PHARM_MOD_II_DOC_BAC

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soren101
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97068
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PHARM_MOD_II_DOC_BAC
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2011-09-01 22:28:56
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PHARMACOLOGY MSII DOC BACTERIAL
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PHARMACOLOGY MOD_II DOC BACTERIAL
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  1. CAP (OUT-Pt)
    P.O. MACROLIDE

    (AZITHROMYCIN OR CLARITHROMYCIN)
  2. CAP OUTPATIENT WITH STRUCTURAL LUNG DISEASE (COPD, ASTHMA)
    P.O. "RESPIRATORY" FQ = LEVOFLOXACIN

    OR

    • MOXIFLOXACIN
    • (A "RESPIRATORY" FQ IS A FQ GOOD ACTIVITY AGAINST STREP PNEUMO)
  3. PNEUMONIA (INPATIENT)
    (CAP THAT DOES NOT RESPOND TO
    OUTPATIENT TX WITH CLARI, OR CAP IN AN UNTREATED PATIENT ADMITTED TO THE HOSPITAL)
    I.V. CEFTRIAXONE or I.V. CEFOTAXIME

    PLUS

    I.V. OR P.O AZITHROMYCIN

    OR

    I.V. MOXIFLOXACIN OR LEVOFLOXACIN
  4. INPATIENT PNEUMONIA IN A PATIENT
    WITH PCN ALLERGY
    I.V. MOXIFLOXACIN OR LEVOFLOXACIN
  5. HOSPITAL-ACQUIRED (NOSOCOMIAL)
    PNEUMONIA
    I.V. PIPERACILLIN - TAZOBACTAM,

    OR

    I.V. CEFEPIME
  6. STREP PNEUMO
    I.V. PEN G
  7. SEND HOME ON P.O. AMOXICILLIN
  8. ONLY 2 CEPHAMYCINS WHICH COVER ANAEROBES
    2ND GEN CEFOXITIN AND CEFOTETAN

    Tx PID AND INTRA-ABD INF

    DOC FOR INTRA-ABD SURGERY
  9. PEN G RESISTANT STREP PNEUMO
    (LOW LEVEL OF PCN RESISTANCE)
    I.V. CEFOTAXIME

    OR

    I.V. CEFTRIAXONE
  10. MDR STREP PNEUMO
    (INCLUDING HIGH-LEVEL PCN-RESISTANT)
    I.V. VANCOMYCIN,

    OR

    I.V. MOXIFLOXACIN

    OR

    HIGH-DOSE I.V. LEVOFLOXACIN
  11. CHARACTERISTICS OF TETRACYLINES
    INH PROT SYNTH - 30S; STATIC

    MOD G+, POOR G-

    • G+
    • --65% STAPH AUR INCLUD MRSA
    • --STREP, BUT NOT GrpB, SO COMBO AMOX OR CEPHALEXIN FOR SSTI

    • EXCEL INTRACELLULAR
    • --MYCOPLASMA
    • --CHALMYDIA
    • --RICKETTSIA
    • --ATYP PNEUMO ie legionella

    • OTHERS
    • --BORRELIA
    • --YERSNIA
    • --ENTAMOEBA HISTO
    • --PLASMOD FALC (MALARIA)

    ACNE Tx -- MINO

    BUG RESISTANCE THROUGH CHANGED BINDING SITE OR EFFLUX PUMP

    • WIDESPREAD USE IN LIVESTOCK INC R
    • -----------------------------------------------------

    • KINETICS
    • --BOTH IV AND PO (NO PO TIGE
    • --DO NOT GIVE w MILK, MULTI-VIT, Ca, Mg, Al, Fe, bc CHELATE & PREVENT ABS
    • --F OF DOXY & MINO 100%, LONG t1/2
    • --HIGH CONC IN BILE (CHECK LFTs)
    • --MINO --> PARTLY MET IN LIVER
    • --DOXY ELIM FECALLY, SO DOC FOR RENAL DYSF
    • ---------------------------------------

    • TOX
    • --N/V esp TIGECYCLINE
    • --REDUCED w FOOD BUT CATIONS AFFECT ABS
    • --TEETH DISCOLORATION AND BONE FORMATION. DONT GIVE PREGOs OR <15yrs
    • --PHOTOSENSITIVITY
    • --LARGE DOSE HEPATOTOXIC
    • --SUPERINFECTIONS ie C.DIFF
  12. MDR STREP PNEUMO INCLUDES ISOLATES PREVIOUSLY KNOWN AS ___, AND ARE STRAINS RESISTANT TO TWO OR MORE OF WHAT ANTIBIOTICS?
    • --PRSP (PENICILLIN-RESISTANT
    • STREPTOCOCCUS PNEUMONIAE)

    --PENICILLIN, 2ND GENERATION CEPHALOSPORINS, E.G., CEFUROXIME, MACROLIDES, TETRACYCLINES AND TRIMETHOPRIM/SULFAMETHOXAZOLE.
  13. LEGIONELLA PNEUMONIA
    I.V. AZITHROMYCIN,

