Therapeutics 1

Front 1

MOA: all inhibit cell wall synthesis
Bactericidal (except enterococcus)
Time dependent killers

Back 1

beta-lactams

Front 2

Resistance of beta lactams (3)

Back 2

1. beta-lactamase degradation
2. penicillin binding protein alteration (main site of action)
3. decreased penetration

Front 3

Penicillin G (IV) and Penicillin VK (PO)

Back 3

natural penicillins

Front 4

Two natural penicillins

Back 4

pen G and pen VK

Front 5

this type of penicillins cover:
gram + (strep) and anaerobes above diaphragm

Back 5

natural penicillins (pen G and pen VK)

Front 6

This type of penicillin is the drug of choice for treating:
N meningitidis, syphilis

Back 6

natural penicillins

Front 7

Nafcillin and Oxacillin (IV), Dicloxacillin (PO)

Back 7

penicillinase-resistant penicillins

Front 8

Three penicillinase-resistant penicillins

Back 8

Nafcillin, Oxacillin, Dicloxacillin

Front 9

This type of penicillins cover:
gram + (strep, s. aureus- MSSA) and anaerobes above diaphragm

Back 9

penicillinase-resistant penicillins

Front 10

This type of penicillin is RAPIDLY BACTERICIDAL

Back 10

penicillinase-resistant penicillin

Front 11

Ampicillin (IV/PO) and Amoxicillin (PO)

Back 11

aminopenicillins

Front 12

Two aminopenicillins

Back 12

ampicillin and amoxicillin

Front 13

This type of penicillins covers:
gram + (strep, enterococcus faecalis), gram - (LIMITED-p. mirabilis, H. influenzae, Listeria) and anaerobes above diaphragm

Back 13

aminopenicillins (ampicillin and amoxicillin)

Front 14

This type of penicillin is the drug of choice for:
Listeria Monocytogenes (gram -)

Back 14

aminopenicillins

Front 15

Ticarcillin (IV) and Piperacillin (IV)
*aminopenicillin with increase gram - activity*

Back 15

extended spectrum penicillins

Front 16

Two extended spectrum penicillins

Back 16

ticarcillin and piperacillin

Front 17

This type of penicillin covers:
gram + (strep, enterococcus faecalis->piper only), gram - (EXTENDED-enterobacteriaceae, pseudomonas aeruginosa, H, influenzae) and anaerobes above and limited below diaphragm

Back 17

extended spectrum penicillins (ticarcillin and piperacillin)

Front 18

This type of penicillin is used primarily for treatment of severe infections

Back 18

extended spectrum penicillins

Front 19

these were developed to enhance activity against beta-lactamase producing organisms

Back 19

beta-lactamase inhibitor combos

Front 20

These inhibitor combos cover:
gram + (strep, MSSA, enterococcus), gram - (Excellent-enterobacteriaceae, h influenzae, moraxella, pseudomonas aeruginosa) and anaerobes above and below
**commonly used in polymicrobial infections!**

Back 20

beta-lactamase inhibitor combos

Front 21

Augmentin, Unasyn, Timentin, Zosyn

Back 21

beta-lactamase inhibitor combos

Front 22

Amoxicillin/Clavulanate, type of beta lactamase inhibitor combo?

Back 22

augmentin (PO)

Front 23

Ampicillin/sulhactam, type of beta lactamase inhibitor combo?

Back 23

unasyn

Front 24

Ticarcillin/clavulanate, type of beta-lactamase inhibitor combo?

Back 24

timentin

Front 25

piperacillin/tazobactam, type of beta-lactamase inhibitor combo?

Back 25

zosyn

Front 26

All penicillins cover what two things?

Back 26

strep and mouth anaerobes

Front 27

which penicillins cover gram + MSSA? (6)

Back 27

1. amp/sulbactam combo (unasyn)
2. amox/clav combo (augmentin)
3. dicloxacillin (penicillinase-resistant penicillin)
4. oxicillin (same)
5. piperacillin (+/-, extended spec)
6. pip/tazo combo (zosyn)

Front 28

Do any penicillins cover gram + MRSA?

