antimicrobial agents naplex. empiric therapy identify the causative organism test the sensitivity of...

ANTIMICROBIAL AGENTS

ANTIMICROBIAL AGENTS

NAPLEX

Empiric therapy Identify the causative organism Test the sensitivity of the organism to

antimicrobial drugs Identify important host factors:

Site of infection-CNS, bone, prostate, UTI Susceptibility to toxicity Patient allergies

Empiric therapy Identify the causative organism Test the sensitivity of the organism to

antimicrobial drugs Identify important host factors:

Site of infection-CNS, bone, prostate, UTI Susceptibility to toxicity Patient allergies

Selecting Appropriate Antimicrobial AgentsSelecting Appropriate Antimicrobial Agents

PG 52

Interference with cell wall synthesis penicillins, cephalosporins

Inhibition of protein synthesis macrolides, clindamycin, tetracyclines, quinolones

Interference with enzyme unique to bacterial cell sulfonamides

Interference with the permeability of microbial cell membranes

amphotericin B

Interference with cell wall synthesis penicillins, cephalosporins

Inhibition of protein synthesis macrolides, clindamycin, tetracyclines, quinolones

Interference with enzyme unique to bacterial cell sulfonamides

Interference with the permeability of microbial cell membranes

amphotericin B

Mechanisms of Action of Antimicrobial AgentsMechanisms of Action of Antimicrobial Agents

PG 52

PABA dihydrofolic acid (DHFA) tetrahydrolfolic acid (THFA) PABA dihydrofolic acid (DHFA) tetrahydrolfolic acid (THFA)

SulfonamidesSulfonamides

PG 53

SulfaSulfa

Mechanism of action : competitive antagonism of PABA in enzyme system essential for bacteria growth.

For ophthalmic use, sulfa sodium salt solutions are very alkaline (i.e., pH 10+). The only sodium salt suitable for ophthalmic use is sulfacetamide sodium (solutions have pH of about 7.4).

Sulfas are eliminated renally unchanged. Makes them good for UTIs.

Sulfas are less soluble in acid urine. This is one cause of crystalluria.

Stevens-Johnson syndrome is associated with sulfa use.

Mechanism of action : competitive antagonism of PABA in enzyme system essential for bacteria growth.

For ophthalmic use, sulfa sodium salt solutions are very alkaline (i.e., pH 10+). The only sodium salt suitable for ophthalmic use is sulfacetamide sodium (solutions have pH of about 7.4).

Sulfas are eliminated renally unchanged. Makes them good for UTIs.

Sulfas are less soluble in acid urine. This is one cause of crystalluria.

Stevens-Johnson syndrome is associated with sulfa use.

PG 53

General considerations - SulfonamidesGeneral considerations - Sulfonamides

Combinations of sulfamethoxazole and trimethoprim (Bactrim, Septra, etc.) are less likely to result in bacterial resistance.

Sulfasalazine (Azulfidine) is used in treating inflammatory bowel disease and RA. Watch for sulfa allergy, salicylate allergy, and urine discoloration. - GI side effects, dose is titrated upward slowly, monitor blood counts – dyscrasias

If a patient cannot use sulfasalazine because of sulfa sensitivity, use mesalamine products, i.e., Asacol, Pentasa, Rowasa. – various dosage forms

Remember that silver sulfadiazine (Silvadene) and mafenide (Sulfamylon) are used topically for treatment of serious burns.

Combinations of sulfamethoxazole and trimethoprim (Bactrim, Septra, etc.) are less likely to result in bacterial resistance.

Sulfasalazine (Azulfidine) is used in treating inflammatory bowel disease and RA. Watch for sulfa allergy, salicylate allergy, and urine discoloration. - GI side effects, dose is titrated upward slowly, monitor blood counts – dyscrasias

If a patient cannot use sulfasalazine because of sulfa sensitivity, use mesalamine products, i.e., Asacol, Pentasa, Rowasa. – various dosage forms

Remember that silver sulfadiazine (Silvadene) and mafenide (Sulfamylon) are used topically for treatment of serious burns.

PG 53

General considerations – Sulfonamides (cont’d)General considerations – Sulfonamides (cont’d)

PG 54

PenicillinsPenicillins

Mechanism of action: interfere with bacterial cell-wall synthesis (bactericidal)

Note that all penicillins have a beta lactam ring and thiazolidine ring.

Possible cross-sensitivity with other beta lactam antimicrobials (e.g., cephalosporins).

- percent cross-sensitive ranges from 5-7%

Mechanism of action: interfere with bacterial cell-wall synthesis (bactericidal)

Note that all penicillins have a beta lactam ring and thiazolidine ring.

Possible cross-sensitivity with other beta lactam antimicrobials (e.g., cephalosporins).

- percent cross-sensitive ranges from 5-7%

PG 54

General Considerations – Penicillins General Considerations – Penicillins

PG 55

Structure Activity Relationships:Structure Activity Relationships:

AMino penicillins – AMpicillin, AMoxicillin, bacAMpicillin

NOX penicillins – penicillinase (beta lactamase) resistant penicillins: Nafcillin, OXacillin, clOXacillin (PO), diclOXacillin(PO)----MSSA (vanco alternative)

MEZPCT penicillins – antipseudomonal penicillins: MEZlocillin, Piperacillin, Carbenicillin, Ticarcillin (combo with aminoglycosides, not in the same IV)

Therapy problems with penicillins: Acid Resistance

Beta-lactamase (penicillinase) resistance (combo products; Zosyn, Timentin, Augmentin)

HypersensitivityHypersensitivity

AMino penicillins – AMpicillin, AMoxicillin, bacAMpicillin

NOX penicillins – penicillinase (beta lactamase) resistant penicillins: Nafcillin, OXacillin, clOXacillin (PO), diclOXacillin(PO)----MSSA (vanco alternative)

MEZPCT penicillins – antipseudomonal penicillins: MEZlocillin, Piperacillin, Carbenicillin, Ticarcillin (combo with aminoglycosides, not in the same IV)

Therapy problems with penicillins: Acid Resistance

Beta-lactamase (penicillinase) resistance (combo products; Zosyn, Timentin, Augmentin)

HypersensitivityHypersensitivity

Which of the following is an adverse

effect associated with use of

aminopenicillins?

a. polydipsia

b. hemolytic anemia

c. cholelithiasis

d. tardive dyskinesia

e. angina

Which of the following is an adverse

effect associated with use of

aminopenicillins?

a. polydipsia

b. hemolytic anemia

c. cholelithiasis

d. tardive dyskinesia

e. angina

PG 56

CephalosporinsCephalosporins

Contains beta-lactam ring. Therefore, may have cross-sensitivity with penicillins.

