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131 Cards in this Set
- Front
- Back
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What three drugs are best against B. fragilis?
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amp/sulbactam (bactrim), metronidazole, and the cephamycins (cefoxitin, cefotetan)
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What is the mainstay of spontaneous (primary) bacterial peritonitis tx? (What are we targeting?)
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3rd gen cephalosporins (targeting E. coli, K. pneumo, Strep spp.)
Also use amp/genti, B-lactam/B-lactamase inhibs, FQs, TMP/SMX |
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What is the course of treatment for primary bacterial peritonitis?
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5-7 days
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What drugs do we use for primary bacterial peritonitis prophylaxis?
(2 specifically with different dosing schedules) |
TMP/SMX (5 d/wk) or Ciprofloxacin (once weekly)
(used in patients at high risk for recurrence of primary bacterial peritonitis) |
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What drugs do we use to treat community acquired secondary and tertiary peritonitis? How does this change for nosocomial infections?
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Cephalosporin + metronidazole (sub FQs for Cephalosporin if B-lactam allergy)
For nosocomial: expand coverage with a carbapenem, pip/tazo. cefepime, or FQ (probs cipro or levo) (all of these plus metronidazole except carbapenems) |
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Duration of treatment for intra-abdominal infections?
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4-7 days (depending on source control; stop therapy when temp normalizes, WBC is normal, and GI fxn is back)
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What is the most important thing you can do for someone who has a case of infectious diarrhea?
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REHYDRATE
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Anti-motility (anti-diarrheal agents) should not be given in the case of what kind of infectious diarrheas?
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Diarrheas that are produced by toxin producing organisms (shigella, EHEC, C. diff, etc.)
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Do we usually treat salmonella?
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No, but do treat in severe disease and susceptible patients
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Two best drugs for treating salmonella?
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Amino-penicillins (amp/amoxicillin)
FQs (cipro in particular) |
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Duration of treatment for Salmonella?
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5-7 days (14 in immunosuppressed)
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Two best drugs for shigella tx?
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Amino-penicillins (amp/amox)
FQs (Also 3rd gen cephalosporins, TMP/SMX, azithromycin [ALL ALSO USED FOR SALMONELLA; did not note on salmonella flashcard], and Naslidixic acid [quniolone NOT fluoro] |
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Duration of tx for shigella (normal and immunocompromised)
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3-5 days for normal (SHORTER THAN SALMONELLA BY A COUPLE DAYS)
7-10 days for immunocompromised (SHORTER THAN SALMONELLA BY A COUPLE DAYS) |
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Duration of tx for E. coli cystitis
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3 days
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Put the following bugs in descending order based on duration of tx:
E.coli, Salmonella, Shigella, Aeromonas |
Salmonella (5-7;14) > Shigella (3-5; 7-10) > E. coli (3) = Aeromonas
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What is the standard tx for V. cholera?
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1 dose doxycycline at 300mg (high dose = 1 dose)
Can also give lower dose of tetracylcine or TMP/SMX for 3 days OR a single dose FQ |
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Drug of choice and duration of tx for Giardia?
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Metronidazole for 7-10 days
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What is the mainstay drug (class) for traveler's diarrhea?
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FQs (exceptions giardia w/ metronidazole, V. cholera w/ doxycycline)
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What is the primary thing we want to do with antibiotic induced C. diff infection?
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GET PATIENT OFF THE ANTIBIOTIC!
(same thing happens with acid suppressive drugs too so get patient off PPI or whatever if you can) |
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Two mainstay drugs in treatment of C. diff pseudomembranous colitis
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PO metronidazole, PO vanco
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Duration of therapy for tx of C. diff
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10-14 days
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Is there a vaccine for Hep B?
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YES!
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What two drugs are given for post-exposure prophylaxis in patients who were exposed to HBV but not previously vaccinated?
