Antibiotic Overview

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twinklemuse
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Antibiotic Overview
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2011-02-02 22:56:23
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  1. most common microbial entry site?
    mucosal surfaces
  2. aspergillos is common in ______ patients.
    immunocompromised
  3. Streptococcus is gram ___ cocci and is ___ (aerobic/anearobic).
    • positive
    • aerobic
  4. Enterococcus is gram ___ cocci and is ___ (aerobic/anearobic).
    • positive
    • aerobic
  5. S. aureus is gram ___ cocci and is ___ (aerobic/anearobic).
    • positive
    • aerobic
  6. Staph epidermidis is gram ___ cocci and is ___ (aerobic/anearobic).
    • positive
    • aerobic
  7. Listeria is gram ___ bacilli and is ___ (aerobic/anearobic).
    • positive
    • aerobic
    • * sometimes causes meningitis
    • * often present in patients <2yo, >50yo or pregnant
  8. Corynebacterium is gram ___ bacilli and is ___ (aerobic/anearobic).
    • positive
    • aerobic
  9. Peptococcus and peptostreptococcus are gram ___ cocci and is ___ (aerobic/anearobic).
    • positive
    • anaerobic
  10. Clostridium is gram __ bacilli and is (aerobic/anaerobic).
    • positive
    • anaerobic
  11. Tetani is is gram ___ bacilli and is ___ (aerobic/anearobic).
    • positive
    • anaerobic
  12. Nisseria (meningitis and gonorrhea) is gram ___ cocci and is ___ (aerobic/anearobic).
    • negative
    • aerobic
  13. Moraxella is gram ___ cocci and is ___ (aerobic/anearobic).
    • negative
    • aerobic
  14. Enterobacteraciae family is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • aerobic
  15. What are enterobacteraciae family members?
    SPACE EK

    • Serratia
    • Proteus
    • Acinetobacter
    • Citrobacter
    • Enterobacter
    • E. coli
    • Klebsiella
  16. Pseudomonas is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • aerobic
  17. Haemophilus influenzae is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • aerobic
  18. Is there Gram negative ANAerobe COCCI?
    NONE
  19. Bacteriodes fragilis is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • anaerobic
  20. Melaninogenicus is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • anaerobic
  21. Fusobacterium is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • anaerobic
  22. Prevotella is gram ___ bacilli and is ___ (aerobic/anearobic).
    • negative
    • anaerobic
  23. Legionella is ___ bacteria.
    atypical
  24. Mycoplasma is ___ bacteria.
    atypical
  25. Chlamydia is ___ bacteria.
    atypical
  26. What are two kinds of mycobacteria?
    • Mycobacterium tuberculosis (MTB)
    • Mycobacterium avium intracellulare (MAI) (for HIV patients)
  27. Where do mycobacterium usually travel to, why?
    • lungs
    • due to oxygen
  28. Is virus curable?
    • No
    • we either prevent or get them and self limit.
