568 Midterm Study Guide
Week 1
Things to know about each of the major antibiotic drug classes
- Aminoglycosides (Gentamicin, Neomycin, Tobramycin) ‘icin
Precautions / Contraindications
Pregnancy: fetal ototoxicity
With other ototoxic drugs: furosemide, minocycline
With nephrotoxic drugs: vancomycin, cisplatin
Elderly patients
Those with kidney disease
Cautious use of muscle relaxants
Do not mix with any other drug in same syringe
High Risk Patients
Are allergic to sulfites (often found in certain wines and dried fruits)
Have kidney or hearing problems, including problems with balance and uncontrollable eye
movements
Have a disorder affecting the nerves and muscles, like multiple sclerosis or myasthenia
gravis.
Are 65 years of age or older
You have a newborn or very young baby who might be treated for a serious infection
using aminoglycosides
- Carbapenems (Doripenem, Ertapenem, Imipenem) ‘nem
Precautions / Contraindications/High Risk Patients
Contraindicated in patients with prior allergic reactions to beta lactam antibiotics.
Contraindicated in patients with prior adverse reactions to lidocaine.
Contraindicated in patients who are taking valproic acid for seizures, as it has been
shown to decrease valproic acid concentrations by as much as 90%
Carbapenems are powerful antibiotics that kill bacteria causing a range of diseases
including pneumonia, urinary tract infections, serious skin infections, meningitis, and
septicaemia (blood poisoning)
Only Given for serious infections
Patients who are taking valproate to control seizures should not be placed on Imipenem
Dosage should be reduced in patients with renal impairment
- Cephalosporins (Cefadroxil, Cefazolin, Cephalexin) ‘in
Precautions / Contraindications/High Risk Patients
Contraindicated for patients Hx of allergic reactions to cephalosporins or severe reactions
to penicillin
Dosage should be reduced in patients with renal impairment
1
, 568 Midterm Study Guide
Report stool frequency (can promote Clostridiodies difficile infection)
- Fluoroquinolones (Ciprofloxacin, Delafloxacin, Lovofloxacin) ‘xacin
Precautions / Contraindications
Previous allergic reaction to Fluoroquinolones
Certain disorders that predispose to arrhythmias (eg, QT-interval prolongation, uncorrected
hypokalemia or hypomagnesemia, significant bradycardia)
Use of drugs known to prolong the QT interval or to cause bradycardia (eg, metoclopramide,
cisapride, erythromycin, clarithromycin, classes Ia and III antiarrhythmics, tricyclic
antidepressants)
High Risk Patients
arthritis or problems with your tendons, bones or joints (especially in children);
diabetes, low blood sugar;
nerve problems;
an aneurysm or blood circulation problems;
heart problems, or a heart attack;
muscle weakness, myasthenia gravis;
liver or kidney disease;
a seizure, head injury, or brain tumor;
trouble swallowing pills;
long QT syndrome (in you or a family member); or
low levels of potassium in your blood (hypokalemia).
Do not give this medicine to a child without medical advice.
Precautions / Contraindications/High Risk Patients
- Glycopeptides & Lipoglycopeptides (Vancomycin, dalbavancin, oritavancin ,telavancin)
Use of glycopeptides and lipoglycopeptides during pregnancy is not recommended, but
sometimes the benefits of treatment may outweigh the risks. For example, vancomycin taken by
mouth may be used to treat C. difficile–induced diarrhea in pregnant women
Patients with history of antibiotic associated diarrhea must be cautious about using Vancomycin.
Discuss with your doctor regarding your history of the same.
Patients with history of opportunistic infections must be cautious about using Vancomycin.
Discuss with your doctor regarding your history of the same.
Patients with history of diminished hearing and ototoxicity are at increased risk for hearing loss
with Vancomycin. Discuss with your doctor regarding safety with Vancomycin use.
Vancomycin is not metabolized and is excreted unchanged in the urine. Individuals with
compromised renal functions tend to retain the drug in the circulation longer, thus resulting in
toxicity. Vancomycin should be avoided or used with extreme caution in such individuals.
Individuals with history of seizures and hallucinations can present with exacerbation of these
symptoms with Vancomycin. Vancomycin should be avoided or used with extreme caution in
individuals with seizure history.
Vancomycin should be avoided or used cautiously in individuals with history of cardiac
arrhythmias, as it has the potential to induce life-threatening cardiac arrest. Individuals with
history of chronic disturbance in serum magnesium and potassium ions are at increased risk for
arrhythmias. Also, individuals taking Lasix are at increased risk for losing potassium, thus setting
the ground for life-threatening arrhythmias with Vancomycin.