(What are a couple other options?) |
HBV vaccine + HBVIG
(IFN-alpha and some HIV meds [lumivudine and adefovir]) |
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Side effects (5) of IFN-alpha? (Pogue says to learn this!)
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Flu like symptoms
Thrombocytopenia Granulocytopenia Severe Depression Rash/Alopecia |
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What two drugs are given for Hep C?
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IFN-alpha and Ribavirin
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What is the MOA of ribavirin?
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mimics guanine and causes DNA chain termination
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Main side effect of Ribavirin?
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HEMOLYTIC ANEMIA! (need to monitor hgb/hct)
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What is the MOA for Teleprivir/Boceprivir?
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HCV protease inhibitors (ONLY STUDIED AS AN ADD-ON TO RIBAVIR + IFN-alpha; shortens duration of tx significantly)
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Side effects (2) of Telepravir?
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Rash and anemia
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Side effects (4) of Bocepravir?
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Headache, anemia, taste disturbances, CYP3A4/5 inhibitor/metabolite
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We DON'T TREAT PEDS WITH TETRACYCLINES! So what do you give for V. cholera to a kid?
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3 days of TMP/SMX
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Duration of tx for TMP/SMX or FQ given for cystitis? What about B-lactams or Nitrofurantoin?
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TMP/SMX or FQ: 3 days
B-lac or Nitro: 7 days (TARGETING E. coli) |
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What is the duration of tx for Staph saprophyticus cystitis?
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7 days
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What is the MOA for Fosfomycin?
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Inhibits the enolpyruvate transferase enzyme which is necessary for the production of the peptidoglycan cell wall
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What is the only thing Fosfomycin is indicated to treat (in the US)?
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UTIs (can only be given orally)
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What makes Fosfomycin cool as a drug for uncomplicated cystitis?
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Highly highly renally excreted so you can give it once (3g dose) and it is effective for 48 hours
Off-label: give once every three days for complicated cystitis |
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3 best options for pyelonephritis?
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FQs
3rd gen cephalosproins TMP/SMX |
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Why is nitrofurantoin inappropriate in the tx of pyelonephritis?
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Doesn't maintain good tissue concentrations for a long time (dumps into bladder, so good for cystitis)
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Duration of tx for pyelonephritis?
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Can be 7-10 if uncomplicated, by typically 14 days
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What condition (conditions really but both are closely related) is aminoglycoside mono-therapy appropriate for?
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Pyelonephritis (also cystitis but pyelo is cooler so it gets first mention)
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What do we need to cover for with nosocomial UTIs?
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Pseudomonas (don't really need to worry about MRSA)
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We don't normally treat asymptomatic bacteruria, but there is one VERY notable exception. What is it?
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Pregnancy! Can cause intrapartum infection otherwise.
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What is the best drug to treat Chancroid with?
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Azithromycin (1g PO x 1 dose!)
can also give: 1 dose IM ceftraixone, 500mg cipro BID x 3 days, topical erythromycin TID x 7 days |
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Do we generally treat sexual partners for chancroid?
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Yea (10 day window, but "People lie" - House)
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How long do we give Acyclovir for treatment of primary Herpes Simplex 2 infection?
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7-10 days (must be given like 5x a day; can give Valacyclovir less frequently due to greater bioavailability)
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What do we give for Herpes suppressive therapy?
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Once daily Valacyclovir (or twice daily acyclovir); can totally stop recurrence of virus.
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Duration of tx w/ Acyclovir for an episodic recurrence of herpes?
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5 days
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Drug of choice for Primary/Seconday Syphilis infection?
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Benzathine penicillin G (long acting IM)
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What is different about the tx of latent syphilis vs primary/secondary syphilis?
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Same drug (benzathine penicillin G), but instead of giving 1x you give 1 x per week x 3 wks
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What do we give for neurosyphilis?
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MAX DOSE IV aqueous crystalline penicillin G
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Describe the Jarisch Herxheimer reaction, and what causes it.