  29. Where are these bacteria located?
    peptococcus
    eptostreptococcus
    actinomyces
    mouth
  30. Where are these bacteria located?
    S. aureus
    S. pyogenes
    S. epidermis
    pasteurella
    skin and soft tissue
  31. Where are these bacteria located?
    S. aureus
    S. epidermis
    streptococci
    N. gonorrheae
    Gram (-) rods
    bones and joints
  32. Where are these bacteria located?
    E. coli
    proteus
    Klebsiella
    enterococcus
    bacteroides
    abdomen
  33. Where are these bacteria located?
    E. coli
    proteus
    Klebsiella
    enterococcus
    Staph saprophyticus
    Urinary tract
  34. Where are these bacteria located?
    S. pneumoniae
    H. influenza
    M. catarrhalis
    S. pyogenes
    upper respiratory tract
  35. Where are these bacteria located?
    S. pneumoniae
    H. influenza
    K. pneumoniae
    Legionella penumo
    mycoplasma
    chlamydia
    lower respiratory tract
  36. Where are these bacteria located?
    K. pneumo
    P. aeruginosa
    enterobacter spp
    serratia spp
    S. aureus
    lower respiratory tract in hospital
  37. Where are these bacteria located?
    S. pneumo
    N. meningitis
    H. influenzae
    Group B strep
    E. coli
    Listeria
    meningitis
  38. Four advantags of gram stain diagnostic tool
    • 1) rapid diagnosis (meningitis)
    • 2) identify organism difficult to grow (anaerobes)
    • 3) evaluate specimen quality (sputum vs. saliva)
    • 4) identify cell types indicative of infection (WBC)
  39. What diagnostic tool should meningitis use?
    gram stain
  40. What diagnostic tool should mycobacteria use?
    acid fast stain
  41. What diagnostic tool should nocardia (G+, catalase +, bacilli bacteria) use?
    acid fast stain
  42. When do you use DNA probe and acid fast stain?
    to diagnose what type of mycobacterium it is
  43. When do you use PCR and acid fast stain?
    TB only
  44. Acid fast stain has ___ (low/high) sensitivity.
    low
  45. Influenza uses ___, which is an antigen test.
    nasopharyngeal swab
  46. RSV uses ____, which is an antigen test.
    nasopharyngeal swab
  47. Legionella's antigen test should be done using ____.
    urine
  48. Antigen tests are for the bacteria that takes ___ (short/long) time to grow as cultures.
    long
  49. Colonization means there is no infection. T or F?
    True
  50. Normal level of WBC?
    12
  51. Immunocompromised patients favor (cidal or static) agents.
    cidal
  52. Aminoglycosides are ____(concentration or time) dependent antibiotic.
    concentration
  53. Mechanism of aminoglycosides?
    inhibit protein synthesis (irreversibly bind to 30s ribosome)
  54. Aminoglycosides are bacteri___ (cidal or static).
    cidal
  55. Where is aminoglycoside's distribution?
    • primarily in extracellular and body fluids
    • LOVES water
    • some to fat
  56. How is aminoglycoside eliminated?
    renally (because it loves WATER)
  57. Which is the ONLY aminoglycoside that can be used for Gram Positive Aerobe Synergy?
    • gentamicin
    • (NOT tobra or amikacin)
  58. Aminoglycoside must be combined with another agent to treat G(+) aerobe. T or F?
    True (synergy only)
  59. Which bacteria groups can aminoglycoside treat?
    • G(+) aerobe (synergy only - gentamicin)
    • G(-) aerobe
    • Mycobacteria
  60. Can aminoglycoside cover pseudomonas?
    YES!
