Naplex 7

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Naplex 7
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2013-08-08 22:24:21
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  1. Gram Positive Organisms
    • Staphylococcus, streptococcus, enterococcus, clostridium, and listeria
    • Gram negative are generally NOT any of the above
  2. Hydrophilic Abx (5)
    • Beta lactams, aminoglycosides, glycopeptides, daptomycin, and colistin
    • 1. Small Vd 2. Renal elimination 3. No intracellular concentrations 4. Increase clearance and/or distribution in sepsis 5. Poor F
    • 1. Poor tissue penetration 2. Nephrotox 3. Not active against atypical (intracellular) bugs 4. Consider loading dose and aggressive dosing in sepsis 5. less than 1:1 with PO and IV therapy
  3. Protein Synthesis Inhibitors
    • Bacteriostatic (except AG and some pathogens for streptogramins)
    • 50S (4) - macrolides, clindamycin, oxalolidiones (linezolid), streptogramins (synercid)
    • 30S (2) - AG, tetracyclines
  4. Cell Membrane Inhibitors
    • Bactericidal
    • Polymixins (colistin)
    • Daptomycin
  5. Cell Wall Inhibitors
    • Bactericidal
    • Penicillins, cephs, carbapenems, vancomycin, monobactams, fosfomycin
  6. DNA/RNA Inhibitors
    • Bactericidal
    • Quinolones (DNA gyrase/topo)
    • Rifampin, metronidazole
  7. Folic Acid Synthesis Inhibitors
    • Static alone, cidal together
    • Bactrim
  8. Lipophilic (6)
    • 1. Large Vd 2. Hepatic metabolism 3. Achieves intracellular concentration 4. Cl and distribution has minimum change in sepsis 5. Excellent F
    • 1. Excellent tissue penetration 2. Hepatotox and DDI 3. Active against atypicals 4. Dose adjustment not needed in sepsis 5. 1:1 with PO and IV therapy
  9. Aminoglycosides (3)
    • Gentamicin, Tobramycin, Amikacin
    • Bind to 30S and 50S ribosomal subunits
    • Conc depen kill and PAE, cidal
    • Mainly active against G-, Ami has broadest activity
    • Dose on IBW unless TBW is less, use AdjBW if TBW greater than 30% of IBW
    • BBW: Neurotoxicity, nephrotoxicity
    • SE: nephrotox and ototox
    • Extended interval dosing is less nephrotoxic and more cost-effective
    • Gent/tobra 1-2.5 mg/kg/dose and ami 5 to 7.5 CrCl greater than 60 every 8 h, CrCl 40 to 60 every 12 H, CrCl 20 to 40 Q24 H
    • Extended interval once daily gent/tobra 4 to 7 mg/kg and ami 15 to 20 mg/kg
    • Gent/tobra peak 5 to 10 and trough less than 2 Ami peak 20 to 30 and trough less than 5
    • Preg Cat D
  10. Penicillins
    • Inhibit bacterial cell wall synthesis - bind to PBP
    • Time Dep, bactericidal except against enterococci where AG are needed for cidal activity
    • Gram + cocci and some G- bacilli, no atyp coverage
    • Allerigc rxn, rash, pruritis, GI, AIN, colitis, agranulocytosis, increase LFTs
    • Preg Cat B
    • Augmentin must be R, Amoxil can be R for taste but is stable for 14 days at room temp
    • Pen VK suspension should be R
    • Ampicillin IV compatible with NS only and stable 8 h at room temp
    • Nafcillin is a vesicant
  11. Moxatag
    Amoxicillin ER tablets
  12. Unasyn
    Ampicillin + sulbactam
  13. Zosyn
    Pip/tazo
  14. Antistaphylococcal Pens
    • Nafcillin, oxacillin, and dicloxacillin
    • Don't have to be renally adjusted
  15. Cephalosporins
    • Inhibit bacterial cell wall synthesis by binding to PBPs
