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Test IV Drugs
Test IV Drugs
88
Pharmacology
Graduate
04/11/2012

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Term
Natural Penicillins
Definition
-Penicillin G
-Penicillin V
Term
Penicillin G & V
Definition
-IM or IV
-Used for Gram +/-, anaerobes
-Common uses: gas gangrene, strep pyogenes, pasteurella muctocida, *Syphilis
-Do not used with: Beta-lactam producing organsisms
Term
Anti-Staph PCNs
Definition
Heard my "CD MON"?
-Cloxacillin (PO)
-Dicloxacillin (PO)
-Methacillin (OFF MARKET)
-Oxacillin (IV)
-Nafcillin (IV)
Term
Clox, Diclox, Oxa, Naf
Definition
-Used for: Staph infections (MSSA)
-Do not use with: MRSA
Term
AminoPCN
Definition
-Ampicillin (PO, IV, IM)
-Amoxicillin (PO)
Term
Amp, Amox
Definition
-Ampicillin used for: Listeria Meningitis, Infectious Endocarditis

-Amoxicillin used for: PUD, otitis, sinusitis
Term
Anti-Pseudomonal PCN
Definition
-Piperacillin
-Ticarcillin
-Mezlocillin
-Carbenicillin
Term
Piperacillin, Tic, Mez, Carb
Definition
-Broad spectrum
-Often used for: pseudomonas, klebsiella
Term
Beta-Lactamase Inhibitors
Definition
-Clavulanic Acid (PO)
-Sulbactam (IV)
-Tazobactam (IV)
Term
Clav acid, sulbac, tazobac
Definition
-Broaden antibacterial spectrum
-Used for: DM foot ulcers, Biliary infxn, human bites, peritonitis, lung abscess from aspiration, pseudomonas burn wound infxn, nosocomial pneumonia
Term
1st Gen Cephalosporin
Definition
Cefazolin
Term
Cefazolin
Definition
-Best Gram + coverage
-Often used for post-op prevention
Term
2nd Gen Cephalosporin
Definition
-Cefamadole
-Cefmetazole
-Cefotetan
-Cefoxitin
Term
Cefa, Cefmeta, Cefot, Cefox
Definition
-Post-op infxn prevention
-Mostly works on lower abdominal and GI
-SE: some cause bleeding
Term
3rd Gen Cephalosporin
Definition
-Cefoperazone
-Ceftazidimine
-CetriAXone
-CefotAXimine
Term
Cefop, Ceftaz, AXes
Definition
-Better Gram - coverage
-Lyme Dz
-CAP
-Peritonitis
-Meningitis
-Sepsis
-SE: Kernicterus (don't give during pregnancy), Gallbladder sludge, bleeding, C. Diff
Term
4th Gen Cephalosporins
Definition
-Cefepime
-Ceftazidine
-Ceftobiprole
Term
Cefep, Cefta, Ceftob
Definition
-Equal Gram +/- coverage
-Often used for Pseudomonas aeruginosa
-Cefepime has good CNS penetration for CNS infxn
Term
5th Gen Cephalosporins
Definition
-Cephtobiprole
Term
-Ceph
Definition
-Can cover GPC, GNR, including MRSA
-Do not use with Extended spectrum Beta-Lactamases
Term
Carbapenems
Definition
-Imipenem--Cilastatin (IV or IM)
-Meropenem
-Ertapenem
Term
Imipenem--Cilastatin
Definition
-Empiric Tx of Polymicrobial skin, lung, or abdominal infxn
-SE: seizures in 1%; avoid in PCN allergic - 10% cross-reactivity
Term
Meropenem
Definition
-Same spectrum as Imipenem BUT with lower risk of seizure
-Commonly used for: Meningitis
-SE: wicked hangovers
Term
Ertapenem
Definition
-Same spectrum as other Carbapenems BUT does not cover P. aeruginosa or acinobacter
-Only have to give QD (as opposed to the other two which are TID)
Term
Carbacephem
Definition
-Loracarbef
Term
Loracarbef
Definition
-Synthetic B-lactam similar to 2nd gen cephs
-Only really used for lower abdominal or GU tract infxns post-op
Term
Monobactams
Definition
-Aztreonam
Term
Aztreonam
Definition
-Only works with Gram -
-Safe for pts with PCN allergic rxns (except pts who reacted to ceftazidime)
Term
Nitroimidazoles
Definition
-Metronidazole
-Ornidazole
-Tinidazole
Term
Nidazoles
Definition
-Oral or Vaginal Gel
-BEST bacteriocidal activity against anaerobes
-BEST Tx of bacterial vaginosis
-Good for anaerobic infxns like Brain abscesses
-Tx for C. Diff pseudomembranous colitis
-SE: Major - seizure, encephalopathy, peripheral neuropathy, cerebellar toxicity
-Minor - metallic taste, rust-colored urine, gynecomastia
Term
Macrolides
Definition
-Erythromycin
-Clarithromycin
-Azithromycin
Term
Erythro, Clarithro, Azithro
Definition
-PO
-Tx for Pneumonia and URI
-Tx for non-gonococcal Urethritis (chlamydia)
