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Therapeutics IV > Intro to ABX (Clinical Pearls) - Block 1 > Flashcards

Intro to ABX (Clinical Pearls) - Block 1 Flashcards

1
Q

Penicillin MOA

A

Inhibits the cross-linking of peptidoglycan in cell wall, causing autolysis & cell death

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2
Q

Types of penicillins?

A
  1. Natural
  2. ANti-staph
  3. AMinopenicillins
  4. Aminopenicillisn + BLI
  5. Extend spec + BLIs
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3
Q

Natural penicillins?

A

Penicillin G and V
Pen G benzathine

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4
Q

Natural penicillin indication?

A
  1. Pharyngitis
  2. Syphillis
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5
Q

BBW of penicillins?

A

Pen G benzathine should not be given IV -> fatal

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6
Q

What is Pen G benzathine specifically used for?

A

Bicillin LA -> drug ofchoice for syphillis

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7
Q

Types of anti-staph pens?

A
  1. Nafcillin
  2. Oxacillin
  3. Dicloxacillin
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8
Q

Indications for anti-staph pens?

A

MSSA: ABX are therapeutically interchangeable

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9
Q

Because of the short half-life and frequent dosing what do you need to consider about anti-staphs?

A

Increased risk for phlebitis -> consider using 1st gen cephs for better tolerability

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10
Q

CP of anti-staphs?

A
  1. Metabolized by liver -> no renal dose adj
  2. Consider sodium content in CHF on Na restriction
  3. ABXs are interchangeable for MSSA
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11
Q

Types of aminopenicillins?

A
  1. Amoxicillin
  2. Ampicillin
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12
Q

Indications for aminopenicillins?

A
  1. URTIs
  2. Otisi media
  3. Strep throat
  4. H. pylori
  5. enterococci
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13
Q

CP of aminopenicillins?

A
  1. Diarrheas as PO
  2. Amoxicillin&raquo_space; ampicillin
  3. Alternative for UTIs in pregnant women
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14
Q

When would ampicillin be considered over amoxicillin?

A

Suspectible enterococci infections
* E. faecalis = S
* E. faecium = R

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15
Q

Types of Aminopenicillins + Beta-Lactamase Inhibitors?

A

Amoxicillin/clavulanate (PO)
Ampicillin/sulbactam (IV)

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16
Q

Indication for Aminopenicillins + Beta-Lactamase Inhibitors?

A
  1. URTIs
  2. LRTIs
  3. Animal and human bites
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17
Q

CP for Augmentin?

A

Causes diarrhea -> take with food

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18
Q

Do Beta-lactamase inhibitors cause complete inactivation of all BL enzymes?

A

No

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19
Q

CP of ampicillin/sulbactam?

A

active against Acinetobacter baumannii associated with nosocomial infections

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20
Q

Types of extended spec + BLI?

A

Zosyn

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21
Q

Indication for ZOsyn?

A
  1. Empiric coverage of nosocomial infections
  2. Susceptible P. aeruginosa infection
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22
Q

CP of Zosyn?

A
  1. Broad spec activity against G- and G+ anaerobes
  2. COnsider sodium content in BHF on Na restriction
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23
Q

ADRs of penicillins?

A

Hypersensitivity
C. diff colitis

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24
Q

Monitoring parametrs of penicillins?

A

Hypersensitivity reactions

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25
Q

Cephalosporins MOA?

A

Inhibits the cross-linking of peptidoglycan in cell wall, causing autolysis & cell death

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26
Q

Types of 1st gen cephalosporins?

A
  1. Cefazolin
  2. Cephalexin
  3. Cefadroxil
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27
Q

Indication of 1st gen cephs

A
  1. SSTI
  2. surigical prophylaxis
  3. MSSA bacteremia and endocarditis
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28
Q

CP of 1st gen cephs?

A
  1. Alt agent for anti-staph
  2. Cephalexin and cefadroxil -> high cross reactivity to beta-lactams
  3. Ceffazolin: low cross reactivity to beta-lactams
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29
Q

Types of 2nd gen cephs?

A
  1. Cefuroxime
  2. Ceprozil
  3. Cefoxitin
  4. Cefotetan
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30
Q

Indication for 2nd gen ceph?

