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Flashcards in Infectious Disease Deck (466):
0

What's Gram-positive organism?

Thick cell wall

Stain purple/bluish in color

1

What's Gram-negative organism?

Thin cell wall

Take up safranin counterstain

Stain pink or reddish in color

2

Gram-positive bacteria consist of mainly what species?

SSLEC

Staphylococcus

Streptococcus

Listeria

Enterococcus

Clostridium

3

Organisms under gram-positive Cocci?

Ending in "cocccus"

4

Organisms under gram-positive Rods?

Propionibacterium acnes

Bacillus anthracis

Clostridium difficle, Clostridium perfringens,
Corynebacterium diphtheriae, Corynebacterium jeikeium

Listeria monocytogenes

Nocardia asteroids (branched)

Actinomyces israelii (branched)

Mycobacterium species (acid-fast)

5

Organisms under gram-negative Cocci?

Neisseria gonorrhoeae

Neisseria meningitidis

6

Organisms under Spirochetes?

Borrelia burgdorferi; Borrelia recurrentis

Leptospira interrogans

Treponema pallidum

7

Organisms under Atypicals?

Chlamydia/Chlamydophilia

Mycoplasma hominis; Mycoplasma pneumoniae

Ureaplasma urealyticum

8

Organisms under gram-negative Coccobacillary?

Acinetobactor sp.

Bartonella henselae; Bordetella pertussis

Family rickettsiaceae; Francisella tularensis

Moraxella catarrhallis

Pasteurella multocida

9

Organisms under gram-negative rod?

All others

10

Whats Minimum Inhibitory Conc (MIC)?

Lowest drug conc that prevents visible microbial growth in 24 hrs

(Gen in practice, the MIC used is to prevent growth of 90% of microorganisms MIC90)

11

What's breakpoint?

Level of MIC at which a bacterium is deemed either susceptible or resistant to an antibiotic

12

What's Minimum Bactericidal Conc (MBC)?

Lowest drug conc that reduces bacterial density by 99.9% in 24 hrs (kills bacteria)

13

What's Synergy?

Effect of 2 or more agents produces a greater effect than each agent alone

14

Purpose of Antimicrobial Stewardship Programs (ASP)?

Reduce emergence of resistance

Limiting drug-related adverse events

Minimizing risk of unintentional consequences associated with Antimicrobial use

15

Factors to consider when selecting a drug regimen?

Etiology/epidemiology (community V. Hospital-acquired inf) of inf

Site/ severity of inf

Patient xteristic (age, body wt, renal/liver fxn, allergies, pregnancy status, immune fxn)

Spectrum of activity and pharmacodynamics/pharmacokinetics of the drug regimen

16

Factors to consider when monitoring for therapeutic effectiveness?

Fever curve

WBC count

Radiographic findings

Pain/inflammation

Reduction in s/sx of inf

Gram stain, cultures and Antimicrobial susceptibilities

17

List Hydrophilic agents

DC BAG

Daptomycin

Colistimethate

Beta-lactams

Aminoglycosides

Glycopeptides

18

Xtics of hydrophilic agents? (Beta-lactams, Aminoglycosides,
Glycopeptides, Daptomycin, Colistimethate)

Small volume of distribution

Renal elimination

Doesn't achieve intracellular conc

Increased clearance and/or distribution in sepsis

Poor-moderate bioavailability

19

Effects of hydrophilic agents? (Beta-lactams, Aminoglycosides,
Glycopeptides, Daptomycin, Colistimethate)

Poor tissue penetration

Nephrotoxicity (ATN- Acute tubular necrosis, AIN- Acute interstitial nephritis)

Not active against atypical (intracellular) pathogens

Consider loading doses and aggressive dosing in sepsis

< 1:1 with PO to IV ratio

20

List Lipophilic agents

Fluoroquinolones

Macrolides

Rifampin

Linezolid

Tetracyclines

Chloramphenicol

21

Xtics of Lipohilic agents (Fluoroquinolones, Macrolides, Rifampin,
Linezolid, Tetracyclines, Chloramphenicol)

Large vol of distribution

Hepatic metabolism

Achieves intracellular conc

Clearance/distribution has minimal change in sepsis

Excellent bioavailability

22

Effects of Lipohilic agents (Fluoroquinolones, Macrolides, Rifampin,
Linezolid, Tetracyclines, Chloramphenicol)

Excellent tissue penetration

Hepatoxicity and DDI (drug-drug interaction)

Active against atypical (intracellular) pathogens

Dose adjustment generally not needed in sepsis

1:1 with PO to IV ratio

23

How's the dose of Beta-lactam maximized?

By extending the infusion time (such as over 4 hrs)

Or

Given as a continuous infusion which can lead to a greater time above the MIC

24

Which drugs are listed under Cmax:MIC (Max plasma conc:Min inh conc)?

C FAD

Colistin

Fluroquinolones

Aminoglycosides

Daptomycin

25

Which drugs are listed under AUC:MIC (Area under curve:Min inh conc)?

VMT

Vancomycin

Macrolides

Tetratcyclines

26

Which drugs occur under T>MIC?

Beta-lactams (penicillins, cephalosporins etc)

Dose: more freq dosing, extended, continuous infusions

27

Which antibiotics are Cell Wall Inhibitors: bactericidal?

PCC VMF

Penicillins

Cephalosporins

Carbapenems

Vancomycin

Monobactams

Fosfomycin

28

Which antibiotics are DNA/RNA Inhibitors: bactericidal?

Q RMT

Quinolones (DNA gyrase/Topoisomerase)

Rifampin

Metronidazole

Tinidazole

29

Which antibiotics are Folic Acid Synthesis Inhibitors: bacterioSTATIC alone; bactericidal (in combo)?

Sulfonamides

Trimethoprim

30

Which antibiotics are Protein Synthesis inhibitors: bacterioSTATIC?

BacterioSTATIC
Except Aminoglycosides and some pathogens for Streptogramnis

31

Which antibiotics are Protein Synthesis inhibitors: 50S?

COMS

Clindamycin

Oxazolidinones (Linezolid)

Macrolides

Streptogramins (Quinupristin, Dalfopristin)

32

Which antibiotics are Protein Synthesis inhibitors: 30S?

AT

Aminoglycosides

Tetracyclines

33

Which antibiotics are Cell Membrane Inhibitors:Bactericidal?

PD

Polymyxins (Colistin)

Daptomycin

34

What warning comes with all antibacterial agents?

Risk of superinfection with prolonged use including C. difficle-associated diarrhea (CDAD) and Pseudomembranous colitis

35

MOA of Aminoglycosides (AMGs)?

Binds to 30s and 50s ribosomal subunits

Exhibit conc-dependent killing

Have a post-antibiotic effect (PAE)

36

Advantage of extended interval dosing v. Traditional dosing?

Extended interval dosing may decrease nephrotoxicity

37

Coverage of Aminoglycosides (AMG)?

Gram-negative bacteria (e.g. Pseudomonas)

In combo with beta-lactam or vanco: Gram-tve cocci e.g. Staphylococci and Enterococcus endocarditis

38

Drugs under AMGs

TAGS

Tobramycin

Amikacin

Gentamicin

Streptomycin

39

How do u dose AMGs?

Using IBW

40

Black box warning of AMGs (TAGS)?

Neurotoxicity (hearing loss, vertigo ataxia)

Nephrotoxicity (esp in renal impairment or concurrent use with other nephrotoxic drugs)

41

SEs of AMGs (TAGS)?

Nephrotoxicity (acute tubular necrosis - ATN)

Hearing loss (early toxicity associated with high-pitched sounds)

42

Adv of extended interval dosing of AMGs?

Less nephrotoxic and more cost-effective

43

Which has the broadest spectrum of activity?

Amikacin

44

What's the peak and trough of Gentamicin for gm-negative infection?

Peak - 5-10mcg/mL

Trough - < 2 mcg/mL

45

What's the peak and trough of Gentamicin for gm-tve infection?

Peak - 3-4mcg/mL

Trough - < 1mcg/mL

46

What's the peak and trough of Tobramycin?

Peak - 5-10mcg/mL

Trough - < 2mcg/mL

47

What's the peak and trough of Amikacin?

Peak - 20-30 mcg/mL

Trough - < 5mcg/mL

48

MOA of penicillins (PCNs)?

