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156 Cards in this Set

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