A
  1. URTIs
  2. CAP
  3. Surgical prophylaxis (Cefoxitin and cefotetan)
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31
Q

How does 2nd gen compare to 1st gen?

A

Less strep and staph activity

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32
Q

2nds gen cephs that have anaerobic coverage?

A

Cefoxitin and cefotetan

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33
Q

ADR of cefotetan?

A

MTT side chain -> inhibits Vit K production and causes prolonged bleeding

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34
Q

Which 2nd gen has a high cross reactivity with beta lactams

A

Cefprozil

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35
Q

Types of 3rd gen cephs?

A
  1. Cefdinir
  2. Cefpodoxime
  3. Cefotaxime
  4. Ceftriaxone
  5. Seftazidime
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36
Q

Indication for 3rd gen?

A
  1. URTIs
  2. LRTIs
  3. gonorrhea
  4. SSTIs
  5. Bacteremia
  6. Osteomylitis
  7. Menigitis and Lyme (ceftriaxone)
  8. Nosocomial and febrile neuropenia (Ceftazidime)
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37
Q

ADR of 3rd gen?

A
  1. C. diff infection
  2. Increased risk of GNR resistance
  3. Cefpodoxime -> MMT side chain inhibits Vit K production -> prolonged bleeding
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38
Q

How does ceftazidime coverage differ from other 3rd gens?

A

Only has Pseudomonas activity, poor strep and staph coverage

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39
Q

rd gens that are used for CNS infection?

A
  1. Ceftriaxone (meningitis and Lyme)
  2. Cefotaxime
  3. Ceftazidime (febrile neutropenia)
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40
Q

Ceftriaxone

Dosing, DDI, ADR, CI

A

Dosing: QD, menigitis BID
* No renal adjustment

DDI: intercts with calcium-containing meds (forms crystals in lungs and kidneys)
ADR: biliary sludging -> hyperbilirubemia
CI: Neonates (cefotaxime is safer)

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41
Q

Types of forth gen cephs?

A

Cefepime

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42
Q

Indication cefepime?

A
  1. Empiric therapy for nosocomial infection
  2. Febrile neutropenia
  3. Intra ab infction
  4. SSTIs
  5. UTI

Pseudomonas activity (permanent charge)

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43
Q

Caution with cefepim?

A
  1. Neurotoxicity
  2. Renal dose adjustment
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44
Q

Types of 5th gen cephs?

A

Ceftaroline

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45
Q

Indication of ceftaroline?

A
  1. CAP
  2. MRSA
  3. Complicating SSRI
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46
Q

ADR of ceftaroline?

A

Neutropenia

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47
Q

Types of sideophor ceph? MOA

A

Cefiderocol (Fetroja): contains a sideophore side chain that allows it to be taken up into the abcteria bypassing resistance mechanisms

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48
Q

Indication for Cefiderocol?

A
  1. Complicated UTI
  2. HAP
  3. P. aeruginosa, ESBL- and carbapenemase producing organisms)
  • Only used in patients with resistance of common ABX for the inidcation
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49
Q

Types of Cephalosporin + Beta-Lactamase Inhibitors?

A

ceftazidime/avibactam (IV), ceftolozane/tazobactam (IV), cefepime/enmetazobactam (IV)

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50
Q

Indication for Cephs + BLI?

A
  1. MDR P. aeruginosa
  2. ESBL-producign organsims
  • ONLY in patients with bacterial infections which are resistant to other commonly-used antibiotics for the indication
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51
Q

What ceph combo has activity against carbapenem resistant enterobacterales?

A

Ceftazidime/avibactam

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52
Q

What can be added to ceph +BLI therapies if resistance is observed?

A

Metronidazole

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53
Q

ADR of Cephs?

A
  1. Hypersensitivity rx
  2. C diff colitis
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54
Q

Monitoring parameters of cephs?

A
  1. Hypersensitivity rx
  2. Renal function
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55
Q

MOA of carbapenems?

A

Inhibits the cross-linking of peptidoglycan in cell wall, causing autolysis & cell death

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56
Q

Types of cabapenems?

A
  1. Imipenem/cilastatin
  2. Meropenem
  3. Ertapenem
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57
Q

Indications for carbapenems?

A
  1. Nosocomial
  2. Febrile neutropeia
  3. Intra ab infection
  4. ESBL infections
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58
Q

ABX with the broadest spec? Caution?

