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141 Cards in this Set

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Chloramphenicol:

MOA: Binds reversibly to the ____ subunit of the bacterial ribosome
__________ broad spectrum antibiotic
Active against both gram (+) & gram (-):
Neisseria meningitides
Haemophilus influenzae
Some strains bateriodes

Dose adjustment: not needed in renal insufficiency; required in ________
50S

Bacteriostatic

hepatic failure
Chloramphenicol-Clinical Uses

mostly obsolete due to toxicity & resistance
Maybe considered for use in treatment of serious infections:
Typhus or Rocky mountain fever in children < 8yrs where _________ is contra-indicated

Alternative to β-lactam ATBs for _____________ in pts hypersensitive to PCN or PCN resistant strains of pneumococcus
Adult dose: ______ mg/kg/day in ___ divided doses

Occasional used for eye infections due to penetration of occular tissues
Tetracycline

meningococcal meningitis

50-100 mg/kg/day in 4 divided doses
Chloramphenicol - Adverse Effects

GI disturbances – N/V, diarrhea
__________ - alteration of normal microbial flora

Bone Marrow disturbances -
Decreased _______ production-doses >50mg/kg/day x 1-2wks
_________ – rare, irreversible, can be fatal

Newborn Toxicities
_________ from doses >50mg/kg/day - caused by drug accumulation
Vomiting
Flaccidity
Hypothermia
Gray color
Shock & collapse
Oral or vaginal candidiasis

red cell

Aplastic anemia

Grey baby syndrome
Chloramphenicol - drug Interactions

prolonged t½ & increased serum concentrations of:
________
________
__________ - tolbutamide, chlorpropamide

antagonize bactericidal drugs such as _____ & _______
Phenytoin
Warfarin
Anti-diabetics

PCNs, Aminoglycosides
TETRACYCLINE: OVERVIEW
TCNs are _________ broad spectrum antibiotics

Mechanism of Action:
Inhibit protein synthesis- bind to the ___ subunit of the bacterial ribosome
bacteriostatic

30S
TETRACYCLINE : ACTIVITY

Active against g(+)& g (-) bacteria (_______):
Chlamydia
Mycoplasmas
Protozoa
Anaerobes

Antibacterial activity of most TCNs similar except:
TCN resistant strains may remain susceptible to __________ & __________
atypicals

doxycycline & minocycline
TETRACYCLINE: RESISTANCE

Decreased _________ accumulation due to either impaired influx or efflux
_________ protection due to production of proteins that interfere with TCN binding ribosome
Enzymatic _________ of TCN
intracellular

Ribosome

inactivation
TETRACYCLINE: PHARMACOKINETICS

Absorption impaired by _____
Absorption impaired by divalent ______ - Ca, Mg, Fe, Al, dairy products, antacids

Widely distributed to tissue & blood, fluid except for _____
Minocycline – high conc in ______, useful eradication of ____________ carrier state
TCN crosses the placenta to reach fetus –chelates with Ca & damage growing ______ & ______
food

cations

CSF

saliva

meningococcal

bones & teeth
TETRACYCLINE: PHARMACOKINETICS
_________ - unlike other TCNs, eliminated by non renal mechanisms
Doxy- does not accumulate significantly in renal failure - TCN of choice in __________
Dose: ________ (tetracycline, Oxytetracycline)
Dose: ________ (Doxycycline, Minocycline)
Doxycycline

renal insufficiency

250-500mg PO qid

100mg PO qd or bid
TETRACYCLINE:CLASSIFICATION

Short Acting TCNs (t½ 6-8hrs)
Chlortetracyline
Tetracycline (______®)
Oxytetracycline (_______®)

Intermediate Acting TCNs (t½ 12hrs)
Demeclocyline (________®)
Methacycline (________®)

Long Acting TCNs (t½ 16-18hrs)
Doxycycline (_______®)
Minocycline (_______®)
Achromycin

Terramycin

Declomycin

Rondomycin

Vibramycin

Minocin
TETRACYCLINE - CLINICAL USES.
1.TCNs are drugs of choice for infections with:
_________
_________
_________

2. Used in combination regimens (w/ PPI) to treat gastric & duodenal ulcers caused by __________

3. Maybe used for g (+) & g (-) bacterial infections including _______

4. Effective in _______ infections - including sexually transmitted diseases (NOT GC)
Mycoplasma pneumoniae
Ricketsiae
Spirochetes

Helicobacter pylori

vibrio

chlamydia
TETRACYCLINE - CLINICAL USES
Also used for treatment of:
Exacerbation of bronchitis - ______
Pneumonia - TCN + _____
Acne - _______
Lyme disease
Relapsing fever
SIADH - ______
Elimination of menigococal carrier state - Minocycline 200mg po qd x 5days, but ______ now preferred
doxy

3rd gen cephalosporin

minocycline

demeclocyline

rifampin
TETRACYCLINE - CLINICAL USES.
Used with ________ to treat Plague, Tularemia, Brucellosis

Used in protozoa infections caused by __________ or ___________
Aminoglycosides

entamoeba histolytica or Plasmodium falciparum
TETRACYCLINE - DOSING

Tetracycline -
Adults: _________
Children (8yrs & older): _________

Methacycline - _________

Demeclocyline - ________

Doxycycline - _________

Minocycline - _________

__________ is the TCN of choice because it can be given once/day & absorption not affected by food
250-500mg PO QID
20-40mg/kg/day in 4 divided doses

100mg po 1-2x/day

300 mg PO bid

100mg IV/PO qd or bid

100mg po bid

Doxycycline
Precautions:
All TCNs chelate ______
Do not give with _____, antacids or ferrous sulfate

