Infectious diseases Flashcards
(381 cards)
1
Q
what color do gram + orgs stain?
A
purple, blue
2
Q
what color do gram - orgs stain?
A
pink from safranin
3
Q
what is the MIC?
A
the lowest drug concentration to stop growth w/in 24 hours. MIC90: mic needed to inhibit growth of 90% of isolate
4
Q
what is the breakpoint?
A
the level of MIC at which the bacterium is considered susceptible or resistant
5
Q
whats the MBC
A
minimum bactericidal concentration : lowest drug [ ] that kills 99.99% of bacteria in 24 hours
6
Q
which antibiotics typically do not have good concentration in the urine (generally)
A
those that are hepatically cleared
7
Q
what are the top 5 most common Gram + bacteria?
A
staphylococcus streptococcus enterococcus clostridium listeria
8
Q
Gram + cocci
A
streptococcus
staphylococcus
9
Q
gram + rods
A
propionipacterium bacillus clorstirdum corynebacterium listeria nocardia actinomyces
10
Q
gram - cocci
A
neisseria
11
Q
spirochetes
A
borrelia
leptosipra
treponema pallidum
12
Q
atypicals
A
chlamydia
mycoplasma
ureaplasma
13
Q
which are the hydrophillic antibiotics
A
ABCDG aminoglycosides Beta lactams Colistin Daptomycin Glycopeptides (vancomycin)
14
Q
which are the lipophillic antibiotics?
A
FQ Macrolides rifampin tetracyclines linezolid chloramphenicol
15
Q
how are the hydorphillic compounds typically cleared
A
renally
16
Q
how are the lipophillic compounds cleared?
A
hepatically
17
Q
which drug classes have nearly 100% oral bioavailability
A
fluroquinolones doxycycline metronidazole fluconazole, voriconazole SMX/TMP RIfampin Linezolid
FLM DiVRS = Flame Divers
18
Q
which FQ does not penetrate into urine?
A
moxifloxacin
19
Q
which antibiotics have good bone penetration?
A
tetracyclines & fluroquinolones & rifampin
20
Q
which of the penicillins is not renally cleared?
A
nafcillin
21
Q
which of the AMGs is not renally cleared?
A
none
22
Q
which of the cephalosporins is not renally cleared?
A
ceftriaxone! :)
cefotaxime some renal but more heaptic
23
Q
which of the FQ is not renally cleared?
A
moxifloxacin
cipro R= H
24
Q
which of the macrolides is not renally cleared?
A
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
