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A - NAPLEX > Chapter 22: ID I - Background and Antibacterials by Class > Flashcards

Chapter 22: ID I - Background and Antibacterials by Class Flashcards

1
Q

Gram positive organisms have a ___ cell wall and stain ___ from the ____ stain

Gram negative organisms have a ___(thick or thin) cell wall and take up ____ counterstain, resulting in what color

A

thick
dark purple or blueish
Crystal violet

thin
Safranin
Pink or reddish

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2
Q

Which organisms are gram-positive cocci clusters

A

Staphylococcus spp. (including MRSA and MSSA)

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3
Q

Which organism is a gram-positive rod

A

Listeria monocytogenes

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4
Q

Which organisms are gram-positive anaerobes

A
  • Peptostreptococcus
  • Actinomyces spp.
  • Clostridium spp
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5
Q

Which organisms are gram-positive cocci in pairs and chains

A
  • Strep pneumoniae (diplococci)
  • Streptococcus spp (including Strep. pyogenes)
  • Enterococcus spp (including VRE)
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6
Q

Which organism is a gram-negative cocci

A

Neisseria spp

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7
Q

Which organisms are gram-negative anaerobes

A
  • Bacteroides fragilis

- Prevotella spp

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8
Q

Which organisms are gram-negative coccobacilli

A
  • Acinetobacter baumannii
  • Bordetella pertussis
  • Moraxella catarrhalis
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9
Q

Which organisms are gram-negative rods that colonize the gut (enteric)

A
  • Proteus mirabilis
  • E. coli
  • Klebsiella spp
  • Serratia spp
  • Enterobacter cloacae
  • Citrobacter spp
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10
Q

Which organisms are gram-negative rods that do not colonize the gut

A
  • Pseudomonas aeruginosa
  • H. influenzae
  • Providencia spp
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11
Q

Which organisms are curved or spiral shaped gram-negative rods

A
  • H. pylori
  • Campylobacter spp
  • Treponema spp
  • Borrelia spp
  • Leptospira spp
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12
Q

The higher the MIC value, the more ____-spectrum it is

The lower the MIC value, the more ____-spectrum it is

A

narrow (choose drugs with high MIC)

broad

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13
Q

What is intrinsic resistance

A

the resistance is natural to the organism

ex: E.coli is resistant to vanco bc this antibiotic is too large to penetrate the bacterial cell wall of E.coli

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14
Q

What is selection pressure

A

resistance occurs when antibiotics kill off susceptible bacteria, leaving behind more resistant stains to multiply

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15
Q

What is enzyme inactivation

A

enzymes produced by bacteria break down the antibiotic

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16
Q

What are extended-spectrum beta-lactamases (ESBLs)

A

beta-lactamases that can break down all penicillins and most cephalosporins

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17
Q

What are carbapenem-resistant Enterobacteriaceae (CRE)

A

they are multidrug-resistant (MDR) gram-negative organisms (e.g, Klebsiella spp., E. coli) that produce enzymes (e.g., carbapenemase) capable of breaking down penicillins, most cephalosporins, and carbapenems

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18
Q

What is collateral damage

A

Unintended consequences of antibiotic use. Antibiotics kill normal, healthy GI flora along with the pathogens they are targeting, resulting in overgrowth or organisms that are resistant to the drug and can lead to superinfections, such as C. diff

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19
Q

Common resistant pathogens

A
  • Remember: Kill Each And Every Strong Pathogen*
  • Klebsiella pneumoniae (ESBL, CRE)
  • E. coli (ESBL, CRE)
  • Acinetobacter baumannii
  • Enterococcus faecalis, Enterococcus faecium (VRE)
  • Staphylococcus aureus (MRSA)
  • Pseudomonas aeruginosa
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20
Q

Which antibiotics inhibit folic acid synthesis

A
  • Sulfonamides
  • Timethoprim
  • Dapsone
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21
Q