A

Imipenem/cilastatin and meropenum -> should not be used as empiric therapy for CA infections

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59
Q

ADRs of imipenem/cilastatin?

A

Seizures
* Renal adjustment to minimize sz

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60
Q

DDI with carbapenems?

A

Valproic acid
* carbapenems induce VPA -> sub therapeutic VA [C] and breakthrough sz

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61
Q

How does ertapenen differ from other carbapenems?

A
  1. QD (more convenient)
  2. Weaker spec
    * Pooractivity against Pseudmonas, acinetobacter, enterococci
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62
Q
A
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63
Q

Types of Carbapenems + Beta-Lactamase Inhibitors?

A

imipenem/cilastatin/relebactam (IV)

meropenem/vaborbactam (IV)

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64
Q

Indication for carbapenems + BLI?

A
  1. Complicated UTI
  2. Intra ab infection
  3. HAP
  4. VAP
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65
Q

ADR of carbapenems?

A
  1. Hypersensitvity
  2. C diff colitis
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65
Q

CP of carbapenems + BLI?

A
  1. Activity against carbapenemase-producing Enterobacterales and ESBL
  2. Imipenem/cilastatin/relebactam has . carbapenem-resistant Pseudomonas coverage
  3. Vaborbactam has no CR-pseudomonas coverage
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66
Q

Monitoring paratmeters of carbapenems?

A
  1. Hypersensitivity rx
  2. Renal function
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67
Q

Cautions when using carbapenems?

A

SZ higher in elderly with hx of sz or renal dysfunction

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68
Q
A
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69
Q

MOA of monobactams?

A

Inhibits the cross-linking of peptidoglycan in cell wall, causing autolysis & cell death

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70
Q

Types of monobactams?

A

Aztreonam

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71
Q

Indication for manobactams?

A
  1. G- infections including Pseudomonas (especially hx of beta-lactam allergy)
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72
Q

ADR of monobactams?

A

C diff colitis
Anaphylactic penicillin allergy
Avoid if patient has a ceftazidime allergy

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73
Q

Monitoring parameters of aztreonam?

A

Renal function

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74
Q

Macrolides MOA?

A

Binds to 50S subuntis on bac ribosome -> inhibits it from adding new aa to elongate protein chain

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75
Q

Types of macrolides?

A
  1. Azithromycin
  2. Clarithromycin
  3. Erythromycin
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76
Q

Indication of macrolides?

A
  1. RIs
  2. Atypical infection
  3. Travelers diarrhea (Azitrhomycin)
  4. H pylori PUD (clarithromycin)
  5. CAP butnot as a monotherapy due to increasing resistance
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77
Q

DDI of Macrolides?

A

Not Azithromycin: potent CYP3A4 inhibits

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78
Q

ADRs of macrolides?

A
  1. GI intolerance
  2. Diarrhea (Erythromycin -> prokinetic and GI stimulating)
  3. QTc prolongation
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79
Q

MOA of fluroquinolones?

A

Inhibits DNA topoisomerase -> DNA breakage and cell death

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80
Q

Types of fluroquinolones?

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. Moxifloxacin
  4. Delafloxacin
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81
Q

Quinolones indicated for MRSA?

A

Delafloxacin

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82
Q

Quinolone not for respiratory?

A

Ciprofloxacin: poor S. pneumoniae coverage)

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83
Q

What is not an indication for moxifloxacin?

A

UTI -> poor urinary concntration

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84
Q

All quinolones reque renal adjustment?

A

Except for moxifloxacin

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85
Q

CI of quinolones?

A

Pregnancy and children -> imparied bone and cartilage development

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86
Q

BBW of quinolones?

A
  1. Tendon rupture
  2. Peripheral neuropathy
  3. CNS effect
  4. Myasthenia gravis
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87
Q

Precaution of quinolones?

A
  1. Aortic aneurysm and dissection
  2. Hyperglycemia
  3. Hypoglycemia
88
Q

Quinolones with P. aeruginosa coverage?

A

Levofloxacin and ciprofloxacine must be given in higher doses when treating infection

89
Q

______ is necessary due to increasing resistance of P. aeruginosa?

A

Susceptibility testing

90
Q

Compare bioavailabilties of quinolone formulations?

