Term
| 'Left Shift' indicates what? What is it? |
|
Definition
Acute Infection
Increase in the relative number of immature forms of neutrophils (>10%) |
|
|
Term
| When might leukocytosis occur without left shift? |
|
Definition
| when the body is stressed: exercise anxiety fight or flight |
|
|
Term
| Segs or Bands: which are mature neutrophils? |
|
Definition
| Segs: (segmented) = mature |
|
|
Term
|
Definition
MOST VIRULENT (true pathogen)
ONLY one that is COAGULASE+ |
|
|
Term
|
Definition
Commensal (part of normal skin flora)
Diseases: associated with immunocompromised, burns (violations of natural barriers), foreign devices (pacemakers) |
|
|
Term
|
Definition
Rarely causes infection
Most noted in UTIs in women |
|
|
Term
|
Definition
pus producing lesion on skin
infection of hair follicle or sweat gland
acne vulgaris
stye |
|
|
Term
|
Definition
spreading of lesions to SQ tissue
serious-can lead to bloodstream infection |
|
|
Term
|
Definition
highly communicable, superficial skin infection
large blisters containing viable staff
Mostly in infants/kids |
|
|
Term
| Does staph or strep appear in clusters? |
|
Definition
Staph: clusters
Strep: chains/pairs |
|
|
Term
| S. pyogenes (classification) |
|
Definition
Group A, beta hemolytic strep
prominent cause of bacterial pharyngitis |
|
|
Term
| S. pneumoniae (classification) |
|
Definition
| alpha hemolytic (no group) |
|
|
Term
| S. agalactiae (classification) |
|
Definition
| Group B, beta hemolytic strep |
|
|
Term
|
Definition
alpha hemolytic strep (no group)
usually in mouth and nasopharynx
can cause subacute bacterial endocarditis (in kids/teens = very damaging to heart) |
|
|
Term
| Enterococci classification |
|
Definition
| Group D gamma hemolytic strep |
|
|
Term
| Rapid Strep test (for strep throat) |
|
Definition
Test to rule out Group A strep
Good specificity, fair sensitivity = false negative likely
SO, if test comes back negative for strep, might still have it |
|
|
Term
| Why we are concerned with strep pharyngitis infections: |
|
Definition
Sequella (additive risk with each sequential infection)
1. Rheumatic fever (heart valve disease)- more common with strep pharyngitis
2. acute glomerulomephritis (Chronic renal failure) - more common with strep impetigo (NOT same as STAPH impetigo) |
|
|
Term
| Most common infections with Strep agalactiae |
|
Definition
a leading cause of pneumonia, sepsis, and meningitis during first 2 months of life
contamination in birth canal and/or not enough of mothers IgG
Tx: Penicillin and aminoglycoside |
|
|
Term
| Infections associated with strep pneumo |
|
Definition
bacterial CAP (most common)
meningitis (most common)
URI (sinusitis and otitis media)
endocarditis, arthritis, peritonitis
**Consider location when selecting drug** |
|
|
Term
| What are the 3 most common causes of bacterial meningitis? What do they all have in common? |
|
Definition
H. flu
N. meningiditis
S. pneumoniae (most common)
all capsular |
|
|
Term
| Which enterococcus is more resistant to antibiotics (including vancomycin) |
|
Definition
faecium (bad)
faecalis = more common and susceptible to abx |
|
|
Term
| Spectrum of oxygen dependency (most oxygen-requiring to least) |
|
Definition
Obligate aerobes
Facultative anaerobes
Microaerophilic bacteria (aerotolerant anaerobes)
Obligate anaerobes (most difficult to culture) |
|
|
Term
|
Definition
Gram positive, obligate anaerobes
botulism (flaccid paralysis)
tetanus (rigid paralysis)
gas gangrene (C.perfringens - endotoxins destroy skin, soft tissue, and muscle
pseudomembranous entercolitis (C.diff) |
|
|
Term
|
Definition
gram negative, anaerobes
B.fragilis: most common bacteria in colon, beta-lactamase prodcuer |
|
|
Term
|
Definition
gram negative, aerobes (diplococci)
N. meningiditis:
-meningitis
-transmitted via droplet nuclei (ex. sneezing)
-vaccination available
-Tx: pen G, alternatively 3rd gen ceph
N.gonorrhea
-asymptomatic (more so in women)
-chlamydia trachomatis often a co-infection - usually treat both)
-Tx: 2nd/3rd gen ceph, fluoroquinolones, spectinomycin (increased resistance to Pen G)
-can cause blindness in baby (prophylaxis with silver nitrate soln 1%) |
|
|
Term
|
Definition
gram negative aerobic diplococci
low pathogenicity
increasing concern in URIs and pneumonia (esp in chronic bronchitis)
Tx: erythromycin, tetracycline, augmentin, cephalosporins |
|
|
Term
|
Definition
1. Non-diarrheagenic - most common cause of UTIs
2. Diarrheagenic - different strains |
|
|
Term
|
Definition
enterobactericeae
Diseases:
-predominately nosocomial
-pneumonia, UTIs, bateremia
beta-lactamase production
endotoxin |
|
|
Term
|
Definition
Enterobacteriaceae
Diseases:
UTIs (pyelonephritis and cystitis)
Nosocomial pneumonia and bacteremia
entotoxin and beta-lactamase production |
|
|
Term
|
Definition
Enterobacteriaceae
Diseases:
UTIs
Nosocomial pneumonia and bacteremia
Infective arthritis for intra-auricular injections (steroid shots)
Endotoxin and beta-lacatase production |
|
|
Term
|
Definition
enterobacteriaceae
indole positive
Disease:
UTIs, urolithiasis
endotoxin, flagella, some beta-lactamase production |
|
|
Term
|
Definition
enterobacteriaceae
true pathogen
Disease:
enteric fever (Typhoid fever)-->bacteremia |
|
|
Term
|
Definition
causes watery diarrhea with fever, N/V, usually self-limiting
bacteremia occasionally
transmitted: fecal/oral, contaminated food |
|
|
Term
|
Definition
| dysentery: watery diarrhea, fever, N/V |
|
|
Term
|
Definition
bubonic plague: rapidly fatal
fever, chills, sudden onset-->bacteremia, sepsis, vasculitis and gangrene
transmitted by fleas |
|
|
Term
|
Definition
meningitis
epiglotittis (most common cause in kids)
sinusitis and otitis media (most common)
purulent conjunctivitis
vaccine available for type b strain (common) |
|
|
Term
| Pseudomonas aeruginosa and Burkholderia |
|
Definition
hot tubs, pools ->swimmers ear
cystic fibrosis
ventilator associated pneumonia
multiple forms of resistance-usually requires multiple drugs |
|
|
Term
| Stenotrophomonas and Acinetobacter |
|
Definition
gram negative aerobes
multiple drug resistance
Disease:
often in hospitalized patients who have undergone recent courses of antibiotics
nosocomial pneumonia and bacteremia |
|
|
Term
|
Definition
legionar's disease exotoxin (unique) impairs phagocytes Atypical pneumonia that is fatal in immunocompromised and elderly Treatment:erythromycin DOC
macrolides, tetracyclines, fluoroquinolones |
|
|
Term
|
Definition
urease producer-so can live in stomach
Disease:
chronic gastritis-superficial mucosal inflammation
gastric and duodenal/peptic ulcer- extension of chronic gastritis
gastric carcinoma
Tx: clarithromycin amoxicillin and PPI (PrevPak) |
|
|
Term
|
Definition
Disruption of cell wall synthesis by binding to PGP (inhibits transpeptidases)
irreversible
time-dependent killing |
|
|
Term
|
Definition
|
|
Term
|
Definition
given with penicillin to block drugs tubular secretion (increase half-life of penicillin)
Also given with colcrys |
|
|
Term
| Which penicillin formulation has the longest half-life |
|
Definition
| Benzathine Penicillin G IM suspension |
|
|
Term
| What is Penicillin used to treat? |
|
Definition
Syphillis
Strep A pharyngitis (pyogenes)
oral cavity infections
some anaerobes (Clostridia [not difficile]) |
|
|
Term
| What two penicillins are administered IM? |
|
Definition
Procaine Pen G
Benzathine Pen G |
|
|
Term
|
Definition
GI: NVD
rare: seizures, acute interstitial nephritis, anaphylaxis |
|
|
Term
| Two drugs to treat MRSA out-patient |
|
Definition
| Bactrim and Cleocin (clindamycin) |
|
|
Term
| What is the advantage of dicloxacillin over cloxacillin? |
|
Definition
| increased bioavailability (can halve the dose) |
|
|
Term
| What is ampicillin used to treat? |
|
Definition
H.flu and Entercocci (URI)
Some strains of E.coli and P.mirabilis (UTI)
*not active against beta-lactamase producers |
|
|
Term
| Biggest drawback with ampicillin |
|
Definition
diarrhea
amoxicillin has much less associated (+ better bioavailability) |
|
|
Term
|
Definition
Otitis media
bacterial sinusitis
exacerbations of chronic bronchitis
some Salmonella |
|
|
Term
|
Definition
N/V
Diarrhea (less than with Ampicillin)
Rash (higher than with other penicillins) |
|
|
Term
|
Definition
Klebsiella, Pseudomonas, Serratia, Enterobacter, Enterococci, and anaerobes
empiric use in hospitals as Zosyn |
|
|
Term
| What patients are at an increased risk of rash with amoxicillin/ampicillin |
|
Definition
patients with mononucleosis (~90%)
will be falsely branded with a penicillin allergy |
|
|
Term
| What is Jarixch-Herxheimer reaction? When does it occur? |
|
Definition
Occurs with penicillins used to treat spirochete infections
-occurs because the drug is so effective at treating it causes the release of toxins at once
begins 2 hours after administration and lasts about a day
fever, chills, sweating, tachycardia, myalgias, hyperventilation
Treat symptoms with ASA and prednisone |
|
|
Term
| How long should a second form of birth control when antibiotics are given to a patient on OC? |
|
Definition
| up to two weeks after finishing the antibiotic |
|
|
Term
| Most common penicillin hypersensitivity reaction |
|
Definition
Morbiliform eruption
maculopapular rash (late reaction)
treat with antipruritic (ex: hydroxyzine or diphenhydramine)
occurs where the patient has been laying (ex: pressure), then will spread |