    • Time Dep. killing with cidal activity
    • Activity against staph generally decreases with each generation while activity of strep and G- pathogens increases with each generation
  16. 1st generation cephs (3)
    • Better staph then strep and G- activity, covers PEK (proteus mirabilis, E.Coli, and Kleb)
    • Cefadroxil, Cefazolin, Cephalexin
  17. Kefzol
    Cefazolin
  18. Keflex
    Cephalexin
  19. 2nd generation cephs (5)
    • Better GM- activity compared to 1st but similar GM+ activity, covers HNPEK (haemophilus and neisseris with others)
    • Cefaclor, Cefotetan, Cefoxitin, Cefprozil, and Cefuroxime
    • Cefotetan, cefoxitin, and cefuroxime cover bacteroids fragilis (anerobe)
    • Cefotetan contains NMTT or 1-MTT side chain which cancause bleeding and disulfuram reaction
  20. Ceftin
    Cefuroxime
  21. Zinacef
    Cefuroxime
  22. 3rd generation cephs (8)
    • Better GM- than 2nd including HNPEK and Serratia and additional gram - rods, less staph but more strep, ceftazidime has less gm+ but enhanced Gm- psuedo
    • Cefdinir, cefditoren, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone
  23. Spectracef
    Cefditoren
  24. Suprax
    Cefixime
  25. Claforan
    Cefotaxime
  26. Fortaz and Tazicef
    Ceftazidime
  27. Cedax
    Ceftibuten
  28. Rocephin
    • Ceftriaxone
    • No renal adjustment needed
  29. 4th Generation Cephs
    • Best GM- activity, including HNPEKS, Citrobacter, Acinetobacter, Pseudo, enterobacter, and Serratia (CAPES), GM+ similar to 3rd gen
    • Cefepime
  30. Maxipime
    Cefepime
  31. 5th generation
    • Best GM +, covers MRSA, some GM- similar to ceftriaxone
    • Ceftarolline
  32. Teflaro
    Ceftaroline
  33. Carbapenems (4)
    • Inhibit bacterial cell wall synthesis by binding to PBP
    • Time dependent, bactericidal
    • Broad spectrum Gm+ and - and anaerobes
    • No atypicals, MRSA, VRE, C dif
    • Erta doesn't cover psuedo or acinetobacter
  34. Primaxin
    • Imipenem and Cilastatin - cil prevents degradation by renal tubular dehydropeptidase
    • More seizure risk than others
  35. Merrem
    Meropenem
  36. Invanz
    • Ertapenem
    • No activity against psuedo or acinetobacter
  37. Doribax
    Doripenem
  38. FQs
    • Cidal and conc. dep.
    • Inhibit bacterial DNA top IV and inhibit DNA gyrase
    • GM- and +, atypical coverage (Levo, moxim gemi), enhanced GM- including pseudo (cipro and levo) and enhanced GM+ and anerobe (moxi)
    • Tendon rupture BBW, photosensitivity, more hypoglycemia, arthropathy in children QT prolongation
    • Cipro mixed clearance, levo renal cl, and moxi hepatic cl
  39. Floxin Otic drops
    Ofloxacin
  40. Noroxin
    Norfloxacin
  41. Cipro
    • Ciprofloxacin
    • Cipro oral suspension - don't give via NG other feeding tube as it will adhere to side
    • Cipro IR - can crush, mix with water, and give via NG tube, but hold feedings at least one hour before and 2 hours after
  42. Ciloxan opth, Cetraxal and Ciprodex Otic
    Ciprofloxacin
  43. Levaquin
    Levofloxacin
  44. Zymar and Zymaxid opth
    Gatifloxacin
  45. Avelox
    • Moxifloxacin
    • Doesn't need to be renally adjusted
    • Prolongs QTc interval the most
  46. Vigamox
    Moxifloxacin opth
  47. Factive
    Gemifloxacin
  48. Iquix and Quixin Ophth
    Levofloxacin
  49. Moxeza
    Moxifloxacin Ophthalmic
  50. Macrolides
