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156 Cards in this Set
- Front
- Back
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some abx not renally dosed?
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moxiflox, nafcillin, oxacillin, doxycycline, cephs
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gram positive microorganisms stain what color?
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purple
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gram negative stain?
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pink
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def of MIC?
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Lowest drug concentration that prevents microbial growth
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def of MBC
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lowest drug concentration that prevents microbial density by 99.9%
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what 5 factors are used to select a drug regimen?
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site of infection, severity of disease, pt charactoristics (including renal, ALLERGIES, preg?, genetic traits (like g6pd deficiency), immunologic status
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drug of choice for short course of peri operative antibiotic prophylaxis?
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cefazolin
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pharmacokinetics of AG? name some
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conc dependent...tobramycin, amikacin, gentamicin
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difference in neomycin?
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most nephrotoxic agent
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diff in streptomycin
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no longer used due to widespread resistance, given IM
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diff in amikacin
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broadest antimicrobial activity of the class
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MOA of AG
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binds 30s ribosome, inhibiting rna synthesis
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AG spectrum
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mainly gram -, including pseudomonas...some synery with pennicillins and gram+ (strepto, entero)
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AG activity against anaerobes or atypicals?
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NO
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common uses of AG
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gram -, pseudo, complicated UTI, enterococcal endocarditis (in combo with penicillin)
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SE of AG
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oto and nephro toxicity
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who should be dosed with caution in AG?
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elderly and those with impaired renal fxn
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drug inxns of AG
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others with oto and renal toxicity: neuromuscular blocking agents, ampho B, cisplatin, cyclosporine, furosemide, nsaids, contrast dye, vanco
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when dosing AG, if total body weight is over 130% of IBW, then use what?
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adjusted bw: IBW + [0.4(tbw-ibw)]
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what is the traditional dosing of gent and tobra? amikacin?
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1-3mg/kg/dose....5-7.5mg/kg/dose
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for ag, use ibw unless total body weight is less
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true
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timeline to get levels for AG
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trough,
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toxicity of AG
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trough over 2 for gent and tobra, over 8 for amikacin
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what percentage of hospitals use extended interval?
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80%
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dosing of extended interval AG
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gent and tobra 5mg/kg...amikacin 15mg/kg
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exclusions of extended interval dosing?
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preg, dialysis, endocarditis, burns over 20% bsa, synergy for gram +, anasara, crcl under 30, CF, infants
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when to get a level
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8-12 hours post dose
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advantages of extended interval?
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same effectiveness as normal, less nephrotoxicity, cost effective, post antibiotic effect
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pharmacokinetics of penicillin
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time dependent
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Name the beta lactams that do not need renal adjustments? Name the FQ
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oxicillin nafcillin, ceftriaxone, moxifloxicin, cefoperazone
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what type of killing are the beta lactams: carbapenems, cehps, penicillins?
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time dependent
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drug interactions with all the beta lactams (pen, cephs, carpa)
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probenecica nd asa interfere with renal excretion (INcreases levels), OC's, warfarin
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what are the specific inxns of carbapenems?
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decrease valproic acid levels
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what is the carbapenem that does not have pseudomonas or acinetobacter coverage, therefore should not be used for broad spectrum?
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ertapenem
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generations for cephs
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k
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what is the cross sensitivity of cephalosproing for pcn allergic pts?
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10%
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generations for cephs
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k
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what are the major AE of FQ?
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qt prolong, BBW for etndon rupture, ..also nvd, blood sugar changes
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what is the cross sensitivity of cephalosproing for pcn allergic pts?
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10%
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Inxn of FQ
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increase levels of caffeine, warfarin, sulfonylureas, theophylline, probenecid increase levels
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what are the major AE of FQ?
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qt prolong, BBW for etndon rupture, ..also nvd, blood sugar changes
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Inxn of FQ
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increase levels of caffeine, warfarin, sulfonylureas, theophylline, probenecid increase levels
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what are the groups of people that should be careful with rupture tendon in FQ pts?