As you go from 1st generation to 4th generation, you get:

increased gram-negative activity

decreased gram-positive activity

increased resistance to beta-lactamase destruction

increased ability to enter cerebrospinal fluid

Contains beta-lactam ring. Therefore, may have cross-sensitivity with penicillins.

As you go from 1st generation to 4th generation, you get:

increased gram-negative activity

decreased gram-positive activity

increased resistance to beta-lactamase destruction

increased ability to enter cerebrospinal fluid

PG 56

General considerationsGeneral considerations

Which of the following antimicrobial

agents has effective coverage of streptococcus pneumoniae?

I. amoxicillin

II. doxycycline

III. gentamicin

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III



I. amoxicillin

II. doxycycline

III. gentamicin

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III



I. amoxicillin

II. doxycycline

III. gentamicin

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III



I. amoxicillin

II. doxycycline

III. gentamicin

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III

Gram +Gram +

Non-DRSPNon-DRSP

First generation (generally start with CEPH):

Good for surgical prophylaxis

Second generation (generally start with CEF):

Good for otitis, sinusitis and respiratory tract infections

Third generation (generally end with IME or ONE):

● Good for meningitis, CAP, gram-negative bacilli, gonorrhea, Proteus, Salmonella, Klebsiella

● Cefixime (suprax), cefotaxime (claforan), ceftriaxone (rocephin)

Fourth generation (cefepime) Maxipime:

● Good antipseudomonal activity

First generation (generally start with CEPH):

Good for surgical prophylaxis

Second generation (generally start with CEF):

Good for otitis, sinusitis and respiratory tract infections

Third generation (generally end with IME or ONE):

● Good for meningitis, CAP, gram-negative bacilli, gonorrhea, Proteus, Salmonella, Klebsiella

● Cefixime (suprax), cefotaxime (claforan), ceftriaxone (rocephin)

Fourth generation (cefepime) Maxipime:

● Good antipseudomonal activity

PG 57

General considerations (cont’d) General considerations (cont’d)

TetracyclinesTetracyclines

PG 58

Products:

Tetracycline HCI (Achromycin V, Sumycin, Robitet, Panmycin)

Minocycline (Minocin)

Doxycycline (Vibramycin, Doxy 100, Doxychel, Vibra-Tabs)

These are bacteriostatic antimicrobials. They interfere with protein synthesis.

Broad spectrum antimicrobials. Work against many gram-positive and gram-negative organisms.

- also effective against atypical organisms mycoplasma and

chlamydia pneumoniae, useful for patients allergic to penicillin b/c gram +

coveragecoverage

Products:

Tetracycline HCI (Achromycin V, Sumycin, Robitet, Panmycin)

Minocycline (Minocin)

Doxycycline (Vibramycin, Doxy 100, Doxychel, Vibra-Tabs)

These are bacteriostatic antimicrobials. They interfere with protein synthesis.

Broad spectrum antimicrobials. Work against many gram-positive and gram-negative organisms.

- also effective against atypical organisms mycoplasma and

chlamydia pneumoniae, useful for patients allergic to penicillin b/c gram +

coveragecoverage

PG 58

General ConsiderationsGeneral Considerations

PG 58

Not for use in children under age 8. May cause discoloration of developing tooth enamel.

Not for pregnant women. May adversely affect fetal development.

Most have the potential for causing phototoxicity.

Drug interaction with divalent (Mg, Ca, Fe) or trivalent (Al) compounds and tetracyclines may result in complexation and impaired absorption. Do not use together.

Broad spectrum activity can lead to thrush or vaginal candidias

Not for use in children under age 8. May cause discoloration of developing tooth enamel.

Not for pregnant women. May adversely affect fetal development.

Most have the potential for causing phototoxicity.

Drug interaction with divalent (Mg, Ca, Fe) or trivalent (Al) compounds and tetracyclines may result in complexation and impaired absorption. Do not use together.

Broad spectrum activity can lead to thrush or vaginal candidias


PG 59

Macrolides

General Considerations:General Considerations:

Bacteriostatic – inhibit protein synthesisBacteriostatic – inhibit protein synthesis

May be good for patients who are May be good for patients who are

hypersensitive to beta-lactam hypersensitive to beta-lactam

antimicrobials.antimicrobials.

Good respiratory coverageGood respiratory coverage..

CAP caused by S.pneumo, M.cat, H.flu or atypicals CAP caused by S.pneumo, M.cat, H.flu or atypicals (mycoplasma, legionella, and chlamydia)(mycoplasma, legionella, and chlamydia)

PG 59

Erythromycin

Oral Products

Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)Coating used on most productsCoating used on most productsAdminister on an empty stomachAdminister on an empty stomach

Erythromycin stearate (Erythromycin Stearate, Erythromycin stearate (Erythromycin Stearate, Wyamycin S)Wyamycin S)

Better absorbed than erythromycin baseBetter absorbed than erythromycin base

PG 59

Erythromycin esolate (Ilosone)Erythromycin esolate (Ilosone)

Associated with cholestatic hepatitisAssociated with cholestatic hepatitis

Better absorbed than erythromycin baseBetter absorbed than erythromycin base

Erythromycin ethylsuccinate (eryPed, E.E.S.)Erythromycin ethylsuccinate (eryPed, E.E.S.)

Most well absrobedMost well absrobed

Available in liquid formAvailable in liquid form

400 mg of EES = 250 mg of erythromycin base400 mg of EES = 250 mg of erythromycin base

Parenteral ProductsParenteral Products

Erythromycin lactobionateErythromycin lactobionate

Erythromycin glucepateErythromycin glucepate

Drug Interactions:Drug Interactions: Mainly due to enzyme inhibition of erythromycin – (3A4) Mainly due to enzyme inhibition of erythromycin – (3A4)

Erythromycin (cont’d)

PG 60

Clarithromycin (Biaxin)

Usually used BID. XL form used once daily.Usually used BID. XL form used once daily.

Prodrug: May be given with or without mealsProdrug: May be given with or without meals

Used in combination with a proton pump inhibitor for Used in combination with a proton pump inhibitor for H. H. pyloripylori treatment. treatment.

Metallic tasteMetallic taste

PG 60

Azithromycin (Zithromax)

More gram-negative activity than erythromycin or More gram-negative activity than erythromycin or clarithromycinclarithromycin

Once-daily dosing, usually for five days after otitis media Once-daily dosing, usually for five days after otitis media (e.g., Z-Pack)(e.g., Z-Pack)

Available as suspension, tablets, IVAvailable as suspension, tablets, IV

Suspension should not be taken with food or antacids.Suspension should not be taken with food or antacids.

