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NAPLEX STUDY > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Key Counseling points: Azole antifungals

A

can cause liver damage, QT prolongation (except cresemba), many drug interactions

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2
Q

Key Counseling points: Ketoconazole

A

hepatotoxicity has led to liver damage and/or death, possible drug interactions due to high gastric pH (need acidic environment)

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3
Q

Key Counseling points: Itraconazole

A

tablets and capsules must be taken with food, solution must be taken on an empty stomach, can cause heart failure, possible drug interactions due to high gastric pH (need acidic environment)

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4
Q

Key Counseling points: Posaconazole (Noxafil)

A

tablets - take with food
suspension - take with full meal or oral liquid nutritional supplement

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5
Q

Key counseling points: Voriconazole (Vfend)

A

take on an empty stomach - at least one hour before or one hour after meals, can cause photosensitivity and vision changes, store reconstituted oral suspension at room temperature

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6
Q

Key counseling points: nystatin

A

oral suspension - shake well before using

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7
Q

Key counseling points: terbinafine

A

oral - can cause liver damage, can take several months after finishing treatment to see the full benefit of this drug - takes time for new healthy nails to grow and replace the infected ones

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8
Q

Key counseling points: oseltamivir

A

treatment should begin within 2 days of onset of influenza symptoms, can cause delirium

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9
Q

Key counseling points: acyclovir and valacyclovir

A

does not cure herpes infections - use safe practices to lower transmission risk, start treatment within 24 hours of the onset of symptoms

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10
Q

Key counseling points: acyclovir

A

drink plenty of fluids, topical cream can cause temporary burning and stinging

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11
Q

ZDS <3 LATTE (NRTIs)

A

Zidovudine
Didanosine (NLR)
Stavudine (NLR)
Lamivudine
Abacavir
TDF
TAF
Emtricitabine

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12
Q

NRTIs

A

competitively inhibit the reverse transcriptase enzyme - preventing the conversion of HIV RNA to HIV DNA in Stage 3 of the HIV Life cycle
[low barrier to resistance]

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13
Q

All NRTIs

A

lactic acidosis and hepatomegaly with steatosis (fatty liver); boxed warning for didanosine, stavudine, and zidivudine
-common side effects: nausea, diarrhea, headache, increased LFTs

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14
Q

NRTIs: HBV and HIV Confection boxed warnings

A

severe acute HBV exacerbation can occur if emtricitabine, lamuvidine, or tenofovir-containing products are discontinued (some NRTIs treat HBV). DO NOT USE Epivir-HBV for the treatment of HIV (contains lower dose of lamivudine)

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15
Q

Abacavir (Ziagen)

A

-boxed warning for HSR
-must be screened for HLA-B*5071 allele before starting
-must carry a card indicating HSR is an emergency
-never re-challenge patients with a history of HSR
-Consider avoid with CVD due to a potential increase risk of MI

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16
Q

Emtricitabine (Entrivia)

A

hyperpigmentation of the palms of the hands or soles of the feet

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17
Q

Tenofovir Formulations (Higher risk with TDF)

A

-renal impairment (acute renal failure and Fanconi syndrome)
-decrease dose with renal impairment and avoid other nephrotoxic drugs
-decrease bone mineral density: consider calcium/vitamin D supplementation and DEXA scan
-monitor lipids if switching from TDF to TAF for an improved side effect profile

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18
Q

Zidovudine

A

-hematologic toxicity: neutropenia and anemia (increased MCV is a sign of adherence)
-myopathy

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19
Q

Didanosine and stavudine

A

pancreatitis, peripheral neuropathy (can be irreversible)

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20
Q

BRED

A

Bictegravir
Raltegravir
Elvitegravir
Dolutegravir

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21
Q

BRED Side Effects and Warnings

A

-Bictagravir and dolutegravir; increase SCr with no effect on GFR
-Raltegravir; increase CPK, myopathy, and rhabdo
-Elvitegravir; proteinuria
-Dolutegravir; HSR, neural tube defects in fetus, increased CPK/myalgia
-All: HA, insomnia, D, weight gain, rare risk of depression and suicidal ideation in patients with pre-existing psychiatric conditions (except bictegravir)