|
|
Term
| What type of bacteria are NEVER covered by cephalosporins? |
|
Definition
|
|
Term
| What are the two notable first generation cephalosporins? (Hint 1 IV and 1 PO) |
|
Definition
|
|
Term
| What do the first generation cephalosporins cover? |
|
Definition
| Class effect (all first generations cover the same things) Good gram positive (NOT Coag negative, MRSA, Enterococci) use for MSSA or Strep E.coli, K.pneumoniae, P.mirabilis most anaerobes BUT B.fragilis |
|
|
Term
| Advantages of second generation ceph over 1st gen. (General) |
|
Definition
| greater anaerobic coverages (B.frag) - can be used in colon procedures enhanced beta-lactamase stability and relative loss of G+ activity H.flu, Strep pneumo, Moraxella catarrhalis (respiratory) |
|
|
Term
| Name 2 IV 2nd gen cephalosporins and 1 PO |
|
Definition
| Cefoxitin (colon surgery) Cefuroxime (respiratory) Cefuroxima axetil |
|
|
Term
| What is the cross sensitivity rate between penicillins and cephalosporins |
|
Definition
| ~8% Dont give cephalosporins to patients to people with anaphylactic rxn or severe rash with penicillins low risk in patients who exhibited a mild rash |
|
|
Term
| Name 2 IV 3rd generation cephalosporins and 2 PO |
|
Definition
Ceftriaxone (enterobatericeae; meningitis)
Ceftazidime (anti-pseudomonal)
PO: cefdinir, cefixime |
|
|
Term
| What is the only 4th generation ceph currently approved? |
|
Definition
| Cefepime (=cefazolin + cefrazidime) |
|
|
Term
| Only cephalosporin approved for MRSA |
|
Definition
|
|
Term
| What are the SPACE bugs and what is their significance? |
|
Definition
Serratia
Pseudomonas
Acineobacter
Citrobacter
Enterobacter
When encounter put on 2 drugs (ceph + aminoglycoside) because will induce their own beta-lactamase production |
|
|
Term
| What is the best empirically used drug for infection (in hospital) |
|
Definition
| Zosyn (pipericillin + tazobactam) |
|
|
Term
| What are the four carbapenems |
|
Definition
Imipenem
Meropenem
Ertapenem
Doripenem |
|
|
Term
| What is the benefit to using carbapenems? |
|
Definition
Usually resistant to beta-lactamases BUT are very potent inducers of beta-lactamase production (bad for other drugs)
Use only when necessary |
|
|
Term
|
Definition
|
|
Term
| Imipenem administration and ADR |
|
Definition
must be given with cilastatin (blocks hydrolysis of drug in kidney - prevents toxicity and promotes antibiotic effect)
Seizure risk with high doses
Broad spectrum |
|
|
Term
| Meropenem compared to imipenem |
|
Definition
| similar spectrum with less seizure potential |
|
|
Term
|
Definition
long half-life so QD
Good G+, enterogacteriaceae, anerobes but BAD psuedomonas
-good for intra-abdominal infections
-bad for ICU hospitals (need pseudo coverage) |
|
|
Term
| Broad spectrum antibiotics used empirically should have coverage of what two bacteria? |
|
Definition
|
|
Term
|
Definition
Broad spectrum
Good against G+, enterobacteriaceae, psuedomonas, anaerobes
Extered infusion time takes advantage of interval dependent killing |
|
|
Term
|
Definition
'designer drug'
ONLY gram NEGATIVE
-no anaerobes of G+
Anti-psuedomonal
Good for patients with a penicillin allergy
Should always be combined with something, but dont combine with other beta-lactams |
|
|
Term
|
Definition
Adults 125-500 mg Q6-8H
adjust for renal impairment
250 and 500 mg tab
125 and 250 mg/5 mL susp (refrigerate)
Take on empty stomach (1-2 hr before meal)
ADR: NVD |
|
|
Term
| Dosing and administration of dicloxacillin |
|
Definition
take on empty stomach
125-250 mg Q6h (Max: 500 mg Q6H)
available as capsule and susp |
|
|
Term
| Clinical uses of dicloxacillin |
|
Definition
|
|
Term
| Clinical uses of amoxicillin/ampicillin? |
|
Definition
otitis media
sinusitis
bronchitis
SSTIs (including bites - augmentin)
UTIs
NOTE: augmentin covers MSSA and G- beta-lactamase producers |
|
|
Term
| Counseling points with ampicillin (ADR, admin) |
|
Definition
take on empty stomach (decreased absorption)
diarrhea and rash are common |
|
|
Term
| Counseling points with amoxicillin and augmentin |
|
Definition
less diarrhea than ampicillin
take without regard to food (with food may help GI upset) |
|
|
Term
| Clinical uses of cephalexin |
|
Definition
SSTI
UTIs
Strep pharyngitis |
|
|
Term
| Should you take cephalexin with or with out food? |
|
Definition
|
|
Term
| Clinical uses of cefuroxime axetil |
|
Definition
otitis media
bronchitis
sinusitis |
|
|
Term
| Should you take cefuroxime axetil with or without food? |
|
Definition
| Better absorbed WITH FOOD |
|
|
Term
| Does cefdinir have good or bad gram positive coverage? |
|
Definition
| Good coverage of staph and strep |
|
|
