Antimicrobials Flashcards
(129 cards)
1
Q
Which classes of antibiotics are time-dependent?
A
Penicillins
Cephalosporins
2
Q
Which classes of antibiotics are concentration-dependent?
A
Quinolones
Macrolides
3
Q
What is unique about atypical bacteria? Clinical significance?
A
Lack a cell wall
Beta lactams, which target the cell wall, are not effective
4
Q
What stain color are gram positive bacteria? Why?
A
Purple
Outer peptidoglycan layer
5
Q
What stain color are gram negative bacteria? Why?
A
Red/pink
Un-exposed peptidoglycan layer
6
Q
What are the 3 main mechanisms of action for antibiotics?
A
(1) Interfere with cell wall maintenance or synthesis
(2) Interfere with nucleic acid synthesis/function
(3) Interfere with protein synthesis
7
Q
What classes of antibiotic (7 examples) interfere with cell wall synthesis and maintenance?
A
BETA LACTAMS
(1) Penicillins
(2) Cephalosporins
(3) Carbapenems
(4) Monobactams
(5) Vancomycin
(6) Fosofomycin
(7) Daptomycin
8
Q
What classes of antibiotics (4 examples) inhibit nucleic acid synthesis/function?
A
(1) QUINOLONES: Inhibit DNA Gyrase +/- Topoisomerase IV
(2) TRIMETHROPRIM / SULFAMETHOXAZOLE: Inhibits folate synthesis
(3/4): METRONIDAZOLE, NITROFURANTOIN: Create free radicals
9
Q
What classes of antibiotics (6 examples) inhibit protein synthesis?
A
(1) Aminoglycosides
(2) Clindamycin
(3) Linezolid
(4) Macrolides
(5) Tetracyclines
(6) Tigecycline
10
Q
What is the unique side effect of carbapenem?
A
Seizures
11
Q
What are the 4 groups of Beta Lactam antibiotics?
A
(1) Penicillins
(2) Cephalosporins
(3) Carbapenems
(4) Monobactams
12
Q
Name 2 kinds of Natural Penicillins.
A
Natural Penicillins:
Benzathien penicillin, penicillin G
13
Q
What are the 2 1st Generation Cephalosporins?
A
1st Generation:
Cefazolin, cephalexin
14
Q
Name 3 kinds of Carbapenems.
A
Meropenem
Ertapenem
Imipenem
15
Q
Name 1 kind of Monobactam.
A
Aztreonam
16
Q
What are 2 unique traits about aztreonam?
A
(1) Only works on Gram (-)
(2) No cross sensitivity with PCN
17
Q
Augmentin is a (abx class) that contains (abx name) and (beta-lactamase inhibitor).
A
Class: Penicillin
Name: Amoxicillin
BLI: Clavulanic Acid
18
Q
Unasyn is a (abx class) that contains (abx name) and (beta-lactamase inhibitor).
A
Class: Penicillin
Name: Ampicillin
BLI: Sulbactam
19
Q
Zosyn is a (abx class) that contains (abx name) and (beta-lactamase inhibitor).
A
Class: Penicillin
Name: Piperacillin
BLI: Tazobactam
20
Q
1st generation cephalosporins have Primary Coverage against ____ and Secondary Coverage against ____. Two examples are: ______.
A
Primary Coverage: Gram + (except MRSA)
Secondary Coverage: None
Names: Cefazolin IV, Cefalexin PO
21
Q
2nd generation cephalosporins have Primary Coverage against ____ and Secondary Coverage against ____. Two examples are: ______.
A
Primary Coverage: Anaerobes
Secondary Coverage: Gram + (except MRSA), Gram - (except Pseudomonas)
Names: Cefotetan, Cefoxitin
22
Q
3rd generation cephalosporins have Primary Coverage against ____ and Secondary Coverage against ____. Three examples are: ______.
A
Primary Coverage: Gram - (only ceftazidine treats Pseudomonas)
Secondary Coverage: Gram + (except MRSA)
Names: Ceftriaxone, cefpodoxime, ceftazidine
23
Q
4th generation cephalosporins have Primary Coverage against ____ and Secondary Coverage against ____. One example is: ______.
