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957: Infectious Disease
N/A
260
Pharmacology
Professional
08/29/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
T or F: When an organism is pathogenic it is also resistant.
Definition
F: pathogenesis does NOT equal resistant.

Actually, because both require energy, they have an inverse relationship
Term
What are two examples of an antigen or antibody test?
Definition
Strep Test (Group A Streptococcus)
Rapid HIV Test
Term
How can the mecA of S.aureus be detected?
Definition
DNA Amplification
Term
What is the MIC measuring
Definition
The drug/organism interaction (simplest method)
Term
How accurate is an MIC?
Definition
Can't usually get a true MIC (only 1,2,4,8...)

Additionally, lab standards are MIC+/- 1 dilution (so if says MIC = 4, could be anywhere between 2 and 8)
Term
How do you measure the MBC?
Definition
on agar plate (kills 99.9% of germs)
Term
E Test
Definition
Strip with different concentrations of antibiotic placed on agar plate - zone of inhibition forms when bacteria is susceptible

Can get MIC by looking at lowest drug concentration it is susceptible to.
Term
Kirby Bauer Method
Definition
Multiple discs with antibiotics placed on agar plate with bacteria. Zone of inhibition around each antibiotic bacteria is susceptible to (~1 mm)

Doesn't give an actual MIC
Term
Which is worse, giving an antibiotic because the patient was thought to be susceptible and really wasn't, or not giving an antibiotic because they thought the patient was resistant?
Definition
Giving an antibiotic to which the patient is actually resistant (still not getting adequate treatment)

if didnt give them an antibiotic that was falsely read as resistant, then most likely still got an antibiotic that works for them
Term
T or F: FQs can be used for Pseudomonas?
Definition
F - even though the lab results will come back saying it is susceptible, it is not.

Never use a fluoroquinolone ALONE for Pseudomonas
Term
Vancomycin/MRSA MIC comes back as 2, what could be an issue?
Definition
Resistance. Even though MIC of 2 is seen as susceptible (breakpoint) resistance is increasing so may need drug in greater concentrations

if MIC>2 for S.aureus, use alternative agent
Term
What is an instance in which the lab reports that Klebsiella (or other enterobacteriaceae) is susceptible to a certain antibiotic, but when used treatment fails?
Definition
When the bacteria is an ESBL producer and a penicillin is used - ESBLs get induced.
Term
When reading an antibiogram, the number that is reported is the susceptible or resistant population?
Definition
Susceptible
Term
What is selection pressure?
Definition
(Think Natural Selection)

The idea that the resistant bacterium will live and multiply and others will die (vertical resistance)
Term
What are the most common plasmid-mediated beta-lactamases in gram negative bacteria?

What drugs are stable in their presence?
Definition
TEM-1, TEM-2, SHV-1

Extended-spectrum ceph (2nd/3rd)
beta-lactams + beta-lactamase inhibitors
Carbapenems
Term
What beta-lactams are stable in the presence of ESBLs
Definition
Carbapenems
Clavulanic acid
Term
How do we screen for ESBL producers?
Definition
If MIC> or = 2mcg/mL to ceftazidime, cefotaxime, or ceftriaxone then do an ESBL confirmatory test

(Test the drug with clavulanic acid - if the organism then presents as susceptible (having 3+ decreases in MIC read) the organism is an ESBL producer

Must report as resistant to ALL cephalosporins and penicillins
Term
What is the DOC for ESBL producing organisms?
Definition
Carbapenem


**Amox/Clav Acid cant be used in high enough concentration to be therapeutic
Alt: Cefepime - still treatment failures
Tigecycline
Other drug that is susceptible
Term
Amp C Beta-lactamases
Definition
NOT inhibited by beta-lactamase inhibitors (clavulanic acid)

Chromosomal and Inducible

Produced by the SPACE bacteria (nosocomial pathogens)

'stably de-repressed' - there is no repression, always turned on
Term
2 DOC for AmpC beta-lactamase producers
Definition
carbapenems and cefepime
Term
Issue with culturing a patient who has a bacteria with the Amp-C gene
Definition
Stable de-repression - will appear to be susceptible upon initial testing, but then treating with the drug will induce beta-lactamase production - will be seen as resistant 3 days later.
Term
Carbapenemases
Definition
Two types: serine beta-lactamases and metallo-beta-lactamases (MBL)

chromosomally or plasmid encoded

Can lead to resistance in carbapenems and anti-pseudomonal cephalosporin/penicillins
Term
Treatment of carbapenemase producers
Definition
Polymyxin B + rifampin or imipenem

Tigecycline

Aminoglycosides
Term
What is gene that causes the replacement of PBP2 with PBP2a?
Definition
mecA

(MRSA)
Term
What is the only beta-lactam that can target PBP2a?
Definition
Teflaro (Ceftaroline)
Term
Penicillin resistance in what organisms is associated with 4 PBPs?
Definition
Strep. pneumoniae

in resistant to PCN, then increased macrolide resistance, BUT FQ resistance still low
Term
Which gene carries clindamycin inducible resistance? How can the lab screen for this?
Definition
erm gene

Disc Diffusion Test (D Test)
Term
Which organism has the highest incidence of changing the bacterial target site against vancomycin (change to D-ala-D-lac or D-ala-D-ser)
Definition
E.faecium
Term
What are the VanA and VanB genes?
Definition
Genes that change the target site of penicillin to:
A: D-ala-D-lac
B: D-ala-D-ser
Term
When MRSA acquires the VanA gene it is considered _______.
Definition
VRSA
Term
What PD parameter correlates to efficacy in vancomycin dosing?
Definition
AUC/MIC