-Tx for pulmonary infxn due to MAC
SE: GI upset, cholestatic hepatitis, hearing loss, PROLONGED QT-INTERVAL, C. Diff
Term
Ketolides
Definition
-Telithromycin
Term
Telithromycin
Definition
-Works on macrolide resistant bacteria
-Only indicated for pt >18 for Tx of CAP
-SE: **EXACERBATION OF MG, hepatotoxicity, LOC, visual disturbance
Term
Lincosamides
Definition
-Clindamycin
-Lincomycin
Term
Clinda, Linco
Definition
-Do a "D-Test"
-Used for: Lung abscesses, gas gangrene, bacterial vaginosis, acne vulgaris
SE: rash, urticaria, anaphylactic RXN, liver injury , C. Diff
Term
Glycopeptides
Definition
-Vancomycin
-Teicoplanin
Term
Vanc, Teico
Definition
-IV unless Tx of Pseudomembranous Colitis or Staph Enterococcus
-Used for: MRSA, Meningitis (combo w/ "AX" cephs), C. Diff
SE: phlebitis, "Red-Man syndrome", ototoxicity, nephrotoxicity, neutropenia
Term
Lipoglycopeptides
Definition
-Telavancin
Term
Telavancin
Definition
-Skin and Soft tissue infxn
-VRSA
-Rapidly bacteriocidal
Term
Oxazolidinones
Definition
-Linezolid
Term
Linezolid
Definition
-PO
-Used for CAP + HAP: PRSP, MRSA
-Do not use with: Gram -
SE: **SEROTONIN SYNDROME, myelosuppression
Term
Streptogramins
Definition
-Quinoprisin/Dalfopristin
Term
Quin/Dalf
Definition
-Only given through CV
-Gram +/-
-Do not give E. Faecalis
-SE: arthralgia, myalgia, caution with liver Dz
Term
Lipopeptides
Definition
-Daptomycin
Term
Daptomycin
Definition
-Gram + Bacteriocidal
-Used for: Skin infxn, R-Sided MRSA
-Do not use with: Pneumonia
Term
Aminoglycosides
Definition
-Streptomycin
-Neomycin
Term
Strepto, Neo
Definition
-1st Line for Gram - Rods and 2nd line for Mycobacterium TB
-Topical: Otitis externa, Conjunctivitis
-IV: Burn, nosocomial pneumo, DM foot infxn, Multi-Drug Resisitant TB
-IV or Inhaled: CF
-Do Not Use: Low pH or O2 tension environment
-SE: ototoxicity, neuromuscular blockade (DO NOT GIVE TO MG PT), nephrotoxicity
Term
Quinolones
Definition
-Ciprofloxacin
-Moxifloxacin
-Levofloxacin
Term
Floxacins
Definition
-Lev/Mox used as a single agent against CAP
-Upper or lower UTI/pyelonephritis
-GI infxns
-Do Not Use: Mox for UTI; Cipro for S. pneumo
-SE: Gi disturbance, PROLONGED QT INTERVAL, skin rxn, Tendonitis/Achille's tendon rupture
Term
Sulfanomides
Definition
-Sulfamethoxazole
-Silver Sulfadiazine
-Trimethropim/Sulfamethexazole (Bactrim)
Term
Sulfamethoxazole
Definition
-UTIs - combined with other compounds
Term
Silver Sulf
Definition
-Topical sulfanomide
-Burn creams
-Bacterial vaginosis and conjunctivitis
Term
Bactrim
Definition
-MSSA
-Used on organisms with + D-Test
-2nd line PCN allergic pt with Listeria
-UTI
-PCP, HIV prophylaxis
-SE: Steven Johnson's, G6PD anemia, kernicterus in newborns, hyperkalemia
Term
Tetracyclines
Definition
-Doxycycline
-Minocycline
Term
Doxy, Mino
Definition
-Most commonly used for CAP
-Chlamydia
-Lyme Dz (early)
-RMSF
-SE: GI, hepatotoxicity, photosensitivity, SLE-like syndrome, Teeth Discoloration (avoid in children/pregnant women)
Term
Glycocyclines
Definition
-Tigecycline
Term
Tigecycline
Definition
-NO resistants
-SE: teeth discoloration, hepatic impairment, interacts with warfarin and OCPs
Term
Polyenes
Definition
-Amphoterecin B
Term
AmB
Definition
-IV X 1 day
-"Amphiterrible"
-Broad spectrum antifungal
-Crypto: Give 2 wks then switch to Fluconazole for 3-6mths
-Zygomycetes: Give 2-6wks then switch to Pasoconazole for 3-6mths
-SE: nephrotoxicity - renal insufficiency by 30 days; Infusion toxicity - 50% of pts
Term
Azoles
Definition
-Fluconazole
-Voriconazole
-Itraconazole
-Posaconazole
Term
Fluconazole
Definition
-IV or PO
-Very good CNS penetration (Meningitis/Crypto) and urine penetration (UTI)
-1st choice for UTI
-1st choice for candida
-1st choice for Crypto
-2nd choice for: Histo/coccidio/blasto
Term
Voricanozole
Definition
-PO or IV
-Caution with IV in Pt with <50 creatinine clearance
-Decrease dose in hepatic cirrhosis
-Excellent CNS penetration
-1st choice for aspergillosis