Term
| What is the generic for Suprax? What generation? |
|
Definition
| Cefixime and 3rd generation |
|
|
Term
| What is the generic for Cedax |
|
Definition
|
|
Term
| What generation cephalosporin is cefdinir? |
|
Definition
|
|
Term
| Counseling points with cefdinir |
|
Definition
Take with or without food
Decreased absorption with iron supp
ADR: N/V/D |
|
|
Term
|
Definition
MSSA
penicillin-susceptible S. pneumo |
|
|
Term
| Ceftibuten - dosage forms and with/without food? |
|
Definition
Suspension and capsule (interchangeable)
Food decreases absorption |
|
|
Term
| Cefpodoxime proxetil: name brand and generation |
|
Definition
| Vantin and 3rd generation |
|
|
Term
| Special counseling point with cefpodoxime |
|
Definition
Requires acid and food increases its absorption.
Take with food and avoid antacids, H2RA, PPIs |
|
|
Term
To refridgerate or not: (how long is it good?)
Cefdinir
Cephalexin
Cefixime
Cefaclor
Cefpodoxime proxetil
Augmentin
Amoxicillin
Ceftibuten
Pen VK |
|
Definition
Cefdinir: no (good for 10 days)
Cephalexin: yes (good for 14 days)
Cefixime: either (good for 14 days)
Cefaclor: yes (good for 14 days)
Cefpodoxime proxetil: yes (good for 14 days)
Augmentin: yes (10 days)
Amoxicillin: either, but fridge prferred (14 days)
Ceftibuten: yes (14 days)
Pen VK: yes (14 days) |
|
|
Term
|
Definition
competitive inhibition of dihydropteroate synthase (blocks synthesis of dihydrofolic acid)
-needed for purines = block cell growth (bacteriostatic) |
|
|
Term
| Why should you drink lots of water with sulfa abx? |
|
Definition
(Especially the older compounds) will crystallize in acidic urine
-drinking water minimizes crystal formation |
|
|
Term
| Sulfisoxazole: administration, what does it treat |
|
Definition
QID (short-acting)
UTIs (sometimes) and otitis media |
|
|
Term
| Sulfadiazine (PO): administration, what does it treat |
|
Definition
short acting
readily passes into CSF due to minima protein binding (susceptible meningitis)
used in combo with other antibiotics to treat nocardial infections (typically in immunocompromised) and toxoplasmosis |
|
|
Term
|
Definition
BID
synergistic
drink lots of water
ADRs: Rash (more common in AIDS pts), N/V/D, photosensitivity, kidney stones, thrombocytopenia/neutropenia (more common in AIDS patients) |
|
|
Term
|
Definition
serum concentration: 1:20
Oral combos: 1:5
(DS: 160-800)
always prep bactrim based on TMP (first) component |
|
|
Term
| Mechanisms of resistance against Bactrim |
|
Definition
1. Increased production of PABA
2. Change of target (dihydropteroate synthase and/or dihydrofolate reductase)
3. Increased production of dihydropteroate synthase (overcomes ABX)
4. Reduced uptake of drug |
|
|
Term
| Contraindications of Bactrim (Sulfas) |
|
Definition
1. Pregnant women (3rd trimester = kernicterus) and neonates < 2 mo due to immature hepatic enzymes
2. G6P dehydrogenase deficiency: increased risk of hemolytic rxns during therapy
3. Hypersensitivity
4. Folic acid deficiency: increased risk of hematologic toxicitiy (leukopenia, thrombocytopenia) |
|
|
Term
|
Definition
1. UTIs
2. prophylaxis for travelers diarrhea
3. acute exacerbations of bronchitis, otitis media, sinusitis
4. community acquired MRSA
*NOT strep pharyngitis |
|
|
Term
| Spectrum of activity of Bactrim |
|
Definition
G+: MSSA, MRSA, S.pneumo, S. epidermidis
G-: most enterobacteriaceae, H.flu, M.catarrhalis, Salomonella, Shigella
NOT: enterococci, Pseudomonas, anaerobes |
|
|
Term
|
Definition
ophthalmic
resistance limits usefulness |
|
|
Term
|
Definition
broad spectrum
topical
used in burn patients: diffuses well thru devascularized areas
good against Psuedomonas
both mafenide and its metabolite are carbonic anhydrase inhibitors (can cause metabolic acidosis- would hyperventilate to compensate) -->use with caution in patients with renal or pulmonary insufficiency
ADRs: fungal colonization (oppor), local pain, burning sensation (if nerve not damaged) |
|
|
Term
|
Definition
broad spectrum (including pseudomonas)
topical
silver ion is an active component
Advantages vs mafenide: less painful and fewer applications
Sulfadiazine can be absorbed and crystaluria can be an issue |
|
|
Term
|
Definition
Sulfa + anti-inflammatory agent
Tx of IBD
poor absorption in GI tract
Metabolized by intestinal bacteria to sulfapyridine (which gets absorbed and renally excreted) + ASA |
|
|
Term
|
Definition
inhibition of protein synthesis
Binds 23s rRNA (part of 50s subunit) |
|
|
Term
| Spectrum of Activity of Macrolides |
|
Definition
G+: S. pneumo (resistance common)
G-: H.pylori (PUD), M.catarrhalis, H.flu, C.jejuni, N.gonorrheae, N.meningitidis, B.pertussis
Atypicals: Mycoplasma, Chlamydia, Legionella, Mycobacterium avium |