A
Primary Coverage: Pseudomonas
Secondary Coverage: Gram + (except MRSA), Gram -
Name: Cefepime
24
Q
5th generation cephalosporins have Primary Coverage against ____ and Secondary Coverage against ____. One example is: ______.
A
Primary Coverage: MRSA
Secondary Coverage: Other Gram +, Gram -
Name: Ceftaroline
25
Which antibiotic group is effective in treating meningitis?
Cephalosporins
| They have good penetration of meninges and CNS
26
What are the 3 drug names and generations of Quinolones?
2nd: Ciprofloxacin
3rd: Levofloxacin
4th: Moxifloxacin
27
Which 2 Quinolones are effective against bacterial respiratory infections?
(1) Levofloxacin
(2) Moxifloxacin
(especially DRSP)
28
QUINOLONES
- Mechanism of Action
- Indications
- Unique traits
- Side effects
- MoA: Inhibit bacterial DNA gyrase enzyme
- Indications:
(1) Cipro: UTI, prostatitis, intraabdominal, GI bone, joint + Anthrax
(2) Levo & Moxi: Community acquired PNA (DRSP)
- Traits: Avoid Ca++, iron, antacids; poor CNS penetration
- Side effects: Elevated LFTs, inhibit caffeine metabolism causing insomnia
- QT interval prolongation, increased risk of AA
- Risk of tendonitis and rupture (elderly + steroids)
- Interferes with bone growth (young)
29
MACROLIDES
- Mechanism of Action
- Indications
- Unique traits
- Side effects
- MoA: Inhibit protein synthesis
- Indications:
(1) Respiratory infections: PNA (atypical)
(2) Acne, prophylaxis in dental procedures
(3) Alternative for PCN allergies
- Traits:
(1) Azithro: Least side effects & interactions
(2) Clarithro: H. pylori infection; CYP inhibitor, many drug interactions
(3) Erythro: Severe gastric irritation
- Side effects:
- QT interval prolongation (predispose to Vtach)
- Hepatotoxicity
- Confusion
30
TETRACYCLINES
- Mechanism of Action
- Indications
- Unique traits
- Side effects
MoA:
- Indications: broad-sprectrum = lots of uses
(1) Chlamydia: Lymphogranuloma venereum, endocervicitis, urethritis
(2) Mycoplasma: PNA
(3) Rickettsia: Q-fever, Rocky Mountain spotted fever
(4) Other bacteria: Acne, Lyme disease, H. pylori, syphilis, chancroid, cholera
(5) Protozoa: Balantidiasis
- Side effects:
(1) Permanent teeth staining (2nd trimester till 8 years)
(2) Photosensitivity (use sun block)
(3) Hemolytic anemia
(4) Exacerbation of SLE
(5) Thrombocytopenia, coag abn
31
What are the 5 major side effects of Tetracyclines?
(1) Permanent teeth staining (2nd trimester till 8 years)
(2) Photosensitivity (use sun block)
(3) Hemolytic anemia
(4) Exacerbation of SLE
(5) Thrombocytopenia, coag abn
32
SULFANAMIDES
- Mechanism of Action
- Indications
- Unique traits
- Adverse effects
BACTRIM & SEPTRA
- MoA: Inhibits folate synthesis
- Indications:
(1) UTI
(2) Prophylaxis/treatment of opportunistic infections in HIV patients, especially Pneumocystis jirovecii (HIV PCP)
(3) Previously Sulfasalazine used in IBD
- Adverse effects:
(1) Sulfa allergy (delayed cutaneous rxn, fever + rash)
(2) Bone marrow suppression & neutropenia
(3) Renal insufficiency
33
What are 2 contraindications of Sulfanamides?