    OR

    I.V. LEVOFLOXACIN OR MOXIFLOXACIN
  14. PCP PNEUMONIA
    • TRIMETHOPRIM-SULFAMETHOXAZOLE
    • (LARGER THAN NORMAL DOSES)
  15. ASPIRATION PNEUMONIA
    I.V. OR P.O. CLINDAMYCIN
  16. OUTPATIENT URI IN PATIENT WITH PCN ALLERGY
    • P.O. MACROLIDE
    • (CLARITHROMYCIN, OR AZITHROMYCIN)
  17. BETA-HEMOLYTIC STREP IN PATIENT WITH PCN ALLERGY
    P.O. CLINDAMYCIN (TEXTBOOKS)
  18. P.O. FQ = LEVO OR MOXI (REAL WORLD)
  19. PROPHYLAXIS FOR BETA-HEMOLYTIC STREP
    I.M. PROCAINE PEN G,

    OR

    I.M. BENZATHINE PEN G

    DO NOT GIVE I.V.!!!
  20. INFECTED DIABETIC FOOT ULCER
    I.V. PIPERACILLIN-TAZOBACTAM
  21. PRIMARY/SECONDARY SYPHILIS
    I.M. BENZATHINE PENICILLIN
  22. NEUROSYPHILIS
    I.V. PENICILLIN G
  23. GONORRHEA
    SINGLE DOSE P.O. CEFIXIME,

    OR

    I.M. CEFTRIAXONE

    (IN THE ER, ABOUT 50% OFPATIENTS WILL RECEIVE P.O. CEFIXIME AND 50% WILL RECEIVE I.M. CEFTRIAXONE - IT HURTS!)
  24. CHARACTERISTICS OF VANCOMYCIN
    COVERS G+ INCLUDING ANAEROBES

    NO G-

    DOC FOR SEVERE MRSA, AMP-R ENTERO

    LARGE MOL --> NOT ABSORBED BY GUT. GIVE IV

    RENAL EXCRETION / TOXICITY PROB OVERESTIMATED

    OTOTOXICITY

    RED-MAN SYND --> NOT ALLERGY, FROM GIVING TOO RAPIDLY --> HIST RELEASE

    po VANC FOR C.DIFF ONLY IF METRONIDAZOLE-R
  25. COMMUNITY-ACQUIRED MENINGITIS (EMPIRIC THERAPY WHEN THEBUG IS UNKNOWN). IF PATIENT IS ONE MONTH - 50 Y.O.? IF PATIENT < ONE MONTH OR > 50 Y.O.?
    • 1 MONTH TO 50 yr:
    • I.V. CEFTRIAXONE OR I.V. CEFOTAXIME

    PLUS

    I.V. VANCOMYCIN

    • <1 MONTH OR > 50 yr
    • ADD I.V. AMPICILLIN TO COVER LISTERIA

    P.O. AMPICILLIN CAUSES DIARRHEA!!!
  26. BACTERIAL MENINGITIS WHERE THE BUG HAS BEEN IDENTIFIED (H. FLU, STREP PNEUMO OR NEISSERIA SPP. IDENTIFIED BY CULTURE)
    I.V. CEFOTAXIME,

    OR

    I.V. CEFTRIAXONE
  27. FEBRILE NEUTROPENIA
    (EMPIRIC THERAPY)
    I.V. PIPERACILLIN-TAZO OR I.V. CEFEPIME
  28. PLUS
  29. I.V. VANCOMYCIN TO COVER GRAM (+) BUGS
  30. CELLULITIS (MSSA) INPATIENT
    • I.V. OXACILLIN OR I.V. NAFCILLIN
    • (TEXTBOOK = $$$)
  31. I.V. CEFAZOLIN
    (REAL WORLD = CHEAP)
  32. OXACILLIN vs. VANCOMYCIN
    OXACILLIN, NAFCILLIN, CLOXACILLIN, AND DICLOXACILLIN ARE ALWAYS SUPERIOR TO VANC

    THEY KILL QUICKLY
  33. 1st GEN CEPHALOSPORINS
    • 1) iv CEFAZOLIN
    • --DOC FOR srg PROPHYL, SSTI, AND MSSA (mssa better than vanc ~ cefazolin oxacillin nafcillin)

    • 2) po CEPHALEXIN
    • --SSTI, SAFE FOR PREG

    • 3) po CEPHRADINE
    • --rarely used

    • 4) CEPHALEXIN & CEPHRADINE
    • --rarely used
  34. 2nd GEN CEPHALOSPORINS
    • 1) iv CEFOXITIN
    • 2) iv CEFOTETAN
    • --both only 2 cephs that cover anaerobes; doc for prophyl abd srgy

    • 3) po CEFUROXIME
    • 4) po CEFACLOR
    • --both tx pedi and fp outpt
  35. 3rd GEN CEPHALOSPORINS
    • 1) iv CEFOTAXIME*
    • --renal cl, t1/2 1h, pcn-r s.pneumo ~ low mic; meningitis n.gono, b-hemo strep. h-flu

    • 2) iv CEFTRIAXONE*
    • --can give im, hep elim, t1/2 8h, s.pneumo & b-hemo ~ low mic; meningitis

    • 3) iv CEFTAZIDIME*
    • --only 3rd for pseudomonas and 'bacters. w genta until S known. no g+

    • 4) iv CEFTAROLINE*
    • --mrsa and 'triaxone-r s. pneumo

    • 5) po CEFPODOXIME
    • --bitter taste, kids spit up. uti

    • 6) po CEFDINIR
    • --good taste; strep pneumo. otitis media after no-go amox or amox+clav

