naplex study tips

Acetylcholine

Agonist action = Increase SLUDD (salvation, lacrimation, urination, diarrhea/defecation and digestion) * pilocarpine, bethanechol

Antagonist action = Decrease SLUDD * atropine, oxybutynin

Acetylcholine

Agonist action = Increase HR, BP *nicotine

Antagonist action = Neuromuscular blockade *rocuronium

Epinephrine, Norepinephrine

Agonist action = smooth muscle vasoconstriction, INCREASE BP * phenylephrine, dopamine (dose-dependent)

Antagonist action = smooth muscle vasodilation, DECREASE BP * alpha-1 blockers = doxazosin, carvedilol, phentolamine

Epinephrine, Norepinephrine

Agonist action = DECREASE release of epinephrine and norepinephrine, DECREASE BP * clonidine, brimonidine

Antagonist action = INCREASE BP * ergot alkaloids, yohimbine

Epinephrine, Norepinephrine

Agonist action = INCREASE myocardial contractility, CO, HR *dobutamine, isoproterenol, dopamine (dose-dependent)

Antagonist action = DECREASE CO, HR * Beta-1 selective blockers - metoprolol and non-selective beta-blockers - propranolol, carvedilol

Epinephrine

Agonist action = Bronchodilation *albuterol, terbutaline, isoproternol

Antagonist action = Bronchoconstriction *non-selective beta-blockers

Dopamine

Agonist action = renal, cardiac and CNS effects * Levodopa, pramipexole

Antagonist action = renal, cardiac and CNS effects * first-generation antipsychotics *haloperidol, metoclopramide

Serotonin 5-HT

Agonist action = platelet, GI and psychiatric effects * triptans (sumatriptan)

Antagonist action = platelet, GI and psychiatric effects * ondansetron, second-generation antipsychotics (quetiapine)

Breaks down acetylcholine

Donepezil
Rivastigmine
Galantamine

Block acetylcholinesterase = increase in Ach levels used to treat Alzhimer's dz

Converts angiotensin I to angiotensin II (a potent vasoconstrictor)

lisinopril
ramipril

Inhibits production on angiotensin II = Decrease vasoconstriction and Decrease aldosterone secretion; used to treat HTN, HF and kidney dz

Breaks down levodopa

Entacapone

Blocks COMT enzyme to prevent peripheral breakdown of levodopa = Increase duration of action of levodopa

Tx Parkinson dz

converts arachidonic acid into prostaglandins = cause inflammation
and thromboxane A2 = causes platelet aggregation

NSAIDs - aspirin, ibuprofen

Block COX enzyme = Decrease prostaglandins and thromboxane A2

Tx pain/inflammation and Decrease platelet activation/aggregation (aspirin)

Breaks down catecholamines - DA, NE, epinephrine, 5-HT

TIPS

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid
Selegiline
Rasagline
Methylene blue
Linezolid

Block MAO = INcrease catecholamine levels (tx depression)

Toxic effects occurs - HTN crisis or serotonin syndrome

Converts vitamin K to the active form required for production of select clotting factors

Warfarin

Blocks Vitamin K epoxide reductase enzyme which = Decrease production of clotting factors II, VII, IX and X

Tx or prevent blood clots

breaks down hypoxanthine and xanthine into uric acid

Allopurinol

Blocks xanthine oxidase enzyme which = Decrease uric acid production

Prevent gout attack

what the drug does to the body
(effect that a drug has on the body)

Profound sedation
Respiratory depression
Coma
Death

What the body does to the drug (ADME)

with oral drugs = occurs in small intestine

through the blood and dispersed throughout the tissues

enzymatic reactions

removal of the drug or end products (metabolites) from body

G Love PACMAN

Grapefruit

Protease inhibitors - PIs = ritonavir

Azole antifungals = fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole and isavuconazonium

Cyclolsporine, cimetidine, cobicstat

Macrolides - clarithromycin and erythromycin (not azithromycin)

Amiodarone - and dronedarone

Non-DHP CCBs - diltiazem and verapamil

DECREASE metabolism

INCREASED serum concentrations and INCREASED clinical effect

INhibitors = INcreased effects/levels/ADRs/toxicities of substrates

DECREASED conversion to the active drug and decrease levels

Decrease dose of substrate (UNless Prodrug)

Use alternate drug to avoid combination

PS PORCS

Phenytoin

Smoking

Phenobarbital

Oxcarbazepine and eslicarbazepine

Rifampin and rifabutin, rifapentine

Carbamazepine = also AUTO-INDUCER

St. John's Wort

Increase metabolism

DECREASE serum concentrations and DECREASED clinical effect

InDucers = Decreased effects/levels of substrates

INCREASE conversion to the active drug and level increases

Increase dose of substrate (unless a PRODRUG)