(1) Folate deficiency anemia
| (2) Heart failure, as sulfa abxs decrease K+
34
DAPSONE: A SULFONAMIDE
- Mechanism of Action
- Indications
- Adverse effects
ACZONE
- MoA: Bacterial folic acid synthesis inhibition
- Indications:
(1) LEPROSY
(2) Alternative med for HIV PCP
(3) Bullous pemphigoid & dermatitis herpetiformis
- Adverse effects:
(1) Rash
(2) Hemolysis with G6PD deficiency
(3) Metheglobinemia
35
AMINOGLYCOSIDES
- Mechanism of Action
- Indications
- Unique traits
- Adverse effects
GENTAMICIN, TOBRAMYCIN, AMIKACIN
- MoA:
- Indications: Serious Gram -, also with BL for serious Gram +
(1) Intraabdominal infections
(2) Bacterial endocarditis
(3) Skin + bone infections
- Traits: IV only; peak and trough to ensure efficacy and avoid side effects; bacteriocidal
- Side effects:
(1) Ototoxicity (irreversible)
(2) Nephrotoxicity in 7 days (nephrotoxicity)
36
MISC: CLINDAMYCIN
- Mechanism of Action
- Indications
- Unique traits
- Adverse effects
- MoA:
- Indications:
(1) Staph & Strep ANAEROBIC infections ABOVE the diaphragm (lung abscess, aspiration PNA, oral cavity infections)
(2) Cellulitis, erysipelas, impetigo
(3) Pelvic infections (& BV & toxoplasmosis)
- Adverse effects:
(1) GI troubles
(2) Higher risk of pseudomembranous colitis (C. diff)
37
MISC: LINEZOLID (oxazolidinones)
- Mechanism of Action
- Indications
- Adverse effects
- Interactions
- MoA: Inhibits bacterial protein synthesis
- Indications:
(1) Hospital-acquired PNA
(2) MRSA - even with PO
- Adverse effects: Headache, nausea, diarrhea, vomiting
- Decreased platelet count
- Interactions:
(1) Potentiate vasopressors
(2) Serotonin syndrome with SSRIs
(3) Raise BP with tyramine foods (aged cheese, wine, soy sauce, smoked meat, fish)
38
MISC: METRONIDAZOLE
- Mechanism of Action
- Indications
- Adverse effects
- Interactions
FLAGYL
- MoA: Inhibits microbial DNA synthesis
- Indications:
(1) Anaerobic (intraabominal & gynecologic)
(2) Protozoal (amebiasis, giardia, trichomoniasis)
(3) C. diff - PO
- Adverse effects: Metallic taste, dizziness, nasal congestion, reversible neutropenia, thrombocytopenia.
- -> OD causes seizures
- Interactions: Safe in pregnancy. Severe NV with ETOH.
- Increases toxicity of lithium, benzodiazepines, cyclosporine, CCBs.
39
MISC: NITROFURANTOIN
- Mechanism of Action
- Indications
- Adverse effects
- Interactions
- Unique trait
MACROBID
- MoA: Creates free radicals & interferes with nucleic acid synthesis/function
- Indications: UTIs caused by E. coli, S. aureus, Klebsiella spp., Enterobacter spp.
- Adverse effects: GI discomfort, dizziness, irreversible peripheral neuropathy, rarely fatal hepatotoxicity
- Interactions: Antacids reduce absorption. Probenecid reduces its excretion.
* Take on full stomach to give crystals time to break down
40
MISC: VANCOMYCIN
- Mechanism of Action
- Indications
- Adverse effects
- Interactions
- MoA: Binds to bacterial cell wall and inhibits its synthesis (not like BL)
- Indications: Gram +
(1) First choice for MRSA
(2) Second choice for C. diff (PO)
(3) Bone & joint infections, Staph blood infections (IV)
- Adverse effects: Ototoxicity & nephrotoxicity
- Red man syndrome: Flushing, itching of the head, neck, face
41
Name 6 antibiotics (2 groups) that are effective on MSSA infections.
PENICILLINS
- PO: Cloxacillin, Dicloxacillin
- IV: Oxacillin, Nafcillin
1st GENERATION CEPHALOSPORINS
- PO: Cephalexin
- IV: Cefazolin
42
Name 5 antibiotics that are effective on MAJOR MRSA infections.
(1) Vancomycin (televancin & oritavancin)
(2) Linezolid
(3) Daptomycin
(4) Ceftaroline
(5) Tigecycline
43
Name 3 antibiotics effective against vancomycin-resistant enterococci (VRE).
(1) Linezolid
(2) Daptomycin
(3) Tigecycline
44
Name 3 antibiotics that are effective on MINOR MRSA SKIN infections.