Vancomycin intake can increase the risk for skin rash, ranging from mild to severe exfoliating
rash, easy bleeding, bruising, and blister formation. Individuals with history of extreme skin
rashes and taking Vancomycin should be aware of this response and observe a close watch on
the same.
High Risk Patients
2
, 568 Midterm Study Guide
Telavancin has a boxed warning highlighting the increased mortality in patients with preexisting
kidney dysfunction (creatinine clearance 50 mL/min or less).
Precautions / Contraindications/High Risk Patients
- Macrolides (Erythromycin and azithromycin) ‘mycin
Concomitant administration of macrolides with astemizole, cisapride, pimozide, or
terfenadine is contraindicated because potentially fatal cardiac arrhythmias (eg, QT
prolongation, ventricular tachycardia, ventricular fibrillation, torsades de pointes) may
occur when clarithromycin or erythromycin is given with these drugs.
High Risk Patients
liver disease;
kidney disease;
myasthenia gravis;
a heart rhythm disorder;
low levels of potassium in your blood; or
long QT syndrome (in you or a family member).
Precautions / Contraindications/High Risk Patients
- Monobactams (aztreonam)
Aztreonam for injection should be halved in patients with estimated creatinine
clearances between 10 and 30 mL/min/1.73 m2 after an initial loading dose of 1 or 2 g.
- Oxazolidinones (linezolid & tedizolid) ‘zolid
Precautions / Contraindications
- Penicillin’s (Amoxicillin, Dicloxacillin, Penicillin G, V)
Precautions / Contraindications
Doses should be adjusted in older adults with renal dysfunction
Renal impairment can cause penicillins to accumulate to toxic levels. Monitor function in
patients with renal disease.
- Polypeptides (Bacitracin, Colistin, Polymyxin B)
- Rifamycin’s (Rafampin, Rifaximin, Rafapentine) starts with R..
- Sulfonamides (Mafenide, Sulfadoxine, Sulfisoxazole)(Sulfamethoxazole w/ trimethoprim)
- Streptogramins (qunupristin & dalfopristin) ‘pristin
- Tetracyclines (Doxycycline, Eravacycline, Minocycline, Tetracyclines, Omadacycline)
‘cycline
3
Week 1
Things to know about each of the major antibiotic drug classes
- Aminoglycosides (Gentamicin, Neomycin, Tobramycin) ‘icin
Precautions / Contraindications
Pregnancy: fetal ototoxicity
With other ototoxic drugs: furosemide, minocycline
With nephrotoxic drugs: vancomycin, cisplatin
Elderly patients
Those with kidney disease
Cautious use of muscle relaxants
Do not mix with any other drug in same syringe
High Risk Patients
Are allergic to sulfites (often found in certain wines and dried fruits)
Have kidney or hearing problems, including problems with balance and uncontrollable eye
movements
Have a disorder affecting the nerves and muscles, like multiple sclerosis or myasthenia
gravis.
Are 65 years of age or older
You have a newborn or very young baby who might be treated for a serious infection
using aminoglycosides
- Carbapenems (Doripenem, Ertapenem, Imipenem) ‘nem
Precautions / Contraindications/High Risk Patients
Contraindicated in patients with prior allergic reactions to beta lactam antibiotics.
Contraindicated in patients with prior adverse reactions to lidocaine.
Contraindicated in patients who are taking valproic acid for seizures, as it has been
shown to decrease valproic acid concentrations by as much as 90%
Carbapenems are powerful antibiotics that kill bacteria causing a range of diseases
including pneumonia, urinary tract infections, serious skin infections, meningitis, and
septicaemia (blood poisoning)
Only Given for serious infections
Patients who are taking valproate to control seizures should not be placed on Imipenem
Dosage should be reduced in patients with renal impairment
- Cephalosporins (Cefadroxil, Cefazolin, Cephalexin) ‘in
Precautions / Contraindications/High Risk Patients
Contraindicated for patients Hx of allergic reactions to cephalosporins or severe reactions
to penicillin
Dosage should be reduced in patients with renal impairment
1
, 568 Midterm Study Guide
Report stool frequency (can promote Clostridiodies difficile infection)
- Fluoroquinolones (Ciprofloxacin, Delafloxacin, Lovofloxacin) ‘xacin
Precautions / Contraindications
Previous allergic reaction to Fluoroquinolones
Certain disorders that predispose to arrhythmias (eg, QT-interval prolongation, uncorrected
hypokalemia or hypomagnesemia, significant bradycardia)
Use of drugs known to prolong the QT interval or to cause bradycardia (eg, metoclopramide,
cisapride, erythromycin, clarithromycin, classes Ia and III antiarrhythmics, tricyclic
antidepressants)
High Risk Patients
arthritis or problems with your tendons, bones or joints (especially in children);
diabetes, low blood sugar;
nerve problems;
an aneurysm or blood circulation problems;
heart problems, or a heart attack;
muscle weakness, myasthenia gravis;
liver or kidney disease;
a seizure, head injury, or brain tumor;
trouble swallowing pills;
long QT syndrome (in you or a family member); or
low levels of potassium in your blood (hypokalemia).