  61. What is the Aminoglycoside coverage for Pseudomonas?
    ___> ___> ___ (strongest to weakest)
    • amikacin
    • tobramycin
    • gentamycin
  62. Which aminoglycoside do you use to cover mycobacterium tuberculosis? (MTB)
    streptomycin
  63. Which aminoglycoside do you use to cover mycobacterium avium intracellulare? (MAI)
    amikacin
  64. Which aminoglycoside can you use with B-LACTAM for synergy, enterococci, streptococci, MSSA, MRSA and listeria?
    gentamicin
  65. Which amionoglycoside do you use with synergy for Streptococcus viridans and Enterococcus faecalis?
    streptomycin
  66. aminoglycoside adverse effects
    • nephrotoxicity
    • ototoxicity
  67. Is nephorotoxicity of aminoglycoside reversible?
    • yes
    • if caught early
  68. How do you check aminoglycoside nephrotoxicity? (clinical presentation)
    • low urine output
    • increase in BUN and serum Cr
  69. Which are older FQ?
    • norfloxacin
    • ciprofloxacin
  70. How is levofloxacin supplied?
    • PO
    • IV
  71. How is moxifloxacin proided?
    • PO
    • IV
  72. How is ciprofloxacin provided?
    • PO
    • IV
  73. How is gemifloxacin provided?
    PO
  74. What are the dual mechanism of FQ?
    • DNA gyrase: removes excess positive supercoiling in the DNA helix
    • Topoisomerase IV: essential for separation of interlinked daughter DNA molecules
  75. What kind of bacteria does the DNA gyrase mechanism of FQ target?
    gram negative
  76. What kind of bacteria does topoisomerase IV inhibition mechanism of FQ target?
    gram positive
  77. FQ is bacteri___ (cidal or static).
    cidal
  78. Does FQ have a good oral bioavailability?
    Yes
  79. Where is FQ distributed?
    • extensive tissue distribution: prostate, liver, lung, skin/soft tissue, bone, urinary tract
    • prostate and bone are important
    • some CSF penetration
  80. How is ciprofloxacin eliminated?
    1) renal 2) hepatic 3) both
    both
  81. How is levofloxacin eliminated?
    1) renal 2) hepatic 3) both
    • renal
    • "le"vo and "re"nal
  82. How is moxifloxacin eliminated?
    Why is this important?
    1) renal 2) hepatic 3) both
    • hepatic
    • thus moxifloxacin is NOT for prostatitis and UTI
  83. Which of these can you NOT use for prostatis and UTI?
    1) cipro 2) levo 3) moxi
    Why?
    • moxifloxacin
    • because it is hepatically eliminated only
  84. Which FQ is used for gram POSITIVE bugs?
    1) older 2) newer 3) both
    • newer agents: levo, moxi, gemi
    • MSSA, strep pneumo including PRSP
    • also CA MRSA
  85. Which FQ is used for gram NEGATIVE bugs?
    1) older 2) newer 3) both
    • ALL have excellent activity
    • enterobactericiae
    • H influ, M catarrhalis, Neisseria
    • Pseudo aeruginosa
  86. Which FQ can you NOT use for pseudomonas aeruginosa?
    1) cipro 2) levo 3) moxi 4) gemi
    • moxifloxacin
    • cipro and levo have FDA approved indications
  87. Which 2 FQs can you use for pseudomonas aeruginosa?
    • ciprofloxacin
    • levofloxacin
  88. FQs do not cover oral anaerobes. T or F
    • F
    • they do cover
  89. Mycobacterium tuberculosis is covered by FQ. T or F
    True
  90. FQ causes QT prolongation. T or F
    • True.
    • could lead to torsades
    • check CV function, see if the patient is on other drugs that may cause QT prolongation as well.
  91. You do not need to monitor LFT with FQ. T or F
    • false
    • LFT can be elevated due to potential hepatoxity AE.
  92. Phototoxicity caused by FQ is more common with ___ (older/newer) FQ agents.
    • older FQ: norfloxacin and cipro
    • due to halogen at position 8
  93. BBW of FQ?
    • articular damage: arthropathy including articular cartilage damage, arthralgia, joint swelling
    • tendon rupture
  94. Can FQ cause dysglycemia?
    • Yes
    • dysglycemia is hypo and hyperglycemia
  95. FQ is associated with clostridium dificile. T or F
    True
  96. All FQ have drug interaction with ____ and ____ . What's the problem?
    • divalent and trivalent cations: zinc, iron, calcium, aluminum, mangesium, antacid, sucralfate, some enteral feeding
    • impairs oral absorption
    • warfarin: idiosyncratic
  97. Divalent and trivalent should be avoided with ciprofloxacin __ hours prior and __ hours after.
    • 2 hours prior
    • 6 hours after
  98. Divalent and trivalent should be avoided with moxifloxacin __ hours prior and __ hours after.
    • 4 hours prior
    • 8 hours after
  99. Divalent and trivalent should be avoided with levofloxacin __ hours prior and __ hours after.
    • 2 hours prior
    • 2 hours after
  100. Theophylline and cyclosporin should be avoided with which FQ?
    • ciprofloxacin
    • inhibition of metabolism thus increases level then increases toxicity.
