Infectious diseases Flashcards Preview

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Flashcards in Infectious diseases Deck (381):
1

what color do gram + orgs stain?

purple, blue

2

what color do gram - orgs stain?

pink from safranin

3

what is the MIC?

the lowest drug concentration to stop growth w/in 24 hours. MIC90: mic needed to inhibit growth of 90% of isolate

4

what is the breakpoint?

the level of MIC at which the bacterium is considered susceptible or resistant

5

whats the MBC

minimum bactericidal concentration : lowest drug [ ] that kills 99.99% of bacteria in 24 hours

6

which antibiotics typically do not have good concentration in the urine (generally)

those that are hepatically cleared

7

what are the top 5 most common Gram + bacteria?

staphylococcus
streptococcus
enterococcus
clostridium
listeria

8

Gram + cocci

streptococcus
staphylococcus

9

gram + rods

propionipacterium
bacillus
clorstirdum
corynebacterium
listeria
nocardia
actinomyces

10

gram - cocci

neisseria

11

spirochetes

borrelia
leptosipra
treponema pallidum

12

atypicals

chlamydia
mycoplasma
ureaplasma

13

which are the hydrophillic antibiotics

ABCDG
aminoglycosides
Beta lactams
Colistin
Daptomycin
Glycopeptides (vancomycin)

14

which are the lipophillic antibiotics?

FQ
Macrolides
rifampin
tetracyclines
linezolid
chloramphenicol

15

how are the hydorphillic compounds typically cleared

renally

16

how are the lipophillic compounds cleared?

hepatically

17

which drug classes have nearly 100% oral bioavailability

fluroquinolones
doxycycline
metronidazole
fluconazole, voriconazole
SMX/TMP
RIfampin
Linezolid

FLM DiVRS = Flame Divers

18

which FQ does not penetrate into urine?

moxifloxacin

19

which antibiotics have good bone penetration?

tetracyclines & fluroquinolones & rifampin

20

which of the penicillins is not renally cleared?

nafcillin

21

which of the AMGs is not renally cleared?

none

22

which of the cephalosporins is not renally cleared?

ceftriaxone! :)
cefotaxime some renal but more heaptic

23

which of the FQ is not renally cleared?

moxifloxacin
cipro R= H

24

which of the macrolides is not renally cleared?

ALL, clarithry H>R

25

how is doxycycline cleared?

H>R

26

is vancomycin renanally cleared?

YES

27

is linezolid renally cleared

NO, hepatic

28

is clindamycin renally cleared?

no, hepatic

29

is rifampin renally cleared?

no hepatic

30

is daptomycin renally cleared?

R>H

31

is metronidazole reanally cleared?

H>R

32

is SMX/TMP renally cleared

S = hepatically
T = Renally
so R= H

33

B lactams, time dependent or concentration dependent?

time dependent

34

Aminoglycosides, time dependent or concentration dependent?

concentration dependent

35

define time dependent?

killing depends on how much time is spent above the MIC so more frequent dosing is desireable

36

define concentration dependent?

killing depends on achieving higher peaks to maximize concentration of drug

37

Vancomycin, time dependent or concentration dependent?

concentration

38

macrolides, time dependent or concentration dependent?

concentration

39

tetracyclines, time dependent or concentration dependent?

concentration

40

which antibiotics are bacteriocidal vs bacteriostatic?

all are bacteriocidal except: Macrolides, Clindamycin, Linezolid, quinaprisitin/dalforisint, tetracyclines

41

what is so special about how AMGs kill bacteria?

they have a post-antibiotic effect

42

spectrum of activity for AMGs?

most all gram negatives
used for syndergy in treating gram + cocci (staph and enterococcus endocarditis)

43

of all the AMG's which has the broadest spectrum?

Amikacin

44

which weight do you used to does AMGs

Ideal body weight
unless their actual weight is less
OR they are > 30% IBW, then use adjusted body weight

45

what is the BBW in AMGs?

can cause neurotoxicity and nephrotoxcity

46

what are the main SE os AMGS?

nephrotoxicity : acute tubular necrosis, Avoid other nephrotoxins
ototoxicity

47

when should you take a peak for an AMG?

1/2 hour after the end of the infusion

48

when should you take a trough level for a AMG?

right before the 4th dose (steady state)

49

what is the goal peak an trought for gent/tobra?

peak 5-10, trough < 2

50

what is the traditional dosing for gent/tobra?