A

Levofloxacin and moxifloxacin: PO=IV
Cipro and delafloxacin: PO<IV

91
Q

DDIs with qinolones?

A

Mulivalent cations -> separate by at least 2 hrs

92
Q

ADRs of fluoroquinolones?

A
  1. GI intolerance
  2. Photosensitivity
  3. QTc prolongation
  4. Tendon rupture
  5. Peripheral neuropathy
  6. SZ
  7. C diff colitis
93
Q

Monitoring parameters of fluoroquinolones?

A

Renal function

94
Q

MOA of tetracyclines?

A

Binds to 30S subunit of bacterial ribosome -> preventing the docking of tRNA with new amino acids from adding to elongating protein chain

95
Q

TYpes of tetracyclines?

A
  1. Doxycycline
  2. Minocycline
  3. Tetracycline
96
Q

Indication of tetracyclines?

A
  1. URTIs
  2. LRTIs
  3. SSTIs
  4. Atypicals
97
Q

What is a con for tetracyclines have a large Vd?

A

Good tissue penetration -> not good for bacteremia

98
Q

Doing of doxycycline and minocycline?

A

PO andIV are equivalent

99
Q

DDI of tetracycline?

A

Multivalent cations -> separate for at least 2 hrs

100
Q

Types of modified tetracyclines?

A
  1. Tigecyclne
  2. Eravacycline
  3. Omadacycline
101
Q

Why is tigecycle not used?

A

BBW -> increased risk of mortality

102
Q

Tetracyclines that don’t require renal dosing?

A

Eravacycline and omadacycline

103
Q

How should omadacycline be dosed?

A
  1. Empty stomach
  2. 2 hrs before or 4 hrs after meals
  3. DDI with multivalent cations
104
Q

Modified tetras have better activity against ___ than normal tetras?

A

VRE and MRSA

105
Q

ADR of tetras?

A
  1. Esophageal ulcerations
  2. Photosensitivity
  3. Pseudotumor cerebri
  4. C diff colitis
106
Q

Counseling points fr Tetras?

A
  1. Takewith 8 oz of water and sit upright for 30 minutes
  2. Avoid in pregnancy
  3. Doxycycline can be used in pediatrics <21 days
107
Q

MOA of pleuromutilins?

A

Inhibits protein synthesis through various interaction with A and P sites of PTC (peptidyl transferase center) in domain V of 23S rRNA of the 50S ribosomal subunity

108
Q

Types of pleuromutilins?

A

Lefamulin

109
Q

Indication for lefamulin?

A

CAP (G+, G-, MRSA, Atypicals)

110
Q

How is lefamulin metabolized?

A

CYP3A4 -> avoid CYP3A4 inhibitors -> QTc prolongation

111
Q

ADr of pleuromutilins?

A
  1. Gi intolerance
  2. QT prolongation
  3. C diff colitis
112
Q

Monitoring parameters of pleuromutilins?

A

Pregnancy testing -> teratogenic

113
Q

Counseling points for Lefamulin?

A
  1. Take 1 hr before or 2 hr after meals
  2. Swallow whole with 6-8oz of water
  3. Don’t crush or divide tablets
114
Q

MOA of AGs?

A

Binds to 30S subunit of bacterial ribosome -> misreading of genetic code, incorrect protein

115
Q

What are the types of AG?

A
  1. Gentamicin
  2. Tobramycin
  3. AMikacin
  4. Plazomicin
  5. Streptomycin
116
Q

What is plazomicin used for?

A

Complicated UTIs from MDR enterobacterales (ESBL and cabapenem resistant strains)

117
Q

How is AG dosed?

A

IBW or AdjBW, but not TBW

118
Q

Can AG be used has a monotherapy?

A

No, due to poor concnetrations achieved in the lungs and CNS

119
Q

What are types of dosing strategies for AG?

A
  1. Traditional
  2. Extended interval
120
Q

What is traditional dosing?

A

Before 4th dose: draw trough level wihin 30 min before next dose
After 4th dose: draw a peak level 30 min after infusion

121
Q

What is the difference between peak and trough?

A

Peak: measures efficacy
Trough: measures toxicity

122
Q

How do we fix peak?

A

Adjust dose

123
Q

How do we fix trough?

A

Adjust dosing intervals

124
Q

Who should not get extendd interval dosing?

