant)
h flu (drug unaffected by beta lactamase) m cat (" ") s. pyogenes (macrolide resistant) **all the same MOs as macrolides |
|
|
Which patients should not recieve a ketolide?
|
1. Class Ia or III antiarrhythmics
2. pts w/prolonged QT |
think rhythm
|
|
How are aminoglycosides excreted?
|
kidney
|
|
|
Are aminoglycosides concentration or time dependent?
|
concentration
|
|
|
Adverse effects of aminoglycosides?
|
ototoxicity or vestibular damage
nephrotoxicity (ATN) Neuromuscular blockade in myasthenia gravis pts |
|
|
What are the two main examples of aminoglycosides and their formulations?
|
gentamycin (IV)
tobramycin (inhaled, IV) |
|
|
What organisms are covered by Aminoglycosides?
|
aerobic gram negatives (proteus, e. coli, klebsiella, enterobacter, pseudomonas, serratia)
|
|
|
what anaerobic organisms are covered by aminoglycosides?
|
none!
|
|
|
Can aminoglycosides be used for gram positives?
|
Not most - except enterococcus
but. . . . must give in combination with PCN or ampicillin or vanco |
covers gram - aerobes
|
|
Which aminoglycoside is most effective against pseudomonas? (gram neg aerobe)
|
tobramycin
|
|
|
Are fluoroquinolones cidal or static?
|
cidal
|
|
|
What is the similarity between fluoroquinolones and tetracyclines in terms of absorption?
|
multivalent cations decrease absorption
|
same pt ed about what not to take the drug with
|
|
Adverse effects of fluoroquinolones
|
1. arthropathy
- CI if <18. . . except maybe cipro for complicated UTI or anthrax 2. CNS toxocity - watch kidney fcn 3. photosensitivity 4. QT prolongation 5. hypoglycemia |
|
|
Hypoglycemia is most common with which fluoroquinolone?
|
gatifloxacin
|
|
|
What are the clinical uses of 1st generation quinolones?
|
none really
|
|
|
Name a 2nd generation fluoroquinolone
|
Ciprofloxacin (Cipro) - PO/IV
|
|
|
What organisms are covered by 2nd generation fluroquinolones?
|
gram negatives (e. coli, klebsiella, enterobacter, pseudomonas, proteus, serratia, gonorrhea, pasteurella, m. cat, h. flu)
B. anthracis |
|
|
Name 3 3rd generation fluoroquinolones
|
levofloxacin (PO/susp/IV)
gatifloxacin (PO/IV) moxifloxacin (PO/IV) |
|
|
What is the difference between 2nd and 3rd generation fluoroquinolones in terms of coverage?
|
3rd offer great coverage of respiratory pathogens including atypicals (s. pneumo, s. pyogenes, legionella, mycoplasma, chlamydia)
Also - 3rd generation have significant anaerobic activity |
|
|
Which fluoroquinolone would you choose to treat CAP?
|
levaquin, not cipro
|
must cover strep pneumo!
|
|
What might you use ciprofloxacin to treat?
|
UTI, aspiration, perforation (diverticulosis, PUD), anthrax
|
|
|
Is TMP-SMX static or cidal?
|
static
|
|
|
How is TMP-SMX excreted?
|
kidney
|
|
|
What organisms does Bactrim cover?
Bactrim = TMP-SMX |
s. pneumo
h. flu m. cat p. jiroveci pasteurella stenotrophomonas maltophila e. coli klebsiella proteus MRSA |
|
|
Which patients cannot take TMP-SMX
|
sulfa allergy (have to use just trimethoprim)
G6PD deficiency (will cause hemolytic anemia) |
|
|
What might you treat with TMP-SMX?
|
NOT outpatient CAP (despite pathogens covered) b/c resistance is too high
ok for ears and sinuses PCP UTIs (covers gram negs) |
|
|
Which drug is a Lincosamide?
|
clindamycin
|
|
|
What organisms are covered by clinda?
|
anaerobes (best for above the diaphragm)
s. aureus and strep pyogenes in those with PCN allergies |
|
|
Are lincosamides (clindamycin) cidal or static?
|
static
|
|
|
What is a major adverse effect of lincosamides?
|
diarrhea ( + C. dif colitis)
|
|
|
What categories of pathogens does clindamycin cover?
|
G + cocci
anaerobes NOT gram negatives! |
|
|
What is the difference between linezolid against staph, enterococci, and streptococci?
|
static against staph/entero
but cidal against strep |
|
|
What category of drug is linezolid?
|
Oxazolidinone
|
|
|
2 side effects of linezolid?
|
reversible thrombocytopenia
reversible inhibition of MAO (watch dietary tyramine) |
|
|
What is linezolid used for ?
|
MRSA
VancoResistant Enterococcus |
only 2 circumstances
|
|
What drug is a cyclic lipopeptide?
|
daptomycin
|
|
|
What is the main indication for daptomycin? (cyclic lipopeptide)
|
MRSA
vanco is still standard of care in this situation - but this is another IV option |
|
|
Why must you be careful with daptomycin if pt is on a statin?