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elderly, corticosteroid takers
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what are the groups of people that should be careful with rupture tendon in FQ pts?
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elderly, corticosteroid takers
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which FQ has great activity against strep?
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moxi (also no renal adjustment)
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what are the activity differences between the macrolides azithromycin and clarithromycin?
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clarithro better against the G+ staph and strep...azithro better agains H fluenza and other G-'s
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name some atypicals?
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chlamydia, mycoplasma, ureaplasma, spirochetes
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name some G-
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ecoli, pseudo, legionella, camphylobacter, neisseria meningitidis, moraxella, fragilis, haemophilus influenzae, H pylori, klebsiella, proteus, salmonella,
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whicha macrolide has the least amount of inxns?
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azithromycin
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macrolides and their inxns
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k
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what is the pneumogram of azithromycin drops (Azasite?)
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flip, whip and drip
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what is the common inxns of tetracyclines? doxy
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antacid issues, OC's, anticonvulsants, warfarin
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what is a alternative use of the tetracyclines?
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inflammatory acne
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does doxycycline need renal adjustment?
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no
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what are some differences with erythromycin?
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most GI SE, QID dosing
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what is the general activithy of the tetracyclines?
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mainly atypicals, few g- and +
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what populations are tetracyclines not used in?
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children under 8, pregnancy
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brand name of doxycycline?
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vibramyin, vibratab
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what is the historical change of sulfas?
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not used as much anymore due to widespread resistance
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what is the main activity and use of aztreonam?
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GRam - ONLY, pseudomonas
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BBW of chloramphenical?
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serious and fatal blood dyscrasias, monitor CBCs, pancytopenia, aplastic anemia
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does chloramphenical need renal adjustments?
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no
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activity of clindamycin?
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gram +, anaerobes
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BBW of clinda
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severe possibly fatal colitis
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general uses for clinda?
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alternative to metro for anaerobe infxns,
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general activity of carbapenems?
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G+ G- and anaerobes...NO atypicals
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Intrabdominals
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k
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what type of infxns should clinda be avoided in?
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CNS
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activity of metronidazole
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anearobes ONLY
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what is the classic inxn of metro?
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disulfiram like with alcohol
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what is "disulfram like" mean?
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Under normal metabolism, alcohol is broken down in the liver by the enzyme alcohol dehydrogenase to acetaldehyde, which is then converted by the enzyme acetaldehyde dehydrogenase to the harmless acetic acid. Disulfiram blocks this reaction at the intermediate stage by blocking the enzyme acetaldehyde dehydrogenase. After alcohol intake under the influence of disulfiram, the concentration of acetaldehyde in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. As acetaldehyde is one of the major causes of the symptoms of a "hangover" this produces immediate and severe negative reaction to alcohol intake.
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typical dosing of metro?
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250-500 q 6-8
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a use of rifaximin? derivative of rifampin
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travelers diarrha by non invasive ecoli
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what is a kinetic thing about rifaximin?
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not sysetmically absorbed, rifampin is
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max final concentration of vanco?
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5mg/ml, infuse slowly
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Linezolid activity and general use,
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entero, staph strep...VRE, MRSA
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some SE of linezolid?
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LFT increase, myelosuppression
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dosing adjustments for linezolid?
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no renal, hepatic adjustments
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inxns of linezolid?
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it is a weak monoamine oxidase inh, avoid tyramine...SSRI, moa-is, amphetamines, meperidine, dextromethorphan etc, watch adrenergic agents for hypertensive crisis..sert syndroe, caffeine tryptophan pnenylalanine
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linezolid route and dosing?
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IV or PO, q12
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daptomycin activity?
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gram + (MRSA), strep, Entero
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AE of dapto?
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NVD, anemia, HA, rash insomina hyper/hypokalemia
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electrolyte issues with dapto?