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Head ache, fever, myalgia, tachycardia seen 1-2 hours after initiating tx for syphilis caused by the release of pyrogens from the organism.
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Two courses of tx for C. trachomatis?
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1g x 1 dose azithromycin
OR 100mg PO doxycycline x 7 days |
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What sexual partners should be informed when patient is tx'd for Chlamydia?
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Anyone they have had sexual contact with 60 days prior to initiating tx
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How long should patients with Chlamydia abstain from sexual activity?
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7 days (which is really until course of tx is up; 7 days because while the course of treatment is literally 7 days in the case of 100mg doxycycline PO, when giving 1g of azithromycin we are only giving it once, but it acts over 7 days; don't want to tell patient "wait until the course of tx is up to reinitiate sexual activity" because they might think they can start as soon as they eat the azithromycin)
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What is the gold standard Gonorrhea treatment?
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1 x 250mg IM ceftriaxone
CAN give 400mg PO cefixime, but considered inferior |
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Regardless of results of test for Chlamydia, do we tx patients with documented Gonorrhea for Chlamydia as well?
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YES (the flipped case is not necessarily true tho)
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How do we treat bacterial vaginosis?
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7 days of metronidazole (mostly anaerobes)
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How do we treat fungal vaginosis?
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1 dose fluconazole
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How do we treat parasitic vaginosis (trichomoniasis)
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Metronidazole 2g x 1 dose! (or low dose for 7 days)
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How many drugs do we want to include in an HIV tx regimen?
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2, ideally 3, active drugs from different classes
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With reference to CD4 counts, when do you treat HIV?
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CD4 count < 500 (stronger rec for less than 350)
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What special populations (3) get HIV treatment regardless of CD4 count?
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Pregnant women
People with AIDS defining illness (i.e. HIV assoc. nephropathy) People with HBV (since we use anti-retrovirals to treat and if we just tx with one antiretroviral as indicated for HBV, we're going to scratch that drug from our HIV playbook because it will mutate to be resistant) |
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What are the three basic HIV drug regimens?
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Backbone of 2 NRTIs + one of the following:
1) NNRTI 2) PI (boosted) 3) Raltegravir (integrase inhibitor) |
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6 classes of HIV drugs?
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NRTI
NNRTI PI Fusion inhibitors CCR5 antagonists Integrase inhibitors |
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Which HIV drug class: Efavirenz
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NNRTI
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What is the preferred NNRTI?
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Efavirenz
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When wouldn't we use Efavirenz at the preferred NNRTI adjunct to the 2 NRTI backbone?
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During first trimester of pregnancy (or high pregnancy potential) due to neural tube defects.
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Which HIV drug class: Nevirapine
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NNRTI
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Which drug do we give if we can't give Efavirenz as the preferred NNRTI?
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Nevirapine
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Which HIV drug class: Delavirdine
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NNRTI
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Which HIV drug class: Ertavirine
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NNRTI
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With the NNRTIs is HIV resistance to drugs acquired on a drug-by-drug basis or is it acquired as a class?
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Class!
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MOA for NNRTIs?
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Non-competitive inhibitor of Reverse transcriptase.
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3 side-effects of Efavirenz?
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1) Neural tube defects (teratogenic)
2) Psychiatric/CNS symptoms (up to 50%) 3)Rash/SJS |
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What go-to drug for HIV is Efavirenz a PART of?
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Atripla
Contains tenofovir + emtricitabine as the NRTI backbone and Efavirenz as the NNRTI component |
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2 biggest side effects with Nevirapine?
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Hepatotoxicity (occurs at high CD4 counts [ >250 for females, >400 for males])
Rash/SJS (w/ or w/o flu like symptoms) |
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What are a couple of advantages to the NNRTIs as a class?
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They generally have a long half life which makes compliance easier (AND WE NEED >90% COMPLIANCE FOR HIV TX TO WORK!)
