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
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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