1-2.5mg/kg/dose

51

how do you determine how frequently to give the get/ tobra?

clcr <20: give loading dose, mx levels
Clcr 20-40 : q24h
40-60 : q12h
Clcr: q8H

52

what is the Adjusted body weight equation?

IBW + 0.4 x (ACtual minus ideal)

53

amoxil

amoxicillin

54

amoxicillin brand

amoxil

55

augmentin

amox/clave

56

amox/clav brand

aumentin

57

unasyn

amp/sulbactam

58

amp/sulbactam brand

Unasyn

59

Pen VK

penicillin

60

penicillin brand

Pen VK

61

piperacillin/tazo brand

Zosyn

62

zosyn

pip/tazo

63

which of the penicillins has enhanced activity against MSSA?

nafcillin

64

which of the penicillins has activity against pseudomonas?

piperacillin/tazo
ticarcillin

65

which penicillins do not need to be renal dose adjusted?

nafcillin
oxacillin
dicloxacillin

66

which penicillin is DOC in pregnancy ?

amoxicillin

67

pregnancy category for penicillins

category B

68

for how long must augmentin be refrigerated?

always

69

for how long should amoxil be refrigerated?

can be stable for 14 days, but can be refrigerated to improve taste

70

how should you take the Pen VK tablets

on an empty stomach

71

how long should your refrigerate the pen VK suspension?

always

72

with what is Ampicllin IV compatible w/ for diluents?

normal saline only and it is stables only for 8 hours at room temperature

73

what do you do if you have extravasation of nafcillin?

use cold packs and hyaluronidase injections

74

what are the side effects of penicillins:

Diarrhea, Gi upset
allergic reactions: rash, anaphylaxis, pruritis
-if accumulation: seizures
-Acute interstitial nephritis
-bone marrow suppression w/ long term use

75

main DDis w/ penicillins?

May decrease effectiveness of oral contraceptives ; check package insert for each agent
-probenecid/allopurinol can increase levels of PCNs by interfering w/ renal excretion

76

first generation cephalosporins:

cefazolin
cephalexin

77

brand cephalexin

keflex

78

brand cefazolin

kefzol

79

kefzol

cefazolin

80

keflex

cephalexin

81

typical cephalexin doseing

250-500 q 6 h

82

typical cefazolin dose

250-2000 q 8 hours

83

what do the 1st generation cephalosporins cover?

staph> strept
PEK

84

2nd genration cephalosporins

cefprozil
cefuroxime
cefactor
cefotetan
cefoxitin (mefoxin)

85

spectrum of activity 2nd gen ceph

HNPEK
cefotetan , cefuroxime,cefoxitin also cover Bfrag

86

typical cefurxime dose

250-1500 q 8 h

87

typical cefprozil dose

250-500 q 12-24h

88

3rd generation cephalosporin

ceftriaxone
cefdinir
ceftazidime
ceftoaxime

89

brand ceftriaxone

rocephin

90

brand ceftazidime

Fortaz
Tazicef

91

typical ceftriaxone dose

1-2 rams q12 h-24h

92

typical ceftazidime dose

1-2 g q 8 / 12h

93

what is the advantage of ceftazidime over other 3rd gen cephalosporins?

it covers pseudomonas

94

what is the spectrum of activity of 3rd gen ceph?

HNPEKS

95

spectrum of cefepime?

HNPEKS
+ CAPES

96

typical dose of cefepime

1-2 grams q8-12h

97

brand cefepime

maxipime

98

maxipime

cefepime

99

what is special about cetaroline?

covers MRSA and has gram - coverage like ceftriaxone (HNPEK)

100

typical dose of ceftaroline

600mg q 12h

101

what is the cross reactivity in allergic reactions w/ cephalosprins and PCN?