(1) TMP/SMX
(2) Clindamycin
(3) Doxycycline
45
If a patient has a PCN allergy, can we safely give Cephalosporins?
- If the pt has a minor allergy (maculoapular skin rash; Type II hypersensitivity) --> Cephalosporins OK
- If the pt has a severe allergy (anaphylaxis, hives; Type ! hypersensitivity) --> Avoid Cephalosporins.
- -- Minor infections: Use Macrolides or Clinda
- -- Severe infections: Use Vanco or Linezolid
46
What are the first & second line antibiotics to use in Strep infections?
(1) Penicillin (ampicillin, amoxicillin)
| 2) Vancomycin (used empirically
47
Name 4 antibiotics that can treat GI anaerobic infections.
(1) Metronidazole
(2) Carbapenems
(3) Piperacillin / ticarcillin
(4) 2nd generation cephalosporin
48
Name 2 antibiotics that can treat respiratory anaerobic infections.
(1) Clindamycin (anaerobic Strep- lung & dental abscess)
| (2) Piperacillin, ticarcillin
49
Name 4 antibiotic drug groups that have NO anaerobic coverage.
(1) Aminoglycosides
(2) Aztreonam
(3) Cephalosporins (except cefotetan & cefoxitin)
(4) Oxicillin, nafcillin, cloxacillin, dicloxacillin
50
Name 3 antibiotics that can treat Pseudomonas infection.
(1) Cefepime
(2) Piperacillin
(3) Ticarcillin
51
Which antibiotic drug classes are effective against Gram - infections?
All except amoxicillin (needs body guard)
52
What are the 4 mechanisms of antibiotic resistance?
(1) Altered target
(2) Enzymatic inactivation
(3) Efflux pump
(4) Decreased permeability
53
The mechanism of antibiotic resistance used by MRSA and DRSP is _______.
Alteration in target site
| altering Penicillin-Binding Proteins at their cell walls
54
Name 3 antibiotics that can treat C. diff.
(1) Metronidazole (PO/IV)
(2) Vancomycin PO
(3) Fidaxomicin (Dificid) for severe cases
55
What are risk factors for C. diff that are NOT antibiotics?
(1) Hospitalization
(2) Advanced age
(3) PPI therapy
(4) Enteral feeding
(5) S/P abdominal surgery
56
The highest risk for C. diff include the antibiotics: (1), (2), (3).
The lowest risk for C. diff include: (4), (5).
(1) Clindamycin
(2) Broad-spectrum beta lactams
(3) Quinolones
(4) Aminoglycosides
(5) Metronizadole
57
What 2 antibiotic groups may lead to QT prolongation?
Quinolones (erythromycin, azithromycin)
Macrolides (moxifloxacin, levofloxacin, ciprofloxacin)
Which can lead to Torsades de Pointes
58
What are the modifiable risk factors for drug-induced Torsades De Pointes?
(1) High doses
(2) Rapid infusion
(3) Concurrent use of other QT prolonging drugs
(4) Electrolyte abnormality (low K, low Mg)
59
What are the NONmodifiable risk factors for drug-induced Torsades de Pointes?
(1) Advanced age
(2) Baseline QT prolongation
(3) Bradycardia
60
Antibiotic use leads to increased bleeding in concomitant use of Warfarin. What is the mechanism of interaction?
(1) Disruption of normal intestinal flora which normally synthesize vitamin K.
(2) Inhibition of the CYP enzymes metabolizing warfarin, as well as displacement of warfarin from its plasma protein binding sites.
61
What are the 6 major risk factors for CAP (DRSP)?
(1) Age >65 years
(2) Recent antibiotic exposure
(3) Alcoholism
(4) Medical comorbidities (COPD, DM, RF, CHF, CA)
(5) Immunosuppressive illness or therapy
(6) Exposure to child in daycare (S. pneumo and often take abx for OM)
62
Which antibiotic will you give to a pt who has CAP and meets only one of the 5 risk factors for DRSP?
Levofloxacin, the only drug that covers DRSP, atypical PNA, and H. flu
63
Smoking is a risk factor in developing CAP with the microorganism ______.
H. influenzae
Gram -
Beta-lactamase secreting
64
3 atypical bacteria that lead to atypical CAP.