A
  1. Pregnancy
  2. Critcally ill
  3. Renal dysfunction
  4. Morbidly obese
125
Q

Dosing for extended interval?

A

Draw a random level after 1st dose based on Hartford nomagram

126
Q

ADR of AG?

A
  1. Tubular necrois (nephrotox)
  2. Renal failure (nephrotox)
  3. Vestibulr and cochlear toxicity (ototox)
127
Q

Monitoring paramters for AG?

A
  1. Renal function
  2. Serum drug concentration
128
Q

MOA of glycopeptides

A

Binds to terminal D-ala D-ala chains on PG in the cell wall preventing elongation of PG chains

129
Q

Types of glycopeptides?

A

Vancomycin

130
Q

What is the preferred option for MSSA infections starting out?

A

b-lactams

131
Q

What is vanc for?

A
  1. MRSA
  2. C diff (PO only)
132
Q

PK/PD of vanc?

A

Time dependent, bactericidal

133
Q

Dosing of vancomycin?

A

SHould not exceed 5 mg/mL by IV infusion over >60minutes
* Infusion period of 30 minutes for every 500 mg administered

134
Q

Goal range for vanc?

A

Normal: 10-20 mcg/mL
Severe infection: 15-20 mcg/mL

135
Q

Monitoring of vanc levels should include?

A

Trough taken 30 minutes before next dose
* before 4th dose

136
Q

Ho should we adjust vanc?

A

Trough > goal range: increasing the interval or decreasing the dose
Trough < goal range: decreasing the interval or increasing the dose

137
Q

What is the the target AUC value?

A

400-600

138
Q

ADR of glycopeptides?

A

Vanc flushing syndrome
* Prolonging vanc infusions -> premedicate antihistamines

139
Q

Monitoring paraemters of vancs?

A
  1. Renal function
  2. Serum drug concentration
140
Q

MOA of lipoglycopeptides?

A
  1. Binds to D-al D-ala chains on PG in the cell wall, preventing elongation of PG chains
  2. Interferes with cell membrane disrupting membrane function
141
Q

Types of lipogycopeptides?

A
  1. Telavancin
  2. Dalbavancin
  3. Oritavancin
142
Q

Indications of lipoglycopeptides?

A
  1. SSTIs
  2. HAP (telavancin)
143
Q

Describe the efficacy of telavancin over vanc?

A

Bactericidal effects more rapidly than vanc

144
Q

DOA for lipoglycopeptides?

A

Oritavancin and dalbavancin: >1 week t1/2

145
Q

DDI of lipoglycopeptids?

A

Heparin and warfarin: Oritavancin alters PT and activated pTT

146
Q

Scope of activity of lipoglycopeptides?

A
  1. MRSA
  2. VRE (oritavancin)
147
Q

ADR of lipoglycopeptides?

A
  1. C. diff colitis
  2. Infusion related rx
  3. Nephrotox
  4. Metallic taste disturbances (telavancin)
  5. Foamy urine (telavancin)
148
Q

Monitoring parameters of lipoglycopeptides?

A
  1. Renal function
  2. Pregnancy test -> telavancin is teratogenic
149
Q

MOA of cyclic lipopeptides?

A

Binds to cell membrane of G+ -> causing leakage of intracellular cations that maintain membrane polarization -> rapid depolarization and cell death

150
Q

Types of cyclic lipopeptides?

A

Daptomycin

151
Q

Indication of daptomycin?

A

MRSA, VRE

152
Q

CI of cyclic lipopetides?

A

Pneumonia -> inacitivation by lung surfactant

153
Q

ADR of daptomycin?

A
  1. Elevated cr phosphokinase (CPK)
  2. Rhabdomyolysis
154
Q

Monitoring parameters of cyclic lipopetides?

A
  1. Renal function
  2. CPK (patients with prior or concomitant statin therapy)
155
Q

Dosing of daptomycin?

A
  1. Elevated CPK >5 times ULN in patients with sx of rabdomyolysis
  2. Elevated CPK > 10 times ULN in asymptomatic patients
156
Q

MOA of oxazolidinones?

A

Binds to 50S subunit -> blocks the formation of the 70S initiation complex resulting in the inhibition of protein synthesis

157
Q

Types of oxazolidinones?