Contraindications:
Avoid in ________ & children < ___ of age to avoid deposition in bones & teeth
metals

milk

pregnant women

8yrs
TETRACYCLINE: ADVERSE EFFECTS
GI- _________ → direct irritation of GI tract (give with food to decrease effects)
_________
Oral or Vaginal __________
___________ - C. difficile
Bone & teeth structure - teeth _________
N/V, diarrhea

Pruritis

candidiasis

Pseudomembranous enterocolitis

discoloration
TETRACYCLINE: ADVERSE EFFECTS
Liver toxicity –hepatic necrosis with daily doses of ______
_______ toxicity- renal tubular injury (All TCNs accumulate – except _________)
Local _______ injury - IV venous thrombosis, IM painful irritation
Photosensitization - esp _________
Vestibular Rxns - dizziness, vertigo - esp _________
4gm IV

Kidney

doxycycline

tissue

Demecocycline

Minocycline
MACROLIDES- OVERVIEW

MOA: Inhibition of protein synthesis by binding to ____ ribosomal RNA
_________ maybe inhibitory or bactericidal esp. at high concentrations for susceptible organisms

Prototype drug: Erythromycin - 1952
Semi-synthetic derivatives of erythromycin: _________ & _________
50S

Erythromycin

Clarithromycin & Azithromycin
ERYTHROMYCIN PHARMACOKINETICS
Erythromycin ____ - destroyed by stomach acid
Must be given as ________
_____ & ______ are acid resistant & better absorbed
_____ impairs absorption
Excreted in bile & feces
Adjustment unnecessary in _________
Not removed by _______ - don't give extra doses
Crosses the ______ - reaches the fetus
base

enteric coated

Stearates & esters

Food

renal failure

dialysis

placenta
ERYTHROMYCIN ANTIMICROBIAL ACTIVITY
Effective against ____ organism especially:
Pneumococci
Streptococci
Staphylococci
Corynebacteria

Also effective against
Mycoplasma
Legionella
Chlamydia
C.Pneumoniae
Helicobacter
Listeria - DOC is _______
Mycobacterium (certain)
for atypicals, use in combo w/ a ______
g (+)

ampicillin

cephalosporin
ERYTHROMYCIN ANTIMICROBIAL ACTIVITY
Active against ___ organisms such as:
Neisseria species
Bordetella pertusis
Treponema Pallidum
Campylobacter specie
Haemophilus influenzae
Rikettsiae (some species
G (-)
ERYTHROMYCIN CLINICAL USES:
Drug of choice for __________ infections (diphtheria ,corynebacterium sepsis)
Prophylaxis against ________ during dental procedures in persons with valvular disease - _______ is a better alternative
As a PCN susbstitute for PCN allergic pts with infections caused by ______ & ______(assuming susceptibility)
Tx of ____
Respiratory , neonatal occular or genital ______ infections
corynebacterium

endocarditis

Clindamycin

staph & strept

CAP

chlamydia
MACROLIDES-ERYTHROMYCIN DOSING

Erythromycin base, stearate or estolate
Adults _________
Children _________
Estolate is best absorbed, greatest risk of ADR
_______ preferred b/c of less GI SE

E. Ethylsuccinate __________

Erythromycin base ______ + ______ as pre-op for surgery of the colon

Erythromycin Lactobioate given IV at _______
(not used b/c of GI irritation)
250-500mg PO q6hr

40mg/kg/day PO

Stearate

400-600mg PO Q6hrs

1gm PO + Neomycin

0.5-1gm q6hrs
MACROLIDES-ERYTHROMYCIN ADR
GI - ________, N/V & diarrhea-gut stimulation
Liver toxicity (esp estolate) - _________: fever, jaundice, impaired liver function
_______ rxns - fever, eosinophilia, rash
Anorexia

cholestatic hepatitis

allergic
MACROLIDES: ERYTHROMYCIN DRUG INTERACTIONS
Inhibits cytochrome P450 enzymes causing increased serum concentrations for drugs like:
Theophylline
_________ (Oral)
Cyclosporine
_________
________
Anticoagulants

Methylprednisone

Digoxin
MACROLIDES: ERYTHROMYCIN-RESISTANCE
3 Mechanisms exist
Reduced ________ of cell membrane or active efflux
Production of _______ that hydrolyze macrolides
Modification of _________
permeability

esterases

ribosomal binding site
MACROLIDES - CLARITHROMYCIN(______®)
Derived from erythromycin - addition of methyl group
MOA- same as erythromycin
Antibacterial activity:
Same as erythromycin, except active against _____

Erythromycin resistant ____ & _____ also resistant to Biaxin
BIAXIN

MAC (mycobacterium avium complex)

staph & strept
CLARITHROMYCIN - KINETICS
Has improved acid stability & _____ absorption, compared to erythromycin
Metabolized in the _____; major metabolite eliminated in urine

Dose
__________
XL ________
Pts w/ CrCl < 50ml/min - LD 500mg x1, then ________
oral

liver

500 mg PO bid

1 gm qd

250mg q24hrs
CLARITHROMYCIN
Drug Interactions –similar to erythromycin

Advantages over Erythromycin
Lower frequency of _________
Less frequent ______
Otherwise, therapeutically equivalent

Disadvantages over erythromcyin
Clarithromycin, more ______
GI intolerance

dosing

costly
MACROLIDES-AZITHROMYCIN (_________)
Derived from erythromycin by addition of a methyl group
Microbial activity & clinical uses similar to clarithromycin- active against M.avium, T. gondii, H. influenzae
Highly active against _______
Slightly < active against _______ & _______ than erythromycin & clarithromycin
ZITHROMAX

chlamydia

staph & strept
AZITHROMYCIN KINETICS
Half Life : 2-4 days; allows for __ dosing, shorter duration
Penetrates most tissues except the ____
Give __________ meals

Does not inactivate the Cytochrome P450enzymes therefore free of drug interactions that occur with erythromycin & clarithromycin
QD

