Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
106 Cards in this Set
- Front
- Back
|
Do fluoroquinolones need to be renally adjusted?
|
Yes; dosage adjustment for CrCl <50mL/min
|
|
|
2nd generation fluoroquinolones
|
Cipro and Floxin
|
|
|
2nd generation fluoroquinolones cover what pathogens?
|
Gram-negative - Proteus, E. coli, Klebsiella, Pseudomonas, Enterobacter
Intestinal Pathogens - Shigella, Campylobacter, Salmonella Gram-positive - Staph. aureus, Staph. epidermidis Respiratory Pathogens - H. flu, M. cat, Legionella Genital Pathogens - Gonorrhea, Chlamydia |
|
|
What coverage does Levaquin have?
|
Gram-negative - Proteus, E. coli, Klebsiella, Pseudomonas, Enterobacter
Intestinal Pathogens - Shigella, Campylobacter, Salmonella Gram-positive - Strep. pneumo, Staph. aureus, Staph. epidermidis Atypicals - Chlamydia, Mycoplasm, Mycobacterium Respiratory Pathogens - H. flu, M. cat, Legionella Genital Pathogens - Gonorrhea, Chlamydia Anaerobes - Bacteroides fragilis |
|
|
Clinical uses of 2nd and 3rd generation fluoroquinolones.
|
UTIs, prostatitis, respiratory infections, sinusitis, infectious diarrhea, uncomplicated skin and skin structure infections, infections of soft tissues, bone, joints, and intraabdominal, traveler's diarrhea
|
|
|
What is the drug of choice for prophylaxis and treatment of anthrax?
|
Cipro
|
|
|
What are the side effects of fluoroquinolones?
|
N/V/D, CNS (dizziness, heacache, insomnia), rash, elevated transaminases, tremor
|
|
|
When should you avoid using fluoroquinolones?
|
In patients with known QTc prolongation, uncorrected hyperkalemia, patients on class 1A (quinidine, procainamide) or Class III antiarrhymics (sotalol, ibutilide, amiodarone), patients on erythromycin or tricyclic antidepressants
|
|
|
Drug interations of fluoroquinolones
|
CYP450 - Warfarin
May prolong PT |
|
|
Is Bactrim renally adjusted?
|
Yes; should be reduced by half for patients with CrCl 15-30 mL/min
|
|
|
What is the activity of Bactrim?
|
Gram-positive - Staph. aureus, MRSA, Pneumococcous
Gram-negative - H. flu, E. coli, M. cat, Klebsiella, Salmonella, Literia |
|
|
What are the clinical uses of Bactrim?
|
UTIs, prostatitis, acute otitis media, exacerbations of COPD, treatment and prophylaxis of Pneumocystis jiroveci, traveler's diarrhea, shigellosis, and salmonella
|
|
|
Adverse effects of Bactrim.
|
N/V, rash, photosensitivity
|
|
|
Drug interactions with Bactrim.
|
CYP450 - Warfarin
May prolong PT |
|
|
What activity do aminoglycosides have?
|
Aerobic gram-negative bacilli - Pseudomonas, Mycobacteria
|
|
|
Do aminoglycosides need to be adjusted with renal impairment?
|
Yes
|
|
|
Adverse effects of aminoglycosides.
|
Irreversible ototoxicity - high frequency hearing, tinnitus, vertigo, ataxia, loss of balance, vestibular damage
|
|
|
Monitoring with aminoglycosides with once daily dosing.
|
Measure trough levels on second and third day of therapy - >2 mcg/mL is predictive of toxicity
|
|
|
Monitoring of aminoglycosides three times a day dosing.
|
Peak and Trough monitoring - immediately after infusion, and then immediately before the next dose.
5-10 mcg/mL for peak <2 mcg/mL for trough |
|
|
Activity of Vancomycin
|
Bactericidal against most gram-positive - Streptococci and Staphylococci including MRSA, Bascillus species, Clostridium species including C. diff.
