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59 Cards in this Set
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Penicillin SOA
Indxns DOC |
SOA:s.pyogenes,peptostreptococci,streptococci,treponema pallidum
*note: inactivates AMG, separate IV PCNs from concurrent adm |
DOC
pharyngitis (strep throat) rheumatic fever dental px/infxn bicillin LA (pcn G benazthine) for syphilis |
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Penicillinase-resistant PCNs
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SOA/DOC: MSSA
*No dose adj for renal impairment (all other PCNs need to be dose adj) |
oxacillin unique: hepatotoxicity
nafcillin: neutropenia PO forms: dicloxacillin,cloxacillin take on empty stomach |
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Aminopenicillins
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SOA: strep pneum, enterococci, listeria, H. infl,M. catarralis
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ampicillin=DOC enterococi & listeria
Amoxicillin: 500mg PO q8 or 875 bid 40-90mg/kg/d for AOM (1st line agent) h. pylori 2gm dental px |
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Beta-lactam combination agents
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SOA: staph, strep, enterococcus, HNPEK, B. frag
Zosyn/Timentin: (+) pseudomonas |
Unasyn: DOC for animal/human bites
(also better enterococcal activity) Timentin: high sodium load and weaker enterococcus and pseudomans vs zosyn |
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BQ Focus: Augmentin (amoxicillin/clavulanate)
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indxn: acute bacterial sinusitis, AOM, animal/human bite wounds,LRI by susceptible organisms (strep pneumo)
*additonal coverage of beta-lactamase producing M.catarr,H. influen |
general dosing: child>40kg and adults: PO 250-500 q8h OR 875mg q12h
Tabs: 250, 500, 875mg do not use 875mg tabs in Crcl <30 Chewable/Susp: 200, 400: BID Susp: 125, 250: TID XR: 1000mg: 2 tabs BID; not for <16yo, CI in Crcl <30 |
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Carbapenems
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gram pos/neg,pseudomonas, anerobes
*Primaxin: dose dep sz, Q6-8H *Merrem: longer half life, less sz potential *Doribax: Q8H, SJS, more potent against pseudomonas in vitro vs imipenem *Invanz: qday, no activity against pseudomonas, acinetobacter, less active against gram-positive |
DOC: ESBL producing GNRs such as E.coli, klebsiella
*used for multiple drug resistant gram negative infxns *cross sensitivity w/PCN is ~50% |
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Aztreonam
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monobactam
SOA: AEROBIC GRAM (-) including pseudomonas ONLY |
indxn: Rescue drug for AMG nephrotoxicity
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Macrolides
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indxn: CAP, PCN-allergic pts AOM, when TCN are CI (pregnant, children)
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suprress RNA dep protein synth
lipophilic, inc concentration in MAC,PMNs, greater resp tract conc vs serum Not well penetrated to CSF |
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Erythromycin salts
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SOA: MSSA, strep,mycoplasma, chlamydia, M. catarr leginoella,bordetella pertussis
*Not H.influenza, enterococci Clinical use: gastroparesis: 250mg EES or 500mg base QID *DOC for legionaire's, whooping cough,mycoplasma pneumoniae -AOM w/sulfisoxazole-->which provides coverage for H.infl -PCN-allergic for strep, syphilis, gonorrhea (except neurosyphilis MUST desensitive for PCN) |
400mg EES = 250mg base or stearate
Major ADR: N/V ery-base/stearate: dec abs w/food EES: inc abs w/food (take after meal) Max daily dose: 4gm ototoxicity w/OD, arrhythmia *Potent cyp 3A4 inhibitor |
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Biaxin
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clarithromycin
SOA: staph, strep,M.catarr (+) H.influ, H.pylori, MAC Clinical uses: CAP,MAC px/tx, pharyngitis, sinusitis, Prevpac ( biaxin 500mg bid, w/amox 1gmbid, prevacid 30mg qd) CI in pregnancy |
Available PO only: 250-500mg bid, 1000mg XL qd w/food
*Less potent CYP3A4, caution DDIs with HIV meds Renal adjust Metallic taste |
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Zithromax
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azithromycin
SOA: gram pos, atypicals, M.catarr, H. influe (+) STDs (N.gonorrhea, chlamydia, ureaplasma) |