CSF

1hr before or 2hrs after
AZITHROMYCIN DOSING
Available IV & PO

CAP: __________

Chlamydia cervicitis, urethritis: ________
Above as effective as 7 days of doxycycline
LD 500mg, then 250mg IV/PO q24hrs x 4days

1gm PO x1 dose
________
Are semi-synthetic 14 member ring macrolides
Differ from erythromycin by the substitution of a 3 keto group
KETOLIDES
KETOLIDES - TELITHROMYCIN (_______)
Active against:
S.pyogenes
S. pneumoniae
H.Influenzae
Moraxella catarrhalis
N. gonorrhea
*Mycoplasma*
*Legionella*
*Chlamydia*
Bacteriodes fragilis - *Anaerobe*
T. gondii
Mycobacteria (non tuberculous)
*Many macrolide resistant strains susceptible to ketolides*
Ketek
KETOLIDES - TELITHROMYCIN
Oral bioavailabilty – 57%
Tissue penetration good
Metabolized by ______, eliminated by biliary & urinary route

Treatment of respiratory tract infections including ____: Acute exacerbation of bronchitis or Sinusitis
________ pharyngitis
Dose: ________

It is a reversible inhibitor of the CYP3A4 enzyme system
liver

CAP

Streptococcal

800mg PO qd
VARIOUS ANTIMICROBIALS: ________ - Derivative of Lincomycin

MOA- Inhibition of protein synthesis, by binding to the ____ subunit of the bacterial ribosome
CLINDAMYCIN

50S
CLINDAMYCIN: Antimicrobial Activity

_____ & ______ coverage -
Streptococci
Staphylococci
Pneumococci
Bacteriodes & other anaerobes

Enterococci & g (-) organisms resistant to Clindamycin in contrast to susceptibility to erythromycin
G+ & anaerobic
CLINDAMYCIN: Kinetics
Excreted in liver bile & urine
Penetrates into _______
Half life 2.5hrs

Typical Dose:
PO ________
IV ________

PID Dose: ______
Abscess dose: ______
abscesses

150-300mg PO q6hrs
600-900mg IV q8hrs

900 mg IV q8hrs
600 mg IV q8hrs then PO
CLINDAMYCIN: Clinical Uses

Severe _______ infections
Combined with _______ or _______ for penetrating wounds & abscesses
Clindamycin + _______, effective alternative to Bactrim for ___________
anaerobic

aminoglycosides or cephalosporins

Primaquine

pneumocystis carinii
CLINDAMYCIN: Adverse Effects

GI- N/V, severe diarrhea & ________ (use Flagyl or Vanc qid to treat)
Dermatological - _______
Impaired _____ function
enterocolitis

skin rashes

liver
Various Antimicrobials: Streptogramins

Quinupristin-Dalfopritin (________)
________ for most organisms except enterococcus faecium
Active against multi-drug resistant strains of S. Pneumoniae, MSSA, MRSA
T1/2 - 1hr
Prolonged antibiotic effect

Dose: ________
Dose adjustment unnecessary in renal failure

Toxicities:
pain at injection site
Arthralgia
therefore give in a _______
Synercid

Bactericidal

7.5mg/kg IV Q8-12hrs

Pain

central line
Sulfonamides Overview
MOA: structural analogues of _____
Inhibit growth of organisms by reversibly blocking ____________

Divided into 3 groups
__________
__________
__________
Plus IV Sulfamethoxazole/trimethoprim
PABA

folic acid synthesis

Oral Absorbable
Oral Non-absorbable
Topical
Sulfonamides Antimicrobial Coverage

Inhibit growth of _______ bacteria including:
Nocardia
Chlamydia trachomatis
Protozoa (some)
Enteric bacteria such as:
E. Coli
Klebsiella
Salmonella
Shigella
Enterbacter
No activity against ________
both gram (+) and gram (-)

rikettsiae
Sulfonamides – Oral Absorbable Kinetics

Classified into 3 categories based on _____:
Short Acting
Medium Acting
Long Acting

Well absorbed into body fluids, CNS & CSF
Excreted in urine
Dose adjustment necessary in _________
half life

renal impairment
Sulfonamides –Oral Absorbable (Clinical Uses)

Infrequently used as a ____ agent
Formerly drugs of choice for infections such as:
Pneumocystis carini pneumonia
Toxoplasmosis
Nocardiosis

Used in fixed combinations - ___________
single

trimethoprim/sulfamethoxazole
Sulfonamides – Oral Absorbable (Clinical Uses)

Many strains formerly susceptible to organism listed below, but now ______:
Meningococci
Pneumococci
Streptococci
Staphylococci
Gonococci
resistant
Sulfonamides – Oral Absorbable

SULFISOXAZOLE & SULFAMETHOXAZOLE - short to medium acting
Used to treat ____
Dose ________

SULFADIAZINE - Achieves therapeutic conc. In CSF
First treatment for acute _________ when used in combination with _________
UTI

1gm PO QID

toxoplasmosis

pyrimethamine
Sulfonamides – Oral Absorbable

SULFADIAZINE + pyrimethamine = synergistic
Pyrimethamine (Daraprim)-_________, potent inhibitor of dihydrofolate reductase
Dose: Sulfadizine _______ plus Pyrimethamine ____________
Combination given with ___________ to minimize marrow suppression
antiprotozoa

1gm po qid

75mg po x 1 dose, then 25mg po qd

folic acid 10mg po qd
Sulfonamides – Oral Non Absorbable

SULFASALAZINE (________)
widely used to treat _________ & other inflammatory bowel disease