  101. What are examples of lipopeptide?
    • daptomycin
    • televancin
  102. what is the mechanism of action of lipopetide?
    • rapid depolarization of membrane potential
    • doesnt rupture the cell wall so it may lessen the immune response from sudden release of exotoxin proteins
  103. Lipopeptides have ____ (cidal/static) activity.
    cidal
  104. What bacteria does daptomycin cover?
    • gram positive:
    • staph (MSSA, MRSA)
    • enterococcus faecalis (VRE faecium and faecalis - not FDA approved but data available)
    • strep (PRSP)
  105. What is the drug of choice for enterococcus? Alternatives?
    • Drug of choice: ampicillin
    • vancomycin
    • daptomycin
  106. Daptomycin has a great coverage for gram negative bugs. T or F
    • FALSE
    • intrinsically inactive!
  107. What three condition/disease does daptomycin cover?
    • cSSTI (complicated skin and soft tissue infection)
    • bacteremia
    • right sided endocarditis
  108. What is the daptomycin dose used for SSTI?
    4mg/kg/d
  109. What is the daptomycin dose for endocarditis?
    • 6mg/kd/d
    • higher dose than cSSTI
  110. What is the daptomycin dose for bacteremia?
    • 6mg/kg/d
    • higher dose than cSSTI
    • same dose as endocarditis
  111. Daptomycin is not excreted via kidney T or F?
    • False
    • excreted via kidney
  112. Should you dose adjust for daptomycin in case of CrCl<30, HD, CAPD?
    • Yes
    • q48
  113. Daptomycin is dosed by ___ body weight. (actual/ ideal)
    actual body weight
  114. Daptomycin is effective against pneumonia. T or F
    • FALSE
    • NOT efficacious for treatment of pneumonia
    • because daptomycin is inhibited by lung surfactant
  115. Daptomycin interacts with commercially available _________ used in determining PT and INR. How does this affect PT and INR? So what should you do?
    • thromboplastin reagents
    • Interaction leads to an erroneous prolongation of PT or elevated INR.
    • so measure PT/INR before daptomycin dose (or daptomycin trough concentration)
  116. Adverse effects of daptomycin
    • myopathy: skeletal muscle tissue (monitor CPK's weekly)
    • d/c S&S off myopathy and CPK 5x ULN or CPK 10x ULN
    • consider suspending HMG-Co reductase inhibitor
    • headache
    • GI issue
    • phlebitis
    • Divalent and trivalent should be avoided with
    • ciprofloxacin __ hours prior and __ hours after.
  117. Mechanism of televancin?
    • inhibit bacterial cell wall synthesis
    • inhibit cell membrane permeability
  118. Telvancin has activity against _____.
    • staphylococcus
    • streptococcus
    • enterococcus
    • corynebacterium spp
  119. Televancin dose for SSTI? How long do you administer for?
    • 10mg/kg/d
    • administer over 60 min
  120. What are side effects of televancin?
    • taste disturbance
    • foamy urine
    • nephrotoxicity
    • QTc prolongation
    • N/V
    • coagulation test interference
  121. Can you televancin for pregnant patients?
    • NOPE
    • avoid in pregnant patients
  122. Penicillinase resistant penicillin has a great coverage for _____.
    Example of penicillinase resistant penicillin
    • G+ bacteria
    • nafcillin
    • so a great tip to memorize is naf for staph
  123. What is an example of carboxypenicillin drug?
    ticarcillin (Timentin)
  124. What is an example of ureidopenicillin drug?
    piperacillin (Zosyn)
