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116 Cards in this Set
- Front
- Back
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Aminoglycosides MOA
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Interfere with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits resulting in a defective bacterial cell membrane
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Aminoglycosies PK/PD
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Concentration dependent killing
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Aminoglycosides do/do not have post antibiotic effect
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AG have PAE
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Aminoglycosides are associate with nephrotoxicity when they have a...
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High Trough
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Aminoglycosides are associate with ototoxicity when they have a...
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High Peak
Ototoxicity can be reversible |
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What type of weight should be used to dose AGs?
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Ideal Body Weight
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Do AGs need to be avoided in ESRD?
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No just dose appropriately
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Dosing of AGs
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Conventional/traditional or Extended Interval
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Tobramycin cover what bug that is specific to it in the AG class?
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Pseudomonas
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What bugs do AGs mostly cover?
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Gram -
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When would AGs be used in a Gram + cocci organism?
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Synergy and shoot for a peak of 3-4
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What bugs do AGs not cover?
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Atypicals and Anaerobes
Pseudomonas is only covered by Tobramycin |
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Tobramycin inhaled is used for what disease state and how is it used?
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Cystic fibrosis
28 days on and 28 days off |
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What is the conventional dosing of tobramycin?
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1-2 mg/kg/dose but is based on CrCl
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Why would you want to do extended interval dosing for AGs?
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Conc. dependent killing
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What are 2 reasons why would want to use extended interval AG dosing?
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Less nephrotoxic & Cost effective
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What is the black box warning associated with AGs?
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Can cause nephrotoxicity and neurotoxicity such as vertigo and/or ataxia
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What is the traditional dosing of Gent/Tobra?
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1-2 mg/kg/dose
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What is the traditional dosing of Amikacin?
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5-7.5 mg/kg/dose
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What levels do you take when using traditional dosing of AGs?
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Peaks and Troughs
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When do you take the levels when using traditional dosing of AGs?
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Trough: right before 3rd dose
Peak: 30 min after 30 min infusion time |
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What is the extended interval dosing of Gent/Tobra?
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4-7 mg/kg
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What is the extended interval dosing of Amikacin?
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15-20 mg/kg
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What levels do you take when using extended interval dosing of AGs?
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Random levels
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When do you take the levels when using extended interval dosing of AGs?
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8-12 hrs post dose
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What are the traditional optimal peak drug concentrations of Gentamicin/Tobramycin?
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5-10 mcg/mL
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What are the traditional optimal trough drug concentrations of Gentamicin/Tobramycin?
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<2 mcg/mL
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What are the traditional optimal peak drug concentrations of Amikacin?
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20-30 mcg/mL
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What are the traditional optimal trough drug concentrations of Amikacin?
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< 5 mcg/mL
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Penicillins MOA
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beta-lactams that inhibit bacterila cell wall synthesis by binding to one or more penicillin binding protein which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls
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Penicillins PK/PD parameter
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Time dependent killing
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What penicillins do not need to be dose adjusted in renal impairment?
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Nafcillin and Oxacillin
Pen VK, Amp/Sul, Amox/Clav, Pip/Tazo, & Tic/Clav must all be dose adjusted |
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Penicilins do not cover
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Atypicals
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Does Augmentin (Amox/Clav) need to be refrigerated?
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Yes
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Does Amoxil (Amoxicillin) nee to be refrigerated?
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No but improves taste
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What is something special about Moxatag (Amoxicilin)?
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It must be taken within 1 hr of finishing a meal
Commonly used for strep throat pharyngitis |
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Does Pen VK suspension need to be refrigerated?
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Yes
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What is something interesting about the administration of Pen VK?
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Must be taken on an empty stomach
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What is an important PCN DDI?
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Uricosuric agents such as allopurinol an probeneci can increase the levels of PCNs by interfering with renal excretion
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What is the usual drug and dose given before dental procedures to prevent endocarditis?
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Penicllin 2 g
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Cephalosporins MOA
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Beta-lactams that inhibit bacterial cell wall synthesis by binding to one or more penicillin binding protein which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls
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Cephalosporins PK/PD parameter
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Time-dependent killing
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Can you give a cephalosporin in a PCN allergic pt?
