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130 Cards in this Set
- Front
- Back
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what aminoglycoside is used topically
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neomycin
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aminoglycosides: bactericidal or static? concentration _____
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cidal
dependent |
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aminoglycosides: major use
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gram- aerobic bacilli
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what combination with aminoglycosides permits entry into cell
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beta-lactam or vancomycin
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aminoglycosides: action vs anaerobes
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ineffective
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DOC for endocarditis caused by E. faecalis and non-VRE E. faecium
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ampicillin + gentamicin
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most often used AG for synergism with penicillins vs enterococci, streptococci, or staphylococci
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gentamicin
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used against strains of P. aeruginosa resistant to gentamicin
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tobramycin
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amikacin: major clinical use
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empiric therapy of nosocomial aerobic gram- bacillary infx with serious gentamicin resistance
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neosporin: combo of what 3 drugs
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neomycin
bacitracin polymyxin B |
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AGs: excellent or poor CSF entry
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poor
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how are AGs eliminated
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excreted entirely through glomerular filtration
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AGs: high or low therapeutic index
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low
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most frequent cause of drug-induced contact dermatitis
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topical neomycin
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what are the major ADRs of AGs
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ototoxicity
nephrotoxicity allergic rxn (neomycin) |
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what AG is more likely to affect vestibular function
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gentamicin
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indicated for management of CF patients with p. aeruginosa infections
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tobramycin solution for inhalation
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what tetracyclines are long-acting?
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doxycycline
minocycline |
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tetracyclines: bactericidal or static?
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static
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what intracellular organisms are tetracyclines active against
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spirochetes
mycoplasma chlamydia rickettsia |
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what tetracycline can be taken with milk? (others have DI with dairy)
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doxycycline
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tetracyclines: excellent or poor CSF entry
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poor
not indicated for meningitis |
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tetracyclines: teratogenic effect
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crosses placental barrier and undergoes permanent sequestration in newly forming bone and teeth
causes discoloring of teeth |
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how is doxy eliminated
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active biliary excretion and enterohepatic circulation
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what drug is used for chronic/severe cases of acne vulgaris? how is it administered?
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tetracycline (oral, low dose, longterm)
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DOC for tx of early stage Lyme disease
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doxycycline
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DOC for prophylaxis of Lyme disease
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doxycycline (200 mg)
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DOC for Borrelia recurrentis? another name for this?
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tetracycline or doxycycline
relapsing fever |
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DOC for nongonococcal urethritis
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doxy
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PID (salpingitis) treatment
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ceftriaxone (gonococcal coverage)
doxy (c. trachomatis) |
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DOC for atypical pneumonias (mycoplasma, chlamydia)
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tetracyclines
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DOC for rickettsial infections
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doxycycline
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DOC for vibrio infections
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doxycycline
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DOC for anthrax
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doxycycline
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unlabeled indication for management of SIADH
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demeclocycline
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tetracyclines should be avoided in who
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pregnant
children < 8 yrs |
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what tetracyclines should be taken on empty stomach? with meals?
