Antimicrobials Pharm I

Front 1

Fluoroquinolones MOA

Back 1

inhibit DNA replication in bacterial cell wall (DNA gyrase inhibitors)

Front 2

fluoroquinolones routes of admin

Back 2

PO, IV, topical

Front 3

FQ coverage

Back 3

gram +, gram - very limtited anaerobe coverage (Avelox)

Front 4

excretion of FQ

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renal

Front 5

FQ meds

Back 5

Norfloxacin (Noroxin) UTI only
Ciprofloxacin (Cipro)good bone penetration; 45% pseudo. resistance
Ofloxacin (Floxin)
Enoxacin (Penetrex) UTI, STD
Levofloxacin (Levaquin) HAP 65% pseudo. sens.
Moxifloxacin (Avelox) some anaerobic coverage

Front 6

FQ contraindications

Back 6

pregnancy
pediatrics
pts on meds known to cause QT seg prolongation

Front 7

FQ SE

Back 7

n/v/d, CNS effects, phototoxicity, liver toxicity, connective tissue problems, QT segment elongation

Front 8

FQ great "switch" drug secondary to __________ when taken po

Back 8

approx 100% bioavailability

Front 9

Vancomycin MOA

Back 9

inhitibs wall synthesis

Front 10

Vancomycin coverage

Back 10

Must have MRSA if using on pt with staph

Front 11

Vancomycin routes of admin

Back 11

IV or oral (no absorption) is acutally topical to GI lumen

Front 12

Vancomycin SE

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"red man", ototoxicity, ?nephrotoxicity (pt also on aminoglycoside)

Front 13

when should peak and trough levels be check when using Vanco?

Back 13

never, unless renal dysfxn or endocarditis

Front 14

excretion of Vanco

Back 14

renal, but not dialyzed

Front 15

Daptomycin (Cubicin) MOA

Back 15

unique mechanism; binds to bacterial cell wall causing rapid depolarization of membrane potential (decrease replication)

Front 16

Daptomycin coverage

Back 16

gram +, MRSA and ?VRE

Front 17

daptomycin is alternative to ______

Back 17

vancomycin

Front 18

Linezolid (Zyvox) MOA

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unique mechanism; binds to 50s ribosomal subunit, prevens translation

Front 19

Linezolid coverage

Back 19

gram +, MRSA, VRE

Front 20

Linezolid routes of admin

Back 20

IV and PO both give 100% bioavailability

Front 21

Metronidazole (Flagyl) coverage

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anaerobes and some parasites

Front 22

Metronidazole routes of admin

Back 22

PO, IV, topical

Front 23

Metronidazole SE

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GI (nausea, metalic taste), peripheral neuropathy (prolonged use), disulfiram-like rxn (etoh, perfume/cologne)

Front 24

antifungal agents

Back 24

amphotericin B, Fluconazole (difulcan, Miconazole (Monistat), Flucytosine (Ancobon), Ketoconazole (Nizoral), Itraconazole (Sporanox), Clotrimazole (Myclelex), Echinocandins, Boriconazole(Defend)

Front 25

1st line non albicans tx

Back 25

amphotericin B

Front 26

1st line candida albican tx

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Fluconazole (tx only c. albicans)

Front 27

topical cream suppository

Back 27

Miconazole, Flucytosine, Ketoconazole

Front 28

tx for c. albicans and aspergilas

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Itraconazole and Boriconazole

Front 29

Flucytosine coverage

Back 29

non albicans

Front 30

Echinocandins coverage

Back 30

candida albicans, c. glabrata, c tropicalis

Front 31

Best anitfungal around

Back 31

Amphotericin B (ampho "terrible")

Front 32

Amphotericin B admin

Back 32

IV, irrigational, topical, liposomal preparations

Front 33

dosing of Amphotericin B

Back 33

1/2 mg/kg Q D also hydrocortisone to decrease SE

Front 34

Amphotericin B SE

Back 34

electrolyte imbalance (decrease Mg, K), renal toxicity, hepatotoxicity

Front 35

other antifungals

Back 35

Nystatin (Mycostatin)-topical for thrush
Terbinafine (Lamisil)-cream or po for onychomycosis

Front 36

Urinary Antispetics

Back 36

Ntrofurantoin (Macrodantin) negative SE in pregnancy
Nalidixic acid (Negram) indwelling catheters
Methenamine mandelate (Mandelamine) breaks down formaldihyde ototoxicity

Front 37

Pentamidine coverage

Back 37

anitprotozan

Front 38

Pentamidine admin

Back 38

IV (tx only)or inhalation (only for prophylaxis)

Front 39

Pentamidine SE

Back 39

hyper and hypoglycemia-FSBS QD
electrolyte disturbance-dec K
renal dysfxn-BUN and creatinine

Front 40

Antiviral agents for Herpes

Back 40

acyclovir (Zovirax), Famcylovir (Famvir), Velacyclovir (Valtrex) PO and IV, don't use topical unless liver dysfxn and must have tx