|
--> myalgias
monitor the CPK more closely |
|
|
Where is metronidazole excreted?
|
liver
|
|
|
Is metronidazole cidal or static?
|
cidal
|
|
|
What MOs are covered by metronidazole?
|
anaerobes (esp below diaphragm)
some protozoa (trichomonas, giardia, entamoeba) |
think GI
|
|
2 main side effects of metronidazole?
|
disulfiram-like rxn
metallic taste if you give too much |
|
|
Possible long term side effect of Nitrofurantoin?
|
pulmonary fibrosis
|
|
|
What does nitrofurantoin cover?
|
gram negatives
enterococcus for UTIs! |
|
|
What organisms are covered by chloramphenicol?
|
h. flu
s. pneumo n. meningitidis some anaerobes |
|
|
Why isn't chloramphenicol used much?
|
toxicities - but used as last resort in CNS infxn because it reaches therapeutic levels in CNS
|
|
|
What is Fosfomycin used for?
|
uncomplicated UTIs due to enterococci or e. coli
|
|
|
What is Polymyxin B used for?
|
only against gram negatives
(often topical) |
|
|
What is Methanamine used for?
|
uncomplicated/chronic UTIs
(no systemic effects) |
|
|
What is Rifaximin used for?
|
Traveler's diarrhea from noninvasive strains of e. coli
|
|
|
Which diarrheal infections can Rifaximin not be used for?
|
those associated w/fever or bloody stools
|
|
|
What are 2 ABX associated with hemolytic anemia in pts with G6PD deficiency?
|
Sulfa (Bactrim)
Nitrofurantoin (anti-malarials also) |
|
|
What ABX are most commonly associated with immune-mediated urticaria?
|
Beta lactams and sulfonamides
|
|
|
What ABX is associated with nonimmune-mediated urticaria?
|
Vanco (red neck syndrome)
|
|
|
With what ABX do you worry most about anaphylaxis?
|
Beta lactams
|
|
|
What drugs are associated with Drug-induced exanthems? (a drug eruption)
|
beta lactams and sulfonamides
|
|
|
What ABX are associated with hypersensitivity vasculitis?
|
Beta lactams and sulfonamides
|
same two ABX that cause everything
|
|
What drugs are associated with exfoliative dermatitis/erythroderma?
|
Penicillins mostly
but also sulfa |
|
|
What ABX is associated with SJS (Stevens Johnson Syndrome) and TEN (toxic epidermal necrolysis)?
|
Sulfonamides
|
|
|
How is SJS from a sulfonamide managed?
|
stop drug
tx like burn high dose steroids |
|
|
What two ABX are associated witha fixed drug eruption? (plaques with grayish center or frank bullae)
|
tetracyclines
sulfonamides |
|
|
What abx is classically associated with serum sickness
|
cefaclor (2nd gen cephalosporin)
also. . .sulfonamides of course |
|
|
Which ABX have photosensitivity as a side effect?
|
fluoroquinolones
tetracyclines sulfonamides |
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What ABX might be associaled with drug-induced lupus?
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minocycline
sulfonamides rifampin nitrofurantoin |
other drugs - procainamide, hydralazine, penicillamine, diltiazem, infliximab, methyldopa, phenytoin, quinidine, Li, HCTZ, glyburide
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What ABX are associate with drug fever?
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beta lactams
sulfonamides nitrofurantoin minocycline phenytoin carbamazepine allopurinol H2blockers (cimetidine) |
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What ABX cause yellow-brown urine?
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Nitrofurantoin
Sulfamethoxazole |
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What abx causes orange/pink urine?
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rifampin
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"red lobster syndrome"
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What 2 abx cause brown-black urine?
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Metronidazole
Nitrofurantoin |
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What is the P450 action of rifampin?
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inducer of 3A4 and 2C9
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What is the P450 action of macrolides?
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Both substrates and inhibitors of 3A4
(except azithromycin) |
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The elimination of which ABX is affected by glomerular filtration?
(will build up if filtration is affected) |
Aminoglycosides
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What ABX (IV and oral) work against pseudomonas?
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Piperacillin/tazobactam
aztreonam ceftazidime (3rd) cefipime ciprofloxacin (IV/oral) levofloxacin (IV/oral) tobramycin (not gent) meropenem imipenem |
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What ABX cover strep pneumo?
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Cefuroxime (2nd gen)
Ceftriaxone (3rd gen) Cefepime(4th)*better than 3rd Doxycycline Macrolides/Ketolides Fluoroquinolones (3rd gen - not cipro) TMP-SMX (but not CAP) Aminopenicillins & augmented Betalactam/Betalactamase |
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What ABX cover staph? (MSSA)
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Nafcillin*
Dicloxacillin (PO)* Cefazolin (1st gen) Cephalexin (PO 1st gen)* Cefuroxime (2nd gen) Cefepime (IV only) Minocycline* Doxycycline* (may get MRSA) TMP-SMX* Clindamycin |
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What ABX is the #1 cause of chemical phlebitis?
