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
26

Know the adverse effects of macrolides.

Palpitations, chest pain, headache, dizziness, nausea,
hepatotoxicity, vomiting, rash, hearing loss
27. 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 infections

30. 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 microglide
usual dosage: PO 250- 500 mg qid
Indications: infections of respiratory and GI tracts and skin
caused by
various gram- positive, gram- negative, and
miscellaneous organisms,
burn wound infection
Adverse effects: N/V, seizures, dysrhythmias, hepatoxicity,
esophagitis, anaphylaxis
Clarithromycin:
Semisynthetic macroglide
Usual dosage: PO 500 mg twice daily
Indications: comparable to to those for erythromycin, but
especially
GU and respiratory tract infections, including
MAC infections, skin
structure infections
Adverse effects: ventricular dysrhythmias, hepatoxicity,
tooth/ tongue
discoloration, pancreatitis, N/V
Azithromycin:
Semisythetic macroglide
Usual 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 infections
Adverse effects: dizziness, QT prolongation, hepatoxicity,
pseudomembranous colitis, angioedema,
Stevens- Johnson syndrome
50. Aminoglycosides (amikacin, gentamicin, streptomycin, neomycin)
amikacin:
Usual dosage: IV 15 mg/kg/day divided 2-3 times daily or 1520
mg/kg once daily
Indications: severe systemic infections of CNS, respiratory
tract, GI
tract, urinary tract, bone, skin, soft tissues
caused by MSSA or E. Coli
Adverse effects: seizures, neurotoxicity, neuromuscular
blockade with
respiratory paralysis, oliguria, hematuria, renal
damage, azotemia,
renal failure, anemia
Gentamicin:
Usual dosage: IV/IM 2-6 mg/ kg/day divided 1-4 times daily or
5-7
mg/ kg once daily
Indications: severe systemic infections of CNS, respiratory
tract, GI
tract, urinary tract, bone, skin, soft tissues

caused by susceptible
strains of Pseudomonas aeruginosa
and other bacteria
Adverse effects: seizures, neurotoxicity, encephalopathy,
ototoxicity,
hepatic necrosis, oliguria, hematuria, renal
damage,
thrombocytopenia,
anaphylaxis, apnea
Streptomycin:
Indications: treating TB
Adverse effects: black- tarry stools, chest pain, chills,
dizziness,
nausea, SOB, swollen glands, unsteadiness
Neomycin:
Usual dosage: PO/PR 3000-9000 mg divided between 3-9
doses
Indications: 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 glycopeptide
Indication: severe staph infections, including MRSA infections other
serious
gram- positive infections, including strep infections
52. Clindamycin (Lindcosamide)
Class: lincosamide
Indications: anaerobic infections, strep and staph infections of bone,
skin, respiratory and GU tract
53. They are NOT from the same class!