|
|
Term
| 4 mechanisms of resistance with macrolides |
|
Definition
1. membrane penetration diminished (pores of G-)
2. Enzyme obstruction
3. Efflux pumps
4. Altered target (methylation) |
|
|
Term
| Which macrolide is safest to use in someone with renal failure? |
|
Definition
| Erythromycin (not renally eliminated) |
|
|
Term
| Should macrolides be taken with or without food? |
|
Definition
Erythromycin: without (food decreases the absorption of most dosage forms)
Clarithromycin and Azithromycin: with or without food (decreases GI SE with food)
-Azith CAPSULES should be taken withOUT food |
|
|
Term
| What is unique about azithromycin distribution? |
|
Definition
| It concentrates in WBCs so it will be concentrated at the site of infection |
|
|
Term
| Does erythromycin and clarithromycin induce of inhibit CYP enzymes? |
|
Definition
3A4 inhibitor
azithromycin is only minorly metabolized by this enzyme so it has less of an effect |
|
|
Term
| Interaction between macrolides and quinolones |
|
Definition
| Can cause QT prolongation (most common with the quinolones that have been removed from the market) |
|
|
Term
| Interaction between macrolides and Class Ia and III antiarrhythmics |
|
Definition
Can increase antiarrhythmic concentration which can lead to QT prolongation and torsades de pointes (in addition to erythromycins ability to cause QT prolongation independently)
(ex: quinidine, amiodarone) |
|
|
Term
|
Definition
1. CAP (espeically if atypicals suspected)
2. Strep throat
3. Acute exacerbations of chronic bronchitis (only C and A, NOT E)
4. STDs (2g Azith for gonorrhea and chlamydia)
5. PUD (PrevPak)
6. Cat scratch fever
7. Whooping cough
8. Lyme Disease
9. MAC (Mycobacterium avium complex) |
|
|
Term
|
Definition
GI: N/V/D cramping
Dose-related hearing loss or tinnitus (Reversible)
QT prolongation and torsades de pointes |
|
|
Term
|
Definition
B: azithromycin and erythromycin
C: clarithromycin (adr in animals, no info in humans) |
|
|
Term
| What other two disease states are macrolides useful in? |
|
Definition
1. Cystic fibrosis (Azithromycin)
2. diabetic gastroparesis (erythromycin) |
|
|
Term
| Cystic fibrosis and azithromycin |
|
Definition
reduces exacerbations
decreased toxins, inhibition of biofilms and quorum sensing, decreased sputum and mucus production
can take QD or MWF (prophylaxis) |
|
|
Term
| Diabetics gastroparesis and erythromycin |
|
Definition
MOA: binds to motilin receptor
take before meals to help move food along |
|
|
Term
|
Definition
| Inhibit protein synthesis by binding to 30s subunit |
|
|
Term
| Spectrum of activity of tetracyclines |
|
Definition
**Little variation of activity between diff tetracylcines**
G+: CA-MRSA, S.pneumo (increasing resistance)
G-: H.flu, M.catarrhalis
Spirochetes (Borrelia, Rickesttia, Chlamydia, Mycoplasma)
DOC: Brucella spp. and Vibrio cholerae
Used in combo for PUD |
|
|
Term
| What is nitrofurantoin used to treat? |
|
Definition
|
|
Term
|
Definition
inhibits bacterial carbohydrate production (acetyl-CoA) and can inhibit cell wall formation
*MOA is dependent on urine acidity |
|
|
Term
| Which form of nitrofurantoin is better tolerated |
|
Definition
Macrocrystalline form (produces fewer GI ADR)
this form is more slowly absorbed, taking it with food which will prolong gastric movement will increase absorption |
|
|
Term
| What is the advantage of Macrobid over other nitrofurantoin products? |
|
Definition
| It requires only BID dosing (not QID) x7 days |
|
|
Term
| Nitrofurantoin and pregnancy |
|
Definition
Category B, but contraindicated at term (38 weeks) because it can cause hemolytic anemia in patients deficient in G6P or glutathione in RBC (which includes neonates)
-gets in breast milk (must evaluate above issue before use) |
|
|
Term
| Interaction between nitrofurantoin and quinolones |
|
Definition
Only relevant if the quinolone is being used to treat the UTI too
Nitrofurantoin inhibits the quinolones action in the urine (not elsewhere) |
|
|
Term
|
Definition
1. Acute or chronic pulomary complications (may need to d/c drug)
2. peripheral neuropathy (more common in patients with existing conditions ex diabetes)
3. GI SE (especially microcrystalline form)
4. Hepatotoxicity (careful in hepatic disease)
5. Urine discoloration (darken/brown) |
|
|
Term
| Administration of tetracyclines |
|
Definition
Doxy and Mino are nearly completely absorbed
Tetra ~60-80% absorbed
Food and milk DECREASE absorption (esp tetra)
Divalent cations can chelate to drug |
|
|
Term
| Which tetracycline is more likely to penetrate CNS? |
|
Definition
Minocycline (>doxy>tetra)
more lipophilic
**Readly crosses placenta/breast milk |
|