Use alternate drug to AVOID combination

American College of Chest Physicians - CHEST
*Stroke prevention in AFib
*Venous Thromboembolism

American College of Cardiology/American Heart Association - ACC/AHA
*Acute Coronary Syndromes
*Atrial Fibrillation
*Heart Failure
*High Cholesterol
*Hypertension

American Association of Clinical Endocrinologists - AACE
American Diabetes Association - ADA

Infectious Diseases Society of America - IDSA
HI V/AIDS - US Dept. of Health and Human Services - AIDSInfo
Sexually transmitted infections - Centers for Disease Control - CDC

American Society of Clinical Oncology - ASCO
National Comprehensive Cancer Network - NCCN

The American Academy of Pediatrics - AAP

The American College of Obstetricians and Gynecologists -ACOG

American Psychiatric Association APA Diagnostic and Statistical Manual of Mental disorders - DSM-5

Asthma - Global Initiative for Asthma - GINA
COPD - Global Initiative for Chronic Obstructive Lung Disease - GOLD

Kidney Disease Improving Global Outcomes - KDIGO

Advisory Committee on Immunization Practices - ACIP
Centers for Disease Control - CDC

List of approved drugs that can be interchanged with generics based on therapeutic equivalence

Information on epidemiology and vaccine preventable diseases

News reports on regulatory, legislative, legal and business developments

List of biological drug products, including biosimilars

Drug pricing information

Summaries of pediatric infectious diseases, antimicrobial treatment and vaccinations

Information on the health risks of international travel, required vaccines and prophylaxis medications

Information on approved animal drug products

Methylphenidate - Daytrana - hip - QAM 2hrs prior to school

Nicotine - NicoDerm CQ -

Rivastigmine - Exelon

Rotigotine

Selegiline

Testosterone - nightly not on scrotum

Lidocaine - Lidoderm *1-3 patches, on for 12 hours, then off 12hours PRN

Nitroglycerin - on for 12-14 hours, then off for 10-12 hours

diclofenac

Estradiol (Alora, Vivelle-Dot)
Oxybutynin (Oxytrol)

Buprenorphine - Butrans

Clonidine - Catapres-TTS

Estradiol - Climara

Estradiol/Levonorgestrel

Ethinyl estradiol/Norelgestromin - Xulane - back, abdomen, or buttock *weekly for 3 weeks, off for the 4th week

Fentanyl - Duragesic - Q72H, if it wears off after 48H, change to Q48H

Scopolamine - Transderm Scop - Q72H, if needed

Leach Absorbs To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin

A DIAbetic Can't Eat Pie

Ampicillin
Daptomycin
Infliximab
Ampicillin/Sulbactam (Unysan)
Caspofungin
Ertapenem
Phenytoin

BOAS

Bactrim
Oxaliplatin
Amphotericin B
Synercid (Quinupristin/Dalfopristin)

GAL PLAT whose head is flat
Golimumab
Amiodarone
Lorazepam
Phenytoin
Lipids
Amphotericin B
Taxanes (except docetaxel )

(Dear Sweet Pharmacist, Freezing Makes Me Edgy)
Dexmedetomidine
SMX/TMP
Phenytoin - crystallizes
Furosemide - crystallizes
Moxifloxacin
Metronidazole
Enoxaparin

Protect Every Necessary Med from Daylight
Phytonadione
Epoprostenol
Nitroprusside
Micafungin
Doxycycline

INCrEASeD
Immunosuppressants
NSAIDS
Cocaine
Erythropoiesis-stimulating Agents
Amphetamine and ADHD drugs
Steroids
Decongestants - sudafed

Renal insufficiency/failure
Pregnancy
Excess salt intake
Obesity
Adrenal tumors

Antihypertensives
Vasodilators
Opioids
Benzodiazepines
Anesthetics
Phosphodiesterase inhibitors

Anaphylaxis
Blood loss
Infection (sepsis)
Dehydration (orthostatic hypotension)

Stimulants - ADHD, weight loss drugs
Decongestants
Beta agonists overuse
Theophylline
Anticholinergic - tricyclics, antihistamines
Bupropion
Antipsychotics
Excess caffeine/nicotine, illicit drug use
Vasodilators - nitrates, hydralazine, dihydopyridine CCBs

Arrhythmias - Afib, ventricular tachycardia
Hyperthyroidism
Anemia
Dehydration
Anxiety, stress, pain
Hypoglycemia
Infection
Drug withdrawal
Serotonin syndrome

Beta-blockers
Non-Dihydropyridine CCBs
Digoxin
Clonidine, guanfacine
Antiarrhythmics - class III
Opioids
Sedatives
Anesthetics
Neuromuscular blockers
Acetylcholinesterase inhibitors