Back 28

NO

Front 29

Which penicillins cover gram + E. faecalis? (6)

Back 29

1. ampicillin (aminopen)
2. amp/sulbactam (combo)
3. amoxacillin (aminopen)
4. amox/clav (combo)
5. piperacillin (extended spec)
6. pip/tazo (combo, zosyn)

Front 30

3 first generation cephalosporins (beta-lactams)

Back 30

1. cefadroxil
2. cephalexin
3. cefazolin (IV)

Front 31

5 second generation cephalosporins (beta lactams)

Back 31

1. cefaclor
2. cefprozil
3. cefuroxime
4. cefotetan (anaerobe activity)
5. cefoxitin (anaerobe activity)

Front 32

6 third generation cephalosporins (beta lactams)

Back 32

1. cefdinir
2. cefixime
3. cefpodoxime
4. ceftazidime (antipseudomonal activity)
5. cefotaxime
6. ceftriaxone

Front 33

1 fourth generation cephalosporin (beta lactam)

Back 33

cefepime (antipseudomonal activity)

Front 34

1 advanced cephalosporin

Back 34

ceftaroline fosamil (MRSA activity)

Front 35

Two cephalosporins with antipseudomonal activity?

Back 35

ceftazidime (3rd) and cefepime (4th)

Front 36

Two cephalosporins with anaerobe activity?

Back 36

cefotetan and cefoxitin (2nd both)

Front 37

Only cephalosporin with possible MRSA activity...

Back 37

ceftaroline

Front 38

Skin infections
SPEcK organisms
Coverage of these cephalosporins:
gram + (strep, MSSA), gram - (Proteus spp, E. Coli, Klebsiella spp) and anaerobes above diaphragm

Back 38

first generation cephalosporins
cefadroxil, cephalexin, cefazolin

Front 39

Lower resp. tract infxns or surgical site prophylaxis
HMN-SPEcK organisms
Coverage of these cephalosporins:
gram +(strep, MSSA), gram - (Proteus, E. Coli, Klebsiella, H. influenzae, M. catarrhalis, N. gonorrhoeae

Back 39

second generation cephalosporins
cefaclor, cefprozil, cefuroxime, cefotetan, cefoxitin

Front 40

Lower resp. tract infxns or serioius infxns
Strong inducers of beta-lactamase production
Coverage of these cephs:
gram + (strep, MSSA), gram - (enterobacteriaceae, H influenzae, M catarrhalis, N gonorrhoeae, P aerugiosa (ceftazidime), lyme (ceftriaxone) and anaerobes above diaphragm (b. fragilis-cefotetan, cefoxitin)

Back 40

third generation cephalosporins
cefdinir, cefixime, cefpodoxime, ceftibuten, ceftazidime, cefotaxime, ceftriaxone

Front 41

Treatment of serious nosocomial infxns
Increase stability against beta-lactamase hydrolysis
Coverage of these cephs:
gram + (strep, MSSA), gram - (increased activity against enterobacteriaceae, p aeurginosa) and anaerobes above diaphragm

Back 41

fourth generation cephalosporins
cefepime

Front 42

Recently FDA approved in fall 2010 for complicated skin soft tissue infxns and community acquired pneumonia

Back 42

ceftaroline fosamil (advanced gen. cephalosporin)

Front 43

Prodrug undergoes rapid dephosphorylation
Coverage of this ceph:
gram + (strep, MSSA, MRSA), gram - (similar to ceftraixone), anaerobes above diaphragm
**NO activity against nonlactose fermenters

Back 43

advanced gen. cephalosporins
ceftaroline fosamil

Front 44

ALL cephalosporins (beta lactams) have activity against which two gram negative bacteria?

Back 44

e. coli and klebsiella

Front 45

Only cephalosporin with MRSA activity?

Back 45

ceftaroline fosamil (advanced gen)

Front 46

All cephalosporins EXCEPT this one cover MSSA and strep, gram positive bacteria?

