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IPAP 21-2 Soph Semester > ABX > Flashcards

ABX Flashcards

1
Q

What three drugs cover VRE

A

Linezolid, Daptomycin, Colistin

Snoop in the LDC with VRE

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2
Q

What 7 abx groups cover MRSA and MSSA

A

5th gen Cephalosporins, Vancomycin, Daptomycin, TMP/SMX, CLindamycin, Doxycycline

MRSA (I got 5 on it, 5th gen)
VDC-mycin and doxy
TMP/SMX (just know that one)

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3
Q

What 8 drug groups do not cover MSSA

A

Penicillin, Ampicillin, Azteronam, Ciprofloxin, Azithromycin, Gent/Tobra/Amikacin, Colistin, and metronidazole

Peter And A Cat All Got To Amsterdam Chasing Money

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4
Q

What 9 drug groups cover Abdominal anaerobes

A

Ampicillin/ sulbactam, Pipercillin/ tazobactam, 2nd gen Cephalosporins, Ertapenem, Imipenem/Cilastatin, Doripenem, Meropenem, Moxifloxacin, TMP/SMX, Clindamycin, Metronidazole

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5
Q

What 5 drug groups cover Atypical gram negs

A 
Moxifloxacin
Ciprofloxacin
Azithromycin 
Clindamycin 
Doxycycline
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6
Q

What do penicillins cover

A

Many gram postive and some gram neg

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7
Q

What does penicillin cover with an added B-Lactamase inhibitor

A

More gram pos, gram neg, and some pseudomonas

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8
Q

What do 1st gen Cephalosporins cover

A

Gram pos and neg

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9
Q

What is the MOA of beta Lactams

A

MOA: Cell wall synthesis inhibitors

Bactericidal (time dependent)

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10
Q

All beta lactams are renal excretion with an exception for which three

A

Nafcillin
Oxacillin
Dicloxacillin

(Biliary secretion)

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11
Q

What is the ADE of Penicillins

A

cross sensitivity with other B-lactams & c. dif

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12
Q

What is the DOC for PCN sensitive gangrene

A

Penicillin

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13
Q

What is the DOC for syphillis

A

Penicillin G benzathine

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14
Q

What are the 3 penicillins

A

Penicillin G, Penicillin G Benzathine, and Penicillin V

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15
Q

What are the three anti staph PCNs

A

Dicloxacillin
Oxacillin
Nafcillin

D.O.N.

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16
Q

Anti staph penicillins are important because they can cover..

A

MSSA

And do not require renal adjustment (biliary secretion)

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17
Q

What are the 4 aminopenicillins

A

Amoxicillin
Ampicillin
Amoxicillin+Clauvanic Acid (Augmentin)
Ampicillin-sulbactam (Unasyn)

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18
Q

What is amoxicillins drug class and use

A

Amino penicillin (beta lactam) (Oral)

  • 1st line peds OM
  • Endocarditis prophylaxis going for oral, dental or upper resp sx procedures (or clindamycin allergic).
  • UTI to for pregos
  • duodenal ulcer by H.Pylori
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19
Q

What is the role of ampicillin

A

Gram neg coverage beta lactam that -Combined with Aminoglycosides -Clavulanic Acid/Sulbactam/Tazobactam are B-lactamase inhibitors that prevent bacteria from being resistant to B-lactams

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20
Q

What is the role of Amoxicillin- Clauvanic Acid

A

Gram Neg coverage beta lactam
(Augmentin)

Abd. Anaerobes
- Otitis media resistant to amoxicillin

  • DOC animal bite
  • human bites: Early
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21
Q

In OM, if there is resistance to Amoxicillin , what drug combination should be used

A

Augmentin

Amoxicillin+Clauvanic Acid

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22
Q

What is the role of Ampicillin+Sulbactam

A

Gram neg coverage beta lactam
(Unasyn)

Abd. Anaerobes

  • Human bites: Later
  • HAP
  • MSSA
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23
Q

What are the drugs to use in early versus late human bites

A

Early: Amoxicillin-Clavulanic Acid (Augmentin)
Late: Ampicillin-Sulbactam (Unasyn)

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24
Q

What in the Anti Pseudomonal PCN

A

Pipercillin/Tazobactam (Zosyn)