Dirithromycin (Dynabac)Dirithromycin (Dynabac)

ProdrugProdrug

Once-daily dosingOnce-daily dosing

PG 61

Lincosamides Lincosamides

General considerationsGeneral considerations

Watch for pseudomembranous enterocolitis Watch for pseudomembranous enterocolitis (Clostridium (Clostridium difficile).difficile).

•Treat clostridium with metronidazole (Flagyl) or oral Treat clostridium with metronidazole (Flagyl) or oral vancomycin.vancomycin.

Good in gram positive (staph) and gram-negative infections, Good in gram positive (staph) and gram-negative infections, particularly anaerobesparticularly anaerobes

Lincomycin (Lincocin, Lincorex)Lincomycin (Lincocin, Lincorex)Morbilliform rash possible; DC drug if it happensMorbilliform rash possible; DC drug if it happens

Clindamycin (Cleocin)Clindamycin (Cleocin)Available in topical form for acneAvailable in topical form for acne

Which of the following antibiotics has

bacteriostatic activity?

a. amoxicillin

b. ciprofloxacin

c. erythromycin

d. penicillin

e. cephalexin


bacteriostatic activity?

a. amoxicillin

b. ciprofloxacin

c. erythromycin

d. penicillin

e. cephalexin


bacteriostatic activity?a. amoxicillin (cell wall)

b. ciprofloxacin (inhibits DNA gyrase)

c. erythromycin (protein synthesis)

d. penicillin (cell wall)

e. cephalexin (cell wall)


bacteriostatic activity?a. amoxicillin (cell wall)

b. ciprofloxacin (inhibits DNA gyrase)

c. erythromycin (protein synthesis)

d. penicillin (cell wall)

e. cephalexin (cell wall)

PG 61

Aminoglycosides Aminoglycosides


Glycosides – poorly absorbed from the GI tractGlycosides – poorly absorbed from the GI tract

BactericidalBactericidal

Good for serious gram-negative pathogens (pseudomonas, Good for serious gram-negative pathogens (pseudomonas, proteus, etc.)proteus, etc.)

Frequently administered with extended-action penicillin (Frequently administered with extended-action penicillin (IV IV incompatibleincompatible) - ) - dosed q8h or q24h (conc. dependant kill)dosed q8h or q24h (conc. dependant kill)

Eliminated by glomerular filtration; Watch for ototoxicityEliminated by glomerular filtration; Watch for ototoxicityMonitor peaks and troughs – peaks 30 min after infusion, trough 30 Monitor peaks and troughs – peaks 30 min after infusion, trough 30 minutes before next dose.minutes before next dose. peak = 4-10ug/ml trough = 0.5-2, adjust peak = 4-10ug/ml trough = 0.5-2, adjust dose if CrCl < 60ml/min. hearing test if prolonged therapydose if CrCl < 60ml/min. hearing test if prolonged therapy

Which of the following antimicrobial agents is available for parenteral use only?

I. cefaclorII. tobramycinIII. ticarcillin

a. I onlyb. III onlyc. I and II onlyd. II and III onlye. I, II, and III

Which of the following antimicrobial agents is available for parenteral use only?

I. cefaclorII. tobramycinIII. ticarcillin


PG 61

Parenteral use

Streptomycin sulfateStreptomycin sulfate

Kanamycin sulfate (Kantrex)Kanamycin sulfate (Kantrex)

Gentamicin sulfate (GaramycinGentamicin sulfate (Garamycin (4mcg-10mcg/ml)(4mcg-10mcg/ml)

Tobramycin sulfate (Nebcin) Tobramycin sulfate (Nebcin) (4mcg-10mcg/ml)(4mcg-10mcg/ml)

Amikacin sulfate (Amikin) Amikacin sulfate (Amikin) (15mcg-25mcg/ml)(15mcg-25mcg/ml)

Netilmicin sulfate (Netromycin)Netilmicin sulfate (Netromycin)

Reference Peak RangeReference Peak Range

Which of the following antibiotics

requires monitoring of serum levels?

a. penicillin

b. ceftazidime

c. azithromycin

d. gentamicin

e. cephalexin

Which of the following antibiotics

requires monitoring of serum levels?

a. penicillin

b. ceftazidime

c. azithromycin

d. gentamicin

e. cephalexin

PG 62

Oral useOral use

Not for systemic actionNot for systemic action

Neomycin sulfate (Mycifradin) - Neomycin sulfate (Mycifradin) - Used for bowel prep prior to Used for bowel prep prior to surgery , treat diarrhea caused by e.coli, neomycin also binds surgery , treat diarrhea caused by e.coli, neomycin also binds ammonia, use in patients w/hepatic encephalopathy, watch for ammonia, use in patients w/hepatic encephalopathy, watch for absorption interactions absorption interactions

Tobramycin (TOBI) –Tobramycin (TOBI) – inhaled product for CF patientsinhaled product for CF patients

PG 62

FluoroquinolonesFluoroquinolones

General Considerations - Inhibits DNA-GyraseGeneral Considerations - Inhibits DNA-Gyrase

May cause phototoxicity May cause phototoxicity

Not for patients under 18 – Not for patients under 18 – affects growthaffects growth

Do not use within 2-4 hours of Do not use within 2-4 hours of antacidsantacids; ; iron – also inhibits iron – also inhibits CYP1A2 (increased levels of theophylline and caffeine)CYP1A2 (increased levels of theophylline and caffeine)

Generally useful for UTI, lower respiratory infections, Generally useful for UTI, lower respiratory infections, gonorrhea, prostatitis – gonorrhea, prostatitis – older agents have more gram -, older agents have more gram -, less gram + coverage, newer agents have broader gram + less gram + coverage, newer agents have broader gram + [moxifloxacin, gatifloxacin][moxifloxacin, gatifloxacin]

All end in All end in -oxacin-oxacin

PG 62

Names

Second generationSecond generation

Norfloxacin (Noroxin) – Norfloxacin (Noroxin) – high urine levels - UTIshigh urine levels - UTIs

Ciprofloxacin (Cipro)- Ciprofloxacin (Cipro)- renal elimination: reduce dose renal elimination: reduce dose

Ofloxacin (Floxin)Ofloxacin (Floxin)

Third generationThird generation

Levofloxacin (Levaquin) – Levofloxacin (Levaquin) – renal elimination: reduce doserenal elimination: reduce dose