    • Bind to the 50 S ribosome¬†
    • Bacteriostatic activity related to total exposure of drug AUC/MIC
    • Gm+ strep, some Gm-, good atypical coverage
    • GI upset, liver dysfunction, QT prolongation espeically with eryth and clarith
  51. Zithromax
    • Don't R suspension
    • Better gm- coverage than erythro
  52. Azasite
    Azithromycin opthalmic
  53. Biaxin
    • Clarithromycin
    • Better gm+ coverage
    • Don't R Biaxin oral suspension
    • Biaxin XL take with food
  54. Ery-tab, Erythrocin
    • Erthromycin
    • Must R Erthromycin ethylsuccinate oral granule suspension and use within 10 days
  55. Tetracycline
    • Reversible binding to 30S ribosome
    • Bacteriostatic activity related to total exposure of drug AUC/MIC
    • GM+ activity, GM- including respiratory tract flora, some unique bugs
    • Option for MRSA in mild skin infections and VRE in UTI
    • DRESS, increase in LFTs, lupus-like syndrome
    • Take on empty stomach with lots of water
    • Don't give with retinoic acid derivatives due to risk of pseudotumor cerebri
  56. Vibramycin
    Doxycycline
  57. Doryx
    Doxycycline
  58. Oracea
    • Doxycycline
    • Take on empty stomach
  59. Minocin, Dynacin, Solodyn, Ximino
    Minocycline
  60. Sulfonamides
    • Interferes with baterial folic acid synthesis via inhibition of dihydrofolic acid formation from para-aminobenzoic acid and TMP inhibits dihydrofolic acid reduction to tetrahydroflate resulting in inhibition of enzymes in the folic acid pathway; individually they are 'static but together they are cidal'
    • Always 5:1 ratio
    • No atypical or anerobe coverage, covers GM+ and GM-, some opportunistic organisms
    • GI upset, skin reactions, crystalluria, photosensitivity, false elevations in SCr, and hyperkalemia
    • Preg C/D risk for kernicterus and spina cord defects
    • Bactrim suspension store at Rooom temp
    • Bactrim IV - room temp, 6 hour stability, dilute with D5
  61. Vancocin
    • Vancomycin
    • DOC MRSA infections: 15 to 20 mg/kg Q8 to 12 hours IV
    • blocks glycopeptides polymerization by binding to D-ananyl-D-alanine portion and so inhibits bacterial cell wall synthesis
    • Time depending killing, slow cidal'
    • MRSA, not VRE
    • Nephrotox, ototox, red man syndrome, hyotension, flushing, neutropenia
    • Infuse 500 mg per 30 minutes
    • Trough 15 to 20 for penmonia, endocarditis, osteomyelitis, meningitis, bacteremia
    • Infuse peripheral IV at a concentration not to exceed 5 mg/ml
    • Consider alternative agents when MIC greater than or equal to 2
  62. Zyvox
    • Linezolid - binds to 23S ribosomal unit of 50S subunit (oxazolidinone class)
    • Bacteriostatic
    • Active against most GM+, including MRSA, VRE, faeciu, and faecalis
    • CI MAO inhibitors, uncontrolled HTN, sympathomimetics,¬†
    • SE: myelosuppression duration related, HA, diarrhea, increase in pancreatic enzymes
  63. Synercid
    • Quinupristin and dalfopristin
    • Binds to different sites on 50S ribosome (streptogramin class)
    • static and cidal
    • GM+, MRSA, VRE, faecium but not faecalis
    • SE: hyperbilirubinemia, phlebitis, inflammation, edema and pain at infusion site, arthralgias, and myalgias
    • Must give in volume of 250 ml or greater D5W only to be given peripherally
  64. Cubicin
    • Daptomycin
    • Concentration dependent, bactericidal