< 10%

102

which pts that have a PCN allergic reaction should avoid cepalosporins?

if they have a type 1 sensivity: swelling, angioedema, anaphylaxis

103

cephalosporins pregnancy category

B

104

special side effects of cefotetan

cotnains NMTT side chain that can lead to bleeding and a disulfiram like reaction w/ alcohol ingestion

105

which three cephalosporins must be taken w/ food

cefaclor, cefpodoxime, cefurxoime

106

DDIs cephalosporins

probeneicid/allopurinol increase levels through renal secretion inhibitions
-decrease effectiveness of OCs

107

brand name imipenem

primaxin

108

typical dose of imipeneme

250-100mg VI q 6-8h

109

brand meropenem

Merrem

110

Primaxin

imipenem

111

Merrem

meropenem

112

brand ertapenem

Invanz

113

invanz

ertapenem

114

doribax

doripenem

115

typical meropenem dose

500-100mg iv q 6-8h

116

tipical ertapenem dose

1000mg IV/ IM q d

117

typical dose of doripenem

500 iv q 8h

118

which is the only carbapenem that does not have activity against pseudomonas or acenitobacter?

ertapenem

119

what is the spectrum of the carbopenemems

cover almost everything except : MRSA, VRE, C. diff, stenotorphomonas or naocardia

120

DDIs carbapenems

same as PCN/cephalosporins

121

why does imipenem come w/ cilastin?

because cilastin inhibits a renal dehydropeptidase from degrading imimpenem

122

main SEs carbapenems?

Diarrhea
rash
seisures at higher doses (esp. imipenem)

123

what is the MOA of fluroquinolones?

they inhibit bacterial cell DNA toposiomerase IV and inhibit DNA gyrase: leads to breaking of the double stranded DNA

124

fluroquinolones bacterisstatic or bacteriocidal?

bacteriocidal

125

what is the typical cipro PO dose/

250-750 po

126

what si the typical cipro dose IV

200-400 IV

127

how do you dose frequency for cipro based on clcd?

> 50 q8-12
30-50: q12
<30: q18-24

128

typical moxifloxacin dose?

400mg po q 24

129

typical levofloxacin dose

250-750mg po IV q 24 h if crcl > 50

130

what is the spectrum of activity of FQs

great gram +
great gram -
excellent atypical coverage

131

which of the FQs have pseudomonal coverage?

cipro
levo

132

what is the BBW of FQs

tendon inflammation and/ or rupture esp w/ concurrent corticosteroid use , if > 60 or organ transplant patient

133

comon SEs FQs

photosensisitivity and hyperglycemia
QT prolongation
GI- NVD
HA, rash

134

can u use FQs in pregnancy

do not use due to cartilage damage in immature animals : preg C

135

DDIs of FQs

Antacids , divalent ations: Ca, Fe, ZN, Al, MG, MVIs
Bile acid bindingg resins
- Warfarin
-QT prolonging rugs (esp moxi)
-SUs, Warfarin, NSAIDs

136

how much should you separate your FQs from other meds

Cipro: if you take the cipro first, you have to wait 6 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your cipro
Levo: if you take the cipro first, you have to wait 2 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your Levo
Moxi: if you take the cipro first, you have to wait 8 hours to give the other meds. If you take the other meds first, you have to wait 4 hours to take your Moxi

137

what is the MOA of macrolides?

bind to 50S ribosome leading to inhibition of protein synthesis

138

brand azithromycin

zithromax
z-pack

139

macrolides spectrum of activity

streptococus
Heamophilus, neisseria, moraxella
Atypicals

140

SEs of macrolides

GI upset: D, abd pain/cramping esp erythro,
liver dysfucntion,
QT prolongation

141

brand of clarithromycin

biaxin
biaxin XL

142

dosing of aztithro

500 x 1 , then 250mg x 4 days
or 500mg qd x 3 days

143

refrigerate aztithromycinn oral suspension?

NO

144

referiatgerate biaxin oral suspension?

NO

145

how should you take biaxin XL

w/ food!

146

typical clarithromycin dose

250-500mg po BID to 1 g daily

147

erythormycin brand

erythorcin
ery-tab
eryped
EES

148

typical erythomycin dose

EES 400mg QID
others 250-500mg po QID

149

refrigerated erythromycin ?

must ref E.E.Es : erythromycin ethylsuccinate and use w/ 10 days
the powder suspension is table at room temp x 35 days

150

renal dose adjustment for azithro/erythro

NONE!