Target AUC/MIC is greater than 400
-to achieve, trough target = 15-20 mcg/mL
Term
What is a major mechanism of resistance against Tetracyclines?
Definition
Efflux pumps

tet genes

NOTE: tigecycline has steric hindrance and is not a substrate for these pumps (why broader spectrum)
Term
T or F: tigecycline can be used to treat all common infections
Definition
F - very broad spectrum but doesnt cover Pseudomonas
Term
T or F: bacteria can have more that one mechanism of resistance.
Definition
T: ex, meropenem and Psuedomonas/Acinetobacter ->up-regulation of efflux pump gene and loss of porin channel protein are both required for resistance to be noted
Term
If someone has a drug hypersensitivity then they have a drug allergy - T or F.
Definition
F: if someone has a drug hypersensitivity it can be allergic or non-allergic hypersensitivity
Term
Risk factors for having an allergy
Definition
Genetic factors
Concurrent medical illness (Ebstein-Barr Virus, HIV, asthma)
Previous drug reaction
Multiple allergy syndrome
The nature of the drug (its interaction with the immune system, dose, duration, route, cross-sensitization)
Term
Mechanism of a Type I hypersensitivity reaction
Definition
IgE mediated
triggers the release of histamine

manifests as urticaria, angioedema, anaphylaxia/shock, bronchial asthma
Term
Type II and III hypersensitivity reactions mechanism and presentation
Definition
Antibody, immune-complex, or phagocyte-mediated

presents as:
Immune hemolytic anemia
Thrombocytopenia
Blood cell dyscrasias
Organ-specific reactions
Term
What is the mechanism and presentation of Type IV hypersensitivity
Definition
T cell mediated Delayed Rashes: maculopapular exanthema, SJS/TEN, delayed urticaria, eczema Organ-specific reactions
Term
What is a prohapten?
Definition
A chemically non-reactive drug that becomes reactive (to the immune system) upon metabolism

Potent and rapid intracellular detoxification of the hapten can prevent immunogenicity elsewhere in the body, but can cause an organ-specific reaction (liver-hepatitis or kidney-interstitial nephritis)
-Ex: GSH - depletion of glutathione in HIV patients
Term
Does a hapten cause a Type I, II, III, or IV reaction?
Definition
Could cause any

Depends on:
1. Where it binds (surface vs soluble)
2. What binds it (IgE, IgG, T cells)
Term
If patient presents with urticaria after first exposure to a drug, how will they present if they are exposed a second time?
Definition
There is no way to know, they could just get urticaria again or they could progress to angioedema or worse
Term
Urticaria presentation and mechanism
Definition
wheal and flare rxn (IgE)
-increased vascular permeability (small venules)
-mast cells and basophils release histamine, eicosanoids
-cutaneous neurons release neuropeptides (axon reflex)

Skin swells and itches

No mucus membrane involvement
Term
Angioedema presentation and mechanism
Definition
well-demarcated non-pitting edema

rxn deeper in dermis and SQ tissue than urticaria

Usually face, tongue, lips, eyelids
Can get respiratory distress

GET PATIENT SEEN
Term
T or F: even though IgE mediated reactions usually occur within 1-2 hours and T-cell mediated reactions usually take 2 hr-10 days, timing doesn't always go by the book.
Definition
T
Term
Stevens Johnson Syndrome (SJS) and Toxic Epidermis Necrolysis (TEN)
Definition
Fever, sore throat, cough, eye burning

facial swelling, target lesions, skin pain, red/purple rash, blistering (skin and mucous membranes), sloughing of skin
Nikolskys sign - scratch skin and epidermis comes off

Usual causes: Sulfa, PCNs, NSAIDs, anticonvulsants, infections

Treat like a burn patient
Term
Maculopapular exanthem (MPE) and Bullous Exanthem
Definition
higher activation of circulating T Cells

MPE: CD4 (only certain MHC-II cells)
Bullous: CD8 (all cells)- more reaction [why they look fused together]
Term
What should be done if a patient presents with a delayed hypersensitivity reaction?
Definition
Stop all ongoing antibiotics

Do liver, renal, and blood tests
Term
What is the most likely cause of a small petechiael rash?
Definition
Virus
Term
What is the most likely agent being used when someone with an Epstein-Barr viral infection presents with maculopapular exanthem
Definition
Aminopenicillins (amoxicillin/ampicillin)
Term
With what drug are HIV-patients most likely to have an increased risk of an allergic reaction?
Definition
Sulfonamides (rashes)
Term
What are some lab (serology) tests that could be used to confirm a drug allergy?
Definition
Immediate reactions:
1. serum tryptase
2. serum histamine

Delayed reactions
3. CBC: eosinophilia and lymphocytosis, leukocytosis
4. Liver function tests: increased ALT, AST, ALP
5. Serum creatinine: increased = +
6. Urine microscopy and dipstick: nephritis, proteinuria
7. CRP: can increase or decrease = sign of inflammation
Term
When is the skin prick or intradermal test used for drug allergies
Definition
use to deterimine if reaction is IgE mediated
Term
Skin prick test: time, sensitivity, and specificity
Definition
15-20 minutes

Specific and fairly sensitive
Term
Intradermal skin test: when indicated and sensitivity and specificity
Definition
Do it when skin prick test is negative and allergen is highly suspect

more sensitive than skin prick test
may induce false positive reactions (less specific)

May induce systemic reactions
Term
What is drug provocation tests and when should it be used
Definition
Give a drug and monitor patients for allergic reaction

Indications:
1. Exclude hypersensitivity in non-suggestive history
2. Utilize structurally similar drugs in proven hypersensitivity (ex: want to use cephalexin in an penicillin allergic patient)
3. Definitive diagnosis in suggestive history with negative, non-conclusive or non-available tests

DO NOT USE IF:
1. pregnant
2. a co-morbidity exists where DPT can provoke a situation beyond medical control (ex: acute infection, uncontrolled asthma, cardiac disease, brittle)
3. immunobullous drug eruptions
4. severe systemic initial reactions (SJS)

Must explain risk vs benefit to patient (informed consent)
Ideal to: d/c antihistamines (3 days short acting and 7 days long acting); fasted overnight
careful observation and resuscitation equipment available
Term
When to desensitize a patient
Definition
When there is no reasonable alternative
-NOTE: if anaphylaxis originally it is NOT contraindicated, but if the patient had SJS/TEN do NOT do desensitization

**Patient will still be considered allergic to the drug
Term
How to desensitize a patient
Definition
Must be done by a physician (ICU preferred)
d/c all beta-adrenergic antagonists (including ophthalmics)
do NOT premedicate with corticosteroids/antihistamines (For some drugs, premedication is recommended - FQ, vanco)
monitor with ECG

Start low (can be oral or parenteral)
Double dose every 20-30 min until reach target

If skip a dose, must start all over
If patient has transient allergic reaction - dont stop treatment
Term
Possible mechanisms of desensitization
Definition
IgE mediated reactions

Consumption of IgE in immune complexes
Mediator depletion from mast cells and basophils
Antigen specific mast cell desensitization
Term
Cross-reactivity between penicillins and cephalosporins
Definition
more common with type I reactions
IgE mediated reaction to PCNs is 10% cross-reactivity to ceph (esp. 1st gen)

If reactive to ceph but not pcn - there is a higher incidence of ceph cross-reactivity among drugs with similar R1 side chains
-Ceftriaxone = cefotaxime = cefepime
-Cefuroxime = ceftazidime