Bacteriostatic against Enterococcus species |
|
|
What do you give with Vancomycin to be bacteriocidal against Enterococcus?
|
Aminoglycoside
|
|
|
Clinical uses of Vancomycin.
|
Sepsis or endocarditis caused by MRSA, meningitis
|
|
|
If a patient has hypersensitivity to beta-lactams, what can you use?
|
Vancomycin
|
|
|
Adverse reactions to Vancomycin
|
Phlebitis at injection sight, Red Man syndrome and chills/fever
Rare - ototoxicity and nephrotoxicity |
|
|
Monitoring of Vancomycin
|
Trough concentrations after 3 days - 5-15 mcg/mL
|
|
|
Activity of Metronidazole (Flagyl)
|
Anaerobic - bacteriodes, C. diff, C. perfringens, Trichomonas vaginalis, H. pylori, and Giardia
|
|
|
Clinical uses of Flagyl
|
Anaerobic or mixed intra-abdominal infections, vaginitis, C. diff diarrhea, brain abscess
|
|
|
Adverse effects of Flagyl
|
Disulfiram reaction with alcohol, N/V/D, stomatitis, peripheral neuropathy, vertigo, headache
|
|
|
Drug interations with Flagyl
|
CYP450 - Warfarin
Prolongs PT |
|
|
Which drugs may accumulate with hepatic insufficiency?
|
Flagyl and Clindamycin
|
|
|
Which drug crosses the blood-brain-barrier?
|
Flagyl
|
|
|
Activity of Clindamycin.
|
Bacteriodes, Streptococcus, Staphylococcus aureus (not MRSA), anaerobic streptococci, C. perfringens, Toxoplasma gondii
|
|
|
Clinical Uses of Clindamycin
|
Anaerobic infections, infections originating in female tract, aspiration pneumonia, dental abscesses
|
|
|
How would you treat a penetrating wound of the abdomen?
|
Clindamycin plus an aminoglycoside or cephalosporin
|
|
|
How would you treat endocarditis?
|
Vancomycin and Gentomycin or Penicillin
|
|
|
Adverse Effects of Clindamycin.
|
N/V/D, pseudomembranous colitis, rash, impaired liver function and neutropenia
|
|
|
Activity of Nitrofurantoin (Macrobid)
|
Gram-positive and gram-negative
|
|
|
Contraindication of Macrobid
|
Renal Insufficiency
|
|
|
Adverse Effects of Macrobid
|
Anorexia, nausea, vomiting
|
|
|
What drugs can cause neuropathies and hemolytic anemia in patients with G6Pd deficiency?
|
Macrobid and Bactrim
|
|
|
Clinical Uses of Zanamivir (Relenza) and Oseltamivir (Tamiflu)
|
Prophylaxis or symptomatic treatment of influenza A and B
|
|
|
Do Tamiflu and Relenza need to be dose adjusted for renal insufficiency?
|
Yes
|
|
|
When do you need to start Tamiflu or Relenza?
|
within 36-48 hours after onset
|
|
|
Side Effects of Tamiflu
|
N/V, headache
|
|
|
Contraindication of Relenza
|
patients with underlying airway disease
|
|
|
Side Effects of Relenza
|
Nasal and throat irritation, headache, bronchospasm
|
|
|
Do antiviral agents need dosage adjustment for renal insufficiency?
|
Yes
|
|
|
Do antivirals cross the blood brain barrier?
|
Yes
|
|
|
What's the drug of choice for HSV1 and HSV2?
|
Acyclovir
|
|
|
Adverse Effects of acyclovir and valacclovir
|
Thrombophlebitis from IV administration, headache, crystal neuropathy, neurotoxicity (lethargy, coma, seizure, tremor, hallucinations)
|
|
|
Adverse Reactions of Ganciclovir and Valganciclovir
|
Bone marrow suppression, neutropenia, thrombocytopenia, anemia, GI symptoms, TERATOGENIC AND CARCINOGENIC.
|
|
|
Adverse effects of Foscarnet and Cidofovir
|
Nephrotoxicity, teratogenic and carcinogenic,
|
|
|
What do you do to help prevent the nephrotoxicity of foscarnet and cidofovir?
|
IV prehydration and administration with probenecid
|
|
|
Drug of Choice for disseminated fungal infections.