Dose
LD: __________
MD: __________
Azulfidine

ulcerative colitis

1 gm tid or qid

1 gm bid
Sulfonamides – Oral Non Absorbable

SULFADOXINE – only long acting sulfonamide in US
Results in prolonged levels

Sulfadoxine + Pyrimethamine = _______
1 tab = __________
Dose acute malaria: ________
Prophylaxis: one tablet weekly or 2 tabs q2wks
Fansidar

Sulfadoxine 500mg + Pyrimethamine 25mg

2-3 tabs x 1 dose
Sulfonamides – Topical Agents

SODIUM SULFACETAMIDE
______ soluntion & oint
Used to treat _________ & adjunctive treatment for trachoma

MAFENAMIDE ACETATE
Used topically to prevent bacterial colonization in ________
Absorbed from burn sites - inhibits carbonic anhydrase causing _________ (S/E limits use)
Ophthalmic

conjunctivitis

burn wounds

metabolic acidosis
Sulfonamides – Topical Agents

SILVER SULFADIAZINE (_________)
Less _____ topical sulfonamide
Preferred over Mafenamide for prevention of ________ of burn wounds
Silvadene

toxic

infection
Sulfonamides - Adverse Effects

For sulfonamides & their derivatives (thiazide, loop diuretics, diazoxide & sulfonylureas, cross allergenic)
Most common adverse effects:
_____
Skin ______
Exfoliative dermatitis
_________
Urticaria
Nausea/Vomiting
________
Fever

Rashes

Photosensitivity

Diarrhea
Sulfonamides - Adverse Effects

________ – rare (<1%) but potentially fatal type of skin & mucous membrane eruption

________ disturbances - May precipitate in urine producing crystalluria, hematuria & obstruction
e.g. sulfadiazine, sulfizoxazole
TX- ______ to alkalinize urine, ______ for hydration
Stevens Johnson’s syndrome

Urinary

NaHCO3

fluids
Sulfonamides - Adverse Effects

___________ Disturbances -
Hemolytic & Aplastic anemia, granulocytopenia, thrombocytopenia

Risk of _________ in newborns if taken at end of pregnancy
Hematopoietic

kernicterus
Sulfonamides - combination drugs

_________ - inhibits bacterial dihydro folic acid reductase
_________ - inhibits activity of dihydro folic acid reductase of protozoa

Trimethoprim + sulfonamide or
Pyrimethamine + sulfonamide = results in marked enhancement of activity of both drugs
Combination, _________ compared to bacteriostatic activity of sulfonamides
TRIMETHOPRIM

PYRIMETHAMINE

bactericidal
Sulfonamides - Trimethoprim Clinical Uses

Trimethoprim:
Can be given alone in ____
Dose - ________

Trimethoprim/Sulfamethoxazole:
Pneumocystis Carini
Shigellosis
Salmonella
Respiratory Organisms
Haemophilus species
Moraxella catarrhalis
Klebsiella (but not mycoplasma pneumoniae)
UTI

100mg po bid
Sulfonamides - Trimethoprim

UTI:
Bactrim DS (Trimethoprim ____/sulfamethoxazole ____) given q12hrs

Prophylaxis of recurrent UTI:
___ tab Bactrim DS 3x/wk x months

Salmonella/shigella:
Bactrim DS _______

Pneumocystis Carini:
____ trimethoprim / ____ sulfamethoxazole per 5ml in 125ml D5W over 60-90mins
Trimethoprim 160mg / sulfamethoxazole 800mg

0.5 tab

1 tab q12hrs

80mg trimethoprim / 400mg sulfamethoxazole
Sulfonamides - Trimethoprim

Pneumocystis Carini:
80mg trimethoprim/400mg sulamethoxazole per 5ml in 125ml D5W over 60-90mins

Dose: 5mg/kg 3-4x/day based on ________ portion of agent
Typical dose: __________
Trimethoprim

15-20ml IV q6-8hrs
Sulfonamides - Trimethoprim Adverse Effects

________
N/V
Vasculitis
____ damage
____ pts –fever, rashes, leukopenia, diarrhea
Leuokopenia

Renal

AIDS
Acetaminophen Antidote:

N-Acetylcysteine (_________) -
also for carbon tetrachloride OD
LD: __________
MD: __________
Admit pt for 3 days

_______ - IV form
dose: ________
admit for only 1 day
Mucomyst
140 mg/kg PO
70 mg/kg q4hr for 17 doses

Acetadote
150 mg/kg over 1 hr then 50 mg/kg over 4 hrs then 100 mg/kg over 16 hrs
Acetaminophen Overdose:

Peds - follow adult dosing
dilute to 5%
ineffective if _________ is used prior to administration
If pt vomits w/in 1 hr - _________
activated charcoal

repeat dose
Potential hepatotoxic serum acetaminophen leves at intervals after ingestion:
4 hr -
6 hr -
10 hr -
20 hr -
24 hr -

dont check levels earlier than ___ b/c hasnt reached peak yet
150 mcg/mL
100 mcg/mL
50 mcg/mL
8 mcg/mL
3.5 mcg/mL

4 hrs
Acetaminophen Overdose:
administer Mucomyst for levels > ____ at ___ hrs

toxic concentrations w/ probably hepatoxicity - _________
150 mcg/mL at 4 hrs

> 200 mcg/mL at 4 hrs or 50 mcg/mL at 12 hrs
Mucomyst: other indications

adjunctive mucolytic therapy in pts w/ abnormal or viscid mucous secretions such as _________ or _________

Usual Dose: nebulize _______
COPD or Cystic fibrosis

6-10 mL of 10% solution OR 3-5 of 20% solution
Mucomyst: other indications

prevention of radio contrast induced renal dysfunction
Dose: ________ beginning the day before the procedure
dilute with juice or soda
600 mg PO bid x2 days
Ethylene Glycol/Methanol Antidote: _______
LD - ________
MD - non drinkers ________
MD - dialysis pts ________
MD - alcoholics ________
MD - alcoholics on dialysis ________
Ethanol

