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Flashcards in InfectiousDiseasesFC Deck (305):
1

Aminoglycosides are ______ dependent killers and exhibit a _______. Therefore they are normally dosed _____ daily

concentration-dependent
post-antibiotic effect (continued suppression of bacterial growth when antibiotic levels are below the MIC of the organism
once daily

2

Which drugs are in the class aminoglycosides

gentamycin, tobramycin, and amikacin, streptomycin

3

Which aminoglycosides can be given IV/IM and which can only be given IM

Iv/IM: gentamycin, tobramycin and amikacin
IM: streptomycin

4

Tobramycin comes IV, IM and _____ for the treatment of _____

inhaled formulation
CF

5

You dose aminoglycosides on _______

Ideal body weight

6

What black box warning do aminoglycosides come with

may cause neurotoxicity (vertigo, ataxia) and nephrotoxicity

7

What side effect are common for aminoglycosides

nephrotoxicity (ATN) and ototoxicity

8

Which patients should aminoglycosides be used in caution with

elderly, impaired renal function, and those on other nephrotoxic drugs (amphoteracin B, cisplatin, NSAIDs, vancomycin, contrast dyes, cyclosporine)

9

What are some common nephrotoxic drugs

aminoglycosides, amphoteracin B, cisplatin, NSAIDs, vancomycin, contrast dyes, cyclosporine

10

What monitoring parameters are important for aminoglycosides

renal function, hearing tests, and peak/troughs with traditional dosing and random level with extended dosing

11

What pregnancy category are aminoglycosides

D

12

What is something important to know about aminoglycosides effect on neuromuscular blocking agents

they increase levels of those agents

13

What are doses of aminoglycosides in traditional dosing

traditional
gent/tobra: 1-2.5mg/kg/dose
amikacin: 5-7.5mg/kg/dose

14

What are doses of aminoglycosides in extended interval dosing

extended interval
gent/tobra: 4-7 mg/kg
amikacin: 15-20 mg/kg

15

In traditional dosing of aminoglycosides how do dosing intervals change based on renal function

crcl>60 q 8 hr; crcl 40-60 q 12 h; crcl 20-40 q 24 h, crcl <20 give loading dose and monitor levels

16

When should trough and peak levels be taken for traditional aminoglycoside dosing

trough level right before next dose and peak level 1/2 hour after the end of the dosing interval

17

How are dosing frequency determined using extended interval dosing and when are levels taken

draw random level 6-16 hours post dose (depends on nomogram) and place level on nomogram to find out how frequently the dose should be given

18

What are the peak and trough levels that should be obtained with aminoglycosides using traditional dosing

gent/tobramycin: peak 5-10 and trough <5

19

penicillins exhibit ______ dependent killing and are bactericidal except against _______ where aminoglycosides are needed for ________ activity

time dependent killing
enterococci species
bactericidal

20

Aminopenicillins include which drugs

amoxicillin (amoxil, moxatag), amoxicillin + clavulanate (augmentin), ampicillin (principen), and ampicillin + sulbactam (unasyn)

21

ampicillin + sulbactam brand name is

unasyn

22

brand name of ampicillin is

principen

23

what drugs are referred to as natural penicillins

penicillin (penG and pen VK)

24

What drugs are referred to as ureidopenicillins

piperacillin + tazobactam (zosyn)

25

What is the generic name for zosyn

piperacillin + tazobactam

26

What is a carboxypenicillin

ticarcillin + clavulonic acid (timentin)

27

what are antistaphylococcal penicillins

nafcillin, oxacillin, and dicloxacillin

28

Which penicillin is hepatically cleared and which ones are renally cleared

hepatically- nafcillin
renally- all others

29

Amoxicillin is the doc for which conditions

acute otitis media, h. pylori regimen, pregnancy, prophylaxis for endocarditis

30

piperacillin and ticarcillin are the only penicillins with activity against

pseudomonas

31

penicillins combined with a beta-lactamase inhibitor have a broader spectrum of activity and are often used against ______ infections

mixed (intra-abdominal, aspiration pneumonia, diabetic foot ulcers, etc)

32

reduced dose and/or extended intervals are needed in renal impairment for all penicillins except

nafcillin, oxacillin, and dicloxacillin

33

side effect of penicillins are

allergic reactions (including anaphylaxis), rash, pruritis, gi upset, diarrhea, seizures with accumulation, acute interstitial nephritis (AIN), colitis, agranulocytosis, inc LFTs, bone marrow suppression with prolonged use