Z-pak: 500mg x1, 250mg qd x 4d
Tri-pak: 500mg qd x 3d Z-max: 2gm/60ml ER susp single dose for gonorrhea (redose w/in 1 hr if vomit)- take on empty stomach;poorly tolerated-->prefer Roceph, doxy? 1gm single dose for chlamydia CAP: 500mg IV/PO qd x 7-10d 1200mg qwk for MAC px * little to no CYP inhibition |
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Erythromycin, Clarithromycin
DDIs |
CYP 3A4 inhibitors
inc serum lvls: CBZ, VPA, PHT, theophylline, cyclosporine, tacrolimus,RTV, warfarin, statins |
Caution: QTc prolongation (ery,clar)
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FQs
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MOA: DNA gyrase inh, bactericidal
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ALL FQ DDI: multivalent cations d/t chelation -->dec cmax by 60%
BBW: Tendonitis/rupture (inc risk in >60yo, concurrent steroid, transplant pt), avoid in children/adolescent <18 yo Preg Cat C ADR: nvd, rash, photosensitivity, seizure/cns stim, qtc prolongation (most w/moxi (levo)) |
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Norfloxacin (Noroxin)
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UTI, gonorrhea,spont bact peritonitis px, no indxn for RTI (no systemic!), no providencia coverage
SOA: gram - aerobes (urine) |
1st gen
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Ciprofloxacin (Cipro)
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SOA: excellent gram neg incl pseudomonas, poor gram pos act, min atypical legionella
*Cipro best pseudomonas act Dosing: Q12H 250-750mg PO q12 200-400mg IV q12 500mg XR qd x 3d for UTI 1000mg XR qd x 7-14d for compl UTI |
2nd gen
Most DDIs: theophylline, warfarin, dig potent CYP1A2inh, weak 3A4 inh, pgp sub |
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Ofloxacin (Floxin)
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most active against chlamydia.
also tx gonorrhea, UTI |
2nd gen
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Levofloxacin (Levaquin)
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SOA: gram neg, gram pos (better s.pneumo act vs cipro), excellent atypical activity (chlamydia, mycoplasma spp)
*PNA, UTI Dosing: 250, 500m 750mg PO/IV qday |
3rd gen
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Moxifloxacin (Avelox)
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Dosing: 400mg PO/IV qday
*Only non-renal FQ, no need to renal dose adjust *also some anaerobic act, but less potent against pseudomonas |
3rd gen
Worst QTc prolongation risk, rare hepatic injury CI w/geodon |
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Gemifloxacin (Factive)
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CAP, ABECB
better gram pos, good for pcn/cipro resistant strep pneumo |
*Rash 2.8%
Risk/higher incidence in women <40yo, treatment duration (7d 9%, 14 d 23%) |
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Gatifloxacin (Zymaxid) 0.5%
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bacterial conjunctivitis
day 1: 1gtt q2hr while awake (max 8x/d) day 2-7: 1gtt 2-4x/d while awake |
3rd gen
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Aminoglycosides
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MOA: ionic interaction w/ cell surface, energy dep uptake, binds to 30s ribosome/inh protein synthesis
*SOA: Gram neg incl pseudomonas, acinetobacter, mycobacteria Synergy only for gram pos: mssa, staph epi, enterococcus |
ADRs: nephrotoxcity (8-26% onset ~day 5; higher risk w/concurrent nephrotoxic: vanco, ampho, foscarnet, radiocontraset), ototoxicity, neuromuscular block (rare/CI in myasthenia gravis)
(high renal cortex, inner ear penetration) Urine conc exceed peak plasma lvls 25-100x w/in 1hr of drug admin, and ext PAE *DDI: physically incompatible w/PCNs |
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Gentamicin
Tobramycin |
Gent=1st line AMG for gram neg infections
Both Dosing: 1 7mg/kg *3-5mg/kg traditional *5-7mg/kg HDQD |
peak: 5-10 mcg/ml and tr<2
Synergy: pk 3-4mcg/ml; tr <1 TOBI used for CF,more active against pseudomonas vs gent |
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Amikacin
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MAC, TB (non-fda approved indxns)
Dosing: 7.5-15mg/kg |
Pk: 20-30mcg/ml tr <10 (8)
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Neomycin
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Indxns: gut sterilization to prep for GI sx, adjunct to tx hepatic encephalopathy (ammonium detoxicant), tx of diarrhea d/t e. coli