600-700 mg/kg IV/NG/PO

non drinker: 66-154 mg/kg/hr
alcoholics: start at 154 mg/kg/hr
dialysis pts: 169 mg/kg/hr
alcoholics on dialysis: 257 mg/kg/hr
Ethanol:
has great affinity for enzymes responsible for methanol metabolism (ADH)
give IV or PO to maintain Ethanol level at > _______ thereby saturating ADH w/ Ethanol in the liver

Give Ethanol when:
methanol level is > _____
greater than _____ has been ingested
when acidosis or visual disturbances are present in suspected methanol poisoning
100 mg/dl

20 mg/ml

30 ml
continue tx unitl ethylene glycol or methanol level is < _____
Fomepizole (_______) inhibits elimination of ethanol
administration w/ concomitant ethanol ingestion, not recommended since toxic ethanol levels may result

Ethanol ADR:
________ - DIC, leukocytosis, leukopenia, thrombocytopenia
________ - a. fib, v. tach
10 mg/dl

Antizol

Hematologic

Cardiovascular
Fomepizole (Antizol)
also an antidote for ethylene glycol or methanol OD

IV dose:
LD - ________
MD - ________
continue MD until level is < ______ & pt is asx w/ normal pH

PO Dose:
LD - _________
MD - _________
continue until levels are undectable
OR
LD - ________
MD - ________
continue for for up to 96 hrs
LD - 15 mg/kg IV
MD - 10 mg/kg q12hr x 4 doses then 15 mg/kg q12hr
20 mcg/dl

LD - 15 mg/kg PO q12hr
MD - 5 mg/kg q12hr x 1 dose then 10 mg/kg q12hr

LD - 10 mg/kg PO
MD - 5 mg/kg bid up to 36 hrs then 10 mg/kg bid up to 96 hrs
Fomepizole (Antizol):
in cases of renal failure, _____ should be considered in addition to Antizol

Monitor during Tx b/c of:
severe metabolic acidosis
elevated anion gap
significant creatinine increase

Check:
urine oxalate
plasma urinary osmolality
renal/hepatic fxn
serum electrolytes
blood gases
WBC
in comatose pts, do an ____

Continue until ethylene glycol/methanol levels are < _____
dialysis

EEG

20 mg/dl
Fomepizole (Antizol):
Administer dilute doses in at least ____ NS or D5W, infuse over ____

Do not give w/ _____ b/c toxicity can occur
a pre-existing ethanol level does not preclude the use
100 ml

30 min

ethanol
Fomepizole (Antizol) ADR:
____ - bradycardia, tachycardia, hypotension
____ - dizziness, HA, seizure, abnormal sense of smell, roaring in ears, agitation, anxiety
_____ - lipid abnormalities, hypertriglyceridemia
____ - mild nausea, bad taste
_____ - visual disturbances
CV

CNS

Endocrine

GI

Ocular
Rattlesnake/Copperhead Antidote: Polyvalent crotalid antivenim immune fab (________)

LD: _________
can repeat dose in 1 hr is sx are not controlled
MD: _________
Crofab

4-6 vials over 1 hr

2 vials q6hrs for 18 hrs (3 more doses)
Rattlesnake/Copperhead Antidote: Crofab
use w/in ___ of snake bites
local sx (______) & neuro manifestations (_____) improve during a 1 hr infusion
local sx can recur in 6-18 hrs
coagulopathy (________, _______) has been evident for up to 2 wks
6 hrs

swelling

myokimia

thrombocytopeniz, hypofibrinogenemia
Crofab MOA:
bind & neutralize venom toxins
facilitate the re-distribution & ulimate elimination from affected body tissue

ADR: ________

Cost: 2 vials = $8920
hypersensitivity rxns
Digoxin Antidote: Digoxin immue fab (_______)
_____ will bind approximately 0.5 mg digoxin or digitoxin

DOSE (in vials): (serum digoxin conc [ng/ml] x wt [kg])/100

levels higher than ____ requires the antidote
Normal dig level is 0.8-2 ng/mL
toxic at > 3 ng/mL
Digibind

38 mg

4-6 ng/ml
Digoxin Antidote: Digoxin immue fab ovine (_______)

available in 40 mg vials
shorter half life
dosing is same as Digibind
costs less
Digifab
Digoxin Antidote

Infuse IV over _____ using 0.22 micron filter
Life threatening - __ vials (760 mg) IV
Adult or peds acute ingestion - if unknown amt give ___ vials (380-400 mg) IV, observe response then repeat prn
Pediatric chronic toxicity - infants 20 kg or less give __ vial initially
30 mins

20 vials

10 vials

1 vial
Methylphenidate (________) can cause ___________
also called MAOI crisis
caused by inhibited uptake of serotonin
Ritalin

Serotonin syndrome
Dehydroeipandrosterone (DHEA)

Indications (3)
weight loss
aging
Alzheimer's dz
Melatonin

Sleep
Dose: __________

Jet Lag
Dose: __________
.3-10 mg (max 20 mg)

5-8 mg
Feverfew
Garlic
Gingseng
Gingko Biloba
All are CI w/ anticoagulants
Echinacea - usually taken at the first sign of a cold
reduces ________
duration
Gingko Biloba

Effects:
increase blood flow
decreased viscosity
antioxidant effects

Tx for cerebral insufficiency
Dose: ___________

ADR: GI (______), ______
affects _______ fxn - causes bleeding
120-240 mg given 2-3 divided doses

Nausea, vomiting

platelets
Tetanus Prophylaxis:
if a bite in minor & the wound is clean, a shot is not indicated unless it has been _____ since last dose
If wound is major and/or not clean, a prophylaxis Td shot is recommended if it has been more than ___ since last dose
10 yrs