    • 7) po CEFIXIME
    • --oral n. gono, uti. no good s. pneumo or mssa

    *GOOD CNS ~ MENINGITIS
  36. 4th GEN CEPHALOSPORINS
    iv CEFEPIME

    INC R TO b-LACTAMASES

    GOOD PSEUDOMONAL ACTIVITY

    EXCELLENT G- & MOD G+

    1st + 3rd = 4th

    GOOD CNS ~ MENINGITIS

    BETTER 'BACTER COVERAGE THAN CEFTAZIDINE
  37. CELLULITIS (MSSA) OUTPATIENT
    P.O. DICLOXACILLIN,

    OR

    P.O. CEPHALEXIN
  38. CELLULITIS (MSSA) OUTPATIENT
    WITH PCN ALLERGY
    P.O. CLINDAMYCIN,

    OR

    P.O. DOXYCYCLINE
  39. CELLULITIS (MRSA) OUTPATIENT
    P.O. CLINDAMYCIN,

    OR

    P.O. TRIM-SULFA,

    OR

    P.O. DOXYCYCLINE
  40. MRSA (HOSPITAL)
    I.V. VANCOMYCIN
  41. MRSA (HOSPITAL) IN A PATIENT WHO CANNOT TOLERATE VANCOMYCIN
    I.V. DAPTOMYCIN,

    OR

    I.V. OR P.O. LINEZOLID,

    OR

    I.V. CEFTAROLINE

    (IF YOU SURVEYED HOSPITALS ACROSS THE USA, THE DOC WOULD BE 1/3 DAPTO, 1/3 LINEZOLID AND 1/3 CEFTAROLINE
  42. MRSA PNEUMONIA
    I.V. VANCOMYCIN,

    OR

    I.V. LINEZOLID

    OR

    I.V. CEFTAROLINE
  43. OSTEOMYELITIS (CHILDREN)
    P.O. CLINDAMYCIN
  44. MRSA OSTEOMYELITIS
    I.V. VANCOMYCIN
  45. ANY SSTI CAUSED BY A "LETTER" STREP
    • I.V. PEN G
    • (INPATIENT)
  46. P.O. AMOXICILLIN
    (OUTPATIENT)
  47. b-LACTAMASE INHIBITORS
    CLAVULANATE

    SULBACTAM

    TAZOBACTAM (tazo)
  48. OTITIS MEDIA
    P.O. AMOXICILLIN,

    OR

    P.O. AMOXACILLIN +CLAVULANATE,

    OR

    P.O. CEFDINIR
  49. STATS ON CARBAPENEMS
    SAME MOA AS PCNs, BUT GIVEN IV ONLY

    COVER MANY NOSOCOMIAL G- RODS

    GOOD TISSUE PENETRATION

    DRUGS OF LAST RESORT FOR MULTI-RESISTANT BUGS (FAILED PIP-TAZO OR CEFTEPIME)

    MULTI-BUG & LIFE-THREATENING INF ex INTRA-ABD TRAUMA AND NOSOCOM INF BY CITROBACTER, ENTEROBACTER etc

    MAY CROSS-REACT WITH 10-15% PCN ALLERGIC Pt
  50. CILASTATIN
    DIHYDROPEPTIDASE (DHP) INHIBITOR

    DHP = RENAL ENZYME

    IMIPENEM (CARB) + CILA = PRIMAXIN

    COVER G- RODS ex PSEUDOMONAS
  51. PIP TAZO; TICARCILLIN + CLAVULANATE
    GIVEN IV IN ICU

    TREAD PSEUDOMONAS AND OTHER NOSOCOMIAL G-

    GOOD MSSA AND STREP PNEUMO COVERAGE

    EXCELLENT ANAEROBE ACTIVITY
  52. PSEUDOMONAS
    I.V. PIPERACILLIN – TAZOBACTAM,

    OR

    I.V. CEFTAZIDIME,

    OR

    I.V. CEFEPIME
  53. FLUOROQUINOLONES
    FQs INH DNA SYNTH -- TOPOISOM II & IV

    RAPIDLY CIDAL

    po & iv

    CATION CHELATION DEC ABS

    GOOD G-, BAD G+

    • DOC: MDR STREP PNEUMO
    • --LEVO, MOXI, GEMI. NO CIPRO
    • --FQ-R IN NURSING HOMES, Tx AS IF NOSOCOMIAL ie anti-pseudomon pip-tazo or cefepime
    • --IF CRITICAL ADD AMINOGLYC (GENTA) AND FQ (levo=cipro)

    • G+
    • MOXI=GEMI > LEVO > CIPRO

    • G-
    • LEVO = CIPRO = MOXI = GEMI

    • ANTI-PSEUDOMONAL IF CULTURE-S 1st
    • LEVO = CIPRO

    • ANAEROBIC: DON'T USE
    • --MOXI > LEVO=CIPRO
    • --USE PIP-TAZO
    • --OR FQ WITH METRONIDAZOLE

    • GOOD INTRACELLULAR
    • --ATYPICAL CAP

    NO MRSA!!!

