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Pharm Exam 3 > Infectious Diseases part 1 > Flashcards

Infectious Diseases part 1 Flashcards

(38 cards)

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1
Q

Fourth generation Cephalosporins

A

Cefepime (Maxipime) IV

Further expanded gram-neg coverage
Same + pseudomonas aeruginosa
Very commonly used for serious HAI
Concern for seizure if not dosed properly

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2
Q

Second Generation Cephalosporins

A

Cefuroxime (Ceftin) PO/ IV
Cefoxitin (Mefoxin) IV

Enhance gram-negative activity
Spectrum: Streptococcus, MSSA, enteric GNR, Haemophilus
Cefoxitin has anerobic gram-negative activity
Class less commonly used
Clinical use: De-escalation when cultures are back, prophylaxis for abdominal surgeries

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3
Q

Vancomycin (Vancocin) – IV, PO

A

MOA: inhibits cell wall synthesis
Spectrum: gram-positive only, drug of choice for MRSA
Given IV for systemic infections including pneumonia, CNS, UTI, bone, blood
Given PO for C diff associated diarrhea
Use the IV formulation and compound an oral solution
Also available as commercially made capsules, but very expensive
MUST monitor drug levels for efficacy and toxicitiy
ADE: Nephrotoxicity with elevated levels
Rare: ototoxicity – very high levels
Red Man’s Syndrome – histamine mediated reaction secondary to rapid infusions - not an allergic , simply slow the infusion time

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4
Q

Fifth generation cephalosporins

A

Ceftaroline (Teflaro) IV

Breaks the rule??
Spectrum : covers MRSA, does not cover Pseudomonas
“Ceftriaxone with MRSA coverage”
Approved for pneumonia and skin infections
Currently being studied for other serious infections (bone)

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5
Q

Monobactams

A

Aztreonam (Azactam) – IV

Inhibit cell wall synthesis
Only covers gram-negative organisms
Spectrum: very broad, including Pseudomonas aeruginosa
Safe to use in PCN allergy
Similar structure to ceftazidime , caution in patients allergic to ceftazidime
Not commonly used empirically due to its lack of gram-positive coverage, high cost
Well tolerated, similar ADE to cephalosporins

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6
Q

Beta-lactamase Inhibitors

A

Amoxicillin-clauvulanate (Augmentin)
Ampicillin-sulbactam (Unasyn)
Piperacillin-tazobactam (Zosyn)

inhibit the activity of the beta-lactamases
preserves the spectrum of the agent it’s combined with
Unasyn and Zosyn are IV, Augmentin PO
Used empirically for hospital infections
Augmentin = high rates of diarrhea
Very commonly used

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7
Q

Daptomycin (Cubicin) – IV

A

MOA: causes rapid depolarization leading to inhibition of protein, DNA and RNA synthesis
Spectrum: ONLY gram-postiive organisms including MSSA, MRSA, VRE
Clinical Uses: Alternative agent to linezolid for resistant gram-positive infections
NOT used to treat pneumonia (inactivated by lung surfactant)
ADE: associated with myopathy, monitor CPK
Dose largely dependent on MIC, do not assume sensitivity

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8
Q

Metronidazole (Flagyl) IV, PO

A

MOA : interferes with DNA synthesis
Spectrum: anaerobic gram-negative organisms, C. diff
First line recommendation for mild C. diff
Use in combo with vancomycin for severe C. diff
ADE: GI upset, metallic taste, headache, dark urine, peripheral neuropathy
Exhibits a disulfiram-like reaction, do not take with ETOH, will cause severe vomiting
Excellent bioavailability, IV and PO interchangeable
Used for distal colon infections

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9
Q

Cephalosoporins ADE

A

Overall well tolerated
Hypersensitivity less commonly seen
5-10% cross reactivity see in those allergic to PCNs
Clinically ok to challenge if patient experienced rash
Anaphylaxis, request allergy testing or avoid
GI intolerance (diarrhea)
Seizure in not dosed properly (Cefepime more common)
Neutropenia with long term use

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10
Q

Anti-Staphylococcal Penicillin

A 
Oxacillin Nafcillin
Created to tx PCN-resistant Staph aureus
Methicillin d/c because toxic
Spectrum: MSSA , drug of choice for serious MSSA infections
Very short half-life, dosed every 4 hours
Cleared by liver, no renal adjustments
	*other beta lactams renally adjusted
Oral option (dicoloxacillin) rarely used
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11
Q

Natural Penicillin (Penicillin V, Penicillin G)

A

Spectrum: staph aureus (PCN-susceptible), streptococcus, syphilis
No gram-negative activity
Initiallly excellent for skin infections
RESISTANCE
Available in IV and IM as Peniciilin G ,
V is oral form (low absorption)