5 yrs
Rabies Immunization:
pts w/ a bite from a ______ dog are at higher risk for infxn
Pre-exposure prophylaxis (3)
Post-exposure prophylaxis (5)
non-provoked

0, 7, 21 days

0, 3, 7, 14, 28 days
_______ is when you administer an antigen to the host to induce the formation of antibodies
can be inactivated (killed) or attuenuated (live)

_______ is when you transfer immunity to a host
animal or human immunoglobins are used
IV Ig dose ________
active immunity

passive immunity

200-400 mg
all vaccinations doses are __________
0.5 mL IM per dose
Antidote for bradyarrhythmia-producing drugs (B-blockers, CCB, digitalis glycosides): _______

dose:_______
atropine sulfate

1-2 mg IV, repeat q15-30min prn
GI decontamination: ________

Iron overload: _______
Dose: _______
activated charcoal

deferoxamine mesylate (Desferal)
15 mg/kg/hr IV
Benzodiazepine antidote: ________
Dose: ________

Opoid antidote: _______
Dose: ______

Oral sulfonyurea antidote: _________
also used for diarrhea
flumazenil (Romazicon)
0.2 mg IV over 30 secs

naloxone (Narcan)
0.4-2mg IV, may repeat at 2-3min intervals up to 10 mins

octreotide (Sandostatin)
Warfarin antidote: _______
dose: ________

Enoxaparin or Heparin Antidote: _________
phytonadione (vitamin K)
2.5-10mg SC/PO/IM
rarely up to 50mg
may repeat in 6-8hrs

protamine sulfate
Polyenes (5)
1. Amphotericin B
o Conventional Formulation (___________)
o Lipid Formulations (_______,_______,_______)
2. __________
Fungizone
Abelcet, Ambisome, Amphotec
Nystatin
Polyenes (5)
MOA: binds to ________ causing loss of cell membrane integrity and leakage of cellular contents (cell dies).
ergosterol
_________
o Ampho B -- Conventional formulation
o More ________than lipid formulations (use lower doses)
o Requires test dose – _ mg in __ ml D5 over 20-30min
Fungizone
nephrotoxic
1mg in 20ml
Fungizone
o Adverse Effects:
o ________/electrolyte imbalance – supplement with K/Mg
o ___-like sx – give benedryl or Tylenol
o Extravasation
o ______tension
o GI effects – N/V/D
Nephrotoxic
Flu
Hypotension
Fungizone
Dose
Available __only
General dosing:
o _______ mg/kg/day IV
o Empirical tx (neutropenic pt)  Low dose
o Proven fungal inf.  high dose
__________
o total dose up to 3.6g over 11 months
___fungal infection (severe)
o 0.01-0.1 mg ______Q 48-72 hrs
_____ fungal infection (severe)
o LD: 5mg _______ injection
o MD: 50mg daily
_____________(severe)
o 30-50mg diluted in 20-100ml sterile H2O
o Administration: BLADDER IRRIGATION
IV
0.25 – 1 mg/kg/day IV
Aspergillosis
CNS : INTRATHECALLY
Lung : INTRACAVITARY
Urinary Tract Mycosis
Fungizone
Indications
Potenially life-threatening fungal infections

**___________**
Candidiasis (if life threatening)
_____________
Cryptococcosis
Amer Mucocutaneous ___________
____________
Basidiobolus infection
Conidiobolus infection
Mucomycosis
N. Amer Blastomycosis
Sporotrichosis

all dosed .25-1 mg/kg/day IV
Aspergillosis
Coccidioidomycosis
leishmaniasis
Histoplasmosis
Lipid Formulations (Abelcet, Amphotec, Ambisome)
o Less ________– can use higher doses
o Expensive
o Adverse Effects:
o Hypotension
o GI: N/V/D
nephrotoxic
Lipid Formulations (Abelcet, Amphotec, Ambisome)
General Dosing:
o_______ mg/kg/day IV
3 – 5 mg/kg/day IV
Lipid Formulations (Abelcet, Amphotec, Ambisome) Indications:

Patients with severe fungal infections who are unable to tolerate __________
conventional formulation (Fungizone)
Abelcet
o Ampho B -- Lipid Complex
General dosing:
o __ mg/kg/day IV
TX:
___________
Blastomycosis
Candidiasis
_____________
Leishmaniasis
Systemic _________
5 mg/kg/day IV
Aspergillosis
Cryptococcal meningitis
mycosis
___________
o Ampo B – Cholesterol Sulfate Complex
o Not used much due to infusion reactions

Aspergillosis
o ____ mg/kg/day
o MAX: 7.5 mg/kg/day

Candidiasis (non-FDA)
o _______ mg/kg/day
Amphotec
3-4 mg/kg/day

3.9 – 6 mg/kg/day
________
o Ampo B – Liposome
Cryptococcal meningitis (HIV)
o ___ mg/kg/day IV once daily

_________(Aspergillus, candida, or Cryptococcus)
o 3-5 mg/kg/day

Visceral ____________
Mycosis, empiric tx for __________
o 3 mg/kg/day
o immunocomp: 4mg/kg/day
Ambisome
6 mg/kg/day IV once daily

Systemic mycosis
leishmaniasis
febrile neutropenia
Nystatin (Mycostatin)
o Not used to tx _______ inf.
o Topical & Oral suspension
o Low cost
o Adverse Effects
o Oral: N/V/D
o Topical: ____, skin irritaion
systemic
rash
Nystatin (Mycostatin)

Oral ______ (Candidiasis)
Candida __________
Candidiasis of skin
GI _________
___________ Candidiasis


***Not Used for Systemic Infections
Thrush
Vaginitis
Mycoses
Mucocutaneous
Nystatin (Mycostatin)
Candida Vaginitis
o vaginal cream (100,000 U/g)
o _________ daily
100,000 units VAGINALLY qd
Nystatin (Mycostatin)
Mucocutaneous Candidiasis
o Apply powder ______daily to affected area