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22
Q

Preferred regimen for HIV

A

2 NRTI and 1 INSTI

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23
Q

INSTIs drug interaction with polyvalent cations

A

Take INSTIs 2 hours before or 6 hours after; aluminum, calcium, magnesium and iron-containing products - except for dolutegravir, bictegravir, and raltegravir

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24
Q

Polyvalent cations and dolutegravir and bictegravir

A

can be taken with oral calcium or iron if also taken with food

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25
Q

Polyvalent cations and raltegravir

A

dose separations with raltegravir may not be effective; avoid polyvalent cations if possible

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26
Q

INSTIs

A

block the integrase enzyme, preventing HIV DNA from inserting into the host cell DNA in stage 4 (integration) of the HIV life cycle
-higher barrier to resistance than NRTIs and NNRTIs

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27
Q

NRTIs

A

non-competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA in stage 3 (reverse transcription) of the HIV life cycles
-lower barrier to resistance than INSTIs or PIs

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28
Q

REDDEN

A

Rilpivirine, Efavirenz, Doravirine, Delavirdine (NLR), Etravirine, Nevirapine

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29
Q

All NNRTIs

A

hepatotoxicity and rash/severe rash, including SJS/TEN

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30
Q

Efavirenz

A

psychiatric symptoms (depression, suicidal thoughts), CNS effects (impaired concentration, abnormal dreams, confusion), generally resolve in 2-4 weeks, increase total cholesterol and TG

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31
Q

Rilpivirine

A

depression, increased SCr with no effect on GFR, do not use if viral load > 100,000 copies/mL and/or CD4 count < 200 cells/mm3 (higher failure rate), take with a meal and water (DO NOT substitute with a protein drink)

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32
Q

NNRTI drug interactions

A

all are major CYP3A4 substrates. Rilpivirine and doravirine - do not use with strong CYP3A4 inducers (carbamazepine, oxacarbazepine, phenobarbital, phenytoin, rifampin, rifapentine, St. Johns Wort)
-efavirenz and etravirine are moderate CYP3A4 inducers
-rilpivirine and acid suppressants

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33
Q

Rilpivirine and PPIs

A

DO NOT USE

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34
Q

Rilpivirine and H2RAs

A

take at least 12 hours before or 4 hours after rilpivirine

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35
Q

Rilpivirine and antacids

A

take antacids at least 2 hours before or 4 hours after rilpivirine

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36
Q

-navir

A

protease inhibitor

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37
Q

PI key features and safety

A

-metabolic abnormalities (increased LDL/TG & blood glucose, insulin resistance, increased risk of CVD (lowest risk with atazanavir and darunavir & highest with LPV/r)
-hepatic dysfunction (increased LFTs, hepatitis, and/or exacerbation of preexisting hepatic disease)
-HSR
-D/N

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38
Q

Atazanavir (Reyataz)

A

-hyperbilinrubinemia (reversible does not require discontinuation)
-requires acidic gut for absorption

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39
Q

Atazanavir and antacids

A

take atazanavir 2 hours before or 1 hour after

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40
Q

Atazanavir and H2RAs

A

avoid or take atazanavir 2 hours before or 10 hours after

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41
Q

Atazanavir and PPIs

A

-avoid with unboosted atazanavir
-boosted atazanavir: take boosted at least 12 hours after the PPI (dose should not exceed omeprazole 20 mg or equivalent)

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42
Q

Darunavir, fosamprenavir, tipranavir

A

caution with sulfa allergy

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43
Q

LPV/r (Kaletra)

A

oral solution contains 42% alcohol can cause a disulfram reaction if taken with metronidazole

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44
Q

Tipranavir

A

intracranial hemorrhage

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45
Q

PIs and CYP3A drug interactions

A

alfuzosin, colchicine, dronedarone, lovastatin and simvastatin, CYP3A4 inducers, anticoagulants/antiplatelets (apixaban, rivaroxaban, edoxaban, ticagrelor), direct acting-antivirals for hepatitis C, some hormonal contraceptives, steroids

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46
Q

PIs and warfarin

A

not contraindicated but should monitor INR frequently

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47
Q

Which HMG-CoA can be used with PIs

A

rosuvastatin and atorvastatin are preferred

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48
Q

Pharmacokinetic boosters

A

ritonavir (Norvir) and cobicistat (Tybost)