|
Amphotericin B
|
|
|
Adverse Effects of Amphotericin B
|
Renal dysfunction, hypokalemia, hypomagnesemia
INFUSION RELATED TOXICITIES - fever/chills, and rigors, hypotension |
|
|
How do you prevent the infusion-related toxicities of Amphotericin B?
|
Premedicate with antipyretics, antihistamines, meperidine, or corticosteroids
|
|
|
Indications of the Azoles.
|
Candidiasis, mycoses, dermophytes
|
|
|
Indication for Voriconazole (Vfend)
|
invasive aspergillosis, disseminated candida, esophageal candidiasis
|
|
|
Indication of Intraconazole (Sporanox)
|
invasive susceptible fungal infections (histoplasmosis)
|
|
|
Adverse Effects of the Azoles
|
GI upset and Hepatic dysfunction (rare)
|
|
|
Adverse Effects of Fluconazole
|
hepatitis and reversible alopecia (rare)
|
|
|
Adverse Effects of Voriconazole
|
acute blurring of vision with changes in color perception
|
|
|
Contraindications of Azoles
|
Midazolam and trizolam (benzos) - potentiation of their hypnotic and sedative effects
HMG-CoA reductase inhibitors - increased risk of rhabdomyolysis Intraconazole has been associated with heart failure - and monitor for hepatic toxicity |
|
|
Drug Interactions of Azoles
|
CYP450 drugs
Intraconazole - antacids, phenytoin, carbamazepine, digoxin, cyclosporine |
|
|
Adverse Effects of Isoniazid
|
N/V, hepatotoxicity, peripheral neuropathy, agranulocytosis, aplastic anemia, thrombocytopenia
|
|
|
Drug Interactions of Isoniazid
|
Inhibitor of CYP450
|
|
|
Adverse Effects of Rifampin
|
N/V/D, rash, hepatotoxicity, orange or red discoloration of sweat, tears, and urine
|
|
|
Drug interactions of Rifampin
|
Substrate and potent inducer of CYP450
|
|
|
Indication of Penicillin
|
Steptococci, meningococci, enterococci, penicillin-susceptible pneumococci, Treponema pallidum
Few gram-negative and Clostridium species |
|
|
Indications of Extended-Spectrum Penicillins
|
Gram-positive - streptococcal species, enterococcus, penicillin-susceptible pneumococci, Treponema pallidum
Gram-negative including H. flu and shigella |
|
|
What is ampicillin effective for?
|
Shigellosis
|
|
|
What are the antipseudomonal penicillins?
|
Ticarcillin and Piperacillin
|
|
|
True or False:
Piperacillin can treat Klebsiella |
True
|
|
|
What are the antistaphylococcal penicillins?
|
Dicloxacillin, Nafcillin, Oxacillin
|
|
|
Indications of Antistaphylococcal penicillins.
|
Infections caused by beta-lacamase-producing staphylococci; penicillin-susceptible strains of streptococci and pneumocoocci
|
|
|
Adverse Reactions of Antistaphylococcal Penicillins
|
Hypersensitivity, Seizures
Nafcillin - neutropenia Oxacillin - hepatitis Ampicillin - pseudomembranous colitis |
|
|
Indications of Beta-Lactam/Beta-Lactamase Inhibitors
|
Ampicillin/sulbactam (Unasyn) and Amoxicillin/Clavulanic Acid (Augmentin) - H. flu, M. cat, E. coli, Klebsiella, Proteus, Gonorrhea
Piteracillin/Tazobactam (Zosyn) and Ticarcillin/Clavulanic Acid (Timentin) - H. flu, M. cat, E. coli, Klebsiella, Proteus, Gonorrhea PLUS pseudomonas, enterobacter, salmonella |
|
|
Clinical Uses of Beta-Lactam/Beta-Lactamase Inhibitors
|
Septicemia, LRI, bone and joint, skin/skin structure, urinary tract, GYN, and intraabdominal infections
|
|
|
Adverse Effects of Beta-lactam/beta-lactamase inhibitors
|
N/V/D, pseudomembranous colitis, hypersensitivity, seizure
|
|
|
Examples of Carbapenems
|
Ertapenem (Invanz), Imipenem/Cilastin (Primaxin), and Meropenem (Merrem)
|
|
|
Indications of Carbepenems
|
Broad Spectrum
Gram-positive - streptococci and staphylococci Anaerobes Gram-negative - H. flu, M. cat, E. coli, Klebsiella, Pseudomonas, Enterobacter |
|
|
Which carbapenem isn't active against pseudomonas, acinetobacter, and enterococcus?