Which antibiotics are cell wall inhibitors

A
  • BL (penicillins, cephalosporins, carbapenems)
  • Monobactams (aztreonam)
  • Vancomycin, dalbavancin, telavancin, oritavancin
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22
Q

Which antibiotics inhibit protein synthesis

A
  • Aminoglycosides
  • Macrolides
  • Tetracyclines
  • Clindamycin
  • Linezolid, tedizolid
  • Quinupristin/dalfopristin
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23
Q

Which antibiotics are cell membrane inhibitors

A
  • Polymyxins
  • Daptomycin
  • Telavancin
  • Oritavancin
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24
Q

Which antibiotics are DNA/RNA inhibitors

A
  • Quinolones (DNA gyrase, topoisomerase IV)
  • Metronidazole, tinidazole
  • Rifampin
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25
Q

Which antibiotics are hydrophilic

Lipophilic?

A
  • BL
  • AMG
  • Glycopeptides
  • Daptomycin
  • Polymyxins
  • Quinolones
  • Macrolides
  • Rifampin
  • Linezolid
  • Tetracyclines
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26
Q

Lipophilic antibiotics have a (large/small) volume of distribution, giving them (excellent/poor) tissue penetration, whereas hydrophilic antibiotics have a (large/small) volume of distribution, giving them (excellent/poor) tissue penetration

A

Lipophilic - large Vd = excellent tissue penetration

Hydrophilic - small Vd = poor tissue penetration

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27
Q

Hydrophilic antibiotics are eliminated ____

Lipophilic antibiotics are metabolized ____

A

renally, possibly causing nephrotoxicity or accumulation of drug

hepatically, possibly causing hepatotoxicity and DDI

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28
Q

Hydrophilic antibiotics have (high/low) intracellular concentrations, meaning they (are/are not) active against atypical pathogens.

Lipophilic antibiotics have (high/low) intracellular concentrations, meaning they (are/are not) active against atypical pathogens.

A

Hydrophilic - low intracellular concentrations; they are not active against atypical pathogens

Lipophilic - high intracellular concentrations; they are active against atypical pathogens

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29
Q

(Hydrophilic or lipophilic) antibiotics have increased clearance and/or distribution in sepsis

A

Hydrophilic (consider loading doses and aggressive dosing in sepsis)

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30
Q

Hydrophilic agents have (excellent/poor) bioavailability.

Lipophilic agents have (excellent/poor) bioavailability.

A

Hydrophilic- poor

Lipophilic- excellent

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31
Q

Which antibiotic classes have concentration dependent killing

Drugs with concentration dependent killing can be dosed

A

AMG, quinolones, daptomycin

less frequently and in higher doses to maximize the concentration above the MIC (large dose, long interval)

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32
Q

Which antibiotic class has time-dependent killing

Drugs with time-dependent killing can be dosed

A

BL

more frequently or administered for a longer duration to maximize the time above the MIC (e.g., extending the infusion time from 30 min to 4 hrs or administering as a continuous infusion)

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33
Q

Beta-lactam MOA

A

inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PCPs), which prevents the final step of peptidoglycan synthesis in bacterial cell walls

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34
Q

Aminopenicillins combined with beta-lactamase inhibitors (clavulanate, sulbactam, and tazobactam) have added activity against

A

MRSA, gram negative bacteria [e.g., Haemophilius, Neisseria, Proteus, E. coli, & Klebsiella (HNPEK)] & gram-negative anaerobes (B. fragilis)

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35
Q

piperacillin-tazobactam covers

A
  • Gram-positive bacteria (streptococci, MSSA, Enterococci)
  • Gram-positive anaerobes (mouth flora)
  • more resistant strains of Haemophilius, Neisseria, Proteus, E. coli, & Klebsiella (HNPEK)
  • Gram negative anaerobes (B. fragilis)
  • Expanded coverage of other GNB, including Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia (CAPES)
  • PsA
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36
Q

Which penicillins are Natural penicillins, brand and route of admin

A

Penicillin V Potassium
Penicillin G Benzathine (Bicillin L-A) - IM
Not for IV use; can cause cardio-respiratory arrest and death