Arrhythmias - sinus bradycardia
Hypothyroidism

Stimulants

Astma and COPD
Anxiety, stress
Keotacidosis
Pneumonia

Opioids
Sedatives

Hypothyroidism

Inhaled anesthetics
Antipsychotics
Topiramate

Fever
Hyperthyroidism - thyroid storm
Trauma
Cancer
Serotonin syndrome

Exposure to cold
Hypothyroidism - myxedema coma
Hypoglycemia

Untreated medical condition
Medications used without an indication
Improper drug selection
Dose that is too low or high
Therapeutic duplicaiton
Lack of patient understanding about medication
Drug allergy
Drug interaction
Improper use of medication
Failure to receive medication
Adverse drug reaction
Nonadherence

average

the value in the middle of the ranked ordered list

The value that occurs most frequently in a given data set.

the difference between the highest and lowest scores in a distribution

TRUE

TRUE

Statistical significance
Ex. Difference (95% CI)
38 (18-58) - No 0 = Statistical Significant

0.313 (-0.26-0.89) - Includes 0 = Not statistical significant

Statistical significance
Ex. Relative Risk (95%)
0.92(0.61-1.29) - includes 1 = Not statistical significant

0.85 (0.72-0.99) - No 1 = Statistically significant

Not statistical significant

Statistically significant

round up to 53

round down 41

Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine
Loop diuretics
NSAIDS
Polymyxins
Radiographic contrast dye
Tacrolimus
Vancomycin

CrCl (ml/min) = 140-pt age x wt kg / 72 x SCr x 0.85 if female

Use actual body weight if < IBW

Use IBW if normal weight (by BMI)

Use adjusted body weight if overweight by BMI

used for staging kidney disease and for dosing select drugs:
Metformin
SGLT2I
ACE inhibitors and ARBs for Albuminuria:
Who?
Why?
How?

Who = ALL patients with albuminuria

Why = To PREVENT kidney dz progression

How = Inhibit renin-angiotensin-aldosterone system RAAS, causing efferent arteriolar dilation

What = REDUCE pressure in the glomerulus, DECREASE albuminuria and provide cardiovascular protection

1. Stabilize the heart by using CALCIUM GLUCONATE (prevent arrhythmias)

2. Move it- Regular insulin, Dextrose, Sodium bicarbonate, Albuterol (shift K intracellularly)

3. Remove it - Furosemide, Sodium polystyrene sulfonate, Patiromer, Sodium zirconium cyclosilicate, Hemodialysis (eliminate K from the body)

2-3 Direct-acting antivirals DAAS with DIFFERENT MOA

-previr

P for PI

Glecaprevir, Grazoprevir, Paritaprevir, Voxilaprevir

-asvir

A for NS5A

Ledipasvir, Ombitasvir, Pibrentasvir, Velpatasvir

-BUVIR (B for NS5B)
dasabuvir
sofosbuvir

FALSE
has same MOA

TRUE

Protease Inhibitors & Grub (PIG) Take WITH FOOD

Acute
Fecal-oral
Vaccine
Supportive Tx

Acute and chronic
Blood, body fluid transmission
Vaccine
PEG-INF or NRTI (Tenofovir or entecavir) tx

Acute and chronic
Blood, body fluid transmission
No vaccine
Tx naive - DAA combination
DAA combination + RBV or
DAA combination + RBV + PEG-INF

Alfa - HBV. HCV and some cancers

Beta - Multiple Sclerosis MS

TRUE

Flu-like symptoms

BW - Neuropsychiatric, autoimmune, ischemic or infectious disorder if used with ribavirin, teratogenic/anemia risk

Inc. AST/ALT

Increased AST/ALT, Alk Phos, Tbili, LDH, PT/INR
Decreased albumin

Increased AST > increased ALT
Increased GGT

increased ammonia

increase Tbili

Never round until the last step in the calculation

teaspoon (5ml)

tablespoon (15ml)

30 mL

8 oz, 240 mL

16 oz, 480 mL

2 pints
960 mL

4 quarts
3,840 mL

2.2lbs

28.4g

454 g

65 mg

1 mEq = 1 mmol

1 mEq = 0.5 mmol

2.54 cm

100 cm

Numerators of both ratios have to be same unit.
Denominators of both ratios have to be same unit.