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tetracycline
doxycycline and minocycline |
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3 FDA indications for tigecycline
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complicated skin infx
complicated intra-abd infx comm-acquired bacterial pneumonia |
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erythromycin: active vs what gram+ cocci? inactive vs ___
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group A and B streptococci, S. viridans, PCN-sensitive S. pneumo
enterococci |
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erythromycin is active against what intracellular bacteria
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legionella pneumophila
mycoplasmas chlamydiae |
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azithromycin compared to erythro: has superior activity against what
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mycoplasma
chlamydia h. influenzae |
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DOC for pneumonia caused by chlamydia
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azithro or erythro
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DOC for pneumonia caused by mycoplasma
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azithro or erythro
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DOC for pneumonia caused by legionella
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azithro
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DOC for whooping cough
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erythromycin
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DOC for diphtheria
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erythromycin + antitoxin
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prophylaxis for gonococcal ophthalmia neonatorum
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erythromycin topical ointment
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erythromycin: ADRs
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nausea, diarrhea, cramps
toxicity with estolate rare cases of torsades |
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what macrolide has been associated with rare cases of torsades
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erythromycin
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erythromycin and azithromycin: association with P450 system
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E - drug interactions due to inhibition of P450
A - least amt of P450 inhibition |
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telithromycin: developed specifically for tx of _____
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community acquired resp tract infx caused by both common and atypical pathogens
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what drug is unaffected by resistance mechanisms used against macrolides
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telithromycin
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telithromycin strongly inhibits ____
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CYP3A4
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telithromycin: ADR
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may prolong the QTc interval
case reports of jaundice, abnormal hepatic fxn, acute hepatic failure, and fulminant hepatitis |
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clindamycin is largely restricted to ____ infections
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anaerobic (due to association with pseudomembranous colitis)
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clindamycin: good or poor entry into CSF
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poor
not indicated for meningitis |
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clindamycin: clinical uses
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anaerobic infx
anaerobic coverage for mixed aer/anaer infx staph or anaerobic osteomyelitis acne vulgaris |
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major ADR of clindamycin
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antibiotic associated pseudomembranous colitis
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major symptoms of antibiotic associated pseudomembranous colitis
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profuse watery diarrhea (blood and mucus may be present)
intestinal lesions covered by a pseudomembrane |
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DOC for anti ass pseudo colitis
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metronidazole (po)
vancomycin (po) is alternate agent |
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chloramphenicol: spectrum of activity
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broad spectrum act vs aerobic and anaerobic gram+ and gram- bacteria, some chlamydiae, spirochetes, and rickettsiae
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chloramphenicol: CSF levels
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20-50% with uninflamed meninges
45-90% with inflamed meninges |
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chloramphenicol: low or high TI
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low
reserved only for serious infections for which less toxic agents are ineffective |
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what drug is an alternate DOC for rickettsial infx in pregnancy or in tetracycline allergy
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chloramphenicol
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chloramphenicol: ADRs
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reversible bone marrow depression
aplastic anemia "gray" syndome in fullterm neonates |
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mupirocin: administered how? indications?
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topical ointment
impetigo due to s. aureus, B-hemolytic strep, and s. pyogenes |
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quinupristin/dalfopristin: mech of action
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synergistic
dalfo affects early stage of protein synthesis, quinu affects the late |
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quinupristin/dalfopristin: FDA approved indications
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serious or life-threatening infx associated with vancomycin-resistant E. faecium bacteremia
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quinupristin/dalfopristin: ADR and DI
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infusion site reactions
potent inhibitor of CYP3A4 |
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linezolid: approved indications
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VRE E. faecium including concurrent bacteremia
nosocomial pneumonias (MRSA) complicated skin infx, including diabetic foot infx |
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preferred DOC for VISA and VRSA, as well as PRSP pneumonia
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linezolid
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linezolid: ADR
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thrombocytopenia (rare)
myelosuppression |
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linezolid: DI
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weak, reversible, nonselective MAOI
potential DI with adrenergic and serotonergic agents interaction with tyramine-containing foods |
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DOC for prevention of colonization at burn sites
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silver sulfadiazine cream
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sulfonamides: ADRs
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hemolytic anemia in pts with G6PD deficiency
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advantages of TMP-SMX
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synergistic inhibition of folic acid synthesis
bactericidal |
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DOC for UTIs due to gram- enterics
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TMP-SMX
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DOC for ampicillin-resistant shigella
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TMP-SMX
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DOC for acute exacerbation of chronic bronchitis
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TMP-SMX
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TMP-SMX: ADRs
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rash and urticaria are common
rare incidence of SJS and exfoliative dermatitis |
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TMP-SMX: drug interactions
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increased pharm effects of sulfonylureas and warfarin
increased toxicity of methotrexate |
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instructions on how to take TMP-SMX
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take each tablet with full glass of water on an empty stomach
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norfloxacin: indications
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only for UTIs