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37
Q

Which penicillins are aminopenicillins, brand and route

A

Amoxicillin - tab, susp, cap, chew
Amoxicillin/clavulanate (Augmentin) - tab, susp, chew
Ampicillin - cap, susp, inj
Ampicillin/Sulbactam (Unasyn) - inj

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38
Q

Which penicillins are antistaphylococcal penicillins

When are they preferred

A

Dicloxacillin, Nafcillin, Oxacillin

MSSA soft tissue, bone and joint, endocarditis and bloodstream infections

Do not require renal dose adj

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39
Q

Penicillin CI

A

CrCl < 30 mL/min: do not use ER oral forms of amoxicillin and Augmentin or 875 mg strength of Augmentin

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40
Q

Penicillin side effects

A

Seizures (with accumulation), GI upset, diarrhea, rash (including SJS/TEN)

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41
Q

Which Antistaphylococcal PCN is a vesicant & what should be done if extravasation occurs

A

Nafcillin

Use cold packs and hyaluronidase injections

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42
Q

Which drug can increase the levels of beta-lactams by interfering with renal excretion

A

Probenacid

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43
Q

All penicillins should be avoided in patients with BL allergy except:

A
  • Treatment of syphilis during pregnancy (all pts)

- HIV patients with poor compliance/follow-up - desensitize and treat with benzathine PCN

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44
Q

Which PCN is first line for strep throat and mild non-purulent skin infections (no abscess)

A

Penicillin VK

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45
Q

Which PCNs are first line for acute otitis media & dose

A

Amoxicillin (80-90 mg/kg/day), Augmentin (90 mg/kg/day)

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46
Q

Which PCN is DOC for infective endocarditis ppx before dental procedures & dose

A

Amoxicillin (2 grams PO x 1, 30-60 min before procedure)

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47
Q

Which PCN is used in H. pylori treatment

A

Amoxicillin

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48
Q

Which PCN is first line for sinus infections (if an antibiotic is indicated)

A

Augmentin (use the lowest dose of clavulanate to decrease diarrhea)

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49
Q

Which PCN is DOC for syphilis & dose

A

PCN G Benzathine 2.4 million units IM x1

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50
Q

As a class, cephalosporins are not active against

A

Enterococcus spp

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51
Q

First-generation cephalosporins

A

Cefazolin

Cephalexin

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52
Q

Second-generation cephalosporins

A

Cefuroxime

Cefotetan (Cefotan)

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53
Q

Third-generation group 1 cephalosporins

Third–generation group 2 cephalosporin & brand name

A

Cefdinir
Ceftriaxone (no renal adj)
Cefotaxime

Ceftazidime (Fortaz)

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54
Q

Fourth-generation cephalosporin & coverage

A

Cefepime

broad gram-negative activity (PsA)

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55
Q

Fifth-generation cephalosporin & brand & coverage

A

Ceftaroline fosamil (Teflaro)

similar broad gram-negative activity to ceftriaxone, but broad-gram positive activity
It is the ONLY BL THAT COVERS MRSA

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56
Q

Ceftriaxone CI

A

hyperbilirubinemic neonates (causes biliary sludging, kernicterus); concurrent use with calcium-containing IV products in neonates < / = 28 days old

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57
Q

Cefotetan contains a side chain, which can increase the risk of ____ and cause a ____ reaction

A

bleeding

disulfuram-like reaction with alcohol ingestion

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58
Q

Cephalosporin SE

A

Seizures (with accumulation), GI upset, diarrhea, rash

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59
Q

Which cephalosporin comes as a chewable tab

A

Cefixime

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60
Q

Ceftazidime/avibactam covers some

A

CRE

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61
Q

Which cephalosporins should be separated by 2 hours from short-acting antacids

A

Cefuroxime, cefpodoxime

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62
Q

Which cephalosporin is commonly used for skin infections (MSSA) and strep throat

A

Cephalexin (outpatient)