34

What are monitoring parameters for penicillins

renal function, signs of anaphylaxis with 1st dose

35

What pregnancy category are penicillins

B

36

penicillins can cause false ____ for both urinary glucose tests and galactomannan test for aspergillosis

positive

37

Which penicillin suspensions must be refrigerated?

augmentin must be refrigerated and amoxicillin suspension is refrigerated only to improve taste but stable 14 days at room temp, pen VK suspension should be refrigerated after reconstitution

38

how should you take Moxatag

Amoxicillin (Amoxil, Moxatag) should be taken within an hour of finishing a meal

39

How should pen VK be taken

penicillin should be taken on an empty stomach

40

Amoxicillin IV is only compatible with what solvent and stable for only ___ hours at room temp

Normal saline only
8 hours at room temp

41

Nafcillin is a _______ so if extravasation occurs use cold packs and hyaluronidase injections

vesicant

42

______ agents can increase levels of pcns by interfering with renal excretion

uricosuric agents (probenacid, allopurinol

43

Penicillins may decrease the effectiveness of what other drug

oral contraceptives

44

Cephalosporins mechanism of action

inhibit bacterial wall synthesis

45

Cephalosporins are ______ dependent killers with bacteriacidal activity

time

46

First generation cephalosporins include (brand and generic)

cefadroxil, cefazolin (kefzol), cephalexin (keflex)

47

keflex is the brand name for

cephalexin (first generation)

48

kefzol is the brand name for

cefazolin first generation

49

what is the normal dose of cefadroxil and what generation of cephalosporin is it

500 to 1000mg q 12 hr (po)
first generation

50

what is the normal dose of cefazolin, brand name and what generation of cephalosporin is it

kefzol
250 to 2000mg po q 8hr (iv)
first generation

51

what is the normal dose of keflex, what is the generic name and what generation of cephalosporin is it

cephalexin
250 to 500 mg q 6 hr (po)
first generation

52

in which time increments are first generation cephalosporins dosed

cefadroxil p 12 hr (po)
cefazolin (kefzol) q 8 hrs (iv)
cephalexin (keflex) q 6 hrs (po)

53

what drugs are second generation cephalosporins

cefactor
cefotetan
cefoxitin (mefoxin)
cefprozil
cefuroxime (ceftin, zinacef)
Cefuroxime

54

what is the generic name of mefoxin, what generation is it

cefoxitin 2nd generation cephalosporin

55

what is the generic name of ceftin, zinacef? what generation is it?

cefuroxime
2nd generation cephalosporin

56

what is the normal dose of cefotetan and cefoxitin (mefoxin)?

cefotetan 1-2 grams q 12 hrs (iv)
cefoxitin 1-2 grams q 6-8 hrs (iv)
both are second generation cephalosporins

57

what is the normal dose of cefprozil and cefactor

Cefaclor 250- 500mg q 8 hrs (po) to 12 h for ER
cefprozil 250 - 500mg q 12-24 hrs (po)

58

what is the normal dose of cefuroxime (ceftin, zinacef)

250- 1,500mg q8 hrs (po/iv)

59

3rd generation cephalosporins include

cefdinir, cefditoren (spectracef), cefixime (suprax), cefotaxime (claforan), cefopodoxime , ceftazidime (fortaz, tazicef), ceftibuten, ceftriaxone (rocephin)

60

what is the normal dose of ceftoxamine (claforan), ceftazidime (fortaz, tazicef) and ceftriaxone (rocephin)?

cefotaxime (claforan) 1-2 grams q 8-12 hr (iv/im)
ceftazidime (fortaz, tazicef) 1-2 grams q 8-12 hr (iv)
ceftriaxone (rocephin) `1-2 grams q 12-24 hrs (iv/im)

61

what is the normal dose of cefixime (suprax), cefditoren (spectracef) and ceftibuten (cedax)?

cefixime (suprax) 400 mg divided q 12 to 24 hr (po
cefditoren ( spectracef) 200-400mg q12 hr (po)
ceftibuten (cedax) 400mg qd (po))

62

what is the normal dose of cefdinir?