PCNs are beta-lactam that inhibit bacterial cell wall synthesis

49

Xtics of PCNs?

PCNs exhibit time-dependent killing

Bactericidal, except against Enterococci species (AMGs, gentamicin and streptomycin are needed for bacterial activity)

50

Coverage of PCNs?

Mainly active against

Gram-tve cocci (Streptococcus)

Some gram-nag entire bacilli coverage

51

Which PCNs have activity against Enterococci?

PAA

Piperacillin

Ampicillin

Amoxicillin

52

Which PCNs have activyt against methicillin susceptible
Staphylococcus aureus (MSSA)?

Nafcillin

53

Effect of addition of beta-lactamase inhibitor to PCNs?

Adds gram-negative coverage (Proteus, E.coli, Klebsiella), H.influenza, MSSA and Anaerobic coverage

54

List PCNs under Aminopenicillins

Amoxicillin (Amoxil)

Amoxicillin + Clavulanate (Augmentin, Augmentin ES-600, Augmentin XR, Amocian)

Amoxicillin + Sulbactam (Unasyn)

55

Brand name of Amoxicillin (Aminopenicllins)?

Amoxil

56

Brand name of Amoxicillin + Clavulanate (Aminopenicllins)?

Augmentin

Augmentin ES-600

Augmentin XR

Amocian

57

Brand name of Amoxicillin + Sulbactam (Aminopenicllins)?

Unasyn

58

List PCNs under Natural penicillins

Penicillin (Pen VK)

Penicillin G Benzathine (Bicillin L-A)

Penicillins G Aqueous (Pfizerpen-G)

Pen G Benzathine and Pen G Procaine (Bicillin C-R)

59

What's the brand name of Penicillin (Natural Penicillins)?

Pen VK

60

What's the brand name of Penicillin G Benzathine (Natural Penicillins)?

Bicillin L-A

61

List PCNs under Ureidopenicillins

Piperacillin + Tazobactam (Zosyn)

62

Brand name of Piperacillin + Tazobactam (Ureidopenicillins)?

Zosyn

63

List PCNs under Carboxypencillins

Ticarcillin + Clavulanic acid (Timentin)

64

List PCNs insider Antistaphylococcal penicillins

NAFCILLIN

Oxacillin

Dicloxacillin

65

Which PCN must be refrigerated?

Augmentin (Amox + Clavulanate) oral SUSPENSION must be refrigerated

66

Which PCN is refrigerated to improve taste?

Amoxil (amoxicillin) oral suspension, stable for 14 days at room temp

67

How do u take Pen VK (Penicillin)? Storage after reconstitution?

On an empty stomach

Refrigerate after reconstitution

68

What diluent is Ampicillin IV compatible with? Stability at room temp?

NS only

Stable for 8 hrs at room temp

69

Which PCN is a vesicant? How can one mitigate SE?

Nafcillin

Use cold packs and hyaluronidase injections (admin thru central line is preferred)

70

In what case is amoxicillin (Amox) DOC for?

Acute otitis media

H.pylori regimen

Pregnancy

Prophylaxis for endocarditis

71

Which PCNs have activity against Pseudomonas?

Piperacillin and Ticarcillin

72

Effects of tetracycline & other bacterioSTATIC on PCNs?

Tetracycline may decrease the effectiveness of PCN, by slowing bacterial growth (PCNs work best against actively growing bacteria)

73

MOA of Cephlosporins?

Inhibit bacterial cell wall

74

Xtics of Cephalosporins?

Time- dependent killing with bactericidal activity

Spectrum of activity is dependent upon gen. of cephalosporin, eg activyt against staphy gen decreases with each generation, while activity against Strep and Gm-negative pathogens increases

75

List agents under 1st generation Cephalosporins

Cefadroxil

Cefazolin (Kefzol)

Cephalexin (Keflex)

76

Xtics of 1st generation Cephalosporins (Cefadroxil; Cefazolin (Kefzol); Cephalexin (Keflex))

Staphylococci activity

Covers - Proteus mirabilis, E. coli and Klebsiella species

Lower - Streptococci and Gm-negative activity (compared to 2nd/3rd generation)

77

Brand name of Cefazolin (1st generation Cephalosporin)?

Kefzol

78

Brand name of Cephalexin (1st generation Cephalosporin)?

Keflex

79

List agents under 2nd generation Cephalosporins

Cefaclor

Cefotetan

Cefoxitin

Cefprozil

Cefuroxime (Ceftin, Zinacef)

80

Xtics of 2nd generation Cephalosporins (Cefaclor; Cefotetan; Cefoxitin; Cefprozil; Cefuroxime (Ceftin, Zinacef))

Better gm-negative activity than 1st gen

Similar gm-tve activity including PEK, Haemophilus & Neisseria species (HNPEK)

81

Which 2nd generation cephalosporin have anaerobic activity (Bacteroides fragilis), but less gm-tve activity?

Cefotetan

Cefoxitin

82

Brand name of Cefuroxime (2nd generation cephalosporin)?

Ceftin

Zinacef

83

List 3rd generation cephalosporin agents

CEFDINIR

Cefditoren (Spectracef)

Cefixime (Suprax)

Cefotaxime (Claforan)

Cefpodoxime

Ceftazidime (Fortaz, Tazicef)

Ceftibuten (Cedax)

Ceftriaxone (Rocephin)

84

Xtics of Ceftazidime (Fortaz, Tazicef) 3rd generation cephalosporin?

Less gm-tve activity, but enhanced gm-negative activity, including Pseudomonas

85

Brand name of Ceftazidime (3rd generation cephalosporin)?

Fortaz

Tazicef

86

Brand name of Ceftriaxone (3rd generation cephalosporin)?

Rocephin

87

List 4th generation cephalosporin agent

Cefepime (Maxipime)

88

Xtics of 4th generation cephalosporin (Cefepime - Maxipime)?

Best gm-negative activity, including HNPEKS, Citrobacter, Acinetobacter, Pseudomonas, Enterobacter and Serratia species (CAPES)

and

Gm-tve activity similar to 3rd gen

89

What's the brand name of Cefepime? (4th generation cephalosporin agent)?

Maxipime

90

List 5th generation cephalosporin agent

Ceftaroline fosamil (Teflaro)

91

Xtics of Ceftaroline fosamil (Teflaro) 5th generation cephalosporin agent?

Best Gm-tve activity

Covers MRSA

Some gm-negative activity (no Pseudomonas coverage)

92

What's the brand name of Ceftaroline? 5th generation cephalosporin agent

Teflaro

93

Is there cross-sensitivity btw Cephlosporins and PCNs?

Cross sensitivity (< 10%) with PCN allergy

Don't use in pts who have a type 1 mediated PCN allergy (swelling, angioedema, anaphylaxis

94

Which cephalosporin shouldn't be given via Y-site or mixed with calcium-containing solns or used in neonates? Which is preferred?

Ceftriaxone (Rocephin)

Preferred-Cefotaxime (Claforan)

95

Which cephalosporin contains N-methylthiotetrazole (NMTT or 1-MTT) side-chain? Effect of this?

Cefotetan

Can increase the risk of hypoprothrombinemia (bleeding) and a disulfiram-like rxn with alcohol ingestion

96

Effect of Probenecid on all Beta-lactams?

Increase beta-lactam levels by interfering with renal excretion

97

MOA of Carbapenems?

They inhibit bacterial cell wall synthesis

They exhibit time-dependent killing with bactericidal activity

98

Coverage of Carbapenems?

Very Broad spectrum (gm-tve, gm-negative and anaerobic pathogens)

99

What don't Carbapenems cover?

Atypical pathogens

MRSA

VRE

C.difficle

Stenotrophomonas

100

What does Ertapenem (Carbapenem) not cover?

Psuedomonas

Acinetobacter

101

List agents under Carbapenems?

Imipenem/Cilastatin (Primaxin)

Meropenem (Merrem)

Ertapenem (Invanz)

Doripenem (Doribax)

102

Brand name of Imipenem/Cilastatin (Carbapenems)?

Primaxin

103

Brand name of Meropenem (Carbapenems)?

Merrem

104

Brand name of Ertapenem (Carbapenems)?

Invanz

105

Brand name of Doripenems (Carbapenems)?