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amg for oral, topical use
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Vancomycin
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SOA: all gram positives, MRSA/MRSE, coag-neg staph DOC
Clinical use: PCN/ceph allergic pt w/gram pos infxn Oral vanco: 2nd line agent for c.diff mild-mod dosing: 125-500mg PO QID x 7-10d Used together w/AMG for endocarditis |
SEs: nephrotoxicity, ototoxcity, neutropenia
Tr: 10-20mcg/ml BQ: red man syndrome d/t his release, rapid infusion cause hypotension |
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Tetracycline
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SOA: propionibacterium acne, listeria, protozoa, tick borne (rikettsia,borrelia), h. pylori, chlamydia
Dosing: 250-500mg Q6H |
PO only
Limited strep No MSSA/RA!! |
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Minocycline
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SOA: strep(no enterococci), staph, atypicals, tick borne, gram neg
Clinical use: CA-MRSA, SSTI, Acne Dosing 100mg q12h |
* Lupus
*dizziness/itransient vestibular toxicity |
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Doxycycline
(Vibramycin) Periostat Oracea |
SOA: same as mino + covers enterococci,not c.diff
CA-MRSA/PNA, acne, STDs (syphilis, uncompl gonorrhea, chlamydial): 100mg PO/IVq12h malaria px 100mg daily 1-2 d prior to travel, then continue daily x 4 wks after leave area periodontitis: 20mg PO bid rosacea: 40mg qd |
* reflux esophagitis (upright 30min)
Better in renal imp vs TCN (no renal adjustment) |
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Demeclocycline
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SIADH (unlabeled use)
900-1200mg/d |
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tetracylcine class DDIs,
contraindications, precautions |
DDI: divalent cations; separate dose from milk/antacids/iron by >2hrs (dec absorp 50%),
oral contraceptives (use back-up), bile acid seq (cholestyramine,coletipol) Photosensitivity: more common in TCN Preg cat D: affect skeletal/bone growth of fetus Tooth discoloration: CI in children </= 8 yrs old |
ADR: hepatotoxicity > risk in those w/pre-exisiting imp
Renal imp caution: ARF, azotemia dose adjust (EXCEPTION DOXY b/c elim via hepatobiliary) Other DDIs: anticonvulsants, warfain potentiation *Vertigo/lupus: minocycline |
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Tygacil
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tigecycline
SOA: broad-spect inclu anaerobe and atypical but NO COVER pseudomonas! clinical use: MRSA/MRSE, VRE |
* not for sepsis
*tooth discoloration (der of minocycline) |
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Bactrim (400mg/80mg(
Bactrim DS (800/160) Septra DS Sulfatrim (oral susp) |
sulfamethoxazole/Trimethoprim
general oral: 1-2 DS (800/160) tab Q12-24h IV: 8-20mg TMP/kg/day Q6-12h Renal adjust: Crcl <30 by inc interval UTI,PCP px/tx, CA-MRSA IV dose based on TMP *DOC for nocardia (GPR), unlabeled use opportunistic SOA: PCP (DOC?), s. maltophilia (DOC), toxoplasma, MRSA, HPEKSS No cover: enterococci, pseudomonas, or anaerobes |
Preg cat C (avoid in 1st, last trimester--> kernicterus), SJS/TEN photosensitivity , report rash
Crystalluria (elim via tubular secretion), ADRs also include: Monitor: Scr, bun, hyperkalemia at high doses, hematologic (dose related) Inform if HIV + (more skin rxns), G6PDef, liver or kidney dz DDI:SMP: CYP 2C9 inh/substrate; TMP CYP 2C9 inh, substrate of 2c9, 3A4 sulfonylurea protein binding displacement, PHT/Fos dec clearance d/t inh met by TMP, MTX toxicity, warfarin (PB, dec vit K) TMP: prostatic tissue concentration >2-3x plasma levels |
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Clindamycin
(Cleocin HCl/Pediatric/Phosphate) |
SOA: strep, staph (incl MRSA) and anaerobes. NOT enterococci, no gram neg aerobes, no atypicals
But does covers: T. gondii, PCP, gardnerella vaginalis Lots of off label use: PCP, toxoplasmosis Alternative dental px for PCN-allergic pts, anaerobic infxns, CA-MRSA, endocarditis px, colorectal sx px |
MLS phenotype
D test to check for inducible resistance Biliary elimination/enterohepatic recirculation SE: associated with C.diff, report severe diarrhea/DNU antidiarrheals |
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Flagyl
Flagyl 375 Flagyl ER |
metronidazole