Back 46

cefepime (4th gen)

Front 47

Which two first generation cephs DON'T cover h. influenzae and all others do?

Back 47

cefazolin and cephalexin

Front 48

Which two cephalosporins cover p. aeruginosa?

Back 48

ceftazidime (3rd) and cefepime (4th)

Front 49

Which is the only cephalosporin to cover B. fragilis anaerobe?

Back 49

cefoxitin (2nd)

Front 50

Four carbapenems

Back 50

ertapenem, imipenem, meropenem, doripenem

Front 51

These beta lactams have broadest spectrum of antimicrobial activity
Use reserved for sever life threatening polymicrobial infxns due to multidrug resistant organisms

Back 51

carbapenems
erta/imi/mero/doripenem

Front 52

What is the administration route for carbapenems?

Back 52

parenteral admin only

Front 53

Coverage of this type of beta lactams:
gram + (strep, MSSA, E. faecalis), gram - (excellent-enterobacteriaceae, nonfermenting GNRs-p aeruginosa-except ertapenem) and anaerobes both above and below

Back 53

carbapenems

Front 54

This type of beta lactam has NO cross reactivity with penicillins and cephalosporins
Only parenteral admin and inhalation
Coverage:
gram + (NONE), gram - (most, enterobacteriaceae, non fermenting GNRs-p aeruginosa), anaerobes (NONE)

Back 54

monobactams
azetreonam

Front 55

Name only monobactam

Back 55

aztreonam

Front 56

Two common adverse effects with beta lactams

Back 56

allergic reactions (rash, fever) and gastrointestinal problems (GI upset-NVD, clostridium difficile colitis)

Front 57

Which beta lactam can be used in penicillin allergic patients due to no cross reactivity

Back 57

aztreonam (monobactam)

Front 58

These antibiotics were developed in response to growing resistance

Back 58

fluoroquinolones
cipro/moxi/levofloxacin

Front 59

MOA: nucleic acid synthesis inhibitors
inhibit bacterial topoisomerases nexessary for DNA synthesis
DNA Gyrase (gram -)
topoisomerase IV (gram +)

Back 59

fluoroquinolones
cipro, moxi, levo

Front 60

What type of activity do fluoroquinolones have

Back 60

concentration dependent bactericidal activity

Front 61

2 resistance methods of fluoroquinolones

Back 61

1. target site mutations
2. efflux pumps

Front 62

Spectrum of activity:
gram + (strep, MSSA) Moxi>levo>>cipro
gram - (enterobacteriaceae, h influenzae, m catarrhalis, neisseria, p aeruginosa (cipro and levo) cipro=levo>moxi
anaerobes (minimal)
atypical (respiratory pathogens)

Back 62

fluoroquinolones
moxi, cipro, levo

Front 63

which fluoroquinolones are best for strep and MSSA gram positives?

Back 63

levo and moxi.. cipro is less effctive

Front 64

All fluoroquinolones cover which three gram negative bacteria

Back 64

e coli, klebsiella, h influenzae
cipro and levo cover p aeruginosa

Front 65

atypicals covered by fluoroquinolones? 3

Back 65

legionella, c. pneumoniae, m. pneumoniae

Front 66

fluoroquinolone adverse effects profile inclues what major cardiac risk and what black box warning

Back 66

cardiac= torsades de pointes
black box=articular damage, tendon ruptures

Front 67

divalent and trivalent cations decrease absorption
QT prolonging agents increase AEs risk
corticosteroids increase tendon rupture risk

Back 67

Drug interactions for fluoroquinolones

Front 68

MOA: 50S ribosome protein synthesis inhibitor

Back 68

macrolide

Front 69

what type of activity do macrolides have

Back 69

time dependent bacteriostatic activity

Front 70

2 resistance methods for macrolides

Back 70

target site mutations and efflux pumps

Front 71

Coverage of these protein synthesis inhibitors:
gram + (strep, MSSA, s pneumonia -emerging resistance)
gram - (minimal, h influenzae, m catarrhalis)
anaerobes- mouth only
atypicals (legionella, chlamydia, mycoplasma)
others (helicobactor pylori (clarithro), mycobacterium avium complex MAC