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NO for the exam
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1st generations spectrum of activity
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Better Gram + than Gram -
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2nd generations spectrum of activity
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Better Gram - activity compared to 1st gen with similar Gram +
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3rd generations spectrum of activity
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Better Gram - activity compared to 2nd gen with less Gram + activity compared to 2nd
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4th generations spectrum of activity
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Best Gram - activity an Gram + activity similar to 1st gen
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5th generations spectrum of activity
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covers MRSA and Gram + with some Gram -
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What is the new 5th gen cephalosporin and how is it administered?
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Ceftaroline (Teflaro)
IV only |
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What is the usual dosage of the new cephalosporin?
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Ceftaroline (Teflaro) IV 200-600 mg Q12
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What is the usual percentage of cross sensitivity of the cephalosporins with PCN allergic pts?
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10%
Do not use |
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What is NMTT and why is it important?
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it is a side chain called N-mehtylthiotetrazole
It is important because it can lead to an increased risk of hypoprothrombinemia (bleeding) and a disulfiram-like reaction with alcohol ingestion |
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What cephalosporins contain NMTT?
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Cefamandole (Mandol), Cefmetazole, Cefoperazone (Cefobid), & Cefotetan (Cefotan)
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What is a common drug interaction with cephalosporins?
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Uricosuric agents (probenecid/allopurinol) can increase levels of cephalosporins by interfering with renal excretion
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Carbapenems MOA
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Beta-lactams that inhibit cell wall synthesis by binding to one or more PBP which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls
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Carbapenems PK/PD parameter
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Time-dependent killing
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What is different about ertapenem in its spectrum of activity?
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Does not cover pseudo or acinetobacter
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What is the common spectrum of activity of the carbapenems?
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most Gram +, Gram - and anaerobes
NO ATYPICALS |
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What do carbapenems not cover?
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Atypicals
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Common side effects seen with carbapenems?
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Seizures mostly with imipenem
Common at higher doses and in pts with renal impairment |
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Why is imipenem combined with cilastatin?
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Prevent its degradation by renal tubular dehydropeptidase
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Can you use carbapenems in patients with a PCN allergy?
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NO
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What is a common DDI with carbapenems?
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Uricosuric agents such as probenecid and allopurinol
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What antiepileptic medication do carbapenems interact with?
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Valproic Acid
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Fluoroquinolones MOA
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Inhibit bacterial DNA topoisomerase IV an inhibits DNA gyrase which promotes breakage of double-stranded DNA
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Fluoroquinolones PK/PD parameter
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Concentration dependent killing
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What is the normal ciprofloxacin dosing?
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250-750 mg PO or 200-400 IV
CrCl > 50: Q8-12 hr CrCrl 30-50: Q12 hr CrCl < 30: Q 18-24 hr |
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What is the normal levofloxacin dosing?
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CrCl < 50: 500 mg QD
CrCl 20-49: 500 mg then 250 mg QD CrCl < 20: 500 mg then 250 mg Q48 hr |
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Fluorquinolones black box warning
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Tendon inflamm and/or rupture
Risk increases with concurrent corticosteroid use, organ transplant pts, and pts > 60 yo |
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What is the fluoroquinolones pregnancy category?
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C
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AEs of fluoroquinolones
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photosensitivity, hypo (mostly) and hyperglycemia, arthropathy in children, crystalluria, QT prolongation
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Can Cipro oral suspension be given by NG tube?
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NO and should hold tube feedings for at least 1 hr before and 2 hrs after dose
should use IR tablets or capsules |
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How should Proquin XR (ciprofloxacin) be given?
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It should be given with the main meal of the day and evening is preferred
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Can these agents be used in PCN allergic pts?
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Yes
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What are some common DDIs with fluoroquinolones?
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Antacids, didanosine, sucralfate, bile acid resins, Mg, Al, Ca, Fe, An, MVI or any other cations that can chelate
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How should you separate fluoroquinoles from cation containing drugs?
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Give 2 hours before or 4-6 hours after
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How should you separate Proquin XR (ciprofloxacin) from cation containing drugs?
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4 hours before or 6 hours after
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How do fluoroquinolones affect warfarin?
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Can increase its levels
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Ciprofloxacin is metabolized by what enzyme and what is its activity?