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25
What is the role of Pipercillin/ Tazobactam
``` Beta lactam (often combined with aminoglycoside) -Tx of *Pseudomonas, MSSA, Abd. Anaerobes Severe infx ```
26
What are the DDI of Antistaph PCNs
Warfarin
27
Which cephalosporins x the BBB
3rd Gen- Ceftriaxone (Rocephin)
28
What are the 4 1st gen Cephalosporins
1. Cephradine (Velosef) 2. Cefadroxil (Duricef) 3. Cephalexin (Kelflex) 4. Cefazolin (Ancef) Phrad-Fad-phal-faz
29
What are 1st Gen Cephalosporins used for
- Sx/wound prophylaxis, | - Abd Sx prophylaxis (+ metronidazole)
30
What drug should be combined with 1st gen Cephalosporins for Abd surgery prophylaxis
Metronidazole
31
What is the MOA of Cephalosporins
``` Beta Lactams Cell Wall inhibitors Bactericidal Time Dependent Renally secreted Preg Cat B ```
32
What drug group should be used for OM if the patient is allergic to PCN
2nd gen Cephlosporins
33
What are the 6 2nd Gen Cephalosporins
1. Cefuroxime axetil 2. Cefuroxime 3. Cefprozil (Cefzil) 4. Cefaclor(Ceclor) 5. Cefoxitin (Mefoxin) 6. Cefotetan (Cefotan)
34
Which 2nd gen cephalosporin has anaerobe coverage and is good for pre and post Abd Surgery
Cefoxitin and Cefotetan
35
What are the 7 3rd gen Cephalosporins
1. Ceftriaxone (Rocephin) 2. Ceftazidime (Fortaz) 3. Cefotaxime (Claforan) 4. Cefditoren pivoxil (Spectracef) 5. Cefixime (Suprax) 6. Ceftibutin (Cedax) 7. Cefpodoxime (Vantin)
36
What is the cephalosporin DOC for meningitis
Ceftriaxone (rocephin)
37
What 3rd Gen Cephalosporin is the DOC for N. Gonorrhea
Ceftriaxone (Rocephin)
38
What is the ADE with 3rd Gen Ceftriaxone
Do NOT use on NEONATES, crystals in lungs or biliary slugging
39
What 3rd gen cephalosporin covers pseudomonas
Ceftrazidime (FortaZ)
40
3rd Gen Cephlosporins are mostly good for what three conditions
OM Meningitis N. Gonorrhea
41
What is the 4th Gen cephalosporin
Cefepime
42
What is the role of 4th gen cefepime
- Broadest spectrum - ICU - MSSA - Pseudomonas Coverage
43
What is a cephalosporin that can be used in complicated UTI
4th gen Cephalosporin | Cefepime
44
What is the 5th gen cephalosporin
Ceftaroline (Teflaro)
45
What is 5th gen Ceftraroline good for
SSTI CAP MRSA/MSSA
46
Which gen of cephalosporins covers MRSA and MSSA
5th Gen | Ceftaroline
47
What are the combination cephalosporins that can be used to treat psuedmonas (last line cover eagle)
1.Ceftolozane/Tazobactam(Zerbaxa) 2.Ceftazidime/Avibactam(Avycaz)
48
What are the 4 Carbapenems
Dorienem Imipenem/ Cilastatin Meropenem Etrapenem (DIME)
49
All 4 Carbapenems are good against pseudomonas except for..
Ertapenem
50
What are Carbapenems used for
Very broad- should not be used liberally MSSA Pseudomonas (Except Ertapenem) anaerobic coverage
51
What is the one Monobactam
Aztreonam
52
What is axtreonam used for
Monobactam used for - Pseudomonas - No gram (+) coverage - Can use in PCN/cephalosporin allergic PTs
53
Aztreonam can be used when a pt is allergic to what other ABX
PCN/cephalosporin allergic PTs
54
If the pt is allergic to ceftazadime what drug can you also not use
Aztreonam
55
What is the risk with taking Imipenam <4g/day
SZR
56
What are the 4 drug groups that fall under beta lactams
Penicillins Cephalosporins Carbapenems Monobactams
57
What is the MOA of Glycopeptides and Lipoglycopeptides
``` MOA: cell wall synthesis inhibitor Bactericidal Time dependent Renal adjust Safe for pregnancy (B) ```
58
What drug class in Vancomycin
Glycopeptides & Lipoglycopeptides | Cell wall synth inhibitor
59
What is the 1st line DOC for C. Diff
Vancomycin
60
What is the role of Vancomycin
``` cell wall synthesis inhibitor Bactericidal Time dependent Renal adjust Safe for pregnancy (B) ``` Gram + only MRSA/MSSA 1st line C. difficile oral only 100% remains in intestines
61
Does PO vancomycin need renal adjust? | Does IV?
PO no, 100 percent remains in intestines | IV yes, renally secreted
62
What is the MOA of Cyclic Lipopeptides
``` MOA: bacterial cell membrane inhibitor Bactericidal CONCENTRATION dependent Renal adjust Pregnancy: adv events not observed in animal studies ```
63
What is the MOA of Daptomycin
Cell membrane inhibitor -cidal, concentration dependent Renal excreted
64
What is the role/ use of Daptomycin
MRSA/MSSA/VRE (Covers the big three) Only gram + USE: Complicated SSTI, MRSA/MSSA Bacteremia, Endocarditis, Osteomyelitis
65
Daptomycin can not be used to pulm infx because of what
It’s degraded by surfactant
66
What is Daptomycins ADE
ADV: Nephrotoxicity | -Rhabdomyolysis (MUST MONITOR CK)
67
What drug class does Daptomycin fall under
Cyclic Lipopeptide
68
What is the MOA of polymyxins
acts as detergent and damages bacterial cytoplasmic membrane Bactericidal Renal adjust Nephro and Neuro toxic