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12
Q

Total Exposure drugs

A

Azithromycin

Vancomycin

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13
Q

Polymyxin B / Colistin - IV

A

MOA: Alters charge of the cell membrane and leads to increased permeability of the membrane -> cell death
Spectrum: broadest antibiotic available to treat gram-negative organisms
Used as a last line resort for multi-drug resistant GNRs
MUST always be used in combo with other antibiotics to px resistance
ADE: nephrotoxicity , respiratory paralysis (rare)

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14
Q

Clindamycin (Cleocin) – IV , PO

A

MOA: Inhibits protein synthesis
Spectrum: Broad gram-positive (including MRSA) anaerobic pathogens (including oral pathogens) and minimal gram-negative (mainly anaerobic enteric gram-negative organism)
Used in patients with penicillin allergies for skin infections
ADE: GI upset (high rates of diarrhea)

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15
Q

First Generation Cephalosporins

A

Cephalexin (Keflex) –PO
Cefazolin (Ancef) – IV

Alternative to anti-staphylococcal penicillins
Spectrum: Streptococcus, Staph aureus (MSSA)
Minimal gram-negative activity – resistance
Short ½ life , dosed 3 – 4 x a days
Very common for skin infections and prophylaxis prior to surgeries

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16
Q

ALL ANTIBIOTICS

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A

Development of C. diff overgrowth
Development of resistance
Will adapt to all that tries to kill them

17
Q

Vanco Dosing

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A 
Dose based on total body weight
Usually 15 mg/kg/dose with interval based on renal function:
CrCl (ml/min) 	Interval
>60			every 12 hrs
20-60			every 24 hrs
<20 			based on level
18
Q

Concentration dependent drugs

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A

Aminoglycosides
Fluoroquinolones
Daptomycin

19
Q

PSEUDOMONAS DRUGS

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A

Zero Preference for CLAMs and CARBs
Zosyn (Piperacillin/tazobactam), Polymyxins, Fortaz (Ceftazidime), Ciprofloxacin, Levofloxacin, Aztreonam, Maxipime, Aminoglycosides, CARBapenems (not ertapenem)

20
Q

Tetracyclines

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A

Doxycycline (Vibramycin) IV, PO
Minocycline (Minocin) IV, PO
Tigecycline (Tygacil) IV

MOA: inhibit protein synthesis
Spectrum: expanded gram-positive coverage (including MRSA) and gram-negative (NOT pseudomonas)
Tigecycline also has anaerobic activity and VRE
Extensive distribution (bone, skin)
ADE – all have extensive GI intolerances
Tigecycline – n/v in 40% of patients
Minocycline – higher vestibular toxicities (vertigo)
Do not use in pregnancy , kids < 8 y/o
Bone deformity and teeth staining
Photosensitivity (avoid sunlight)

21
Q

Amino-penicillin

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A

Amoxicillin , Ampicillin
Developed to provide gram-neg coverage
Spectrum: Streptococcus, Enteric gram-negative rods, Haemophilus influenza, Enteroccus faecalis
Less reliable for staph aureus
Ampicillin avialbe IV and PO
Mainly used in IV form (oral with poor biovailablity)
Amoxicillin used PO (better bioavailablity)
Clinical use: otitis media and acute pharyngitis
Not used empirically for hospital infections
Gram negatives are usually resistant
Inactivated by beta-lactamases

22
Q

Cephalosporins

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A

Inhibit cell wall synthesis
Many drugs in this class, divided into generations based on spectrum of activity
Greater gram positive coverage in first generation
Greater gram negative coverage in fifth generation

23
Q

Anti-Pseudomonal Penicillin

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A

Piperacillin
include coverage for Pseudomonas aeruginosa (Hospital-associated GNR)
Spectrum : same as aminopenicillins (+ pseudomonas)
Only IV, used in hospital for serious infections
Not used empirically due to resistance

24
Q

Beta-lactamase

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A

Enzyme that hydrolyzes the beta-lactam ring
Antibiotic becomes inactive
Natural or acquired from other organisms