300mg q 12 hr or 600mg daily (po)

63

what is the generic name for fortaz, tazicef)?

ceftazidime
3rd generation cephalosporin

64

what is the generic name for rocephin

ceftriaxone

65

what are the names of fourth generation cephalosporins

cefepime (maxipime)

66

what is the generic name for maxipime

cefepime
4th generation cephalosporin

67

what is the generic name for teflaro

ceftaroline fosamil
5th generation cephalosporin

68

what is the normal dose of maxipime

cefepime (maxipime) 1-2 grams q 8-12 hr (iv)

69

what is the normal dose of teflaro

ceftaraline(teflaro) 600mg q 12 hr (iv)

70

what are common side effects of cephalosporins

allergic reactions (anaphylaxis), rash, gi upset, diarrhea, colitis, increased LFTS, bone marrow suppression with prolonged use

71

what should be monitored in cephalosporins, what other drug class is this like?

renal function, signs of allergic reaction (anaphylaxis) with first dose
penicillins

72

cross sensitivity of cephalosporins with pCNs is _____

<10%

73

cephalosporins should not be used in pts with type ___ reaction to pcns

1

74

cephalosporins are pregnancy category ___

B

75

___________ have test interactions with positive direct coomb's test and false positive urinary glucose tests

cephalosporins

76

reduced doses and extended intervals are needed in cephalosporins except for ________

ceftriaxone

77

______________ cephalosporin can cause biliary sludging and should not be given via y-site or mixed with ca-containing solutions

ceftriaxone

78

cefotetan contains NMTT or 1-MTT side chain and can leasd to risk of ______________________ and a disulfram-like reaction with _____ ingestion

hypoprothrombinemia (bleeding)
alcohol

79

ceftibuten should be taken _________food

without (on an empty stomach)

80

how should cefpodoxime, cefaclor, cefuroxime, and cefdiltoren tablets all should be taken how in regards to food

with food

81

probenecid and allopurinol as well as other urosurgic agents can ____levels of cephalosporins by interfering with renal excretion

increase

82

cephalosporins can ____ levels of oral contraceptives

decrease

83

Which carbapenems are given q 6-8 hrs and which daily?

q6-8 hrs--> imipenem/cilastin (primaxin) 250-1000mg iv q6-8hr
meropenem (merrem) 500-1000mg iv q 6-8hrs
--q8hrs doripenem (doribax) 500mg iv q8hrs
q24hrs ertapenem (invanz) 1000mg iv/im daily

84

which carbapenem is not active against pseudomonas?

ertapenem (invanz)
note: also the only one dosed daily as wel (iv/im)

85

what is the generic name for primaxin

imipenem/cilastin
carbapenem

86

what is the generic name for merrem

meropenem
carbopenem

87

what is the generic name for invanz

ertapenem
carbapenem

88

what is the generic name for doribax

doripenem

89

what are common side effects of carbapenems

diarrhea, rash, and seizures with higher doses and patients with decreased renal function (mostly imipenem)

90

who is at risk for a seizure with carbapenems, which one is worst?

patients on higher doses with impaired renal function
--primarily with imipenem (primaxin)

91

what category are carbapenems, which is a different category

b
c- imipenem

92

why is imipenem combined with cilastin?

to prevent degradation by renal tubular dehydropeptidase

93

which carbapenems need reduced dose or extended intervals with renal impairment

all

94

it is ok to use carbapenems in a patient with a pcn allergy

no cross sensitivity between 50-<10%

95

uricosurgic agents (probenacid, allopurinol) can ___levels of carbapenems

increase

96

which drugs are affected by uricosurgic agents (probenacid, allopurinol)

PCN, cephalosporins, carbapenems

97

carbapenems can _____ serum conc of valproic acid

decrease which can lead to a loss of seizure control

98

imipenem is ok to take with ganciclovir

FALSE
avoid use due to increased risk of seizures

99

ciprodex

ciprofloxacin otic

100

carbapenems are ok to use in patients at risk for seizures

FALSE
do not use

101

cetraxal

ciprofloxacin

102

what is MOA of FQ's and they exhibit _____ dependent killing with bactericidal activity

inhibit bacterial DNA topoisomerase IV and inhibit DNA gyrase (topoisomerase II).
Concentration

103

ciloxan

cipro opthalmic

104

what drugs are considered FQ's

ofloxacin (floxin otic), norfloxacin, cipro, levo, gati, gemi

105

Noroxin

nofloxacin

106

Cipro

ciprofloxacin (cipro, cipro XR, ciloxan ophthalmic, cetraxal, and ciprodex otic)

107

levaquin

levofloxacin

108

zymar and zymaxid

gatifloxacin (zymar and zymaxid ophthalmic)