69
What drug class does Colistimethate (Colistin) fall under
Polymixins
70
What is Colistimethate (Colistin) used for
Only gram – Pseudomonas INH (INHALED) for pulmonary infections (pneumonia with Cystic Fibrosis) Complicated gram – infections
71
What is the polymixin to use in complicated gram neg infections
Colistimethate (Colistin) IV/INH
72
What is the ADE of Colistimethate (Colistin)
nephrotoxicity | neurotoxicity (neuromuscular blockade)
73
What is the rout of admin for Colistimethate (Colistin)
IV and inhaled (Pulm INfx w/ cystic fibrosis)
74
What is the DOC for a pulm infx with cystic fibrosis
Colistimethate (Colistin)
75
What is Topical Polymixin B used for
Gram (-) USE: ear infections, bladder irrigation, ocular infections
76
What is the MOA of topical polymixin B
MOA: acts as detergent and damages bacterial cytoplasmic membrane Bactericidal
77
What is the MOA of bacitracin
MOA: Inhibits cell wall synthesis
78
What is the coverage of bacitracin
Gram +
79
What is the MOA of neomycin
Protein synth inhibitor
80
What is the coverage of neomycin
Gram -
81
What are the three drugs that make up neosporin
Polymixin B, Bacitracin, Neomycin
82
What is the MOA of Tetracyclines and Glycylcyclines
MOA: Protein synthesis inhibitor | Bacteriostatic
83
What are the ADE of Tetracyclines & Glycylcyclines
Tissue hyperpigmentation (major risk in children, irreversible teeth stains) Photosensitivity NOT SAFE FOR PREGNANCY! Breastfeeding (pump and dump) No children under 8 years old!
84
What is the 1st line Tetracycline that is used for Tick borne diseases
Doxycycline (Vibramycin)
85
Does Doxy need to be renal adjusted
No
86
What is the MOA of doxy
Protein synthesis inhibitor | -static
87
What is Doxy good for
MRSA Option for Malaria prophylaxis & treatment Option for chlamydia trachomatis Resp tract infections (S. Pneumonia) H.Pylori SSTI
88
What are the 3 tetracyclines
Doxy Tetracycline Minocycline
89
Does Doxy cover pseudomonas
No
90
What are the ADE of Doxy
N/V, Tissue Hyperpigmentation (teeth) , Photosensitivity
91
What is the one Glycylcyclines
Tigecycline (IV)
92
What does Tigecycline (IV) cover
Is a Glycylcyclines (protein synth inhibitor) - MRSA (good) - VRE
93
What is Tigecycline (IV) used for
-Increases all-cause mortality and should be reserved for cases when other therapies are not suitable.
94
What is the dose adjustment for the gylcyline: tigecycline
-Eliminated hepatically, only adjust in severe hepatic impairment.
95
What is the MOA for Aminoglycosides
MOA: Protein synthesis inhibitors. Bactericidal Concentration dependent Excreted unchanged renally, dose based on creatine clearance. NOT SAFE FOR PREGNANCY (D) Not absorbed orally/topically; route is highly relevant to site of infection (IV, INH, Topical)
96
What are the 5 aminoglycosides
1. Gentamicin 2. Tobramycin 3. Amikacin 4. Streptomycin 5. Neomycin B STAN-G
97
How are aminoglycosides used
Mono Therapy rarely used only for complicated infections with susceptible gram (–) UTI Combination with cell-wall inhibitors used for severe infections caused by Gram +/- pathogens (no anaerobic coverage)
98
Do Aminoglycosides have anaerobic coverage
No
99
What is the coverage of Aminoglycosides
Gram (– ) more potent Pseudomonas Amikacin or streptomycin > Tobramycin or Gentamicin
100
What is the ADE of Aminoglycosides
ADV: Nephrotoxicity (acute but reversible) And ototoxic Use in caution with elderly pts (5 days)
101
Aminoglycosides can be used with what other ABX groups to help cover pseudomonas
B-lactams, Vancomycin and Daptomycin
102
For the test gentamicin only covers
Pseudomonas
103
For the test tobramycin only covers
Pseudomonas
104
For the test Amikacin and Stroptomycin only cover
Pseudomonas
105
What is the MOA of Macrolides and Ketolides
MOA: Protein synthesis inhibitors Bacteriostatic Both time/concentration dependent Atypicals
106
What is the ADE of macrolides and Ketolides
ADV: Acute cholestatis, hepatotoxicity NONE ARE A GOOD CHOICE FOR INFECTIONS THAT REQUIRE BACTERIOCIDIAL ACTIVITY!
107
If a infx requires -cidal activity can you use Erthymoycin or Azithromycin
No they are -static
108
Macrolides are a good alternative agent for pts allergic to..
B-lactams
109
What are the three macrolides
Erythromycin Azithromycin Clarithromycin All end in romycin
110
What is the ADE of erythromycin
causes most GI problems, used as a promotility agent. Cardiac QT interval prolongation (pharmacy will verify with you if safe) Acute cholestatis, hepatotoxicity
111
What is Azithromycin good for
Macrolide Alternative for B-Lactam pts Chlamydia Infections Safe for Pregnancy Low DDI
112
What is the MOA of Erythromycin, Azithromycin, and Clarithromycin
Protein synth inhibitors | -static
113
