Interstitial nephritis is a potential adverse effect for which drug? What kind of reaction is this?
type IV hypersensitivity reaction
What does aztreonam cover?
gram NEGATIVE only
Aztreonam covers pseudomonas aeruginosa?
Aztreonam could have a cross-allergy with beta lactams?
monobactam's structure makes cross allerginicity with b-lactam unlikely.
What does vancomycin cover?
gram POSITIVE only
NO activity against gram negative aerobes
also NONE against anaerobes.
What is a special issue with C.diff and vancomycin?
For C. difficile treatment, you can use ORAL ONLY
Does vancomycin cover enterococcus?
Vancomycin covers MSSA, MRSA and CoNS but which other agent might work faster against them?
1st generation cephalo
How is the vancomycin distribution? How do you dose it?
widely distributed into body tissues and fluids, including adipose tissue
use TBW for dosing
inconsistent peneration into CSF
Should you adjust vancomycin renally?
eliminated via kidneys
When do you use vancomycin?
serious gram positive infections in B-lactam allergic patients
oral vanco for C. diff colitis
What is the target trough for vancomycin?
Red man syndrome is related to the ___ of vancomycin infusion. What is the goal then?
infuse over 60 minutes (at least 15mg/min)
How commons is nephrotoxicity if vancomycin is used alone?
Nephrotoxicity may occur if the dose of vancomycin is over _____.
Nephrotoxicity of vancomycin may be more common in following conditions...
How is linezolid supplied?
PO and IV
What does linezolid cover?
resistant gram positives
MRSA, GISA, VRE
What is the MoA of linezolid?
bind to 50S ribosomal subunit then inhibit protein synthesis
Linezolid is mostly bacteri___ (cidal/static).
cidal against some like strep pneumo, streptococcus
To which bacteria does linezolid present bacteriostatic activity?
Enterococcus faecium AND faecalis
Which abx covers both enterococcus faecium and faecalis?
For which indications can you use linezolid 600mg q12h?
For which indications can you use linezoild 400mg q12h?
What is the bioavailability of linezolid?
Should you adjust linezolid dose in case of renal issues?
also not removed by HD
What are some adverse effects of linezolid?
myelosuppression (blood levels will drop after 2 weeks)
peripheral and optic neuropathy
Linezolid is not approved and should not be used for the treatment of patients with ____ bloodstream infection or ___ related infections.
What is the benefit of tigecycline compared to tetracycline?
avoids the resistance mechanisms seen with tetracycline such as efflux and ribosomal protection mechanisms
Tigecycline is bactericidal or static?
Tigecycline's mechanism of action
binds 30S ribosome so prevent protein synthesis
Does tigecycline cover MRSA?
Does tigecycline cover VRE and GISA?
Does tigecycline cover gram negative?
e.coli, klebsiella, enterbacter, acinetobacter
Does tigecycline cover anaerobes?
Does tigecycline cover pseudomonas?
What are the indications of tigecycline?
What is a regular dosing for tigecycline?
MD: 50mg q12h
Do you have to adjust tigecycline dose for renally impaired?
Do you have to adjust tigecycline dose for hepatically impaired?
LD: 100mg (same)
MD: 25mg q12h (half the dose)
What is child pugh? What are the parameters? How is the grade divided?
classification of severrity of liver disease
ascites, bilirubin, albumin, prothrombin time, encephalopathy
grade A, B, C: C is the worst
What are the most common SEs of tigecycline?
When do these occur?
Are these dose related? gender related? age related?
Why does this happen?
How can you relieve? Also can you relieve by extending the infusion time?
occur within the first 2 days of therapy
yes dose related, more in female, more in younger (18-50yo)
result from an excess release of serotonin
extending the infusion time does not help
tigecycline can be used in pregnant patient. T or F
In macrolides, what are benefits are the newer agents?