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63
Q

Which cephalosporin is commonly used in acute otits media

A

Cefuroxime

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64
Q

Which cephalosporins are commonly used in CAP

A

Outpatient (oral):
Cefuroxime, Cefdinir

Inpatient (parenteral):
Ceftriaxone, Cefotaxime

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65
Q

Which cephalosporins are commonly used in surgical ppx

A

Cefazolin, Cefotetan & cefoxitin (colorectal procedures)

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66
Q

Which cephalosporins are commonly used in sinus infection (if antibiotic is indicated)

A

Outpatient (oral):

Cefuroxime, Cefdinir

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67
Q

Which cephalosporins are commonly used in spontaneous bacterial peritonitis and pyelonephritis

A

Ceftriaxone, Cefotaxime

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68
Q

Which two cephalosporins are active against PsA

A

Ceftazidime and Cefepime

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69
Q

Carbapenems are very broad-spectrum antibiotics that are generally reserved for:

They do not have coverage for

A

MDR gram-negative infections (active against ESBL-producing bacteria, & PsA, except ertapenem)

atypical pathogens, MRSA, VRE, C. diff, Stenotrophomonas

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70
Q

Ertapenem does not have coverage for

A

PsA, Acinetobacter, or Enterococcus (remember PEA)

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71
Q

All carbapenems are ___ only

A

IV

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72
Q

Common uses of carbapenems

A
  • Polymicrobial infections (e.g., diabetic foot infection)
  • Empiric therapy when resistant organisms are suspected
  • Resistant PsA or Acinetobacter infections (except ertapenem)
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73
Q

Which drug is a monobacam & brand name

When can it be used

Coverage?

A

Aztreonam (Azactam)

When a BL allergy is present since it makes cross-reactivity with a BL allergy unlikely

G- organisms, including PsA
No gram + or anaerobic activity

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74
Q

Aminoglycosides coverage

A

GNB (including PsA)

Gentamycin and streptomycin are used for synergy in combination with a BL or vanco when treating G+ infections

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75
Q

Traditional dosing of AMG uses ___ doses ___ frequently

Extended interval dosing of AMG uses ___ doses ___ frequently

A

lower doses more frequently (e.g., Q8H if renal function is normal)

higher doses (to attain higher peaks) less frequently (e.g, once daily if renal function is normal)

Extended interval dosing has been shown to decrease nephrotoxicity and cost (but it is not clinically superior to traditional dosing)

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76
Q

Which drugs are AMGs

A

Gentamycin, tobramycin, amikacin, streptomycin, plazomicin

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77
Q

If patients are underweight, use ___ for AMG dosing

If patients are obese, use ___ for AMG dosing

A

TBW

AdjBW

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78
Q

Traditional IV dosing of gentamicin and tobramycin

Renal dose adjustment for CrCl >/= 60 mL/min in AMG traditional dosing

A

1-2.5 mg/kg/dose

Q8H

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79
Q

Gentamycin and tobramycin extended interval IV dose

A

4-7 mg/kg/dose (remember, in extended interval dosing, you are using higher doses to attain higher peaks)

80
Q

AMG boxed warnings

A

Nephrotoxicity, ototoxicity, neuromuscular blockade

Use caution with AMGs in patients with:

  • impaired renal function
  • elderly
  • taking nephrotoxic drugs (amphotericin B, cisplatin, polymyxins, cyclosporine, loop diuretics, NSAIDs, radiocontrast dye, tacrolimus, and vancomycin)
81
Q

With traditional dosing of AMGs, when should a trough level be drawn

With traditional dosing of AMGs, when should a peak level be drawn

A

Trough: right before the 4th dose

Peak: 30 min after the end of the 30-min drug infusion for the 4th dose

82
Q

In extended interval dosing of AMGs, which level should be drawn after the first dose