Match both numerators and both denominators
Match numerator and denominator of each fraction

4:8 = 4/8 = 1/2
or 1 part to 2 parts

B-PEMDAS
Billy, Please Eat Moms Delicious Apple Strudel
Brackets - Parentheses - Exponents - Multiplication and Division - Addition and Subtraction

Does the answer match the question
Is the answer in the correct units
Is the answer rounded correctly
Does the answer make sense

0.9% (w/v) NaCl

half normal saline 0.45%

0.22% normal saline

5% dextrose in water

20% dextrose in water

D5NS - 5% dextrose and 0.9% NaCl in water

D51/2NS - 5% dextrose and 0.45% NaCl in water

Na+ and Cl-

2 particles and Valence =1

Ca2+ and Cl- and Cl-
3 particles and Valence = 2

4 kcal

9 kcal

4 kcal

Ensure
Osmolite
Jevity
Glucerna

3.4

4.3

1.1 kcal/mL

2 kcal/mL

3 kcal/mL

4 kcal

5 x 12 = 60 inches + 6 = 66 inches

6 x 12 = 72 +3 =75 inches

ROME
1. Look at pH (acidosis - low or alkalosis - high)
2. Check the CO2 (resp. indicator) - less than 35 (alkalosis) more than 45 (acidosis)
3. Check the HCO3 (metabolic indicator) - less than 22 (acidosis) more than 26 (alkalosis)
4. Determine primary disorder (matches the pH)
5. Determine if its compensated (pH returns to normal or near normal)

Anti-infectives - aminoglycosides = INCREASE dosing, beta-lactam antibiotics excpe antistaphylococcal penicillins and ceftriaxone; Fluconazole, Quinolones except moxifloxcin and Vancomycin

Cardiovascular Drugs
LMWHs -enoxaparin
Rivaroxaban for AFib
Apixaban for AFib
Dabigatran for AFib

Gastrointestinal Drugs
H2RAs famotidine, ranitidine
Metoclopramide

Bisphosphontes
Lithium

Contraindicated Drugs IF:

CrCl < 60
-nitrofurantoin

CrCl < 50
-TDF (Stribild, Compera, Atripla, Symfi, Symfli Lo)
-Voriconazole IV

CrCl < 30
-TAF (Genvoya, Biktarvy, Descovy, Odefsey, Symtuza)
-NSAIDS
-Dabigatran (DTE/PE)
-Rivaroxaban (DVT/PE)
-SGLT 2 Inhibs (empaglizflosin, etc)
-Metformin
-Meperidine = *seizures*

Acetaminophen
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
NRTIs
Propylthiouracil
Tipranavir
Valproic Acid

Refers to a list of medicinal drugs, with preparation instructions

Sets the standards for preparation, strength, quality and purity of human and animal drugs, including both manufacutred and compounded drugs.

Antineoplastic Drugs - Chemotherapeutics

Non-Antineoplastic Hazardous Drugs on the NIOSH List
Abortifacient - Misoprostol
Antibiotics - Chloramphenicol, Telavancin
Antiocagulants - Warfarin
Antifungals - Fluconazole, Voriconazole
Antiretrovirals, HIV - Abacavir, Entecavir, Nevirapine, Zidovudine
Antivirals, Cytomegalovirus - Cidofovir, Ganciclovir, Valganciclovir
Acne -Isotrentinoin
Arrhythmias - Dronedarone
Autoimmune Conditions - Acitretin (psroasos), Leflunomide, Terflunomide, Fingolimod, Interferon Beta -1b
Benign Prostate Hypertrophy BPH - Dutasteride, Finasteride

Depression - Paroxetine
Diabetes - Exanetide
Dyslipidemia - Lomitapide

Seizures/Epilepsy
Clobazam, Clonazepam
Carbamazepine, Oxcarbazepine, Esilcarbazepine, Divalproex, Fosphenytoin, Phenytoin, Topiramate, Vigabatrin, Zonisamide

Gout - Colchicine

Heart Failure - Ivabradine, Spironolactone
Hepatitis - Ribavirin
Hormones - Androgens, Estrogens, Progesterones, SERMS, Ulipristal
Hypercalcemia of Malignancy - Pamidronate, Zoledronic Acid and osteoporsis
Hyperthyroidism - Methimazole, pROPYLTHIOURACIL

Insomnia - Temazepam, Triazolam

Migraine - Dihydroergotamine

Parkinson Dz - Apomorphine, Rasagline
Pulmonary Arterial Hypertension PAH - Ambrisentan, Bosentan, Macitentan, Riociguat

Renal Dz - Darbepoetin alfa

Schizophrenia - Ziprasidone

Transplant - Azathioprine, Cyclosporine, Mycophenolate, Tacrolimus, Sirolimus

COZY IV RM

Cholera
Oral Typhoid
Zoster - Zostavax
Yellow Fever
Intranasal Influenza
Varicella
Rotavirus
MMR

Vaccines can usually be given at the same time - same visit or same day (EXCEPT in pts with asplenia, Prevnar and Menactra should be be separated by 4 WEEKS)

Multiple live vaccines can be given on the same day or (if not given on the same day) spaced 4 WEEKS apart - EXCEPT NO separation is required for oral rotavirus vaccines

If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they CANNOT be shortened in most cases.