    • Cycli lipopeptide class - binds to cell membrane, causing rapid depolarization and inhibiting all intracellular replication processes including protein synthesis
    • Activity against most GM+ MRSA and VRE faecium and faecalis
    • SE: GI, edema, chest pain, eosinophilia pneumonia
    • Do not use to treat pneumonia as it is inactivated by surfactant
    • Compatible with NS
  65. Vibativ
    • Televancin
    • Lipoglycopeptide derivative of vanco
    • BBW: fetal risk
  66. Azactam IV or Cayston
    • Aztreonam
    • Monobactam that inhibits cell wall synthesis by binding to PBPs
    • Gm-, no GM+
    • Rash, N/V/D, increase in LFTs
    • Can be used in pen allergic patients
  67. Chloramphenicol
    • Rarely used due to side effects
    • Binds to 50S
    • Gm+ and -, anaerobes, and atypicals
    • BBW: fatal blood dyscrasias
    • SE: myelosuppression, gray syndrome, CNS
  68. Ketek
    • Telithromycin
    • Ketolide class - binds to 2 sites on the 50S subunit
    • Concentration dependent, cidal activity
  69. Tygacil
    • Tigecycline - derivative of monocycline
    • Binds to 30S ribosome subunit
    • Bacteriostatic
    • GM+ including MRSA, VRE faecium and faefacils, GM-, anaerobes and atypicals
    • No activity against the 3 P's including Pseudomonas, Proteus and Providencia
    • SE: N/V/D, increase LFTs, avoid use in blood stream infections because it doesn't get adequate concentration due to lipophilicity
  70. Cleocin
    • Clindamycin
    • Bacteriostatic
    • Binds to 50S subunit
    • Most aerobic GM+ (not enterococcus) and anaerobic GM- and GM+
    • BBW Can cause fatal colitis
    • SE: NVD, rahs, urticaria, hepatotox, abx associated diarrhea
  71. Flagyl
    • Metronidazole - cidal
    • Causes loss of helival DNA structure and inhibits protein synthesis
    • Anaerobes and protozoal infections
    • DOC for bact vag, trich, giardiasis, amebiasis, and C dif
    • CI in 1st trimester, cat B in rest
    • SE: GI, metallic taste, furry tongue, glossitis, dark urine, rash, disulfiram reaction, peripheral neuropathy
    • Take ER on empty stomach
  72. Tindamax
    • Tinidazole
    • Derivative of metronidazole
  73. Xifaxan
    • Rifaximin - derivative of rifampin
    • For treatment of traveler's diarrhea caused by non-invasive E.Coli
  74. Monurol
    • Fosfomycin
    • Single dose used to treat uncomplicated UTI
  75. Macrobid
    • Nitrofurantoin
    • Bacterial cell wall inhibitor
    • For uncomplicated UTI due to E.Coli, S. aureus, Enterococcus, Kleb, and Enterobacter
    • CI: CrCl less than 60
    • SE: N, HA, hepatotox, peripheral neuropathy, pulmonary tox if used long term
  76. Colistin
    • Colistimethate
    • Covers gram -
    • ATN, neurological disturbances
  77. Dificid
    Fidaxomicin
  78. Oral Agents with activity against CA-MRSA
    • Bactrim
    • Tetracyclines
    • Linezolid
    • Clindamycin
  79. Do Not Refrigerate
    • VFEND
    • ZMAX
    • Biaxin
    • Cleocin
    • Suprax
    • Cipro
    • Vibramycin
    • Bactrim IV
    • Diflucan
    • Levaquin
    • Zyvox
  80. Regrigerate
    • Augmentin
    • Cefprozil
    • Ceftin
    • Keflex
    • Erythromycin/sulfisoxazole
    • Pen VK
    • Vantin
  81. Abx that don't require renal adjustment (22)
    • Azithromycin, Erythromycin
    • Ceftriaxone
    • Clindamycin
    • Chloramphenicol