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hyper/hypokalemia possible
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telithromycin BBW
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CI in myasthenia gravis, life threatening respiratory failure
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Tigecycline activity
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G+, including MRSA, faecium and faecalis, many G-, anaerobes and atypcal
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what are the general warnings of tigecycline?
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hepatic dysfunction, anaphylaxis, liver failure, pregnancy inssues
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classes that NEED refriguration?
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cephs, pen, antiviral, augmentin
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classes that does NOT need refridge
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FQ, azithro, doxy, sulfa, fluc
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Do not refridge?
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clarithro, clinda, voriconazole
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what % of UTIs are from ecoli? comm acquired? nosocomial?
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85% ecoli in community, 50% ecoli nosocomial
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complicated vs uncomplicated uti?
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k
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what is the amount of bacteria to make a diagnosis for uti?
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10^5, 10^3 for men (longer urethra)
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how many WBC are required for uti diagnosis?
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10
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treatment for general mild UTI?
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sulf X 3days...or nitro if allergic 100mg X 5days
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if sulfa resistance for mild uti treatment?
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cipro bid X 3 days
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Is there a different in sulf/tri 3 vs 1 day?
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Yes, 3 days is better
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what FQ is specifically mentioned as not having good urine conc?
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moxi
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uncomp pyelonepharits treatment, what if in the hospital?
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cipro or levo 5-7 days, 14 days FQ, amp + gent, ceftriaxone
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complicated UTI treat?
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amp + gent, pip/taz, ticar/clav, carbapenems for 2-3 weeks
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phenazopyridine should be avoided in which patients?
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clcr under 50
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what patients states would inrease the risk of pseudomonas and staphylococcus?
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hosptial, cathetor
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prostatitis treatmnet?
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FQ or sulfa 4-6 weeks
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what patients might need proph travelers diarrhea? what agents?
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immunocompromised, cipro, levo, ofloxacin
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what should travelers diarrhea be treated? treat with what?
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if persisting for more than 3 days or associated with fever or bloody stools...FQ is doc, loperamide
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outpt treatment for comm acq pneum? if no abx last 3 months, and previously healthy?
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macrolide, doxycycline
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outpt if drug resistance risk CAP
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FQ (resp moxi, levo, gem), beta lactam plus macrolide
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treat CAP inpatient non icu
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FQ or Beta lactam plus macrolide
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treat CAP inpt ICU
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IV beta lactam plus azithro or FQ, cover pseudo if needed, cover mrsa with vanco or lzld if mrsa is a concern
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HSv1 vs hsv2
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1 mouth and 2 is genitals generally
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typical recurrence rates for HSV1 and 2
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1X year for 1 and 4X year for 2
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how is influenza spread?
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droplets
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who should not get theflu shot with regard to allergies?
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egg allergy
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pharm class of oseltamavir and zanamivir?
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neuroamidase inh
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what is the issue with asthma childrean and copd and zanamivir?
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bronchospasms caused,
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what sort of adjustment for oseltam?
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renal
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route of oseltam, zanam?
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capsule, dishaler
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preg cat of neuroamidase inh?
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C
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amantadine and rimantadine NOT recommended
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k
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what do the guidelines rec about initial treatment of acut otitis media?
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observation for 48-72 hours to assess clinical improvement, treat only symptoms at this time, if children under 2 they are treated earlier though
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primary treatment for AOM
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high dose amox (80-90 mg/kg/day) q12 or q8
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next step after doc AOM? if allergic to amox
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augmentin...azithro, clarithro, erythro, flagyl...ceftriaxone IM may be given
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treatment length for children over and under 6
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10 days, 5-7 days
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name 6 causative systemic fungal infection organisms
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candida albicans, aspergillus, blastomycosis, crytococcosis, coccidioidomycosis, histoplasmosis
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name the 4 ampho agents, which is most nephrotoxic
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ampho b desoxycholate, ampho b lipid complex, liposomal amphotericin B, amphotericin B cholesteryl sulfate complex
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what are the premedications for ampho B formulations
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apap or nsaid, diphen 25, hydrocortisone 25, meperidine 25-50 (rigors), saline boluses (500ml) for nephrotoxicity
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which are the 2 most concerned about nephro?