(1) C. pneumoniae
(2) M. pneumoniae
(3) Legionella (not transmitted with coughing)
65
S. pneumoniae is a Gram ____ organism that is comprised of 2 categories: (1) (2)
Gram +
(1) Non-resistant S. pneumo
(2) DRSP
66
On which CAP is regular dose Amoxicillin effective?
Non-resistant S. pneumo
67
Which antibiotic will you give to a pt who has CAP but NO risk factors for DRSP?
Azithromycin, doxycycline, and levofloxacin
(these are effective against atypical and H. flu)
But spare LEVO for DRSP!
68
What are the 2 antibiotics that are effective against DRSP?
(1) High dose Amox / clav
| (2) High dose Levo
69
Which antibiotic will you give to an outpt with CAP and no risk for DRSP?
Azithromycin
| or doxy
70
Which antibiotic will you give to an outpt with CAP and risk for DRSP?
Levofloxacin
(high-dose Amox or Amox /Clav) PLUS Azithromycin
71
Which antibiotic will you give to a non-ICU inpatient with CAP?
Levofloxacin
| ceftriazone PLUS azithromycin
72
Which antibiotic will you give to an ICU inpatient with CAP?
Ceftrixone PLUS azithromycin
| ceftriaxone PLUS levo
(levo PLUS aztreonam if PCN allergy)
73
Which antibiotic will you give to a pt with CAP and pseudomonas is a consideration?
Piperacillin-Tazobactam PLUS levo
(piperacillin-tazobactam PLUS gentamicin PLUS azithro)
(piperacillin-tazobactam PLUS gentamicin PLUS levo)
(for PCN allergic pts, substitute aztreonam for the BL)
74
What is the preferred antibiotic for bacterial bronchitis? What is the least effective?
Preferred: Azithromycin (treats atypical and gram -)
| Least effective: Beta-lactam
75
The first choice antibiotic in treating bacterial rhinosinusitis is _____; the second choice is _____.
(1) Augmentin 5-7 days 2-3 doses (high or low dose depending on if we suspect resistance)
(if PCN allergy, doxycycline)
(2) Levofloxacin 500mg PO daily x7 days
Failure of both therapies: Pt should be referred to specialist.
76
If a pt with ABRS experiences recurrence of sx, how should we proceed?
Mild sx: Treat with longer course of same antibiotic
Moderate/Severe Sx: Change abx, 7-10 days. If sx persists, refer.
77
What are the 2 factors that determine antibiotic choice when treating children with ABRS?
(1) Severity of symptoms (cut-off is 8)
(2) Risk factors for resistance
- Living in area with high endemic rates (>10%) of invasive PCN nonsusceptible Strep pneumoniae
- Age <2 years
- Daycare attendance
- Antibiotic therapy within the past month
- Hospitalization within the past 5 days
- Unimmunized or under-immunized with pneumococcal conjugate vaccine
78
What antibiotic regimen can we give to a child with ABRS who has a severity score of <8 and NO risk factors for resistance?
Mild/Moderate Case
Regular dose amox/clav 45mg/kg/d PO BID x10 days
79
What antibiotic regimen can we give to a child with ABRS who has a severity score of <8 WITH risk factors for resistance?
Mild/Moderate Case
High dose amox/clav 90mg/kg/d PO BID x10 days
80
What antibiotic regimen can we give to a child with ABRS who has a severity score of > 8 WITH risk factors for resistance?
Severe Case
High dose amox/clav 90mg/kg/d PO BID x10 days
OR
Levofloxacin 10-20mg/kg/d PO BID x10 days
81
What is the antibiotic of choice in treating Strep Pharyngitis? Alternatives?
(1) Penicillin V 500mg 2-3 times/day x10 days
(2) Amoxicllin alternative
(3) If PCN allergy: Clindamycin or Macrolide
82
What is the antibiotic of choice when treating OM in children? In adults?
Children: Amoxicillin
(if PCN allergy, azithromycin, clindamycin, TMP/SMX)
Adults: Amox/Clav
(treatment failure: Ceftriaxone IV or levofloxacin)
(if PCN allergy, azithromycin or doxycycline)
83
How many days is the duration of therapy for the treatment of UTI?