They also save the PIs for later if we have a mutation that renders the NNRTIs useless as a class. |
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One disadvantage to the NNRTIs as a class?
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Low genetic barrier means HIV easily out-mutates them thus adding emphasis to the general theme of COMPLIANCE with HIV drugs.
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What is the MOA for HIV protease inhibitors?
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Bind and inhibit viral protease which keeps the protease from activating HIV polypeptides.
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Which HIV drug class: Atazanavir
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PI
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Which HIV drug class: Darunavir
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PI
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Which HIV drug class: Fosamprenavir
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PI
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Lopinavir/Ritonavir
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PI (boosted! Ritonavir is part of the formulation)
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Major side effects (5) of the HIV PI drug class?
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DYSLIPIDEMIA
Disturbances in normal distribution of fat INSULIN RESISTANCE GI problems Rash (DYSLIPIDEMIA and INSULIN RES can compound cardiac problems) *Think PI, THINK DIABETES! |
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Major Drug Interaction of HIV PI drug class?
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Inhibitors and substrates of CYP 3A4
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Why do we add Ritonavir to the HIV PI drugs and call it "boosting"?
(2 reasons; one of which is the MAIN reason) |
A) It's actually a PI itself
B) It is a POTENT inhibitor of CYP 3A4. Thus we reduce the metabolism of the other PIs and require less frequent dosing, lowering the pill burden, and VERY IMPORTANTLY increasing COMPLIANCE. The preferred drugs in the PI class are combinations of Ritonavir and Atazanavir, Darunavir, Fosamprenavir, and Lopinavir |
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What is the major advantage of HIV PIs over the NNRTIs?
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Has a greater genetic barrier; not as easy to mutate out of efficacy
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What are the major disadvantages of HIV PIs?
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Mostly just the side effects and drug interactions:
Insulin res (metabolic issues) Dyslipidemia (metabolic issues) GI problems CYP 3A4 drug interactions |
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What is the preferred combo of NRTIs for the backbone of HIV therapy?
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tenofovir/emtricitabine
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MOA for NRTIs?
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Added to growing nucleotide chain and cause chain termination.
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HIV drug class: tenofovir/emcitirabine
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NRTI
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HIV drug class: Abacivir/lamivudine
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NRTI
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HIV drug class: didanosine/lamivudine or emcitirabine?
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NRTI
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HIV drug class: Zidovudine/lamivudine
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NRTI
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2 important side effects of NRTIs as a CLASS
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Lactic acidosis and liver steatosis (fatty liver; lipoatrophy)
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Drug class and biggest side effect with Abacavir?
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NRTI, hypersensitivity (genetic basis, we can test for the allele; presents as fever, rash, abdominal pain, and fatigue)
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Drug class and biggest side effects (2) with Stavudine
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NRTI; Pancreatitis and peripheral neuropathy
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Drug class and biggest side effects (3) with Didanosine
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NRTI; Pancreatitis, peripheral neuropathy, and hepatotoxicity
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Which NRTI is the most well tolerated/safest
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lamivudine
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Drug class and biggest side effect with tenofovir?
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NRTI; Renal insufficiency
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Drug class and biggest side effect with Zidovudine?
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NRTI; bone marrow suppression
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Drug class and components: Truvada
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NRTI; tenofovir + emcitirabine
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Drug class and components: Trizivir
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NRTI; abacavir + lamivudine + zidovudine
can be used as an entire tx regimen (3 NRTIs) BUT not favored to 2xNRTI + PI or NNRTI |
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Drug class and components: Epzicom
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NRTI; abacavir + lamivudine
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Drug class and components: Combivir
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NRTI; abacavir + zidovudine
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Drug class and components: Kaletra
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PI; liponavir + ritonavir
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Drug class and components: Atripla
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Whole regimen (2NRTIs + NNRTI); Efavirenz (NNRTI) + tenofovir + emcitirabine (NRTIs)
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Truvada + Kaletra comprise an HIV tx regimen. What are the drug components as classes and individual drugs?