A

Random level

83
Q

What is the goal trough for tobramycin & Gentamycin used for G- infections

A

< 2 mcg/mL

84
Q

Quinolone MOA

A

inhibit bacterial DNA topoisomerase IV and DNA gyrase

85
Q

Quinolones have _____-dependent antibacterial activity & a broad-spectrum f activity against a variety of gram-negative, G+ and atypical pathogens

A

concentration

86
Q

What are the respiratory quinolones & what do they have coverage against

A

Gemifloxacin, levofloxacin and moxifloxacin

enhanced coverage of S. pneumo and atypical pathogens

87
Q

Which quinolones have enhanced G- activity, including coverage of PsA

A

Cipro and levofloxacin [used for PsA infections including pneumonia, UTIs, intra-abdominal infections, TD (without dysentery)]

88
Q

Which quinolone has enhanced gram+ and anaerobic activity and can be used for mixed infections (e.g., intra-abdominal infections)

A

Moxifloxacin (no dose adj in renal)

89
Q

What is the only quinolone that cannot be used to treat UTIs

A

moxifloxacin (no dose adj in renal)

90
Q

Which quinolone is approved for MRSA

A

Delafloxacin

91
Q

Moxifloxacin brand name

A

Avelox

92
Q

Quinolone BW

A
  • Tendon inflammation and/or rupture (within hours/days of starting)
  • Peripheral neuropathy
  • Seizures; caution in pts with CNS disorders or with drugs that cause seizures
93
Q

Quinolone warnings

A
  • QT prolongation (highest risk with moxifloxacin)
  • Hypoglycemia & hyperglycemia
  • psychiatric disturbances
  • Avoid systemic quinolones in children and in pregnancy/breastfeeding d/t risk of musculoskeletal toxicity
  • photosensitivity (avoid sun exposure)
94
Q

Which quinolone should not be put through a NG or other feeding tube

A

Cipro oral suspension

95
Q

Quinolone drug interactions

A
  • Antacids and other polyvalent cations can chelate and inhibit quinolone absorption
  • Lanthanum carbonate and sevelamer (Renelva) can decrease the serum conc of oral quinolones and should be separated
96
Q

Macrolide MOA

A

bind to the 50S ribosomal subunit

97
Q

Macrolide activity

A
  • atypicals
  • community-acquired upper and lower respiratory tract infections (CAP & as an alternative to BL for strep throat)
  • Chalmydia and gonorrhea
98
Q

Which drugs are macrolides

A

Azithromycin, clarithromycin, erythromycin

99
Q

Z-pak dosing

Tri-Pak dosing

A

500 mg on day 1, then 250 mg on days 2-5

500 mg daily for 3 days

100
Q

Do not use clarithromycin and erythromycin with which 2 drugs

A

lovastatin and simvastatin (increases risk of muscle toxicity)

101
Q

Macrolide warnings

A 
QT prolongation (caution with CVD, low K/Mg, and drugs like azole antifungals, antipsychotics, methadone, and quinolones)
Hepatotoxicity
102
Q

Clarithromycin should be used with caution in patients with

A

CAD

103
Q

Macrolide SE

A

GI upset

104
Q

Erythromycin and clarithromycin are ___ inhibitors

A

3A4 (may need to avoid warfarin)

105
Q

Azithromycin is used for

A

COPD exacerbations, monotherapy for chlamydia, combination therapy for gonorrhea, and ppx for MAC; DOC for severe TD

106
Q

Clarithromycin is used for treatment of

A

H. pylori

107
Q

Erythromycin is used for

A

gastroparesis (increases gastric motility)

108
Q

Tetracycline MOA

A

reversibly bind to 30S ribosomal subunit

109
Q

Tetracycline coverage

A
  • atypicals
  • CAP, tick-borne/rickettsial diseases, chlamydia, gonorrhea, CA-MRSA, VRE, acne, COPD exacerbations, sinusitis, UTI (doxycycline)
  • H. pylori treatment (tetracycline)
110
Q

Doxycycline brand name

Minocycline brand names

A

Vibramycin (no renal adj)