MMR and varicella-containing vaccines not zoster REQURIE Separation from antibody-containing products - Blood transfusions, IVIG

Vaccine --> 2 WEEKS --> Antibody-containing product

Antibody-containing product --> 3 months or longer --> Vaccine

Simultaneous administration - in the form of immunoglobulin

Hepatitis A
Hepatitis B
Rabies
Tetanus

Vaccinations may be given, if indicated in the following situations:
*Mild acute illness - slight fever, mild diarrhea
*Current antimicrobial treatment
*Previous local skin reaction mild/moderate from a vaccine
*Allergies - bird feathers, penicillin, allergies to products not in the vaccine
*Pregnancy - EXCEPT LIVE VACCINES, breastfeeding, preterm birth
*Recent tuberculin skin test
*Immunosuppressed person in the household, recent exposure to the disease or convalescence
*Family history of adverse events to the vaccine

All pts age >/= 6 months, unless CI

Any vaccine can be used within the FDA indications

All brand names have FLU in the name - Afluria, Fluzone, FluMist

Age 6 months - 8 years (NOT previously vaccinated) = give 2 DOSES (4 WEEKS Apart)

Patients with EGG ALLERGY = Can receive any age-appropriate INACTIVATED Influenza vaccine, even if severe allergy symptoms (wheezing, requiring epinephrine, hypotension or cardiovascular changes)

Administration should be supervised by a HCP who is able to recognize and treat severe allergic reactions. No additional observation period is recommended - beyond the required 15 minutes

FLUBLOK = Egg-Free product approved for age >/= 18 ONLY

Do NOT administer the LIVE influenza vaccine FLUMIST

Can receive ANY Age-appropriate INACTIVATED INFLUENZA Vaccine

DO NOT administer the LIVE Influenza Vaccine FLUMIST

FLUZONE HIGH-dosed
FLUZONE HIGH-dose Quadrivalent
FLUAD - adjuvanted influenza vaccine

Only once in their lifetime

Give 1 dose - if never received:
*Immunocompromised pts age 6-64 years (sickle cell dz, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids

*Can be considered in patients age >65

1, 2, or 3 doses

Give 1 dose BEFORE age 65 years:
*Immunocompetent patients age 2-64 (diabetes, heart, lung, or liver dz, alcohol abuse, smokers)

Give 2 doses BEFORE age 65 years:
*Immunocompromised patients age 2-64 (sickle cell dz, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids)

Give 1 dose at age >/= 65 years:
*ALL PATIENTS (whether 0, 1, or 2 doses were received before age 65)

*Bismuth subsalicylate 524-1050 mg PO 4 x daily WITH MEALS and at BEDTIME
*Antibiotics - Rifaximin preferred (ONLY use if high risk of complications from TD)

*Mild TD = Loperamide or Bismuth Subsalicylate

*Moderate TD = Loperamide +- antibiotics (Quinolones if low resistance, Azithromycin or Rifaximin)

*Severe TD (including dysentery) = Antibiotics (Azithromycin preferred, quinolones or rifaximin as alternatives) +- Loperamide

Hepatitis A - Havrix, VAQTA
Hepatitis B - Engerix-B, Recombivax HB
Hepatitis A/B - Twinrix
Japanese encephalitis - Ixiaro
Meningococcus - Menveo, Menactra
Polio - IPOL
Typhoid-IM -Typhim Vi

Cholera-PO (Vaxchora)
Typhoid-PO (Vivotif)
Yellow-fever-SC (YF-VAX)

More Lipid Soluble = w/o
<10

More Water Soluble = o/w
>10

Cocci:
*Clusters = Staphylococcus spp. (MRSA, MSSA)
*Pairs and chains = Strep. pneumonaie (diplococci), Streptococcus spp. (Strep. pyogenes), Enterococcuss spp. (VRE)

Rods:
*Listeria monocytogenes

Anaerobes:
*Peptostreptococcus
*Actinomyces spp.
*Clostridium (clostridiolides spp.)

purple

Chlamydia spp.
Legionella spp.
Myclopasma pneumoniae
Mycobacterium tuberculosis

Do not gram stain well

Cocci:
*Neisseria spp

Rods:
*Colonize gut enteric (Proteus mirabilis, E. Coli, Klebsiella spp., Serratia spp., Enterobacter cloacae, Citrobacer spp.

Rods:
*Do NOT colonize gut (Pseduomonas aeruginosa, Haemophilus influenzae, Providencia spp.

Coccobacilli
*Acinetobacter baumannii, Bordetella pertussis, Moraxella catarrhalis

Anaerobes:
*Bacteroides fragilis, Prevotella spp.

Curved or spiral shaped Gram-negative rods:
*H. Pylori, Campylobacter spp., Treponema spp., Borrelia spp., Leptospira spp.