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Potent Inhibitor of CYP 1A2
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How do probenecid and NSAIDs affect fluoroquinolones?
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Increase the FQ levels
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Macrolides MOA
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Bind to the 50S ribosomal subunit resulting in inhibition of RNA protein synthesis
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Common Azithromycin dosing
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500 mg day 1, then 250 mg days 2-5 or 500 mg QD X 3d
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Do you need to refrigerate azithromycin oral susp (Zmax)?
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NO
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Do you need to take Biaxin XL (clarithromycin) with foo?
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Yes
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Do you need to refrigerat Biaxin (clarithromycin) oral susp?
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No
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Do you need to refrigerate erythromycin ethyl succinate (EES) oral susp?
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Yes
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What is the most common AE seen with macrolides?
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Diarrhea
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What is the spectrum of activity of macrolides?
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Gram +, some Gram -, and good atypical coverage
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What is important about Azasite (azithromycin opth)?
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Flip/Whip/rip
Viscous soln for ophthalmic use Store at room temp because cold makes more viscous |
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What is important about azithromycin in renally impaired pts?
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Use with caution when CrCl < 10
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Is Zmax the ER suspension bioequivalent to Zithromax?
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NO
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Erythromycin and clarithromycin are metabolized by which enzyme and have what activity?
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Major 3A4 inhibitors
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Azithromycin is metabolized by which enzyme and has what activity?
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Minor 3A4 inhibitor
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Erythromycin and Clarithromycin should not be used with what medications?
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QT prolonging drugs
Class I and II antiarrhythmics, Quinolones, Azoles, TCAs, Antipsychotics, etc. |
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Fluoroquinolones spectrum of activity
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Extensive activity against Gram -, Gram + and some atypical coverage
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Tetracyclines MOA
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Inhibits bacterial protein synthesis by reversible binding to 30S ribosomal subunit
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Tetracyclines spectrum of activity
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Atypicals, spirochetes, rickettsial disease, anthrax, syphilics, acne, etc.
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Contraindications to tetracyclines
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Children < 8 yo
causes tooth discoloration |
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Pregnancy category of tetracyclines
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D
retards bone growth an skeletal development |
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AEs of tetracyclines
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photosensitivity, tooth discoloration in children, exfoliative dermatitis, fixed drug eruptions, etc.
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How should tetracyclines be given?
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Take with 8 oz of water to minimize GI irritation and remain upright for 30 min
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Should doxycycline be dose adj in renal impairment?
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NO
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Tetracyclines DDIs
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Drugs that can chelate (take 1-2 hrs before or 4 hrs after)
Many anticonvulsants decrease the levels of tetracyclines Avoid concomitant use with retinoic acid derivatives |
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How do tetracyclines interfere with warfarin?
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Can increase INR
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Sulfonamides MOA
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SMZ interferes with bacterial folic acid synthesis via inhibition of dihydrofolic acid formation from para-aminobenzoic acid and TMP inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in inhibition of enzymes of the folic acid pathway
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Sulfonamides common dosing in UTI
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1 DS BID x 3 days
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What is the common ratio of SMZ to TMP?
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5:1
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What is the common dose of SMZ to TMP in SS?
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400 mg SMZ to 80 mg TMP
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What are the contraindications to Bactrim?
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Pts with sulfa allergy, Pregnancy at term, Anemia due to folate deficiency, marked renal/hepatic disease
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AEs of Bactrim
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Skin rxns (rash, urticcaria, Stevens-Johnson syndrome, TENS), Cystalluria (take with 8 oz of water), photosensitivity
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Special concerns of Bactrim IV
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Store at room temp
Short stability of ~ 6 hrs however the more concentrated the soln the shorter the stability Dilute with D5W |
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How should Bactrim susp be stored?
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At room temp
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Sulfonamides are metabolized by what enzymes and what is their activity?
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Moderate inhibitors of 2C8/9
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What is an important DDI with Bactrim?
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Warfarin
2C9 |
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Sulfonamides can increase levels of which drugs?
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Sulfonylureas, phenytoin, dofetilide, azathioprine, methotrexate, and others
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Levels of sulfonamides may be decreased by what drugs?
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Leucovorin, Levoleucovorin and 2C8/9 inducers
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