  125. How is benzathine penicillin different from Pen G and Pen VK? When is it used?
    • it is longer acting
    • used for syphilis patients
  126. What is the primary coverage of natural penicillins? (pen G, pen VK, benzathine penicillin)
    Gram positive: staph, strep, enterococcus
  127. Why was penicillinase resistant penicillin developed?
    developed to overcome the penicillinase enzyme of S. aureus which inactivated natural penicillin
  128. What do penicillinase resistant penicillin cover?
    Gram positive: MSSA, streptococci
  129. Penicillinase resistant penicillin can be used to treat MRSA. T or F
    False
  130. Why was aminopenicillin developed?
    developed to increase activity against gram negative aerboes
  131. What bacteria do aminopenicillins cover?
    • Gram positive: MSSA, streptococci, entercoccus sp, listeria monocytogenes
    • Gram negative: proteus mirabilis, salmonella, shigella, E.coli, H. influ
  132. Why was carboxypenicillin developed?
    developed to further increase activity against resistant gram negative aerobes
  133. What bacteria do carboxypenicillin cover?
    • ticarcillin
    • gram positive: marginal
    • gram negative: proteus mirabilis, salmonella, shigella, e.coli, h.influ, enterbacter sp, pseudomonas aeruginosa
  134. Can carboxypenicillin treat pseudomonas aeruginosa?
    Yes
  135. Why was ureidopenicillin developed?
    developed to further increase activity against resistant gram negative aerobes.
  136. What do ureidopenicillin cover?
    • piperacillin
    • gram positive: strep, MSSA, enterococcus
    • gram negative: proteus mirabilis, salmonella, shigella, e.coli, h.influ, enterbacter, pseudomonas aeruginosa, serratia marcescens, klebsiella
    • anaerobes: fairly good activity
  137. Can ticarcillin and piperacillin cover MRSA?
    No
  138. Can piperacillin and ticarcillin cover pseudomonas aeruginosa?
    Yes
  139. Do b-lactamase inhibitor contribute to antibacterial activity? What are some examples? What kind of substrate do they act as?
    • they have weak antibacterial activity
    • clavulanic acid, sulbactam, tazobactam
    • suicide substrate
  140. Unasyn is ampicillin and ____.
    sulbactam
  141. Timentin is ticarcillin and ____.
    clavulanic acid
  142. Zosyn is piperacilin and ____.
    tazobactam
  143. Which cephalosporin generation has the best activity vs. gram + aerobes? What are the examples?
    • first generation
    • cefazolin, cephalexin, cephalothin, cefaclor, cefadroxil
  144. First generation cephalosporins have ___ (great, mediocre, limited) activity vs. gram negative aerobes.
    limited
  145. First generation cephalo covers pseudomonas. T or F
    F
  146. First generation cephalo covers MRSA. T or F
    F
  147. Cefazolin.
    Which cephalosporin generation?
    How supplied?
    • 1st generation
    • IV
  148. Cephalothin
    Which cephalosporin generation?
    1st generation
  149. Cefaclor
    Which cephalosporin generation?
    How supplied?
    • 1st
    • PO
  150. Cephalexin
    Which cephalosporin generation?
    How supplied?
    • 1st generation
    • PO
  151. Cefadroxil
    Which cephalosporin generation?
    How supplied?
    • 1st generation
    • PO
  152. First generation cephalo covers H. Influenza. T or F
    • F
    • second generation covers this
  153. First generation cephalo does not cover M. catarrahlis. T or F
    • T
    • second generation covers this
  154. Nesseria can be treated with first generation cephalo. T or F
    • F
    • covered by second generation
  155. What are cephamycins? What is so special about them?
    • cefoxitin, cefotetan, cefmetazole
    • the only 2nd generation cephalo that cover anaerobes. (bacteroides fragilis group)
  156. Cefuroxime covers bacteroides fragilis. T or F
    • F
    • only cephamycins cover them.
  157. Cefoxitin covers bacteroides fragilis. T or F
    • T
    • this is a cephamycin.