    NO VRE OR ENTEROCOCCUS

    • GROWING R IN E.COLI
    • -------------------------------------

    CIPRO 20% MET BY CYP 1A2 IN LIVER & MANY CYP450 INTERACTIONS including inh caffeine met

    LEVO ELIM RENALLY; NO CYP450

    MOXI HEP MET, BUT NO CYP450

    • NO MOXI FOR UTI -- LOW po CONC IN URINE
    • ------------------------------------------------

    ADVERSE

    MAY DAMAGE GROWING CARTILAGE

    • Q-T PROLONG
    • --CONGENITAL
    • --DRUGS THAT INC Q-T: SOTALOL, AMLODARONE
    • --TORSADE DE POINTES

    TENDON RUPTURE

    PHOTOTOXICITY esp CIPRO
  54. NAMES OF FLUOROQUINOLONES END IN
    -FLOXACIN
  55. TIME vs. CONCENTRATION DEPENDENT KILLING
    • TIME:
    • --b-LACTAMS
    • --VANCOMYCIN
    • --CONC ABOVE MIC DOESN'T ENHANCE KILLING

    • CONC:
    • --FLUOROQUINOLONES
    • --AMINOGLYCOSIDES (GENTAMYCIN, AMIKACIN, TOBRAMYCIN
  56. POST-ANTIBIOTIC EFFECT
    ex FLUOROQUINOLONES AND AMINOGLYCOSIDES
  57. ANTIMETABOLITES
    ex TRIM-SULFA

    TRIMETHOPRIM + SULFAMETHOXAZOLE

    • GIVEN SINGLY = STATIC
    • GIVEN TOGETHER = STATIC / CIDAL
  58. CHARACTERISTICS OF CEPHALOSPORINS
    MOA SAME AS PCNs AND BUGS GET RESISTANCE DUE TO CHANGE IN BINDING SITE

    RELATIVELY RESISTANT TO B-LACTAMASES

    • 1st ~ G+
    • 2nd ~ G+ and some G-
    • 3rd ~ G- and some G+
    • 4th ~ *G- and mod G+ (1st + 3rd = 4th gen)

    NO ACTIVITY AGAINST ENTEROCOCCUS, LISTERIA, PCN-R STREP PNEUMO, & MRSA. EXCEPTION ~ CEFTAROLINE FOR 'TRIAXONE-R STREP PNEUMO AND MRSA

    CROSS-REACTIVE WITH PCN ALLERGIES. AS GEN INC ~ CROSS REACTIVITY DEC.

    THROMBOPHLEBITIS esp CEFOXITIN

    • INC PROTHROMBIN TIME (PT)
    • --INH VIT K --> BLEEDING
    • --esp CEFOTETAN (metabolite nmtt side chain inh vit k)
  59. b-LACTAMS INCLUDE:
    PENs (PCN's)

    CEPHALOSPORINS

    CARBAPENEMS

    AZTREONAM
  60. AMINOGLYCOSIDES
    • STREPTOMYCIN
    • GENTAMYCIN
    • TOBRAMYCIN
    • AMIKACIN

    • VERY DANGEROUS
    • --CONC AND TIME TOX
    • --NEPHRO, 2+ wks, inc w other neph tox vanc, ampho-b, cyclospor, nsaid
    • --OTO irrev, 5+ days high conc
    • --ADJUST CONC DOWN FOR OBESE bc DOESN'T DISTRIBUTE INTO FAT

    --IV bc POORLY ABSORBED FROM GI LIKE VANC

    • IRREV INH OF PROT SYNTH
    • --30S SUBUNIT
    • --RAPIDLY CIDAL

    • G- SEVERE INF
    • --HIGH DOSE ONCE DAILY ALLOWS WASHOUT TO GIVE LIVER REST
    • --nL GIVEN w ANOTHER G- DRUG ie b-lac


    • G+ INF
    • --NEVER USE AS MONOTHERAPY
    • --LOW DOSE
    • --SYNERGISTIC w PCNs CEPHs AND VANC bc THEY IHN CELL WALL SYNTH ALLOWING AGs TO ENTER CELL

    • GENTA
    • --ADJUST IF RENAL PROBS bc ELIM RENALLY
    • --POST-ANTIBIOTIC EFFECT
    • --OTO TOX
    • --WIDELY USED AS EAR/EYE DROPS & TOPICAL

    • NEOMYCIN
    • --DECONTAMINATE GUT PRIOR TO SRGY

    • BUGS R BY
    • --BAC TRANSFERASE ENZ --> ADDS PHOS, ADENYL, OR ACETYL TO DRUG
    • --DEC TRANSPORT INTO CELL BY PORIN MUTATION
    • --CHANGE 30S BINDING SITE

    • AMIKACIN
    • --ACE-IN-HOLE FOR GENTA-R AND TOBRAMYCIN-R BAC
  61. SERIOUS GRAM (-) INFECTIONS
    (AS EMPIRIC THERAPY)
    ANTI-PSEUDOMONAL b-LACTAM

    PLUS

    AN AMINOGLYCOSIDE
  62. SEVERE GRAM (-) INFECTION IN PATIENTS ALLERGIC TO PCN’S
    AZTREONAM -- MONOBACTAM

    IV ONLY

    GOOD PSEUDOMONAS; COMPARABLE TO CEFTAZIDIME

    GOOD CNS PERF

    CROSS-REACTION WITH MANY 3RD GEN CEPHs, esp CEFTAZIDIME AND 4TH CEFEPIME
  63. SURGICAL PROPHYLAXIS
    (NOT INTRA-ABDOMINAL)
    I.V. CEFAZOLIN
  64. GUT DECONTAMINATION PRIOR TO G.I. SURGERY
    • P.O. NEOMYCIN
    • (NOT ABSORBED FROM GI TRACT)
  65. PERIOPERATIVE PROPHYLAXIS FOR GI SURGERY
    I.V. CEFOXITIN,

