ID 1 Introduction/Everything about the Drugs (NAPLEX)

Thick cell wall (stain purple)

gram positive

Thin cell well (stain pink)

gram negative

Gram negative anaerobes

bacteroides

Common Resistant Pathogens (6 mnemonic)

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae

Escherichia coli

Acinetobacter baumanni

Enterococcus faecalis/faecium

Staphylococcus aureus

Pseudomonas aeruginosa

Concentration dependent drugs (3)

Cmax:MIC

FAD

fluoroquinolones

aminoglycosides

daptomycin

Exposure dependent drugs (4)

AUC:MIC

vancomycin

macrolides

tetracyclines

polymyxins

Time dependent drugs (1)

Time > MIC

beta lactams (penicillins, cephalosporins, carbapenems)

Hydrophilic agents (5)

small VD

Lipophilic agents (6)

large VD

What classes are considered beta-lactam ABX? (3)

penicillins

cephalosporins

carbapenems

Beta-lactam MOA

inhibit bacterial cell wall synthesis by binding to PBPs

Natural PCN drugs & coverage **

Pen VK, Pen G

Entero, strep

Anti-staph PCN drugs & coverage **

Naficillin, oxacillin, dicloxacillin

MSSA, strep

Amino-PCN drugs & coverage **

Amoxicillin, ampicillin: entero, strep, HN

Augmentin, Unasyn: MSSA, entero, strep, HN, PEK, anaerobes

Not for IV use because it can cause cardio-respiratory arrest & death

A. Penicillin V Potassium

B. Penicillin G benzathine

C. Penicillin G Aqueous

B. Penicillin G benzathine

Match with Formulations (1 each)

A. Penicillin V Potassium

B. Penicillin G benzathine

C. Penicillin G Aqueous

A. Penicillin V Potassium --> PO

B. Penicillin G benzathine --> IM

C. Penicillin G Aqueous --> IV

Augmentin renal adjustment cutoff

CrCl <30 - do not use ER or 875 mg

what ABX class can cause seizures with accumulation if not renally adjusted?

BETA LACTAMS (Imipenem highest risk)

penicillins, cephalosporins, carbapenems

Pediatric dose for acute otitis media (know per video)

90mg/kg/day

First gen cephalosporins drugs (2) + bugs

Cephalexin, Cefazolin

MSSA, strep, PEK

Second gen cephalosporins drugs (3) + bugs

Cefuroxime, Cefotetan, Cefoxitin

MSSA, strep, HN, PEK

Third gen cephalosporins drugs (3) + bugs

Group 1: cefdinir, ceftriaxone

MSSA, strep, HN, PEK anaerobes

Group 2: Ceftazidime

strep, HN, PEK, pseudomonas

Fourth gen cephalosporins drugs (1) + bugs

Cefepime

MSSA, strep, HN, PEK, CAPES, pseudomonas

Fifth gen cephalosporins drugs (1) + bugs

Ceftaroline (teflaro)

MRSA, MSSA, strep, HN, PEK

Ceftriaxone Contraindication (2)

Hyperbilirubinemic neonates can cause biliary sludging, kernicertus

Concurrent use with calcium IV products in neonates

What cephalosporin can cause a disulfiram like reaction with alcohol ingestion? (1)

Cefotetan

What cephalosporin has no renal adjustments? (1)

Ceftriaxone

What cephalosporin is avaliable in a chewable tablet? (1)

cefixime

T/F: If a patient with a PCN allergy on the exam, NEVER choose a cephalosporin

True - dont select, even if done in real life

What cephalosporins can be used in pseudomonas? (2)

cefepime

ceftazidime

Cephalosporin DDI with PO agents

H2RA and PPI - separate by 2 hours

What carbapenem is NOT active against ESBL organisms?

Ertapenem

Carbapenem & valproic acid DDI

Carbapenems can decrease levels of valproic acid which can increase risk of seizures

Aztreonam coverage

HN, PEK, CAPES, pseudomonas

T/F: Aztreonam can be usd in penicillin allergies

TRUE

Aminoglycosides MOA

Bind to 30S subunit and inhibit protein synthesis

Aminoglycoside drugs (3) + coverage **

Gentamicin, Tobramycin, Amikacin

HN, PEK, CAPES, Pseudomonas

Synergistic for gram positive organisms when combined with a beta-lactam or vancomycin

Aminoglycosides BW (4)

Nephrotoxic

Ototoxic

Neuromuscular blockage

Fetal harm

Aminoglycoside dosing ***

Underweight use TBW

Obese use AdjBW

Traditional: 1-2.5 mg/kg/dose

Draw trough or peak

Extended: 4-7 mg/kg/dose

Draw random & plot on nomogram

CrCl ≥60: q8hr

what does post ABX effect mean with aminoglycoside?

killing continues after serum level drops below MIC

FQ MOA

Inhibit bacterial DNA topoisomerase IV and DNA gyprase (topo II) preventing supercoiling

FQ BW (3)

Tendon rupture

Peripheral neuropathy

CNS effects (seizures)

FQ coverage

Broad spectrum gram positive, gram negative, atypicals

Ciprofloxacin is contraindicated with concurrent administration of _______.

tizanidine

CYP1A2 inhibitor - increases levels of tizanidine

What FQ has highest risk of QT prolongation?