  158. Cefotetan covers bacteroides fragilis. T or F
    • T
    • this is a cephamycin
  159. Cefmetazole covers bacteroides fragilis. T or F
    • T
    • this is a cephamycin
  160. Cefprozil covers bacteroides fragilis. T or F
    • F
    • this is not a cephamycin.
  161. Cefuroxime
    Which cephalosporin generation?
    How supplied?
    • 2nd
    • IV and PO
  162. Cefotetan
    Which cephalosporin generation?
    • 2nd
    • also cephamycin
  163. Cefoxitin
    Which cephalosporin generation?
    • 2nd
    • also cephamycin
  164. Cefmetazole
    Which cephalosporin generation?
    • 2nd
    • also cephamycin
  165. Cefprozil
    Which cephalosporin generation?
    How supplied?
    • 2nd
    • PO
  166. Loracarbef
    Which cephalosporin generation?
    How supplied?
    • 2nd
    • PO
  167. 3rd generation cephalo has ____ (more/less) activity against gram positive aerobes and has ___ (more/less) activity against gram negative aerobes.
    • LESS for positive
    • MORE for negative
  168. Unlike the other 3rd generation cephalo, ____ and ____ have good activity against gram positive aerobes, such as S. pneumoniae.
    • ceftriaxone
    • cefotaxime
  169. Cefdinir is a good choice for S. pneumoniae?
    • No
    • 3rd generation cephalo generally do not have a good activity vs. gram positive aerobes, except ceftriaxone and cefotaxime
  170. Cefotaxime is a good choice for S. pneumoniae?
    • Yes
    • one of 2 exceptions for 3rd generation cephalo
  171. Cefpodoxime is a good choice for S. pneumoniae?
    • No
    • not one of 2 exceptions for 3rd generation cephalo that cover gram positive.
    • ceftriaxome and cefotaxime
  172. Several 3rd generation cephalo are strong inducers of _____.
    extended spectrum beta lactamase
  173. 3rd generation cephalo covers enterobacter spp?
    Yes
  174. 2nd generation cephalo covers enterobacter spp?
    Nope
  175. Which 2 cephalosporins cover pseudomonas aeruginosa?
    • ceftazidime (3rd generation)
    • cefepime (4th generation)
  176. Ceftriaxone
    Which cephalosporin generation?
    3rd
  177. Ceftazidime
    Which cephalosporin generation?
    3rd
  178. Cefotaxime
    Which cephalosporin generation?
    3rd
  179. Cefixime
    Which cephalosporin generation?
    How supplied?
    • 3rd
    • PO
  180. Cefpodoxime
    Which cephalosporin generation?
    how supplied?
    • 3rd
    • po
  181. Cefdinir
    Which cephalosporin generation?
    how supplied?
    3rd
  182. 4th generation cephalo covers gram positive?
    Yes~
  183. 4th generation cephalo covers gram negative? How about pseudomonas aeruginosa?
    • yes~
    • yes as well~
  184. As opposed to the 3rd generation cephalo, 4th generation is a ___ (strong/poor) inducer of extended spectrum beta lactamases
    • poor inducer
    • 4th generation has stability against b-lactamases
  185. Which abx class has the most broad spectrum of activity?
    • carbapenems
    • activity vs. gram positive and negative and aerobes and anaerobes
  186. Generic name for Primaxin?
    imipenem/cilastatin
  187. Which carbapenem would you use for enterococcus, gram positive?
    imipenem
  188. Which carbapenem would you use for acinetobacter?
    imipenem
  189. Which carbapenem would you use for pseudomonas aeruginosa?
    • meropenem
    • more active vs. gram negative
  190. Which carbapenem can you NOT use for enterococcus?
    ertapenem
  191. Which carbapenem can you NOT use for pseudomonas?
    ertapenem
  192. Which carbapenem can you NOT use for acinetobacter?
    ertapenem
  193. Which carbapenem has more activity vs. gram positive?
    imipenem
  194. Which carbapenem has more activity vs. gram negative?
    meropenem
  195. Generic name for Invanz?
    ertapenem
  196. Doripenem seems to act similar to imipenem and meropenem. T or F
    T
  197. What is the benefit of ertapenem in terms of t/2?
    • it has a longer half life so daily dosing is possible
    • but INvanz is INcomplete coverage!