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Truvada = 2 NRTIs = tenofovir + emcitirabine
Kaletra = Boosted PI = lopinavir + ritonavir |
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HIV drug class: Enfuvirtide
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Fusion inhibitor
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MOA for Enfuvirtide
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gp41 inhibitor (rememeber HIV loses SU off TM "hook" and TM hooks into gp41 to initiate fusion)
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What is the only method of Enfuvirtide administration?
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Sub-Q (thus only used in experienced patients who have developed resistance)
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3 adverse drug reactions with Enfuvirtide?
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Injection site reactions
Pneumonia Hypersensitivity |
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HIV drug class:Maraviroc
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CCR5 inhibitor (only works for patients who have CCR5; tested for genetically)
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Main drug interaction with Maraviroc?
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CYP3A4 substrate
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HIV drug class: Raltegravir
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Integrase inhibitor
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Main side effect of concern with Raltegravir?
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CPK elevation leading to concerns of rhabdomyolysis
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Drug for Tx, Prophylaxis, and CD4 cell counts below which you prophylax for: Pneumocystis Pneumonia (PCP)
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Drug for Tx: TMP/SMX (HIGH DOSE)
Drug for Prophylaxis: TMP/SMX Prophylax at CD4 < 200 (d/c when CD4 > 200 for 3mos) If patient gets PCP, you get prophylaxis for life. If presents with severe PCP you get corticosteroids. |
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Duration of therapy for PCP
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21 days
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Alternative drug for PCP: Pentamidine. MOA?
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Interferes with protozoal RNA/DNA protein synth.
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Major drug interaction with Pentamidine?
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CYP2C19 substrate so use caution with azole antifungals and omeprazole (NARROW therapeutic range so these can throw you into nasty side effects [nephrotox, hepatotox, bone marrow supp] EASILY!)
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3 major side effects with Pentamidine?
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Nephrotoxicity, Hepatotoxicity, Bone marrow suppression
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Course of treatment when using pentamadine to treat PCP (prophylaxis)
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Dosed once a month.
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Drug for Tx, Prophylaxis, and CD4 cell counts below which you prophylax for: Mycobacterium Avian Complex (MAC)
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DOC for Tx Clarithromycin
DOC for prophylaxis is Azithromycin (given once weekly) (use rifabutin as an adjunct but is also a CYP3A4 interactor) Prophylaxis when CD4 < 50 (d/c when CD4 > 100 for 3mos+) |
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Drug for Tx, Prophylaxis, and CD4 cell counts below which you prophylax for: Cryptosporidiosis
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Drug for Tx: Just get CD4 counts back up with HAART and rehydrate (some people use Nitazoxinide)
Greatest risk when CD4 < 100 but we don't really prophylax |
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HAART acronym meaning?
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Highly active anti-retroviral therapy
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Drug for Tx, Prophylaxis, and CD4 cell counts below which you prophylax for: Toxoplasmosis
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DOC for Tx :Pyrimethamine + sulfa (or clindamycin) + leucovorin (to decrease bone marrow suppression)
DOC for prophylaxis: TMP/SMX (but should already be on for PCP!) Prophylax if CD4 < 100 |
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MOA for Pyrimethamine; what is is used for again?
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Inhibits parasitic dihydrofolate reductase; used to treat HIV associated toxoplasmosis
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Primary presentation of toxplasmosis in HIV patients?
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Encephalitis
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Why do we use Pyrimethamine instead of other sulfa drugs in treating HIV associated toxoplasmosis?
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Because HIV associated toxoplasmosis manifests as encephalitis and pyrimethamine crosses the BBB well
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Leucovorin is a reduced form of folate to supplement normal folic acid when using high dose sulfa drugs
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JUST FYI :) :) :)!!!!!!!!1111!!111!!
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Major drug interactions with Pyrimethamine?
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CYP3A4 substrate (so HIV PIs and such)
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