Do not give this medicine to a child without medical advice.
Precautions / Contraindications/High Risk Patients
- Glycopeptides & Lipoglycopeptides (Vancomycin, dalbavancin, oritavancin ,telavancin)
Use of glycopeptides and lipoglycopeptides during pregnancy is not recommended, but
sometimes the benefits of treatment may outweigh the risks. For example, vancomycin taken by
mouth may be used to treat C. difficile–induced diarrhea in pregnant women
Patients with history of antibiotic associated diarrhea must be cautious about using Vancomycin.
Discuss with your doctor regarding your history of the same.
Patients with history of opportunistic infections must be cautious about using Vancomycin.
Discuss with your doctor regarding your history of the same.
Patients with history of diminished hearing and ototoxicity are at increased risk for hearing loss
with Vancomycin. Discuss with your doctor regarding safety with Vancomycin use.
Vancomycin is not metabolized and is excreted unchanged in the urine. Individuals with
compromised renal functions tend to retain the drug in the circulation longer, thus resulting in
toxicity. Vancomycin should be avoided or used with extreme caution in such individuals.
Individuals with history of seizures and hallucinations can present with exacerbation of these
symptoms with Vancomycin. Vancomycin should be avoided or used with extreme caution in
individuals with seizure history.
Vancomycin should be avoided or used cautiously in individuals with history of cardiac
arrhythmias, as it has the potential to induce life-threatening cardiac arrest. Individuals with
history of chronic disturbance in serum magnesium and potassium ions are at increased risk for
arrhythmias. Also, individuals taking Lasix are at increased risk for losing potassium, thus setting
the ground for life-threatening arrhythmias with Vancomycin.
Vancomycin intake can increase the risk for skin rash, ranging from mild to severe exfoliating
rash, easy bleeding, bruising, and blister formation. Individuals with history of extreme skin
rashes and taking Vancomycin should be aware of this response and observe a close watch on
the same.
High Risk Patients
2
, 568 Midterm Study Guide
Telavancin has a boxed warning highlighting the increased mortality in patients with preexisting
kidney dysfunction (creatinine clearance 50 mL/min or less).
Precautions / Contraindications/High Risk Patients
- Macrolides (Erythromycin and azithromycin) ‘mycin
Concomitant administration of macrolides with astemizole, cisapride, pimozide, or
terfenadine is contraindicated because potentially fatal cardiac arrhythmias (eg, QT
prolongation, ventricular tachycardia, ventricular fibrillation, torsades de pointes) may
occur when clarithromycin or erythromycin is given with these drugs.
High Risk Patients
liver disease;
kidney disease;
myasthenia gravis;
a heart rhythm disorder;
low levels of potassium in your blood; or
long QT syndrome (in you or a family member).
Precautions / Contraindications/High Risk Patients
- Monobactams (aztreonam)
Aztreonam for injection should be halved in patients with estimated creatinine
clearances between 10 and 30 mL/min/1.73 m2 after an initial loading dose of 1 or 2 g.
- Oxazolidinones (linezolid & tedizolid) ‘zolid
Precautions / Contraindications
- Penicillin’s (Amoxicillin, Dicloxacillin, Penicillin G, V)
Precautions / Contraindications
Doses should be adjusted in older adults with renal dysfunction
Renal impairment can cause penicillins to accumulate to toxic levels. Monitor function in
patients with renal disease.
- Polypeptides (Bacitracin, Colistin, Polymyxin B)
- Rifamycin’s (Rafampin, Rifaximin, Rafapentine) starts with R..
- Sulfonamides (Mafenide, Sulfadoxine, Sulfisoxazole)(Sulfamethoxazole w/ trimethoprim)
- Streptogramins (qunupristin & dalfopristin) ‘pristin
- Tetracyclines (Doxycycline, Eravacycline, Minocycline, Tetracyclines, Omadacycline)
‘cycline
3