Back 71

macrolides spec of activity

Front 72

GI: NVD, ab pain/cramps
erythro>>clarithro>azithro
Cardiac: QT prolongation, ventric, tachycardia, same as above
Increase transaminases
Ototoxicity
Allergic rxns

Back 72

adverse effects for macrolides
eryth/clarith/azithromycin

Front 73

Three macrolides

Back 73

erythro, clarithro, azithromycin

Front 74

Erythro>> clarithro are STRONG INHIBITORS of which cytochrome p450 system

Back 74

3A4--decreased substrate clearance

Front 75

Coverage of these protein synthesis inhibitors:
gram + (strep, MSSA, s pneumonia -emerging resistance)
gram - (minimal, h influenzae, m catarrhalis)
anaerobes- mouth only
atypicals (legionella, chlamydia, mycoplasma)
others (helicobactor pylori (clarithro), mycobacterium avium complex MAC

Back 75

macrolides spec of activity

Front 76

GI: NVD, ab pain/cramps
erythro>>clarithro>azithro
Cardiac: QT prolongation, ventric, tachycardia, same as above
Increase transaminases
Ototoxicity
Allergic rxns

Back 76

adverse effects for macrolides
eryth/clarith/azithromycin

Front 77

Three macrolides

Back 77

erythro, clarithro, azithromycin

Front 78

Erythro>> clarithro are STRONG INHIBITORS of which cytochrome p450 system

Back 78

3A4--decreased substrate clearance

Front 79

MOA:
30S ribosome protein synthesis inhibitor
Time dependent bacteriostatic activity

Back 79

tetracycline

Front 80

Name the three tetracyclines

Back 80

doxy/tetra/minocycline

Front 81

Type of activity do tetracyclines have

Back 81

time dependent bacteriostatic

Front 82

Isolates resistant/intermediate to tetracycline may be susceptible to

Back 82

doxy/minocycline

Front 83

Resistance methods for tetracyclines

Back 83

target site mutations and efflux pumps

Front 84

Spectrum of activity of these:
gram + (strep, MSSA and MRSA, mino>doxy)
gram - (minimal, h influenzae and m catarrhalis
anaerobes mouth only
atypical (legionella, chlamydia, mycoplasma
others (helicobacter pylori-2nd line, borrelia burgdorgeri-lyme, propionibacterium acnes)

Back 84

tetracyclines
mino/doxy/tetra

Front 85

MOA:
30S ribosome protein synthesis inhibitor
Time dependent bacteriostatic activity

Back 85

tetracycline

Front 86

Name the three tetracyclines

Back 86

doxy/tetra/minocycline

Front 87

Type of activity do tetracyclines have

Back 87

time dependent bacteriostatic

Front 88

Isolates resistant/intermediate to tetracycline may be susceptible to

Back 88

doxy/minocycline

Front 89

Resistance methods for tetracyclines

Back 89

target site mutations and efflux pumps

Front 90

Spectrum of activity of these:
gram + (strep, MSSA and MRSA, mino>doxy)
gram - (minimal, h influenzae and m catarrhalis
anaerobes mouth only
atypical (legionella, chlamydia, mycoplasma
others (helicobacter pylori-2nd line, borrelia burgdorgeri-lyme, propionibacterium acnes)

Back 90

tetracyclines
mino/doxy/tetra

Front 91

major adverse effect of tetracycline

Back 91

deforms and discolors teeth-avoid in kids < 8yo

Front 92

this class of drugs interacts with anticonvulsants and penicillins as well as divalent and trivalent cations

Back 92

tetracyclines

Front 93

this tetracycline derivative has broad spectrum:
gram + (strep, MRRA, MRSA, enterococcus VRE)
gram - (broad-respiratory MOs, enterobacteriaceae, acinetobactor and stenotrophomonas)
anaerobes (above and below diaphragm)
atypicals (legionella, chlamydia, mycoplasma)