Low rate of cross-reactivity between PCN and carbapenems

NO cross-reactivity with aztreonam
Term
Up to 50% of HIV patients have an allergy to what medication?
Definition
sulfonamides

SMX can be a hapten (able to cause all forms of drug allergies)
Term
T or F: if you are allergic to one fluoroquinolone you are considered allergic to all of them
Definition
There is cross reactivity, so:

if an immediate hypersensitivity - must chose different drug

if delayed hypersensitivity can challenge and desensitize
Term
How to decide to treat a drug allergy as inpatient or outpatient
Definition
Inpatient: observation, skin care, I/V, allergist referral
-Chose if: angioedema, severe skin (ex: SJS), systemic symptoms (fever, lymphadenopathy), possibly >1 implicated drug

Outpatient: treat if urticaria/maculopapular rash, fixed drug erruption, no systemic symptoms

Refer to allergist if: uncertain cause or if uncertain allergy
Term
Treatment of a drug allergy
Definition
stop suspected drug(s)

Resuscitation (CPR in anaphylaxis)

Give:
Antihistamines (IV or PO)
IM epinephrine for anaphylaxis
Systemic corticosteroids for DiHS, SJS
High dose IVIG for early TEN/SJS

Emollients and skin care
Hydration and prevention of skin superinfections (TEN)
Term
What is another name for an upper UTI?
Definition
pyelonephritis
Term
What constitutes an uncomplicated (vs a complicated) UTI
Definition
Uncomplicated: otherwise healthy female ages 15-45)

Complicated: men; lesions, obstruction, neurologic dysfunction (cant void completely), upper and lower tract
Term
What are the two types of recurrent UTIs
Definition
3+ UTIs in 1 year in healthy, NONpregnany women

Reinfection: different organism (>2 weeks apart)
Relapse: same organism, persistent sourse of infection (stones, catheter) (<2 weeks apart)
Term
If there is non urinary pain, but UA comes back positive for bacteria, does the patient have a UTI?
Definition
No, asymptomatic bacteriuria
Term
T or F: you can only rule out a lower UTI, you cant really rule out an upper UTI
Definition
T

usually if no symptoms then no UTI
Term
Clinical presentation of a UTI (upper vs lower)
Definition
Lower: DYSURIA, urgency, nocturia, suprapubic heaviness, hematuria, foul-smelling

Upper: FLANK PAIN, fever, N/V, malaise, muscle weakness

Elderly: mental status changes
Term
Typical lab diagnosis of a UTI
Definition
UA:
clarity is cloudy
Color: orange/red (blood)
pH: increased (normally acidic)
WBC or RBC may be present
Leukocyte esterase may be present (breakdown of WBC)
nitrite (gram negative bacterial metabolite)
Organisms present - lower threshold amount for men than for women

Urine culture (NOTE UA does not culture anything in urine - just quantifies how much is present)

CBC (done if UTI severe or worsens)
Term
What is the most common pathogen found in UTIs
Definition
E.coli

(Proteus, Klebsiella, Staphylococci, saprophyticus, other)
Term
What are two drug classes that have been used to treat UTIs that cause A LOT of collateral damage
Definition
FQ
3rd gen ceph
Term
What are some options for the treatment of UTIs
Definition
1. Nitrofurantoin monhydrate/macrocrystals
Make sure patient has adequate renal function to make sure drug gets there and to avoid toxicity

SMX-TMP: DS BID x3 days

Fosfomycin 3 gm once
-minimal resistance/collateral damage; inferior efficacy

Augmentin or PO cephalosporins

Cipro/levo: 3 days is usually sufficient
-reserve for more serious infections because of collateral damage (and growing resistance)
Term
If patient presents with pyelonephritis what is the first thing you should do?
Definition
get a urine culture BEFORE starting antibiotics
Term
How do you decide to treat pyelonephritis inpatient or outpatient?
Definition
Inpatient: pregnancy, diabetes, immunocompromised, structural abnormalities

treat with IV (at first) if inpatient because of big risk of N/V with most abx
Term
Treatments for pyelonephritis
Definition
Can start PO regimens with IV x 24h or until hemodynamically stable

IV/PO cipro/levofloxacin (7-10 days)

IV extended spectrum beta-lactam +/- aminoglycoside

PO beta-lactams (cephalosporins>augmentin b/c of resistance) x10-14days

PO Bactrim x 14 days (only if susceptible)
Term
Should you treat asymptomatic bacteruria
Definition
No, except for:

1. pregnant women (b/c development issues associated with bacteria in urine)
2. Children <5 yr (increased risk of long-term damage)
3. Patients undergoing TURP or urologic procedure


NOTE: recurrence is common and there is 100% incidence in patients with a catheter
Term
T or F: pregnant women have more pyelonephritis
Definition
T - they have higher incidence of acute pyelonephritis, but bacteriuria rates are equal in pregnant and non-pregnant women
Term
What do you use to treat UTIs in pregnancy and for how long
Definition
Beta-lactams
Sulfonamides
Nitrofurantoin

Use for ~7 days
Term
Why should you treat a UTI in pregnancy?
Definition
They are associated with significant morbidity for mom and baby

prematurity, low birth weight, still birth
Term
What are some risk factors for UTI recurrence?
Definition
sexual intercourse
diaphragm or spermicide use
Term
How to treat recurrent UTIs
Definition
If sex related: post-coital voiding and single dose bactrim

If no precipitating event:
-6 month therapy
-Bactrim, FQ, macrobid
Term
What is a fever?
Definition
>101 F >100.4 x 2 readings >1 hr apart
Term
What is a common species of staph that is referred to as 'coag. negative staph?'
Definition
Staph epi
Term
What patient population is candiduria commonly seen in?
Definition
catheterized patients
Term
Who should be treated for candiduria?
Definition
ONLY treat symptomatic or high-risk patients

Neutropenic, neonates, urologic prodecure
Term
How should candiduria be treated?
Definition
CHANGE THE CATHETER!

