Infectious disease Flashcards Preview

Pharm > Infectious disease > Flashcards

Flashcards in Infectious disease Deck (46):
1

Resistance causes

use abx overuse broad spectrum
age 65
day care
exp. young children
comorbidities
immunosuppression

2

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

3

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

4

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

5

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

6

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

7

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

8

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)

9

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

10

MACROLIDES AND AZALIDES cont.
Monitor

CYP interactions
hepatic/renal impairment
hearing loss

11

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)

12

OXALODINONES

interactions

ADRS

USE

Linezolid

limited

d/n/h MYELOSUPPRESSION

pneumonia, skin infections, expensive**

13

TETRACYCLINES

Contraindicated in

Interactions

____ decreases absorption

tetracycline, doxycycline, minocycline

pregnant, lactating, children <8 years

many

food, milk/calcium

14

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

15

LIPOGLYCOPEPTIDES

Gram
treat

ADR

Vancomycin, telavancin

GRAM (+)
MRSA resistant to first-line antibiotics
vanco used to treat c.diff

otoxocity; nephrotoxicity, "red man syndrome"

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

Chancroid tx

azithromycin ceftriaxone cipro or erythromycin

24

Bacterial vaginosis
treatment

metronidazole PO or intravaginally
or clindamycin cream

25

Herpes treatment

Systemic acyclovir, famciclovir and valacylovir

26

STI's
PID tx

broad spectrum coverage may need iv abx (required if pregnant)

27

STI sexual assault

common infections

recommendations

trich, bv, g/c

prophylaxis for STI's post exposure heb B

28

Vaginitis

common diseases

drug selection

trich, bv, candidiasis

otc inexpensive, intravaginal fewest interactions

29

Immunizations

Live Vaccines

considerations

interaction with

Flumist
MMR
OPV (not used)
Rotavirus
Varicella virus
Herpes zoster

dont give to immunocompromised or febrile or pregnant (avoid 1 month post)

if giving two: give same day or sep. 4 weeks

antivirals

30

Flumist

type

contraindicated in

avoid

live

egg allergy, asthma

avoid immunocompromised 7 days

31

MMR

type

contraindicated in

ADR

Interactions

live

neomycin gelatin allergy
wait 3 months from recieiving blood

fever, transient maculopapular rash

Immunosuppressants (high dose corticosteroids and chemo)
Immune globulin
PPD

32

MMRV

ADRS

contraindicated in

similar to mmr + higher risk fever and febrile seizures

patients with history cerebral injury or seizures

33

Rotavirus- cause of

Contraindicated

Live virus shed in

ADRS

gastroenteritis

blood products last 42 days

stool

GI

RV1- 2 doses
RV5- 2 doses

34

Varicella

Contraindications

Interactions

ADRS

neomycin gelatin

avoid aspirin 6 weeks post (reye) drugs that effect immune system

fever rash injection site reaction

35

Herpes Zoster

Contraindications

Interactions

Most effective in

Not recommended if

shingles vaccine

neomycin or gelatin allergy
active TB
younger than 60 years old

high dose steroids and antivirals

60-69

received varicella vaccine

36

Inactivated vaccines

Administration

DTPV
H. B Conjugate
Inactivated Polio Virus
Hep B
Hep A
HPV
Influenze
Pneumococcal
Meningococcal

can be given with other vaccines, no need to restart if off schedule

37

DTPV

Dtap
Tdap

Contraindications

Immunocompromised?

ADRs

Pregnant patients?

Dtap- primary
Tdap- booster

Anaphylactic, NEUROLOGIC disease, high temp or seizure after previous Tdap

Okay for immunocompromised

pain, low grade fever, aches, headache

recommended Tdap every pregnancy

38

HIB conjugate

Contraindications

ADRS

mod-severe illness, children <6 years old

inj site pain and redness

39

Inactivated Poliovirus Vaccine

Contraindicated

Interaction with

IPV preferred over oral

neomycin allergy, streptomycin or polymyxin

immunosuppressants

40

Hep B Vaccine

Contraindications

Pregnancy?

ADR

yeast allergy, mod-severe illness, immunosuppression (larger doses)

C- can be used if indicated

regular (local, fever, malaise)

41

Hep A Vaccine

Contra:

Pregnancy?

younger than 12 months, mod illness
patients on immunosuppressants or antineoplastic may have decreases immunological response

C may be used if indicated

same adrs as hep B

42

HPV

gardasil dont give if

ADR

Pregnancy?

contraindicated allergic reaction

allergy to yeast

syncope (must observe)

Says B but not recommended in pregnancy

43

Inactivated influenze vaccine
two

Contraindications

Pregnancy?

Interactions

Trivalen (2type a 1 type B)
Quadrivalent (2type a 2type b)

anaphylaxis to eggs or vaccine, guillain barre syndrome within 6 weeks of vaccine, febrile illness

immunocompromised may have lower vaccine induced antibody levels

C- may be safely administered, also in lactating women

decreased effect immunosuppressants, DRUGS THAT INHIBIT CLEARANCE (theophylline, phenytoin, warfarin)

44

Pneumococcal Polysaccarhide (PPV)

Contraindications

Interactions

10-14 days after splenectomy, organ transplant or chemo DO NOT GIVE TO CHILDREN <2

Immunosuppressants give 10-14 days before

45

Pneumococcal Conjugate (PCV)
used for

Contraindicated

Interactions

children 6weeks-5years or adults >19 with immunocompromising conditions

splenectomy, organ transplant or chemo (give 10-14 before)

Give immunosuppressants 10-14 days before

46

Meningococcal

Contraindicated

febrile illness

adrs local no drug interactions