Sparfloxacin (Zagam) – Sparfloxacin (Zagam) – reports of prolongation of QT interval (D/C)reports of prolongation of QT interval (D/C)

Gemifloxacin (Factive) – Gemifloxacin (Factive) – renal elimination: reduce dose, skin rash renal elimination: reduce dose, skin rash

Fourth generationFourth generation

Moxifloxacin (Avelox) – Moxifloxacin (Avelox) – Multi-drug resistant Streptococcus pneumonia Multi-drug resistant Streptococcus pneumonia (MDRSP)(MDRSP)

PG 63

MISCELLANEOUSMISCELLANEOUS ANTIMICROBIAL AGENTSANTIMICROBIAL AGENTSAntibacterialsAntibacterials

Mupirocin (Bactroban) – topical use for impetigo, intranasal for staphMupirocin (Bactroban) – topical use for impetigo, intranasal for staph

Vancomycin (Vancocin) – associated with red man syndrome Vancomycin (Vancocin) – associated with red man syndrome (must be (must be infused slowly, over min of 30 minutes); reserved for serious/resistant infused slowly, over min of 30 minutes); reserved for serious/resistant gram + infections (MRSA, enterococcus) gram + infections (MRSA, enterococcus)

– – rapid drop in BP accompanied by rash in neck or chest arearapid drop in BP accompanied by rash in neck or chest area

- Monitoring – 1 hour before and 1 hour after- Monitoring – 1 hour before and 1 hour after

- Peak – 25-40mcg/dl & Trough 5-12mcg/dl- Peak – 25-40mcg/dl & Trough 5-12mcg/dl

Metronidazole (Flagyl) – active against gram-negative organisms and Metronidazole (Flagyl) – active against gram-negative organisms and protozoa, protozoa, (anaerobes)(anaerobes) Avoid alcohol. May darken urine. Avoid alcohol. May darken urine.

PG 63

MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)

CarbapenemsCarbapenems

•broad spectrum; used for resistant gram +/– organisms, pseudomonas, broad spectrum; used for resistant gram +/– organisms, pseudomonas, MRSA, enterococcus, anaerobesMRSA, enterococcus, anaerobes

•similar to penicillins (cross-sensitivity) but b-lactamase resistant similar to penicillins (cross-sensitivity) but b-lactamase resistant

•Risk of seizures and renal adjustmentRisk of seizures and renal adjustment

Imipenem/cilastatin (Primaxin) – cilastatin is a renal dipeptidase Imipenem/cilastatin (Primaxin) – cilastatin is a renal dipeptidase inhibitorinhibitor

Meropenem (Merrem)---lacks good pseudomonas coverage Meropenem (Merrem)---lacks good pseudomonas coverage

Doripenem (Doribax)Doripenem (Doribax)

Ertapenem (Invanz)Ertapenem (Invanz)

----Aztreonam (Azactam)---monobactam, ok with PCN allergy----Aztreonam (Azactam)---monobactam, ok with PCN allergy

Which of the following antibiotic is

classified as a macrolide?

a. telithromycin

b. tobramycin

c. azithromycin

d. doxycycline

e. kanamycin

Which of the following antibiotic is

classified as a macrolide?

a. telithromycin

b. tobramycin

c. azithromycin

d. doxycycline

e. kanamycin

PG 63-64

MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)

VRE and MRSA drugsVRE and MRSA drugs

Quinupristin / dalfopristin (Synercid) –Quinupristin / dalfopristin (Synercid) –

Linezolid (Zyvox) –……oral dosing availableLinezolid (Zyvox) –……oral dosing available

Tigecycline (Tygacil) – Tigecycline (Tygacil) –

Chloramphenicol (Chloromycetin) – for typhoid fever; may cause Chloramphenicol (Chloromycetin) – for typhoid fever; may cause aplastic anemia and gray baby syndromeaplastic anemia and gray baby syndrome

PneumoniaPneumonia Organisms:

Treatment:

Organisms:

Treatment:

--Comorbidities: --Comorbidities: Chronic obstructive Chronic obstructive pulmonary disease pulmonary disease (COPD), diabetes, (COPD), diabetes, chronic renal failure, chronic renal failure, chronic liver failure, chronic liver failure, heart failure (HF), heart failure (HF), cancer, asplenia, cancer, asplenia, immunosuppressedimmunosuppressed

PneumoniaPneumonia Treatment: Treatment:

--Risk factors for --Risk factors for MDR organisms: MDR organisms: recent antibiotic recent antibiotic therapy (in last 90 therapy (in last 90 days), hospitalized ≥ days), hospitalized ≥ 5 days, 5 days, resistance in resistance in environment, nursing environment, nursing home resident, home resident, chronic dialysis, home chronic dialysis, home infusion therapy, infusion therapy, immunosuppressedimmunosuppressed

MeningitisMeningitis Organisms:

Treatment:

Organisms:

Treatment:

Urinary Tract InfectionUrinary Tract Infection Organisms:

Treatment:

Organisms:

Treatment:

STDsSTDs Organisms:

Treatment:

Organisms:

Treatment:

Antitubercular DrugsAntitubercular Drugs

R rifampin

I isoniazid

P pyrazinamide

E ethambutol

S streptomycin

R rifampin

I isoniazid

P pyrazinamide

E ethambutol

S streptomycin

PG 64

PG 64

Antitubercular DrugsAntitubercular Drugs

Isoniazid (Nydrazid, Laniazid)Isoniazid (Nydrazid, Laniazid)

May cause BMay cause B6 6 deficiency – deficiency – supplement malnourished, alcoholics, kidssupplement malnourished, alcoholics, kids

Used for prophylaxis or in combo with other drugs for active disease Used for prophylaxis or in combo with other drugs for active disease

6 months of prophylaxis if +PPD; For treatment used in combo with 6 months of prophylaxis if +PPD; For treatment used in combo with

rifampin for at least 6 months rifampin for at least 6 months

Metabolized by acetylation (slow versus rapid acetylators)Metabolized by acetylation (slow versus rapid acetylators)

monitor for hepatoxicitymonitor for hepatoxicity

Rifampin (Rifadin, Rimactane)Rifampin (Rifadin, Rimactane)

Potent enzyme inducer (potential drug interactions with many drugs)Potent enzyme inducer (potential drug interactions with many drugs)

Potentially hepatotoxic; Potentially hepatotoxic;

Use may result in discoloration of virtually all body fluids (urine and Use may result in discoloration of virtually all body fluids (urine and tears----watch contact lenses) tears----watch contact lenses)

PG 65

Antitubercular Drugs (cont.)