Gram negative
Proteus
E. Coli
Klebsella

Gram negative
Haempophilus
Neisseria
Proteus
E. Coli
Klebsiella

Gram negative
Citobacter
Acinetobacter
Providencia
Enterobacter
Serratia; mouth flora (anaerobes) = Peptostreptococcus, Actinomyces

Susceptible or Sensitive
Antibodies with S can be an effective treatment
Pick most narrow-spectrum antibiotic that is safe for the patient and adheres to guidelines

Resistant
Antibodies with R should not be selected to treat the bacteria from the culture.

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae - ESBL, CRE
Acintobacter baumannii
Enterococcus faecalis, Enterococcus faecium - VRE
Staphylococcus aureus - MRSA
Pseudomonas aeruginosa

Avoid in patient with Beta-Lactam ALLERGY
*EXCEPT treatment of syphilis during pregnancy and in HIV patients with poor compliance/follow-up - desensitize and treat with benzathine penicillin

Increase risk of SEIZURES

Oral
First-line tx for STREP THROAT and mild nonpurulent SKIN INFECTIONS (no abscess)

Oral
First-line tx for ACUTE OTITIS MEDIA - (80-90 mg/kg/day)

Drug of Choice for INFECTIVE ENDOCARDITIS Prophylaxis before dental procedures (2 grams PO x 1, 30-60 minutes before procedure

H. pylori tx

Oral
First-line tx for ACUTE OTITIS MEDIA (90 mg/kg/day) and SINUSE INFECTIONS (if antibiotic indicated)

Use the lowest dose of calvulanate

Parenteral

Drug of choice for SYPHILIS (2.4 million units IM x 1)
NOT for IV use; can cause death

Parenteral/Oral

Dicloxacillin and Oxacillin
*Covers MSSA only - NO MRSA
*NO RENAL DOSE adjustment needed

Inpatient Parenteral
Only Penicillin ACTIVE AGAINST PSEUDOMONAS
Extended infusions - 4 hours can be used to maximaze T>MIC

Do NOT use if pt has PENICILLIN ALLERGY
*EXCEPT = Pediatric Patients with acute otitis media

SEIZURE risk

Outpatient oral
Skin Infections (MSSA)
Strep Throat

Outpatient oral
Acute Otitis Media
Commonly-acquired pneumonia (CAP)
Sinus Infection (if antibiotic indicated)

Outpatient oral
CAP
Sinus infection (if antibiotic indicated)

Inpatient Parenteral
Surgical Prophylaxis

Inpatient Parenteral
Anaerobic coverage - B. fragilis
Surgical Prophylaxis (colorectal procedures)
Cefotetan can cause a disulfiram-like reaction with alcohol ingestion

Inpatient Parenteral
CAP
Meningitis
Spontaneous Bacterial Peritonitis
Pyelonephritis

No renal dose adjustment

Neonates (age 0-28 days)
*causes biliary sludging, kernicterus

Active against PSEUDOMONAS

MDR Gram-negative organism including PSEUDOMONAS

ONLY beta-lactam ACTIVE against MRSA

ALL cover ESBL-producing organisms
ALL EXCEPT (ERTAPENEM) covers PSEUDOMONAS
DO NOT use with PENICILLIN ALLERGY
SEZIURE risk

Atypicals
VRE
MRSA
C. diff
Stenotrophomonas

PEA
*Pseudomonas
*Acinetobacter
*Enterococcus

- Polymicrobial infx (ex. diabetic foot infx)
- Empiric therapy when resistant organisms are suspected
- Resistant Pseudomonas or Acinetobacter infx (EXCEPT ertapenem)

ALL are IV ONLY

Normal Saline

Kill Gram-negative fast
Synergistic with beta-lactams for organisms
Low resistance and drug cost

Concentration-Dependent activity
Post-Antibiotic effect = bacterial killing continues after the serum level drops below the MIC

Toxicities:
*Renal damage
*Ototoxicity (hearing loss/tinnitusalance problems

Require monitoring

Levofloxacin
Moxifloxacin
Gemifloxacin

Pneumonia (reliable S. pneumonia activity)

Ciprofloxacin
Levofloxacin

Pseudomonas infections (including pneumonia)
UTIs
Intra-abdominal infections
Traveler's Diarrhea (without dysentery)

Only quinolone NOT RENALLY ADJUSTED
DO NOT use to tx UTIs

1:1

Caution with CVD
Decrease K/Mg and other QT-prolonging drugs (azole antifungals, antipsychotics, methadone, macrolides)

Avoid in patients with a SEIZURE hx or if using SEIZURE DRUGS

Avoid in children

Watch for tendon rupture, neuropathy, CNS or psychiatric side effects

AVOID sun exposure
SEPARATE from CATIONS
Monitor Blood Glucose - DM

CAP
Strep-throat - alt. to beta-lactams

Azthromycin - COPD exacerbation, mono for chlamydia, combination therapy for gonorrhea, prophylaxis for MAC, severe travelers diarrhea (including dysentery)