    OR

    I.V. CEFOTETAN
  66. ANAEROBIC INFECTIONS
    (PENETRATING GI TRAUMA, APPENDICITIS, LUNG ABSCESS, AND POST-OP GI SURGERY)
    I.V. PIPERACILLIN + TAZOBACTAM
  67. INPATIENT PELVIC INFLAMMATORY DISEASE (PID)
    I.V. CEFOXITIN, OR I.V. CEFOTETAN

    PLUS

    I.V. DOXYCYCLINE
  68. OUTPATIENT PID
    SINGLE DOSE I.M. CEFTRIAXONE
  69. PLUS
  70. P.O. METRONIDAZOLE (2 WEEKS)
  71. PLUS
  72. P.O. DOXYCYCLINE (2 WEEKS)
  73. ANAEROBIC INFECTIONS IN PCN ALLERGIC PATIENTS
    I.V. METRONIDAZOLE
  74. ENTEROCOCCUS
    I.V. AMPICILLIN,
  75. --IF AMP RESISTANT USE I.V. VANCOMYCIN
  76. --IF VANC RESISTANT USE I.V. OR P.O. LINEZOLID
  77. AMPICILLIN-RESISTANT ENTEROCOCCUS
    I.V. VANCOMYCIN
  78. LINEZOLID
    SYNTHETIC ANTIBIOTIC

    • INH PROT SYNTH - STATIC
    • --23S ON 50S; BLOCKS INITIATION
    • --UNIQUE MOA --> NO CROSS-REACTIONS

    • EXCELLENT G+
    • --MRSA if can't use vanc
    • --DOC VRE esp e.faecium
    • --PCN-R STREP PNEUMO
    • --COMPLICATED SSTI

    DONT USE AS EMPIRIC IF BUG UNKNOWN

    MIN G-

    • GREAT F, iv & po
    • --IV VANC Pt SENT HOME WITH po LINEZOLID

    • FAIRLY WELL TOLERATED
    • --N/V
    • --BONE MARROW SUPPRESSION 2+wks
    • --NEUROPATHIES 2+wks
    • --------------------------------------------

    • WEAKNESSES
    • --STATIC mrsa vre
    • --DEEP-SEATED INF endocarditis/osteomyelitis
    • --MITOCHONDRIAL TOX
    • --BONE MARROW SUPPRESSION
    • --IRREV MOAI --> +SSRI CAUSES 5-HT SYND
    • --PERIPH NEUROPATHIES irrev optic neuritis
    • --$$, $200-PER DAY. VANC $12-18
  79. DAPTOMYCIN
    DEPOLARIZES CELL

    COMLICATED MRSA IF CAN'T TOLERATE VANC

    --NO MRSA PNEUMO OR SSTI bc INACTIVATED BY SURFACTANT

    MUSCLE TOX

    $$$ 250-500 PER DAY

    VANC BEATS DAP & LINEZOLID IN HEAD-TO-HEAD
  80. TELAVANCIN
    SYNTH DERIV OF VANC

    MORE POTENT THAN VANC AGAINST MRSA

    2x NEPHROTOX

    MOA -- VANC + DAP

    G+ ONLY

    NO VRE
  81. TRIMETHOPRIM / SULFAMETHOXAZOLE
    TRIM-SULFA

    • GREAT F
    • --po IN SERIOUS INF TO AVOID HUGE IV VOLS

    • MOA
    • --SULFA COMP ANTAG OF PABA --> INH SYNTH OF DHF

    --TRIM INH DHF REDUCTASE --> INH DHF TO THF

    GIVEN SINGLY = STATIC; TOGETHER = CIDAL

    • BROAD SPECTRUM
    • --MRSA, clinda prefered
    • --ENTEROBACTER
    • --*E.COLI
    • --*KLEB
    • --DOC PNEUMOCYSTITIS JIROVECI

    • *GOOD UTI, HIGH CONC IN URINE
    • --UNCOMPLICATED UTI IN HEALTH WOM
    • --65% E.COLI SUSEPT

    DOC NOCARDIA IN IMMUNO-COMP

    • DONT USE
    • --PSEUDOMONAS
    • --ENTEROCOCCI
    • --BACTEROIDES
    • --GAS, FOR UNKNOWN SSTI GIVE po (CEPHALEXIN OR AMOX) + TRIM-SULFA TO COVER

    • SULF INDUCED ALLERGY
    • --RASH IN 30% AFTER 2wks
    • --FEVER
    • --PHOTOSENSITIVITY
    • --URTICARIA (hives)
    • --ERYTHEMA MULTIFORME
    • --STEVENS-JOHNSON SYND, SEVERE ERYTH MULTI w SEVERE MUCOCUTAN LESIONS OF MOUTH, ANOGENITAL, CONJUNCTIVA
    • --TOX EPIDERM NEC (TENS) FULL-THICKNESS EPIDERM NECROSIS
    • --HYPERKALEMIA, trim is k-sparing diuretic. older men with prostatitis
  82. NITROFURANTOIN
    BAC ENZ ACTIVATED --> DNA DAMAGE