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49
Q

which pharmacokinetic booster can be co-formulated

A

cobicistat

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50
Q

Booster drug interactions

A

Alfuzosin, tamsulosin
Colchicine (with hepatic or renal impairment),
Lovastatin and simvastatin,
Azole antifungals (especially isavuconazonium, itraconazole, or voriconazole),
Cardiovascular drugs: amiodarone (ritonavir only), dronedarone, eplerenone, ivabradine, ranolazine,
PDE-5 inhibitors used for pulmonary hypertension (tadalafil, sildenafil) (dose reductions required if taking it for erectile dysfunction or BPH),
Many tyrosine kinase inhibitors (nibs),
CYP3A4 inducers
Any NTI drug that is highly dependent on CYP3A4 for clearance

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51
Q

CCR5 Antagonist

A

Blocks HIV from binding (and subsequently entering) the CD4 cell in virus strains that use CCR5 co-receptor in stage 1 of the HIV life cycle

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52
Q

Attachment Inhibitor

A

Converted to temsavir (active form) which binds to the gp120 subunit of HIV envelope proteins, inhibiting the interaction between the virus and CD4 host cell in stage 1 of the cell cycle

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53
Q

Post-attachment Inhibitor

A

Binds to a select domain of CD4 cell receptors in stage 1 (binding/attachment) of the HIV life cycles, blocking entry of the virus into the cell

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54
Q

Fusion Inhibitor

A

Prevents HIV from fusing to the CD4 cell membrane in stage 2 (fusion) of the HIV life cycle, which prevents virus entry into the cell

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55
Q

TDF

A

CrCl < 50 mL/min: do not start - TDF or TDF containing products (< 70 mL/min for Stribild)

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56
Q

TAF

A

CrCl < 30 mL/min: do not start TAF containing products

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57
Q

Stribild

A

Eltivegravir/ cobicistat/ emtricitabine/ TDF
-take with food

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58
Q

Atripla

A

Efavirenz / emtricitabine/ TDF
-take on an empty stomach

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59
Q

Complera

A

Rilpivirine/ emtricitabine/ TDF
-take with food

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60
Q

Genvoya

A

Elvitegravir/ cobicistat/ emtricitabine/ TAF
-take with food

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61
Q

Biktarvy

A

bictegrvair/ emtricitabine/ TAF

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62
Q

Triumeq

A

Dolutegravir/ abacavir/ lamivudine

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63
Q

Dovato

A

dolutegravir/ lamivudine

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64
Q

Odefsey

A

Rilpivirine/ emtricitabine/ TAF
-take with food

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65
Q

Descovy

A

Emtricitabine/ TAF
-do not use if CrCl < 30 mL/min

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66
Q

Truvada

A

Emtricitabine/ TDF
-do not use if CrCl < 30 mL/min
-do not use if CrCl < 60 mL/min if using for PrEP

67
Q

Diagnosis of aids

A

CD4 count < 200 cells/mm3 or an AIDs defining illness

68
Q

breastfeeding in HIV + patients

A

should be avoided

69
Q

combination drugs for HIV+ pregnant patients

A

Epzicom, Truvada, Cimduo

70
Q

PrEP

A

-Truvada or Descovy
-IM Inj of Cabotegravir (Apretude) - administered by a healthcare provider monthly for 2 doses then every 2 months

71
Q

Follow-up for PrEP

A

-truvada and Descovy: 3 months
-Cabotegravir: 1 month after the first injection then every 2 months

72
Q

PEP

A

-treatment should be started ASAP within 72 hrs of exposure and continued for 28 days
-Truvada, Tivicay or Isentress
-should receive baseline HIV Ab test and follow-up test at 4-6 weeks, 3 months and 6 months after the exposure

73
Q

Common Resistant Pathogens: Kill Each And Every Strong Pathogen

A

-Klebsiella pneumoniae (ESBL, CRE)
-E. Coli (ESBL, CRE)
-E. Facalis, E. Faecium (VRE)
-Staph Aureus (MRSA)
-Pseudomonas