Doribax

106

Main SE of Carbapenems?

Seizures

107

MOA of Fluoroquinolones (FQs)?

Fluoroquinolones inhibit bacterial DNA Topoisomerase IV and inhibit DNA gyrase (Topoisomerase II)

Exhibit conc-dependent killing

108

Which FQs have gm-negative activity, including Pseudomonas?

Ciprofloxacin

Levofloxacin

109

Which FQs are referred to as respiratory FQs? Why?

Gemifloxacin

Levofloxacin

Moxifloxacin

Due to enhanced coverage of Stretococcus pneumoniae and atypical coverage

110

List FQs agents

OFLOXACIN

Norfloxacin (Norozin)

Ciprofloxacin (Cipro, Cipro XR)

Levofloxacin (Levaquin)

Gatifloxacin (ophthalmic only)

Moxifloxacin (Avelox)

Gemifloxacin (Factive)

111

What's the brand name of Ciprofloxacin? FQs

Cipro

Cipro XR

112

What's the brand name of Levofloxacin? FQs

Levaquin

113

What's the brand name of Otic Ciprofloxacin? FQs

Ciprodex

114

What's the brand name of Moxifloxacin? FQs

Avelox

115

What's the brand name of Ophthalmic Moxifloxacin? FQs

Vigamox

116

What's the dosing of Ciprofloxacin (IV/PO)?

250-750mg PO

200-400mg IV Q8-12H

117

What's the dosing interval of Ciprofloxacin if CrCl = 30-50ml/min?

Q12H

118

What's the dosing interval of Ciprofloxacin if CrCl < 30ml/min?

Q18-24H

119

What's the dosing of Levofloxacin (IV/PO)?

250-720mg daily

500mg, them 250mg daily or 250mg daily

120

What's the dosing of Moxifloxacin (IV/PO)?

400mg Q24H

121

What's the dosing of Gemifloxacin (PO)?

320mg daily

122

Black box warning of FQs?

Tendon inflammation and/or rupture (most often in Achilles' tendon)

123

Warnings to FQs use?

May prolong QT interval (avoid with class Ia and III antiarrhythmics)

Peripheral neuropathy (with both oral and IV formulations)

CNS effects e.g. Seizures

Hypoglycemia (may be severe and sometimes fatal)

Photosensitivity

124

Can FQs be used in children?

Avoid in children - risk of arthropathy

125

FQs SEs?

GI upset/diarrhea

126

How should Cipro oral suspension NOT be given?

Through a NG or other feeding tube

Don't refrigerate oral suspension

127

Which Cipro formulation can be fed through feeding tube?

Cipro IR - crush, mix with water

128

How should Levofloxacin oral soln be taken? Storage?

On an empty stomach

At room temp

129

List agents that can chelate FQs

Antacids
Didanosine
Sucralfate
Bile acid resins
Mg
Al
Ca
Fe
Zn
Multivitamin

130

When do u give Cipro before and after cheating agents?

Cipro - 2hrs b4 or 6hrs after agents

131

When do u give Levo before and after cheating agents?

2hrs b4 or after

132

When do u give moxi before and after cheating agents?

4hrs b4 or 8hrs after

133

List Macrolides agents

Azithromycin (Zithromax, Z-Pak)

Clarithromycin (Biaxin, Biaxin XL, Biaxin XL Pac)

Erythromycin (E.E.S, Ery-Tab, EryPed, Erythrocin)

134

What's the brand name of Azithromycin? Macrolide

Zithromax

Z-Pak

135

What's the brand name of Clarithromycin? Macrolide

Biaxin

Biaxin XL

Biaxin XL Pac

136

What's the brand name of Erythromycin? Macrolide

E.E.S

Ery-Tab

EryPed

Erythrocin

137

Warning of Macrolides?

QT prolongation (like FQs)

Hepatoxicity

138

SEs of Macrolide?

GI upset (diarrhea, abdominal pain and cramping esp with Erythromycin)

139

Storage of Azithromycin oral suspension (Zmax)?

Don't refrigerate

140

How do u take Biaxin XL (Clarithromycin)?

With food

141

Storage of Biaxin (Clarithromycin) oral suspension?

Don't refrigerate (can gel)

142

Which Macrolide must be refrigerated? Expiration?

Erythromycin ethylsuccinate (E.E.S) oral granule suspension

Use w/in 10 days

143

Stability of Erythromycin powder suspension?

Stable at room temp x 35 days

144

Which Macrolide doesn't have many clinically significant drug interactions?

Azithromycin

145

What must be avoided with ALL Macrolides?

With agents that can prolong QT interval

146

List tetracycline agents

Doxycycline

Minocycline

Tetracycline

147

How should Oracea (Doxycycline) be taken?

On empty stomach (1hr before or 2hrs after meals)

Take other forms with food to reduce GI irritation

148

Warnings ass with Tetracycline agents?

Children 8 yrs and under

Pregnancy

Breastfeeding

149

SEs of Tetracycline agents

GI upset

Photosensitivity

150

What's Doxycycline IV to PO conversion ratio?

1:1

151

Storage of Doxycycline oral suspension

Not to be refrigerated

152

MOA of Sulfonamides?

Inhibit enzymes of the Folic acid pathway

Individually, they are bacterioSTATIC, but collectively they are bactericidal

153

List agent under Sulfonamides?

Sulfamethoxazole and Trimethoprim (Bactrim, Septra, Sulfatrim)

154

What's the brand name of Sulfamethoxazole and Trimethoprim?

Bactrim

Septra

Sulfatrim

155

What's always the ratio of Sulfamethoxazole and Trimethoprim?

5:1 ratio

Eg SMX/TMP 400/80

156

Indication for Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

Adult female uncomplicated UTI - 1 DS tab bid x 3 days

PCP prophylaxis - 1 DS or SS tab daily

157

CI to Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

Sulfa allergy

158

SEs of Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra)?

GI upset (n/v/d)

Skin rxns (rash, SJS, TEN)

Crystalluria (take with 8oz of water)

Photosensitivity

Hyperkalemia

Hypoglycemia

159

Storage of Bactrim IV? Diluent?

Store at room temp (Bactrim susp too)

Dilute with D5W

160

Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) IV to PO?

1:1

161

Sulfamethoxazole and Trimethoprim (Bactrim, Sulfatrim, Septra) are strong inh of 2C8/9. What med should caution be used with?

Warfarin

162

MOA of Vancomycin?

Blocks Glycopeptides

Exhibits time-dependent killing and is bacticidal

163

What's Vancomycin (Vancocin) DOC for? Dose?

MRSA inf

15-20mg/kg Q8-12H IV

164

What's oral Vancomycin used for? Dosing?

C.diff

125-500mg QID Z 10-14 days

165

SEs of vancomycin?

Infusion rxn/red man syndrome

Nephrotoxicity

166

What's Vanco trough (after 4th dose) for Pneumonia, Endocarditis, Osteomyelitis, Menigitis, Bacteremia?

15-20 mcg/mL

167

What's Vanco trough (after 4th dose) for other infections?

10-15 mcg/mL

168

What the max infusion rate for peripheral IV vanco?

Don't exceed 5 mg/mL

169

When is an alternative agent considered instead of vanco?

When MIC of organism >= 2 mcg/mL

170

Coverage of Linezolid?

Most gm-tve bacteria, including MRSA, VRE faecium and faecalis

Approved for pneumonia and uncomplicated/complicated skin and soft-tissue infections including diabetic foot inf and inf caused by Staphylococcus aureus and Strep species and for VRE inf

171

What's the brand name of Linezolid?

Zyvox

172

CI to Linezolid (Zyvox) use?

Concurrent use or w/in 2 wks of MAO inh

173

Warnings to Linezolid (Zyvox) use?

It's a weak MAO inh

174

SEs to Linezolid (Zyvox) use?

Headaches

Diarrhea

175

What's the IV to PO conversion of Linezolid (Zyvox)?

1:1

176

Does Linezolid (Zyvox) req adjustment in renal impairment?

NO!

177

Storage of Linezolid (Zyvox)?

Room temp

178

What's brand name of Quinupristin/Dalfopristin?

Synercid

179

Whats Quinupristin/Dalfopristin (Synercid) approved for?