What is clarithromycin used for
H. Pylori/ GI ulcer
114
Can clarithromycin be used in pregnancy
NO
115
What are Ketolides good for
Have activity against strains resistant to macrolides
116
What is the one Ketolide
Telithromycin
117
What is the MOA of telithromycin
Protein synth inhibitor | -static
118
What is the MOA of drugs that end in -romycin
Macrolides & Ketolides MOA: Protein synthesis inhibitors Bacteriostatic Both time/concentration dependent
119
What is the MOA of drugs that in the -damycin
Lincosamides MOA: Protein synthesis inhibitor Safe for pregnancy (B) Does not cross BBB. No renal adjustment
120
What is the MOA of clindamycin
Lincosamides MOA: Protein synthesis inhibitor Safe for pregnancy (B) Does not cross BBB. No renal adjustment
121
What ABX has the highest risk of causing C. Diff
Clindamycin
122
What is the ADE that clindamycin causes in HIV pts
Rash
123
What is Clindamycin used for
USE: SSTI, MRSA, MSSA, Malaria anaerobic intra-abdominal infections associated with trauma ORAL cavity, ACNE, Diabetics, Atypicals, Anearobes
124
What is the MOA of drugs that end in -pristin
Streptogramins MOA: Conformational change Bactericidal
125
What is the MOA of Quinupristin/Dalfopristin
Streptogramins MOA: Conformational change Bactericidal
126
What is the ADE of Quinupristin/Dalfopristin
Hyperbillirubinemia
127
What is Quinupristin/Dalfopristin good for
Good MRSA/MSSA, VRE (the big three) USE: MDR organisms, endocarditis, bacteremia, SSTI
128
What is the MOA of oxazolidinones
MOA: Protein synthesis inhibitor Bacteriostatic Pregnancy (C) No dose adjustment for renal or hepatic dysfunction
129
What is the MOA of linezolid and tedizolid
MOA: Protein synthesis inhibitor Bacteriostatic Pregnancy (C) No dose adjustment for renal or hepatic dysfunction
130
What is Linezolid and tedizolid used for
Good MRSA/MSSA, VRE (The big three) Widely distributed CANNOT be used for bacteremia
131
Can linezolid be used for bacteremia
NO
132
What is the coverage of linezolid
Gram + only
133
What is the MOA of floroquinolones
MOA: DNA gyrase inhibitors Bactericidal Concentration dependent Pregnancy C
134
What are the three Fluoroquinolones
Cirpofloxacin Levofloxacin Moxifloxacin
135
What is the MOA of drugs that end in floxcain
MOA: DNA gyrase inhibitors Bactericidal Concentration dependent Pregnancy C
136
What is the DOC for anthrax
Ciprofloxacin
137
What is Ciprofloxacin good for
- Pseudomonas & - UTI - DOC for anthrax
138
What is levofloxacin good for
* Better Pseudomonas coverage than ciprofloxacin - S. pneumonia (CAP) - UTI
139
What is Moxifloxacin good for
Anaerobic coverage S. Pneumonia CAP
140
Oral absorption of Ciprofloxacin, levofloxacin, and Moxifloxacin are all reduced by
Antacids
141
What is the ADE of fluroquinolones
ADV: CNS elderly/critically ill cause hallucinations, delirium, seizures Muscular skeletal, tendon rupture (Achilles most common, athletes beware) QT prolongation Not recommended for CNS or bone
142
Which fluoroquinolones should be used for UTI/ GU
Ciprofloxacin and levofloxacin
143
Which fluoroquinalones should be used for Resp infx
Levofloxacin and Moxifloxacin
144
When dealing with athletes/ runners what precautions should be used with fluoroquinolones
Runner: 10% increase in load after use per week (5 weeks) Athletes: 2-4 weeks off of sports Tendon ruptures
145
What is the MOA of Sulfonamides
MOA: Folate synthesis inhibitor Bacteriostatic Time dependent Adjust for renal Not safe for pregnancy (D) Pump and dump for breastfeeding NO to G6PD!
146
What are the three Sulfonamides
1. Sulfamethoxazole/Trimethoprim (SMX/TMP) (Bactrim) 2. Sulfadoxine & Pyrimethamine 3 Pyrimethamine(anti-malarial)
147
What is Sulfamethoxazole/Trimethoprim | (SMX/TMP) (Bactrim) good for
Sulfonamide MRSA/MSSA Resp infections Opportunistic infections TX or prophylaxis
148
What are SMX/TMP (Sulfonamides), Sulfadoxine & Pyrimethamine all good for
Cross BBB Contraindicated <2mos MRSA/MSSA ``` Use in Malaria UTI/GU OM RTI SSTI ```
149
If a pt has G6PD def. | what drugs can not be used
``` Sulfonamides Nitrofurantoin Dapsone Primaquine Quinidine ```
150
What is the ADE of Sulfonamides | SMX/TMP
ADV: Cross reactivity with sulfonamide moiety. Renal, crystalurea is possible, drink lots of water. Contraindicated <2mos Not safe for pregnancy (D)/Pump and dump for breastfeeding NO to G6PD!
151
What is the MOA of Nitroimidazoles
MOA: Protein synthesis inhibitor
152
What is the DOC for Trichamonas vaginalis
Metronidazole (Flagyl) & Tinidazole (Tindamax)
153
What is the DOC for giardiasis
Metronidazole (Flagyl) & Tinidazole (Tindamax)
154
Vancomycin is the 1st line for C. Diff, was is a good alternative
Metronidazole (Flagyl) & Tinidazole (Tindamax)
155