74
Q

Hydrophilic antibiotics

A

beta-lactams, aminoglycosides, vancomycin, daptomycin, polymixins

75
Q

Lipophilic antibiotics

A

quinolones, macrolides, rifampin, linezolid, tetracyclines

76
Q

Natural penicillins

A

Penicillin V Potassium
Penicillin G
Penicillin G Benzathine

77
Q

Antistaphylococcal Penicillin

A

Dicloxacillin, Nafcillin, Oxacillin

78
Q

Aminopenicillin

A

amoxicillin, augmentin, ampicillin, unasyn

79
Q

Extended-spectrum penicillins

A

zosyn

80
Q

Class effects of penicillins

A

-should be avoided in patients with beta-lactam allergy > except treatment of syphillis during pregnancy or patients with poor compliance
-risk of seizures due to accumulation

81
Q

Penicillin VK

A

first line treatment for strep throat and mild nonpurulent skin infections (no abscess)

82
Q

Amoxicillin

A

-first line treatment for AOM
-DOC for infective endocarditis ppx before dental procedures
-used in H. pylori tx

83
Q

Augmentin

A

-first line treatment for AOM and bacterial sinusitis
-use lowest dose of clavulante to decrease diarrhea

84
Q

Dicloxacillin

A

-covers MSSA only
-no renal adjustment needed

85
Q

Penicillin G Benzathine

A

-DOC for syphillis
-Not for IV use; can cause death

86
Q

Nafcillin and Oxacillin

A

covers MSSA & no renal adjustment required

87
Q

Zosyn

A

-only penicillin active agent against pseudomonas
-extended infusions (4 hours) can be used to maximize T > MIC

88
Q

1st gen cephalosporin

A

cefazolin & cephalexin

89
Q

2nd gen cephalosporin

A

cefuroxime, cefotetan, cefoxitin

90
Q

3rd gen cephalosporin (group 1)

A

cefdinir, CTX, cefotaxime, cefpodoxime

91
Q

3rd gen cephalosporin (group 2)

A

ceftazidime - lacks gram positive activity but covers pseudomonas

92
Q

4th gen cephalosporin

A

cefepime

93
Q

5th gen cephalosporin

A

ceftaroline

94
Q

Cephalosporin class effect

A

-do not use in patients with penicillin allergy (except pediatric patients with AOM)
-risk of seizures if accumulation occurs

95
Q

Cephalexin

A

used in skin infections (MSSA), strep throat

96
Q

Cefuroxime

A

commonly used in AOM & CAP

97
Q

cefdinir

A

commonly used in AOM

98
Q

Cefazolin

A

commonly used in surgical ppx

99
Q

cefotetan and cefoxitin

A

-anaerobic coverage (B. fragilis)
-commonly used in surgical ppx (GI procedures)
-cefotetan can cause disulfram-like reactions with alcohol ingestion

100
Q

CTX and Cefotaxime

A

-common uses: CAP, meningitis, SBP, pyleonephritis
-CTX: no renal adjustment, do not use CTX in neonates

101
Q

Ceftazidime and Cefepime

A

active against pseudomonas

102
Q

Cetolozane/Tazobactam (Zerbaxa) and Ceftazidie/Avibactam (Avycaz)

A

used for MDR Gram-negative organisms (including pseudomonas)

103
Q

Ceftaroline

A

-only beta-lactam active against MRSA
-common uses: CAP, skin and soft tissue infections

104
Q

Carbapenem

A

doripenem, imipenem/cilstatin, meropenem, ertapenem

105
Q

monobactam

A

aztreonam

106
Q

Class effect of carbapenem

A

-all active against ESBL-producing organisms
-do not use with penicillin allergy
-seziure risk (highest risk with imipenem)

107
Q

Carbapenems do not cover

A

atypicals, VRE, MRSA, C. diff, Stenotrophomonas

108
Q

ErtAPenem does not cover

A

pseudomonas, actinobacter, enterococcous

109
Q

Common uses of carbapenems

A

polymicrobial infections, empiric therapy when resistance is suspected, ESBL-positive infection, resistant Pseudomonas or acinetobacter (except ertapenem)

110
Q

All carbapenems are IV only

A

ertapenem must be diluted in normal saline

111
Q

Aztreonam

A

-gram-negative
-pseudomonas
-no gram + or anaerobic activity`

112
Q

Gentamicin (Gram + infection - synergy)