|
Term
| Which tetracycline is better for a UTI? |
|
Definition
Tetracycline (60% unchanged in urine - much less with others)
NOTE: tetracycline doesnt have best coverage of E.coli (so must be susceptible to tetracycline to work) |
|
|
Term
|
Definition
Tetra: QID
Doxy: BID
Mino: BID |
|
|
Term
|
Definition
Stomach upset (more common with tetra)
photosensitivity
tooth discoloration (usually in peds)
hepatitis - rare |
|
|
Term
| Tetracyclines and preganacy |
|
Definition
Category D
inhibition of bone growth in fetus |
|
|
Term
| Unique uses for tetracyclines |
|
Definition
Rickettsial infections (Rocky mountain spotted fever)
Lyme disease
Acne
Acute exacerbation of chronic bronchitis
prevention of travellers diarrhea (doxy) |
|
|
Term
| Which tetracycline is usually used for prevention of travellers diarrhea? |
|
Definition
|
|
Term
| What is demeclocycline used for? |
|
Definition
|
|
Term
| Tigecycline administration and use |
|
Definition
glycylcyclines (derivative of minocycline)
IV only (cant be absorbed from GI tract)
intraabdominal infection and complicated SSTI
ADR: N/V
Greatest downfall-poor pseudomonas coverage (otherwise v. broad coverage) |
|
|
Term
| What are the two major toxicities associated with amingoglycosides and are they reversible? |
|
Definition
Nephrotoxicity: reversible
Ototoxicity: irreversible |
|
|
Term
| How are aminoglycosides eliminated? |
|
Definition
Glomerular filtration only
All can be removed my hemodialysis
**CAUTION in renal disease |
|
|
Term
| T or F: Aminoglycosides have more toxic potential the longer they are given. |
|
Definition
| T: usually used for very short therapy |
|
|
Term
|
Definition
bactericidal then post-antibiotic effect (extended interval dosing)
1. Diffuse through aqueous porin channels of the outer membrane of G- bacteria
2. actively transported across the cytoplasmic membrane (rate limiting)
3. bind to ribosomes and inhibit protein synthesis (irreversible)
Causes: cell wall permeability/transport changes, inhibition of protein synthesis, misreading of genetic code |
|
|
Term
| 3 mechanisms of resistance with aminoglycosides |
|
Definition
1. altered target site of action
2. decreased drug uptake
3. **Plasmid-mediated production of inactivating enzymes (more important)
Note: amikacin is designed to have the least likelihood of being inactivated my plasmid-mediated enzymes |
|
|
Term
| Which aminoglycoside is least likely to be inactivated my plasmid-mediated enzymes? |
|
Definition
|
|
Term
| When should the level for aminoglycoside dosing be drawn? |
|
Definition
|
|
Term
| Which type of aminoglycoside dosing takes advantage of their ability to kill in a concentration-dependent fashion |
|
Definition
|
|
Term
| Which aminoglycoside has a dose and blood concentration that is 4 times greater than all other aminoglycosides? |
|
Definition
| Amikacin - toxicities are the same at this level |
|
|
Term
| Spectrum of activity of aminoglycosides |
|
Definition
All especially active against enterobactericeae
Pseudomonas (tobra over gent)
NOT active agst: N.gonorrhea, H.flu, M.cat or common atypicls
G+: some activity but never DOC (always used with other drug - ex: enterococcal)
NO anaerobic coverage (b/c require ATP to get across membrane) |
|
|
Term
| What are the three notable toxicities associated with aminoglycosides |
|
Definition
1. Neuromuscular paralysis: rare and reversible (block NMJ)
2. Ototoxicity: irreversible and cumulative (auditory and vestibular)
3. Nephrotoxicity: reversible and cumulative (dont use with other drugs that are nephrotoxic and stay hydrated) |
|
|
Term
| Summary of indications of aminoglycosides |
|
Definition
1. multi-drug resistance
2. Hospital infection
3. multiple bug infection |
|
|
Term
|
Definition
Target: DNA gyrase and Topoisomerase IV
inhibit DNA replication |
|
|
Term
| Which fluoroquinolones are active against Psuedomonas? |
|
Definition
|
|
Term
| Which fluoroquinolones are active against S.pneumo? |
|
Definition
| All but Cipro (Levo, Moxi, Gemi) |
|
|
Term
| Which fluoroquinolone is active against B.fragilis? |
|
Definition
|
|
Term
| Which fluoroquinolones are active against Enterococcus? |
|
Definition
|
|
Term
| What are the mechanisms of resistance against fluoroquinolones? |
|
Definition
1. DNA nutations (= altered target sites)
2. Cell membrane permeability decreased
3. Efflux pumps |
|
|
Term
| Which two fluoroquinolones would be ok to use for a UTI? |
|
Definition
Cipro and Levo
becuase get eliminated via kidney (partially) unchanged
Also both cover PEcK |
|
|
Term
| Which fluoroquinolone is metabolized hepatically |
|
Definition
|
|
Term
Which fluoroquinolone should NOT be used for URI?