151

bioequivalency of zithromax & azithromycin ER suspention (ZMAX)

none and should not be interchanged

152

how to take the Zmax oral suspension:

w/in 12 hours of reconstitution on an empty stomach

153

which macrolides are QT polongers

E
C

154

which macrocodes are mod-strogn cup 3a4 inhibitors

E
C

155

macrolides bacteriostatic or cidal?

static

156

tetracyclines static or cidal?

static

157

MOA of tetracyclines

inhibiitonof 30s ribosomal subunit

158

brand doxycycline

Vibramycin
Oracea
doryx

159

typical dose of doxy

100mg po q 12h

160

brand minocylcine

minocin
dynacin
soldyn
ximino

161

typical dose of minocycline

50-100mg qd -bid

162

Spectrum of activity of doxy

mild skin infix w/ mesa
VRE UTIS
staph strep, enterococcus, nocardi, propio, bacillus
atypicals, HI, moraxella

163

how should you take your tetracyclines?

w/ 8 oz better to minimize go irritation
best on empty stomach (avoid DDIs)

164

SE of tetracyclines:

GI upset
photosensitivity
tooth discoloration in children
DRESS
lupus like syndrome
inc in LFTs

165

renal adjustment in tetracylines?

not for doxy or mino yes for tetra

166

Tetracycline DDs

divalent cations
sucralfate
bile acid b resins
-warfrain
-OCs

167

who should you separate your tetracyclines

take your tetra, then wait 1-2 hours for your other meds
or take your other meds and wait 4 hours to take your doxy

168

what is the MOA of SMX /TMP

interfferes w/ folic acid synthesis via inhibition of dihydroflic acid formation

169

SMX/TMP dosing for most common indications

adult UTI: 1 ds tab bid x 3 days
PCP ppx: 1 ds or ss tab daily
and other doses: depends

170

what is the SS strength of smx/tmp

400 smx/ 80tmp 5:1 ratio

171

what is the DS strength of Smx/tmp

800 smx/ 160 tmp 5:1 ratio

172

contraindications for SMx/TMP

pregnancy (at term)
breastfeeding
anemia due to folate deficinecy
marked hepatic/renal disease
sulfa allergy

173

SE smx/ tmp

hyperkalemia
go upset
skin reactions
photosensitivity
false inc in scr

174

bactrim susp refrigerate?

no, keep at room temp and protect from light

175

DDIs SMX/tmp

warfarin
any cup 2c9 inducers

176

what is the MRSA dose for vancomycin

15-20mg/kg q8-12h

177

concetration or time dependent killing?

time dependent killin

178

side effects vancomycin

nephrotoxicity
ototoxicity
redman syndrome if infused too quickly (500mg 30 min each

179

what are the sx of redman syndrome

maculopapular rash
hypotensio
flushing
neutropenia

180

when should you target trough 15-20

pneumonia
endocarditis
osteomyelitis
meningitis
bactermia

181

when should you target 10-15

all other infections or decreased renal funciton

182

brand vancomycin

vancocin

183

how do you determine the dosing interval for vancomycin

Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels

183

how do you determine the dosing interval for vancomycin

Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels

184

max perifpher iv vancomcing concentration

5mg/kg

184

max perifpher iv vancomcing concentration

5mg/kg

185

whats the dose for C diff infections for vancomycin

125-250mg po QID

186

brand name of linezolid

Zyvox

187

MOA of lniezolid

binding the 23 s risomaal ran of the 50s subunit inhibition bacterial translation and protein synthesis

188

linezolid bacteriostatic or cidal

static

189

what to avoid to avoid serotonin syndrome w/ linezolid?

tyramine containing foods: wine and feremtend foods
ssris, maox, tcas, pusparione

190

contraindication of linezolid

concurrent use or w/in 2 weeks of MAOIs
uncontrolled HTN
sympathomimetics

191

what to avoid to avoid serotonin syndrome w/ linezolid?

tyramine containing foods: wine and feremtend foods
ssris, maox, tcas, pusparione

192

main side effects of linezolid

myelosuppression (> 14 days ) , thrombocytopenia
diarrrhea
incease pancreatic ezymes

193

renal dose adj linezolid

none

194

refrigerate linezolid?

keep oral suspension at room temp

195

quinuprisitin/dalfopristin brand

synercid

196

diluent for synercid

d5w

197

renal dose adj for syndercid

none

198

diluent for synercid

d5w

199

brand daptomycin

cubicin

200

why use dap to?

mrsa, vre, faecium and faecalis
gram + coverage

201

what to monitor for dapto

CPK esp if w/ statin

202

what diluent to use w/ dapto

normal sailine

203

what to monitor for dapto

cpk esp if w/ statin

204

what is the MOA of aztreonam?

nhibits cell wall synthesis by binding to PBPs

205

spectrum of activity of aztreonam

gram - inc pseudomonas

206

SE aztreonam

NVD
inc LFTs
rash

207

dose adjust renal imp? Afternoon

yes

208

why use tigecycline?