Pts taking Metronidazole (Flagyl) & Tinidazole (Tindamax) shroud avoid what due to the disulfiram reaction
Alcohol
156
What is Metronidazole (Flagyl) & Tinidazole (Tindamax) good for
DOC Trichomonas vaginalis and giardiasis Good, C. diff alternative (Vancomycin 1st choice) Moderate, H. pylori (TX in combo PPI/acid suppressant and Metronidazole)
157
What is the DDI interaction for Metronidazole (Flagyl) & Tinidazole (Tindamax)
Warfarin
158
What is the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)
Metallic taste
159
What is the 2nd line agent to treat C.diff
1. Fidaxomicin (Dificid)
160
What is the MOA for Fidaxomicin (Dificid)
MOA: inhibit protein synthesis
161
If a pt is allergic to macrolides (Clindamycin and Azithromycin) what other drug can they not take
Fidaxomicin (Dificid)
162
What is the DOC in impetigo
Mupirocin (Bactroban)
163
What is the coverage for Mupirocin (Bactroban)
MRSA/ MSAA
164
What is the MOA of Mupirocin (Bactroban)
MOA: inhibit protein synthesis
165
What is Mupirocin (Bactroban) good for
DOC for impetigo Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks
166
What are the three specific UTI agents
1. Nitrofurantoin 2. Fosfomycin 3. Methenamine 4. Phenazopyridine (Pyridium)
167
What is the drug that is used for the Eradication of nasal colonization of MRSA in adult PTs and healthcare workers during institutional outbreaks
Mupirocin
168
Of the UTI Agents, which is for prophylaxis only
Fosfomycin
169
What is the use of Nitrofurantoin
Uncomplicated UTI Tx
170
What is the MOO of Nitrofurantoin
Protein Synth Inhibitor
171
What is the ADV and Preg Cat for Nitrofurantoin
ADV: NO G6PD! Discolors urine brown | Safe for pregnancy (B)
172
For UTI, how is Methanamine used
Prophylaxis/suppression (recurring on elderly)
173
What are the ADE of Methanamine
ADV: crystalurea, painful urination
174
What is the preg cat for Methanamine
C
175
For UTI, how is phenzaopyridine used
An analgesic only product that discolored the urine orange, can be used for 3 days
176
What are the 5 prophylaxis malaria ABXs
``` Doxycycline Chloroquine Atovapuone-proguanil Melfoquine Primaquine ``` D-CAMP
177
What is the use of chloroquine
Not really used 1-2 was before 4 weeks after Use: areas without resistant P. falciparum
178
What is the use of Atovoquone-proguanil
1-2 days before 1 week after Use: areas with chloroquine resistant P. falciparum FOLATE INHIBITOR Thx and prophylaxis of Uncomplicated Malaria
179
What is the MOA of atovaqoune-proguanil
Atovaqoune: interfere with electron transport in the parasitic mitochondria Proguanil: selective inhibition of plasmodial dihydrofolate reductase; key enzyme for synthesis of folate.
180
What is the advantage of atovaqoune-proguanil
requires shorter periods of treatment before and after travel. 1,2 days before, 1 week after travel
181
What is the food instructions for atovaqoune- proguanil
Take with food/ milk to enhance absorption
182
What are the ADE of atovaqoune-proguanil
ADV: avoid in renal impairment PT (creatinine <30mL/min). Not safe for pregnant or breastfeeding women <11kg babies. May not prefer due to daily medication intake.
183
What is the time and location use of Melfoquine
Use: areas with chloroquine resistant P. falciparum 2 weeks before 4 weeks after travel
184
Which ABX should be used in areas without P. Falciparum resistance
Chloroquine
185
Which ABX should be used in areas with chloroquine resistant P. falciparum
Melfoquine Or Atovaqoune-proguanil
186
What is the DOC for malaria prophylaxis
Doxycycline
187
What ABX should be used in areas with MDR P. falciparum
Doxycycline
188
What are the restrictions and advantages of using doxycycline for malaria
DOC for chemoprophylaxis No <8 y/o, or pregnant. Prevents additional infections for hike, camp, swim in freshwater.
189
What is the use a length of Primaquine for Malaria
Use: Terminal prophylaxis of P.vivax & ovale infections. Alternate for primary prevention. Daily for 7 days post travel
190
Which malaria drugs work on the blood stage
Chloroquine Atovaqoune-proguanil Melfoquine Doxycycline D-CAM no P
191
Which malaria drugs work on the Liver Stage
Atovaqoune-proguanil Primaquine PA
192
Which Malaria dug works on both the liver and blood stage
Atovaqoune- proguanil
193
For Tx malaria, what is the DOC for pregnant women
Melfoquine
194
What are the ADV for Melfoquine
-ADV: No psych patients. Psych disturbances, vivid dreams, mood swings ect. Drug label states neuro side effects could be permanent. No patients under 6mos. No to PTs with cardiac conduction abnormalities.m QTC elongation
195
Which Malaria ABX has the advantage of only requiring weekly dosing
Mefloquine
196
When using Primaquine for malaria it must be combined with one of two other drugs..