Back 93

glycycline (tegecycline)

Front 94

Adverse effects of this tetracycline derivative:
N/V, hyperbilirubinemia

Back 94

glycycline (tigecycline)

Front 95

MOA:
30S ribosomal protein synthesis inhibitors

Back 95

aminoglycosides

Front 96

What type of activity do aminoglycosides have

Back 96

concentration dependent bactericidal activity

Front 97

Resistance:
inactivation enzymes
decrease intracellular penetration

Back 97

aminoglycosides

Front 98

Name the three aminoglycosides

Back 98

gentamicin, tobramycin, amikacin

Front 99

This class of protein synthesis inhibitors is very HYDROPHILIC and distributes widely into body fluids (NOT CSF) and has dosing based on body weight

Back 99

aminoglycosides

Front 100

Spectrum of activity:
gram + (ONLY in combo with CELL WALL INHIBITOR-s. aureus and coagulase negative staph, viridans strep, enterococcus-gent/streptomycin)
gram - (majority-enterobacteriaceae, nonfermenting acinetobacter, p aeruginosa-amikacin>tobra>gent)
NO anaerobes
mycobacteria

Back 100

aminoglycosides

Front 101

major adverse effect of tetracycline

Back 101

deforms and discolors teeth-avoid in kids < 8yo

Front 102

this class of drugs interacts with anticonvulsants and penicillins as well as divalent and trivalent cations

Back 102

tetracyclines

Front 103

this tetracycline derivative has broad spectrum:
gram + (strep, MRRA, MRSA, enterococcus VRE)
gram - (broad-respiratory MOs, enterobacteriaceae, acinetobactor and stenotrophomonas)
anaerobes (above and below diaphragm)
atypicals (legionella, chlamydia, mycoplasma)

Back 103

glycycline (tegecycline)

Front 104

Adverse effects of this tetracycline derivative:
N/V, hyperbilirubinemia

Back 104

glycycline (tigecycline)

Front 105

MOA:
30S ribosomal protein synthesis inhibitors

Back 105

aminoglycosides

Front 106

What type of activity do aminoglycosides have

Back 106

concentration dependent bactericidal activity

Front 107

Resistance:
inactivation enzymes
decrease intracellular penetration

Back 107

aminoglycosides

Front 108

Name the three aminoglycosides

Back 108

gentamicin, tobramycin, amikacin

Front 109

This class of protein synthesis inhibitors is very HYDROPHILIC and distributes widely into body fluids (NOT CSF) and has dosing based on body weight

Back 109

aminoglycosides

Front 110

Spectrum of activity:
gram + (ONLY in combo with CELL WALL INHIBITOR-s. aureus and coagulase negative staph, viridans strep, enterococcus-gent/streptomycin)
gram - (majority-enterobacteriaceae, nonfermenting acinetobacter, p aeruginosa-amikacin>tobra>gent)
NO anaerobes
mycobacteria

Back 110

aminoglycosides

Front 111

Aminoglycosides only cover gram + bacteria when used in combination with

Back 111

cell wall inhibitor (beta-lactam or glycopeptides)

Front 112

which aminoglycoside is best for treating the majority of gram - bacteria?

Back 112

amikacin>tobra>gent

Front 113

Adverse effects profile of:
nephrotoxicity
ototoxicity (irreversible)-vestibular and cochlear/auditory
neuromuscular paralysis (RARE)

Back 113

aminoglycosides

Front 114

gram positive agents:
MOA: inhibits bacterial cell wall synthesis at final stage of peptidoglycan polymers (glycopeptide)

Back 114

vancomycin

Front 115

what type of activity does vancomycin have

Back 115

time dependent bactericidal activity

Front 116

Resistance:
modification of D-alanyl-D-analine binding site --> site of action

Back 116

vancomycin

Front 117

Spectrum of activity:
gram + (BROAD-staph MSSA, MRSA, s epidermidis, strep, enterococcus, corynebacterium, bacillus)
NO GRAM -
anaerobes (gram + ONLY, c. difficile)

Back 117

vancomycin

Front 118

How long are procurement files kept for your purchase card statement?