Minocin, Solodyn

111
Q

Tetracycline warnings

A

Children < 8 years of age, pregnancy and breastfeeding, photosensitivity

112
Q

Minocycline can cause

A

DILE

113
Q

counseling for doxycycline

A

Sit upright for at least 30 min after dose to avoid esophageal irritation & take with 8 oz of water

114
Q

Tetracycline drug interactions

A

Antacids and other polyvalent cations, sucralfate, bismuth subsalicylate, and bile acid resins can chelate and inhibit tetracycline absorption. Doses should be separated

115
Q

TMP/SMX coverage

A
  • Gram-negative: Shigella, Salmonella, Stenotrophomonas
  • Some opportunistic pathogens (Pneumocystitis, Toxoplasmosis)
  • NOT COVERED: PsA, Enterococci, atypicals and anaerobes
116
Q

TMP/SMX single strength dose

TMP/SMX double strength dose

TMP/SMX dosing is based on which component

A

400 mg SMX/80 mg TMP

800 mg SMX/160 mg TMP

TMP (Ratio of SMX/TMP 5:1)

117
Q

TMP/SMX dosing for uncomplicated UTI

A

1 DS tablet PO BID x 3 days

118
Q

TMP/SMX dosing for PCP prophylaxis

A

1 DS or SS tablet daily

119
Q

TMP/SMX warnings & SE

A
  • SJS/TEN, TTP
  • G6PD Deficiency - d/c if hemolysis occurs
  • Photosensitivity
  • Increased K
  • Hemolytic anemia (identified with a positive Coombs test)
  • Crystalluria
120
Q

SMX/TMP is a strong inhibitor of ____ & can cause significantly elevated ___

A

2C9

INR (caution with warfarin)

121
Q

SMX/TMP common uses

A

CA-MRSA, UTI, PCP

122
Q

Vanco inhibits bacterial cell wall synthesis by binding to which cell wall precursor and blocking peptidoglycan polymerization

A

D-alanyl-D-alanine

123
Q

Consider an anternative to vanco when MRSA MIC >/= __ mcg/dL

A

2

124
Q

Vanco dosing for systemic infections (IV only)

A

15-20 mg/kg Q8-12H (use TBW)

125
Q

Vanco dosing interval for systemic infections (IV only) when CrCl 20-49 mL/min

A

Q24H

126
Q

Vanco dosing for C. diff infections (PO only)

A

125-500 mg QID x 10 days

127
Q

Vanco warnings

A

Ototoxicity, nephrotoxicity

Infusion reaction/red man syndrome

128
Q

Goal trough for vanco in serious MRSA infections

A

15-20 mcg/mL

129
Q

Lipoglycopeptide MOA

A

inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall

130
Q

Lipoglycopeptides have ___-dependent killing

A

concentration

131
Q

Televancin is approved for

A

SSTIs

132
Q

Televancin BWs

A

fetal risk, nephrotoxicity

133
Q

Televancin warnings

A

Can falsely increase coagulation tests (aPTT/PT/INR)

Red man syndrome

134
Q

What should be used after oritavancin & dalbavancin administration due to interference with aPTT lab results & for how long

A

IV UFH for 5 days (120 hrs)

135
Q

oritavancin & dalbavancin SE

A

red man syndrome

136
Q

What is the dosing regimen for oritavancin & dalbavancin

A

single-dose regimen due to extremely long half-life

137
Q

Daptomycin has ___-dependent killing

A

concentration

138
Q

Daptomycin coverage & brand name

A

MRSA and VRE

cubicin, cubicin RF

DO NOT USE IN PNEUMONIA

139
Q

Daptomycin warnings & SE

A

Myopathy and rhabdomyolysis; increases CPK (monitor weekly)

Can falsely increase PT/INR

140
Q

Linezolid MOA

A

Binds to the 50S subunit of the bacterial ribosome

141
Q

Linezolid coverage & brand name

A

MRSA, VRE

Zyvox

142
Q

Linezolid CI

A

do not use with or within 2 weeks of MAOi; avoid tyramine-containing foods and serotonergic drugs