Clarithromycin - H. pylori

Erthromycin - increase gastric motility and used for gastroporesis

z-pack
two 250 mg tabs PO x 1
Then 250 mg PO daily x 4 days

QT prolongation
*caution with CVD
decrease K/Mg and other QT-prolongation drugs ( azole antifungals, antipsychotics, methadone, quinolones)

Clarithromycin and erythromycin are STRONG CYP3A4 Inhibitors; lovastatin and simvastatin are contraindicated (increase risk of muscle toxicity)

Doxycycline and minocycline - CA-MRSA skin infections and acne

Doxycycline first-line for lyme dz,
rocky mountain spotted fever (tick-borne illnesses)
CAP
COPD extractions
sinusitis ( if indicated)
VRE
UTI
monotherapy for chlamydia, combination therapy for gonorrhea

Tetracycline - H. pylori tx

Pregnancy
Breastfeeding
Children < 8 years old

CA-MRSA skin infections
UTI
Pneumocystis pneumonia (PCP)

5:1
Single strength = 80 mg TMP
Double strength = 160 mg TMP usual dose 1 tablet BID

SULFA ALLERGY
rash/hives common

rarely severe skin rxns SJS or TEN can occur
if rash with fever seek ER

INCREASE
use alt antibiotic

Nitrofurantoin ( Macrobid, Macrodantin)

CrCl < 60

MacroBID = BID
Macrodantin =QID

take with FOOD to prevent N/ cramping
can discolor urine - brown

Dicloxacillin
Nafcillin
Oxacillin
Cefazolin
Cephalexin
Amoxicillin/Clavulanate
Ampicillin/Sulbactam

SMX/TMP
Doxycycline
Minocycline
Clindamycin (D-test must be performed)
Linezolid

Vancomycin - use alt if MIC >/= 2
Linezolid
Daptomycin
Ceftaroline

Vancomycin - use alt if MIC >/= 2
Linezolid
Daptomycin (NOT in Pneumonia)

Pen G
Ampicillin
Linezolid
Daptomycin
Cystitis only = Nitrofurantoin, fosfomycin, doxycycline

Daptomycin
Linezolid
Cystitis only = Nitrofurantoin, fosfomycin, doxycycline

Pipercillin/Tazobactam
Cefepime
Cetazidime
Ceftazidime/Avibactam
Ceftolozane/Tazobactam
Carbapenems (except ertapenem)
Ciprofloxacin
Levofloxacin
Aztreonam
Aminoglycosides
Colistimethate
Polymyxin B

Carbapenems
Ceftolozane/Tazobactam
Ceftazidime/Avibactam

Ceftazidime/Avibactam
Colistimethate
Polymyxin B

Carbapenems (except ertapenem)

Beta-Lactam / beta-lactamase inhibitor

Metronidazole
Beta-lactam / beta-lactamase inhibitor
Cefotetan
Cefoxitin
Carbapenems

Vancomycin (oral)
Fidaxomicin

Azithromycin
Doxycycline
Quinolones

Antistaphylococcal penicllin - Dicloxacillin, Nafcillin
Ceftriaxone
Clindamycin
Doxycycline
Macrolides - Azithromycin and Erythromycin only
Metronidazole
Moxifloxacin
Linezolid

Treat Bacterial infections
Complete full course of therapy
Use measuring devices/syringe - do not use household spoons
Can cause - rash, nausea, diarrhea, including Clostridium difficile-associated diarrhea

Seizures

CNS effects, including Seizures
Hypo/hyperglycemia
Peripheral neuropathy
Photosensitivity
QT prolongation
Tendon inflammation (tendinitis) or tendon rupture
Avoid in pregnancy, breastfeeding and children
Drug interactions due to binding
Avoid consuming calcium-rich foods (dairy products) with the dose

GI upset
QT prolongation

Avoid in pregnancy, breastfeeding and children <8 years old
Drug interaction due to binding
Photosensitivity

Doxycycline (oral) = take with FULL glass of water and remain UPRIGHT for 30 minutes after the dose to AVOID GI irritation

AVOID in pregnancy or breastfeeding, sulfa allergy
Photosensitivity
Crystals in urine
Take with FULL glass of water

Do NOT use any alcohol products while using this medication, and for at least 3 days afterward
Nausea
Metallic taste in mouth

Take with FOOD to decrease Nausea
Nausea
Brown discoloration of urine (temporary and harmless)

1/2 of ointment of tube into each nostril, press at same time and let go, continue for about 1 min
Wash hands after use
Cause burning and itching in nose