Candidiasis of skin
o *same dose as above*
2-3 x
Nystatin (Mycostatin)

GI Candidiasis (non-esophageal)
o Oral suspension (100,000 U/ml)
o ___________ tid SWISH & Swallow

Oral Candidiasis
o ___________ units suspension qid OR
o 200,000-400,000 U troche units 4-5 x daily
500,000 U (5ml) – 1,000,000 U (10ml) tid SWISH & Swallow

300,000 – 400,000
Antifungals: Echinocandins (3)
MOA: Blocks the synthesis of β (1.3)-D-glucan, an important part of the________
o Excellent coverage of ________species
o Advantages: improved safety profile and limited drug interactions
o Disadvantage: poor _________ (must be given IV)
cell wall
Candida
PO bioavailability
Caspofungin (________)
o Safety Concerns
o Adjust for ________ insufficiency (35mg MD)
o ________ rxns
o No need to adjust in renal insuff.
o Better SE profile
Cancidas
hepatic
Infusion site
Caspofungin (Cancidas)

Indications

Refractory invasive _________

Candidal septicemia

Candidal intra-abdomina ____________

__________(empirical tx)
Aspergillosis

abcess or peritonitis

Febrile Neutropenia
Caspofungin (Cancidas)Dose
Available IV only

Typical dose
o LD: __ mg IV (day 1)
o MD: __ mg daily

Esophageal Candidiasis
o 50mg daily
o ________ better (PO)
LD: 70mg IV (day 1)
MD: 50 mg daily

diflucan
Micafungin (_________)
o _________dosing
o Safety concerns:
o ___________rxns
o ___________rxns
o Exacerbation of ________ impairment
Mycamine
Prophylaxis
Infusion site
Hypersensitivity
renal
Micafungin (Mycamine) IV ONLY

Prophylaxis for Candidiasis
o Stem Cell Transplant
o __ mg daily

Esophageal Candidiasis
o ___ mg daily
50 mg daily

150 mg daily
Anidulafungin (_________)
o Has shown superiority over diflucan in tx of ________
o Safety concerns
o Worsening of _______ fxn
Eraxis
candidemia
hepatic
Anidulafungin (Eraxis)
Available IV only

Candidemia & ________ disseminated candidiasis
o LD: ____mg (day 1)
o MD: ____mg daily
Esophageal Candidiasis
o LD: ____mg (day 1)
o MD: ___ mg daily
Intra-abdominal and peritoneal
LD: 200 mg (day 1)
MD: 100 mg daily

LD: 100mg (day 1)
MD: 50 mg daily
Antifungals: Antimetabolites (1)
MOA: Converted to 5-fluorouracil inside the fungal cell and inhibits thymidylate synthetase and interferes with ________

Flucytosine (______)
DNA synthesis

Ancobon
Flucytosine (Ancobon)
Rarely used due to SE and limited indications
Used in combo with _____ for severe infections

Drawbacks:
______ quickly develops
Extreme caution with _______

Adverse Effects:
Skin Dz
GI: _____
Elevated _______
Cardiotoxicity
Leukopenia, Thrombocytopenia
Neurological Complications
Ampho B

Resistance

renal impairment

N/V/D

liver enzymes
Flucytosine (Ancobon): Dosing

Candidiasis (meningitis or pulmonary)
Cryptococcosis (septicemia, endocarditis, UTI, pulmonary) - _________
50 – 150 mg/kg/day PO in 4 equal doses
Antifungals: Triazoles (5)

MOA: Block the activity of 14-α-demethylase which inhibits ________ synthesis (an essential part of the cell membrane)
all triazoles impact __ system
ergosterol

CYP
Antifungals: Triazoles
Fluconazole (______)
DOC for ________
Effective against most Candida species EXCEPT:
C. krusei
C. glabrata
Good coverage of Cryptococcus
PO is less expensive

Drawbacks:
Inhibitor of CYP3A4 (weak) and CYP2C9 (strong) -- Drug interactions
Does not cover ____
Renal elimination – adjust dose in _________

Adverse Effects:
Thrombophlebitis (IV)
GI
Rash
______
Diflucan

Candida albicans

molds

renal insufficiency

SJS
Antifungals: Triazoles
Fluconazole (Diflucan) - dosing
Available IV & PO

Candida Vaginitis - ________

Esophageal or Oral Candidiasis -
LD: ________
MD: ________

Candiduria - _______

Prophylaxis for Candidiasis (bone marrow transplant) - ___________

Cryptococcal Meningitis (severe) -
LD: ______
MD: ______

Disseminated Candidiasis (severe) - _________
150 mg PO 1 x dose

LD: 200 mg IV/PO
MD: 100 mg QD

50-200 mg IV/PO QD

400 mg IV/PO qd

LD: 400 mg IV/PO
MD: 200 mg qd

400 mg IV/PO qd
Antifungals: Triazoles
Fluconazole (Diflucan) - Indications

Candidiasis - Generally 1st line in tx of ______

________ infections
C. albicans

Cryptococcal
Antifungals: Triazoles
Itraconazole (_______)
Broader spectrum than Diflucan
Covers ________
Covers C. glabrata

Drawbacks:
Does not cross ____ – not effective against cryptococcal meningitis
Strong inhibitor of CYP3A4
Decreased PO absorption with drugs that _____ gastric pH

Adverse Effects:
Nausea and abd discomfort
_________(limits use)
Hypokalemia
Sporanox

aspergillus

BBB

increase

Hepatic toxicity
Antifungals: Triazoles
Itraconazole (Sporanox) - dosing
Available PO & IV