Complicated skin and soft-tissue inf caused by Staphylococcus aureus and Streptococcus pyogenes

180

SEs of Quinupristin/Dalfopristin (Synercid)?

Arthralgias/myalgias (up to 47%)

Infusion rxn, including edema and pain at infusion site (up to 44%)

Phlebitis (40%)

Hyperbilirubinemia (up to 35%)

181

How should Quinupristin/Dalfopristin (Synercid) be given peripherally?

Must be in a vol of >= 250ml

Mixed with D5W ONLY

182

What's Daptomycin brand name?

Cubicin

183

What's Daptomycin (Cubicin) approved for?

Complicated skin and soft-tissue inf and staphylococcus aureus bloodstream infections, including right-sided endocarditis

184

SEs of Daptomycin (Cubicin)?

GI upset (constipation, diarrhea, vomiting)

Increased CPK and myopathy

185

Monitoring of Daptomycin (Cubicin)?

CPK level weekly

186

What indication is Daptomycin (Cubicin) not used for?

Pneumonia (as it's inactivated by surfactant)

187

What diluent is Daptomycin (Cubicin) compatible with?

NS (not D5W)

188

Daptomycin (Cubicin) and PT/INR?

Can cause false elevations in PT/INR (but no increase in bleeding risk)

189

What's Telavancin (Vibativ)?

Lipoglycopeptide and derivative of vancomycin

190

What's Telavancin (Vibativ) approved for

Complicated skin and soft-tissue inf caused by Gm-tve org

Hospital acquired pneumonia (HAP) due to gm-.tve pathogens, including MRSA, when alt tx are not appropriate

191

Black box warning of Telavancin (Vibativ)?

Nephrotoxicity

192

Warnings of Telavancin (Vibativ) use?

May prolong QT interval

Red man syndrome

193

SEs of Telavancin (Vibativ)?

Metallic taste

N/v

194

Additional agents to treat gm-negative inf

Aztreonam

Colistimethate

195

Aztreonam and cross-allergenicity with beta-lactams?

Monobactams structure makes cross-allergenicity with beta-lactams unlikely

196

What's the brand name of Aztreonam?

Azactam iv

197

Coverage of Aztreonam (Azactam IV)?

Gm-negative org, including Pseudomonas

NO gm-tve activity

198

Effect of lack of cross-allergenicity of Aztreonam (Azactam IV) with beta-lactams?

Can be used in PCN-allergic pts

199

Brand name of Colistimethate?

Colistin

Coly-Mycin M

200

Moa of Colistimethate (Colistin; Coly-Mycin M)?

Conc-dependent killing

Bactericidal

201

Coverage of Colistimethate (Colistin; Coly-Mycin M)?

Used primarily in multidrug resistant Gm-negative pathogens

202

Warnings of Colistimethate (Colistin; Coly-Mycin M)?

Nephrotoxicity (dose-dependent)

203

SEs of Colistimethate (Colistin; Coly-Mycin M)?

Nephrotoxicity (Proteinuria, increased SCr)

Neurologic disturbance (dizziness, tingling, numbness, parasthesia, vertigo)

204

List other nephrotoxic antibacterial agents

Colistimethate (Colistin; Coly-Mycin M)

Amphotericin B

AMGs

205

Warnings ass with Chloramphenicol use?

Gray syndrome - xterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma and death, associated with high serum levels

206

What's Telithromycin (Ketek) structurally related to?

Macrolides

207

Warnings of Telithromycin (Ketek) use?

Acute hepatic failure

QT prolongation

208

Monitoring of Telithromycin (Ketek) use?

LFTs

209

What class is Tigecycline (Tygacil) structurally related to?

Tetratcyclines

BacterioSTATIC

210

Tigecycline (Tygacil) are Gm-tve and Gm-negative. Which gm-negative does it have no effect against?

The 3 P's

Pseudomonas
Proteus
Providencia

211

What's the recent FDA warning about the use of Tigecycline (Tygacil)?

Only when other alternatives are not possible

212

Black box warning of Tigecycline (Tygacil)?

Increased risk of death

213

When should the use of Tigecycline (Tygacil) be avoided?

In bloodstream infections

214

Black box warning of Clindamycin (Cleocin)?

Severe and possibly fatal colitis

215

SEs of Clindamycin (Cleocin)?

GI upset (n/v/d)

216

Brand name of Metronidazole?

Flagyl

217

Dosing of Metronidazole (Flagyl) for mild-to-moderate C. diff inf?

500mg TID for 10-15 days

218

CI to Metronidazole (Flagyl) and Tinidazole (Tindamax)?

Use of alcohol during therapy or w/in 3 days of therapy d/c

Can increase INR if used with warfarin

219

SEs to Metronidazole (Flagyl) and Tinidazole (Tindamax)?

GI upset

Metallic taste

CNS (peripheral neuropathy)

220

IV to oral ratio of Metronidazole (Flagyl)?

1:1

221

Storage of Metronidazole IV?

Don't refrigerate

222

Indication of Rifaximin (Xifaxan)?

Traveller's diarrhea caused by non-invasive E.cole

And

Prevention of hepatic encephalopathy

223

Indication of Fosfomycin (Monurol)?

Single dose for uncomplicated UTI (cystitis only) due to E.coli and E.faecalis (active against VRE)

224

Indication of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?

Uncomplicated UTI (cystitis only) due to E.coli, S.aureus, Enterococcus, Klebsiella and Enterobacter

225

CI of Nitrofurantoin (Macrodantin, Macrobid, Furadantin)?

Pts with renal impairment (CrCl < 60 mL/min)

226

Coverage of Fidaxomicin (Dificid)?

C. difficile associated diarrhea

227

Limitation to Fidaxomicin (Dificid) use?

Not effective for systemic inf

228

List the main antibiotics that need to be refrigerated

Amox/Clavulanate (Augmentin)

Cefprozil

Cefuroxime (Ceftin)

Cephalexin (Keflex)

Erythromycin ethylsuccinate/sulfisoxazole

Penicillin VK

229

Which AB is recommended to be stored in the fridge? Why?

Amoxicillin (Amoxil) - improves taste

230

List Antiobiotic that should NOT be refrigerated

Azithromycin (Zmax)
Cefdinir
Cefixime (Suprax)
Clarithromycin (Biaxin) - bitter taste and thickening/gels
Clindamycin (Cleocin) - thickening and may crystallize
Ciprofloxacin (Cipro)
Doxycycline (Vibramycin)
Fluconazole (Diflucan)
Levofloxacin (Levaquin)
Linezolid (Zyvox)
SMX/TMP (Septra, Sulfatrim)
Voriconazole (VFEND)

231

Antiobiotic that DO NOT need renal dose adjustment

Azithromycin

Ceftriaxone
Chloramphenicol
Clindamycin

Dicloxacillin
Doxycycline

Erythromycin

Fidaxomicin

Linezolid

Metronidazole
Minocycline
Moxifloxacin

Nafcillin

Oxacillin

Quinupristin/Dalfopristin

Rifaximin
Rifampin

Tigecycline
Tinidazole

232

Main Antiobiotic used for skin and skin structure inf caused by community- associated methicillin-resistant staphylococcus aureus (CA-MRSA)?

SMX/TMP (Bactrim DS) 1-2 DS tab Q12H

233

Main agent used for Nosocomial-Associated MRSA?

Vancomycin

234

Main agents used to treat VRE faecalis?

Pen G or Ampicillin

235

Main agents used to treat VRE faecium?

Daptomycin

236

Main agents used to treat Pseudomonas aeruginosa?

Imipenem; Meropenem; Doripenem

Cefepime; Ceftazidime

Ciprofloxacin; Levofloxacin

Aztreonam

Ticarcillin/Clavulanic acid; Piperacillin; Piperacillin/Tazobactam

Colistimethate (Colistin)

Amikacin; Tobramycin; gentamicin

237

Main agent used to treat Extended spectrum beta-lactamase producing Enteric gram-negative rods (ESBL GNR) - E.coli, Klebsiella pneumoniae, P.mirabili

Carbapenems

238

Agents used to treat Acinetobacter baumannii

Imipenem

Meropenem

Doripenem

239

Agents used to treat Bacteroides fragilis?

Metronidazole

Carbepenems

Beta-lactam/ beta-lactamase inh for combos

Tigecycline

Cefoxitin

Cefotetan

240

Agents used to treat C. difficile?

