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31 Cards in this Set
- Front
- Back
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MoA
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inhibit protein synthesis by binding to 30S (and/or 50S) ribosomal subunits
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gram positive activity (4)
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Synergy...
1. Staph 2. Strep 3. Listeria 4. Enterococci |
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gram negative activity (6)
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1. Enterobacteriaceae (Escherichia coli, Proteus sp., Enterobacter sp., Klebsiella sp., Serratia sp., etc.)
2. Acinetobacter sp. 3. Pseudomonas aeruginosa 4. M. catarrhalis 5. H. influenzae 6. Neisseria sp. |
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mycobacteria (2)
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1. M. tuberculosis: streptomycin, kanamycin, amikacin
2. M. avium-intracellular (MAI): amikacin |
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miscellaneous (3)
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1. Yersinsia pestis (plague): streptomycin, gentamicin
2. Francisella tularensis (tularemia): streptomycin, gentamicin 3. Brucellosis: streptomycin, gentamicin |
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poor coverage of... (3)
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1. S. pneumoniae
2. anaerobes 3. monotherapy vs. gram-positives |
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activity vs Pseudomonas aeruginosa
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tobra > gent
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activity vs Serratia
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gent > tobra
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amikacin use
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reserved for organisms resistant to gentamicin & tobramycin
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synergy for gram (+)
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for serious strep, staph, listeria, enterococci infections combined w/ β-lactam or vancomycin
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anti-TB regimens
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SKA
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atypical mycobacterial infections
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ex. MAI: amikacin
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MIC (2)
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gent/tobra: less than 2 mcg/ml
amikacin: less than 4 – 8 mcg/ml |
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nephrotoxicity MoA
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aminoglycosides are taken up into renal tubules, and cause accumulation of phospholipids in renal tubules and cellular toxicity
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nephrotoxicity incidence
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55%
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relative drug nephrotoxicity
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gentamicin > tobramycin = amikacin > streptomycin
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ototoxicity MoA
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alters Na/K pump function causing changes in intracellular osmotic pressure within the endolymph
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ototoxicity incidence
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43% including subclinical presentations
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other AE (2)
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1. neuromuscular blockade
2. endotoxin-like reactions (larger PO doses) |
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other nephrotoxins (4)
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1. loop diuretics
2. vancomycin 3. amphotericin B 4. cyclosporine |
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other ototoxins (2)
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1. loop diuretics
2. vancomycin |
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Zosyn & AG
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piperacillin/tazobactam
inactivates AG in test tubes to give incorrect level |
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bacterial kill
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concentration-dependent killing
peak:MIC optimal at 8-12 : 1 |
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PAE?
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yes
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large doses & nephrotoxicity?
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will not ↑ nephrotoxicity, but may even lessen it
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route of excretion (2)
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1. renally 85-95%
2. biliary 5-15% |
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routes of administration (2)
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1. IM (very erratic)
2. IV |
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traditional empiric dosing limitations (2)
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1. not individualized
2. doesn’t account for disposition |
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traditional nomograms (Hull-Sarubbi Nomogram) limitations (3)
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1. dosing weight does not account for PT population
2. doesn’t look at follow-up dosing & allow for changing doses 3. no dose suggestion for CrCl <10 ml/min |
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large single daily dosing methods (2)
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1. modified
2. Hartford Nomogram |
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hemodialysis timing
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0.5 hours before dose & 2 hours after end of infusion
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