Moxi>levo>cipro

FQ Adverse Effects (7)

QHPPHCA

QT prolongation

Hypo/Hyperglycemia

Psychiatric disturbances

Photosensitivity

Hepatotoxicity

Crystalluria (stay hydrated)

Aortic anuerysm/dissection

T/F: fluoroquinoles can be used in pregnancy

FALSE - do not use

Can ciprofloxacin oral suspension be put done an NG/feeding tube?

NO - oil based suspension adheres to the tubing

What FQ should not be used for UTI because it does not concentrate in the urine?

Moxifloxacin

FQ DDI (5)

Antacids/cations

Phos binders (lanthanum, sevelamer)

Warfarin

QTc prolongers

Cipro (CYP1A2 inhibitor): tizanidine, theophylline, caffeine

Macrolides MOA

Bind to 50S subunit to inhibit protein synthesis

Macrolide drugs (3) + coverage

Azithromycin, Clarithromycin, Erythromycin

Atypicals

Which macrolide has most risk of QTc?

Erythro>azithro>clarithro

Macrolide main adverse effects

GI upset

What macrolide should be cautioned with CAD?

Clarithromycin

Macrolide DDI & PK

Azithromycin is a minor CYP3A4 substrate and has fewer DDI

Erythromycin and clarithromycin are MAJOR CYP3A4 inhibitors and should not be used with simvastatin, lovastatin

Tetracycline MOA

Reversibly binds 30S subunit to inhibit protein synthesis

Tetracycline drugs (2) + coverage

Doxycycline, Minocycline

Gram positives, gram negatives (including respiratory flora), atypicals

Tetracycline warning to know!

Dont use in <8yo, pregnancy, breastfeeding due to bone suppression and teeth discoloration

What antibiotic can cause drug induced lupus erythematosus?

Minocycline

Why should you sit upright for 30 mins after taking doxycyline?

To avoid esophageal irritation

Tetracycline DDI (1)

Antacids/cations/dairy

Bactrim MOA

Folic acid pathway inhibition

Bactrim coverage

Broad MRSA

Does not cover enterococcus, pseudomonas, anaerobes, atypicals

When dosing bactrim you dose off which component? ***

TMP

Products have SMX:TMP ratio of 5:1

Bactrim adverse effects (7)

SAHTHCP

SJS/TEN

anemia (+Coombs, G6PD)

Hypoglycemia

Thrombocytopenia

Hyperkalemia

Crystalluria (drink water)

Photosensitivity

Bactrim DDI (1)

WARFARIN because bactrim is a CYP2C9 inhibitor

With vanco infusion reactions do not infuse faster than ___ gram per hour

1

Vancomycin MOA

Inhibit cell wall synthesis by binding to D-alanyl-D-alanine cell wall precursor

Which 2 "vancins" are a single dose?

Orita and Dalba

Telavancin BW (3)

Fetal risk: must have negative pregnancy test before starting

Nephrotoxic

Increased mortality when used in patients with preexisting CrCl ≤50

Oritavancin DDI ** (1)

UFH - do not give IV UFH within 120 hours (5 days) due to false elevation of aPTT

Daptomycin coverage

VRE, MRSA, entero, MSSA, strep

Daptomycin adverse effects (3)

Myopathy/rhabo (CPK weekly)

False elevations in INR/PT

Peripheral neuropathy

Linezolid MOA

binds to 50S subunit and inhibits protein synthesis

Linezolid adverse effects (4)

Myelosuppression (dec plts) - need CBC weekly

Optic neuropathy

Serotonin syndrome

Hypoglycemia

Linezolid DDI (1)

Do not use with or within 2 weeks of MAO-I

T/F: You can shake a linezolid suspension

FALSE - do not shake

Tigecycline BW (1)

Increased risk of death

Tigecycline has no activity against the "3 P's"

Pseudomonas, Proteus, Providencia

T/F: Do not use tigecycline for bloodstream infections

True - does not concentrate in the blood since it is lipophilic

What color should the tigecycline soltion be?

Yellow-orange

When are polymyxins used?

MDR gram negative bacteria in combination with other ABX

Polymyxins BW (3)

Dose-dependent nephrotoxicity

Neurotoxicity

Only give to hospitalized patients

What medication is know to cause gray baby syndrome?

Chloramphenicol

Clindamycin MOA

Binds to 50S subunit to inhibit protein synthesis

Clindamycin coverage

Gram positive (CA-MRSA, anaerobes)

Has minimal gram negative coverage

Clindamycin BW (1)

C diff

Can flagyl be taken during pregnancy?

Not during the first trimester

Flagyl DDI (2)

Alcohol (during or within 3 days of stopping)

Warfarin (inc INR)

Lefamulin warning (1)

QT prolongation

Nitrofurantoin do not use in (2) *

CrCl <60

G6PD deficiency

Nitrofurantoin adverse effects (2)

GI upset (take with food)

Brown urine discoloration

ESBL DOC (2)

Carbapenems

Ceftazidime/avibactam

VRE DOC (2)

Daptomycin

Linezolid

What ABX work on folic acid synthesis?

Bactrim

What ABX work on 50S subunit (3 mneumonic)?

Macrolides

Linezolid

Clinda

FIFTY MEN LOVE CLINDA

What ABX work on 30S subunit? (2 mneumonic)

Aminoglycosides

Tetracyclines

TAT (thirty)

What drugs cause photosensitvity? (3)

bactrim

fluoroquinolones

tetracyclines

What drug can cause a metallic taste?

metronidazole