Metronidazole

Vancomycin (PO)

Fidaxomicin

241

List antibiotics that may cause Hepatotoxicity

Rifampin

Macrolides (Azithromycin, Clarithromycin, erythromycin)

Clindamycin
Fluconazole
FQs (Ofloxacin, norfloxacin, Cipro, Levo, Gatifloxacin, Moxi, Gemi)
Quinupristin/Dalfopristin
Tetracycline

242

List antibiotics that may cause renal toxicity

AMGs (acute tubular necrosis - ATN)
Colistin (ATN)

Acyclovir
SMX/TMP
Beta-lactams (acute interstitial nephritis - AIN)
Vanco (AIN)

243

Which Antibiotics increase Neuromuscular blockers, ototoxic?

AMGs

244

Which Antibiotics may cause seizure with accumulations; allergic rxns?

Beta-lactams

245

Which Antibiotics has a BBW of Colitis?

Clindamycin

246

Which Antibiotics should CPK levels be monitored in and should only be mixed with NS?

Daptomycin

247

Which Antibiotics is QT prolongation a concern in?

Fluconazole

Macrolides (Azithromycin, Clarithromycin, erythromycin)

FQs

SMX/TMP

248

Which Antibiotics is serotonin syndrome if used with SSRI or MAO-I and HTN crisis, BMS

Linezolid

249

Which Antibiotics results in metallic taste, darkened urine, PN, no EtOH?

Metronidazole

250

Which Antibiotics is CI in CrCl < 60ml/min

Nitrofurantoin

251

Which Antibiotics has BBW of tendonitis, additive QT, photosensitivity, cations (dosed 1-2 hr b4 or 4-6 hr after di/trivalent cations eg Mg, Ca, Fe), PN?

Quinolones

252

Which Antibiotics causes muscle toxicity, phlebitis, and must be diluted with D5W only?

Quinupristin/Dalfopristin

253

Which Antibiotics causes Red urine and a strong 450 inducers?

Rifampin

254

Which Antibiotics causes allergic rxns, photosensitivity, additive QT, diluted with D5W only, stored at room temp?

SMX/TMP

255

Which Antibiotics must be separated from cations (dosed 1-2 hr b4 or 4-6 hr after di/trivalent cations eg Mg, Ca, Fe), cause photosensitivity and is preg class D (affects the bone)?

Tetracyclines

256

Which antibiotics causes ototoxic, infusion rxns?

Vancomycin

257

Common bacterial pathogens for selected sites of infection (CNS/Meningitis)?

Stretococcus pneumoniae

Neisseria gonorrhoeae

H. influenza

Stretococci/E.coli (young)

Listeria (young/old)

258

Common bacterial pathogens for selected sites of infection (Upper Respiratory)?

M. catarrhallis

H. influenza

Streptococci

259

Common bacterial pathogens for selected sites of infection (Bone and Joint)?

Staphylococcus aureus

Staphylococcus epidermidis

Streptococci

Neisseria gonorrhea

+/- GNR

260

Common bacterial pathogens for selected sites of infection (Mouth/ENT)?

Peptostreptococcus

Actinomyces

Anaerobic GNRs

+/- H. influenza and aerobic GNR

261

Common bacterial pathogens for selected sites of infection (Skin/Soft Tissue)?

Staphylococcus aureus

Streptococcus pyogenes

Staphylococcus epidermidis

Pasteurella

+/- aerobic/anaerobic GNR (diabetics)

262

Common bacterial pathogens for selected sites of infection (Intra-abdominal Tract)?

E. coli, Proteus, Klebsiella

Enterococci/Streptococci

Bacteroides species

263

Common bacterial pathogens for selected sites of infection (Lower
Respiratory - Community)?

Streptococcus pneumoniae

H. influenza

Atypicals: Legionella, Mycoplasma

Enteric GNRs (Alcoholics, IC, HCA)

264

Common bacterial pathogens for selected sites of infection (Lower
Respiratory - Hospital)?

Enteric GNRs (E. coli, Klebsiella, Proteus)

Streptococcus pneumoniae

Pseudomonas aeruginosa

Enterobacter species

S. aureus, including MRSA

265

Common bacterial pathogens for selected sites of infection (Urinary Tract)?

E. coli, Proteus, Klebsiella

Staphylococcus saprophyticus

Enterococci/Streptococci

266

What's surgical antibiotic prophylaxis?

Brief course of AB initiated w/in 60mins before incision

(120 mins before incision if using FQs or Vancomycin)

267

When's a second dose of AB needed surgical antibiotic prophylaxis?

Longer procedures (>= 3-4 hrs)

If there's a major blood loss (>= 1.5L of blood)

268

Drug of choice as surgical antibiotic prophylaxis?

1st or 2nd generation Cephalosporin e.g. Cefazolin/ Cefuroxime

Given 1 hr (60mins) before

269

Alternative to DOC of surgical antibiotic prophylaxis?

In PCN-allergic pts

Vancomycin - given 2 hrs prior to surgical incision

270

When is AB with broader spectrum used? Name the AB used?

In surgeries that involve parts of the bowel or put patients at risk of an anaerobic infection

Cefotetan, Ertapenem or Ceftriaxone with Metronidazole

271

What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in CABG, other cardiac or vascular surgeries?

Hip fracture repair/total joint replacement?

Cefazolin, Cefuroxime

Vancomycin or Clindamycin

272

What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in Colon (colorectal)?

Cefotetan, Cefoxitin, Ampicillin/Sulbactam or Ertapenem

Or

Cefazolin or Ceftriaxone + Metronidazole

Alternative:
Clindamycin + (Aminoglycoside or Quinolone or Aztreonam)
Or
Metronidazole + (Aminoglycoside or Quinolone)

273

What's the recommended AB (and Alt. if pt has Beta-lactam allergy) in Hysterectomy?

Cefotetan, Cefazolin, Cefoxitin or Ampicillin/Sulbactam

Alternative:
Clindamycin or Vanco + (Aminoglycoside or Quinolone or Aztreonam)
Or
Metronidazole + (Aminoglycoside or Quinolone)

274

What's the most likely organism to cause bacterial meningitis?

Streptococcus pneumonia

Neisseria meningitidis

Haemophilus influenzae

Listeria monocytogenes

275

What's empiric therapy of Acute Bacterial Meningitis, in pts 2-50 yrs (primarily S. pneumoniae and N. meningitidis)?

Cefotaxime 2 Gm IV Q4-6H or Q12H

Meropenem 2Gm IV Q8H

+

Vancomycin 30-45mg/kg per day in divided doses +/-
Dexamethasone 0.15 mg/kg IV Q6H x 2-4 days

276

Empiric tx of Acute Bacterial Meningitis in Immunocompromised Pts or those > 50 yrs old (S. pneumoniae, N. meningitidis, L. monocytogenes )?

Vancomycin + Ampicillin + Ceftriaxone

Or

Vanco + ampicillin + Cefotaxime

277

Empiric tx of Acute Bacterial Meningitis for severe PCN allergy?

Chloramphenicol 4,000-6,000 mg/ day in 4 doses + Vancomycin 30-45 mg/kg per day in divided doses

+/- SMX/TMP 5mg/kg IV Q6H

278

In kids 6 months - 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except this one)?

Unilateral AOM without Otorrhea (middle ear effusion/fluid)

AB / observation

279

In kids >= 2 yrs, when is additional observation an option (AB is given all all acute otitis media (AOM) except)?

Bilateral and Unilateral AOM without Otorrhea (middle ear effusion/fluid)

AB / observation

280

What's recommended 1st line tx in AOM?

Amoxicillin 80-90 mg/kg/d in 2 divided dose

Or

Amox/Clav 90 mg/kg/d in 2 divided doses

281

What's recommended tx after 48-72 hrs of failure of initial tx in AOM?

Amox/Clav 90 mg/kg/day of Amox in 2 divided doses

Or

Ceftriaxone 50mg IM/IV x 3 days

282

Duration of tx recommended in < 2 yrs; 2-5 yrs; >= 6 yrs in AOM?

< 2 yrs = 10 days

2-5 yrs = 7 days

>= 6 yrs = 5-7 days

283

Main pathogen responsible for Pharyngitis (upper respiratory tract inf)?