  198. Why is imipenem combined with cilastatin?
    prevent hydrolysis by enzymes in the renal brush border by inhibiting dihydropeptidase 1
  199. What effect does cilastatin have on half life of imipenem?
    prolongs t/2
  200. Does cilastatin add antibacterial effect on imipenem?
    No
  201. Does cilastatin help in maintaining therapeutic urinary concentration?
    Yes maam
  202. Cilastatin prevents ____ effects of imipenem and metabolites.
    nephrotoxic
  203. If beta lactam is given for more than 2 weeks, what adverse effect could happen?
    hematologic: leukopenia, neutropenia, thrombocytopenia
  204. Is there cross reactivity amongst beta lactams?
    • Yes
    • all penicillins and even other b-lactams
  205. Interstitial nephritis is a potential adverse effect for which drug? What kind of reaction is this?
    • nafcillin
    • type IV hypersensitivity reaction
  206. What does aztreonam cover?
    gram NEGATIVE only
  207. Aztreonam covers pseudomonas aeruginosa?
    YES.
  208. Aztreonam could have a cross-allergy with beta lactams?
    • No
    • monobactam's structure makes cross allerginicity with b-lactam unlikely.
  209. What does vancomycin cover?
    • gram POSITIVE only
    • NO activity against gram negative aerobes
    • also NONE against anaerobes.
  210. What is a special issue with C.diff and vancomycin?
    For C. difficile treatment, you can use ORAL ONLY
  211. Does vancomycin cover enterococcus?
    Yes
  212. Vancomycin covers MSSA, MRSA and CoNS but which other agent might work faster against them?
    • Ancef (cefazolin)
    • 1st generation cephalo
  213. 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
  214. Should you adjust vancomycin renally?
    • Yes
    • eliminated via kidneys
  215. When do you use vancomycin?
    • MRSA
    • serious gram positive infections in B-lactam allergic patients
    • surgical ppx
    • MDR
    • oral vanco for C. diff colitis
  216. What is the target trough for vancomycin?
    15-20mg/L
  217. Red man syndrome is related to the ___ of vancomycin infusion. What is the goal then?
    • RATE
    • infuse over 60 minutes (at least 15mg/min)
  218. How commons is nephrotoxicity if vancomycin is used alone?
    rare
  219. Nephrotoxicity may occur if the dose of vancomycin is over _____.
    4 g/day
  220. Nephrotoxicity of vancomycin may be more common in following conditions...
    • dose >4g/day
    • weight >101.4kg
    • ClCr <86.6ml/min
    • ICU stay
  221. How is linezolid supplied?
    PO and IV
  222. What does linezolid cover?
    • resistant gram positives
    • MRSA, GISA, VRE
  223. What is the MoA of linezolid?
    bind to 50S ribosomal subunit then inhibit protein synthesis
  224. Linezolid is mostly bacteri___ (cidal/static).
    • static
    • cidal against some like strep pneumo, streptococcus
  225. To which bacteria does linezolid present bacteriostatic activity?
    • Enterococcus faecium AND faecalis
    • including VRE
  226. Which abx covers both enterococcus faecium and faecalis?
    linezolid
  227. For which indications can you use linezolid 600mg q12h?
    • VRE
    • HAP, CAP
    • cSSTI
  228. For which indications can you use linezoild 400mg q12h?
    uSSTI
  229. What is the bioavailability of linezolid?
    100%!
  230. Should you adjust linezolid dose in case of renal issues?
    • Nope
    • also not removed by HD
  231. What are some adverse effects of linezolid?
    • myelosuppression (blood levels will drop after 2 weeks)
    • peripheral and optic neuropathy
    • lactic acidosis
    • serotonin syndrome
  232. Linezolid is not approved and should not be used for the treatment of patients with ____ bloodstream infection or ___ related infections.
