Therapeutics - Infectious disease 6

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kyleannkelsey
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283696
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Therapeutics - Infectious disease 6
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2014-09-21 13:32:16
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Therapeutics Infectious disease
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Therapeutics - Infectious disease
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  1. What is Fidoxamicin (Macrolide) only indicated for and why?
    C. diff, because it is not absorbed through the GI
  2. Describe the spectrum for macrolides (chart):
    • G +: No MRSA (poor staph), poor/Ok strep, no enterococcus, poor peptostreptococcus (8)
    • G - : Poor H. flue (8), good N. gon, Chlamydia, Helicobacter, Legionella, Listeria, M. pneumonia
    • No E. coli!
  3. What are macrolides mainly used for?
    • CAP, MAC, pertussis, chlamydia, gonococcal STDs, UTRIs, Bacterial conjunctivitis
    • (Atypicals)
  4. What is a normal dose of a macrolide?
    • Azithromycin 500mg x 1 then 250mg qd x 4 days
    • Clarithromycin 500 mg BID
    • Erythromycin – 250-500 mg TID-QID
    • Fidoxamicin 200 mg BID x 10 d
  5. What is a normal dose of Azithromycin?
    500mg x 1 then 250mg qd x 4 days
  6. What is a normal dose of Clarithromycin?
    500 mg BID
  7. What is a normal dose of Erythromycin?
    250-500 mg TID-QID
  8. What is a normal dose of Fidoxamicin?
    200 mg BID x 10 d
  9. What are the peak levels of PO macrolides?
    • 0.1-2 (Erythromycin)
    • 3-4 (Clarithromycin)
    • 0.4 (Azithromycin)
  10. What are the peak levels for IV macrolides?
    • 3-4 (Erythromycin)
    • 3.6 (Azithromycin)
  11. What is the T1/2 of macrolides?
    • Erythromycin: 2-4
    • Clarithromycin: 5-7
    • Azithromycin: 68
  12. What should you monitor for with Macrolides?
    • GI
    • QT prolongation
    • Phlebitis/Ototoxicity
    • DDIs
  13. What drugs can cause CYP450 interactions with Macrolides?
    • (Other than Azithromycin)
    • Cyclosporine/Tacrolimus
    • Digoxin
    • Midazolam, Triazolam
    • Phenytoin, carbemazipine, valproic acid
    • Theophylline, Warfarin
    • Ritonavir, Lopinavir, Atazanavir, Darunavir and Ertavirine
  14. Which oral Macrolide can stimulate GI motility?
    Erythromycin
  15. How should you counsel/screen people for aminoglycosides?
    • Counsel: warn about problematic, N/V/D
    • Screen: Look for CYP450 interactions (except with Azithromycin)
  16. What are the Tetracyclines?
    • Tetracycline
    • Doxycycline
    • Minocycline
    • Tigecycline
  17. Which Tetracyclines are PO?
    • Tetracycline
    • Doxycycline
    • Minocycline
  18. Which Tetracyclines are IV?
    Doxycycline, Minocycline and Tigecycline
  19. Describe the spectrum of Doxycycline (chart):
    • G +: Good staph, some MRSA (step down for MRSA cellulitis), Good Group A strep, OK epptostreptococcus (4)
    • G-: good H. flu, N. gon and E. coli
    • Good Atypical coverage: Chlamydia, Legionella, Micoplasma
  20. Can you treat multi drug resistant acinitobacter with a doxycycline?
    Yes
  21. How does Tigecycline differ in its coverage from Doxycycline?
    • Has MRSA coverage
    • Better enterococcus and S. pneumonia coverage
    • Better G- activity
    • Added G – coverage of E. cloacae
  22. What are the peak levels for Doxycycline ?
    1.5-2.1 ug/mL
  23. What is the oral bioavailability for Doxycycline?
    90%
  24. What is the half-life for Doxycycline?
    18 hours
  25. What is the half life of Tigecycline?
    42 hours
  26. What is the peak level of Tigecycline?
    0.6 ug/mL
  27. What are the main uses for Tetracyclines?
    • MRSA step down
    • STDs
    • DOC- Ricketsial illness (Typhus, RMSF, Lyme)
    • MDR acinetobacter (Tugecycline)
    • DOC – anthrax
  28. Tetracyclines are the Drug of choice for what infections?
    • Ricketsial (Tyfus, RMSF and Lyme disease)
    • Anthrax
  29. What is the dosing interval form tetracyclines?
    BID
  30. What is the dose for tetracyclines?
    • Doxycycline 100 IV/po BID
    • Minocycline 100 IV/PO BID
    • Tigecycline 100 LD then 50 IV BID
  31. What is the dose for Doxycycline?
    100 IV/po BID
  32. What is the dose for Minocycline?
    100 IV/PO BID
  33. What is the dose for Tigecycline?
    100 LD then 50 IV BID
  34. What should you counsel a patient on when they receive a Tetracycline?
    • N/V diarrhea (particularly with Tigecycline)
    • Avoid Al, Fe and Mg with PO (all trivalent cations)
    • Phototoxicity
  35. When and why should you avoid tigecycline?
    • MRSA Bacteremia
    • Because its levels are not high enough to be effective enough for this
  36. What is the ending for Flouroquinolones?
    -floxacin
  37. What are the Flouroquinolones?
    • Ciprofloxacin (Cipro)
    • Levofloxacin (Levaquin)
    • Moxifloxacin (Avelox)
    • Gemifloxacin (Factive)
    • Norfloxacin (Noroxin)

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