S. pyogenes

284

Tx of Acute Bronchitis - except cough to last 2 weeks?

Usually viral - antibiotics not indicated

Recommend anti-tussive +/- inhaled bronchodilators

285

Tx of Acute Bacterial Exacerbation of chronic bronchitis (ABECB) with 2 or more of the ff: increased dyspnea, increased sputum pdt and increased sputum purulence?

Inhaled anticholinergic bronchodilator + oral corticosteroid

286

What's preferred outpatient tx of CAP?

Macrolide (Azithromycin, Clarithromycin, erythromycin)

287

What's preferred inpatient (non-ICU) tx of CAP?

Beta-lactam + Macrolide

(Preferred b-lactam agents include Ceftriaxone, Cefotaxime, Ampicillin, Doxycycline)

288

Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) < 5 days?

Enteric gm-negative bacteria

289

Pathogens most prevalent in Hospital Acquired Pneumonia (HAP) > 5 days?

Nosocomial pathogens (MRSA, Pseudomonas)

290

Howz TB diagnosed?

Tuberculin skin test (TST), also called a PPD test

Look for induration (raised area) w/in 48-72 hrs after injection

291

Name the categories of TB?

Latent and active dx

292

Latent dx tx?

Isoniazid (INH) 300mg daily (or twice weekly) for 9 months (typical regimen, preferred for HIV+ or children)

Rifampin 400mg daily x 4 months

INH + Rifapentine once weekly for 12wks (not for HIV+ or on children)

293

Tx of active TB dx?

4-drug regimen

Rifampin, Isoniazid, Pyrazinamide and Ethambutol (RIPE)

294

T/F? Use direct observed therapy (DOT), if possible? When's DOT preferred?

T

Preferred for regimen dosed 2 or 3 times per wk instead of daily

295

Which is the preferred TB dosing freq?

Daily (unless DOT is possible)

296

Where should pts with active TB be in hospital?

Isolated, single negative pressure rooms

297

What's recommended to adding to INH (Isoniazide)? Why?

Pyridoxine (Vit. B6) 25-50mg PO daily

To reduce risk of neuropathy

298

List agents used in TB?

Whats the pr

299

Preferred initial tx Regimen for initial phase (~ 8 wks) in TB?

Rifampin (RIF) + Isoniazid (INH) + Pyrazinamide + Ethambutol (RIPE) for 56 daily doses (8 wks)

300

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If sensitive to INH + RIF?

Continue INH + RIF daily or twice weekly (18 wks)

Total duration of therapy = 26 wks (6 months)

301

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to INH?

RIF + Pyrazinamide + Ethambutol +/- Moxifloxacin

Total duration of therapy = 26 wks (6 months)

302

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to RIF?

INH + Ethambutol + FQ + (Pyrazinamide x 2 months)

Total duration of therapy = 12-18 months

303

Preferred tx Regimen for continuation phase in TB, Once susceptibilities are known, If resistant to MDR-TB (resistance to 2 or more drugs including INH and RIF)?

FQ + Pyrazinamide + Ethambutol + AMG (Streptomycin/Amikacin/Kanamycin) +/- alt. agents (Cycloserine, Capreomycin, Ethioamide)

Total duration of therapy = 18-24 months

304

Howz Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater) taken?

On empty stomach

305

SEs of Rifampin (Rifadin) + Isoniazid (Rifamate) + Isoniazid/Pyrazinamide (Rifater)?

Increased LFTs

GI upset

Rash/pruritus

Orange-red discoloration of body secretions

Flu-like syndrome

306

What should be added to Isoniazid (Rifamate) + Rifampin (Rifadin) + Pyrazinamide/Rifampin (Rifater) to reduce risk of peripheral neuropathy?

Pyridoxine 25-50mg/day

307

SEs of Pyrazinamide + Rifampin + Isoniazid (Rifater)?

GI upset

Malaise

Hyperuricemia

308

SEs of Ethambutol (Myambutol)?

Optic neuritis

309

Which TB agent is a very potent inducer?

Rifampin

310

What's the main cause of Prosthetic valve infective endocarditis? What's added to tx?

Staphylococci species

Req addition of Rifampin

311

What's usually added to primary Antimicrobial therapy for synergy?

Gentamicin

312

What's the target peak and trough levels when Gentamicin is used for synergy?

3-4 mcg/mL

< 1 mcg/mL

313

What AB should not be used for endocarditis?

Don't use extended interval dosing of AMG

314

What's the preferred oral prophylactic regimens before dental procedure (take a single dose 30-60 mins before dental procedure)?

Amoxicillin 2 gms

315

What's the preferred prophylactic regimens before dental procedure when pt can't take PO (take a single dose 30-60 mins before dental procedure)?

Ampicillin 2 Gm IM/IV

Or

Cefazolin or Ceftriaxone 1 Gm IM/IV

316

What's the preferred prophylactic regimens before dental procedure in a pt allergic to PCN + can take PO (take a single dose 30-60 mins before dental procedure)?

Clindamycin 600mg

Or

Azithromycin or Clarithromycin 500mg

317

What's the preferred prophylactic regimens before dental procedure in a pt allergic to PCN + can't take PO (take a single dose 30-60 mins before dental procedure)?

Cefazolin or Ceftriaxone

Or

Clindamycin

318

What's primary peritonitis?

Infection of peritoneal space and gen occurs in pts with liver dx

319

DOC of primary peritonitis?

Ceftriaxone for 5-7 days

320

Whats Cellulitis?

Affects all layers of the skin and is a serous SSTI

321

For outpt SSTI (skin & soft tissue inf), whats the primary tx for cutaneous abscess?

Incisions and drainage (I & D)

322

What's used for severe SSTI inf, rapid progression, systemic illness etc?

IV antibiotics

323

What's the empiric therapy options for complicate SSTI?

Vancomycin 15 mg/kg IV Q12H (goal trough 10-15 mg/L)

324

Typical s/sx of lower urinary tract infections (cystitis)?

Dysuria

Urgency

Freq

Burning

Nocturia

Suprapubic heaviness

Hematuria (fever is uncommon)

325

What indicates positive urinalysis?

Pyuria (positive leukocyte esterase or >= 10 WBC/mL)

Bacteriuria (>= 10^5 bacteria/mL in uncomplicated pts and 10^3 bacteria/mL in complicated pts and men)

326

In what grp MUST bacteriuria be treated even if asymptomatic with negative urinalysis?

Pregnant women x 7 days

327

What should be avoided in pregnant to treat bacteriuria?

Quinolones (cartilage toxicity and arthropathies)

Tetracyclines (teratogenic)

SMX/TMP (Hyperbilirubinemia and Kernicterus)

328

Preferred tx for bacteriuria ?

Amox-Clav, Amoxicillin, Cephalosporin

329

What may be added to DOC of acute uncomplicated cystitis in females of child bearing age (~ 15-45 yrs of age)? Why?

Phenazopyridine 200mg PO TID x 2 days to relieve dysuria?

330

When is prophylaxis used in UTI inf? What's used?

>= 3 episodes in 1 yr

1 SMX/TMP SS daily
Nitrofurantoin 50mg PO daily

331

What's used as urinary analgesic (to reduce sx of pain or burning with urination)?

Phenazopyridine (Azo, Uristat, Pyridium)

332

SEs of Phenazopyridine (Azo, Uristat, Pyridium) - urinary analgesic?

Headache

Dizziness

Stomach cramps

Body secretion discoloration

333

How to minimize stomach upset from using Phenazopyridine (Azo, Uristat, Pyridium) in urinary analgesic?

Take with or without food + 8oz water to minimize stomach upset

334

T/F? Phenazopyridine (Azo, Uristat, Pyridium) may cause red-orange coloring of the urine and other body fluids. Contact lenses and clothes can be stained

T

335

What should be avoided in C. difficle Infection (CDI)?

Anti motility agents (due to risk of toxic megacolon)

336

Tx of CDI (3rd infection of mild-mod; 1st, 2nd & 3rd CDI sever dx and severe, complicated dx)?

Vanco

337

Tx of CDI (1st inf and 2nd inf (1st recurrence))?

Metronidazole 500mg PO TID X 10-14 days

338

Are prophylactic AB recommended in Traveller's dx (TD)?