A

Peak: 3-4 mcg/mL
Trough: < 1 mcg/mL

113
Q

Gentamicin (gram-negative infection) and tobramycin

A

Peak: 5-10 mcg/mL
Trough: < 2 mcg/mL

114
Q

amikacin

A

Peak: 20-30 mcg/mL
Trough: < 5 mcg/mL

115
Q

drawing aminoglycoside levels

A

-draw a trough level right before (or 30 minutes before) 4th dose
-draw peak level 30 minutes after the end of the 30 min infusion for the 4th dose
-extended interval dosing - draw random level per timing on monogram

116
Q

Quinolones

A

ciprofloxacin, levofloxacin, moxifloxacin

117
Q

Respiratory quinolones

A

levofloxacin, moxifloxacin, gemifloxacin

118
Q

antipseudomonal quinolones

A

ciprofloxacin, levofloxacin

119
Q

moxifloxacin

A

only quinolone that is not renally adjusted (do not use in UTIs)

120
Q

IV to PO 1:1

A

levofloxacin and moxifloxacin

121
Q

Cautions with quinolones

A

-caution in those with CVD, decrease K/Mg and with other QT-prolonging drugs
-avoid in patients with seizure hx or if using seizure drugs
-avoid in children

122
Q

Counseling on quinolones

A

-avoid sun exposure, separate from polyvalent cations, and monitor blood glucose
-watch for tendon rupture, neuropathy, CNS or psychiatric side effects

123
Q

Macrolides

A

Azithromycin, clarithromycin, erythromycin

124
Q

Common uses for macrolides

A

-all macrolides: CAP, and as an alternative to a beta-lactam for strep throat
-azithromycin: COPD exacerbation, pertusis, chlamydia, prophylaxis for MAC, severe travelers diarrhea
-clarithromycin: used in H. pylori tx regimens
-Erythromycin increases gastric motility and is used for gastrophoresis

125
Q

Common Z-pack dosing

A

two 250 mg tablets PO x1 then 250 mg PO QD x 4 days

126
Q

Macrolides and QT-prolongation

A

caution with CVD, decrease K/Mg and other QT-prolonging drugs

127
Q

Macrolides and drug interactions

A

clarithromycin and erythromycin are strong CYP3A4 inhibitors; lovastatin and simvastatin are contraindicated (increased risk of muscle toxicity)

128
Q

Tetracyclines

A

doxycycline, minocycline
Do not use in pregnancy, breastfeeding or children < 8 years old

129
Q

Common uses of tetracycline

A

-doxycycline and minocycline: CA-MRSA skin infections, acne
-Doxycycline: first-line treatment for lyme disease and rocky mountain spotted fever, CAP, COPD exacerbation, bacterial sinusitis, VRE, UTI, Chlamydia
-tetracycline: used in H. pylori treatment regimens

130
Q

Sulfonamides

A

Bactrim

131
Q

common uses of bactrim

A

CA-MRSA skin infections, UTIs, PJP

132
Q

Strength of bactrim tablets

A

-5:1 ratio of bactrim
-SS tablet contains 80 mg TMP
-DS contains 160 mg TMP - usual dose is one tablet BID

133
Q

bactrim and warfarin

A

INR increases when used with warfarin - use alternative abx when possible

134
Q

lipoglycopeptides

A

telavancins, oritavancin, dalbavancin

135
Q

oxazolidinones

A

linezolid and tedizolid

136
Q

Urinary agents

A

fosfomycin & nitrofurantoin

137
Q

Nitrofurantoin

A

-DOC for uncomplicated UTI
-contraindicated when CrCl < 60 mL/min
-MarcoBID is BID
-Macrodantin is QID
-take with food to prevent nausea and cramping
-can discolor the urine

138
Q

MSSA

A

dicloxacillin, nafcillin, oxacillin, cefazolin, cephalexin (and all other 1st and 2nd gen cephalosporins), augmentin, unasyn, doxycycline, minocycline, bactrim

