Infectious Disease Pt 2 Flashcards
(57 cards)
1
Q
+Fluoroquinolones
(3)
Routes
A
Ciprofloxacin (Cipro) IV, PO
Levofloxacin (Levaquin) IV, PO
Moxifloxacin (Avelox) IV, PO
2
Q
+Fluroquinolones
MOA
A
Interferes with normal DNA processes by inhibiting DNA topoisomerases -> leading to cell death
3
Q
+Fluoroquinolones
Spectrum
- B___ coverage including gram-_____ (not _____) and gram _____
A
- Broad, positive (not MRSA), negative
4
Q
+Fluoroquinolones
Spectrum
Which Fluoroquinolone has poor Streptococcus coverage and NOT empirically used for CAP?
ONLY _____ and ______ covers Pseudomonas (NOT _____)
A
Ciprofloxacin
Ciprofloxacin, Levofloxacin, NOT Moxifloxacin
Only Moxifloxacin does not cover pseudomonas*** important!
5
Q
+Fluoroquinolones PK
- ______ distribution used for nearly ___ infection types
- Bioavailability
- Very _____ used which has led to _____ development
A
- Excellent, All
- Excellent (100%) -> can switch from PO -> IV in serious infections
- Commonly, Resistance
There is PO for all bc excellent bioavailability! (similar concentrations PO and IV form)
6
Q
+Fluoroquinolones
AE (4)
A
QTC prolongation
Peripheral Neuropathy
Tendonitis
Hyperglycemia
AEE**** -> QTC, Hyperglycemia in DM
7
Q
+Fluoroquinolones
Contraindications (1)
Black Box Warning
A
Pregnancy
Exacerbates Myasthenia Gravis, Peripheral Neuropathy, Tendinitis
many boxed warnings, XXX pregnancy
8
Q
A
9
Q
A
10
Q
A
11
Q
+Tetracyclines
(3)
Routes
A
Doxycycline (Vibramycin) PO
Minocycline (Minocin) IV, PO
Tigecycline (Tygacil) IV
Like fluoroquinolones very well absorbed PO
12
Q
+Tetracyclines
MOA
A
**Inhibits Protein Synthesis***
13
Q
+Tetracyclines
Spectrum
- Extensive gram-_____ coverage (including _____) and gram-_____ (____ pseudomonas)
- ______ - also has _____ activity and covers ___*
A
Positive + MRSA, Negative - Not Pseudomonas
Tigecycline - anaerobic, VRE*
Tigecycline is the broadest (TIGER ON A BICYCLE a ferocious abx) - can cover VRE
14
Q
+Tetracyclines
Indications
- Very ____ volume of distribution (good for ___ and ___ infections)
- Bad for (2)
A
high, bone and skin infections
X blood infections (bacteremia) and Urine infections
- Because most of it distributes to bone and skin -> LOW SERUMM for blood stream -> bad for blood stream infections*
- TETRACYCLINES SHOULD NOT BE USED FOR TX OF UTIS** Also doesn’t concentrate well in the urine -> worsening UTI -> pyelonephritis**
15
Q
+Tetracyclines
AE
- Tigecycline - ___/___ in 40% of patients
- Minocycline - higher _______ toxicities (_____)
- Do not use in ______ and ______ < __ years of age
- ____ deformity and teeth ______
- ____sensitivity (avoid ______)
A
- N/V
- vestibular (vertigo)
- pregnancy, children, 8
- bone, staining
- Photosensitivity, sunlight
- Highest incidence of N/V than any other abx*
- Minocycline - AVOID IN PTS WITH HX/WITH VERTIGO*
- X pregnancy and children -> bone deformities, teeth staining*
16
Q
+Macrolides
(2)
Routes
A
Azithromycin (Zithromax) IV, PO
Clarithromycin (Biaxin) PO
17
Q
+Macrolides
MOA
A
Inhibits Protein Synthesis
18
Q
+Macrolides
Spectrum
- V______: (3), otherwise ____ gram-negative coverage
- ______ pathogens that may cause ___ and other respiratory infections
- Including ‘_____’ - (2)
- ______ also used for (1)
- ______ pathogens that may cause ___ and other respiratory infections
- Anti _______ properties seen with ______
- Great debate: Benefit in preventing _____ exacerbations
A
- Variable: Streptococcus spp, H. influenzae, Moraxella catarrhalis, weak
- Respiratory, CAP
- atypicals - Mycoplasma pneumoniae, Chlamydophilia pneuomoniae
- Azithromycin, Chlamydia trachomitis
- Respiratory, CAP
- inflammatory, Azithromycin
- COPD
- URI’s like sinusitis*
- Also given for ATYPICAL” PNA caused by those two organisms*
- Battle I come across pulmonologists that just give it for the anti-inflammatory effects with acute exacerbations of COPD -> AE > anti-inflam effects…*
19
Q
+Macrolides
Unique characteristic
A
Post Antibiotic Effect
Continues to work despite subtherapeutic concentrations
POST ABX EFFECT/RESIDUAL EFFECT for about 4-5 days after** this class is notorious for this (some other ones have this quality but this is the main one)
20
Q
+Macrolides
AE
A
GI Upset (Take with food to minimize GI upset)
QTC prolongation
21
Q
+Macrolides
Drug Interactions
A
Inhibits CYP 450 enzymes
Clarithromycin rarely used dt to this DI -> increased GI intolerance and more frequent dosing
- EXAM QUESTION: You have a pt with a cyp substrate which macrolide to prescribe? - Azithro***
- Clarithromycin less favored bc of DI*
22
Q
A
23
Q
A
24
Q
+Miscellaneous Agents
(2)
Routes
A
Sulfamethoxazole-Trimethoprim (Bactrim) PO, IV
Metronidazole (Flagyl) PO, IV
25
**+Sulfamethoxazole-trimethoprim (Bactrim)**
MOA
**Inhibits DNA synthesis** via inhibiton of _folic acid synthesis_ (_synergistic activity_ as each component works in a different step)
26
**+Bactrim**
Spectrum
* Very \_\_\_\_\_, gram-\_\_\_\_\_ including (1) and gram-\_\_\_\_\_\_ **NOT** (1)
Broad
Gram + including *MRSA*
Gram - **NOT** including *Pseudomonas aeruginosa*
27
**+Bactrim**
* Bioavailability ______ ~\_\_% (IV and PO \_\_\_\_\_\_\_)
* Dose based on?