MRSA
VRE (both f's)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia

209

max chloramphenicol per day

4g

210

why use tigecycline?

MRSA
VRE (both f's)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia

211

brand clindamycin

cleocin

212

bbw of clinda

can cause sever and possible fatal colitis

213

activity of clinda

most gram + aerobes but not enterococcus
anaerobic gram - and gram +

214

contraindications of flgayl

pregnancy in 1st trimester

215

metronidazole brand

flagyl

216

contraindications of flgayl

pregnancy in 1st trimester

217

how to take ur metronidazole

IR: w/ or w/o food
ER; on an empty stomach

218

macrobid dose vs macrodantin dose

macrobid 100 po bid
macrodanti 50-100mg po QID

219

how to take ur metronidazole

IR: w/ or w/o food
ER; on an empty stomach

220

macrobid dose vs macrodantin dose

macrobid 100 po bid
macrodanti 50-100mg po QID

221

Suspensions that must be refrigerated

Augemntin
cefprozil
cefuroxime
cephalexin
erythormycin ethylsuccinate
penicillin VK
Amoxil recommneded

224

agets for CA-MRSA skin infectiosn

SMX tmp ds 1-2 ds tab q 12

225

what are the organisms commonly found in the upper respiratory tract?

streptococccus
H. Influenzae
M. catarrhalis

226

what are common organisms found in Lungs for infections

strept. pneumoniae
H. influenza
Atypicals: legionella, mycoplasma
Enteric Grame Negative Rods

227

what are the common organism found in lungs esp if patient has been in the hospital?

Enteric gram - rods (PEK)
Strep penumo
Pseudomonas
Enterobacter
S. A (inc MRSA)

228

what are common CNS/Mengingitis pathogens?

Strep Pneumo
Neisseria gonnorhea
H. I
Strept/ ecoli (young)
listeria (young/old)

229

what organisms are found in the mouth and ENT?

peptostreptoccous
actinomycines
anaerobic GNRs
Aerobic GNRS
H.I

230

what organisms are found in the skin?

strep. pyogennes
S.A
S. Epi
Pasturellea
aerobi/anaerobic GNR if diabetics

231

what organisms are found in the bone/joints?

S. A
S. Epi
Streptococcus
Nesseria Gonnorrhe
+/- GNRs

232

what organisms are found in the intrabdominal tract

PEK
Enterococcus
streptococcus
bacteroides

233

what organisms are found in the urnitary tract?

PEK
S. Saprophyticus
enteroccocs/
streptococus

234

which patients in the hospital should undergo contact precautions?

those w/ mrsa and VRE

235

when do you give antibiotics before surgery?

1 hour before

236

what are the DOC for surgical PPX?

cefazolin
cefuroxime
Vanc w/ 2 hours before surgery if PCN allergic
or Clinda if PCN allergic

237

what do you use if patient is undergoing surgery that involves the bowel?

broader coverage fro anaerobes: cefotetan, ertapenem, CTX + Metronidazole

238

what is the classic triad of meningitis?

fever
nuchal rigidity
altered mental status

239

most common meningitis pathogesn

S. pneumo
N. menigiditis
H. Influezae
L. Monocytogenes

240

What is a common cause of otitis media? should you just observe?

can be viral
appropriate to observe 48-72 hours if not < 6months, not severe, certain diagnosis is viral

241

which age group must get abx for otitis media no matter what?

< 6 months

242

if > 6months, should children get abx?

only if severe illness or you are certain they have bacteria otherwise observe

243

what do you treat the pain in otitis media?

APAP or ibuprofen
If > 5 yo, topical benzocaine: auraglan, americaine otic OK

244

DOC otitis media and dose

amox 90mg/kg/day divided q12 or q 8h

245

2nd choic otitis media if severe or failure?