139
Q

CA-MRSA SSTIs

A

bactrim, doxycycline, minocycline, clindamycin, linezolid

140
Q

severe SSTIs requiring IV treatment or hospitalization

A

vancomycin, linezolid, tedizolid, daptomycin, ceftaroline, telavancin, oritavancin, dalbavancin, tigecycline

141
Q

nosocomial MRSA

A

vancomycin, linezolid, daptomycin (not in pneumonia), telavancin

142
Q

VRE (E. Faecalis)

A

Pen G or ampicillin, linezolid, daptomycin
-cystitis only: nitrofurantoin, fosfomycin, doxycycline

143
Q

VRE (E. Faecium)

A

daptomycin, linezolid
-cystitis only: nitrofurantoin, fosfomycin, doxycycline

144
Q

HNPEK

A

H. Influenzaem Neisseria, Proteus, E. coli, Klebsiella

145
Q

HNPEK commonly used drugs

A

beta-lactam/beta-lactamase inhibitor*, amoxicillin, cephalosporins (except 1st gen), carbapenem, bactrim, aminoglycosides, quinolones

146
Q

atypical organisms

A

azithromycin, clarithromycin, doxycycline, minocycline, quinolones

147
Q

pseudomonas aeruginosa

A

zosyn, cefepime, ceftazidime, Avycaz, Zerbaxa, carbapenem (ertapenem), cirpofloxacin, levofloxacin, aztreonem, aminoglycosides, colistimethane, polymyxin B

148
Q

Acinetobacter

A

carbapenems*, Unasyn, minocycline, tigecycline, quinolones, bactrim, amikacin, colistimethane, polymyxin B

149
Q

ESBL GNR (E. coli, K. pneumoniae, P. mirabilis)

A

carbapenems, Avycaz, Zebraxa, aminoglycosides, cystitis only: fosfomycin

150
Q

CRE

A

Avycaz, colisthimethane, polymyxin B, meropenem/vaborbactam, imipenem/cilstatin/relebactam

151
Q

Bacteroides fragilis

A

metronidazole, beta-lactam/beta-lactam inhibitor, cefotetan, cefoxitin, carbapenems

152
Q

C. diff

A

vancomycin, fidaxomicin, metronidazole

153
Q

Drugs that DO NOT require renal adjsutment

A

antistaphylococcal penicillins, CTX, clindamycin, doxycycline, macrolides, metronidazole, moxifloxacin, linezolid, cholraphenicol, fidaxomicin, rifaximin, rifampin, tedizolid, tigecycline vancomycin PO

154
Q

Storage Requirements: Liquid oral abx - must be refrigerated

A

Penicillin VK, ampicillin, augmentin, cephalexin, cefuroxime, vancomycin oral, valganciclovir

155
Q

Storage Requirements: Liquid oral abx - refrigerated recommended

A

ampicillin - improves taste

156
Q

Storage Requirements: Liquid oral abx - DO NOT REFRIGERATE

A

cefdinir, azithromycin, clarithromycin, doxycycline, ciprofloxacin, levofloxacin, clindamycin, linezolid, bactrim, acyclovir, fluconazole, posaconazole, voriconazole, nystatin

157
Q

Storage Requirements: IV ABX - DO NOT REFRIGERATE

A

metronidazole, moxifloxacin, bactrim, acyclovir

158
Q

ABX that must be taken on empty stomach

A

ampicillin oral capsules and suspension, ceftibuten suspension, levofloxacin oral solution, penicillin VK, rifampin, isoniazid, itraconazole solution, voriconazole

159
Q

ABX that has to be taken within one hour of finishing a meal

A

amoxicillin ER

160
Q

1:1 IV to PO

A

levofloxacin, moxifloxacin, doxycycline, minocycline, linezolid, tedizolid, metronidazole, bactrim, fluconazole, cresemba, posaconazole, voriconazole

161
Q

light production administration

A

doxycycline, micafungin, pentamidine

162
Q

compatible with dextrose only

A

quinupristin/dalfopristin, bactrim, amphotericin B, dalbavancin, oritavancin, pentamidine

163
Q

compatible with saline only

A

ampicillin, unasyn, ertapenem, daptomycin

164
Q

compatible with NS/LR only

A

caspofungin, daptomycin (cubicin)

NAPLEX STUDY (25 decks)

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