Fluconazole
Amphotericin B IV
Amp B bladder irrigation (irritating)

7-14 days
Term
What is the major difference between the treatment of UTIs and prostatitis?
Definition
Duration of treatment

UTI: up to 2 weeks
Prostatitis: 4-6 weeks
Term
What can cause prostatitis?
Definition
Identified by presence of bacteria and inflammatory cells

causes:
-reflux of urine into prostate
-sex
-functional abnormalities of prostate
-catheters
-urinary tract procedures

Bacterial causes similar to UTIs (E.coli)
Term
Treatments for prostatitis
Definition
FQ (most common)
Bactrim
(Cephalosporins and Zosyn)

4-6 weeks
Term
Sensitivity
Definition
the ability of a test to identify positive results in patients who actually have the disease (true positive rate) Higher sensitivity = lower chance of false negative High sensitivity is preferred when the consequences of not identifying the disease are serious (ex: cancer screenings)
Term
Specificity
Definition
the percent of negative results in people without the disease (true negative rate) Higher specificity = less chance of a false positive Good for confirming a diagnosis because the tests are rarely positive in the absence of disease
Term
T or F: infections with any STD increases the risk of HIV acquisition.
Definition
T - sores/inflammation can decrease the skin's ability to prevent infection
Term
What is the number one risk factor for getting an STD?
Definition
Number of sexual partners

Others:
Unprotected sex
Social/Cultural factors
Lower socioeconomic status
Drug abuse (IV drug user)
Term
Which STD is painless?
Definition
syphilis
Term
Which STDs are most painful
Definition
Herpes
HPV

Both viruses are the most painful!
Term
Which STDs present with sores and which present with drips?
Definition
Sores:
1. Syphilis
2. HSV (herpes)
3. HPV
**NOTE- these are the most painful and least painful

Drips:
1. Gonorrhea
2. Chlamydia
3. Trichomoniasis
NOTE - all of these can present with or without discomfort
Term
T or F: you can cure herpes?
Definition
F - cant completely eradicate
Term
What organism/virus causes gonorrhea?
Definition
Neisseria gonorrhea

(G- diplococcus)
Term
Presentation of Gonorrhea
Definition
50% females are asymptomatic

Sx: dysuria, urinary frequency, PURULENT DISCHARGE, rectal discharge, pharyngitis
drips +/-discomfort

NOTE: men are more likely to give it to women than vice versa
Term
DOC for gonorrheal (uncomplicated) infection
Definition
Ceftriaxone 250 mg IM once

(Cefixime and FQ were once recommended, but not any more because of increased resistance)

+ Drug for chlamydia
Term
What two STDs are treated concurrently becuase they are often found together
Definition
Gonorrhea and Chlamydia
Term
How to treat a disseminated gonorrheal infection (it has spread)
Definition
Ceftriaxone 1 gm IM/IV Q24h ->duration not well defined (individualize)
Term
What should you give to a pregnant women who presents with chlamydia?
Definition
Azithromycin 1 g PO x1 dose

Erythromycin is an alternative

(dont give a tetracycline because contraindicated in pregnancy)
Term
What causes chlamydia, and what type of organism is it?
Definition
C. trachomatis

obligate intracellular bacterial parasite
-important because symptoms wont manifest until 1-3 weeks have past
Term
What is the most frequently reported STD in the US?
Definition
chlamydia
Term
Who is more likely to know they have an STD, a man or a woman?
Definition
Man, because women are more likely to be asymptomatic in with most diseases (must be proactive and encourage screening)
Term
What are the screening criteria for chlamydia?
Definition
All sexually active females should be screened annually
-Ages 20-25 (most common age group)
-Multiple sex partners
Term
Symptoms of chlamydia?
Definition
urethral/cervical discharge
-less profuse and more mucoid/watery compared to gonorrhea
drips
+/- discomfort

Asymptomatic in 50% men and 66% women
Term
What are the recommended treatment options for chlamydia and what are some alternatives?
Definition
Recommended:
1. Azithromycin 1 gm PO once
2. Doxycycline 100 mg PO BID x7

Alternative
1. Levofloxacin 500 mg QD x 7 days
2. Erythromycin base 500 mg QID x 7 days

**Azithromycin 2g PO x1 dose treats both Chlamydia and Gonorrhea (more GI issues, good if allergic to ceftriaxone)
Term
How does Trichomoniasis uniquely present
Definition
"Strawberry cervix" - cervical petechiae
Discharge: frothy, gray to yellow-green malodorous

Positive KOH "whiff" test

motile flagellated protazoa, many WBCs

Common among vaginal infections: itching, dysuria, discharge
Term
Recommended treatment of trichomoniasis and some alternatives
Definition
Recommended:
1. Metronidazole 2 gm PO x 1 dose
2. Tinidazole 2 gm PO x 1 dose (esp if metro fails)

Alternatives:
Metronidazole 500 mg PO BID x 7 days (**Preferred if partner is NOT simultaneously treated - because is self-limiting in men after ~7 days)
Term
T or F: Metronidazole gel is just as effective in treating trichomoniasis as the oral regimen
Definition
F - only 50% as effective
Term
What are the stages of Syphilis?
Definition
Primary: single, painless indurated lesion (chancre) - eventually heals
Secondary: rash +/- itching, mucocutaneous lesions, flu-like symptoms
Latent: Asymptomatic
Tertiary: CV (aortic insufficiency), neurosyphilis (meningitis, paresis, dementia), gummatous lesions SYSTEMIC (10-30 years)
Term
What is the treatment of syphilis
Definition
Primary/Secondary/Early latent (<1 year)
Benzathine Pen G 2.4 mil units IM x 1 dose

Late Latent (>1 year) or unknown duration
Benzathine Pen G 2.4 mil units IM Qweek x 3 weeks

Neurosyphilis
-Aqueous crystalline Pen G 18-24 million units IV QD (can be intermittent or continuous infusion) x 10-14 days
-Aqueous cystalline Pen G 2.4 mil units IM daily + probenecid 500 mg PO QID x 10-14 days

Pen-allergic patients
Doxy 100 mg PO BID x 14 (x 28 in late latent)
Tetra 500 mg QID x14 (x28 in late latent)
Ceftriaxone 1 gm IM/IV QD x 8-19 days (only <1 yr disease)
Term
What is the Jarisch-Herxheimer reaction and with what treatment is it notorious for occurring?
Definition
Acute syndrome of flu-like symptoms within 24 hours of penicillin treatment (seen with syphilis tx)
-Fever, HA, myalgia, tachycardia, flushing, increased respiratory rate

Due to endotoxin release/cytokine cascade

Tx: supportive care, bed rest, NSAIDs
-self limiting
Term
Which is worse: the first episode or the recurrent episodes of genital herpes simplex virus?
Definition
First episode: painful ulcers with flu-like sx

Recurrent episodes are usually milder and shorter + have a prodrome in ~50% of cases so can get treated sooner
Term
Genital Herpes is most commonly caused bu HSV-1 or HSV-2
Definition
HSV-2