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Nafcillin
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How are aminopenicillins excreted?
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renal
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What might you treat with amoxicillin or ampicillin?
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Would cover strep throat, pneumo (if strep pneumo), lyme disease, animal bite
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What is the gold standard for treating anaerobic infxns?
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ampicillin/sulfabactam
or amoxicillin/clavulanate **these also cover everything that nL AminoPCNs do plus m. cat and h.flu |
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Which augmented aminopenicillin is IV and which is oral?
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Amp/sulf is IV
Amox/Clav is PO |
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Piperacillin/tazobactam is the gold standard treatment for which (2) infections?
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Pseudomonas and anaerobes
*the augmented aminoPCNs are also considered gold standard for anaerobes |
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Anaerobic organisms include. . . .
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b. fragilis
bacteroides prevotella fusobacterium (above are all gram neg) peptostreptococci actinomyces clostridium |
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Which cephalosporins are anti-pseudomonal?
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ceftazidime (3rd)
cefepime (4th) |
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Examples of infections when anaerobes are suspected
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Diverticulitis (b frag)
GI infections (b frag) lung or dental infxn (prevotella) C. dif colitis brain, liver, lung abscesses? gangrene? *anaerobes are nL flora in the oral cavity, GI tract, and vagina |
let me know if you have other (or better) examples!
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What is zosyn?
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piperacillin/tazobactam
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gold standard for pseudomonas and anaerobes
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Piperacillin/tazobactam is ideal for pseudomonas and anaerobic infxns. . . what other organisms does it cover?
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s. pyogenes
s. pneumo enterococci m. cat/h. flu GN-enterics |
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What are the "gram negative enterics"?
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proteus
e.coli klebsiella enterobacter serratia pseudomonas |
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How are the cephalosporins excreted?
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kidney
EXCEPT CEFTRIAXONE |
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What is a major SE of cephalosporins?
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Associated with C. dif diarrhea
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which macrolide covers MAC (mycobacterium avium complex)?
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Azithromycin
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Name two drugs that cover a chlamydia GU infection.
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Azithromycin and Doxycycline
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TTC and a macrolide
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Doxycycline and Azithromycin can both be used to treat CAP, which one can also be used for animal and tick bites?
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Doxycycline
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In which patients is doxycycline contraindicated?
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<8
or pg |
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WHich cephalosporins can be used to treat community-acquired pneumonia? and what must they be given with?
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Cefuroxime or Cefpodixime
(give w/macrolide or doxycycline to cover atypicals) |
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What infections can be treated with a first or second generation cephalosporin?
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Cystitis or skin/soft tissue infection
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What cephalosporin can be used to treat amoxicillin resistant forms of m. cat and h.flu?
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Cefuroxime
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what organisms do second generation cephalosporins cover that first do not?
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pasturella
m cat h flu |
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what kind of URI would you use an augmented aminopenicillin for?
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amox. failure URI
(AOM, sinusitis, ABECB) |
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What three beta lactams can be used for CAP if you add something to cover atypicals?
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Amox/Clav
Cefuroxime or cefpodoxime |
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what are clinical indications for use of amoxicillin?
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Tick/dog/cat bites
pharyngitis AOM sinusitis endocarditis prophylaxis strep skin infxn ABECB cystitis |
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What does clarithromycin cover that azithromycin does not?
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H. pylori
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Which beta lactam does not cover enterococci or listeria?
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Cephalosporins
(and obviously the nonaminopenicillins) |
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Rank the respiratory fluoroquinolones in their efficacy against strep pneumo (greatest to least)
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Moxi > gati > levo
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Which respiratory fluoroquinolone is least effective against resistant gram negatives?
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moxifloxacin
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Which abx covers stenotrophomonas maltophila?
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TMP-SMX
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Which oral abx can be used for traveler's diarrhea?
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quinolones (all)
TMP-SMX |
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What is Pediazole?
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erythromycin-sulfasoxazole
(alternative for AOM) |
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What two GU infections might you use metronidazole for?
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bacterial vaginosis
trichomonas |
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If you use metronidazole for an anaerobic infxn (abscess), what must be added to it?
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beta lactam or fluoroquinolone
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What oral drugs can be used to treat strep pharyngitis in patient w/beta lactam allergy?
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Clindamycin
or macrolide |
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What oral drugs can be used to treat cystitis?
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nitrofurantoin
TMP-SMX Amoxicillin or Ampicillin Cephalexin or Cefuroxime |
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which abx is used for endocarditis prophylaxis?
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amoxicillin
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what is the big difference between amox and amox/clav or amp and amp/sul?
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the augmented aminopenicillins also cover m.cat h.flu and anaerobes
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what can you treat with an augmented aminopenicillin that you can't with an aminopenicillin?
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CAP (but must add macrolide or doxy)
(and of course amox failure URIs) |
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