Back 118

3 years
(SAP, 5-9)

Front 119

gram positive agent
MOA:
inhibits bacterial protein synthesis by binding to bacterial 23S ribosomal RNA of the 50S subunit
(oxazolidinone)

Back 119

linezolid

Front 120

What type of activity does linezolid have

Back 120

time dependent bacteriostatic activity EXCEPT FOR STREP-cidal

Front 121

Resistance:
active against nearly all Abx resistant gram + bacteria

Back 121

linezolid

Front 122

This gram + agent should only be used if you KNOW you have multidrug resistance... NEVER as first line therapy, very potent and don't want to overuse

Back 122

linezolid

Front 123

Spectrum of activity: ONLY GRAM +
Gram + (broad-staph MSSA, MRSA, s. epidermidis, strep, enterococcus faecium & faecalis including VRE, corynebacterium)
NO Gram - and Anaerobes
Other: mycobacterium

Back 123

linezolid

Front 124

Adverse effects profile:
reversible bone marrow suppression
GI
HA/dizziness
optic neurtitis or peripheral neuropathy

Back 124

linezolid

Front 125

This gram + agent interacts with foods HIGH IN TYRAMINE: aged, fermented, pickled, smoked, cheese, pepperoni, soy sauce, red wines and beer

Back 125

linezolid

Front 126

Serotonin syndrome is possible when this drug is used in tyramine rich foods or serotonergic medications (SSRIs, MAOIs)

Back 126

linezolid

Front 127

gram + agents
MOA:
binds to bacterial membrane and causes rapid depolarization of the membrane potential, inhibiting synthesis of protein, DNA and RNA
(protein synthesis inhibitor as well as nucleic acid synthesis inhibitor)

Back 127

daptomycin

Front 128

this gram + agent is very expensive... weight based dosing

Back 128

daptomycin

Front 129

This gram + agent is INEFFECTIVE for pneumonia, used primarily for complicated skin infections, bacteremia

Back 129

daptomycin

Front 130

Resistance: RARE
membrane alterations and decreased binding

Back 130

daptomycin

Front 131

This gram + agent has poor absorption and low distribution, no CSF penetration and poor bone penetration

Back 131

daptomycin

Front 132

Spectrum of activity: GRAM + ONLY
Gram + (broad= staph MSSA, MRSA, s. epidermidis, strep, enterococcus faecium and faecalis VRE, corynbacterium)
NO Gram - or anaerobes

Back 132

daptomycin

Front 133

Adverse effects: usually well tolerated
Myopathy and increase creatine phosphokinase

Back 133

daptomycin

Front 134

gram + agents
MOA: sequential inhibition of folinic acid synthesis-->necessary for microbial DNA production
1. inhibits dihydropteroate synthase
2. inhibits dihydrofolate reductase
(metabolic inhibitor)

Back 134

trimethoprim/sulfamethoxazole TMP/SMX

Front 135

Individually these gram + agents are _______ but in combination they are ________

Back 135

static, cidal

Front 136

Resistance:
point mutations in target enzymes (dihydrofoliate reductase and dihydropteroate synthase

Back 136

TMP/SMX

Front 137

Absorption: rapid and complete
Distribution: wide
Metabolism and Elimination:
1. extensive liver metab
2. some liver metab

Back 137

TMP/SMX

Front 138

Spectrum of activity:
Gram + (staph MSSA, MRSA, S. saprophyticus, strep, nocardia, listeria)
Gram - (most enterobacteriacae, STENOTROPHOMONAS MALTOPHILIA-drug of choice!!!)
Anaerobes- mouth only
Others: Pneumocystis carinii (PCP)

Back 138

TMP/SMX

Front 139

Drug of choice for Stenotrophomonas maltophilia

Back 139

TMP/SMX

Front 140

Adverse effects:
GI: NV
Hematologic: bone marrow supp.
Hypersensitivity: rash, fever
Hyperkalemia: high doses
Neurologic: HA, ataxia, tremors
Renal: pseudo increas Scr