    • Doxycycline, Minocycline
    • Echinocandins
    • Dicloxacillin, oxacillin, nafcillin
    • Linezolid
    • Metronidazole, Tinidazole
    • Tigecycline
    • Rifaximin
    • Synercid
    • Moxifloxacin
    • Fidaxomicin
    • Ketoconazole, itraconazole, voriconazole (fluconazole is cleared renally)
  82. Agents for VRE faecalis (5)
    • Pen G or ampicillin
    • Linezolid
    • Daptomycin
    • Tigecycline
  83. VRE faecium (4)
    • Daptomycin
    • Linezolid
    • Tigecycline
    • Synercid
    • Pen G and ampicillin typically resistant
  84. Agents with pseudomans coverage
    • Cefepime and ceftazidime
    • Cipro and Levo
    • Imipenem, Meropenem, Doripenem
    • AG
    • Colistin
    • Pip/tazo and tic/clav
    • Aztreonam
  85. Agents for: ESBL producing GNR
    • Carbapenems
    • Cefepime (high doses)
    • Pip/tazo
    • FQs
    • AG
  86. Acinetobacter
    • Carbapenems minus ertapenem
    • Amp/sulb
    • Colistin
    • Minocycline
    • Tigecycline
    • FQs
  87. Bacteroides Fragilis
    • Flagyl
    • Carbapenems
    • Beta lactam/beta lactamase inhibitor combos
    • Tigecycline
    • Cefoxitin
    • Cefotetan
  88. Sun Sensitivity (4)
    • Tetrayclines
    • FQs
    • Bactrim
    • Voriconazole
  89. Rifadin
    • Rifampin - inhibits RNA synthesis by blocking RNA transcription
    • Take 1 hour before or two hours after a meal on an empty stomach
    • SE: flu like syndrome, rash, pruritis, hepatotox, orange red discoloration of body secretions
    • Also increase in uric acid, hyperbilirubinemia, leukopenia, thrombocytopenia and renal failure
    • Potent inducer
  90. Isoniazid
    • Inhibits cell wall synthesis
    • Take one hour before or two hours after a meal on an empty stomach
    • Oral solution at room temp
    • Severe hepatitis, increase in LFTs, peripheral neuropathy (use vitamin B6), lupus like syndrome
    • Major 3A4 and 2C19 inhibitor, increase intake of folic acid, niacin, and magnesium
  91. Pyrazinamide
    • Hepatotox, hyperuricemia (so don't use in people with acute gout)
    • Can cause fatal hepatotox with rifampin
  92. Myambutol
    • Ethambutol
    • Take without regard to meals
    • Optic neuritis, decreases in visual acuity, color blindness
  93. Streptomycin
    • BBW: Neurotoxicity, nephrotxicity, respiratory paralysis
    • SE: nephrotoxicity and ototox
  94. Tx of syphilis
    Pen G benzathin 2.4 million units IM x 1 or weekly x 3 weeks depending on infection duration or unknown duration
  95. Gonorrhea
    • Ceftriaxone 250 mg IM x 1 OR
    • Azithromycin 1 gram PO x 1 preferred for co-infection with chlamydia
  96. Chlamydia
    Azithromaycin 1 g PO x 1
  97. Bacterial Vaginosis
    • Metro 500 mg PO BID x 7 OR
    • Metro 0.75% gel 5 g PV daily x 5 days
  98. Trichomoniasis
    Metro or tinidazole 2 g PO x 1
  99. Amphotericin B
    • Binds to ergosterol altering cell membrane permeability¬†
    • BBW: for lethal fungal infections, dosage less than 1.5 mg/kg/day
    • Hypokalemia, hypomagnesemia, and nephrotox
    • Compatible with D5 only
    • Lipid infusions reduce risk of infusion reactions and nephrotox
    • Infusion related reactions = amphotec greater than ampho B deoxychoate greater than abelcet greater than ambisome
    • Pre medicate for infusion related reactions
  100. Ancobon, 5-FC
    • Flucytosine - converted to fluorouracil which competes with uracil