25
Sulfamethoxazole-trimethoprim (Bactrim) – IV, PO
MOA: inhibits production of folic acid, an essential component to cell production Spectrum: very broad, gram-negatives (NOT pseudomonas) and gram-positives (including MRSA) Excellent bioavailability (IV and PO interchangeable) Contraindicated in patients with sulfa allergies Useful for variety of indications including pneumonia, skin infections, UTI, bone infections and more ADE: skin rxns can be very severe, neutropenia, nephrotoxicity, hyperkalemia, bone marrow suppression Must adjust in renal dysfunction !!
26
Carbapenems
Ertapenem (Invaz) IV, IM ----- only IM Meropenem (Merrem) IV Imipenem/cilastatin (Primaxin) IV Doripenem (Doribax) IV Broadest beta-lactam class (also inhibit cell wall synthesis) Used as last-line options in resistant infections Spectrum: Streptococcus, MSSA, all GNR (including Pseudomonas) and anaerobic gram-negatives Ertapenem does not cover Pseudomonas or Acinetobacter Stable against many beta-lactamases Primaxin has risk of causing seizures bc of cilastatin component Used interchangeably depending on hospital formulary Well tolerated
27
Time Dependent drugs
Beta-lactams | Linezolid
28
Time-dependent
Greater bactericidal activity as drug concentration remains above the MIC
29
Third generation Cephalosporins
Ceftazidime (Fortaz) IV Ceftriaxone (Rocephin) IV Cefpodoxime (Vantin) PO Developed to further expand gram-negative spectrum Spectrum: Streptococcus, MSSA less so, enteric GNR, Pseudomonas (Ceftazidime only) Increased stability against beta-lactamases Inactivated by Extended-spectrum beta-lactamases (ESBLs) Ceftriaxone: longer ½ life, highly protein bound, once daily dosing Hepatically eliminated, no renal adjustments Commonly used in hospital and outpatient for various reasons (pneumonia, skin, blood, bone, CNS)
30
Fluoroquinolones
Ciprofloxacin (Cipro) IV, PO Levofloxacin (Levaquin) IV, PO Moxifloxacin (Avelox) IV, PO MOA: inhibit protein synthesis causing cell death Spectrum: broad coverage including gram-positive (not MRSA) and gram-negatives Ciprofloxacin – poor Streptococcus coverage, not used for pneumonia Only Ciprofloxacin and Levofloxacin cover Pseudomonas , not moxifloxacin Excellent distribution, used for nearly all infection types Excellent bioavailability, can switch from oral to IV in serious infections Very commonly used -> resistance development Levofloxacin and moxifloxacin dosed once daily ADE: *QTc prolongation, *peripheral neuropathy, tendonitis, *C.diff
31
Macrolides
Azithromycin (Zithromax) IV, PO Clarithromycin (Biaxin) – PO MOA: inhibits protein synthesis Spectrum: streptococcus, minimal gram-negatives Respiratory pathogens that cause pneumonia and URIs Including atypicals – Mycoplasma pneumoniae Also used for chlamydia Anti-inflammatory properties seen with azithromycin – used for COPD Post-antibiotic effect- Zpak given for 5 days, works ~9-10 days ADE: GI upset, QTc prolongation , take with food ***Clarithromycin rarely used due to drug interactions (inhibits CYP 450 enzymes) , increased GI intolerance and more frequent dosing
32
Vanco Serum Concentration Monitoring
Trough – serum concentration collected 30 minutes prior to the 4th dose Correlates with efficacy and toxicity Desired concentrations In lung and CNS infections the recommended trough concentrations are 15-20 mcg/ml 10-15 mcg/ml for other infections
33
Aminoglycosides
Amikacin, Gentamicin, Tobramycin MOA: inhibit protein synthesis Spectrum: only gram negative organisms, including Pseudomonas aeruginosa, synergy for gram + infections Amikacin – reserved for gentamicin and tobramycin resistant gram-neg organisms Used in combination with other agents to prevent resistance from developing MUST be adjusted for renal dysfunction, only use conventional dosing MUST monitor levels ADE: *nephrotoxicity* : risk factors: concomitant nephrotoxins, dehydration, duration *Ototoxicity*
34
Penicillin ADE
Hypersensitivity rxns 10% of US population reports allergy Rash most common Almost all agents are renally eliminated / require adjustments Except Oxacillin and Nafcillin are hepatically eliminated – Hepatotoxicity Overall well tolerated GI intolerance / diarrhea – most common with oral agents
35
MRSA DRUGS
VTZDCBT Very Tall Zebras Drink Coffee Before Tests Vancomycin, Teflaro(Ceftarolinee), Zyvox(Linezolid), Daptomycin, Clindamycin, Bactrim, Tetracyclines
36
Concentration-dependent
Greater bactericidal activity as drug concentration (Cmax) exceeds the MIC
37
BETA-LACTAMS
Penicillins Cephalosporins Monobactams Carbapenems
38
Linezolid (Zyvox) – IV, PO
MOA: inhibits protein synthesis Spectrum: Gram+ including MSSA, MRSA, VRE Clincal Uses: reserved for tx of VRE or staph infections Excellent bioavailability = IV and PO interchangeable ADE : thrombocytopenia, drug interactions with SSRIs (may cause serotonin syndrome), diarrhea

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