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ampho bcholesteryl sulftate (amphotec) and ampho B desoxycholate
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itraconazole dosage forms, is there a difference in them?
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capsule and solution...capsule has low bioavailablitlty, should be taken with food to get the acidity....solution should be taken on empty stomach
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what is the difference in activity for voriconazole? inxn difference
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more activity against aspergillus, C glabrata, krusei, fusarium....michaelus menton
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what are the candida species that are resistant to fluconazole?
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C kruei, C glabrata....albicans is fine
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Treatment for Aspergillus?
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Voriconazole doc....lipo ampho B, ampho B lipid complex, caspofungin
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Treat for C albicans?
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Fluconazole if stable, if unstable Caspofungin, micafungin, anidulafungin
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Treatment duration for albicans bloodstream infection?
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2 weeks after last positive blood culture
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treat oral candidiasis, non aids
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fluc, itraconazole oral solution (empty stomach)
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treat oral candidiasis, fluc resistant
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itra, posaconazole, ampho
B |
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treat oral candidiasis AIDS patient
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fluc, itra, clotrimazole troches, nystatin susp
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treat esoph candidiasis?
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all are good
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General cautions for ampho?
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anaphylaxis, nephrotoxicity...premedication
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electrolyte issues with ampho?
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hypokalemia
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itra inxn issues, BBW
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BBW: negative inotropic effects, carefull with cardiac dysfunction...potent 3A4 inh do not give with cisapride, dofetilide, lovastatin, midazolam, pimozide, quinidine, simvastatin, triazolam, ergot alkaloids
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MOA of azole antifungals?
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inh ergosterol synth, which inh cell membrane formation
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primary vs opportunistic fungal infection
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k
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where is the usual focus of fungal infxns? why?
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pulmonary focus, due to aerosol spread of mold spores
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Fungal meningitis bug and treat
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cryptococcus neoformans...ampho B + flucytosine, fluconazole
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pulm fungal bug and treat
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histoplasma capsultatum, itra or ampho B (severe)
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patient counseling of superficial fungal infxns
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use on skin only, clear thoroughly dry, apply and gently rub in, wash hands after using, dont wrap unless told so by doctor, length of tx is determines by med condition and response to therapy, keep out of eyes, nose mouth and vagina (if then flush with water)
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superficial fungal infxn meds
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k
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causative agents for vaginal candida infections
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C albicans
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predisposing factors for vaginal C albicnas
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broad spec abx, OC, poor controlled DM, preg, chronic use of steroids, obesity
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how is vaginal candida dx made?
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based on S&S, confirmed by wet preparation of vaginal secretions using 10% K hydroxinde showing budding
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DOC for vaginal candida infxns
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topical azole therapies, 7 days, fluconazole 150mg X 1
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who should be referred to doctor if vaginal candi?
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HIV or DM
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pt counseling for vaginal candida
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insert at night before bed, complete entire course, oil based meds can weaken latex condoms or diaphragms, may continue treatment thorugh menstration, seek med contact if symptoms persist w/in 2 months
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5 MRSA agents
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lzd, quin-dalf, dapto
vanco, rifampin in combo |
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5 agents for VRE
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lzd, quin-dalf, dapto
PenG, ampicillin, tigecycline |
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15 agents for pseudomonas
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meropenem, imipenem, doripenem, cefepime, ceftaz, piptaz, ticarcillin/clav acid, cipro, levo, moxi, tobramycin, amikacin, gentamincin, aztreonam, colistimethate
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counseling tips for all abx
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only treat bact infxns, dont skip or miss doses (reduce effectiveness), all Beta lactams can cause a rash (if serious get seen right awasy), most liquids need shaking and refridge (clarithromycin, clinda, voriconazole), dont use household spoons for measuring liquids, report symptoms of C diff
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