* Must adjust in _____ dysfunction!!!
* Excellent ~85% (interchangeable)
* Trimethoprim\* component
* Renal\*
* We dose it based on the Trimethoprim component (FOCUSED ON TRIMETHOPRIM)*
* Nephrotoxicity if not dosed properly*
28
**+Bactrim**
AE (4)
Contraindications (1)
_Skin reactions_ (can be very severe) Stevens-Johnsons Syndrome
Neutropenia
Nephrotoxicity
Hyperkalemia
**\*\*SULFA ALLERGIES\*\***
* In no way shape or form - absolutely contraindicated in sulfa allergies no matter what reaction*
* Issues -\> high risk of skin reaction!*
29
**+Bactrim**
Indications
Useful for variety of indications including (4)
Pneumonia
UTI
Skin infections
Bone infections
*V important drug, commonly prescribed for lots of things -\> skin infections dt MRSA coverage*
30
**+When Prescribing Bactrim**
* The following mental checklist should always be used when you consider prescribing Bactrim
1. Is the pt ______ or of child-bearing age? - \_\_\_\_, can be harmful
2. Is the pt on \_\_\_\_\_\_? Interacts causing significant increase in \_\_\_
3. Does the pt have a ________ allergy? \_\_\_\_\_\_\*\*
4. Does the pt have any _____ disease? Must renally \_\_\_\_\_/potentially \_\_\_\_
5. Does the pt have issues with their ______ levels? - Can cause \_\_\_\_\_\_, avoid
6. Does the pt have any _________ issues? - Can cause \_\_\_\_\_\_\_, use caution
7. Has the pt had Bactrim before? ~20% of _____ are resistant in the community
1. Pregnany -\> avoid
2. Warfarin -\> increases INR
3. Sulfonamide -\> Contraindicated\*\*
4. Renal -\> adjust, potentially avoid
5. Potassium -\> hyperkalemia -\> avoid
6. Hematological -\> Neutropenia -\> caution
7. *E.coli*
*For pts w recurrent UTI's - keep in mind drug resistance*
31
**+Metronidazole (Flagyl)**
MOA
Damages DNA of the organism and leads to cell death
32
**+Metronidazole (Flagyl)**
Spectrum
* _______ gram-negative organisms, (1) which is a gram-positive anaerobic organism
* No longer a ____ line recommendation for mild. C.diff
* Used in combo with (1) for severe C.diff
_Anaerobic_ gram negatives, *C. diff* anaerobic gram positives
X first line
Oral Vanco
Covers both anearobic gram + and -
Bc anearobes require a lack of oxygen -\> deeper in the GI tract have higher numbers - Used to be first line for c.diff -\> lack of efficacy/reoccurence
33
**+Metronidazole PK**
Bioavailability
Excellent bioavailability
IV and PO interchangeable
34
**+Metronidazole (Flagyl)**
AE
\_\_\_ upset
\_\_\_\_\_\_ taste
H\_\_\_\_\_\_
Dark \_\_\_\_\_
Peripheral \_\_\_\_\_
* Exhibits a \_\_\_\_\_\_-like reaction - do not take with _____ -\> will cause extreme \_\_\_\_\_\_
* Must inform pts to _____ alcohol for up to ___ hrs after ____ dose
GI upset
Metallic taste
Headache
Dark urine
Peripheral Neuropathy
* disulfiram, alcohol, vomiting
* avoid, 24 hrs, after last dose
*DI with ALCOHOLL - inhibits the metabolism/excretion of alcohol/its metabolites -\> alcohol toxicity*
35
**+Metronidazole (Flagyl)**
Indications (3)
Bacterial vaginosis
Trichomonas infections
GI related illness
*Really just reserved for intraabdominal infections/aspiration PNA*
36
**+Gram Positive Agents**
(3)
Routes
**Vancomycin (Vancocin)** - PO, IV
**Linezolid (Zyvox)** - PO, IV
**Daptomycin (Cubicin)** IV
37
**+Vancomycin (Vancocin)**
## Footnote
MOA
Inhibits cell wall synthesis
38
**+Vancomycin**
Spectrum
Drug of choice for?