143
Q

Linezolid warnings & SE

A

duration-related myelosuppression (thrombocytopenia), optic neuropathy, serotonin syndrome, hypoglycemia

144
Q

Which antibiotic suspension should not be shaken

A

linezolid

145
Q

Quinupristin/dalfopristin MOA

A

binds to the 50S ribosomal subunit inhibiting protein synthesis

146
Q

Quinupristin/dalfopristin coverage

A

MRSA, VRE (but NOT E. faeclais)

147
Q

Quinupristin/dalfopristin SE

A

Arthralgias/myalgias, infusion reactions, hyperbilirubinemia

148
Q

Quinupristin/dalfopristin should only be diluted with ___ and administered via ___ line

A 
D5W
Central line (such as PICC)
149
Q

Among the G- bacteria, tigecycline has no activity against:

A

The 3 Ps: PsA, Proteus, Providencia spp

DO NOT USE FOR BLOODSTREAM INFECTIONS

150
Q

Tigacycline brand name

A

Tygacil

151
Q

Tigacycline BW

A

increased risk of death

152
Q

Tigacycline reconstituted solution should be which color & should be discarded if it is a different color

A

yellow-orange (think of tiger colors)

153
Q

Due to the risk of toxicities, polymyxins are used primarily for which pathogens

A

MDR gram-negative pathogens

154
Q

Colistimethane sodium & polymyxin B sulfate warning

A

dose-dependent nephrotoxicity, neurotoxicity (can result in respiratory paralysis from neuromuscular blockade)

155
Q

Chloramphenicol can cause

A

gray syndrome

156
Q

Clindamycin MOA

A

binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis

157
Q

Clindamycin coverage

A

anaerobes and G+ bacteria

158
Q

Clindamycin systemic brand name

Clindamycin topical brand names

A

Cleocin

topical: Cleocin-T, Clindagel

159
Q

Clindamycin BW

A

Colitis (C. diff)

160
Q

Clindamycin SE

A

N/V/D

161
Q

Which test should be performed on S. aureus that is susceptible to clindamycin but resistant to erythromycin

When do you know if clinda is resistant

A

An induction test (D-test)

A flattened zone between the disks (positive D-test) indicates clindamycin resistance - do not use

162
Q

Metronidazole coverage & uses

A

anaerobes and protozoal infections

bacterial vaginosis, trichomoniasis, intra-abdominal infections

163
Q

Secnidazole is given in how many doses

A

single dose

164
Q

Metronidazole CI

A

Pregnancy (1st trimester), use of alcohol or propylene-glycol containing products during treatment or within 3 days of treatment discontinuation - can cause a disulfuram-like reaction (abdominal cramping, N/V, HA, and flushing)

165
Q

Metronidazole SE

A

Metallic taste

166
Q

Secnidazole SE

A

vulvovaginal candidiasis

167
Q

Metronidazole can increase which lab value

A

INR

168
Q

Fidaxomicin is used for

Brand name?

A

C. diff (oral)

Dificid

169
Q

Rifaximin uses

A

TD, to decrease recurrence of hepatic encephalopathy, IBS-D, C. diff (off-label)

170
Q

Fosfomycin coverage

A

E. coli (including ESBLs) and E. faecalis

Single dose regimen is used for uncomplicated UTI

171
Q

Nitrofurantoin MOA

A

bacterial cell wall inhibitor

172
Q

Nitrofurantoin use & dosing & brand name

A

DOC for uncomplicated UTI
100 mg BID x 5 days (macroBID is dosed BID)

Macrobid, Macrodantin

173
Q

Nitrofurantoin CI

A

CrCl < 60 mL/min

174
Q

Nitrofurantoin warnings & SE

A

hemolytic anemia (caution in patients with G6PD deficiency)

GI upset (take with food)
Brown urine discoloration
175
Q

Mupirocin nasal ointment use & brand name

A

to eliminate MRSA colonization of the nares

Bactroban

176
Q

DOCs for MSSA

A

Dicloxacillin, nafcillin, oxacillin
Cefazolin, cephalexin
Amoxicillin/clavulanate, ampicillin/sulbactam

