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what are primary options for HA MRSA
- vancomycin
- quinupristin/dalfopristen
- linezolid
- datpomycin
- tigecycline
- telavancin
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what are primary options for CA MRSA
- clindamycin
- tmp/smx
- minocycline/doxycycline
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what are current vanco tdm
15-20 mg/L trough. no peak recmmendation
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what are breakpoints for vanco with s aureus
- susceptible <=2
- intermediate 4-8mg/L
- resistant >=16 mg/L
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what kinda killer is vanco
concentration independent killer
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what is the best way to therapeutically monitor vancomycin
- troughs are the most accurate and practical method for moitoring efficacy
- troughs should be maintained >10mg/L (15-20 for complicated)
- monitoring trough serum concntrations to reduce nephrotxicity--best suited for agfressive dosing (troughs 15-20mg/L)
- all patients receiving prolonged therapy should have at least one steady state trough concentration (>4th dose)
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what are three types of antifungal agents
- inhibitors of fungal cell membranes -- ampotericin B, azole, nystatin
- DNA inhibiotrs--flucytosine
- inhibitoris of cell wall biosynthesis--echinocandins
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what is moa, dosing, and adverse reactions of amphotericin B
- binds sterols in fungal cell membrane, change in membrane permeability, cell leakeage, death
- drug of choie for many infections including in pregnancy
- ifusion related reactions--include fevere, chills, nvh thrombophlebities myalgias, arthroalgias. can avoid with premedicating with antihistamine thrombophlebitis can be avoided by slwoing infusion rate
- nephrotoxicity--avoid with preinfusing 500mlNS
- eletrolyte imbalances--esp k, ca, mg
- leukocytosis
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what is moa, dose adjustments, and adverse reactions of flucytosine
- converted to five flurouracil in fungal cells,
- never use alone0--inreased resistance
- adjust in renal dysfunction
- adverse reactions--bone marrow suppression, hepatotoxicity, renal dysfunction, nvd, enterocolitis
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