Gram-positive only
Drug of choice for MRSA
39
**+Vancomycin**
Indications
* IV for _____ infections including (5)
* PO for (1)
Systemic - PNA, CNS, UTI, bone, blood
* C.diff* (PO not absorbed systemically)
* Bc PO not systemically absorbed -\> less toxicities when given for C.diff*
40
**+Vancomycin PK**
Dose based on?
MUST ______ drug levels for efficacy and toxicity (when given \_\_)
Weight, Age, Renal function
Monitor, IV
*A lot of PROS if used properly -\> therefore dosed by weight*
41
**+Vancomycin**
AE
* _______ with elevated levels
* Rare: ______ - very high levels *for long periods can be irreversible*
* ___ \_\_\_ Syndrome\* - ______ mediated reaction secondary to _____ infusions
* NOT an ____ reaction, simply ___ the infusion (min. __ min)
* Nephrotoxicity
* Ototoxicity
* Red Man's - histamine, rapid
* NOT an allergy, slow (60 min)
*60 by 60 rule*
42
**+Vancomycin Serum Concentration Monitoring**
* Trough: collected when? prior to what dose?
* Correlates with ____ and \_\_\_\_
* _____ marker for total exposure
* Desired concentrations for
* serious infections (CNS, blood, lung) =
* mild skin, UTI infections =
* 30 min before 4th dose (steady state for pts with normal renal function)
* Efficacy and toxicity
* Surrogate
* Desired concentrations
* **15-20 mcg/ml**
* 10-15 mcg/ml
43
**Example of MRSA**
44
**+Linezolid (Zyvox)**
MOA
**Inhibits Protein Synthesis**
45
**+Linezolid**
Spectrum
VERY broad gram ____ coverage including (2)
No gram-\_\_\_\_ coverage
* Bioavailability?
Positive - MRSA and VRE
NO Negative
* Excellent (100%)
46
**+Linezolid**
Indications
Reserved for treatment of? (3)
_VRE_ - Drug resistant enterococcus
_Staphylococcal_ infections of _lungs_
Pts with _Vancomycin intolerance_
47
**+Linezolid**
AE
* Use \> 14 days =
* Use \> 28 days =
* Drug interaction (1)
* Contraindication (1)
* Thrombocytopenia
* Optic neuritis
* SSRIs (may cause serotonin syndrome)
* MAOI
## Footnote
*We tend not to use it long term \> 2 wks -\> thrombocytopenia*
48
**+Daptomycin (Cubicin)**
MOA
Causes rapid depolarization leading to inhibition of protein, DNA and RNA synthesis
49
**+Daptomycin**
Spectrum
Same as \_\_\_\_\_
Linezolid
VERY broad gram + coverage including MRSA and VRE
No gram negative
50
**+Daptomycin**
Indications
* ______ agent to linezolid for (2)
* NOT used to treat?
Alternative: resistant gram + infections, linezolid intolerance
**NOT** to treat **pneumonia** (inactivated by lung surfactant)
*We do not use dapto for PNA*
51
**+Daptomycin**
AE (1)
Monitor what?
Associated with myopathy
CPK
*Rhabdo bc can cause elevated CPK - esp when dehydrated*
52
53
**+Applicable to ALL Antibiotics**
| (2)
* ***Clostridium Difficule*** infection
* Normally colonized by *C.diff*
* By giving abx - we kill everything BUT the c.diff which then allows for overgrowth (disease)
* **Resistance** development
* Organisms are VERY smart, will adapt, tries to kill them -\> various mechanisms of resistance (ie. beta-lactamase)
54
**+NEED TO KNOW**
Which medications work on ***Pseudomonas aeruginosa***
(6)
1. **Piperacillin/tazobactam (Zosyn)**
2. **Ceftazidime**
3. **Cefepime**
4. **All Carbapenems EXEPT Ertapenem**
5. **Levofloxacin**
6. **Ciprofloxacin**
**PCC, AL C**ome
55
**+NEED TO KNOW**
Which meds work on ***Methicillin-resistant Staphylococcus aeurus (MRSA)?***
(6)
1. **Vancomycin**
2. **Linezolid**
3. **Daptomycin**
4. **Tetracyclines**
5. **Sulfamethoxazole trimethoprim (Bactrim)**
6. **Ceftaroline**
Very Long Days, To See Crap
56
**+Example of Antibiogram**
On exam: might have to interpret one
Shows the % \_\_\_\_\_\_
Resistant profiles based on hospital stats from?
Susceptible
last years pts in different areas
57
**+Antiobiotic Resistance**
How does it happen?