177
Q

DOCs for CA-MRSA & SSTIs

A

SMX/TMP
Doxycyline, minocycline
Clindamycin (perform D-test first)
Linezolid

178
Q

DOCs for severe SSTIs requiring IV treatment or hospitalization (cover MRSA and streptococci)

A

Vancomycin
Linezolid
Daptomycin
Ceftaroline

179
Q

DOCs for nosocomial MRSA (hospital-acquired)

A

Vanco
Linezolid
Daptomycin (not in pneumonia)

180
Q

DOCs for VRE (E. faecalis)

A
  • Pen G or ampicillin
  • Linezolid
  • Daptomycin
181
Q

DOCs for VRE (E. faecium)

A

Daptomycin
Linezolid
Cystitis only: nitrofurantoin, fosfomycin, doxycycline

Remember VRE stands for vancomycin resistant enterococcus

182
Q

DOCs for PsA

A 
Piperacillin/tazobactam
Cefepime
Ceftazidime
Ceftazidime/avibactam
Ceftolozane/Tazobactam
Carbapenems (except ertapenem)
Ciprofloxacin, levofloxacin
Aztreonam
Aminoglycosides
Colistimthane, Polymyxin B
183
Q

DOCs for ESBL gram-negative rods (E. coli, K. pneumo, P. mirabilis)

A

Carbapenems
Ceftolozane/Tazobactam
Ceftazidime/Avibactam

184
Q

DOCs for carbapenem-resistant (CRE) gram-negative rods

A

Ceftazidime/avibactam

Colistamethane, Polymyxin B

185
Q

DOCs for Acinetobacter naumannii

A

Carbapenems (except ertapenem)

186
Q

DOC for HNPEK

A

Beta-lactam/beta-lactamase inhibitor

187
Q

DOCs for Bacteroides fragilis

A

Metronidazole
BL/beta-lactamase inhibitor
Cefotetan, cefoxitin
Carbapenems

188
Q

DOCs for C. diff

A

Vanco (oral)

Fidaxomicin

189
Q

DOCs for atypical organisms

A

Azithromycin
Doxycycline
Quinolones

190
Q

Which oral antibiotics require refrigeration after reconstitution

A

Penicillin VK
Ampicillin
Augmentin

191
Q

Which oral antibiotic should NOT be refrigerated

A

Cefdinir (formerly Omnicef)

192
Q

Which IV antibiotics should NOT be refrigerated

A

Metronidazole, moxifloxacin, SMP/TMX

193
Q

Antibiotics that do not require renal dose adjustment:

A
  • Doxycycline
  • Ceftriaxone
  • Moxifloxacin
  • Antistaphylococcal PCNs: Dicloxacillin, Nafcillin, Oxacillin
  • Linezolid
  • Clindamycin
  • Macrolides: azithromycin & erythromycin only
  • Metronidazole
194
Q

Antibiotics with 1:1 IV:PO ratio

A
  • Levofloxacin, moxifloxacin
  • Doxycycline, minocycline
  • Linezolid
  • Metronidazole
195
Q

Which antibiotics should be taken on an empty stomach

A 
Ampicillin oral capsules and suspension
Ceftibuten suspension
Levofloxacin oral solution
Penicillin VK
Rifampin
Isoniazid
Itraconazole solution
Voriconazole
196
Q

Which antibiotics require light protection during administration

A

Doxycycline

Micafungin

197
Q

Which antibiotics are compatible with dextrose only

Saline only?

NS/LR only?

A

-DEXTROSE
Quinupristin/Dalfopristin
SMX/TMP
Amphotericin B

-SALINE
Ampicillin
Ampicillin/sulbactam
Ertapenem
Daptomycin (Cubicin RF)

-NS/LR
Caspofungin
Daptomycin (Cubicin)

A - NAPLEX (83 decks)

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