NOTE: this is also the strain that is more likely to cause recurrent infections
Term
What is a major advantage of treating genital herpes recurrences?
Definition
Reduce viral shedding which limits the risk of transmission

Maximal benefit when treatment is initiated early-management of symptoms
Term
What are two possible treatment regimens for herpes?
Definition
Treating each episode on a case by case basis

Continual long-term suppressive therapy (good for more severe)
Term
Agents use to treat herpes episodically
Definition
Acyclovir 400 TID x 7-10
Acyclovir 200 5xdaily x 7-10
Famciclovir 250 TID x 7-10
Valcyclovir 1 g BID x 7-10

If recurrent episode - use same drugs but usually only require treatment for 5 days
Term
Options for long-term suppressive therapy for herpes
Definition
Acyclovir 400 BID
Famciclovir 250 BID
Valcyclovir 500 or 1 g QD
Term
How do you treat a severe herpes infection
Definition
Acyclovir 5-10 mg/kg IV Q8H x2-7 days or until improvement

Follow up with PO therapy to complete a 10 day regimen (can go up to 14 days, or until improvement)
Term
If someone presents with deafness and confusion, which STD would you suspect they have?
Definition
Syphilis
Term
What are two instances when you want to always was to desensitize
Definition
1. Necrotizing facitis
2. Tertiary syphilis

Both with penicillin
Term
C. diff is most commonly transmitted how?
Definition
fecal-oral route
Term
Which antibiotic is associated with a high prevalence of C.diff diarrhea?
Definition
Clindamycin


Others: FQ, 3rd/4th gen Ceph, broad-spectrum Pen
Term
What is the first line treatment for C.diff diarrhea?
Definition
Vancomycin 125 mg PO Q6h

remember: never IV for GI vanc
Term
Microbiology of C.diff
Definition
G+ spore forming anaerobe

endotoxins: detected by PCR
Toxin A (TcdA): osmotic changes/secretions
Toxin B (TcdB): mucosal damage/inflammation
Term
Symptoms of C.diff diarrhea
Definition
watery diarrhea
abdominal pain
nausea
leukocytosis
fever
Term
Risk factors for C.diff diarrhea
Definition
*Antibiotic use
*Contact with C.diff spores
*Gastric acid suppression (PPIs)
Advanced age
Immunosuppresion (Chemo)
Female gender (unknown why)
Prolonged hospital/healthcare exposure

* = modifiable
Term
Issues that we are now facing with C.diff treatment
Definition
Resistance (ex: with FQ)

Increased virulence via more toxin production (loss of suppressor gene)

NAP1/BI/027 - resistant strain
Term
What are some non-drug considerations/treatments for C.diff treatment
Definition
1. D/c antibiotic if possible
2. Do NOT use antidiarrheal or antiperistaltic (loperamide, metoclopramide)
3. Do NOT use anion-exchange resin (cholestyramine - binds vancomycin)
4. Isolate patient with contact precautions
5. Disinfect hands with SOAP AND WATER (no alcohol sanitizers - cant kill spores)
Term
T or F: When treating for Gonorrhea (either diagnosed or suspected) you should always treat for chlamydia too BUT when you have a diagnosis of Chalmydia you do not have to treat for Gonorrhea.
Definition
T - if just suspect chlamydia still treat for both, but if you know it is chalmydia, dont have to treat for gonorrhea

(refer to discussion board)
Term
What constitutes mild/moderate C.diff infection?

What is the treatment?
Definition
WBC<15,000 and SCr<1.5x baseline (normal)

Metronidazole 500 mg PO Q8H x10-14 days
Term
What is the treatment of an elderly person with C.diff?
Definition
Automatically classified as Severe

Vancomycin 125 mg PO Q6H x10-14 days
Term
What are the classifications for Severe C.diff diarrhea?

What is the treatment?
Definition
WBC>15,000 and SCr >1.5 (inflammation and kidney dysfunction)
OR if they are elderly


Vancomycin 125 mg PO Q6h x10-14 days
Term
Examples of complicated C.diff infection

What is the treatment?
Definition
Hypotension or shock
ileus
megacolon

Vancomycin 500 mg PO or NGtube Q6H AND Metronidazole 500 mg IV Q8H x10-14 days

**If ilues present consider rectal administration of vancomycin
Term
T or F: if you only have IV vancomycin on hand, you can not treat C.diff infection
Definition
F - the IV formulation can be given PO
Term
If get a 2nd recurrence of C.diff infection, you should not treat with metronidazole for a 3rd time, why?
Definition
Potential neurotoxicity (increased risk)

peripheral neuropathy
Term
When is metronidazole present in higher concentrations during the treatment of a C.diff infection?
Definition
At the beginning - higher concentrations found in water diarrhea (as infection improves, concentration of flagyl falls)
Term
Which is more effective for the treatment of C.diff, vancomycin 125 Q6H or 500 mg Q6h?
Definition
Both are equally effective - so give 125 mg since probably more tolerable and cheaper

(But the 500 mg is seen in practice)
Term
T or F: fecal drug concentrations after PO administration of metronidazole may be reduced in the presence of shock, ileus, or megacolon with a C.diff infection.
Definition
T - so for complicated infections give metronidazole IV and vancomycin PO/NG
Term
What is the most likely cause of C.diff relapse
Definition
Spore germination
Term
What is an alternative to vancomycin and metronidazole for C.diff infection
Definition
Fidaxomicin

-macrolide - inhibits RNA polymerase (transcription inactivation)
-PO, minimal absorption
-no activity against B.frag or enterococcus (less disruption of normal flora

$$$$ and just as effective as vancomycin
Term
What are some things that can be employed with recurrent C.diff infections?
Definition
Taper and Pulse vancomycin
Supplemental probiotics
Nitazoxanide
Adjuvant rifaximin
Fecal microbiota transplant
IVIG (iv immunoglobulins)
Term
General outline of vancomycin taper and pulse dosing?