Uncomplicated UTI: 3 days
```
Complicated UTI: 7-14 days
UTI can be complicated by:
- Treatment failure
- Pts with DM
- Symptoms greater than 7 days
- Recently used antimicrobials
- Age >65yrs
- Male patients
```
84
What are the 2 antibiotics of choice in treating perforated peptic ulcer (peritonitis)? What are the risks of this dual agent therapy?
(1) Carbapenems (Imipenem)
(2) Aminoglycosides (Gentamicin)
Risks: Kidney injury, which can make the pt more susceptible to seizures
(neuromuscular blockade and myasthenia-like weakness)
85
In what 5 scenarios of a dog bite is it necessary to give antibiotics? What antibiotics should be given?
(1) Hand-bite wounds (risk of tendon infection)
(2) Deep-puncture wounds
(3) Wounds requiring surgical debridement
(4) Older patients
(5) Bite-wound near a prosthetic joint or any infected wound
Give: Amox/Clav
(PCN allergy: clindamycin with quinolone, or TMP/SMX)
Also give tdap
86
What is the diagnostic protocol in diagnosing osteomyelitis?
(1) MRI detects early osteomyelitis (XR will not show)
(2) Bone biopsy is definitive
(3) ESR helps determine response to therapy
87
How do we treat osteomyelitis caused by MSSA?
Nafcillin
Oxacillin
Ceftriaxone
Cefazolin
88
How do we treat osteomyelitis caused by MRSA?
```
Vancomycin
Ceftaroline
Linezolid
Daptomycin
Tigecycline
```
89
How do we treat osteomyelitis caused by Gram - bacillus?
Quinolones (even PO)
90
How do we treat spontaneous bacterial peritonitis?
Cefotaxime or Ceftriaxone (most common organism is E. coli)
Prophylaxis: Norfloxacin (quinolone) or TMP/SMX
91
What antibiotic regimen is effective in treating epiglottitis?
Ceftriazone and clindamycin
OR
Ceftriaxone and vancomycin
92
What is the antibiotic regimen for outpatient management of PID?
Ceftriaxone with doxycycline for 2 weeks
93
What is the antibiotic regimen for inpatient therapy of PID?
Cefoxitin (or cefotetan) with doxycycline
PCN allergic: Clindamycin with gentamicin
94
What is the antibiotic regimen for treatment of infective endocaridits?
Vancomycin PLUS gentamycin
95
What is the antiviral of choice in treating herpes simplex? What are the side effects?
Acyclovir or valacyclovir (prodrug of acyclovir); famiciclovir
(topical acyclovir is useless!)
Side effects: Nephrotoxicity, neurotoxicity (confusion, tremors, hallucinations are rare)
96
What is the antiviral of choice in treating cytomegalovirus? What are the side effects?
Valganciclovir PO
Ganciclovir IV: Neutropenia
Foscarnet: Nephrotoxicity, hypocalcemia, urethral ulcers
Cidofovir: Nephrotoxicity
97
What antivirals are given for influenza? What is the main rule for giving this med?
Oseltamivir (Tamiflu)
Zanamivir (Relenza) - inhaled
Give within first 48 hours of symptom onset
98
What is the HAART combination given to all HIV + patients?
HAART
Highly Active Antiretroviral Therapy
- 2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) PLUS 1 Integrase Inhibitor
- NRTIs: Emtricitabine, tenofovir, abacavir, lamivudine, zidovudine
- II: ralteGRAVIR, doluteGRAVIR, elviteGRAVIR
99
What is the therapeutic regimen given to pregnant ladies who are HIV+
- 2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) PLUS 1 Protease Inhibitor AVIR
PI: SaquinAVIR ritonAVIR, indinAVIR, lopinAVIR
CS is viral load >1000, baby gets Zidovudine
100
What is the medication regimen for post-exposure prophylaxis of HIV?
2 NRTIs PLUS 1 integrase inhibitor for 1 MONTH
101
25% of HIV pts are also infected with HCV. What is the resultant complication?
Liver toxicity from HAART
102
What is the major adverse effect of NRTIs?
Lactic acidosis
103
Protease inhibitors make you ____ and _____, meaning there is a risk of developing ____ abnormalities.