Chloroquine or Hydroxychloroquine
197
What is the only malaria ABX that prevents relapse of P. Vivas and P. Ovale strains
Primaquine Primaquine Prevents Relapse
198
What drug that is used for the chemoprophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS, is also used to treat Malaria
Primaquine
199
What are the 6 Quinolones
``` Chloroquine Mefloquine Primaquine Quinidine Quinine Hydroxycholoquine ```
200
What are the 2 folate synth inhibitor ABX
Atovaqoune-proguanil Pyrimethamine & Sulfadiazine
201
What is the MOA and ADE of Pyrimethamine & Sulfadiazine
Folate Inhibitor | ADE: Mouth Ulcers and Alopecia
202
What are the two Tx uses of Pyrimethamine & Sulfadiazine
Malaria Tx and Toxoplasma Gondi
203
Which ABX is good for last minute travelers for the prophylaxis of Malaria
Atovaquone- Proguanil
204
What are the wanrnings and ADE for Atovaqoune-proguanil
Should be taken with food or milk to enhance absorption Advantage: requires shorter periods of treatment before and after travel. 1,2 days before, 1 week after travel. ADV: avoid in renal impairment PT (creatinine <30mL/min). Not safe for pregnant or breastfeeding women <11kg babies. May not prefer due to daily medication intake.
205
What is the DOC for trichomoniasis vaginalis
Metronidazole (Flagyl) & Tinidazole (Tindamax) | DAZOLE
206
What is the MOA of Metronidazole (Flagyl) & Tinidazole (Tindamax)
Protein synth inhibitor
207
Vancomycin is the 1st choice to for C. Diff, | What is an alternative to this 1st choice drug for C. Diff
Metronidazole (Flagyl) & Tinidazole (Tindamax)
208
IF combined with a PPI, Metronidazole (Flagyl) & Tinidazole (Tindamax) can be used to treat what stomach infections
H. Pylori
209
What are the ADE of Metronidazole (Flagyl) & Tinidazole (Tindamax)
ADV: metallic taste Drug interaction: Inhibit Warfarin AVOID ALCOHOL, due to disulfiram reaction
210
What drug is used for the prophylaxis of Toxoplasmosis Gondi
Sulfamethoxazole- Trimethoprim (Septra)
211
What drugs are used for the Tx of Toxoplasmosis Gondi
Pyrimethanine + (clindamycin or sulfamyicn)
212
Metronidazole (Flagyl) & Tinidazole (Tindamax) is the DOC for Trichamonasis vaginalis, but can also be used to treat what other conditions
TX for symptomatic - Invasive intestinal amebiasis - Invasive extraintestinal amebiasis
213
What is the ABX to use with Intestinal protozoans
Metronidazole or Tinidazole Covers abd anaerobes
214
What are the two ABX used on Pinworms
Albendazole Pyrantel Pamoate
215
What is the MOA of Albendazole
Disruption of growth and division of pinworms
216
What is the use of Albendazole
Preferred Tx for pinworms
217
What are the ADE and warnings with Albendazole
ADV: drug-induced killing of parasite release antigens that can cause allergic reactions. Not safe for pregnancy or breastfeeding. Not safe for <2 y/o Must treat the whole family!
218
What is the MOA of pyrantel pamoate
MOA: depolarizing NMB, paralysis in worm. OTC product, not safe for <2 y/o.
219
What are the 3 drugs to use for lice
Permethrin and Pyrethrins Malathion Benzyl Alcohol Lotion
220
What is the 1st line agent in the Tx of live
Permethrin and Pyrethrins
221
What is the MOA of Permethrin and Pyrethrins
Neurotoxic agents to lice
222
What are the age restrictions for Permethrin and Pyrethrins
permethrin, 2mos< Pyrethrins, 2y/o
223
What is the MOA and use for Malathion
Neurotoxic agent for lice MOA: Neurotoxic - High ovicidal activity - Single application adequate
224
Is Permethrin and Pyrethrins single or multiuse?
Multi
225
Is malathion single or multi use ?
Single use adequate
226
What is the ADE of malathion
HIGHLY FLAMMABLE | Not to use around smokers or open flames
227
What is the MOA and use of Benzyl Alcohol Lotion
MOA: occlusive-(suffocates lice) based therapy - Reapply in 1 wk - Can be used as young as 6mos of age.
228
Of the lice tx, which is single use, which is multiuse and which has to be reapplied in 1 wk
Permethrin- multi use Malathion- single use Benzyl Alcohol- reapply in 1 wk
229
What are the 3 antivirals used for Influenza
1. Oseltamivir (Tamiflu) 2. Zanamivir (Relenza) 3. Peramivir (IV) (OPZ)
230
What is the MOA of antivirals used to treat influenza
MOA: inhibits viral neuraminidase, prevent the release of new virus from host cell. Influenza A & B.
231
What is the length of treatment for Oseltamivir (Tamiflu)
5 days
232
What are the age and time requirements to use Oseltamivir (Tamiflu) for Influenza
5-day TX TX: >2wk old. No symptoms no longer than 48 hrs Prophylaxis: >3 mos old Oral preferred for pregnant women
233
What is the tax length for Zanamivir for influenza
5 days
234
What are the tax lengths and age restrictions for zanamivir in the tax of influenza
5-day TX TX: 7y/o< Prophylaxis: 5 y/o