Why is it thought to work?
Definition
1. Taper - start with 125 mg Q6h -->Q12h x7days --> Q24h x 7days
2. Pulse - 125 mg q48h x7 --> Q3days x2-8 weeks

NO vancomycin promotes spores to germinate - then give vanc to kill live cells
Term
When should nitazoxanide be used for a C.diff infection?
Definition
Approved for diarrhea associated with Cryptosporidia and Giardia

Shown to work with metronidazole failure, comparable to vancomycin
Term
When has rifximin been used in C.diff infections?
Definition
Rifaximin "Chaser" Protocol: give for 2 weeks immediately after completion of last C.diff treatment and before recurrence of symptoms (used to prevent relapse)

ONLY USE ONCE - acquired resistance has been seen after initial treatment

Approved for traveler's diarrhea due to noninvasive E.coli
Term
T or F: Treatment with Fecal Microbiota Transplant in not very effective.
Definition
F - 94-100% cure rate

It restores normal flora, reduces drug costs, low technology procedure
Term
T or F: low IgG concentrations are associated with symptom development in patients colonized with C.diff
Definition
T

and IgM is low in patients with repeated recurrences
Term
T or F: IV immunoglobulin administration is a very effective way to treat recurring C.diff infections
Definition
F - seen to be modestly effective in providing passive immunity in patient with recurrent C.diff infection
Term
Which is associated with less recurrence of C.diff infections, vancomyin or fidaxomicin?
Definition
Fidaxomicin (but $$$$)
Term
Which beta-lactams cause the worst collateral damage? What do they cause?
Definition
3rd generation Ceph (oximinocephalosporins)

Cefotaxime, ceftazidime, ceftriaxone

ESBL production
Selection of stably de-repressed isolates in SPACE bacteria
Selection of VRE
Contribution of MRSA emergence
Increased cases of C.diff associated with diarrhea/colitis

Carbapenems also cause much collateral damage
Term
What is the single most effective measure to prevent spread of resistant organisms
Definition
hand hygiene
Term
Core members of the Antimicrobial stewardship team
Definition
ID physician (director/co-director)
Clinical pharmacist with ID training (co-director)

-Microbiologist
-Information system specialist
-Infection control professional
-Hospital epidemiologist
Term
What are the two active core strategies of antimicrobial stewardship?
Definition
1. Prospective audit with intervention and feedback to reduce inappropriate antimicrobial use
2. Formulary restriction and pre-authorization leading to reductions in antimicrobial use and cost

Neither is mutually exclusive
Term
What is prospective audit with intervention and feedback
Definition
When a pharmacist (or someone else) looks at the prescribed ID treatment for a patient. If it is inappropriate, the pharmacist lets the physician know and offers some alternative agents
Term
What is formulary restriction and pre-authorization?
Definition
Mechanism of antimicrobial stewardship where the hospital formulary is restricted to several antibiotics and if a prescriber wants to go outside of these antibiotics, they must get authorization
Term
What are some additional strategies for antimicrobial stewardship apart from prospective audit and formulary restriction with pre-authorization?
Definition
1. Educational programs
2. Parenteral to oral conversion
3. Creation/implementation of guidelines
4. Antimicrobial order forms
5. Streamlining/de-escalation (when susceptibilities come back)
6. Dose optimization (based on PK/PD)

Combination therapy and antimicrobial cycling have insufficient evidence to support their use as stewardship strategies
Term
Vancomycin MOA
Definition
MOA: inhibits cell wall synthesis - binds to substrate (not enzyme like BL) D-ala-D-ala

Bactericidal and time dependent
Term
Vancomycin indication restriction (UKCMC)
Definition
1. Serious or life threatening infections due to beta-lactam resistant G+ organism 2. Patient with serious beta-lactam allergy 3. PO for colitis that fails metronidazole therapy or if severe 4. Unexplained fever (>101F or 100.4 over 1 hr - PO) in neutropenic patients **Before doing all the calculations make sure vanc in indicated
Term
Which is a bigger concern with vancomycin, nephrotoxicity or ototoxicity?
Definition
Nephrotoxicity (increased risk with other nephrotoxic drugs)
Term
Therapeutic target ranges for vancomycin
Definition
Trough: 10-20 mg/L
Peak: 20-40 mg/L

NOTE: clinically, if trough = 20, then peak will be over 40
Term
Three big ADRs concerning vancomycin (IV)
Definition
1. Ototoxicity
2. Nephrotoxicity
3. Infusion rxn (Red Man's syndrome) - associated with tachycardia, hypotension
Term
If want to premedicate against infusion rxn related to vancomycin what would you give?
Definition
H2RA or Antihistamine (Benadryl)
Term
Do you need to adjust the dose of vancomycin if the patient has hepatic failure?
Definition
No, it is not metabolized

only adjust in renal disease
Term
How much time is vancomycin usually infused over? When is the distribution phase assumed to be complete?
Definition
It is infused over 1 hour (at least).

Distribution is assumed to be complete after 2 hours from the start of infusion
Term
T or F: with vancomycin there is a strong correlation between ABW and Vd/Cl
Definition
T - use ABW in Salazar Corocan Equation for CrCl
Term
Patients with expected altered vancomycin PK
Definition
1. Obese - increased Cl (need bigger doses)
2. Renal failure - decreased Cl
3. Dialysis - hemodialysis does not significantly remove vancomycin from plasma; high-flux dialysis may remove
4. Surgery/Critically Ill/Burn - increased Cl (hypermetabolic), high incidence of renal failure
5. Age - Vd/Cl varies with age; lower doses in elderly
Term
What is the key PK component examined in vancomycin dosing?
Definition
troughs - at steady state (after 4th dose)

minimum of 10 mg/L but 15-20 mg/L for complicated (includes MRSA)

for MIC = 1, target trough >15 mg/L to achieve AUC/MIC = 400
Term
Typical dose of vancomycin?
Definition
Maintenance: 15-20 mg/kg/dose Q8-12H (with normal renal function)

Cap at 2 gm/dose for obese

Loading dose = 25-30 mg/kg
Term
T or F: you need to monitor peak concentrations to watch for nephrotoxicity in vancomycin
Definition
F
Term
T or F: You need to monitor a patient who will be on vancomycin for 2 days
Definition
F - only if taking for 3+ days
Term
What is the definition of nephrotoxicity with vancomycin?
Definition
An increase in SCr of 0.5 mg/dL or >50% increase from baseline, whichever is greater AFTER SEVERAL DAYS of vancomycin (if just 48 hr prob not due to vanco)
Term
When should you monitor for ototoxicty with vancomycin
Definition
When it is given with other ototoxic drugs, not with monotherapy
Term
T or F: vancomycin monitoring is required for therapy with target troughs under 15 mg/L
Definition
F
Term
How often should you monitor vancomycin levels in hemodynamically unstable patients?
Definition
once weekly
Term
In general, what is the dosing change required for Pediatrics with vancomycin and why?
Definition
They have larger volumes of distribution, but kidneys arent working all the way - so give a higher dose and extend the interval
Term
How often should you draw a vancomycin level for uncomplicated and complicated patients?
Definition
Uncomplicated - once every 2 weeks
Complicated - once every week
Term
What other labs should be monitored with vancomycin therapy
Definition
Scr and BUN twice weekly (if complicated Q48H)
Term
T or F: you should always obtain a vancomycin trough for obese patients?
Definition
T - considered to have altered Cl
Term
T or F: you always need to monitor vancomycin troughs when treating pneumonia?
Definition
T - considered life threatening/need higher doses to penetrate to site
(meningitis, endocarditis, pneumonia, sepsis, osteomyelitis)
Term
What are the three types of osteomyelitis
Definition
1. Hematogenous: non-injury/mainly kids
2. Contiguous: injury-caused
3. Peripheral Vascular Disease
Term
Which type of osteomyelitis is most common in children?
Definition
Hematogenous

hair-pen turns in bones
Term
Is osteomyelitis acute or chronic?
Definition
Can be either