Which should be used for CAP?
which should be used for HAP? |
|
Definition
Cipro - no S.pneumoniae coverage
CAP: Levo, Moxi, and Gemi can all be used for CAP (cover S.pneumo)
HAP: levo and cipro (cover Pseudomonas)
**ONLY LEVO FOR BOTH** |
|
|
Term
| What are uses for fluoroquinolones (general)? |
|
Definition
UTI
URI
STD (gonorrhea)
Bacterial Gastroenteritis (Salmonella, Shigella, Campylobacter)-prevent/treat travelers diarrhea
Osteomyelitis
SSTI (Newer agents) |
|
|
Term
| ADRs with fluoroquinolones |
|
Definition
N/V/D cramps
dizziness, HA, mood changes, seizures (rare)
QT prolongation
rhabdomylosis (tendon toxicity)
Cartilage malformation (issue if growing)
Hypo/Hyperglycemia (so cant plan for it if diabetic)
Phototoxicity
Rash
Hepatotoxicity
Kidney stones (mostly with older quinolones) |
|
|
Term
| Quinolones are indicated for patients over ___ years old |
|
Definition
| 18 (cartilage malformation risk) |
|
|
Term
| Interaction between fluoroquinolones are warfarin |
|
Definition
| Increases effect of warfarin |
|
|
Term
| Interaction between antacids and quinolones |
|
Definition
| divalent cations - reduce absorption of antibiotic (up to 50%) |
|
|
Term
| Interaction between quinolones and theophylline (and caffeine) |
|
Definition
| increase theophylline concentrations |
|
|
Term
| Interaction between cipro and tizanidine |
|
Definition
| Cipro increases the concentration of tizanidine (only with cipro) |
|
|
Term
|
Definition
|
|
Term
| Which species of Enterococci is noted for increasing resistance against Vanco? |
|
Definition
|
|
Term
| Spectrum of coverage of vancomycin |
|
Definition
| most all G+ (unless resistant) |
|
|
Term
|
Definition
| prevents peptidoglycan cross-linking |
|
|
Term
| What would be a use for oral vancomycin |
|
Definition
| Only intra-abdominal infections becuase very poor absorption |
|
|
Term
| How vancomycin eliminated? |
|
Definition
|
|
Term
| What are the three major toxicities (ADRs) associated with vancomycin? |
|
Definition
1. Renal toxicity: "Mississippi Mud" because of impurities; increased risk with other nephrotoxic drugs and high doses (less now)
2. Ototoxicity: relatively reversible
3. "Red Man Syndrome" infusion related: itching, flushing, tachycardia, hypotension-- patient dependent and if infused to fast (**NOT true allergy) |
|
|
Term
|
Definition
Quinupristin/Dalfopristin
act synergistically |
|
|
Term
| Class and dosage form of synercid |
|
Definition
|
|
Term
|
Definition
Bind to 50S ribosomal subunit (inhibit protein synthesis)
each drug component has different binding sites here |
|
|
Term
| Spectrum of coverage of Synercid |
|
Definition
| ALL G+ except E. faecalis (unique that it only covers faecium) |
|
|
Term
| Important points about the administration of Synercid |
|
Definition
1. Incompatible to NaCl (will crystallize)
-MUST use D5W
2. Stable at room temp for ONLY 5 hours
3. Must flush line with dextrose before and after infusion
4. Central line infusion is recommended due to phlebitis with peripheral lines |
|
|
Term
|
Definition
Hyperbilirubinemia (hepatically metabolized)
Infusion-line rxns (pain, inflammation, edema)
Arthralgias (joints)
Myalgias (muscles)
N/V/D |
|
|
Term
|
Definition
|
|
Term
|
Definition
| oxazolidinone (Synthetic) |
|
|
Term
| What was linezolid originally investigated to be used for? |
|
Definition
|
|
Term
|
Definition
Inhibits protein synthesis through binging at the 50S ribosomal subunit
ALSO weak MAOI |
|
|
Term
|
Definition
|
|
Term
| How is linezolid administered? |
|
Definition
Orally (100% F) or IV
is NOT affected by food
BID |
|
|
Term
| Approved indications for linezolid? |
|
Definition
1. VRE infections
2. Nosocomial MRSA pneumonia