235
What are the ADE of Zanamivir (Relenza)
Not for athsma, COPD, or resp problems Can cause orphayngeal and facial edema
236
What are the tx lengths and age restrictions when using Peramivir (IV) for tx of influenza
1 day TX (uncomplicated) TX: 18y/o< Not for Prophylaxis
237
What are the 2 VZV (Herpes/ Shingles) vaccines
1. Zostavax: Herpes zoster vaccine | 2. Varivax: Varicella zoster vaccine
238
What is the time frame to start Shingles/ Herpes Zoster tx
C/in 72 hrs
239
What are the 3 drugs to use for Genital HSV
Valacyclovir Famciclovir Acyclovir F.A.V.
240
What is the MOA of Antivirals used to treat HSV
MOA: elongating viral DNA, and halt viral replication. Good, HSV 1 & 2. Moderate, VZV - Suppressive therapy for recurrent genital herpes - HIV, recommended regimen for episodic infection - HIV, daily suppressive therapy *take ASAP if suspecting a breakout*
241
What are the three drugs to use for HIV
1. Tenofovir DF (TDF) 2. Tenofovir alafenamide (TAF) 3. Emtricitabine
242
What is the MOA of 1. Tenofovir DF (TDF) 2. Tenofovir alafenamide (TAF) 3. Emtricitabine
HIV tx/ prophylaxis NucleoSIDE/TIDE Reverse Transcriptase inhibitors
243
How long can HIV live in an unused needle?
42 days
244
What is the ADE of: 1. Tenofovir DF (TDF) 2. Tenofovir alafenamide (TAF) 3. Emtricitabine
Used for HIV ADV: hyperpigmentation of the palms or soles
245
What is the combination of HIV drugs used for POST Prophylaxis tax of HIV
Truvada: Tenofovir + Emtricitabine
246
What is the USE and MOA of 1. Dolutegravir (DTG) 2. Raltegravir (RAL)
MOA: Integrase inhibitor Initial treatment for naïve PTs
247
What is the recommended therapy for post needle stick HIV exposure
1. Truvada QDAY 2. Dolutegravir BID * PRE-Exposure Prophylt START within 72hr! Take on empty stomach. Ca, Mg, Fe decrease effectiveness.
248
What are the HIV drugs used for pre exposure prophylaxis of HIV
Tenofovir DF + Emtricitabine (Truvada)
249
What are the 4 first line agents for TB
Rifampin Isoniazid Pyrazinamide Ethambutol RIPE
250
What is the MOA of rifampin
MOA: Inhibits RNA synthesis by targeting RNA polymerase
251
What is the MOA of isoniazid
MOA: interferes with enzymes responsible for assembly of mycolic acids, essential for mycobacterial cell walls.
252
What is the MOA of ethambutol
MOA: Inhibits an enzyme essential for cell wall synthesis of mycobacterium.
253
What is the DOC for TB
Rifampin
254
What is the DOC for latent TB
Isoniazid
255
What effect does adding pyrazinamide to TB tx have
By adding this we reduce TX from 9mos to 6mos.
256
When would we use Ethambutol in TB tx
- Provides additional coverage if the isolate proves to be resistant to INH, rifampin, or both. - May d/c if known to be susceptible to INH & RIF, after 2 mos or once susceptibility is found know.
257
What is the ADE of Rifampin
ADV: Orange-red secretions (urine, tears, feces ect.). Can stain contact lenses. POTENT CYP 450 inducers. Hepatitis leading to liver failure.
258
What is the DDI of isoniazid
Drug Interaction: Inhibitor of CYP 3A4. Metabolized in liver
259
What is the ADE of isoniazid
ADV: peripheral neuropathy, due to excretion of pyridoxine (B6). MUST GIVE PYRIDOXINE WITH INH! Hepatotoxic. NO G6PD PT!
260
What are the ADE of ethambutol
ADV: Optic Neuritis, red-green color blindness.
261
In Tx Tb what group of people can you not use Ethambutol on
Contraindicated on red-green color blind, <5y/o
262
What are the 5 second line agents for TB
``` Rifabutin Rifapentine Streptomycin Fluoroquinolones Kanamycin/ Amikacin ``` RRFSK
263
What is the active TB ABX regiment/ plan
RIPE for 2 months (RIF, ISO, PZA, EMB) Then IR for 4 months (ISO, RIF)
264
In treating Active TB, what drug should be substituted inplace of Rifampin if the pt has HIV
Rifabutin
265
What is the drug that has to be added when treating pregnant women with active TB
-Treating pregnancy, when DZ is moderate to high. Treat with INH, RIF, EMB for 9 months. (DONT USE Pyrazinamide) Add Pyridoxine (Vitamin B6), because of INH. -Safe for breastfeeding women
266
What is the DOC combination when to Latent TB
Isoniazid + Pyridoxine (B6) X9months
267
What are the age ranges and restrictions on treating latent TB with Isoniazid and Pyrdoxine
``` Preferred TX for -HIV PTs -Children <2 y/o -Pregnant women (Qday or twice weekly) ```
268
What is the Tx combination for Latent Tb in children older than 2 years old
Isoniazid Rifapentine + Pyridoxine (B6) X3 months Not recommended for pregnant women
269
What is the DOC for Mycobacterium Avium Complex
Rifabutin
270
What is the MOA of Rifabutin
MOA: Inhibits RNA synthesis by targeting RNA polymerase | Derivative of Rifampin, less potent induction of CYP450 enzyme system.
271
Rifabutin is the DOC for MAC, what are its ADE