A
  1. Linezolid
  2. Tedizolid
158
Q

Indication for Oxazolidinones?

A

MRSA, VRE

159
Q

Dosing of oxazolidinones?

A

Linezolid and tedizolid: IV-PO (1:1)
Linezolid: No dose adjustment, not eliminated kidneys and liver

160
Q

DDI of oxazolidones?

A

Linezolid -> serotonergic agents due to MOAI activity -> Serotonin syndrome

161
Q

ADR of oxazolidinones?

A
  1. Myelosuppression (thrombocytopenia, leukopenia, anemia) - >2 weeks
  2. Peripheral neuropathy
  3. Serotonin syndrome
162
Q

Monitoring parameters of oxazolidinones?

A
  1. CBC with differential
  2. Serotnin syndrome in patients on concomitant therapy with other serotonergic agents
163
Q

MOA of folate antagonists?

A

Inhibits folate biosynthesis causing the depletion of the nucleotde pool -> inhibition of DNA synthesis in susceptible organisms

164
Q

Types of folate antagonists?

A
  1. Bactrim
  2. Dapsone
  3. Pyrimethamine
  4. Sulfadiazine
165
Q

Fixed ratio of Bactrim?

A

5:1

166
Q

Indication of Bactrim?

A
  1. First line for uncomplicated UTIs
  2. ALt: nitrofurantoin if local E. coli >15-20%
  3. Avoid for empiric tx of complicated UTIs
167
Q

CI of Bactrim?

A
  1. DDI wit warfarin -> increased bleeding risk -> monitor INR
  2. Infants <2 months old
  3. Pregnancy (inhibits folate)
168
Q

ADR of folate antagonists?

A
  1. GI intolerance
  2. Rash
  3. Hyperkalemia
  4. Photosensitivity
  5. Crystalluria with azotemia
  6. SJS/TEN
  7. Sulfa allergy
  8. Methemoglobinemia in patients with G6PD def
169
Q

MOA of streptogramins?

A

Bnds to different sites on the 5S subunit of the bacterial ribosome -> preventing of bacterial protein synthesis

170
Q

Types of streptogramins?

A

Quinupristin - dalfopristin (Synercid)

171
Q

Synercid scope of activity?

A
  1. No activity against E. faecalis
  2. Definitive therapy
  3. Only used for MRSA, VRE (E. faecium)

Bacteriostatic alone, bactericidal together

172
Q

ADR of streptogramins?

A
  1. Myalgia
  2. Arthralgia
173
Q

Dosing of Synercid?

A
  • Mixed and administered with D5W
  • 100% F
174
Q

MOA of lincosamides?

A

Binds to 50S subunit inhibitng them from adding new aa to elongate protein chain (similar to macrolides)

175
Q

Types of lincosamids?

A

Clindamycin

176
Q

How do we test for lincosamide resistance?

A

D-test for erythromycin-resistant, clindamycin-susceptible strains:
* Positive D-test: inducible clindamycin resistance -> avoid clindamycin

177
Q

ADR of lincosamides?

A

Diarrhea, C. diff colitis

178
Q

MOA of nitromidazoles?

A

Forms free radicals can damage DNA and result in cell death of anaerobic bacteria and protozoa

179
Q

Types of nitromidazoles?

A
  1. Metronidazole
  2. Tinidazole
180
Q

DDI of nitromidazoles?

A
  1. Metronidazole inhibits aldehyde dehydrogenase -> concomitant use of alcohol -> disulfurim like rx
  2. CYP3A4 inhibition -> warfarin increased risk for bleeding
181
Q

Bioavailability of metronidazole?

A

PO:IV -> 1:1

182
Q

ADR of nitromidazole?

A
  1. Metallic taste
  2. Peripheral neuropathy -> reversible
  3. Disulfirm rx with alcohol
183
Q

MOA of Nitrofurans & Fosfomycin

A

Nitrofurantoin: redued by bacterial flavoproteins into reactive species that alters ribosomal proteins inhibitngprotein synthesis
Fosfomycin: inhibits bacterial cell wall synthesis by preventing the production of building blocks of PG

184
Q

Indication of nitrofurantoin? Fosfomycin?

A

Uncomplicated UTIs
Both: acute cystitis from VRE

185
Q

CI of nitrofurantoin?