109

avelox, moxeza, vigamox

moxifloxacin (avelox, moxeza, and vigamox ophthalmic)

110

factive

gemfloxacin

111

what is the generic name of cipro or cipro XR

ciprofloxacin FQ

112

what is the generic name of levaquin

levofloxacin

113

what is the generic name of avelox

moxifloxacin

114

what is the normal dose of ciprofloxacin (iv/po); crcl>50, 30-50, and <30

250-750mg po or 200-400iv
crcl>50 q8-12hr
30-50: q12 hr
<30: q 18-24 hr

115

levofloxacin dosing iv/po; crcl>50, 20-49, <20

250-750
crcl>50 qd
20-49: 750 q 48hr, 500, then 250 daily, or 250 daily
<20: 750 then 500 q48hr, or 500 then 250 q48hr or 250 q 48hr

116

moxifloxacin dosing (iv/po)

400mg q 24 hrs

117

Which FQ are renally excreted and which are hepatic

moxifloxacin is hepatic others are renal
cipro is mixed r=h

118

what is black box warning for FQ

tendon inflammation and/or rupture

119

what puts pts at risk for tendon inflammation and/or rupture with fQs

concurrent corticosteroid use, organ transplant patients, and patients >60years old

120

what are common side effects of fQ

photosensitivity, glycemia issues (hypo normally), arthropathy in children, QT prolongation, gi upset (n/v/d), headache rash

121

FQ use should be avoided if possible in what patient pop

children due to arthropathy and concerns of increased mx toxicity may use if risk outweighs benefits

122

what agents should be avoided with FQ due to increased risk of QT prolongation

class 1a and class III antiarrhythmics

123

are FQ safe in pregnancy?

class C
may cause cartilage damage in young animals

124

cipro oral suspension is ok to give NG

no because oil based suspension adheres to tubing

125

what are counseling points on cipro oral suspension

shake vigorously for 15sec before admin
no chew the microcapsules

126

can cipro IR be crushed?

yes, and it can be mixed with water and given via NG tube

127

which version of cipro should be given NG and are there any other recommendations?


hold tube feedings 1 hour before and 2 hours after the dosecipro IR mixed with water ok (cipro susp not ok)

128

which FQ need to have reduced doses or extended intervals in renal impairment

all but moxifloxacin

129

can FQ be used in PCN allergic pts?

yes

130

which agents cannot be given with FQ due to being multivalent cations

antacids, didanosine, sucralfate, bile acid resins, mg, al, ca, fe, zn, multivitamins

131

how long should each type of FQ be seperated from multivalent cations?

cipro 2 hrs before/ 6 hrs after
levo 2 hrs before/2 hrs after
moxi 4 hrs before/8hrs after

132

FQ can increase the levels of .....(3)

warfarin, sulfonylureas, and QT prolonging drusg

133

which FQ has the most prominent effect on QT prolonging drugs

moxifloxacin

134

probenacid and NSAIDs can ____ FQ levels

increase

135

ciprofloxacin is a strong ____ inhibitor and a weak _____ inhibitor

1A2, weak 3A4

136

Macrolides MOA, have bacteriostatic activity and related to __________

bind to 50S ribosomal subunit --> inhibit RNA dpdt protein synthesis
total exposure of the drug (AUC/MIC)

137

what drugs are considered macrolides (brand/generic)

zithromax, zpack (azithromycin)
biaxin, biaxin XL (clarithromycin)
EES, erytab, eryped, erthrocin (erythromycin)

138

what is the generic name for zithromax, z pack

azithromycin macrolide

139

what is the generic name for biaxin, biaxin xl

clarithromycin

140

what is the generic name for EES, erytab, eryped, erythrocin

erythromycin

141

what are common doses of azithromycin

500mg on day 1, then 250 days 2-5
OR 500mg daily x 3 days

142

should you refrigerate azithromycin oral suspension (zmax)?

no

143

common dose of biaxin

clarithromycin (biaxin)
250-500mg bid or
1 gram qd

144

should you take biaxin xl with food?

no

145

should you refrigerate biaxin oral suspension

no

146

which macrolide suspensions do you refrigerate?

only erythromycin (ees)
no fridge: clarithromycin and azithromycin

147

what is the only macrolide that needs to be renally adjusted?

clarithromycin

148

what is the normal dose of erythromycin?

