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20 Cards in this Set
- Front
- Back
-Na+ content (ex. pipercillin/tazobactam = Na+ content of 1 gram = 2.35mEq)
-removal during dialysis/pregnancy category -Pen G or ampicillin + gentamicin (Enterococcus endocarditis) -ampicillin + gentamicin (Listeria sp) |
Penicillins
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Meningitis:
-(Haemophilus influenza) ceftriaxone, cefotaxime, cefuroxime - (Neisseria meningitidis)ceftriaxone and cefotaxime -MTT side chain – cefamandole, cefmetazole, cefoperazone, cefotetan -Pseudomonas sp. – ceftazidime, cefepime -CAP – ceftriaxone + macrolide -Lyme’s disease (Borrelia burgdorferi) (Stage II and III) – ceftriaxone -febrile neutropenia – cefepime, ceftazidime and ciprofloxacin + pipericillin |
Cephalosporins
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- avoid as empiric therapy unless patient is hemodynamically unstable and showing signs of sepsis/severe sepsis
- anaphylactic allergy to penicillins, -lactams or cephalosporins – 10% cross-reactivity - limit as last resort due to higher development of resistance |
Carbapenems
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- monocyclic b-lactam nucleus are structurally different from other b-lactams including penicillins,
- cephalosporins – cross reactivity is rare - Hemodialysis patients – 25% of usual dose Q6-12 hours - combination for synergy (e.g. aminoglycosides - P. aeruginosa) |
Monobactams
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- DOC in patients failed/allergic to penicillins and cephalosporins
- not dialyzable, new high flux filters may affect levels - Draw levels two hours after end of dialysis (Vd equilibrium) - evaluate levels for accuracy serum concentrations monitoring necessary? Effect patient outcome? - audiology testing may be required - no serum levels!!! |
Glycopeptides
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- poor penetration into pulmonary secretions and inactivated by pulmonary surfactant– not indicated for pulmonary infections
-commonly used in home infusion therapy |
Lipopeptides
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- CAP – combo w/ 3rd gen cephalosporin
- Food: consider effects on absorption if oral admin -clarithromycin – pharyngitis, sinusitis, AECB, pneumonia, skin (only PO) - erythromycin – respiratory and skin structure PID (PO and IV) azithromycin - pharyngitis, acute otitis media, gonococcal infections, PID and skin structure, PID (PO and IV) Microbacterium Avium Complex (MAC) – combo with ethambutol, rifabutin or ciprofloxacin photosensitivity reactions |
Macrolides
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- pregnancy category D – do not use during pregnancy
- doxycycline may be used as a sclerosing agent for pleural effusion - doxycycline is DOC for Stage I Lyme disease - permanent discoloration of teeth (during child development < 8) - other uses – gonorrhea, syphilis, PID |
Tetracyclines
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- permanent discoloration of teeth (last trimester of pregnancy,
infancy up to 8 yrs of age) - mixed success for MDR Acinetobacter baumannii infections |
Glycylcyclines
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- extensive drug interactions (weigh risk vs benefit)
Contraindications: Myasthenia gravis – respiratory failure and deaths have been reported - contraindicated – cisapride, pimozide (increase QTc interval) |
Ketolides
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can be used for bacterial endocarditis prophylaxis, PID, PCP pneumonia, diabetic foot and intra-abdominal infections. Topical may cause “glowing of the skin” under black light
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Lincosamides
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traditionally used in synergy ( lactam, cephalosporin, etc…)
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Aminoglycosides
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treatment of 1st choice for C. difficile in clinical practice – should be given in oral form for maximum efficacy. May need to give higher doses IV due to enterohepatic circulation
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Metronidazole (Flagyl)
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- limited use in clinical practice due to severe side effect profile – used primarily for VRE if intolerant to other agents (oxalodinones)
- may be used for meningitis (very good CNS penetration) |
Chloramphenicol (Chloromycetin)
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- not indicated for Enterococcus faecalis/ limited spectrum of activity
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Streptogramin
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- Preferred over quinupristin/dalfopristin for VRE
- covers both Enterococcus faecium and faecalis - has greater FDA approved indications - limited drug interactions (No CYP metabolism) - may be switched IV to PO – significant cost savings - linezolid + MAO + serotonin agonist = hypertensive crisis |
Oxalodinones
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- may discolor body fluids – urine, tears, sweat to red-orange color. May -permanently stain soft contact lenses
monitor LFTs at baseline and every 2-4 weeks during therapy - not altered by HD or peritoneal dialysis |
Rifampin (Rifadin)
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- AUIC for fluoroquinolones – major determinant of efficacy
may be used if penicillin or cephalosporin allergy - switch from IV to PO after 72 hrs of IV or if patient can take PO and is afebrile for 48 – 72 hrs (cost savings) 100% bioavailability of IV and oral - avoid in children < 18 years of age - osteochondrosis/arthropathy - affects ability to grow! |
Fluoroquinolones
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- Dosing must be adjusted for renal dysfunction
- Bactrim: DOC in clinical practice - IV formulation (fluid overload) - consider drug/drug interactions - folic acid antagonist-folic acid anemia if on prophylaxis - PCP pneumonia/sulfa allergy – desensitize patient |
Sulfonamides
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- Treat enterococcus faecalise (G+)
- poor drug: not much activity - prophylaxis: microbial resistance |
Nitrofurantoin (Macrobid)
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