Cefazolin or Cefuroxime
60 min before incision
start of surgery

Quinolone or Vancomycin
120 mins before incision
start of surgery

if surgery > 3-4 hrs
major blood loss

Antibiotics usually not needed
if used D/C within 24 hrs

Ampicillin ( for listeria coverage)
+
Cefotaxime (NO CEFTRIAXONE)
or
Gentamicin

Ceftriaxone or Cefotaxime
+
Vancomycin

Ampicillin (for listeria coverage)
+
Ceftriaxone or Cefotaxime
+
Vancomycin

2-3 days if sx are non-severe ( mild otalgia < 48 hrs or temp < 102.2)

Age 6-23 months sx in one ear only

Age >/= 2 years sx in one or both ears

Use antibiotics if sx do not improve or worsen

Look for COMORBIDITIES:
Chronic heart, lung, liver or renal dz
DM
Alcoholism
Malignancy
Asplenia

Check for MRSA or Psuedomonas aeruginosa risk factors (prior respiratory isolation of either pathogen or hospitalization with receipt of parenteral antibiotics in the past 90 days

Decide whether the pt falls in Cat 1 (no comorbidities)
or Cat 2 (with comorbidities)

Choose one option within the category, be SURE TO LOOK FOR:
ALLERGIES
DRUG-DZ INTERACTIONS (quinolones and seizures)
DRUG-DRUG INTERACTIONS (QT-prolongation)
Culture results

Amoxicillin high-dose 1 g TID (think Penicillin allergies: seizures)

or

Doxycycline (photosensitivity, children <8, pregnancy, breastfeeding

or

Macrolide (azithromycin or clarithromycin) if local pneumococcal resistance is < 25% (DDI with lovastatin and simvastatin strong CYP3A4 inhib, QT prolongation, caution with CVD

Beta-lactam + Macrolide or Doxycycline:
*Amoxicillin/clavulanate or Cephalosporin (cefpodoxime, cefdinir, cefuroxime) plus
*Macrolide or Doxycycline

Respiratory quinolone monotherapy:
*Moxifloxacin
*Gemifloxacin
or
*Levofloxacin

** Quinolone think tendon inflammation and/or rupture, Peripheral neuropathy, Seizures, Caution in pts with CNS disorder or drugs that cause seizures, QT prolongation (highest with Moxifloxacin), Hypoglycemia and Hyperglycemia, Psychiatric disturbances, Avoid in children and preg / breastfeeding, Photosensitivity

(My Good Lung)

Cefepime
Piperacillin/tazobactam

Cefepime + Vancomycin
Meropenem + Linezolid

Pipercillin/tazobactam + Ciprofloxacin + Vancomycin
Cefepime + Gentamicin + Linezolid

*Do not use two beta-lactams together
Pipercillin/Tazobactam
Cefepime, ceftazidime or ceftolozane/tazobactam
Levofloxacin or ciprofloxacin
Imipenem/cilastatin or meropenem
Tobramycin, gentamicin or amikacin (use in combo with another antipseudomonal drug)
Colistimethate or polymixin B (use in combo with another antipsuedomonal drug)

Vancomycin
OR
Linezolid

Sputum sample (for culture)
Symptoms
Chest X-ray (are lungs clear or clearing up?)

Increase LFTs
Increase total bilirubin - monitor

Orange bodily secretions
Strong CYP450 Inducer ( can use Rifabutin if unacceptable DDIs)
Flu-like sx

Peripheral neuropathy - give with pyridoxine 25-50 mg PO daily
Monitor for symptoms of DILE

Risk for hemolytic anemia (identified by a positive Coombs test)

Increase Uric acid - DO NOT use with acute GOUT

Visual damage (requires baseline and monthly vision exams)
Confusion/hallucinations

Vancomycin 125 mg PO QID x 10 days
or
Fidaxomicin 200 mg PO BID x 10 days
or
Metronidazole 500 mg PO TID x 10 days if non-severe episode ( WBC </= 15,000 and SCr <1.5)

Any can be used:
Vancomycin 125 mg PO QID x 10 days
Fidaxomicin 200 mg PO BID x 10 days
Vancomycin tapered and pulsed regimen:
*125 mg PO QID x 10 days, BID x 1 week, daily x 1 week, then 125 mg every 2-3 days for 2-8 weeks

Vancomycin tapered and pulsed regimen
or
Vancomycin 125 mg PO QID x 10 days, then rifaximin 400 mg TID x 20 days
or
Fidaxomicin 200 mg PO BID x 10 days
or
Fecal micorbiota transplant

Bezlotoxumab:
prevention of recurrent C diff for high risk pt (age >/= 65, immunocompromised, severe presentation and/or 2nd episode w/in past 6 months)

MUST use in combination w/ antibiotic against C. Diff (Fidaxomicin or Vancomycin)

CAUTION in HF

genital discharge or no sx

genital discharge or no sx

Painless
Smooth genital sores (chancre)