Chronic if over 1 week
Term
If an adult has hematogenous osteomyelitis, where is it most likely to have occurred?
Definition
Vertebrae (small hairpin turns in these bones)
Term
Symptoms associated with osteomyelitis
Definition
Local: tenderness, swelling, pain

Systemic: fever, chills, malaise, decreased ROM (will always be present, but less prevalent in diabetic foot ulcer)
Term
What labs should be obtained if osteomyelitis is suspected?
Definition
Culture from bone aspirate
Culture potential sources (ex: if wound)
Blood culture

bone scan - can show disease in 1 day
Radiograph - not seen until day 14 of infection (still always get)

**do an MRI if vascular insufficient osteomyelitis (dye cant get to site easily) instead of bone scan
Term
If a patient suspected of having osteomyelitis gets a radiograph and the results are negative, does it mean they dont have osteomyelitis?
Definition
Not necessarily - radiograph wont be useful until day 14 of infection.
Term
What is one of the most important things to look at when deciding what to treat with for osteomyelitis?
Definition
Bone culture! always get one!
Term
Mechanism of the development of hematogenous osteomyelitis
Definition
Kids or vertebral = small bones

Slowed blood flow through hairpin turns of vasculature at growth plate
-Cause avascular necrosis, infection, exudate in bone

over 50% have positive bone culture
Term
Pathogens of hematogenous osteomyelitis?
Definition
Biggest cause: S.aureus
Other in kids: H.flu, S.pyogenes (neonates)
Other in Adults: E.coli, M.tb

IV drug users: G-, often in combination (Pseudomonas)
Sickle Cell: Salmonella (S.aureus, G-)
Term
What is the greatest cause of hematogenous osteomyelitis is people with sickle cell?
Definition
Salmonella - from GI tract
Term
What agent is incorporated into any empiric treatment of hematogenous osteomyelitis?
Definition
Vancomycin (because Staph is most prevalent)

Also include Cefepime/3rd gen Ceph if G- on gram stain (H.flu, E.coli)

Alternatives: bactrim or linezolid
Term
What drug should be used to treat hematogenous osteomyelitis in sickle cell patients?
Definition
Usually cipro or levofloxacin (Cover salmonella)
Term
What is the most common pathogen in contiguous osteomyelitis?
Definition
S. aureus (remember, common on skin and this type is caused by an injury)
Term
What are typical pathogens in contiguous osteomyelitis?
Definition
S. aureus
Strep, S.epidermidis
PEcK, Pseudomonas
Anaerobes

Usually multiple organisms if vascular insufficiency (+ enterococcus risk)
Term
What is the gold standard in imaging for suspected osteomyelitis in diabetic foot infections?
Definition
MRI (bone scan if contraindicated/unavailable)
Term
Is recurrence common in osteomyelitis?

What is recurrence associated with for osteomyelitis?
Definition
YES! major problem (~30%)

Correlated with Pseudomonas and use of vancomycin for Staph aureus
Term
What are two critical dosing considerations when treating osteomyelitis?
Definition
1. Must use HIGH doses to get a high enough concentration in bone (can use impregnanted bone cement/spacers)
2. Adequate duration:
-1-3 weeks: if no residual infected bone
-4-6 weeks: if there is some residual infected bone
-over 3 months: if no surgery
Term
When can oral therapy be used, specifically in osteomyelitis?
Definition
When compliance can be ensured
When good response to IV therapy
Term
Treatment of osteomyelitis with vascular insufficiency?
Definition
Treat like diabetic foot:
-go by the severity classifications for DFI
-must cover staph! (not necessarily MRSA)
-consider covering anaerobes if deep (zosyn, metronidazole, aug)
Term
Empiric therapy for contiguous osteomyelitis without vascular insufficiency
Definition
Foot bone: Levofloxacin OR Cefepime +/- Vancomycin (covers G- and G+)

Long Bone: Vancomycin OR Linezolid + cefepime (DEF COVERING MRSA)
Term
In general, recent antibiotics use increases the chance of what kind of pathogen causing the infection?
Definition
gram negative bacteria
Term
MOA of aminoglycosides
Definition
interfere with protein synthesis by binding to ribososmal subunits

bactericidal, concentration-dependent killing with post-antibiotic effect
Term
Indications for aminoglycosides
Definition
aerobic gram-negative bacilli
SPACE

typically used for synergy with beta-lactams

different dosages for G- (target therapy) or G+ (synergy)
Term
Which toxicity associated with aminoglycosides is reversible/irreversible
Definition
nephrotoxicity = reversible
ototoxicity = irreversible
Term
Ways to minimize aminoglycoside toxicity
Definition
-limit total cumulative dose
-use alternative drugs if available for high risk patients/sensitivities known
-monitor renal function tests
-avoid volume depletion
-avoid concomitant nephrotoxic/ototoxic drugs
-PK monitoring/dosing
-QD dosing might be better (maybe)
Term
How long is the distribution phase for aminoglycosides?
Definition
Conventional dosing: 1 hour after start of infusion
Once-Daily Dosing: 2 hours
Term
Normal half-life of aminoglycosides
Definition
2-3 hours
Term
How is renal function monitored when a patient is on an aminioglycoside? How often?
Definition
SCr/BUN are measured

at least twice weekly

Monitor other signs too
Term
How often should a peak and trough be drawn and measured when a patient is on aminoglycoside therapy (>2 weeks)
Definition
once weekly
Term
T or F: the peritoneum is usually a sterile space
Definition
T
Term
What are the three classes of peritonitis?
Definition
Primary: spontaneous, unidentified sourse (common in alcoholics)
Secondary: perforation in GI tract, uterus, or urinary tract INJURY
Tertiary: persistent or recurrent infection after surgery or antimicrobial therapy
Term
If there is peritonitis due to colon perforation, what must be covered?
Definition
B.frag (anaerobes)
Term
What are the two types of primary peritonitis?
Definition
1. Cirrhotic Origin 2. Dialysis origin
Term
What are the usual organisms for the two types of primary peritonitis?
Definition