Ethambutol (Myambutal) – for treatment of MAC and drug-resistant Tb Ethambutol (Myambutal) – for treatment of MAC and drug-resistant Tb as part of combination therapyas part of combination therapy

- optic neuritis is a rare but serious side effect- optic neuritis is a rare but serious side effect

- monitor with eye exams- monitor with eye exams

Pyrazinamide – used in combination therapy; potentially hepatotoxicPyrazinamide – used in combination therapy; potentially hepatotoxic

- may increase uric acid levels- may increase uric acid levels

Steptomycin- can be used as fourth drug in regimen instead of pyrazinamide

PG 65

AntimalarialsAntimalarials

Quinine sulfate (Quinamm) – also used for muscle cramps; Quinine sulfate (Quinamm) – also used for muscle cramps; no longer used due to hematologic adverse effects no longer used due to hematologic adverse effects

Doxycycline – tetracycline; possible phototoxicity and Doxycycline – tetracycline; possible phototoxicity and binding interactionsbinding interactions

Melfoquine HCl (Lariam) – may cause neuropsychiatric Melfoquine HCl (Lariam) – may cause neuropsychiatric adverse effects; once- weekly dosingadverse effects; once- weekly dosing

Atovaquone/proguanil (Malarone) – newer product; once Atovaquone/proguanil (Malarone) – newer product; once daily; do not use if renally impaireddaily; do not use if renally impaired

PG 66

AntimalarialsAntimalarials

Chloroquine (Aralen) – may worsen psoriasis symptomsChloroquine (Aralen) – may worsen psoriasis symptoms

Hydroxychloroquine sulfate (Plaquenil Sulfate) – may Hydroxychloroquine sulfate (Plaquenil Sulfate) – may worsen psoriasis symptomsworsen psoriasis symptoms

- - also used as a DMARD for RA; phototoxicity, also used as a DMARD for RA; phototoxicity,

hematological side effects, ocular and ototoxicityhematological side effects, ocular and ototoxicity

Primaquine phosphate – take with food to reduce GI upset; Primaquine phosphate – take with food to reduce GI upset; may be used for PCPmay be used for PCP

HIV Antiretroviral TherapyHIV Antiretroviral Therapy Therapy initiated based on CD4 count,

viral load and presence of symptoms Initial regimen in treatment naive patients:

• NNRTI + 2 NRTIs• PI + 2 NRTIs

Learn drug class representatives and major toxicities

Therapy initiated based on CD4 count, viral load and presence of symptoms Initial regimen in treatment naive patients:

• NNRTI + 2 NRTIs• PI + 2 NRTIs

Learn drug class representatives and major toxicities

PG 69

Which HIV drug is correctly matched with its mechanism of action?

Which HIV drug is correctly matched with its mechanism of action?

a. Lamivudine - nucleoside reverse transcriptase inhibitor

b. Enfuvirtide - protease inhibitor

c. Stavudine - binds to human CCR5 receptor

d. Didanosine – protease inhibitor

e. Indinavir – blocks virus entry into human cells and subsequent viral replication

a. Lamivudine - nucleoside reverse transcriptase inhibitor

b. Enfuvirtide - protease inhibitor

c. Stavudine - binds to human CCR5 receptor

d. Didanosine – protease inhibitor

e. Indinavir – blocks virus entry into human cells and subsequent viral replication

NNRTIs non-nucleoside reverse transcriptase non-nucleoside reverse transcriptase

inhibitorsinhibitors (vir in the middle)

NNRTIs non-nucleoside reverse transcriptase non-nucleoside reverse transcriptase

inhibitorsinhibitors (vir in the middle)

Delavirdine (rescriptor) (rash, LFTs) Efavirenz (Sustiva)

Drug of choice Category X, vivid dreams

Nevirapine (Viramune) Rash (Steven Johnson Syndrom) Liver metabolism

Delavirdine (rescriptor) (rash, LFTs) Efavirenz (Sustiva)

Drug of choice Category X, vivid dreams

Nevirapine (Viramune) Rash (Steven Johnson Syndrom) Liver metabolism

PG 72

Exception – darunavir, tenofovir, raltegravir, abacavirException – darunavir, tenofovir, raltegravir, abacavir

Metabolized through the liver (commonly 3A4)Metabolized through the liver (commonly 3A4)

• potential for significant drug interactionspotential for significant drug interactions

Low dose of ritonavir frequently used to enhance Low dose of ritonavir frequently used to enhance the concentrations of coadministered PIsthe concentrations of coadministered PIs

Adverse effects: GI intolerance, hyperglycemia, Adverse effects: GI intolerance, hyperglycemia, dyslipidemia, lipodystrophy, LFT alterationsdyslipidemia, lipodystrophy, LFT alterations

PIs Protease inhibitors (vir at the end)

PIs Protease inhibitors (vir at the end)

PG 69

Exception – maravirocException – maraviroc

All NRTIs (except abacavir) are excreted renally; require All NRTIs (except abacavir) are excreted renally; require dose adjustment but few drug interactionsdose adjustment but few drug interactions

Most common ADRs – GI intolerance, typically subsides in Most common ADRs – GI intolerance, typically subsides in first couple of weeksfirst couple of weeks

- High risk for perpheral neuropathy- High risk for perpheral neuropathy

Black Box warning: Risk of lactic acidosis with hepatic Black Box warning: Risk of lactic acidosis with hepatic steatosissteatosis

NRTIs nucleoside reverse transcriptase nucleoside reverse transcriptase

inhibitorsinhibitors (all the others)

NRTIs nucleoside reverse transcriptase nucleoside reverse transcriptase

inhibitorsinhibitors (all the others)

AIDS – Opportunistic InfectionsAIDS – Opportunistic Infections

PCP / PJP (pneumocystis carninii pneumonia)

trimethoprim-sulfamethoxazole CMV retinitis

Ganciclovir MAC / MAI (mycobacterium avium complex)

Macrolide + ethambutol Cryptococcus neuformans meningitis

Amphotericin B +/- flucytosine Fluconazole used for maintenance

PCP / PJP (pneumocystis carninii pneumonia)

trimethoprim-sulfamethoxazole CMV retinitis

Ganciclovir MAC / MAI (mycobacterium avium complex)

Macrolide + ethambutol Cryptococcus neuformans meningitis

Amphotericin B +/- flucytosine Fluconazole used for maintenance

PG 74

PG 74

Drugs for influenzaDrugs for influenza

M2 inhibitorsM2 inhibitors

Amantadine, rimantidineAmantadine, rimantidine

Effective for influenza A virus onlyEffective for influenza A virus only

Begin within 48h of symptom onset; continue 2-5 daysBegin within 48h of symptom onset; continue 2-5 days