-SE: Photosensitivity, increase light brightness
Term
Itraconazole
Definition
-PO
-Requires acid environment for adequate absorption
-Used for: toe nail fungus
-1st choice for "Endemic" mycosis: Hitso/coccidio/blasto
Term
Poasconazole
Definition
-PO
-Enhanced by High Fat Meal
-1st choice for zygomycetes after Tx with AmB
-Indicated for prophylaxis in immunosuppressed pt
Term
Echinocandins
Definition
-Micafungin
-Caspofungin
-Anidulafungin
Term
Fungins
Definition
-IV
-No activity against crypto
-Drug of choice for candida
-Use these initially and then step down to fluconazole and send pt home
Term
Flucytosine (5-FC)
Definition
-PO
-Common chemo drug
-Crypto: Use with AmB for 2 wks
-Candida Spp. endocarditis
-Monotherapy for UTI
-Rapidly develops resistance
-SE: Anemia, thrombocytopenia, bone marrow suppression; renal failure
Term
Terbinafine
Definition
-PO and Topical
-Alternative to Itraconazole
-Lipophilic
-Best activity against dermatophytes
-Used for: tinea capitis, athlete's foot, toenail infxn
-SE: GI upset, hepatoxicity
Term
Griseofulvin
Definition
-PO
-Active against dermatophytes
-Drug of choice for tinea capitis in children
-SE: Rash, GI upset
Term
M2 Inhibitors
Definition
-Adamantine
-Rimantadine
Term
Mantines
Definition
-Flu Tx
-Only active against Influenza A
-Increased Drug Resistance
-SE: confusion, insomnia, neuro effects
Term
Neuroaminidase Inhibitors
Definition
-Oseltamavir
-Zanamavir
-Peraminivir
Term
Mavirs
Definition
-Effective against Influenza A&B
-Start Tx within 48 hrs of symptoms
-Oseltamavir: (Tamiflu) best choice
-Zanamavir: >7yo; cannot use with pulmonary/respiratory comorbities
-Peraminivir: hard core, last ditch ICU pt (IV)
Term
HSV 1&2 Drugs
Definition
-Acyclovir
-Valacyclovir
Term
Acyclovir/Val
Definition
-Acyclovir: 5x/day
-Valacyclovir: suppressive or outbreak Tx; PO BID X 7 days
-Vala much better tolerated
Term
CMV drugs
Definition
-Ganciclovir
-ValG
-Cidofovir
-Foscarnet
Term
Ganciclovir/Val
Definition
-Selectively inhibit CMV DNA polyperase
-ValG is an orally available Pro-Drug
Term
Cidofovir
Definition
-HSV infxn resistant to Acyclovir
-CMV infxn with decreased WBC
-SE: nephrotoxicity; poorly tolerated overall
Term
Foscarnet
Definition
-Mostly for CMV retinitis (especially in AIDS pt)
-Acts against Herpes, HBV, HIV
-SE: nephrotoxicity; poorly tolerated overall
Term
ARV Classes
Definition
-NRTIs
-NNRTIs
-Integrase Inhibitors
-Protease Inhibitors
-GP120 Fusion Inhibitors
-CCR5 Inhibitors
Term
Goals of HIV Tx
Definition
-Improve quality of life
-Reduce HIV-related morbidity or mortality
-Restore and/or preserve immunologic fxn
-Maximally and durably suppress HIV viral load
-Prevent HIV transmission
Term
Viral Load
Definition
-Viral load <50: immune system is suppressing
-Cannot Dx from viral load; use for gauging infxn
-Check viral load before initiating ART; 2-4 wks after start/change of ART, then every 4-8 wks until suppressed to <200 copies; Every 3-4 mths with stable pt
Term
Who Needs a Genotype?
Definition
-Acute HIV infxn
-Chronic HIV infxn (at entry to care)
-Virologic failure during ART
-Suboptimal suppression
-Any Pregnant woman
Term
-Who Does NOT Need a Genotype?
Definition
-After discontinuation of ARVs (>4wks) -- "Haven't taken meds for 2 mths"
-Plasma HIV RNA <500 copies -- suppressed by immune system
Term
When to start ART?
Definition
-Hx of AIDS-defining illness
-CD4 count <350
-Pregnant
-HIV-associated nephropathy (HIVAN)
-Hep B (HBV) coinfxn
-->Pt must commit to lifelong therapy
Term
Preferred 3-Drug First Line Therapy
Definition
-1 NNRTI + 2 NRTI: Efavirenenz/Emtricitabine/Tenofovir
-Boosted PI + 2 NRTI: Atazanavir + Ritonavir + Emtricitabine/Tenofovir
-INSTI + 2 NRTI: Raltegravir + Emtricitabine/Tenofovir
-Pregnancy: Lopinavir + Ritonavir (BID) + Zidovudine
Term
Combo Toxicity
Definition
-Don't combine 2 "D" drugs
-Don't combine 2 "TC" drugs
-Don't combine d4T and ZDZ
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