Cirrhotic:

-E.coli (*)

-Klebsiella

-Strep

 

Dialysis (from skin/plastic)

-Staph (*)

-Strep

-Some enteric G-

Term
What is a good therapeutic option for treatment of cirrhotic peritonitis?
Definition
Ceftriaxone (covers E.coli, Klebsiella, Strep) x 5-10 days
Term
Which do you treat longer, cirrhotic or dialysis caused primary peritonitis?
Definition
Dialysis (10-14 days) [cirrhotic = 5-10 days]
Term
Which carbapenem doesnt cover pseudomonas?
Definition
Ertapenem
Term
Possible antimicrobial regimens for healthcare-associated infections (intraabdominal infection)
Definition

Zosyn

Antipseudomonal carbapenems (all but Erta)

3rd/4th gen Ceph + metronidazole

FQ + metronidazole

 

Pseudomonas and Anaerobes

Term
Candida is often cultured with intraabdominal infections, should it be treated?
Definition
Not usually, unless immunosuppressed
Term
When should you cover enterococcus in peritonitis?
Definition
NOT for most community-acquired peritonitis
Cover if patient has VRE or are immunocompromised
Term
Does zosyn or ceftriaxone cover psuedomonas?
Definition
zosyn does
ceftrixaone does not cover Pseudomonas
Term
What antibiotics cover anaerobes
Definition
metronidazole
Tigecycline
Zosyn
Term
How would Aspergillus be described by the lab?
Definition
Septate hyphae
Conidia/spores

flat,velvety consistancy
Term
What does hyaline hyphae mean?
Definition
non-pigmented fungi
Term
What does dematiaceous fungi mean?
Definition
pigmented fungi (produce melainin)
brown or black coloring
Term
What type of patients are fungal infections commonly seen in?
Definition
Immunocompromised
Term
How would the lab describe Zygomycetes?
Definition
Aseptate hyphae
Rapid growth (compared to Aspergillus)
Sporangium formation (sac-like structure containing spores)
Term
What two types of dimorphic fungi do we need to be concerned with Kentucky?
Definition
Histoplasma
Blastomyces
Term
How are dimorphic fungi usually transmitted?
Definition
Inhalation
Term
Dimorphic fungi can be either mould-like or yeast-like, what environmental conditions decide this?
Definition
At environmental temps: mould

At body temps: yeast
Term
What advantage did the lipid formulations of Amphotericin B have over the original formulation?
Definition
They are equally effective, they are less toxic
Term
What is itraconazole used for (DOC)
Definition
Dimorphic fungi
Term
What patients still use conventional amphotericin B?
Definition
Only dialysis patients (because lipid formulations are expensive and their kidneys are already dying)
Term
Which antifungal has the broadest spectrum of activity?
Definition
Posaconazole
Term
What is the DOC for Aspergillus?
Definition
Voriconazole
Term
What toxicities are associated with Amphotericin B?
Definition
nephrotoxicity (70% of people taking the conventional form) - less with kids

infusion-related toxicity: slow it down (fever, chills, rigors, N/V, myalgias)
Term
How is the infusion-related toxicity of Amp B managed?
Definition
Low-dose corticosteroids
APAP
Meperidine (rigors)
Term
How is the nephrotoxicity of Amp B managed?
Definition
Hydration/salt loading
USE LIPID PRODUCT
Term
MOA of Amp B compared to Azoles
Definition
Amp B: binds to ergosterol and creates pore in membrane

Azoles: prevents synthesis of ergosterol

Both at high doses will start to target cholesterol too--not seen with echinocandins because they target cell wall, which humans dont have
Term
What is the conventional dose and lethal dose of Amp B? What is the liposomal dose?
Definition
Conventional: 0.5-1 mg/kg
Lethal Dose: 3 mg/kg

Liposomal Dose: 3-5 mg/kg
Term
What is fluconazole DOC for?
Definition
Candida
Term
Spectrum of activity of fluconazole
Definition
Candida and Cryptococcus
Term
What are the dosage forms of itraconazole?
Definition
Solution: empty stomach and tastes bad
Capsule: FATTY meal in acidic environment
Term
When on itraconazole, do you need to monitor kidney or liver function?
Definition
BOTH

Renal - cyclodextrine is the solvent used and is toxic to kidney

Hepatic - BIG drug interactions (3A4)
Term
Which anti-fungal has the WORST drug interaction profile?
Definition
Voriconazole

substrate and inhibitor of 3A4, 2C9, 2C19
Term
When on voriconazole what should be monitored? (kidney?Hepatic?)
Definition
BOTH

Kidney: cyclodextrin solvent (can cause multiorgan failure); contraindicated in renal failure

Hepatic: BIG DRUG INTERACTIONS
Term
What is the dosage form of posaconazole and how is it administered?
Definition
Oral solution

MUST be taken with high fat meal (50g) BID-QID
Term
What is posaconazole used for?
Definition
Zygomyces
Term
Spectrum of activity of echinocandins?
Definition
Aspergillus
Candida

(fairly narrow spectrum)
Term
What are some echinocandins?
Definition
Micafungin
Capsofungin
Anidulafungin
Term
Toxicities associated with echinocandins?
Definition
none, very low toxicity -very safe
Term
What drug is typically added as a second agent in fungal infections to enhance efficacy?
Definition
Echinocandins
Term
What are the three 'recipes' for AIDS therapy?
Definition
2 NRTI + 1 NNRTI
2 NRTI + 1 PI
2 NRTI + 1 II

**if not on one of these regimens, the the patient probably has resistance**
Term
What antibiotics cover Pseudomonas?
Definition
Pip/Tazo
Ceftazidime
Cefepime
Imipenem/Meropenem
Aztreonam
Aminoglycosides (in combo)
Term
What antibiotics have anaerobic coverage
Definition
Metronidazole
Tigecycline
Beta-lactam + beta-lactamase inhibitors (ie Pip/Tazo, Amp/Sul, Amox/Clav)
Cefoxitin
Carbapenems
Moxifloxacin
PO Vanco (C.diff)
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