    UNCOMPLICATED UTIs

    STATIC AT LOW CONC, CIDAL AT HIGH

    • STRENGTHS
    • --HIGH F
    • --HIGH CONC IN URINE
    • --MOST ACTIVE IN ACIDIC URINE (not good pilonephritis)
    • --G+ AND G- UTI (e.coli, kleb, enterococc vre, some proteus are r)
    • --NO CROSS-REACTION
    • --PREGO SAFE

    • WEAKNESSES
    • --LIMITED TO URINE
    • --NO PYELONEPH OR PROSTATITIS
    • --MAKES URINE BROWN
    • --S/E w PROLONGED USE --> HEP, NEUROP, PULM FIB for recurrent
  83. AMPHOTERICIN B
    POLYENE

    ANTIFUNGAL

    BINDS ERGOSTEROL AND CREATES PORES

    • STRENGTHS
    • --VERY BROAD SPECTRUM; GOLD STANDARD
    • --HIV Pt w CRYPTOCOCCAL MENINGITIS

    • WEAKNESSES
    • --TOXIC!
    • --NEPHROTOX, DOSE DEP. EXACERB BY OTHER NEPH-TOX DRUGS (AGs)
    • --RENAL WAISTING OF K & Mg
    • --NO PERM RENAL DAMAGE IN HEALTHY Pts
    • --SHAKE-N-BAKE SYND. FEVER & CHILLS bc IL-1 IL-6 and TNF
    • --ANEMIA bc DEC ERYTHROPOIETIN

    • LIPID FORMULATIONS
    • --DELAYED TOX
    • --$$$

    • OTHER POLYENE NYSTATIN
    • --ORAL SUSPENTION & TOPICAL
    • --TASTES BAD
    • --ONLY CANDIDA AND NOT "MET" BUGS
    • --CLOTRIMAZOLE FOR TASTE INSTEAD
  84. AZOLES
    ANTIFUNGAL -- PREVENTS ERGOSTEROL FORMATION

    KILL SLOWLY -- CONSIDERED STATIC

    CYP450 INH

    • CANDIDA + "MET" BUGS
    • --MICROSPORUM
    • --EPIDERMOPHYTON
    • --TRICHOPHYTON

    • FLUCONAZOLE
    • --MOST COMMON SYSTEMIC ANTIFUNGAL
    • --EXTREMELY ACTIVE FOR C. ALBICANS
    • --VERY NARROW SPECT
    • --NO C.KRUSEI, 15-20% C.GLABRATA
    • --NO ASPERGILLUS
    • --PITYROSPORUM ORBICULARE (MALASSEZIA FURFUR yeast --> TINA VERSICOLOR). TAKE THEN EXCERSIZE
    • ITROCONAZOLE
    • --ASPERGILLUS
    • --NO iv, LOW F

    • VORICONIZOLE
    • --NEW
    • --DOC ASPER; BETTER THAN AMPHO-B
    • --C.KRUCEI FLUCONAZOLE-R
    • --HEP/NEPH TOX
    • --VISUAL DISTURBANCES

    • POSACONAZOLE
    • --NEW
    • --VORICONAZOLE + ZYGOMYCETES
    • --po ONLY

    CANT USE AMPHOTERICIN B AFTER AZOLES bc THEY TAKE AWAY SITE OF ACTION
  85. ECHINOCANDINS
    ANTIFUNGAL

    • DOC FOR CANDIDA
    • --INVASIVE
    • --REPLACED AMPHO-B FOR MOST CANDIDA

    MOA -- INH GLUCAN SYNTH FOR CELL WALL

    • CASPOFUNGIN
    • --SALVAGE FOR AMPHO-R INVASIVE ASPER AND CANDIDA
    • --RAPIDLY CIDAL CANDIDA, EVEN FLUCONAZOLE-R
    • --WELL TOLERATED
    • --NO CROSS REACTION w -AZOLES

    $$$

    NO po

    LIMITED SPECTRUM
  86. FLUCYTOSINE
    ANTIFUNGAL

    INH DNA SYNTH

    • NARROW SPECTRUM
    • --CRYPTOCOCCUS NEOFORMANS MENINGITIS
    • --SOME CANDIDA

    • STRENGTHS
    • --po w RAPID ABS AND CNS
    • --ELIM RENALLY
    • --SYNERGISTIC w AZOLES AND AMPHO-B

    BONE MARROW SUPPRESSION

    QID -- 4 TIMES A DAY

    RAPID R WHEN USED AS MONOTHERAPY
  87. VRE
    I.V. OR P.O. LINEZOLID,

    OR

    I.V. DAPTOMYCIN

    (THE DOC IS HOSPITAL SPECIFIC)
  88. GRAM (+) BACTEREMIA
    • I.V. VANCOMYCIN
    • (EMPIRIC THERAPYWHICH SHOULD BE
    • ADJUSTED BASED ON CULTURE RESULTS)
  89. METRONIDAZOLE
    PROTOZOAL INFECTIONS

    • Tx
    • --TRICHOMONIASIS
    • --GIARDIASIS
    • --AMEBIASIS
    • --ANAEROBES (bacteroides frag, c.diff)

    • DOC:
    • --C. DIFF po
    • --OUT Pt PID po (w/ im ceftriaxone & po doxy)
    • --ANAEROBE INF IN PCN ALLERGIC Pt iv