|
Ertapenem (Invanz)
|
|
|
Adverse Effects of Carbapenems
|
N/V/D, headache, rash, infusion-related, pseudomembranous colitis
Imipenem - seizures |
|
|
What cross-reacts with a penicillin allergy?
|
Carbapenems and cephalosporins
|
|
|
Examples of 1st Generation Cephalosporins
|
Cefadroxil, Cephalexin, Cephradine, Cefazolin
|
|
|
Activity of 1st Generation Cephalosporins
|
Gram-positive - pneumococci, streptococci, and staphylococci
Gram-negative - E. coli, Klebsiella, Proteus |
|
|
Clinical uses of 1st Generation Cephalosporins
|
UTIs, cellulitis, or soft tissue abscess
|
|
|
What 1st generation cephalosporin can be used for surgical prophylaxis?
|
IV cefazolin
|
|
|
Examples of 2nd Generation Cephalosporins
|
Cefuroxime, Cefprozil, Cefaclor, Loracarbef, Cefuroxime IV, Cefotetan IV, Cefoxitin IV
|
|
|
Activity of 2nd Generation Cephalosporins
|
Gram-positive - S. aureus, Streptococcus,
Gram-negative - H. flu, M. cat, Gonorrhea, Proteus, E. coli, Klebsiella |
|
|
Clinical Uses of 2nd Generation Cephalosporins
|
Sinusitis, Otitis, LRI
|
|
|
What two cephalosporins can treat peritonitis or diverticulitis?
|
Cefoxitin and Cefotetan
|
|
|
Which cephalosporin can be used to treat CAP?
|
Cefuroxime (Ceftin) because it is active against beta-lactamase producing H. flu and Klebsiella
|
|
|
Examples of 3rd Generation Cephalosporins
|
Cefixime, Cefpodoxime, Cefdinir, Cefditoren, Ceftriaxone, Ceftazidime, Cefotaxime
|
|
|
Activity of 3rd Generation Cephalosporins
|
Gram-positive - Staph. aureus, Streptococcus
Gram-negative - H. flu, gonorrhea, Proteus, E. coli, Klebsiella |
|
|
What are the only two cephalosporins that are active against Pseudomonas?
|
Ceftazadime (Fortaz) and Cefepime (Maxipime)
|
|
|
Which cephalosporin causes biliary sludging?
|
Rocephin
|
|
|
Clinical Uses of 3rd Generation Cephalosporins
|
Wide variety of infections
Ceftriaxone and cefotaxime - meningitis caused by pneumococci, meningococci, H. flu, but NOT listeria Sepsis of unknown origin Often combined with an aminoglycoside in neutropenic, febrile immunocompromised patients |
|
|
Which is the only true broad spectrum cephalosporin?
|
Cefepime (Maxipime)
|
|
|
Adverse Effects of Cephalosporins
|
Hypersensitivity
|
|
|
Activity of Aztreonam (Azactam)
|
Gram-negative rods (including pseudomonas and serratia)
No activity against gram-positive bacteria or anaerobes Resembles aminoglycosides in spectrum of activity |
|
|
Activity of Macrolides
|
Gram-positive - pneumococci, streptococci, staphylococci
Gram-negative - Neisseria, Bordetella pertussis, Mycobacterium, Legionella, Mycoplasms, Chlamydia |
|
|
Which Macrolide has activity against H. pylori?
|
Clarithromycin
|
|
|
Clinical Uses of Macrolides
|
Respiratory tract infections and STDs
Erythromycin - pertussis and mycoplasm Clarithromycin - H. pylori |
|
|
Activity of Tetracyclines
|
Gram-positive - pneumococci, Staph. aureus
Gram-negative - H. flu, Klebsiella, Legionella, Mycoplasm, Chlamydia, and many more |
|
|
Clinical Uses of Tetracyclines
|
STDs caused by chlamydia and syphillis; CAP, Lyme disease, RMSF, H. pylori, and acne
|
