21.When do you use vancomycin orally? Only used for C. difficile diarrhea

22.What is the therapeutic range of vancomycin? IV: 15mg/kg/day and PO: 500 mg q6h

23.What is the adverse effect of carbapenems when interacting with valproate (an anti-seizure medication)? Reduces concentrations of valproate to subtherapeutic levels which results in a loss of seizure control

24.What medications and/or foods interact with tetracyclines and how do you administer those medications and/or foods with tetracyclines? Dairy products: decreases GI absorption of tetracycline Antacids, antidiarrheal drugs, calcium, and iron salts: reduces the oral absorption of the tetracycline Do not take with dairy products Take tetracycline on an empty stomach; 1 hour before or 2 hours after meals/antacids/calcium Take tetracycline 2 hours before or 3 hours after iron

25.Know the major adverse effects of tetracyclines, including during pregnancy. Causes tooth discoloration in pediatric patients and can be passed through breast milk which causes tooth discoloration Can cause possible retard fetal skeletal development if taken during pregnancy Photosensitivity, diarrhea or vaginal candidiasis, thrombocytopenia, coagulation irregularities, hemolytic anemia

26Know the adverse effects of macrolides. Palpitations, chest pain, headache, dizziness, nausea, hepatotoxicity, vomiting, rash, hearing loss27. Know the major adverse effect of clindamycin Most common: GI tract adverse effect (n/v, abdominal pain, diarrhea, pseudomembranous colitis, and anorexia).

28. Know the drugs and food interactions for linezolid. What are the consequences when those drugs and foods interact with linezolid? Drug Interactions: linezolid has the potential to strengthen the vasopressor (prohypertensive) effects of various vasopressive drugs such as dopamine. Also, there have been post-marketing case reports of linezolid causing serotonin syndrome when used concurrently with serotonergic drugs such as the SSRI antidepressants Food Interactions: tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut can interact with linezolid to raise blood pressure

29. Why is linezolid should only be reserved for severe infection? Linezolid is a reserve antibiotic- one that should be used sparingly so that it will remain effective as a drug of last resort against potentially intractable infections30. What effects does linezolid have on CBC? It decreases platelet count

31. What kind of bacteria does aminoglycoside target and why does it usually combine with beta-lactam antibiotics such as penicillin and cephalosporins? Aminoglycosides target gram positive and gram-negative bacteria. Aminoglycosides are never given alone to treat gram-positive infections. It usually combines with beta-lactam antibiotics because the combined effect of the two antibiotics is greater than the sum of the effects of each drug acting separately (synergistic effect). When aminoglycosides are used in combination with beta-lactams, the beta-lactam antibiotic is given first. This is because beta-lactams break down the cell wall of the bacteria and allow the aminoglycoside to gain access to the ribosomes where they work.

32. Can you give aminoglycoside and penicillin mixed together in the same IV solution? Why or why not? Aminoglycosides cannot be mixed together with penicillin in the same IV solution. Penicillin may inactivate aminoglycosides in vitro. 33. What are the normal peak levels for traditional dosing and once-daily dosing for gentamicin? IV: Peak Concentration- 30 min IM: Peak Concentration- 30-90 min IV/IM: 2-6 mg/kg/day divided 1-4 times daily or 5-7 mg/kg/daily

46. What is the urine color for patients taking nitrofurantonin?Rust yellow to brown

47. Which medication cause c-difficile and what are two medications used to treat c- difficile?Antibiotics cause c- diff. 2 medications that treat c-diff are vancomyin (Vancocin) and metronidazole (Flagyl)48. please do not get confused between:49. Macroglides (erythromycin, clarithromycin, azithromycin)erythromycin:natural microglideusual dosage: PO 250- 500 mg qidIndications: infections of respiratory and GI tracts and skin caused by various gram- positive, gram- negative, and miscellaneous organisms, burn wound infectionAdverse effects: N/V, seizures, dysrhythmias, hepatoxicity, esophagitis, anaphylaxisClarithromycin:Semisynthetic macroglideUsual dosage: PO 500 mg twice dailyIndications: comparable to to those for erythromycin, but especially GU and respiratory tract infections, including MAC infections, skin structure infectionsAdverse effects: ventricular dysrhythmias, hepatoxicity, tooth/ tongue discoloration, pancreatitis, N/V

Azithromycin:Semisythetic macroglideUsual dosage: PO 500 mg x 1 dose, then 250 mg daily x 4 days OR IV 500 mg q day Indications: comparable to to those for erythromycin, but especially GU and respiratory tract infections, including MAC infections, skin structure infectionsAdverse effects: dizziness, QT prolongation, hepatoxicity, pseudomembranous colitis, angioedema, Stevens- Johnson syndrome50. Aminoglycosides (amikacin, gentamicin, streptomycin, neomycin)amikacin:Usual dosage: IV 15 mg/kg/day divided 2-3 times daily or 15-20 mg/kg once dailyIndications: severe systemic infections of CNS, respiratory tract, GI tract, urinary tract, bone, skin, soft tissues caused by MSSA or E. ColiAdverse effects: seizures, neurotoxicity, neuromuscular blockade with respiratory paralysis, oliguria, hematuria, renal damage, azotemia, renal failure, anemiaGentamicin:Usual dosage: IV/IM 2-6 mg/ kg/day divided 1-4 times daily or 5-7 mg/ kg once dailyIndications: severe systemic infections of CNS, respiratory tract, GI tract, urinary tract, bone, skin, soft tissues caused by susceptible strains of Pseudomonas aeruginosa and other bacteriaAdverse effects: seizures, neurotoxicity, encephalopathy, ototoxicity, hepatic necrosis, oliguria, hematuria, renal damage, thrombocytopenia, anaphylaxis, apneaStreptomycin:Indications: treating TBAdverse effects: black- tarry stools, chest pain, chills, dizziness, nausea, SOB, swollen glands, unsteadinessNeomycin:Usual dosage: PO/PR 3000-9000 mg divided between 3-9 dosesIndications: preoperative bowel cleansing (also used with different dosage regimens for hepatic encephalopathy)Adverse effects: hearing impairment, neuromuscular disease, renal disease

51. Vancomycin (glycopeptide)Class: tricyclic glycopeptideIndication: severe staph infections, including MRSA infections other serious gram- positive infections, including strep infections52. Clindamycin (Lindcosamide)Class: lincosamideIndications: anaerobic infections, strep and staph infections of bone, skin, respiratory and GU tract

53. They are NOT from the same class!