EES 400mg qid
erythromycin base/stearate: 250-500mg qid

149

which macrolide is dosed qd, bid, and which is qid

qd- azithromycin
bid- clarithromycin (unless 1gm daily)
qid- erythromycin

150

do you need to refrigerate erythromycin suspension?

yes EES (erythromycin ethylsuccinate) oral granule suspension and use within 10 days
erythromycin powder suspension stable at room temp x 35 days

151

what are common side effects of macrolides

gi upset (diarrhea, abdominal pain/cramping, esp with erythromycin), liver dysfunction, QT prolongation

152

which macrolide has the most gi upset

erythromycin

153

what is the pregnancy categories of macrolides, which is the exception?

b
c- clarithromycin

154

azasite is an ophthalmic formulation of

azithromycin

155

azasite is a viscous solution for ophthalmic use and how must it be stored?

room temp as in fridge it becomes more viscous

156

can macrolides be used in a pt allergic to PCN?

yes

157

which macrolides do not require dose adjustments in renally impaired pts

azithromycin and erythromycin
clarithromycin--->req dose adj

158

azithromycin ER suspension (zmax) is bioequivalent with zithromax and should be interchanged? T/F

F
not bioequivalent, they should NOT be interchanged

159

zmax must be consumed within ____ hours of reconstitution and must be taken how with regards to food?

12 hours on empty stomach

160

which macrolides are moderate to strong 3A4 inhibitors?

erythromycin and clarithromycin

161

______ prolongation agents should not be taken with erythromycin and clarithromycin

QT

162

tetracyclines MOA, have bacteriostatic activity related to _____

moa- bind to 30S ribosomal subunit inhibiting bacterial protein synthesis
total exposure of the drug (AUC/MIC)

163

which drugs are in the class tetracyclines

doxycycline (vibramycin, oracea, doryx)
minocycline (minocin, dynacin, solodyn, ximino)
tetracycline

164

what is the generic name for vibramycin

doxycycline

165

what is the generic name for minocin

minocycline

166

what is a common dose of doxycycline

100mg q 12 hrs

167

oracea should be taken how in regards to food

doxycycline
1 hr before or 2 hrs after meal

168

how should doxycycline be taken?

with food to decrease gi upset unless oracea which is taken on empty stomach 1 hr before or 2 hrs after meal

169

what is the normal dose of minocin

minocycline
40-100mg qd-BID

170

what is the normal dose of tetracycline

250-500 bid-qid

171

what are 2 pt groups that should not take tetracyclines

children pregnant women category D due to suppressing bone growth and skeletal development and stains teeth

172

what pregnancy category are tetracyclines?

d
due to suppressing bone growth and skeletal development and stains teeth

173

how should tetracyclines be taken?

with water and food to decrease gi irritation
unless oracea (doxycycline) which is on empty stomach 1 hr before or 2 hrs after food

174

which tetracyclines should be dose adjusted in renal impairment

not doxycycline and minocycline
tetracycline should be dose adjusted in renal impairment

175

antacids con mg,al, or ca should be avoided with which tetracyclines

all

176

tetracyclines can be taken with divalent cations such as fe-containing preparations sucralfate, bile acid resins, and subsalicylate

no
seperate doses (1-2 hrs before and 4 hrs after)

177

tetracyclines have what effect on INR

increase INR on pts taking warfarin

178

tetracyclines have what effect on oral contraceptives

decrease

179

pseudotumor cerebri can be caused by taking tetracyclines with ___________

retinoic acid derivatives

180

what is the MOA of SMX and TMP? together they are ______, but individually they are ______

SMX- interferes with bacterial folic acid synthesis via inhibition of dihydrofolic acid formation from para-aminobenzoic acid
TMP inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in inhibition of ezymes in folic acid pathway
bactericidal, seperate are bacteriostatic

181

Which drugs are considered sulfonamides

sulfamethoxazole and trimethoprim (bactrim, septra)

182

generic name of septra

sulfamethoxazole and trimethoprim

183

generic name of bactrim

sulfamethoxazole and trimethoprim

184

single strength (ss) bactrim/septra is _ vs ds

sulfamethoxazole and trimethoprim
SS:400mg SMX/ 80mg TMP
DS: 800mg SMX/160mg TMP
always a 5:1 ratio

185

in sulfamethoxazole and trimethoprim, when dosing always a _____ ratio of SMX to TMP

