Infectious disease Flashcards
(46 cards)
Resistance causes
use abx overuse broad spectrum age 65 day care exp. young children comorbidities immunosuppression
BETA LACTAMs: PENICILLINS
natural penicillins
aminopenicillins
combine with
streptococcus, some enterococcus, some staphlococcus
GRAM (-)
urinary GI respiratory
betalactamase inhibitor to broaden spectrum: clavulanate, sulbactam, tazobactam
PENICILLINS cont.
highly. ..
good. ..
ADR
Special population considerations
AOM
Sinusitis
Streptococcal pharyngitis
bound to proteins
distribution to tissues
allergic (2-30 mins) maculopapular rash (appears in 7-10 days) GI c.diff fungal overgrowth
Pregnancy cat B caution in elderly (less protein more free drug)
Amoxicillin
Amoxicillin
Penicillin
BETA LACTAMS: CEPHALOSPORINS
1st gen
2nd
3rd
4th
5th
1- GRAM (+) skin and soft tissue infx (s. aureus, s. epidermis)
2- GRAM (+) SAME AS ABOVE PLUS klebsiella, proteus, e.coli
3- broader, more active with GRAM (-)
4- PRIMARY AGAINST GRAM (+) resistant to betalactamase some GRAM (-)
5- Ceftaroline (Teflaro)- not really using
CEPHALOSPORINS CONT.
Excreted via
ADRS
monitor for
Used for therapeutic failure of _____
1st gen txs….
GC/chlamydia- which drugs used?
CAP- which drugs used?
kidneys- CAUTION IN RENAL pts
allergies, skin rashes, BLOOD DYSCRASIAS RARE BUT SERIOUS, potential for renal failure
monitor for c. diff
AOM
strep pharyngitis
ceftriaxone and cefixime
cefpodoxime, cefuroxime, ceftriaxone
FLUOROQUINOLONES
gram? esp.??
not recommended for
considerations
ADRS
Uses:
GRAM (-) urinary
children <18
Pregnancy
BB warning tendonitis delayed onset GI- colitis CNS- sleep disorders, DIZZINESS RENAL HEPATIC failure - monitor alcohol CV (angine, HF) - moxifloxacin ECG
UTI, pyelonephritis, bacterial prostatis
pneumonia/chronic bronchitis exacerbation
PCN resistant s. pneumoniae, skin infections, bone/joint infections, infectious diarrhea
CEPHALOSPORINS cont.
levofloxacin cipro or moxy (compare)
patient education
moxy- no renal or hepatic concern
cipro/levo- renal adj.
food delays absorption, dizziness, tendonitis stop medication, many interactions
LINCOSAMIDES
gram
ADR
USES:
1st line in
stop if..
CLINDAMYCIN
GRAM (+) some activity NO GRAM (-)
BB warning colitis DERM rx (rash, itching, redness)
Blood (eosinophelia, neutropenia, thrombocytopenia)
often used in derm for gram (+) not at all for genitourinary or intestinal
1st line MRSA in some areas, 1st line in special populations (pregnancy and children ie. if doxy contraindicated)
Infx PCN allergic pts
Drug resistant strep pneumo infections
Dental infections
diarrhea (c.diff high risk)
MACROLIDES AND AZALIDES
ADRS
Interactions
Special populations
Uses
mycins
GI
Skin: urticaria, eruptions, eczema, STEPHENS JOHNSON SYNDROME
CYP- many
Most safe in pregnancy and children
DOC CAP
Pertussis
H. pylori
Chronic bronchitis
alternative for pcn allergies
MACROLIDES AND AZALIDES cont.
Monitor
CYP interactions
hepatic/renal impairment
hearing loss
SULFONAMIDES AND TRIMETHOPRIM
Gram
ADRS
Commonly used with
____ may be susceptible
Low cost alt. for ____ and _____
Monitor
GRAM (+) (-) broad coverage
e.coli s. pyogenes s. pneumoniae, h. influenzae, protozoa
GI CNS (headache, dizziness) photosensitivity, rashes
UTI
MRSA
children >2 months and pcn allergies
C/S if treating UTI
Long term- CBC (potential blood dyscrasias)
OXALODINONES
interactions
ADRS
USE
Linezolid
limited
d/n/h MYELOSUPPRESSION
pneumonia, skin infections, expensive**
TETRACYCLINES
Contraindicated in
Interactions
____ decreases absorption
tetracycline, doxycycline, minocycline
pregnant, lactating, children <8 years
many
food, milk/calcium
TETRACYCLINES
Use:
doxycycline first line therapy for
Tetracycline/monocycline used to treat
which two can be taken with food??
tetra taken _____ doxy taken ___
c. trachomatis, ureaplasma urealyticum
p. acnes
doxy and mino
QID, less often
LIPOGLYCOPEPTIDES
Gram
treat
ADR
Vancomycin, telavancin
GRAM (+)
MRSA resistant to first-line antibiotics
vanco used to treat c.diff
otoxocity; nephrotoxicity, “red man syndrome”
ANTIVIRALS
ADRS
Interactions
Acyclovir
Valacyclovir
Famciclovir
Ganciclovir
A/V- few
Valocyclovir- pot. thrombocytopneia purpura, hemolytic uremic syndrome in immunocompromised patients
F- headache
G- granulocytopenia, anemia, thrombocytopenia, may be carcinogenic
few
ANTIVIRALS
Monitor
Education
rash
temperature
BUN/Cr in high risk
Start at earliest sign of infection
Hydration (pot. renal failure)
Renal failure, encephalopathic changes, blood dyscrasias
Metronidazole and Nitazoxanide
M- treats both ___ and ____
used for ____ infections _____ ______ and treatment of ____
Dont use in which patients
Monitor
Education
parasitical and bacterial infections
protozoal infections, anaerobic infections, bacterial vaginosis and H. pylori
1st trimester pregnancy
signs leukopenia (blood dyscrasia hx esp.)
metallic taste, avoid alcohol- even mouthwash
ANTIRETROVIRAL THERAPY
Initiate in
Types:
Cd4 <350 recommend for patients 350-500 HIV associated nephropathy Hep B Pregnant women**
NRTIs NNRTIs PIs FIs INSTIs CCR5 antagonists
ANTIRETROVIRAL
medication resistance occurs when
first sign of resistance..
ART Failure is
poor adherance, drug or food interactions, abnormal ADME
detectible plasma viral rna levels
failure to acieve suppression viral rep <50 copies/ml
-suboptimal adherence or toxicity
STI’s
Syphilis
screen
DOC- if allergy?
Gonorrhea- DOC
or
Gonorrhea usually coinfected with? Treatment?
high risk pts and pregnant women
parenteral penicillin G if allergy 14 days of doxycycline or tetracycline
PCN for pregnant women
Ceftriaxone (rocephin) IM DOC or Cefixime
(resistant to fluoroquinolones)
Chlamydia-azithromycin 1 gram single or doxycycline BID 7days
Gonorrhea treatment cont.
pregnant women treatment?
azithromycin or amoxicillin (erythro may be used but more ades)
NEED TO BE TESTED FOR CURE and retest in 3 months
Chancroid tx
azithromycin ceftriaxone cipro or erythromycin
Bacterial vaginosis
treatment
metronidazole PO or intravaginally
or clindamycin cream