Front 41

Antivirals for CMV

Back 41

Gancylcovir (Cytovene), Valgancyclovir (Valcyte) IV, PO, intraocular
Foscarnet (Foscavir)
Cidofovir (Vistide) tx with IV then oral for life

Front 42

antivirals for tx of influenza

Back 42

Amantadine (symmetrel), Rimantadine (Flumadil), Zanamavir (Relenza)-inhaled, Oseltamivir (Tamiflu)-oral

Front 43

concentration-dependent killing exhibited by

Back 43

FQ and aminoglycosides

Front 44

Concentration-dependend killiing defined as

Back 44

rate and extent of bacterial killing maximized at high concentrations (doses)

Front 45

usually occurs when drug concentration is ____ the MIC

Back 45

10 times

Front 46

MIC is

Back 46

minimum inhibitory concentration

Front 47

Time-dependent killing defined as

Back 47

killing activity depends on the time drug concentration remains above MIC

Front 48

time-dependent killing exhibited by

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beta-lactams, vancomycin, clindamycin, and ees

Front 49

dosing stratey for Time dependent killing

Back 49

maximize time above MIC
(should be above MIC 50%)

Front 50

bacteriology of community acquired respiratory infxn

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s. pneumoniae, h. influenzae, k. pneumoniae, m. catarrhalis, mycoplasma, legionella, TB

Front 51

bacgteriolgoy of nosocomial acquired resp. infxn

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s. aurea, p. aeruginosa, enerobacger cloacae, fusobacterium species, peptococcus, legionella

Front 52

tx comm. acquired resp. infx

Back 52

PCN, Amox, 2nd gen. ceph., macrolides, FQ

Front 53

tx nosocomial resp. infx

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pipercillin/tazobactam, ticaricillin/clavulanic acid, 3rd gen. ceph, add aminoglycoside, FQ, macrolide

Front 54

CNS infxns:
neonates
infants/childrens
children/young adults

Back 54

s. pnuemonia, e. coli, listeria
h. flu, s. pneumonia, n. meningiditis
s. pneumo, n. meningiditis

Front 55

CNS infxns:
adults
elderly

Back 55

s. pneumo, n. meningiditis
s. pneumo, n. meningiditis, e. coli, klebsiella, listeria

Front 56

CNS infxns:
neurosurgery
closed head trauma
open head trauma

Back 56

s. aureus, s. epidermiditis, gram -
s.pneumo, h. flu
look at environ (sewage ditch vs concrete)

Front 57

CNS tx:

Back 57

must penetrate CNS
cephalosporins
PCN

Front 58

Bacteriology of endocarditis

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s. viridans, s. epidermidis, entercoccus, c. albicans

Front 59

tx endocarditis

Back 59

PCN, vancomycin, add aminoglycoside, long duration

Front 60

prophylaxis of endocarditis

Back 60

dental/oral procedure: amox 3g 1 hr prior, 1.5 g 6 hr later
GI/GU procedure: ampicillin, amox, gentamicin

Front 61

bacteriology of skin and ST infxn

Back 61

Cellulitis: strep and staph
add DM
pseudomonas and anaerobes

Front 62

Tx skin and ST infxn

Back 62

cefzolin, macrolides, amp/sulbactam or ticarcillin/cavulanic acid
FQ with metronidazole

Front 63

GI infxn tx
travellers diarrhea
psuedomembranous colitis
h. pylori

Back 63

pepto-bismol, TMP/SMX, doxy, FQ
oral metronidazole adn vanco
amox, clarithromycin, tcn, metronidazole plus PPI

Front 64

bacteriology of intra-abdominal infx

Back 64

gram +: enterococcus
gram -: e.coli, enterobacter cloacae, acineobacter
anaerobes: bacteroides

Front 65

tx intra-abdominal infx

Back 65

2nd and 3rd gen. ceph
extended spectrum pcn
metronidazole
imipenem-cilastatin

Front 66

bacteriology of UTI

Back 66

e.coli, enterococcus, klebsiella, proteus

Front 67

tx UTI

Back 67

sulfa, trimethoprim, 1st gen ceph, nitrofurantoin, FQ

Front 68

bacteriology of STD

Back 68

syphyllis, gonorrhea, chlamydia, gential herpes, trichomoniasis

Front 69

tx STD

Back 69

syphillis:pcn, spectinomycin
Gonorrhea:3rd gen ceph, ofloxacin, enoxacin, cipro
chlamydia:doxy, ees,FQ,azith
Gent herpe: acyclovir, famcyclovir
trich: metronidazole

Front 70

bacteriology of osteomylitis

Back 70

hematogenous:staph, gram neg
adjacent infx:staph, gram neg, anaerobes
vascular insuff:staph, g -, anaerobes

Front 71

tx osteomylitis

Back 71

bone penetration, IV, oral therapy (cipro)

Front 72

azithryomicin doesn't cover

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septicemia

Front 73

cipro doesn't cover

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strep

Front 74

nosocomial infxn tx

Back 74

need broad spectrum and somthing to cover gram - (aspiration)

Front 75

ventilation associated pneumonia caused by

Back 75

pseudomonas aeruginosa