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norfloxacin: active vs ____; inactive ____
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most gram+ and - aerobes
mycobacteria, mycoplasma, chlamydia, anaerobes, spirochetes |
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norfloxacin: DIs
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aluminum or magnesium containing antacids
bismuth salts iron and zinc products sucralfate |
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norfloxacin: ADRs
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dizziness
HA tremor |
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norfloxacin: contraindications
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pregancy and children < 18 yrs old
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DOC for vancomycin resistant E. faecium UTIs
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nitrofurantoin (Macrobid)
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nitrofurantoin: ADRs
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dose related N/V
acute hemolytic anemia short term pneumonitis (fever, cough, dyspnea...) peripheral neuropathy |
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quinolones vs gonorrhea
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CDC recommends that they should NOT be used in ANY patient
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preferred DOC for community acquired pneumonia
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extended spectrum FQ
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what drugs are not considered 1st line therapy for CA-MRSA due to resistance
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fluroquinolones
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ciprofloxacin: properties
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bactericidal
concentration dependent broad spectrum |
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ciprofloxacin: avoid concurrent consumption of ___
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dairy products
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ciprofloxacin: preferred DOC for what 5 things
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anthrax
UTI due to pseudomonas typhoid fever prophylaxis of meningococcal carrier state traveler's diarrhea |
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ciprofloxacin: alternate DOC for what 2 things
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sepsis and pneumonia due to pseudomonas
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cipro: ADRs
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HA, dizziness, lightheadness
CNS overstimulation: tremor arthropathy and osteochondrosis photosensitivity tendon rupture |
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douching is ___
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BAD
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cipro: DIs
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inhibits hepatic clearance of theophylline
increased anticoagulant effect of warfarin class 1a or III antiarrhythmic agents that prolong QT divalent/trivalent cations |
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ofloxacin: avoid products containing what ___
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divalent and trivalent cations, sucralfate, and didanosine for 2 hrs before and after
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ofloxacin: clinical uses
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alternate DOC for NGU due to C. trachomatis
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name 3 extended spectrum FQs
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levofloxacin
moxifloxacin gemifloxacin |
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preferred DOC for legionella pneumonia
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moxi or levofloxacin
(alternate is azithromycin) |
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preferred DOC for C. difficile AAPMC
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metronidazole (Flagyl)
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preferred DOC for B. fragilis and other Bacteroides
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metronidazole (Flagyl)
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risk factors for c. difficile associated disease
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use of PPIs or H2RAs
use of >3 antibacterial agents FQ or cephalosporin use female gender prior renal failure |
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preferred DOC for tetanus
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metronidazole
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management of active TB
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4 drugs for either 6 months or 9 months of chemotherapy
isoniazid, rifampin, pyrazinamide, ethambutol |
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isoniazid: mech of action
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bactericidal for rapidly dividing organisms
inhibits synthesis of long-chain fatty acids resulting in loss of cell viability |
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isoniazid: administration
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single daily po dose since high peak concentrations are more important than continuous inhibitory levels
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all patients treated with isoniazid should also receive ____
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pyridoxine
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isoniazid: ADRs
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peripheral neuropathy
hepatotoxicity |
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rifampin: mech of action
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bactericidal for both extra and intracellular mycobacteria, and dormant organisms in caseous nodules
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rifampin: highly active vs ___
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mycobacteria
gram+ neisseria |
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rifampin: clinical uses
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treatment of active and latent TB
tx of leprosy (most active agent available) elimination of N. meningitidis from nasopharynx |
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what is the most active anti-leprosy agent available
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rifampin
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rifampin: ADRs
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effects due to histamine release: flushing, rash, itching, flu-like syndrome
red-orange color to all body excretions and secretions hepatitis |
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what drug is the most potent inducer of P450
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rifampin
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what drug causes all body excretions and secretions to turn red-orange
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rifampin
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ethambutol: ADRs
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dose dependent optic neuritis
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avoid pyrazinamide in patients with severe _____
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hepatic disease
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pyrazinamide causes ___ retention
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urate (may precipitate an acute gout attack)
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pyrazinamide: DIs
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oral antidiabetic agents (sulfonylureas)
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what are 2 second line drugs used in tx of TB
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para-aminosalicylic acid
streptomycin |
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streptomycin: ADR
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vestibular toxicity
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what is the triple drug regimen for leprosy? for how long?
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rifampin
dapsone clofazimine 6-24 months |
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dapsone: mech of action
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competitive inhibition of dihydropteroate synthetase and prevents folic acid synthesis
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dapsone: ADRs
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hemolytic anemia
methemoglobinemia |
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thalidomide: mech of action
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immunomodulating agent which suppresses excessive TNF production
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DOC for acute treatment of cutaneous manifestations of erythema nodosum leprosum, as well as for recurrence
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thalidomide
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