No!

339

What's the most important tx in Traveller's diarrhea (TD)?

Oral rehydration therapy, esp in young children, elderly

340

DOC, dosing and duration for Syphilis caused by Treponema pallium, a spirochete (primary, secondary or early latent < 1 yr duration)?

Penicillin G benzathine (Bicillin LA - don't substitute with Bicillin CR) 2.4 million units IM x 1

341

DOC, dosing and duration for Syphilis - late latent ( > 1 yr duration)?

Penicillin G benzathine (Bicillin LA - don't substitute with Bicillin CR) 2.4 million units IM weekly x 3 wks (7.2 MU total)

342

DOC for Gonorrhea? Dosing?

Ceftriaxone (Rocephin) 250mg IM x 1

343

DOC for Chlamydia inf? Dosing?

Azithromycin 1 gm PO x 1

344

DOC for Bacterial Vaginosis? Dosing?

Metronidazole 500mg PO BID x 7 days

Metronidazole 0.75% gel

345

T/F? All sexual partners must also be treated concurrently to prevent re-infection?

T

346

MOA of Terbinafine?

Blocks Squalene to Squalene epoxide

347

MOA of Azole?

Blocks action of Lanosterol (decrease ergosterol synthesis)

Typically fungistatic, but may be fungicidal for select fungal pathogens

348

MOA of Echinocandins?

Inhibits B-glucan synthase

349

SEs of Amphotericin B (conventional)?

Fever

Chills

Headache

Malaise

Rigors

Hypokalemia

Hypomagnesemia

Nephrotoxicity

350

Brand Name of Amphotericin B Lipid formulations?

Amphotericin B Lipid?
Liposomal Amphotericin B?

Amphotericin B Lipid (Abelcet)


Liposomal Amphotericin B (AmBisome)

351

What diluent is Amphotericin B formulations compatible with?

D5W

352

Advantage of Amphotericin B Lipid formulations?

Reduce risk for infusion rxns and nephrotoxicity

353

What's used to pre-mediate Amphotericin B Conventional formulations? Why?

Acetaminophen or NSAID
Diphenhydramine 25 mg IV and/or Hydrocortisone 50-100mg IV
Meperidine 25-50mg IV for reducing duration of sever rigors
Fluid boluses (500-1,000mL) to reduce the risk of nephrotoxicity

To prevent infusion-related rxns

354

SEs of Flucytosine (Ancobon, 5-FC)?

Bone marrow suppression

Hepatitis

Increased SCr and GUN

355

What's Fluconazole DOC for?

Oropharyngeal candidiasis (thrush) in HIV pts

Or

Moderate dx in non-HIV infected pt

356

What's Voriconazole DOC for?

Aspergillus inf

357

List Azoles Antifungals

Itraconazole (Sporanox, Sporanox PulsePak, Onmel)

Ketoconazole (Nizoral, Nizoral AD, Ketodan, Extina, Xolegel)

Fluconazole (Diflucan)

Voriconazole (VFEND)

Posaconazole (Noxafil)

358

Brand name of Fluconazole (Azoles Antifungals)?

Diflucan

359

Brand name of Voriconazole (Azoles Antifungals)?

VFEND

360

Brand name of Posaconazole (Azoles Antifungals)?

Noxafil

361

When should oral Ketoconazole tablets be used?

Only when other effective antifungal therapy is unavailable or not tolerated

362

Main SE of Ketoconazole?

Increased LFTs

363

Are Itraconazole capsules and oral solutions interchangeable?

No! They are not interchangeable

364

Storage of Fluconazole IV?

Should NOT be refrigerated

365

Fluconazole IV to PO conversion?

1:1

366

How should Voriconazole (VFEND) be taken?

1 hr b4 or after meals (empty stomach)

367

CI Voriconazole (VFEND) use?

3A4 substrates (Rifampin, Rifabutin, Ergot alkaloids, long-acting barbiturates, CBZ, pimozide, quinidine, Sirolimus, St. John's wort)

368

Warnings to Voriconazole (VFEND) and Posaconazole (Noxafil) use?

QT prolongation - correct Ca, K, and Mg prior to initiating Voriconazole (VFEND) and Posaconazole (Noxafil)

369

Main SEs of Voriconazole (VFEND)?

Visual changes

Increased LFTs

370

Monitoring of Voriconazole (VFEND)?

LFTs

Renal fxn

Electrolytes (Ca, Mg, K)

Visual fxn

371

Voriconazole (VFEND) and night driving?

Caution to driving at night (due to vision changes)

Avoid direct sunlight

372

How should Posaconazole (Noxafil) taken?

Must be taken with a full meal (during or w/in 20 mins following a meal)

373

SEs of Posaconazole (Noxafil)?

Increased LFTs

374

T/F? All Azoles are 3A4 inhibitors?

True (they will increased conc of 3A4 substrates)

375

What type of absorption does Itraconazole and Ketoconazole have?

PH-dependent absorption (increase PH reduce absorption, t4 avoid using with antacids, H2RAs, PPIs)

376

Effect of strong inhibitors on Voriconazole (VFEND)?

Can increase dangerously when given with drugs that inh Voriconazole's metabolism or small dose increases

377

What's the kinetics of Voriconazole (VFEND)?

1st order

Followed by

Michaelis-Menten (non-linear) kinetics

378

List drugs that concurrent use with Voriconazole (VFEND) should be avoided

Alfuzosin, Apixaban,

Barbiturates

CBZ, Copaxone

Darunavir, Dofetilide, Dronedarone

Eplerenone, Ergot derivatives

Lopinavir, Lovastatin, Lurasidone

Nilotinib

Pimozide

Quinidine

Ranolazine, Rifampin, Rifabutin, Ritonavir, Rivaroxaban

Simvastatin, St. John's wort

Ticagrelor

Thioridazine

379

Role Echinocandins in therapy?

DOC for most systemic Candida infection, including strains resistant to Azoles antifungals, hence the name EchinoCANDINS

380

List Echinocandins agents

Caspofungin (Cancidas)

Micafungin (Mycamine)

Anidulafugin (Eraxis)

381

Brand name of Caspofungin (Echinocandins)?

Cancidas

382

Brand name of Micafungin (Echinocandins)?

Mycamine

383

How should Caspofungin (Cancidas) NOT be mixed?

Don't mix with dextrose-containing solution

384

How's Micafungin (Mycamine) used in Candidemia?

Micafungin (Mycamine) 100mg IV daily

385

How's Micafungin (Mycamine) used in Esophageal Candiasis?

Micafungin (Mycamine) 150mg IV daily

386

How's Anidulafungin (Eraxis) used in Esophageal Candiasis?

100mg IV on day 1, then 50mg daily

387

How's Anidulafungin (Eraxis) used in Candidemia?

200mg IV on day 1, then 100mg daily

388

Ses of Echinocandins (Caspofungin, Micafungin, Anidulafungin)?

Increased LFTs

Hypotension

Fever

Diarrhea

Hypokalemia

Hypomagnesemia

Rash

389

Main SE of Griseofulvin (Grifulvin, Gris-PEG)?

Photosensitivity

390

Preg cat of Griseofulvin (Grifulvin, Gris-PEG)?

X

391

What's the brand name of Terbinafine (antifungal)?

Lamisil

392

Main SE of Terbinafine (Lamisil)?

Headache

Increased LFTs

393

Griseofulvin and OCPs?

Griseofulvin induces OCPs (alternative, nonhormonal form of contraception recommended)

394

Whats DOC for Candida?

Fluconazole or Topicals (Clotrimazole or Nystatin) x 7-14 days

395

Whats DOC for Aspergillus?

Voriconazole (6-12 wks or indefinite)

396

Whats DOC for Onychomycosis? What must be done b4 initiating DOC?

Itraconazole, Terbinafine or Fluconazole (confirm fungal inf prior to tx)

397

What are viruses?

Viruses are obligate intracellular parasites: they depend on host cell metabolic processes for survival

398

List steps to viral replication

1) Attachment of virus to cell membrane

2) Penetration into the host cell

3) Uncoating of viral RNA/DNA

4) Transcription of viral proteins

5) Assembly of new virions (the infective form of the virus)

6) Budding of new, immature virions

7) Release of new virus

399

Dose & duration of Oseltamivir (Tamiflu) for tx in adults?