Neuroaminidase inhibitorsNeuroaminidase inhibitors

Oseltamivir (Tamiflu) Oseltamivir (Tamiflu)

Zanamivir (Relenza)Zanamivir (Relenza)

Effective for influenza A and B virusesEffective for influenza A and B viruses

Begin with 48h of symptoms onset; continue 5 daysBegin with 48h of symptoms onset; continue 5 days

PG 75

Drugs for herpes simplex and herpes zoster (shingles)Drugs for herpes simplex and herpes zoster (shingles)

Acyclovir (Zovirax) – for herpes simplex types 1 and 2Acyclovir (Zovirax) – for herpes simplex types 1 and 2

- dosed 5x/day for 10 days, 5 days if recurrence- dosed 5x/day for 10 days, 5 days if recurrence

Penciclovir (Denavir) – topical treatment for herpes labialis Penciclovir (Denavir) – topical treatment for herpes labialis (cold sores)(cold sores)

Valacyclovir HCl (Valtrex) – for herpes simplex and herpes Valacyclovir HCl (Valtrex) – for herpes simplex and herpes zoster; acyclovir prodrugzoster; acyclovir prodrug

Famcyclovir (Famvir) for herpes simplex and herpes zoster Famcyclovir (Famvir) for herpes simplex and herpes zoster (shingles); penciclovir prodrug(shingles); penciclovir prodrug

- begin therapy as soon as first sign of lesion- begin therapy as soon as first sign of lesion

Docosanol (OTC-Abreva) topical creamDocosanol (OTC-Abreva) topical cream

PG 75

Anthelmintic drugs of choiceAnthelmintic drugs of choice

Nematodes (roundworm)Nematodes (roundworm)

Mebendazole (Vermox)—Mebendazole (Vermox)—do not use in pregnancy – blocks glucose uptakedo not use in pregnancy – blocks glucose uptake

Albendazole (Albenza) – Albendazole (Albenza) – degeneration of cytoplasmic microtubules intestinal cells degeneration of cytoplasmic microtubules intestinal cells of helminthsof helminths

Piperazine citrate Preg B – Piperazine citrate Preg B – blocks affect of ACHblocks affect of ACH

Pyrantel pamoate (Antiminth)Pyrantel pamoate (Antiminth)

Trichuriasis (whipworm)Trichuriasis (whipworm)

Mebendazole (do not use in pregnancy)Mebendazole (do not use in pregnancy)

Hookworm – mebendazole (do not use in pregnancy)Hookworm – mebendazole (do not use in pregnancy)

Which of the following medication(s) can cause nephrotoxicity?

I. GanciclovirII. FoscarnetIII. Gentamicin


Which of the following medication(s) can cause nephrotoxicity?

I. GanciclovirII. FoscarnetIII. Gentamicin


Which of the following agents inhibits the HIV enzyme reverse transcriptase?

I. zanamivirII. ritonivirIII. didanosine



I. zanamivirII. ritonivirIII. didanosine



I. zanamivir (Neuroaminidase inhibitors)Neuroaminidase inhibitors)

II. ritonivir (protease inhibitor)

III. didanosine ((nucleoside reverse transcriptase nucleoside reverse transcriptase inhibitors)inhibitors)



I. zanamivir (Neuroaminidase inhibitors)Neuroaminidase inhibitors)

II. ritonivir (protease inhibitor)

III. didanosine ((nucleoside reverse transcriptase nucleoside reverse transcriptase inhibitors)inhibitors)


PG 146

DERMATOLOGIC STUDY OUTLINEDERMATOLOGIC STUDY OUTLINE

AcneAcne

Pathophysiology— Pathophysiology— abnormal abnormal keratinization leads to obstruction of keratinization leads to obstruction of the follicle and accumulation of the follicle and accumulation of sebum to form a closed comedo or sebum to form a closed comedo or “white-head” “white-head”

Goal of therapy is to unblock folliclesGoal of therapy is to unblock follicles

Normal Pore Inflamed Pore

PG 146

Dermatologic Study OutlineDermatologic Study Outline

PG 146

Dermatologic Study OutlineDermatologic Study Outline

Isotretinoin (Accutane)Isotretinoin (Accutane)

Effective therapy option for the treatment of Effective therapy option for the treatment of severe, inflammatory acne, or more moderate forms that severe, inflammatory acne, or more moderate forms that have been refractory to other treatment options have been refractory to other treatment options

pregnancy category Xpregnancy category X

two forms of contrception, iPLEDGE programtwo forms of contrception, iPLEDGE program

Oral AntimicrobialsOral Antimicrobials

• • TetracyclineTetracycline

• • ErythromycinErythromycin

• • ClindamycinClindamycin

PG 146

PsoriasisPsoriasis

Pathophysiology — Pathophysiology — exact mechanism unknown. May be exact mechanism unknown. May be due to defects in epidermal cell cycle, AA metabolism, due to defects in epidermal cell cycle, AA metabolism, immunologic mechanisms, environmental triggers immunologic mechanisms, environmental triggers

Treatment modalities Treatment modalities

• • Emollients (e.g., petrolatum)Emollients (e.g., petrolatum)

• • Ultraviolet lightUltraviolet light

• • Coal tars (typically compounded)Coal tars (typically compounded)

• • Topical corticosteroidsTopical corticosteroids

• • Systemic corticosteroids (pulse dosing)Systemic corticosteroids (pulse dosing)

• • Antineoplastic agents (methotrexate, Antineoplastic agents (methotrexate, hydroxyurea)hydroxyurea)

• • Psoralens (pulse dosing)Psoralens (pulse dosing)

• • Immunosuppressant agents (Etanercept, Immunosuppressant agents (Etanercept, Efalizumab)Efalizumab)

• • Retinoids (pulse dosing)Retinoids (pulse dosing)

Which of the following psoriasis medications is not pregnancy category

X?

Which of the following psoriasis medications is not pregnancy category

X?

I. Dovonex

II. Methotrexate

III. Soriatane

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

I. Dovonex

II. Methotrexate

III. Soriatane

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended

without a prescription?