Augmentin 90mg/kg/day divided BID or TID
cefdinier, cefpodoxime, cefprozil, cefurxime

246

what if otitis media and PCN allergy?

azithro 10mg/kg/day x 1 then 5mg/kg/day x 4 days, clarithro, erythro sulfisoxazole
SMX/TMP
Clinda

247

duration of tx meningitis

7-14 days

248

duration tx for otitis media

= 2 5-7 days

249

what if otitis media and cannot take anything orally?

ctx IM/IV 50mg/kg x 3 days

250

rocephin

ceftriaxone

251

which people should get the Prevnar 13 pneumococcal vaccine?

people 2-23 months old

252

when can you give the antivirals for FLU?

< 48 hours after symptoms
-if severe
-outbreak scenario

253

what is the treatment duration for antivirals for flu?

5 days

254

when should you give ABX for pharyngitis

they have fever
they have a no cough
tonsil swelling or lymph node
+RADT, cx

255

what is the tx duration for abx for pharyngitis?

5-10days

256

tx agents of phryngitis

amox
pen
cephalexin
macrolides

257

common bacteria or pharyngitis?

s. pyogenes

258

common bacteria for sinusitis?

s. pneumo
H. I
moraxell

259

tx sinusitis

amox
augmentin
cephalosporins
azithro
FQ

260

when should you treat sinusitis w/ abx?

> 7 days sx
tooth face pain
discharge
worsening sx

261

tx for otitis media agents

same as sinusitis , except CTX instead of FQ

262

tx for acute bronchitis

symptomatic tx, NO ABX as its caused by viruses

263

sx of acute bronchitis

cough > 2 weeks
sore throat
coryza
malaise
HA
low-grad fever
+/- purulent sputum

264

whooping cough

> 14 days cough w/ whoop

265

tx for whooping cough

azithromycin zpack
erythormycin 500 QID x 14 days
bactrim ds 1 BID x 14 days
clarithr 500 bid , or 1g ER daily x 7 days

266

when to treat w/ abx for AECB?

inc dyspnea
inc sputum production
inc purulence

267

tx for AECB

debated
mild/mod: amox, doxy, bactim, cephalo
sever: aug, azith, clari,cephalo
FQ

268

which FQ does not work in the lungs?

cipro

269

which FQ does not work in the bladder

moxi

270

CAP outpatient tx

ABx in last 3 mo/HF/DM/immussupression
Resp FQ: moxi/levo
B lactam + macrolide

Otherwise:
macrolide or (can consider FQ instead)
doxy

271

CAP inpatient Medical ward TX

Beta lactam + macrolide OR
just a resp FQ

272

CAP tx in ICU and no pseudomonas risk

B lactam +
( Azithromycin or resp FQ)

If allergic to to BL
Resp FQ + Aztreonam

273

CAP tx ICU ww pseudomonal risk

beta lactam (AP) +
(cipro/levo) OR AMG+ azithro

Allergy BL
Aztreonam +
(cipro/levo) OR AZTh

274

cefpodoxime dose for cap

200mg po q12h

275

cefuroxime dose for cap

500mg q12h

276

ceftin

cefuroxime

277

azithromycin dose for cap

z pack dose

278

clarithrymicin dose for cap

250-500mg q 12
or 1000mg daily

279

erythromycin dose for CAP

250-500 q 6h

280

Levoloxacin dose for CAP

750mh po qd

281

moxifloxacin dose for CAP

400mg po qd

282

avelox

moxifloxacin

283

docy dose for cap

100mg po q12h

284

amoxicillin dose for cap

1 g q 8h

285

augmentid dose fro cap, which augmentin

Augmentin XR
2g q 12h

286

treatment duration for CAP

at leas 5 days and afebrile 48-72 hours and <= one sign of clinical instability

287

duration of treatment for HAP

7 days
unless pseudomonas/acenitobacter or bloodstream infix = 14 days

288

early onset HAP tx

CTX OR levo/mox OR Unysn OR ertapenem

289

what is early onset HAP

when it occurs and you have been in the hops for < = 5 days

290

treatment for late onset HAP tx

2 antipseudomonal agents + anti MRSA

291

for late onset HAP, AP agent 1 and AP agent 2

AP 1 :
cefepime/ ceftazidime
imip/mero
pip/tazo

AP2:
gent/ tobra/amikacin
Levo/cipro

292

what three tests can you do to test for TB

PPD skin test
sputum smear and culture
PCR for acid fast bacillus

293

what is the tx for latent TB?

INH 300mg po daily q 9mos
alt 15m/kg BIW

294

what does RIPE therapy consist of in terms of agents?