0.209027778

186

what is the adult uti dosage of Bactrim

sulfamethoxazole and trimethoprim
1DS tab BID x 3 days
DS: 800mg SMX/ 160mg TMP

187

what is the PCP prophylaxis dose of Septra

sulfamethoxazole and trimethoprim
1 DS or SS tab daily
DS: 800mg SMX/ 160mg TMP; SS: 400mg SMX/ 80mg TMP

188

in more severe infections, what is the dose of sulfamethoxazole and trimethoprim

10-20 TMP mg/kg/day

189

in PCP treatment what is teh dose of sulfamethoxazole and trimethoprim

15-20 mg/kg TMP iv/po divided in 3-4 doses
i.e. 2DS tabs TID

190

what is the dose of sulfamethoxazole and trimethoprim in uti/aom

40mg/kg SMX and 8mg/kg TMP, divided BID x 10days

191

what are 5 contraindications to using sulfamethoxazole and trimethoprim

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

192

How is sulfamethoxazole and trimethoprim excreted?

TMP= R; SMX=H

193

what are common side effects to using sulfamethoxazole and trimethoprim

gi upset (N/V/D), skin reactions (rash, urticaria, SJS, TENS), crystalluria (take with 8 oz of water), photosensitivity, false elevations in Scr (pseudoazotemia), hyperkalemia

194

A pt taking sulfamethoxazole and trimethoprim can develop stephens johnson syndrome or TENS?

yes

195

if a patient taking sulfamethoxazole and trimethoprim with 8 oz of water, why should they do this

bc risk of crystalluria

196

if a pt taking sulfamethoxazole and trimethoprim has elevated Scr should you be worried

maybe, can cause false elevations--> pseudoazotemia

197

What pregnancy category is sulfamethoxazole and trimethoprim

C and D (at term)
risk for kernicterus and spinal cord defects

198

Bactrim IV should be stored ______ and has a ______ stability, however the more concentrated the soln the shorter teh half life.

at room temp
short stability (6 hrs)

199

Bactrim IV should be protected from _____ and diluted with _____

light
D5W

200

bactrim suspension should be refrigerated? T/F

F-- at room temp
protect from light too!!

201

The dose of bactrim should be unchanged during renal impairment? T/F

F should be reduced

202

sulfonamides are mod-strong inhibitors of ______ and should be avoided with __________

2C8/9
warfarin

203

SMX/TMP can ____ levels of sulfonylureas, phenytoin, dofetilide, azatioprine, MTX

increase

204

Levels of SMX/TMP may be ____ by 2C9/9 inhibitors

decreased

205

what effect does leucovorin/levoleucovorin have on SMX/TMP

decreased therapeutic effectiveness

206

5 agents that treat gram positives, not in an antibiotic class

vancomycin (vancocin)
Linezolin (zyvox)
Quinupristin and dalfopristin (synercid)
daptomycin (cubicin)
telavancin (vibativ)

207

generic name of vancocin and spectrum

vancomycin gram positives

208

generic name of linezolid and spectrum

zyvox gram positives

209

generic name of synercid) and spectrum

Quinupristin and dalfopristin gram positives

210

generic name of cubicin and spectrum

daptomycin gram positives

211

generic name of vibativ and spectrum

telavancin gram positives

212

drug of choice for MRSA infections

vancomycin (vancocin) dosed 15-20mg/kg q 8-12 hrs iv

213

what is the MOA of vancomycin

inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization by binding to D-alanyl-D-alanine portion

214

what type of killing does vancomycin exhibit and it is slowly _____

time-dependent killing bacteriacidal

215

side effects of vancomycin

nephrotoxicity, ototoxicity, red man syndrome, hypotension, flushing, neutropenia,

216

vancomycin is infused at what rate to avoid red man syndrome (rash)

30 min for each 500mg of drug given

217

how is vancomycin monitored, what levels for infections

trough 15-20 mcg/ml for pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia
trough 10-15mcg/ml for other infections
monitor: renal func

218

what category is vancomycin (pregnancy)

po b where as iv c

219

vancomycin should be used with caution with what other nephrotoxic agents

AMGs, and cisplatin

220

how is vancomycin dosed in crcl 20-49 ml/min, and crcl <20

20-49: q 24 hrs
<20: give loading dose and monitor levels

221

what concentration of vancomycin cannot be exceeded when given via peripheral iv

no exceed 5mg/ml

222

oral vancomycin is used to treat ______, and is dosed how

c diff
125-500 mg qid for severe cc diff infections or recurrent infections

223

when the mic of vancomycin is > _____ mcg/ml then another agent should be considered