    • INH FERREDOXINS OF ETC
    • --FREE RADS DAMAGE DNA

    • INTERACTIONS
    • --INC BLEEDING w WARFARIN
    • --ETHANOL --> N/V, INC ACETALDEHYDE

    METALLIC TASTE

    • PREGO CATEGORY B
    • --OK BUT AVOID USE IN 1st TRI
  90. C. DIFFICILE (PSEUDOMEMBRANOUS COLITIS)
    P.O METRONIDAZOLE,

    • IF DISEASE IS SEVERE, GIVE:
    • P.O. VANCOMYCIN

    • IF VANC-R, GIVE FIDAXOMICIN
    • --LESS RELAPSE (20-30%)
    • --BUT $$$
  91. MYCOPLASMA
    P.O. DOXYCYCLINE,

    OR

    P.O. MACROLIDE
  92. CHLAMYDIA
    P.O. DOXYCYCLINE,

    OR

    P.O. MACROLIDE
  93. RICKETTSIA
    P.O. DOXYCYCLINE
  94. BORRELIA BURGDORFI
    po DOXYCYCLINE
  95. NOCARDIA
    TRIM-SULFA
  96. DIARRHEA (SALMONELLA, SHIGELLA, E. COLI OR CAMPYLOBACTER)
    p.o. ciprofloxacin
  97. UNCOMPLICATED UTI
    (OUTPATIENT)
    p.o. trim-sulfa
  98. COMPLICATED UTI (OUTPATIENT)
    P.O. LEVOFLOXACIN,

    OR

    P.O. CIPROFLOXACIN
  99. COMPLICATED UTI
    (INPATIENT, INCLUDING UTI FROM A NURSING HOME) (EMPIRIC THERAPY)
    IV CEFOTAXIME

    OR

    IV CEFTRIAXONE

    OR

    PO CEFPODOXIME
  100. PYELONEPHRITIS
    I.V. CEFTRIAXONE,

    OR

    I.V. CEFOTAXIME

    SEND HOME ON P.O. CEFPODOXIME
  101. UTI PREGNANT FEMALE
    p.o. nitofurantoin
  102. TB (SPUTUM POSITIVE)
    (MNEMONIC = RIPE)
    • P.O. RIFAMPIN
    • --PLUS
    • P.O. ISONIAZID
    • --PLUS
    • P.O. PYRAZINAMIDE
    • --PLUS
    • P.O. ETHAMBUTOL
  103. TB (AIDS)

    (THIS IS THE ANSWER FOR THE BIG JUNE EXAM)
    • P.O. RIFABUTIN
    • --PLUS
    • P.O. ISONIAZID
    • --PLUS
    • P.O. PYRAZINAMIDE
    • --PLUS
    • P.O. ETHAMBUTOL
  104. ISONIAZAD
    TB

    • MOA
    • --PRODRUG CONVERTED BY MYCOBACTERIAL CATALASE-PEROXIDASE
    • --PREVENTS MYCOLIC ACID SYNTH NEED FOR CELL WALL

    • STATIC FOR LATENT (NON-DIVIDING)
    • CIDAL FOR RAPIDLY DIVIDING
    • --------------------------------------------------

    IF PPD+ AND -CXR, THEN TAKE INH FOR 9mths

    • SLOW ACETYLATOR "SHIP!"
    • --HEPATO & NEUROTOX
    • --MONITOR LFTs AS 20% Pts HAVE 2-3X INC. TOX INC w AGE.
    • --INC TOX w EtOH

    STRUCTURALLY SIMILAR TO PYRIDOXINE (B6) AND HAS ANTAGONISTIC EFFECT MIMICING B6 DEFICIENCY (sensory polymotor neuropathies). GIVE AS COTHERAPY TO PREGOs, DM, UREMIA, MALNUTRITION, HIV, SEIZURES
  105. TREATMENT OF LATENT TB INFECTION
    IN Pt WITH (+) PPD, BUT (-) CHEST X-RAY AND (-) SPUTUM
    P.O. ISONIAZID,

    OR

    P.O RIFAMPIN
  106. RIFAMPIN & RIFABUTIN
    TB -- "RIPE"

    • MOA
    • --INH mRNA SYNTH BY BINDING TO B-SUB OF BAC DNA-DEPENDENT RNA POL

    CIDAL -- EASILY PENETRATE TISSUES --> GREAT FOR ABSCESSES

    NO MONOTHERAPY DUE TO RAPID RESISTANCE

    • INDUCES CYP450!
    • --DON'T USE FOR HIV+ Pts bc RAPIDLY METABOLs OTHER DRUGS
    • --USE RIFABUTIN bc ONLY INDUCES HALF AS MUCH

    • ALSO ACTIVE AGAINST
    • --MENINGOCOCCI
    • --PNEUMOCOCCI (PCN-R STREP PNEUMO)
    • --STAPH (MRSA)
    • ----------------------------------

    • TOX
    • --SKIN, URINE, TEARS, SWEAT, SALIVA TURN ORANGE
    • --INDUCE CYP450
  107. PYRAZINAMIDE
    TB -- "RIPE"

    MOA -- UNKNOWN

    50% OF INH-R & RIF-R ALSO PYRAZ-R

    • TOX
    • --N/V
    • --HEPATO 1-5%
  108. ETHAMBUTOL
    TB -- "RIPE"

