antibiotics Flashcards
(115 cards)
1
Q
What should you always consider before starting an antibiotic
A
1) what is the most likely infecting organism
2) Have a gram stain and Culture/ Staining done
3) Allergies
4) Kidney function (BUN and Cr)
5) Interactions
2
Q
Augmentin
A
amoxacillin/ clavulonic acid
3
Q
Zosyn
A
piperacillin/tazobactam
4
Q
Unasyn
A
ampicillin/sulbactam
5
Q
Timentin
A
Ticarcillin/clavulonic acid
6
Q
Zyvox
A
linezolid
7
Q
Invanz
A
ertapenem
8
Q
Cubicin
A
daptomycin
9
Q
Tygacil
A
Tigecycline
10
Q
Bactrim
A
TMP/SMX
11
Q
Rocephin
A
cetriaxone
12
Q
Avelox
A
moxifloxacin
13
Q
zithromax
A
azithromycin
14
Q
primaxim
A
imipenem/cilastatin
15
Q
synercid
A
dafopristin/quinupristin
16
Q
Cleocin
A
clindamycin
17
Q
flagyl
A
metronidazole
18
Q
Dose of augmentin
A
500 or 875 mg PO BID
19
Q
Amount of clavulonic acid in Augmentin 500mg and 875 mg
A
both have 125 mg
20
Q
Spectrum of activity for augmentin
A
staph, strep, enterococci, gram negatives, anaerobes
21
Q
What is the dose for Zosyn (3 alternatives)
A
3.375 g IV every 6 hours
Renal dose- 2.25g IV 6 hours
Alternate dose- 4.5g IV q6hours
22
Q
Spectrum of action for zosyn
A
staph, strep, enterococci, gram negatives and anaerobes
COVERS PSEUDOMONAS
23
Q
Unasyn dosing (2)
A
3.0 IV Q6
Renally- 1.5g IV q6
24
Q
Unasyn indications
A
for polymicrobial diabetic foot infections
25
Spectrum of activity
Staph, strep, enteroccoci, gram negatives
26
Timentin dosing
3.1 g IV q4-6 hours
27
Timentin indications
broad spectrum antibiotic for polymicrobial infections
28
Spectrum for Timentin
Staph, strep, gram neg, anaerobes, COVERS PSEUDOMONAS
29
What lab value do you watch for with Timentin
increased NA loads
30
Penicillins that cover pseudomonas (9)
4th and 5th generation cephalosporins
Piperacillin
Zosyn
Ticaricillin
Timentin
Carbenicillin
Mezlocillin
Azlocillin
31
What are IV alternatives for PCN allergic patients (4)
clindamycin, vancomycin, levaquin, bactrim
32
How are PCN's excreted
all are renally excreted except mezlocillin, azlocillin, piperacillin
33
What concern is there of a patient on PCN and probenecid
probenecid will increase duration of serum levels of PCN and most cephalosporins
34
Vancomycin dosing
1g IV q12hours with slow infusion
35
Vancomycin- when are levels drawn
peak taken 30 minutes after the 3rd dose
trough taken 30 minutes before the 4th dose
36
Vancomycin- what should the peaks and troughs be
peak: 15-30 mg/mL
Trough < 10mg/mL
37
How to adjust the dose based on peaks and troughs
If peak is too high decrease the dose
If the peak is too low increase the dose
If the trough is too high increase the interval between doses
If the trough is too low decrease the interval between doses
38
What happens when you infuse Vanco too quickly
Red Man syndrome- pruritis and erythema
39
How to decrease the risk of Red Man syndrome
slow infusion over one hour
40
How to treat Red Man syndrome
anti histamines until symptoms resolve
41
Other side effects of vancomycin
ototoxicity and nephrotoxicity
42
When should PO vancomycin be used and what is the dose
for treatment of pseudomembranous colitis
125mg PO q6 hours
43
What is the dose for bactrim
one tab PO BID
44
How much is in the single strength tablet of bactrim, and in the double strength
single strength- TMP 80mg/SMX 400mg
double strength- TMP 160mg/ SMX-800mg
45
Does Bactrim cover pseudomonas
NO
46
Contraindications with bactrim
patient on oral hypoglycemic or with G6PD deficiencies
47
Zithromax dosing
250mg PO
48
Half life of zithromax
68hours
49
Can zithromax be given with a PCN allergy
yes
50
Dosing for Primaxin
500mg IV q6-8
OR
1 gram q6-8
51
Does Primaxin cover MRSA or Pseudomonas
no and no
52
What is a side effect of primaxin
seizures in patients with a history of seizures
risk of seizure increases with the dosing
53
How does primaxin work. (the individual parts)
imipenem is the antibiotic portion
cilastatin is the renal dehydropeptidase inhibitor which prevents imipenem from being metabolized by the kidneys
54
Which antibiotic is nicknamed gorrilamycin
imipenem
55
Invanz dosing
1g IV q24 hours
56
indications for Invanz
approved for use in adults for treatment of moderate to severe diabetic foot infections
57
What class is Invanz
it is a structural unique 1 beta methyl carbapenem related to Beta-lactam
58
What is the dose for Zyvox
400-600mg PO/IV q12 hours
59
indication for Zyvox
oral Zyvox used for outpatient treatment of MRSA infections
60
Major side effect for Zyvox
thrombocytopenia
61
Dose for cipro (2)
250-750mg PO q 12 hours
200-400mg IV q 12 hours
62
Levaquin dosing
250-500mg PO/IV q24 hours
63
Dose for avelox (moxifloxacin)