A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended

without a prescription?

a. Benzoyl peroxide 2.5% cream

b. Sulfur soap

c. Benzamycin gel

d. Salicylic acid wash

e. Benzoyl peroxide 10% lotion

a. Benzoyl peroxide 2.5% cream

b. Sulfur soap

c. Benzamycin gel

d. Salicylic acid wash

e. Benzoyl peroxide 10% lotion

Fungal InfectionsFungal Infections

Tinea corporis – body surface Tinea capitis – scalp Tinea cruris – groin (“jock itch”) Tinea pedis – feet (“athlete’s foot”) Onychomycosis – nails

Tinea corporis – body surface Tinea capitis – scalp Tinea cruris – groin (“jock itch”) Tinea pedis – feet (“athlete’s foot”) Onychomycosis – nails

PG 67-68 and 147

PG 147

TherapyTherapy

Prophylaxis. Prophylaxis. Keep skin dry; frequent changes and thorough Keep skin dry; frequent changes and thorough cleaning of clothing; and avoid likely areas of contamination.cleaning of clothing; and avoid likely areas of contamination.

Active:Active:

Dusting powders (medicated versus nonmedicated), wet Dusting powders (medicated versus nonmedicated), wet compressescompresses

Topical drug therapyTopical drug therapy

• • Fatty acids (undecylenic acid)Fatty acids (undecylenic acid) • • Tolnaftate (Tinactin, Tolnaftate (Tinactin, Aftate)Aftate)

• • Haloprogin (Halotex)Haloprogin (Halotex) • • Miconazole Miconazole (Micatin,Monistat)(Micatin,Monistat)

• • Clotrimazole (Lotrimin)Clotrimazole (Lotrimin) • Oxiconazole • Oxiconazole (Oxistat)(Oxistat)

• • Sulconazole (Exelderm)Sulconazole (Exelderm) • Butenafine • Butenafine (Mentax)(Mentax)

Nystatin (Mycostatin, Nilstat) – good for superficial candida (thrush)Nystatin (Mycostatin, Nilstat) – good for superficial candida (thrush)

Systemic drug therapy for topical fungal disordersSystemic drug therapy for topical fungal disorders

• • Griseofulvin (microsized versus ultramicrosized)Griseofulvin (microsized versus ultramicrosized)

• • Terbinafine (Lamisil)Terbinafine (Lamisil)

• • Avoid corticosteroidsAvoid corticosteroids

PG 67

Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)

Miconazole (Monistat, Micatin) – Miconazole (Monistat, Micatin) – broad-spectrum antifungal broad-spectrum antifungal agent available as powder, aerosol, cream, and agent available as powder, aerosol, cream, and suppository; may be used topically or vaginallysuppository; may be used topically or vaginally

Clotrimazole (Lotrimin, Mycelex) – Clotrimazole (Lotrimin, Mycelex) – broad-spectrum broad-spectrum antifungal available as cream, lotion, suppositories, and antifungal available as cream, lotion, suppositories, and troches (OTC use for 2 weeks after infection clears)troches (OTC use for 2 weeks after infection clears)

Ketoconazole (Nizoral) – Ketoconazole (Nizoral) – for superficial and systemic fungal for superficial and systemic fungal infections; also available as OTC shampoo for dandruff; infections; also available as OTC shampoo for dandruff; enzyme inhibitorenzyme inhibitor

Itraconazole (Sporanox) – Itraconazole (Sporanox) – for oral or topical treatment of for oral or topical treatment of superficial or systemic fungal disorders; enzyme inhibitor.superficial or systemic fungal disorders; enzyme inhibitor.

- - hepatotoxicity; take w/ food and avoid antacidshepatotoxicity; take w/ food and avoid antacids

Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)

Terbinafine (Lamisil) – used orally for Terbinafine (Lamisil) – used orally for onychomycosis of fingernail or toenail. Used onychomycosis of fingernail or toenail. Used topically for superficial tinea infections (OTC topically for superficial tinea infections (OTC use for 1 week). Monitor for hepatoxicity with use for 1 week). Monitor for hepatoxicity with oral use. oral use.

Ciclopriox (Penlac) – applied topically once Ciclopriox (Penlac) – applied topically once daily for treatment of onychomycosis. – daily for treatment of onychomycosis. – requires long-term therapyrequires long-term therapy

Terbinafine (Lamisil) – used orally for Terbinafine (Lamisil) – used orally for onychomycosis of fingernail or toenail. Used onychomycosis of fingernail or toenail. Used topically for superficial tinea infections (OTC topically for superficial tinea infections (OTC use for 1 week). Monitor for hepatoxicity with use for 1 week). Monitor for hepatoxicity with oral use. oral use.

Ciclopriox (Penlac) – applied topically once Ciclopriox (Penlac) – applied topically once daily for treatment of onychomycosis. – daily for treatment of onychomycosis. – requires long-term therapyrequires long-term therapy

PG 67

Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)

Griseofulvin (Grisactin, Grifulvin V, Fulvicin)Griseofulvin (Grisactin, Grifulvin V, Fulvicin) For tinea only For tinea only Duration of therapyDuration of therapy

• depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., pedis: 4-8 wkpedis: 4-8 wk

Regular versus microsized versus Regular versus microsized versus ultramicrosizedultramicrosized

• ultra is better absorbed; take w/ fatty mealultra is better absorbed; take w/ fatty meal• causes induction interactionscauses induction interactions

Griseofulvin (Grisactin, Grifulvin V, Fulvicin)Griseofulvin (Grisactin, Grifulvin V, Fulvicin) For tinea only For tinea only Duration of therapyDuration of therapy

• depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., pedis: 4-8 wkpedis: 4-8 wk

Regular versus microsized versus Regular versus microsized versus ultramicrosizedultramicrosized

• ultra is better absorbed; take w/ fatty mealultra is better absorbed; take w/ fatty meal• causes induction interactionscauses induction interactions

PG 67

Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d)Antifungal Drugs (cont’d) Other Azoles

Posaconazole (Noxafil) Voriconazole (Vfend)

• Reserved for severe invasive fungal infections (asperigillosis) Echinocandins (less DI, but monitor LFTs)

Anidulafungin (Eraxis) Caspofungin (Cancidas) Micafungin (Mycamine)

Ampho B and related Lipid products nephrotoxicity

Other Azoles Posaconazole (Noxafil) Voriconazole (Vfend)

• Reserved for severe invasive fungal infections (asperigillosis) Echinocandins (less DI, but monitor LFTs)

Anidulafungin (Eraxis) Caspofungin (Cancidas) Micafungin (Mycamine)

Ampho B and related Lipid products nephrotoxicity

PG 68

Sample QuestionsSample Questions

NAPLEX

Which of the following antibiotics does not have a significant drug interaction

with warfarin?

Which of the following antibiotics does not have a significant drug interaction

with warfarin?