    • MOA
    • --INH CELL WALL SYNTH:
    • --INH ARABINOSYL TRANSFERASE FOR ATABINOGLYCAN

    80% INH-RIF-R ARE ETHAM-R

    • TOX
    • --OCULAR DAMAGE!
    • --VISION TEST BEFORE ADMIN AND q4-6 wks

    SOMETIMES "RIPS"

    S - STREPTOMYCIN
  109. BRUCELLOSIS
    (OFTEN FROM EATING UNPASTEURIZED CHEESE)
    P.O. DOXYCYCLINE
  110. PLUS
  111. I.V. GENTAMICIN
  112. CLINDAMYCIN
    LINCOSAMIDE

    IV & PO

    INH PROT SYNTH BY BINDING TO 50S RIBO SU -- STATIC

    F=0.9

    • GREAT G+, NO G-
    • --SSTI (MRSA, B-HEMO STREP)
    • --PCN ALLERGY

    NO VRE

    G+ ANAEROBES (ASPIR PNEUMO)

    GOOD PENETRATION expt CNS

    HIGH BONE/SERUM CONC (OSTEOMYLITIS IN KIDS)

    HEP MET

    CAUSES RASH

    C.DIFF!!! - Tx METRONIDAZOLE OR ORAL VANC

    ONCE DOC FOR BACEROIDES, BUT NOW R
  113. MACROLIDES
    STATIC

    • erythromycin
    • clarithro
    • azithro

    telithro -- lethal hep damage

    MOD G+ ACTIVITY, inc STREP PNEUMO

    MIN G- IF USED w CLARITHROMYCIN AND AZITHROMYCIN

    EXCELLENT FOR INTRACELLULAR BUGS. NOT TB, BUT MYCOBAC AVUM, CHAMYDIA, MYCOPLASMA

    GOLD STANDARD FOR LEGIONELLA

    STREP PNEUMO FOR Pt w PCN ALLERGY

    NOT GOOD SSTI

    NO KIDS OTITIS MEDIA

    • --------------------------------------------------
    • ERYTHROMYCIN - iv and po (severe n/v). stims motilin receptors. inh cyp450. adj for renal fcn

    CLARITHROMYCIN - po only

    • AZITHROMYCIN - iv and po
    • ----------------------------

    • NO ACTIVITY AGAINST
    • --ENTEROCOCCUS
    • --MRSA
    • --VRE

    R BY MOD BINDING SITE ON 50S RIBO SUBUNIT
  114. MYCOBACTERIUM AVIUM (AIDS PATIENT)
    P.O. OR I.V. MACROLIDE
  115. PLUS
  116. ETHAMBUTOL
  117. ACNE
    P.O. MINOCYCLINE,

    OR

    TOPICAL CLINDAMYCIN,

    OR

    TOPICAL ERYTHROMYCIN
  118. LEPROSY
    (MYCOBACTERIUM LEPRAE)
    DAPSONE
  119. TREATMENT OF SKIN AND SOFT TISSUE
    INFECTIONS (SSTIS) = CELLULITIS
    ALL SSTIS SHOULD BE CONSIDER TO BE CAUSED BY STAPH OR STREP UNLESS PROVED OTHERWISE BY CULTURE, SO EMPIRIC DRUG THERAPY SHOULD INCLUDE A DRUG(S) WHICH COVER MSSA, MRSA AND GROUPS A AND B STREP. DRUGS FOR EMPIRIC THERAPY:
  120. LIFE CYCLES OF PLASMODIUM spp
    MALARIA

    • FALCIPARUM AND MALARIAE
    • --ONLY 1 CELL CYCLE IN LIVER, CLEAR >4wks
    • --Tx OF RBC STAGE CURES INFECTION

    • OVALE AND VIVAX
    • --HEP INF PERSISTANT = RELAPSE
  121. CHLOROQUINE
    PLASMODIUM

    MALARIA Tx

    KILLS ERYTH STAGE OF VIVAX, OVALE, MALARIAE, SOME FALC

    CHECK CDC FOR REGIONS OF CHLORO-R MALARIA
  122. PRIMAQUINE
    MALARIA Tx

    KILLS ALL PLASMODIUM spp

    KILLS HEP FORM OF OVALE & VIVAX

    GIVEN AFTER RBC Tx w CHLOROQUINE

    • HEMOLYTIC ANEMIA IN Pt WITH G-6-P GENETIC DEFICIENCY
    • --TEST BEFORE GIVING
    • --MEDITERANIAN OR ASIAN
    • --FAVAISM
    • --PREVENTS NADPH FORMATION WHICH PROTECTS CELL MEM FROM OX
    • --AVOID PREGOs
  123. MEFLOQUINE
    PLASMODIUM MALARIA Tx

    CONTROVERSIAL DRUG

    • 1 OF ONLY DRUGS THAT SUPP/CURE MDR FALCIPARUM
    • --ATOVAQUONE & PROGUANIL ALSO

    • S/E
    • --N/V
    • --HALLUCINATIONS (exacerbate psych probs)
  124. PROPHYLAXIS FOR PLASMODIUM
    • CHLOROQUINE
    • --SAFE FOR KIDS

    • CHLORO-R AREAS
    • --ATOVAQUONE + PROGUANIL
    • --MEFLOQUINE
    • --DOXY
    • --PRIMAQUINE

    • MDR AREAS
    • --MEFLOQUINE

    BEGIN Tx 2 WEEKS PRIOR TO TRAVEL

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