SOA: anaerobes; trichomonas vaginalis, giardia DOC: c. diff mild-mod: 500mg q8h x 10-14d Trich: 2gm single dose (can take 1 gm bid) or 250mg TID x 7d or 375mg bid x 7d Bacterial vaginosis: 750mg ER PO QD x 7d; or 500mg bid regular release anaerobic infxns: oral,IV: 500 q6-8h NTE 4gm/d Giardia: 500mg bid x 5-7d PUD (h.pylori) in combination Colorectal sx px: IV |
CI: 1 st trimester of pregnancy
Peripheral neuropathy w/long term Metallic taste SE/counseling: 1. disulfiram rxn (no etoh during and for 3d after finish) 2. darkens urine 3. GI upset transient |
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Nitrofurantoin
(Macrobid, Furadantin, Macrodantin) |
SOA: gram pos: S. saprophyticus/aureus, E. faecalis and all UTI gram neg except pseudomonas, proteus
Rate of absorption differs w/r/t micro vs macrocrystal (macro more slower rate so better tolerated) |
Take w/food (severe GI upset: most potent nausea), HA, sedation
Dicoloration of urine CI: CrCl <60ml/hr (abs <40) DDI: probenecid dec clearance of NTF and inc levles *Pulmonary fibrosis w/chronic prolonged use |
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Zyvox
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linezolid 600mg PO/IV q12h
SOA: VRE, MRSA, other gram positives |
SEs: dec PLTs, anemia, peripheral neuropathy
CI: Concurrent or w/in 2 wks of MAO inhibitor,uncontrolled htn, tyramine food |
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Cubicin
lipopeptide, ca dep insertion of tail into cell memb--> rapid depolarization--> efflux of K/destroys ion conc of membrane--> cell death |
daptomycin
Dosing: 4-6mg/kg IV daily in NS (not compatible w/D5W) Renal <30: Q48H SE: myopathy (monitor CPK) Clinical use: VRE unreponsive/intolerant to Zyvox, synercid, CSSTI |
NOT indicated for PNA (inactivated by lung surfactants)
FDA approved only for: CSSTI and bacteremia No CYP interactions Concentration dep killing/cidal, PAE: 6hrs |
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Synercid
inh protein synth (seq binding on 50s ribosome) dalfo alters conformation incr afficity for quinu--> tertiary complex |
quinupristin/dalfopristin
SOA: VRE (no faecalis act), MRSA, bacteremia, SSTI Dosing: 7.5mg/kg IV q8H No renal adj |
NOT active against e. FAECALIS (better VRE act vs. zyvox)
SE: venous irritation (phlebitis), arthralgia, myalgia, hyperbili DDI: CYP3A4 inh (weak) Synergy w/ vanco : combo for recalcitrant infxns |
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Mepron
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atovaquone
Tx PCP: 750mg bid w/food x 21 d Px PCP: 1500mg qday w/food |
MOA: inhibits electron transport in mitochondria resulting in inh of key metabolisc enzymes resp for synth of nucleic acids, ATP
Antiprotozoal |
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Chloramphenicol
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Bacteroides, H,infl, Neisseria meningitidis,VRE, salmonella, rickettsia
IV only 50-100mg/kg/d Q6H; max 4gm/d |
Aplastic anemia
gray baby syndrome |
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Pentamidine
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Miscellaneous/antiprotozoal
Tx/Px of PCP inhalation, IM,IV |
less used d/t association w/: Pancreatitis
Type I DM |
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Xifaxan
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rifaximin
indxn: travelers' diarrhea caused by noninvasive e.coli; reduction in the risk of overt hepatic encephalopathy recurrence |
rifampin like drug, inhibitis bact RNA synth by bind to bacterial DNA-sep RNA polymerase
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NS only IV stability
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Amp, unasyn, oxacillin, primaxin, meropenem, erythromycin, daptomycin,
capsofungin |
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D5W only IV stability
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Amphotericin, synercid, bactrim, rifampin
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Protect From Light
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Amphotericin, Cipro, doxy, bactrim, flagyl, linezolid, rifampin
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Short-term stability
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Bactrim,primaxin,meropenem, rifampin
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Potentiates INR
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Bactrim, macrolides (except zithro), cipro, flagyl, tigecycline
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Decreases effect of oral contraceptives