2

224

zyvox is dosed how and what is the moa

600 mg q12 h po/iv
oxazolidinone class binds to bacterial 23S ribosomal RNA of 50S subunit

225

zyvox is _____ activity

bacteriostatic

226

linezolid iv dose is equivalent to what po dose

0.042361111

227

what are contraindications to linezolid (3)

concurrent use or within 2 weeks of mao inhibitors
uncontrolled HTN
sympathomimetics

228

linezolid is a _____ so tyramine containing foods should be avoided, serotonergic, and adrenergic drugs, tcas, meperidine, and buspirone should be avoided due to _____

weak maoi
serotonin syndrome

229

side effects of linezolid

myelosuppression >14 days of use, headaches (11+%), diarrhea, increased pancreatic enzymes

230

linezolid is a pregnancy ____

c

231

is renal adjustment needed with linezolid

no, it's hepatically cleared

232

the oral suspension of linezolid should be stored in the fridge? T/F

F-- at room temp

233

dose of synercid

quinupristin and dalfopristin (synercid) is dosed at 7.5mg/kg iv q 8-12 hr

234

quinupristin and dalfopristin (synercid) is in the streptogramin class which has what moa and what type of activity

binds to diff sites on 50S bacterial ribosomal subunit
bactericidal/static activity

235

side effects of synercid

quinupristin and dalfopristin (synercid)
hyperbilirubinemia (up to 35%), phlebitis (40%), inflammation, edema and pain at the infusion site (13-44%), arthralgias and myalgias (up to 47%)

236

side effects are rare with synercid

quinupristin and dalfopristin (synercid)
no quite common....hyperbilirubinemia (up to 35%), phlebitis (40%), inflammation, edema and pain at the infusion site (13-44%), arthralgias and myalgias (up to 47%)

237

what pregnancy category is quinupristin and dalfopristin (synercid)

b

238

is adjustment needed in renal impairment for quinupristin and dalfopristin (synercid)

no, hepatically cleared

239

what volume of quinupristin and dalfopristin (synercid) is needed in what diluent to be given peripherally

250mL or greater
D5W only

240

cubicin is dosed

4-6 mg/kg iv daily (daptomycin)

241

daptoycin is in the cyclic lipopeptide class and what is the moa and has _____ dependent killing and _____ activity

binds to cell membrane components causing rapid depolarization inhibiting all ic replication processes including protein synthesis
concentration-dpdt
bactericidal activity

242

what are side effects of daptomycin

>10% diarrhea/constipation, vomiting, anemia, peripheral edema, chest pain, hypo/hyper kalemia, inc CPK and myopathy, eosinophilia pneumonia

243

what monitoring should be done with a pt on cubicin

daptomycin
cpk levels weekly (more freq if on statin), muscle pain/weakness

244

what pregnancy category is cubicin

daptomycin is b

245

does dose or frequency need to be reduced for pts on cubicin with reduced renal function?

reduce freq (q24 h to q48 h)

246

can daptomycin be used to treat pneumonia?

no inactivated by lung surfactants

247

is daptomycin compatible with D5W?

no with NS

248

telavancin(vibativ) is dosed how

10 mg/kg iv daily

249

what is MOA of telavancin (vibativ) (a lipoglycopepetide derivative of vancomycin)

inhibits bacterial cell wall synthesis

250

what is the black box warning of telavacin (vibativ)

fetal risk, obtain pregnancy test prior to initiating therapy

251

what is the side effects of telavacin (vibativ)

taste disturbances (33%), N/V (20%), foamy urine (13%), renal dysfunction, qt prolongation, red man syndrome

252

what monitoring is needed for telavacin (vibativ)

renal function, pregnancy status
can inc pt, inr, aptt, act, xa

253

what pregnancy category is telavacin (vibativ)

c but bbw of fetal risk, obtain pregnancy test prior to initiating therapy

254

should the dose be reduced or frequency reduced with patients with renal impairment taking telavacin (vibativ)

yes

255

what drugs can cause red man syndrome

vancomycin (vancocin) and telavancin (vibativ) a lipoglycopeptide derivativve of vancomycin

256

how can red man syndrome be reduced with telavancin (vibativ)

infuse over 60 minutes

257

telavancin (vibativ) can _____ many blood coag levles (pt, inr, aPTT, ACT, Xa

increase

258

what is a common agent to treat gram negatives that is a monobactam

aztreonam (azactam iv, cayston inhaled for CF)