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

295

typical course for a typical active infection?

take 4 drugs x 8 weeks, then check cultures and susceptibilities. If fully susceptible then only take the INH/rifampin for the next 18 weeks

296

what do you do if the patient is resistant to INH?

continue RPE +/- a fluroquinolone for a total of 6 months now

297

what do you do if they are resistant to rifampin?

do IPE + FQ but only do the pyrazinamide for 2 months and the total duration is 1 year - 1.5 years

298

what can you add to INH to reduce neuropathy?

25-50mg vitamin b 6 (pyridoxine) po daily

299

what can you use instead of rifampin to avoid DDIs?

rifabutin

300

what is the MOA of rifampin

inhibits RNA synthesis

301

how should you take your rifampin?

on an empty stomach
1 hour before or 2 hours after a meal

302

dose for rifampin

10mg/kg per day max 600mg (or 2-3 x /week)

303

brand name rifampin

rifadin

304

when is rifampin contraindicated?

when used with Protease inhibitors, switch to rifabutin

305

SEs of rifampin

Flu like syndrome
rash
itchiness
hepatotoxy
** stains secretions orange: tears, urine etc

306

INH for TB?

5mg/kg qd max 300mg
or 15m/kg 2-3x/ week max 900mg

307

contraindications for isoniazid therapy?

active liver disease or previous adverse rection to INH

308

SE of INH?

increased LFTs, Hepatitis
peripheral neuropathy
lupus-like sydnrome

309

pyrazinamide dosing

15-20mg/kg QD max 2 G

310

SE pyrazinamide

hepatoxicity
hyperuricemia, gout
NV
arthralgias, myagias

311

CI pyrazinamide

acute gout
severe hepatic damage

312

ethambutol brand

myambutol

313

ethambutol dose?

15-25 mg/kg QD max 1.5g

314

main SE of ethambutol?

optic neuritis therefore routine vision tests every month

315

who should get pox for endocarditis?

Prosthetic valve
previous IE
congenital heard disease
cardiac transplant who got valvulopathy

316

ppx for dental procedures?

axmo 2g 30-60 minutes before the procdure

317

ppx for dental procedures?

clindamycin 600mg 30-60min before procedure
azithro or clarithro 500mg before procedure

318

what are the most common bugs for primary peritonitis?

streptococcus
enteric gram - PEK
rare anaerobes

319

what is the the DOC is SBP?

ctx x 5-7 days

320

what is cholecytitis?

infection of the gallbladder

321

what is cholangitis?

infection of the biliary ductal system

322

what are the bugs in secondary peritonitis? MILDE to mdoerate

strept
enteric gram - PEK
anaerobes +/- enterococcus

323

what are the bugs in high severe secondary peritonitis?

strept
PEK
CAPES
+/- enterococcus

324

high-severity Secondary peritonitis tx?

imi/mero/dori

325

mild-mod severity secondary peritonitis tx?

Ticarcillin/clav
erta
cefoxitin
tigecycline
moxi

326

what its the dose fro the tx of ricketsial diseases?

dox 100 po/IV BID x ate least 7 days mostly. For ly at least 14 days

327

which are the rickettsial diseases?

lyme disease
rocky mountain spotted fever
typhus
ehrlichiosis
tularemia

328

what are the most common agents that cause cellulitis?

S. pyogenes
S. aureus

329

typicla treatmetn for non-purulent cellulitis?

beta lactam : cephalexi n

330

typical tx for purulent cellulitis?

clinda 300-450 TID
bactim 1-2 ds BID
doxy 100mg bid
minocyline 200mg x1 then 100 id
linezolid 600 bid

331

what duration of tx for purulent cellulitis?

5-10 days

332

inpatient SSTI

Vanco
linezolid
dapto
telvancin
clinda 600mg IV q 8h/ 300-450po q6h

333

duration of tx for inpatient cellutlis?

7-14 days

334

what is uncomplicated cystitis?

women of child bearing age 15-45 w/ a UTI

335

what are the common organisms in uncomplicated cystitis?

e. coli
s. saprophyticus
enterococcus

336

what is the DOC for uncomplicated cystitis?