Aspergillosis, Blastomycosis, Histoplasmosis
PO: ________
IV: ________

Febrile Neutopenia (empiric tx)
IV: ________

Onychomycosis (fingernail) - __________

Onychomycosis (toenail) - ________

Tinea - _______

Oral Candidiasis - ____________

Esophageal Candidiasis - _________
PO: 200 mg qd or bid
IV: 200 mg bid for 4 doses; then 200 mg qd

200 mg bid for 4 doses; then 200 mg qd

200 mg BID x 1 wk, 3 wks off, then 200 mg BID x 1 wk

200 mg qd x 12wks

200 mg qd

200 mg solution swish/swallow qd

100-200 mg swish/swallow qd
Antifungals: Triazoles
Voriconazole (______)
Spectrum similar to itraconazole (broader than diflucan) but better coverage of:
Aspergillosis
Fusarium
Can switch from ______ as sx improve
Reserved for very sick – can send home if need – change IV to PO

Adverse Effects:
______ disturbances
Rash
Photosensitiviy
Increased transaminase (______)
Vfend

IV to PO

Visual

elevated LFTs
Antifungals: Triazoles
Voriconazole (Vfend)
Available IV & PO

Invasive Aspergillosis, Disseminated Candidiasis, Fusarium infection, Monosporium apiospermum infection - ________

Candidal Septicemia - _________

Esophageal Candidiasis -
_______ (pt >40kg)
_______ (pt <40kg)

IV to PO step-down -
_______ (>40kg)
_______ (<40kg)
6 mg/kg IV q 12hrs for 2 doses; then 4 mg/kg IV Q 12hrs

6 mg/kg IV q 12hrs for 2 doses; then 3 mg/kg IV Q 12hrs

200 mg PO q 12hrs (pt >40kg)
100 mg PO q 12hrs (pt <40kg)

200-300 mg PO q 12hrs (>40kg)
100-150 mg PO q 12hrs (<40kg)
Antifungals: Triazoles
Voriconazole (Vfend) - indications

______(DOC along with Ampho B)
Fusarium
Monosporium apiospermum
Candida species resistant to _________
Aspergillosis

Fluconazole
Antifungals: Triazoles
Ketoconazole (______)
Seldom used PO due to adverse events - Fatal ________
Effective as a topical tx
Effective against dimorphic fungi:
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Not for use in _______ (no IV formulation)

Adverse Effects:
Fatal hepatic necrosis
Decrease ________ levels
Inhibit steriodogenesis and decrease plasma cortisol
Anorexia, N/V
Dizziness
Pruritis/rash
Decreased ______
_____ irregularities
Nizoral

hepatic necrosis

systemic infections

testosterone

libido

Menstrual
Antifungals: Triazoles
Ketoconazole (Nizoral)
Available PO & Topical

PO Dose: ________

Candidiasis of the skin - ______ daily

Dandruff - _____ daily to wet hair

Pityriasis Vesicolor - _____ daily to damp skin

Seborrheic Dermatitis - ________ daily

Tinea - _______ OR
_______
200-400 mg qd

2% cream topically

2% shampoo

2% shampoo

2% cream or gel

2% cream daily OR 200-400 mg PO daily
Antifungals: Triazoles
Posaconazole (_______)
New in market
Used prophylaxis during ________
Good coverage of yeasts and molds

Safety concerns:
Severe _______ reactions
Drug interactions (CYP3A4)
________, ____
Noxafil

neutropenia

hepatic

Arrythmias, QT
Antifungals: Triazoles
Posaconazole (Noxafil)
Available in Oral suspension only

Dose - _________

Indications:
Disseminated _______(prophylaxis in severely immunocompromised)
________(prophylaxis)
200 mg (5ml) orally tid

Candidiasis

Aspergillus
o Candida
o C. albicans  __________ is DOC
Fluconazole (Diflucan)
o Aspergillosis (typicall __wks of therapy)
o DOC:
 Conventional Ampho B (________)
• 1 mg/kg/day IV (increase to 1.5 if low dose not working)
 _________(Vfend)
• 6 mg/kg IV q 12hrs x 2; then 4 mg/kg IV q12hrs
• Switch to PO with sx improvement (200 mg PO bid)
10 WKS
Fungizone

Voriconazole
Aspergillosis
Alternatives
 ________ (Sporanox)
• ____ mg IV q __ hrs x 2; then 200 mg IV qd OR 200mg PO tid

_________(Cancidas)
• __ mg IV x 1; then __ mg IV qd
Itraconazole
200 mg IV q 12hrs x 2

Caspofungin
70mg IV x 1; then 50 mg IV qd
o Cryptococcosis
o DOC is a combination of the following
 ________
0.5-1 mg/kg/day IV
 __________(Ancobon)
• 100 mg/kg/day PO for 2 weeks THEN
 __________
• 400 mg PO pd for 8wks (take @ home)
Conventional Ampho B (Fungizone)

Flucytosine

Fluconazole (Diflucan)
o Cryptococcosis
o Alternatives
 _________ – can use in place of fluconazole
• ___ mg PO bid
Itraconazole (Sporanox)
200 mg PO bid
o Blastomyces
o DOC:
 Itraconazole (Sporanox)
• ___mg PO bid for ____months
 Ampho B (Fungizone)
• ______mg/kg/day IV for ________wks
o
Alternatives
 Fluconazole
• ______ mg PO qd
200 mg PO bid for 6-12 months

0.5 -1 mg/kg/day IV for 6-12 wks

400-800 mg PO qd
o Histoplasmosis
o DOC
 __________(Sporanox)
• 200 mg PO bid for ___ months
 Ampho B (________)
• 0.5 – 1 mg/kg/day IV for ____ wks
o Alternatives
 __________
• 400-800 mg PO qd
Itraconazole
6-18

Fungizone
10-12

Fluconazole