    • cather related
    • cather site
  233. What is the benefit of tigecycline compared to tetracycline?
    avoids the resistance mechanisms seen with tetracycline such as efflux and ribosomal protection mechanisms
  234. Tigecycline is bactericidal or static?
    bacteriostatic
  235. Tigecycline's mechanism of action
    binds 30S ribosome so prevent protein synthesis
  236. Does tigecycline cover MRSA?
    Yes
  237. Does tigecycline cover VRE and GISA?
    Yes
  238. Does tigecycline cover gram negative?
    • Yes
    • e.coli, klebsiella, enterbacter, acinetobacter
  239. Does tigecycline cover anaerobes?
    • Yes
    • bacteroides
  240. Does tigecycline cover pseudomonas?
    NOPE
  241. What are the indications of tigecycline?
    • cSSTI
    • cIA
    • CAP
  242. What is a regular dosing for tigecycline?
    • LD: 100mg
    • MD: 50mg q12h
  243. Do you have to adjust tigecycline dose for renally impaired?
    Nope
  244. Do you have to adjust tigecycline dose for hepatically impaired?
    • Yes
    • LD: 100mg (same)
    • MD: 25mg q12h (half the dose)
  245. 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
  246. 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?
    • nausea, vomiting
    • 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
    • ondansetron helps
    • extending the infusion time does not help
  247. tigecycline can be used in pregnant patient. T or F
    • Nope
    • category D
  248. In macrolides, what are benefits are the newer agents?
    • improved PK: better bioavailability, better tissue penetration, prolonged t/2
    • broader spectrum of activity: H.influ, M. catarr, neisseria
    • improved tolerability
  249. Macrolides cover MRSA?
    No
  250. Macrolides cover streptococcus pneumoniae?
    yes
  251. Do macrolides cover anaerobes?
    • Yes
    • activity against upper airway anaerobes
  252. Do macrolides cover atypical bacteria?
    • Yes: excellent activity
    • legionella penumophila, chlamydia, mycoplasma, ureaplasma
  253. Do macrolides cover pseudomonas?
    No
  254. What is the drug of choice for legionella pneumophila?
    macrolides!
  255. Do macrolides cover MAI?
    yes
  256. Do macrolides cover treponema pallidum?
    Yes
  257. How much azithromycin do you give for HIV patients with CD4 <50? Why?
    • 1200mg weekly
    • prophylaxis for disseminated MAC
  258. How is the distribution of macrolides?
    • extensive tissue and cellular
    • minimal CSF
  259. Can macrolides be dialyzed?
    Nope
  260. What is the elimination of clarithromycin?
    • partially eliminated by kidney
    • so must adjust dose when CrCl <30ml/min
  261. How are all macrolides eliminated?
    hepatically
  262. What SE can happen if you use macrolides for a long time? When would such a time be?
    • hearing loss
    • such as TB which takes at least 6 months of therapy
  263. Can macrolides elevate LFT?
    yes
  264. Which macrolide inhibits CYP enzyme? which enzymes? how does this compare to other macrolides?
    • erythromycin
    • CYP 3A4 and 1A2
    • clarithromycin silghtly less extent
    • azithromycin few clinically significant DI
  265. Which has activity against resistant strains?
    telithromycin vs. macrolides?
    telithromycin
  266. MoA of telithromycin?
    same as macrolides (inhibit protein synthesis) but activity against resistant strains
  267. Generic name for Ketek?
    telithromycin
  268. What is telithromycin FDA-indicated for?
    CAP
  269. Telithromycin has many drug interactions. why?
    strong 3A4 inhibitor
  270. What are side effects of telithromycin?
    • hepatotoxicity
    • QTC prolongation
    • visual disturbance

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