SMX/TMP ds tab BID x 3 days
if < 20% of local ecoli is resistant to bactrime and no sulfa allergy

337

alternative tx for acute uncomplicated cystitis?

cipro 250 bid x 3d
cipro ER 500 daily x 3 d
levo 250mg daily x 3 da
nitrofurantoin 100mg bid x 5 days
fosfomycin 3g x 1 (w/ 4oz)

338

when do you use for PPX for UTI (uncomplicated cystitis)?

>= 3 episodes in one year

339

What ppx to use for UTI (uncomplicated cystitis)?

1 SS daily bactrime
macrodanting 50mg po daily
or 1 DS post coitus

340

uncomplicated pyelonephritis organisms

PEK
Enterococus
PA

341

uncomplicated pyelonephritis moderate Out pt PO tx

cipro 500mg po bid
cipro ER, 1000 daily
Levo 750 daily all tx 5-7days

FQ-R: augmentin, cefaclor, cefpodosime, cefdinir and tx 14 days

342

uncomplicated pyelonephritis severe IV tx

FQ, Amp/gent, pip/tazo, ctx x 14 days

343

tx for complicated UTI?

Amp/gent
Pip/tazo
Ticar/clav
CTX/ ceftaxime +/- FQ

344

tx duration of complicated UTI?

7-14 days

345

what if you have a pregnant women w/ a UTI?

must treat x 7 days even if asymptomatic

346

brand phenazopyrdine

pyridium
Azo
Uristat

347

dose for phenazopyridine

200mg PO TID x 2 days
100mg po TID (OTC) x 2 days

348

How should patients take their phenazopyridine?

w/ food to dec stomach upset
no longer that 2 days cuz can mask sx of worsening n
can cause red-orange secretions= staining of lenses and clothes

349

mild-mod tx for c. diff

metronidazole 500mg po TID x 10-14days

350

tx for severe c.diff

vanco 125mg po QID x 10-14 days

351

what is Vanco pulse therapy? and when do you use it?

use it on the third Cdiff infection
vanc 125mg po QID x 14 days
BID x 1 week
daily x 1 week
then q 2-3 days for 2-8 weeks

352

tx for SEVERE (w/ shock, megacolon, ileus) cdiff

vanc 500 po QID + metro 500 IV Q8h

353

Syphilis TX primary, secondary or early latent (<1 year) tx dose

Penicillin Benzathine (Bicillin LA NOT CR)
2.4 Million Units IM x 1

354

Syphilis TX late latetnt > 1 year, tertiary, or unknown duration) tx dose

Bicillin LA
2.4 Million Units IM q Week x 3 doses

355

neurosyphillis tx

pen G aqueous 3-4 million units IV q 4h x 10-14 days

356

gonorrhea tx

CTX IM x 1

357

chlamydia tx

azithromycin 1g po X 1

358

bacterial vaginosis

metronidazole 500mg po bid x 7 days
metro gel 0.75% 5g intravaginall daily x 5 days

359

trichomoniais

metronidazole 2g po x 1
tinidazole 2g po x 1

360

which is the conventional amphotericin?

amphotericin desoxycholate

361

brands of liposomal amphotericin

Abelcet
AmBisome
Aphotec

362

main Side effects of ampho

hypokalemia
hypomagnesimea
nephrotoxicity

363

fluconazole brand

diflucan

364

coverage of fluconzole

candida
cryptococcus

365

why not use ketoconazole?

hepatoxiicity

366

can you interchange oral capsule and oral solution of itraconazole?

NO

367

how should you take your itracolzole capsule?

w/ food for acidity

368

brand name for voriconazole?

VFEND

369

spectrum of activity vori

Candida, Aspergillus but not nucor (zygomycosis)

370

how should you take your voriconazole?

1 hour before or 1 hour after meals (empty stomach)

371

contraindications for voriconazole

CYP3a4 inhibitors

372

SE vori

visual changes
must correct K/Ca/mg abnormalities before starting therapy
caution driving at night due to vision changes
avoid direct sunlight

373

DDIs for all azoles

CYP3A4 inhibitors

374

which two azoles require acidity for absorption?

itra/keto

375

DOC for aspergillus?

vori

376

brand caspofungin

cancidas

377

brand mycafungin

mycamine

378

main SE of caspo

increased LFTS

379

capo dose

IV lD 70mg x1 then 50mg daily

380

mycafungin candidemai dos

100mg Iv daily

381

mycafungin dose for esophageal candidiasis

150mg IV daily over 60 minutes