400mg PO/IV q24 hours
64
Spectrum of activity
good for pseudomonas
Cipro- limited gram positive
Levaquin and Avelox- better for gram positives
65
Who should not be given a quinolone
children with open growth plates. May have risk of cartilage degeneration
66
Aztreonam dosing
1-2grams IV q8 hours
67
aztreonam spectrum of activity
gram negatives and pseudomonas
68
Aztreonam side effects
none
69
What are the aminoglycosides (3)
Gentamycin, Tobramycin and Amikacin
70
Spectrum of activity for aminoglycosides
Gram negative anaerobes
71
Side effects for aminoglycosides
Ototoxicity- irreversible
Nephrotoxicity- reversible
Neuromuscular blockade- prevented with slow infusion
72
Clindamycin dosing
600-900mg IV q8hours OR
150-300mg PO BID
73
Spectrum of activity for clindamycin
most gram positives and most anaerobes
74
What is a side effect of clindamycin
pseudomembranous colitis
75
How is clindamycin metabolized
by the liver
76
Flagyl dosing
500 mg PO TID
77
spectrum of activity for flagyl
some gram positive anaerobes and most gram negative anarobes
78
What antibiotics cover MRSA
PO-4
IV-8
Topical- 1
PO-Linezolid, minocycline, cipro/rifampin, bactrim/rifampin
IV- Vancomycin, linezolid, minocyclin, cipro/rifampin, bactrim/rifampin, synercid, tigecyclin and telavancin
Topical- Bactroban
79
What are the only FDA approved drugs for treating MRSA
```
Vancomycin
Linezolid
Daptomycin
Tigecyclin
Telavancin
```
80
How do you treat VRE
| 2
Linezolid
| Dalfopristin-quinupristin
81
What is the only PO therapy for VRE
Linezolid
82
What drugs cover Pseudomonas
```
Cipro
Ceftazidime, Cefepime
Aztreonam
Aminoglycosides
Timentin
Zosyn
```
83
What are some empiric therapies for polymicrobial foot infections
Vanco/Zosyn
Clinda/Cipro
Vanco/Invanz
84
What are the only FDA approved drugs for treating diabetic foot infections
3 Z's
Zosyn
Zyvox
Invanz
85
2 main causes of antibiotic associated diarrhea
Pseudomembranous colitis-Cdif
Non-specific colitis: staph aureus
86
How to test for C-dif
check stool for C diff
87
What is the most common cause of C-dif colitis
clindamycin
88
How do you treat c-dif colitis
Vanco- 125mg PO q6
Flagyl 500mg PO TID
89
What antibiotics are metabolized by the liver
```
3C's and 1 E
Clindamycin
Cefoperazone
Chloramphenicol
Erythromycin
```
90
Can antibiiotics affect PT/INR
yes antibiotics can affect normal flora, which can alter Vitamin K levels.
PT INR can increase
91
What can Beta lactams cause
leukopenia
92
What is the MOA of aminoglycosides and Macrolides
Aminoglycosides inhibit 30S ribosomes
Macrolides inhibit 50S ribosomes
A boy at 30 will not become a Man until 50
93
What antibiotics can be safely used with PMMA beads
Vancomycin
Gentamycin
Tobramycin
Cefazolin
The curing of PMMA is exothermic, therefore the antibiotic must not be heat labile
94
What open fractures should be treated with antibiotics
Grade 2 and 3
95
Postoperative Day 1-2 source of fever (4)
```
"Wind"
everything with the lungs
-pneumonia
-aspirations
-pulmonary embolisms
-atelectasis
```
96
Postoperative Day 3-5 source of fever
"Water"
| -urinary tract infection
97
Postoperative Day 5-7 source of fever
"wound"
| -infection of the actual surgical incision
98
Postoperative day 5+ source of fever
"walk"
| -deep vein thrombosis/ PE
99
Anytime postoperative source of fever
"wonder drugs"
| drug fever reaction to blood products
100
DOC for clostridium perfringens
-12 million units of Penicillin G
101
Penicillins that are hepatically cleared(4)
Nafcillin, Mezlocillin, Azlocillin and Piperacillin
102
Anti-anaerobic antibiotics (2)
Clindamycin and Metronidazole
103
Anti-pseudomonal drugs (5)
- Maxipime
- Ciprofloxacin
- Avelox
- Tobramycin
- Timentin
104
What to give PO for mild MSSA infection
Keflex
105
What to give IV for mild MSSA infection
Ancef
106
What to give for moderate MSSA infection
Unasyn
107
What to give PO for Mild infection of MSSA+anerobes
Augmentin
108
What to give for moderate infection of MSSA+ anaerobes
ertapenem
109
What to give for moderate infection of MSSA+ ESBL
Imipenem/Cilastatin
110
What to give PO for mild MRSA infection (4)
- doxycycline
- daptomycin
- Bactrim
- Clindamycin (300mg)
111
What to give IV for mild MRSA infection
-Clindamycin( 900mg)
112
What to give for moderate MRSA infection
Linezolid and vancomycin
113
What to give for mild and moderate pseudomonas infection
piperacillin
114
What to give for a MRSA+ pseudomonas infection
- Vanco and Zosyn
| - Cipro and clindamycin
115
What to give for a patient who has recurring infections but has used antibiotics recently
-try to cover for gram negative bacilli
-----fluoroquniolones or aminoglycosides