ADV: uveitis, skin hyperpigmentation, neutropenia
272
If a TB patient has HIV what drug should be substituted for rifampin
Rifabutin
273
What is the MOA of Rifapentine
MOA: Inhibits RNA synthesis by targeting RNA polymerase
274
What is the dosing of Rifapentine
Analog of rifampin. | Longer half life than Rifampin & Rifabutin, permits weekly dosing.
275
What is the ADE of Rifapentine
ADV: POTENT CYP 450 inducers.
276
What are the 4 rifamycins
Rifampin, Rifabutin, Rifapentine, Rifamixin
277
Outside of TB tx when would you used rifamycins
USE: Endocarditis of a prosthetic valve!
278
What is the MOA of all Fungal Agents
Cell Membrane Inhibitors
279
What are the 2 imidazoles
Ketoconazole Clotrimazole Micanazole
280
What is the DOC of tinea versicolor
Ketoconazole (topical only)
281
What is the use of topical and oral clotrimazole
Topical: cutaneous or vaginal candidiasis Oral: oropharyngeal/esophageal candidiasis
282
When treating Influenza, Oseltamivir has what ADE in the Jap population
Sporadic neuro events
283
What are the 3 Triazoles
Fluconazole Voriconazole Posaconazole (CONAZOLE)
284
What is the DOC for fungal infections, including invasive and noninvasive candidiasis.
Fluconazole (diflucan)
285
What is the DOC for Vulvovaginitis Candidiasis (oral)
Fluconazole
286
How is Fluconazole used as a prophylaxis agent
Prophylaxis against invasive fungal infections in immunocompromised (ex. HIV pts for thrush) and organ transplant.
287
What is the DDI of Fluconazole
Least effect on human CYP450 enzymes of all azoles. Warfarin interaction.
288
What is the DOC in invasive pulmonary or extra pulmonary infections caused by Candida Spp.
Voriconazole
289
What is the DOC aspergillus infections
Voriconazole
290
What are the ADE and Warnings associated with voriconazole
Take without food. ADV: high trough concentrations associated with transient visual disturbances. Auditory hallucination. Hepatotoxic.
291
When would you use Posacanazole when treating a fungal infections
Immuno comp pts
292
What is the DDI of posaconazole
Avoid PPI and H2 blockers
293
What are the 3 allylamines
Terbinafine Butenafine Naftifine Ally-BNT
294
What is the DOC for onchymycosis
Terbinafine (oral)
295
What is the ADE of Terbinafine | ( DOC on onychomycosis)
ADV: avoid in pregnancy and do not breast feed (oral) Monitor LFT! Taste disturbance
296
What are the 2 polyenes
Amphotericin B systemic (lipid formula) Nystatin
297
What is the DOC for Invasive fungal infx
Amphotericin B systemic (lipid formula)
298
What is the anti fungal used Prophylactically for bone marrow transplant.
Amphotericin B systemic (lipid formula)
299
Amphotericin B systemic (lipid formula) can be used empirically to tx what?
Empirically for prolonged neutropenia | CA or immunocompromised PT
300
What is the ADE of Amphoterecin B
Nephrotoxic
301
What is Nystatin used for
Oropharyngeal/esophageal -Oral candidiasis (thrush). Swish & swallow.
302
What drug/ anti fungal agent is used on Topical- axillae, groin, gluteal folds, diaper rash.
Nystatin
303
What Anitfungal can be used in Pt w/ liver problems than cant take oral meds
Ciclopirox: Nail lacquer
304
What is the DOC Pneumocystis Jiroveci pneumonia (PCP) in AIDS PTs.
Sulfamethoxazole- Trimethoprim (Septra)
305
What is the oral DOC for Vulvovaginal Candidiasis (VVC)
DOC Oral Fluconazole
306
What are the two Indra-vaginal azoles that can be used for Vulvovaginal candidiasis
1. Clotrimazole | 2. Miconazole
307
If a pt is pregnant with VVC what is the DOC
Pregnancy- Imidazole (topical) 7 days.
308
What is the Tx length for complicated VVC
TX 10-14 days.
309
What is the extended spectrum B- lactamase resistant organisms (SPACE)
``` Serratia Pseudomonas aeruginosa Acinetobacter Citrobacter Enterobacter ```
310
Which two ABX cause Nephrotoxicity
aminoglycosides and vancomycin
311
What three ABX cause Photosensitivity
quinolones, tetracyclines, sulfonamides
312
What are the ABX that are Cell WAll Synth Inhibitors
``` B- Lactams Carbapenems Monobactams PCN Bacitracin Fosfomycin Vancomycin ```
313
What is the only ABXs that is a DNA gyrase Inhibitor
Fluoroquinolones
314
What are the ABXs that are Protein Synth Inhibitors
``` Aminoglycosides Chloramphenicol Clindamycin Macrolides Mupirocin Streptogramins Tetracyclines ```
315
What are the 5 drugs that are cell membrane inhibitors
``` Amphotericin Ketoconazole Polymixin Colistimethate Daptomycin ```
316
What ABX are RNA polymerase inhibitors
Rifampin
317
What ABX are Folate synth inhibitor
Sulfonamides | Trimethoprim
318
What is the only ABX currently approved for the TX of early or late syphilis ?
PCN G Benzathine

IPAP 21-2 Soph Semester (20 decks)

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