Therapeutics - Infectious disease 5

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kyleannkelsey
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283695
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Therapeutics - Infectious disease 5
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2014-09-21 13:32:06
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Therapeutics Infectious disease
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Therapeutics - Infectious disease
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  1. What is the route of administration for all carbepenems?
    All are IV only
  2. Why are Carbapenems problematic for stepdown therapy?
    There are no Oral formulations
  3. Do carbepenems have good MRSA coverage?
    No, >16
  4. Which antibiotics are described as the atom bomb of antibiotics?
    • Carbepenems, because they have such broad spectrum
    • Widest spectrum of all antibiotics
  5. What is the spectrum for Carbepenums?
    Everything on the charts except MRSA, E faecium and fungus
  6. What group of antibiotics has the widest spectrum?
    Carbepenems
  7. Do carbepeneums have cross reactivity with PCNs?
    Yes, 2-10%
  8. What are the major uses for Carbepenums?
    • ESBL (extended spectrum beta lactamase producing organisms)-producing E. coli, K. pneumoniae
    • Intra-abdominal infx
    • Meningitis
  9. What is the dose for Ertepenem?
    1 gram Q24 hours IV
  10. What is the dose for Meropenem?
    500 mg to 1 gram Q8 IV
  11. What is the peak level of Meropenem?
    49 ug/mL (1g)
  12. What is the peak level of ertapenem?
    154 ug/mL (1g)
  13. What is the t1/2 for Meropenem?
    • 1 hour
    • Renal insufficiency: 10 hours
  14. What is the t1/2 for Ertapenem?
    • 4 hour
    • Renal insufficiency: >4 hours
  15. Which Carbapenem does not treat pseudomonas?
    Ertapenem
  16. Which Carbepenems treat pseudomonas?
    Meropenem, Imipenem or Doripenem
  17. What is the advantage to Ertapenem?
    Only carbepenem that is dosed daily
  18. What are the AE of carbepenems?
    • Seizure with unadjusted dose in renal insufficiency
    • Neutropenia/thrombocytopenia/eosinophilia
    • Rash, anaphylaxis, serum sickness
    • C. difficile colitis
  19. Why is Imipenem-cilastatin given together?
    Cilastatin is used to inhibit the renal dihydropeptidase that is responsible for metabolizing imipenem. Other carbapenem – don’t have this problem
  20. What are the aminoglycosides?
    • Gentamicin – Garamycin
    • Tobramycin – Nebcin, Tobi (inhalation)
    • Amikacin – Amikin
    • Streptomycin
  21. What is the inhalation version of tobramycin?
    Tobi
  22. What is streptomycin primarily used for?
    TB
  23. Would you use an aminoglycoside against a G+ bug?
    No
  24. Would you use an aminoglycoside against G – bugs?
    Yes, no G + coverage
  25. What is the spectrum of aminoglycosides?
    • G -:
    • H flu
    • N gon
    • E. coli
    • K. pneumon
    • E. cloacae
    • S. marcescenes
    • P. aureuginosa
  26. What is the route of administration for aminoglycosides?
    Only IV
  27. What type of PK/PD activity do aminoglycosides have?
    Peak conc dependant acviity
  28. What other antibiotics are synergistic with aminoglycosides?
    Beta-lactams
  29. What is toxicity of aminoglycosides dependent on?
    Trough concentration dependent
  30. What are the main uses for Aminoglycosides?
    • Enterococcal endocarditis
    • TB tx – streptomycin, amikacin (usual resistant to other drugs)
    • Option for Gm-negative infections
    • Pseudomonal lung infx – tobi (inhalation)
  31. What route of elimination is used by aminoglycosides?
    Renal
  32. What should you monitor for with aminoglycoside use?
    • Renal (renal elimination) = BUN, SCr
    • Ototoxicity
    • Neuromuscular blockade
    • Potentiating drugs: ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
  33. What are the AEs for Aminoglycosides?
    • Renal failure-leading to dialysis
    • Ototxicity- 8th cranial damage/vestibular damage (irreversible)
    • Neuromuscular blockade – often post-surgery
  34. How do you treat neuromuscular blockade by Aminoglycosides?
    Give calcium IV
  35. What drugs potentiate the SEs of aminoglycosides?
    Ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
  36. What are the macrolides ?
    • Erythromycin – E-mycin
    • Clarithromyin – Biaxin (XL)
    • Azithromycin – Zithromax (ER)
    • Fidaxomicin – Dificid
  37. What are the PO macrolides ?
    • Erythromycin
    • Clarithromyin
    • Azithromycin
    • Fidaxomicin
    • (All)
  38. What are the IV Macrolides (-mycin)?
    • Erythromycin
    • Azithromycin
  39. Are Macrolides (-mycin) bacteriostatic or bactericidal?
    Mostly Bacteriostatic
  40. Do you need to adjust the dose of Macrolides (-mycin)for renal insufficiency?
    No
  41. What is the most important PK/PD factor for Macrolides (-mycin)?
    AUC/MIC
  42. What are macrolides (-mycin) CI in?
    Pregnancy

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