A. ciprofloxacin

B. azithromycin

C. TMP-SMZ

D. Metronidazole

E. Nafcillin

A. ciprofloxacin

B. azithromycin

C. TMP-SMZ

D. Metronidazole

E. Nafcillin

Which of the following medications is the best treatment option for an

uncomplicated urinary tract infection?

Which of the following medications is the best treatment option for an

uncomplicated urinary tract infection?

A. penicillin

B. cefuroxime

C. levofloxacin

D. gentamicin

E. clarithromycin

A. penicillin

B. cefuroxime

C. levofloxacin

D. gentamicin

E. clarithromycin

Which of the following antimicrobial agents is available for parenteral use

only?

Which of the following antimicrobial agents is available for parenteral use

only?

I. piperacillin

II. aztreonam

III. rifampin

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

I. piperacillin

II. aztreonam

III. rifampin

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?

Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?

A. didanosine

B. delavirdine

C. stavudine

D. zidovudine

E. lamivudine

A. didanosine

B. delavirdine

C. stavudine

D. zidovudine

E. lamivudine

Which of the following agents may be utilized in combination with other

medications for H. pylori eradication?

Which of the following agents may be utilized in combination with other

medications for H. pylori eradication?

A. tetracycline

B. azithromycin

C. penicillin

D. fluconazole

E. cefuroxime

A. tetracycline

B. azithromycin

C. penicillin

D. fluconazole

E. cefuroxime

Peripheral neuropathy is associated with which one of the following agents:


A. nevirapine

B. delavirdine

C. Saquinavir

D. Stavudine

E. tenofovir

A. nevirapine

B. delavirdine

C. Saquinavir

D. Stavudine

E. tenofovir



A. Nevirapine (NNRTI)

B. Delavirdine (NNRTI)

C. Saquinavir (PI)

D. Stavudine (NRTI) do not use with AZT (zidovudine)

E. Tenofovir (NRTI)

A. Nevirapine (NNRTI)

B. Delavirdine (NNRTI)

C. Saquinavir (PI)

D. Stavudine (NRTI) do not use with AZT (zidovudine)

E. Tenofovir (NRTI)

Administration of calcium or iron must be separated by at least 2 hours if

antibiotics in this category are prescribed:

Administration of calcium or iron must be separated by at least 2 hours if

antibiotics in this category are prescribed:

I. Macrolides II. TetracyclinesIII. Fluroquinolones

A. I onlyB. III onlyC. I and II onlyD. II and III onlyE. I, II and III

I. Macrolides II. TetracyclinesIII. Fluroquinolones

A. I onlyB. III onlyC. I and II onlyD. II and III onlyE. I, II and III

Which of the following antimicrobial agents has effective coverage for

M. pneumoniae?

Which of the following antimicrobial agents has effective coverage for

M. pneumoniae?

A. amoxicillin

B. erythromycin

C. metronidazole

D. cefotriaxone

E. clindamycin

A. amoxicillin

B. erythromycin

C. metronidazole

D. cefotriaxone

E. clindamycin

Which of the following regimens is most appropriate for C. difficile

eradication?

Which of the following regimens is most appropriate for C. difficile

eradication?

A. Clarithromycin 500 mg PO q 12 hours

B. Clindamycin 300 mg IV q 6 hours

C. Vancomycin 125 mg PO q 6 hours

D. Doxycycline 100 mg PO q 12 hours

E. Vancomycin 1000 mg IV q 12 hours

A. Clarithromycin 500 mg PO q 12 hours

B. Clindamycin 300 mg IV q 6 hours

C. Vancomycin 125 mg PO q 6 hours

D. Doxycycline 100 mg PO q 12 hours

E. Vancomycin 1000 mg IV q 12 hours

Which agent is available in both a topical and an oral product for the

treatment of acne?

Which agent is available in both a topical and an oral product for the

treatment of acne?

I. clindamycin

II. erythromycin

III. doxycycline

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

I. clindamycin

II. erythromycin

III. doxycycline

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

Which of the following drugs represents first (primary) agents in the

treatment of TB?

Which of the following drugs represents first (primary) agents in the

treatment of TB?

A. Ethambutol + PASA

B. Ciprofloxacin + PASA

C. Isoniazid + rifampin

D. Cycloserine + streptomycin

E. Penicillin + Benemid

A. Ethambutol + PASA

B. Ciprofloxacin + PASA

C. Isoniazid + rifampin

D. Cycloserine + streptomycin

E. Penicillin + Benemid

Which of the following antibiotics is considered first line treatment for a

gonorrhea infection?



A. Ampicillin

B. Ciprofloxacin

C. Doxycycline

D. Penicillin

E. Tetracycline

A. Ampicillin

B. Ciprofloxacin

C. Doxycycline

D. Penicillin

E. Tetracycline





A. Ampicillin

B. Ciprofloxacin (also..ceftriaxone, cefixime)

C. Doxycycline (chlamydia)

D. Penicillin

E. Tetracycline

A. Ampicillin

B. Ciprofloxacin (also..ceftriaxone, cefixime)

C. Doxycycline (chlamydia)

D. Penicillin

E. Tetracycline

Which of the following groups of antibiotics may be prescribed for a

gravid patient with gonorrhea?

Which of the following groups of antibiotics may be prescribed for a

gravid patient with gonorrhea?

I. cephalosporins

II. fluoroquinolones

III. tetracyclines

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

I. cephalosporins

II. fluoroquinolones

III. tetracyclines

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?

A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?

A. Ampicillin

B. Levofloxacin

C. Doxycycline

D. Erythromycin

E. Penicillin

A. Ampicillin

B. Levofloxacin

C. Doxycycline

D. Erythromycin

E. Penicillin

Which of the following is the BEST treatment for a patient with

herpes zoster?

Which of the following is the BEST treatment for a patient with

herpes zoster?A. CidofovirB. FamciclovirC. GanciclovirD. PenciclovirE. Tenofovir

A. CidofovirB. FamciclovirC. GanciclovirD. PenciclovirE. Tenofovir

Which of the following medications would be appropriate for the treatment of Pseudomonas

aeruginosa?

Which of the following medications would be appropriate for the treatment of Pseudomonas

aeruginosa?a. Ampicillinb. Cefepimec. Ceftriaxoned. Erythromycine. Clindamycin

a. Ampicillinb. Cefepimec. Ceftriaxoned. Erythromycine. Clindamycin

antimicrobial agents naplex. empiric therapy identify the causative organism test the sensitivity of...

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sulfa use

sulfa slide

sulfa sensitivity

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sulfa allergy

sulfa sodium salt solutions

beta lactam ring

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