```
greasy
sweet
lipid abnormalities:
- Lipodystrophy (cosmetically undesirable)
- Hypertriglyceridemia
- Insulin resistance
```
104
What is a condition that develops after long-term anti-HIV drug use?
Osteoporosis
105
What condition can develop after long-term Zidovudine use?
NRTI, Nuke
| Bone marrow suppression (anemia/macrocytic)
106
What 2 conditions can develop after long-term Didanosine & stavudine use?
NRTI, Nuke
Pancreatitis
Peripheral neuritis
107
What is the characteristic adverse effect of Indinavir?
Kidney stones
108
Which anti-HIV drug has the least side effects?
Lamivudine
109
What is the ONLY HIV medication that is contraindicated in pregnancy? (category D)
Efavirenz, NNRTI
110
What value determines whether we need to start an HIV pt on antibiotic prophylaxis? Which antibiotics?
PCP: CD4 count <200 --> Start TMP/SMX (+steroids is severe)
(if sulfa allergy: dapsone or atovaquone or pentamidine)
MAC: T-cell <50 --> Start TMP/SMX PLUS azithromycin
111
Antifungal drugs work against the ____ layer in the cell membrane.
egosterol
112
What are the characteristic traits of fungal cells that have clinical implications?
(1) Fungal cells are slow-growing, slow to die --> Need to treat for long periods of time
(2) When fungal infections involve hair & nails, they should be treated with systemic antifungal (terbinafine or itraconazole)
113
What are the first and second line of treatment for onychomycosis?
(1) Terbinafine (6 weeks fingernails, 12 weeks toenails)
| 2) Itraconazole (works later in fungal life cycle
114
What are the 4 major side effects/traits of antifungals?
(1) Hepatotoxicity
(2) Drug-drug interactions (interferes with CYP450, the hepatic enzymes that metabolize drugs)
(3) Leukopenia
(4) Pruritus
115
What are the adverse effects of Amphotericin B?
Polyenes: amphoterrible
- Fever or chills
- Azotemia (nephrotoxicity: Renal tubular acidosis)
- Hypokalemia, hypokalemia-induced muscle pain
- CNS: Disturbances in vision & hearing, peripheral neuritis, seizures
- GI upset
- Phlebitis and thrombosis
116
What is the one common side effect of Nystatin?
Mild GI upset
117
What are the two preferred antifungals for neutropenic fever (fever last more than 7 days)?
What would be the next step if those do not work?
(1) Voriconazole (visual disturbances)
(2) Echinocandins (caspoFUNGIN, micaFUNGIN, anidulaFUNGIN)
Posaconazole
(Fluconazole only helps if candida is found)
118
What are the 2 indications for Amphotericin B?
(1) Cryptococcus
| (2) Mucomycosis
119
What is the bacterial coverage of neutropenic fever?
(1) Carbapenem
(2) Cephalosporins
(3) Piperacillin/Zosyn
- If fever persists, 2-3 days later add vancomycin
120
What is the one medication that is effective against all protozoal infections?
Metronidazole
121
What antiprotozoal is given for parasites that remain in the GI tract?
Mebendazole
- Poorly absorbed so not effective against tissue-swelling helminth infections such as hydatid cysts
122
What antiprotozoal is given for parasites that exit the GI tract and into other areas of the body?
Albendazole
- Can reach higher serum concentrations
- Works for hydatid cysts
123
What is the one 2nd Generation Cephalosporin?
2nd Generation:
| Cefotetan
124
What are the 3 3rd Generation Cephalosporins?
3rd Generation:
| Ceftriaxone, Cefpodoxime, Ceftazidime
125
What is the one 4th Generation Cephalosporin?
4th Generation:
| Cefepime
126
What is the one 5th Generation Cephalosporin?
5th Generation:
| Ceftaroline
127
Name the 2 types of Aminopenicillins.
Aminopenicillins:
| Amoxicillin, ampicillin
128
Name the 2 types of Anti-Staphylococcal Penicillins.
Anti-Staphylococcal Penicillins:
| Nafcillin, dicloxacillin
129
Name the 2 types of Anti-Pseudomonal Penicillins.
Anti-Pseudomonal Penicillins:
| Piperacillin, Ticarcillin