3. Complicated/Uncomplicated SSTIs
4. CAP |
|
|
Term
|
Definition
1. Peripheral neuropathy
2. HTN
3. HA
4. Insomnia
5. Dizziness
6. Fever
7. Myelosuppression/Thrombocytopenia - get CBC if on linezolid >1 week
8. Mood swings (remember original use) |
|
|
Term
| What drugs should linezolid be used with extreme caution when given concommitantly? |
|
Definition
SSRIs
MAOIs
TCA
because of increased risk of serotonin syndrome |
|
|
Term
|
Definition
|
|
Term
|
Definition
| cyclic lipopeptide antibiotic |
|
|
Term
|
Definition
Calcium-dependent binding to cell membrane
lipophilic tail gets inserted into membrane, which forms channels, which cause essential electrolytes to leak (K+) |
|
|
Term
| Administration of daptomycin |
|
Definition
|
|
Term
| Spectrum of activity of daptomycin |
|
Definition
|
|
Term
| Indications for daptomycin |
|
Definition
Complicated SSTIs
(other trials currently being studied)
NOT pneumonia - increased MIC with surfactant of lungs |
|
|
Term
|
Definition
1. Breakdown of muscle
2. Hepatotoxicity (rare)
3. Injection site rxns
4. Nausea
5. Rash |
|
|
Term
| T or F: there are no notable drug interactions with daptomycin |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Spectrum of activity for clindamycin |
|
Definition
G+: S.pyogenes, S.aureus (not ideal to use though)
No G-
Anaerobes: B.frag, C.perfringens |
|
|
Term
| Spectrum of activity of metronidazole |
|
Definition
No aerobes
Trichomonas, Giardia, amebiasis
Anaerobes
C.diff (DOC)
Bacteriodes (DOC)
GI INFECTIONS |
|
|
Term
|
Definition
| prevents peptide formation by binding to 50S subunit |
|
|
Term
|
Definition
| becomes a metabolite that interacts with DNA to cause breakage, leads to inhibition of protein synthesis/cell death |
|
|
Term
| Clindamycin - with or without food? |
|
Definition
|
|
Term
| Metronidazole - with or without food? |
|
Definition
|
|
Term
| BIG issue with clindamycin |
|
Definition
| Suppresses bacterial growth of GI - leads to opportunistic infections (C.diff) |
|
|
Term
| T or F: clindamycin is NOT the agent of choice for any infection |
|
Definition
| T - only used as an alternative (2nd line) |
|
|
Term
| When is clindamycin indicated? |
|
Definition
1. Alternative for Bacteriodes fragilis infections (Flagyl - DOC)
2. Alternative in allergic patients (ex: cant take Pen/Ceph for G+)
3. Osteomyelitis: good bone penetration
4. Use with Pen or Vanco to decrease endotoxin production
5. Recurrent Strep pharyngitis
6. Acne |
|
|
Term
| What is metronidazole the drug of choice for? |
|
Definition
Bacteriodes fragilis infections
C.diff |
|
|
Term
| Metronidazole and pregnancy |
|
Definition
Overall category B
Contraindicated in first trimester
-carcinogenic/mutagenic in animals/in vitro but not proven to be in humans |
|
|
Term
|
Definition
Antabuse-like rxn with alcohol
peripheral neuropathies (high doses/long-term use)
Seizures
Increase effectiveness of warfarin
GI symptoms
metallic taste (take with chocolate) |
|
|
Term
|
Definition
C.diff diarrhea
Allergic rxns
Hepatotoxicity
Bone marrow suppression (neutro/thrombopenia) |
|
|
Term
|
Definition
1. Candida
2. Cryptococcus neoformans
3. Pneumocystis jiroveci |
|
|
Term
| What does endemic fungi mean? |
|
Definition
| Associated with a specific region (geographical) |
|
|
Term
|
Definition
| binds to fungal membrane sterols (ergosterol) and alters permeability of K+ and Mg2+ |
|
|
Term
| How is amphotericin supplied |
|
Definition
| IV Only - poorly absorbed |
|
|
Term
|
Definition
|
|
Term
| Spectrum of Activity of Amphotericin B |
|
Definition
Very broad - all major fungi is covered
Yeasts: Candida, Cryptococcus
Molds: Aspergillus, Zygomycetes
Dimorphic: Histoplasma, Cryptococcus, Blastomyces |
|
|