Back 140

TMP/SMX

Front 141

Name the gram positive agents: (4)

Back 141

1. vancomycin
2. linezolid
3. daptomycin
4. TMP/SMX

Front 142

anti-anaerobic agents
MOA:
inhibits ribosomal protein synthesis (lincosamine)

Back 142

clindamycin

Front 143

Alternative to penicillin allergic patients for strep and staph infections

Back 143

clindamycin

Front 144

What type of activity does clindamycin have

Back 144

variable bacteriostatic or bactericidal activity

Front 145

Spectrum of activity:
Gram + (MSSA and some MRSA, strep)
NO GRAM -
Anaerobes-mouth and limited b. fragilis

Back 145

clindamycin

Front 146

Resistance:
ribosomal mutations
binds in close proximity to macrolides, confers resistance to both

Back 146

clindamycin

Front 147

Absorption: rapid and complete
Distribution: high concentrations in body fluids and bones, NOT CSF
Metabolism and elimination: liver, excreted in feces and bile

Back 147

clindamycin

Front 148

Adverse effects profile:
DIARRHEA-c. difficile colitis

Back 148

clindamycin

Front 149

anti-anaerobic agents
MOA:
interacts with DNA causing strand breakage via ferrozid and ultimately inhibition of nucleic acid synthesis
(fluoroquinolone)

Back 149

metronidazole (fluoroquinolone0

Front 150

What type of activity does metronidazole have

Back 150

concentration dependent bactericidal activity

Front 151

Resistance in metronidazole?

Back 151

uncommon

Front 152

Absorption: rapid and complete
Distribution: widely-saliva, bile, seminal fluid, bone, liver, good CSF penetration
Metabolism and elimination: liver, kid excretes most unchanged

Back 152

metronidazole (fluoroquinolone)

Front 153

Spectrum of activity:
Gram + and - anaerobes:
bacteroides, fusobacterium, prevotella, peptostretococcus, clostridium
H pylori
Anaerobic protozoa:
trichomonas vaginalis, giardia, gardnerella vaginalis

Back 153

metronidazole

Front 154

Drug of choice for c. difficile colitis (clostridium)

Back 154

metronidazole (fluoroquinolone)

Front 155

Adverse effects profile;
GI: metalic taste
dark urine
CNS: HA, insomnia
neuromuscular: peripheral neuropathy
Disulfiram like reaction: NO CONCURRENT ALCOHOL FOR AT LEAST 48 HOURS POST TREATMENT

Back 155

metronidazole

Front 156

which anti-anaerobic has a disulfiram-like reaction when used with alcohol?

Back 156

metronidazole

Front 157

DDIs:
warfarin-increase anticoag effect
alcohol and lopi/ritonavir liquid-disulfiram rxn
phenytoin-increases [phenytoin]
lithium- increase [lithium]
barbs and rifampin-decrease this drug

Back 157

metronidazole

Front 158

11 drugs that cover p. aurginosa

Back 158

1. aminoglycosides (gent, tobra, amikacin)
2/3. cipro/levofloxacin (fluoroquinolones besides moxi)
4/5. ceftazidime, cefepime (3rd and 4th gen cephs)
6/7. piperacillin, ticarcillin (extended spec penicillins)
8. aztreonam (monobactam)
9/10/11. imipenem, meropenem, doripenem (carbapenems besides ertapenem)

Front 159

8 drugs that cover MRSA

Back 159

1. Ceftaroline (advanced ceph)
2. Vancomycin (gram + agent, glycopeptide)
3. Linezolid (Oxazolidinone)
4. Daptomycin (lipopeptide)
5. Tigecycline (tetracycline)
6. Tetracyclines-mino>>doxy
7. Clindamycin (lincosamide)
8. TMP/SMX (sulfonamide)

Front 160

General therapeutic monitoring includes which 5 areas:

Back 160

fever, WBC, symptomatic improvement, renal function, drug levels

Front 161

Goal [trough] of vancomycin

Back 161

10-20 mcg/ml