75mg BID x 5 days

400

Dose & duration of Oseltamivir (Tamiflu) for prevention in adults?

75mg BID x 10 days

401

SEs of Oseltamivir (Tamiflu)?

Vomiting

Nausea ("tummy flu")

402

How soon should Oseltamivir (Tamiflu) be started?

W/in 48 hrs of sx

403

Warning associated with Zanamivir (Relenza Diskhaler)? Implication?

Bronchospasm risk: don't use if asthma/COPD or with breathing problems

404

List antivirals used for tx of HSV, VZV, and CMV?

Acyclovir (Zovirax)

Valacyclovir (Valtrex)

Famciclovir (Famvir)

Ganciclovir (Cytovene IV)

Valganciclovir (Valcyte)

Cidofovir (Vistide)

Foscarnet (Foscavir)

405

Brand name of Acyclovir? (antivirals used for tx of HSV, VZV, and CMV)

Zovirax

406

Brand name of Valacyclovir? (antivirals used for tx of HSV, VZV, and CMV)

Valtrex

407

Brand name of Valganiciclovir? (antivirals used for tx of HSV, VZV, and CMV)

Valcyte

408

How should Acyclovir (Zovirax) be dosed in obese pts?

Based on IBW in obese pts

409

SEs of Acyclovir, Valacyclovir, Famciclovir?

Malaise

Headache

N/v/d

Increased SCr and BUN

410

How should Valganciclovir (Valcyte) be taken?

With food

411

BBW of Ganciclovir and Valganciclovir?

Myelosuppression

412

Ses of of Ganciclovir and Valganciclovir?

Fever

N/v/d

Anorexia

Thrombocytopenia

Neutropenia

Leukopenia

Anemia

413

What's the DOC for CMV?

Ganciclovir and Valganciclovir

414

What's the BBW that specific to Cidofovir?

Dose-dependent nephropathy

415

SEs of Cidofovir?

Increased risk of Nephrotoxcity (similar to Ganciclovir)

416

SEs of Foscarnet?

Increased SCr

417

How should Foscarnet be handled?

Like a chemo agent

418

T/F? Up to 50% of pts with HSV remain asymptomatic?

True

419

Whats the definitive sx of HSV? Xtics?

Lesions on external genitalia

Lesions are painful

420

When does tx start in HSV?

Must start tx during Prodrome

Or

Within 1 day of lesion onset for the pt to experience benefit

421

T/F? If pt is resistant to acyclovir, the pt will be resistant to valacyclovir?

T

422

T/F? Strains resistant to acyclovir, will be resistant to famciclovir?

T

423

When should therapy be initiated and most effective?

At earliest s/sx of shingles

Most effective when started w/in 72hrs of onset of zoster rash

424

List malaria agents (Areas with Chloroquine-resistant Plasmodium falciparum)

Atovaquone/Proquanil (Malarone)

Mefloquine (Lariam)

Doxycycline (Vibramycin)

Quinine (Qualaquin)

425

Main SE of Atovaquone/Proquanil (Malarone)?

Increased LFTs

426

Adult Prophylaxis Dose of Atovaquone/Proquanil (Malarone)?
Initiation (pre-travel)?
D/C (post travel)?

250/100mg PO once daily

Initiate - 1-2 days b4 travel

D/c - 7 days

427

Adult Prophylaxis Dose of Mefloquine (Lariam)?
Initiation (pre-travel)?
D/C (post travel)?

250mg PO once weekly

1-3 wks

4 wks

428

Adult Prophylaxis Dose of Doxycycline (Vibramycin)?
Initiation (pre-travel)?
D/C (post travel)?

100mg PO daily

1-2 wks

4 wks

429

Main CI of Mefloquine (Lariam)?

Hx of seizures or psychiatric disorder

430

Main SE of Mefloquine (Lariam)?

Loss of balance/dizziness

GI upset

Chills


Dizziness

Tinnitus

Psychiatric SE

431

Main CI of Quinine (Qualaquin)?

Prolonged QT interval

G6PD deficiency

432

Main SE of Quinine (Qualaquin)?

QT prolongation

433

List malaria agents (Areas with Chloroquine-sensitive Plasmodium falciparum)

Chloroquine (Aralen)

434

Adult Prophylaxis Dose of Chloroquine (Aralen)?
Initiation (pre-travel)?
D/C (post travel)?

500mg PO once weekly

1-2 wks

4 wks

435

Warnings ass with Chloroquine (Aralen) use?

Retinopathy

QT prolongation

436

SE of Chloroquine (Aralen)?

GI upset

Visual disturbance

Photosensitivity

437

List malaria agents (Areas with Plasmodium vivax and P. ovale with or without P. falciparum)

Primaquine

438

SE of Primaquine?

Agranulocytosis

Anemia

Hemolytic anemia (in pts with G6PD deficiency)

439

What does CDC require b4 initiating Primaquine?

G6PD deficiency screening

440

Look at pt counseling pts on pg 308 to 315

Look

441

T/F? Cefdinir, Cipro, Clindamycin (Cleocin) and Voriconazole (VFEND) suspension should NOT be refrigerated

T

442

Voriconazole (VFEND) should be taken with food?

False!

VFEND should be taken on an empty stomach

443

Therapy for outpt community-acquired pneumonia?

Zithromax 500mg PO x 1 day

Then 269mg PO daily (days 2-5)

444

Therapy for inpt community-acquired pneumonia?

Vanco 1gm IV Q12H + Imipenem 500mg Q6H

445

What's a choice to treat Pseudomonas caught while in the hospital?

Doribax (Doripenem)

446

What SE can Anidulafungin cause?

Increase in liver Transaminases

447

What's a choice to UTI caused by E. coli, sensitive to everything?

Nitrofurantoin 100mg PO BID x 5 days

448

List true things about Bactrim wrt to exposure to light, renal impairment and conversion from IV to PO?

Bactrim IV should be protected from light

Needs to be dose adjusted in significant renal impairment

1:1 ratio for IV to PO

449

Doc for gonorrheae STDI?

Ceftriaxone 250mg IM x 1 + Azithromycin 1Gm PO x 1

450

Info about isoniazid (INH) wrt how to take and role in latent TB?

On empty stomach (1 hr b4 or 2 hr after a meal)

Can be used alone to treat latent TB

451

Which med helps prevent peripheral neuropathies in pts on INH?

Pyridoxine (Vit B6)

452

A pt taking Amphotericin B is at risk for which electrolyte abnormalities?

Hypokalemia and hypomagnesemia

453

UTI tx in pregnant woman allergic to Cephalexin?

Nitrofurantoin 100mg PO BID x 7 days

454

VFEND wrt visual SE, how to take, and doc?

Visual change can occur

Must be take on empty stomach

Preferred agent for Aspergillosis inf

455

Which AB doesn't req dose adjustment in renal impairment?

Tigecycline

456

Which AB should be refrigerated?

Keflex (Cefalexin)

457

Which meds should pt use sunscreen when there are on?

Avelox (Moxifloxacin)

VFEND (Voriconazole)

458

Which IV AB should be reconstituted with NS?

Ampicillin

459

List AB that must be taken with water

Clindamycin

Doxycycline

FQ

Metronidazole

(Val)Acyclovir

460

List AB that must be taken with food

Amoxicillin (Clav); Azithromycin

Cefdinir; Cephalexin; Clarithromycin; Clindamycin

Fluconazole

Metronidazole

Nitrofurantoin

Oseltamivir

Terbinafine; TMP/SMX

(Val)Acyclovir

461

List AB that must be taken without food

Azithromycin ER suspension

Cefdinir; Cephalexin; Clindamycin

Doxycycline

FQ

Voriconazole

462

List AB that causes sun sensitivity

Doxycycline

FQ

TMP/SMX

Voriconazole (VFEND)

463

They all cause GI (n/v/d) to some extent

T

464

List AB that cause rash

Amoxicillin (Clav)

Cefdinir; Cephalexin

Fluconazole; FQ

TMP/SMX (sulfa)

Voriconazole

465

List AB that cause HA and CNS effects

Doxycycline

Fluconazole; FQ

Metronidazole

Nitrofurantoin

(Val)Acyclovir

Voriconazole (VFEND)

Decks in NAPLEX Class (73):