    • May be used with amphotericin B for certain fungal infections
  101. Azoles
    Decrease ergosterol synthesis and inhibit cell membrane formation
  102. Sporonax
    • Itraconazole
    • BBW: should not be administered to patients with CHF
    • Different formulations can't be used interchangeably
    • Capsule form - requires food and acid for absorption
    • Solution - take on empty stomach
  103. Nizoral, Extina, Xolegel
    • Ketoconazole
    • BBW: hepatotox
    • Generally not used for fungal infections, used for androgen related disorders
    • Ketoconazole and itraconazole have pH dependent absorption
  104. Diflucan
    • Fluconazole
    • Cleared renally
    • Preg Cat C (all others D)
  105. VFEND
    • Voriconazole
    • Take on an empty stomach
    • CI with 3A4 substrates
    • Visual changes, correct electolyte abnormalities prior to tx
    • DOC for aspergillus infections and for drug interactions (and dosing and adverse effects--visual changes)
  106. Noxafil
    Posaconazole
  107. Echinocandins
    • Inhibit synthesis of something-glucan, an essential part of the cell wall
    • DOC for most Candida species including non-albicans strains resistant to azoles
  108. Cancidas
    Caspofungin
  109. Mycamine
    Micafungin
  110. Eraxis
    Anidulafungin
  111. Tamiflu
    • Oseltamivir - neuraminidase inhibitor
    • Start within 48 hours of sx
    • Tx: 75 mg BID x 5 d
    • Prevention: 75 mg daily x 10 d
    • Vomiting, rhinorrhea, dyspepsia, URI, rarely neuropsych events
  112. Relenza
    • Zanamivir
    • Neuraminidase inhibitor
    • Bronchospasm risk - don't use with asthma or COPD
  113. Flumadine
    Rimantidine for Influenza A
  114. Zovirax
    • Acyclovir 200 to 800 mg Q4 to 8 h
    • Malaise, HA, NVD, rash, pruritis, increase LFTs, rarely TTP/HUS
  115. Valtrex
    • Valacyclovir
    • Prodrug of acyclovir that results in higher concentrations than with acyclovir and less frequent dosing
  116. DTaP
    • Diphtheria toxoid, Tetanus Toxoid, and acellular Pertussis containing vaccines
    • DTap series given to children younger than 7
  117. Hib
    • Haemophilus influenzae type-b containing vaccines
    • Given to children
  118. HepA
    • Hep A givvent to children less than 1 as routine vaccination
    • Hep B 3 dose serious given at 0, 1 and 6 months
  119. HPV4
    • Gardasil (HPV2 is Cervarix and only for females)
    • 3 dose series recommended between the age of 11 and 12 years
    • Males to reduce genital warts and anal cancer
  120. LAIV
    • FluMist Intranasal Live
    • 2 to 29 years
  121. TIV
    Intramuscular and intradermal injections
  122. MMR
    • Measles, Mumps and Rubella
    • Live vaccine, not in pregnancy
    • Given to children
  123. MCV4 and MPSV4`
    • Meningococcal
    • MCV IM
    • MPSV SC
  124. PCV13
    • Pneumococcal vaccine Prevnar 13 - routine vaccination for all infants younger than 2 yo
    • Pneumovax for 65 plus
    • PPXV23 min age 2 years
  125. IPV
    • Polio - vaccinate all children
    • Inactivated Poliomyelitis vaccine
  126. RV
    Rotavirus vaccinate all children
  127. Tdap
    Tetanus Toxoid, and diphtheria and pertussis containing vaccines
  128. Varicella containing vaccines
    • Varivax (chickenpox) - at least 2 doses 4 weeks apart
    • Zostavax (shingles

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