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Tetracyclines, PCNs, Bactrim, Flagyl, Rifampin, griseofulvin
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Tamiflu
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Influenza A & B, H1N1 influenza
Tx: 75mg bid x 5d Px: 75mg qd x 10d |
MOA: neuaminidase inhibitor
Start w/in 2 days of sx Oral suspension >1 yo Px not recommended for <3mo old <12months: 3mg/kg/dose once daily |
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Relenza
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zanamivir
influenza A & B, H1N1 Tx: 10mg inhalation BID Px: 10mg inh qd |
Caution: asthma, COPD
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Cytovene IV
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ganciclovir
PO form used for CMV px in transplant and HIV pts SE: neutropenia |
formulations: PO, IV, intravitreal implant, gel
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Valcyte
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valganciclovir
10-fold higher BA vs oral ganciclovir and similar BA vs IV ganciclovir CMV retitinitis: 900mg bid x 21 days PX of CMV s/p transplant: 900mg qd w/in 10d of transplant; continue until 100days (heart/kidney) or 200 days (kidney) post transplant |
PO, oral soln
Boxed warning: Ganciclovir: Potential teratogen and cause aspermatogenesis -->contraception during and 30 days after, males barrier during and 90 days after MOA: rapidly converted to ganciclovir in body, phosphorylated, then inh viral DNA synthesis |
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Vistide
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cidofovir
indxn: Only for CMV retinitis in AIDs CI: Scr >1.5 BBW: dose dep nephrotoxicity, renal failure,proteinuria,neutropenia,possibly carcinogenic and teratogenic, may cause hypospermia *Adm must be accompanied by oral probenecid and hydration w/ IV normal saline -Use in pt w/or at risk for myelosuprresion But monitor for neutropenia |
MOA: cidofovir disphosphate active metabolite; suppresses CMV repl by sel inh of viral DNA synth, incorporation of cidofovir into growing vDNA chain reduces rate of vDNA synth
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Foscarnet
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CMV retinitis in AIDs
Acyclovir-resistant HSV IV: ~40-80mg/kg/dose Q8-12h induction, maintenance |
SE: renal failure, seizure d/t electrolyte imbalance, myelosuppression,
*Renal adjust Peripheral vein adm: final concentration must not exceed 12mg/ml |
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Zovirax
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acyclovir
Tx genital HSV:oral: 1st episode 200mg 5x/d x 10d or 400mg tid x 7-1-d Recurrent: 200mg x 5x/d x 5d or 400mg tid x 5d or 800mg bid x 5d, or 800mg tid x 2d Px: 400mg bid *Herpes zoster: 800mg 5x/d x 7-10d *Varicella-zoster (chickenpox): >40kg: 800 mg/dose QID x 5d |
IV: HSV initial episode/severe: 5mg/kg/dose Q8H x 5-7d follow w/oral tx to complete at least 10days tx
Zoster: immuncompromised: 10mg/kg/dose Q8H x 10d |
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Famvir
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famciclovir
~120-500mg PO BID zoster, HSV,cold sores *renal dose adjust for CrCl 40-60 |
converted to penciclovir (prodrug) in intestine and liver,phosphorylated, competes w/deoxyguanosine triphosphate to inh HSV polymerase
*neutropenia |
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Valtrex
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valacyclovir
genital herpes: 1st episode 1gm bid x 10d recurrent: 500mg bid x 3d Zoster: 1gm TID x 7d higher bioavailability vs acyclovir |
Converted to acyclovir through 1st pass effect
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Hepatitis B tx
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lamivudine (Epivir/HBV)
adefovir (Hespera) NTRTI: renal toxicity Telbivudine (Tyzeka) NRTI : myopathy Tenofovir (Viread) NTRTI: renal tox, BMD |
entecavir (Baraclude) NRTI: lactic acidosis, hepatomegaly w/steatosis w/ nucleoside analogs
-other BBW: severe, acute excarbation of hep b may occur upon d/c of antihepatitis b tx. |
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Hep C tx
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Ribavirin + Pegylated IFN
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ribavirin: hemolytic anemia
CI: in renal impairment Inhaled ribavirin: used for RSV |