A

CrCl < 60 mL/min
Short term use: >30 mL/min

186
Q

ADR of nitrofurans and fosfomycin?

A

Nitrofurantoin:
1. Peripheral neuropathy
2. Hemolytic anemia
3. Urine discoloration
4. C. diff colitis

Fosfomycin:
1. GI intolerance
2. C. diff colitis

187
Q

Monitoring parameters of nitrofurans and fosfomycin?

A

G6PD activity

188
Q

Formulations of nitrofurans and fosfomycin?

A

Nitrofurantoin: Macrobid and Macrofantin
Fosfomycin: PO powder mixed with waters prior to admin as one-dase regimen

189
Q

MOA of polymyxins?

A

Binds to outer membrane of G- causing disruption of membrane stability and leakage of cellular contents

190
Q

Types of polymyxins?

A
  1. Colistin
  2. Polymyxin B
191
Q

Indication for polymixins?

A

Last line by MDR G- (A. baumannii, P. aeruginosa, and carbapenem-resistant Enterobacterales (K. pneumoniae))

192
Q

Dosing of colistin?

A

400 mg colistimethate = 150 mg colistin base activity

193
Q

ADR of polymyxins?

A
  1. Nephrotox -> dose-dependent effect
  2. Neurotox
  3. Neuromuscular blockade
194
Q

MOA of anti-c diff?

A

Inhibits RNA polymerase resulting in the inhibition of protein synthesis and cell death

195
Q

Types of anti-c diff agents?

A

Fidaxomicin

196
Q

Indication of fidaxomicin?

A
  1. Non-absorbble in narrow spec activity specifically C. diff
  2. First line agent for C diff treatment and prophylaxis
197
Q

ADR of anti-c. diff agents?

A
  1. GI tolerance
  2. Hypersensitivyt reactions
198
Q

Cons of fidaxomicin?

A
  1. Very expensive
  2. Avoid: PO vanc or metronidazole
199
Q

Types of tubercular agents?

A
  1. Rifamycins
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
200
Q

MOA of rifamycins?

A

Inhibits RNA polymerase, which prevents transcription by blocking mRNA production & protein synthesis

201
Q

Spectrum of activity of rifamycns?

A

MRSA

202
Q

ADR of rifamycins?

A
  1. Red orange discoloration of bodily fluids
  2. Hepatotox
203
Q

Monitoring paramters of rifampin?

A

Hepatic function (LFTs)

204
Q

CP of rifampin?

A

Poten CYP450 enzyme inducers
* Rifabutin is less potent

205
Q

MOA of isoniazid?

A

Inhibits enzymes that catalyze the synthesis of mycolic acids in the cell wall

206
Q

Spectrum of activity of isoniazid?

A

Mycobacterium tuberculosis & Mycobacterium kansasii ONLY

207
Q

ADR of isoniazid?

A
  1. GI effects
  2. Hepatotox
  3. Peripheral neuropathy
208
Q

Monitoring parameters?

A

Hepativ function (LFTs)

209
Q

CP of isoniazid

A

Administer pyridoxine (B2) to prevent peripheral neuropathy
* Avoid use of alcohol or APA -> hepatotox
* Avoid serotonergic agents -> MAOI activity

210
Q

MOA of pyrazinamide?

A

Inhibits fatty acid synthetase I, which prevents the production of mycolic acids in the cell wall

211
Q

Soectrum of activity for pyrazinamide?

A

Mycobacterium tuberculosis ONLY

212
Q

ADR of pyrazinamide?

A

Hepatotx (dose dependent)
Hyperuricemia

Pyrazinamide is only used in combo

213
Q

Monitoring parameters of pyrazinamide?

A
  1. Hepatic function (LFTs)
  2. Serum urate
214
Q

MOA of ethambutol?

A

Inhibits arabinosyl transferase III, which prevents the production of arabinogalactan, a key component of the mycobacterial cell wall

215
Q

Spectrum of activity of ethambutol?

A

Mycobacterium

216
Q

ADR of ethambutol?

A

Optic neuritis

217
Q

Monitoring parameters of ethambutol?

A

eye exam

218
Q

What is the only med that is not associated with hepatotox?

A

Ethambutol
* first line agent for MAC infections

Therapeutics IV (31 decks)

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