Therapeutics - Infectious disease 1
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. What would you like to do?
What is the MIC?
- Minimum inhibitory concentration
- The amount of drug that will inhibit the growth of an organism
What is the MBC?
- Minimum bactericidal concentration
- Amount of drug that will kill an organism
What are the classes of Beta lactams?
Mechanisms of resistance for organisms is often the same within a ___________.
A high or low MIC indicates that the organism is susceptible to that drug?
Would you use PCN against a staph infection?
Would you use PCN against a strep infection?
Describe the coverage of PCN as was shown on the chart in class:
- Good: Streptococcus, S. pneumoniae
- Poor: H. influenza, Staph, E. faecalis, E. faecium, Peptostreptococcus, anaerobes
- No: gram negative, except H. influenza
What is the general coverage of PCNs (not chart)?
- Streptococcal infections including: Streptococcus pyogenes (Group A), Streptococcus pneumoniae (PCN sensitive), Group B streptococcus
- Trepomena pallidum (syphilis)
- Neisseria meningitidis
- Peptostreptococcus infections (anaerobic infections - above the diaphragm) (MOUTH)
What is the IV preparation for PCN?
What is the Oral preparation or PCN?
How is PCN eliminated?
250 mg of PCN is equivalent to how many units?
400,000 units = 250 mg
What is the T1/2 of PCN in ESRD?
What is the Normal IV dose of PCN?
0.5-4 mU Q4hrs
What is the Normal dose of PCN?
250-500 mg QID
What is the peak level for PCN G?
25-63 ug/mL (2 Mu IV)
What are the peak levels for PCN VK?
5-6 ug/mL (500 mg)
What is the T1/2 of PCN in a patient with uncompromised renal function?
Allergy to PCN is mediated by what antibody?
With long term use of PCNs, what AE can occur?
- Interstitial nephritis
- Drug fever
If you do not adjust the PCN dose for renal insufficiency, what preventable AE do your risk?
What is the most important kinetic/dynamic parameter in evaluating the efficacy of PCN?
Time above MIC
When a patient is on a PCN and develops diarrhea, at what point should you suggest they see their physician?
>4-6 stools/day for >1 week
What is TEN?
- Toxic epidermal necrosis
- A form of anaphylaxis
What coverage (from the charts shown in class) does ampicillin have?
- G+ bugs, some minimal G- coverage
- Group A strep
- S. pneumonia
- E. faecalis
- G-: H. influenza, N. gonorrhea
Do Aminopenicillins cover Staph?
How does Ampicillin’s coverage of E. faecalis compare to PCN G/VK?
4x better than PCN G/VK
What are the dosage forms/route of administration available for aminopenicillins?
- Ampicillin = IV or oral
- Amoxacillin = oral
Which aminopenicillin has better oral availability?
Amoxicillin – better bioavailability (80%) vs. ampicillin (50%)
How are aminopenicillins eliminated?
Which aminopenicillin has a SR formulation?
What are the normal doses for Aminopenicillins?
- Ampicillin: 250-500 Q6h PO, or 50-200 mg/kg IV/day
- Amoxicillin 250-1000 mg TID
What is the half-life for ampicillin?
- 1 hour in normal kidney function
- 7-20 hours in renal insufficiency
What are the peak levels for Aminopenicillins?
- Ampicillin: 120 ug/mL (2 grams IV)
- Amoxicillin: 5.5-7.5 ug/mL (500 mg PO)
What are the aminopenicillins used for (not from the chart)?
- Ampicillin: Streptococci, Enterococci, Listeria meningitis
- Amoxicillin: Anthrax (in pregnancy), Pharyngotonsillitis, H. pylori, Otitis media infection – 1st episode
Ampicillin is the drug of choice for what type of infections?
What are the penicillinase resistant penicillins?
What are the IV penicillinase resistant penicillins?
What would you like to do?
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