259

generic name for azactam iv

aztreonam

260

aztreonam dosing

500- 2000mg iv q 6-12 hr

261

moa of azactam

aztreonam (azactam) inhibits bacterial cell wall synthesis by binding to pbps

262

side effects of azactam

aztreonam (azactam)
rash, diarrhea, nausea, vomiting, increased lfts

263

what pregnancy category is aztreonam

b

264

does aztreonam need dose adjustment in renal impairment

yes

265

can aztreonam be used in pcn allergic patients

yes

266

What are 3 broad spectrum agents that do not belong to an antibiotic class

chloramphenicol, telithromycin (ketek), tigecycline (tygacil)

267

Generic name for ketek

telithromycin

268

generic name for tigecycline

tygacil

269

How is chloramphenicol dosed and is it used

4gm/day
rarely used do to Ses

270

MOA of chloramphenicol, and what is its activity

reversibly binds to 50S ribosomal subunit
bactericidal against some pathogens

271

Chloramphenicol black box warning

serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia) must monitor cbc weekly

272

due to black box warning on chloramphenicol what must be monitored weekly

cbc
bbw=serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia)

273

side effects of chloramphenicol

myelosuppression (pancytopenia) grey syndrome (circulatory collapse, acidosis, coma, death), cns

274

what syndrome can chloramphenicol cause which is circulatory collapse, acidosis, coma and death

grey syndrome

275

what should be monitored for chloramphenicol

cbc, liver and renal function

276

does chloramphenicol need to be adjusted in patients with impaired renal function

no but use with caution

277

how is ketek dosed

800 mg po daily
telithromycin

278

telithromycin is in the ketolide class and what is MOA, ______ dpdt, and _____ activity

inhibits protein synthesis by binding to 2 sites on 50S ribosomal subunit
concentration dpdt
bactericidal

279

black box warning of telithromycin (ketek)

do not use in myasthenia gravis due to respiratory failure

280

contraindications to telithromycin use (4)

allergy to macrolides
hx of hepatitis or jaundice from macrolides
myasthenia gravis
concurrent use of colchicine, lovastatin or simvastatin

281

which 3 drugs cannot be used with telithromycin

colchicine, lovastatin, or simvastatin

282

what warnings does telithromycin have (5)

acute hepatic failure (can be fatal)
qt prolongation
visual disturbances (blurry vision, diplopia)
loss of consciousness
colitis

283

side effects of telithromycin

diarrhea, ha, n/v

284

what should be monitored with telithromycin

lfts and visual acuity

285

what pregnancy category is telithromycin

c

286

should dose be reduced in renal impairment with telithromycin (ketek)

yes but drug is hepatically cleared

287

Tygacil is a derivative of what drug

tigecycline is a derivative of minocycline

288

how is tygacil dosed?

tigecycline is dosed 100mg iv x 1 dose, then 50mg iv q 12 hrs

289

tigecycline (tygacil) is of glycylcyclines class and what is moa, and has _____ activity

binds to 30s ribosomal subunit inhibiting protein synthesis
bacteriostatic activity

290

what are common se's of tigecycline

n/v (20%), diarrhea, inc lfts, photosensitivity,

291

what drugs cannot be used in children <8

tetracyclines + tigecycline (tygacil)

292

what pregnancy category is tygacil

tigecycline is a category d

293

are adjustments needed during renal impairment for tigecycline

no, is hepatically eliminated

294

_____ cure rates for VAP when using tigecycline

lower

295

tygacil can be used for bloodstream infections

tigecycline cannot be used during blood stream infections as it does not achieve adequate conc in central compartment (blood) due to its lipophiliciy

296

tigecycline is not active against which 3p's

pseudomonas, proteus, providencia species

297

Generic name for cleocin

clindamycin

298

Generic name for flagyl, metrogel topical

metronidazole

299

Generic name for tindamax

tinidazole

300

Generic name for xifaxan

rifaximan

301

Dosing of clindamycin (cleocin)

150-450 mg po 3-4 times daily

302

Dosing of metronidazole (flagyl) and for c diff

250-750 mg q 6-8 hrs (iv,po)
use 500 mg tid for 10-14 days c diff mild to mod infections

303

Dosing of tinidazole (tindamax)

2 grams po daily up to 5 days

304

Dosing of rifaximin (xifaxan)

200 mg tid x 3 days

305

dose of metronidazole in c diff

500 mg tid for 10-14 days c diff mild to mod infections