-Gram positive cocci in chains =

-Gram positive diplococci

-Urethral pus Gram _____ doughnut shaped diplococci within WBC = gonococci

Streptococci or Enterococci

-Pnumonococci

-negative

Why is it important to know a PCN pts renal fct?

What are these two drugs...oxacillin(IV) and nafcillin(IV)

-Can we use these for MRSA?

-They are renally excreted

-Penicillinase-resistant penicillins

-Nope (MSSA okay though)

-A major SE of extended-spectrum PCN is?

-Name specifically which drugs this would be?

-diarrhea.

-Ampicillin and amoxicillin-Amoxil

Ticarcillin-Ticar® and piperacillin-Pipracil®

-What is their major SE?

-Antipseudomonal penicillins

-Platelet disfct (thrombocytopenia...and the few that are there don't stick together well)

What are these?

Ampicillin + sulbactam = Unasyn®
Ticarcillin + clavulanic acid = Timentin®
Piperacillin + tazobactam = Zosyn®
Amoxicillin + clavulanic acid = Augmentin®

-What do they help us do?

Beta-lactamase inhibitors + PCN

-Broaden PCN spectrum to include more Gram Neg...(including pseudomonas...but at very high doses)

Which PCN will also kill these bugs?

H. flu, E. coli, Proteus, Salmonella, Shigella,

-Extended Spectrum PCN...Amox and Ampi

What is MOA of Cephalosporins?

-Contraindicated in PCN allergies?

-They may potentiate nephrotoxicity if combined with what two drugs?

-Beta lactam ring and batericidal

-PCN allergy may be at increased risk for allergic reaction – relatively contraindicated with history of immediate anaphylaxis with PCN
-aminoglycosides and loop diuretics (furosemide)

What are the Broad spectrum GORILLA Abx that are good for resistant bugs.... except MRSA?

SE?

-Carbapenams

-Toxicity – allergy more common in PCN and ceph allergy, superinfections (bc they are so broad), seizures (older patients with renal dysfunction and neurologic problems by lowering seizure threshold), rapid infusion = N/V

Aztreonam-Azactam®

-Bactericidal agents – 30S ribosome

-What is major SE of these Abx?

-Any major problems?

-Aminoglycosides

-Ototoxicity

-Resistance (getn>tobra>amikacin)

Tetracyclins... doxycycline-Vibramycin®, minocycline-Minocin®

WHo doesn't get Tetracyclins?

-Okay for use in blood infections?

-Okay for use in acne?

-those under 8 yo (yellow tooth staining

-Pregos (reduced bone growth)

-No

-Yes, low dose

-work at 50S ribosome, bacteriostatic
Covers: atypicals such as mycoplasma, legionella, chlamydia

-SE?

-Okay for use in Myasthenia Gravis?

-Okay for use in those with PCN allergy?

Macrolides...azithromycin- Zithromax®(IV/PO), clarithromycin-Biaxin®(PO), telithromycin-Ketek®(PO)

-hepatic toxicity, QT prolongation, dizzy,

-no use in myasthenia gravis

-YES DRUG OF CHOICE FOR THOSE WITH SSTI and Resp Infections with PCN ALLERGY

Bacteriostatic 50S ribosome, inhibits toxin production.  Use in PCN allergic patients for GPC – (not enterococci),  staph (community acquired MRSA) and streptococcus, .  Anaerobes above diaphragm- Bacteroides fragilis, Clostridium perfringens and tetani (NOT other Clostridia)

Vancomycin

What are these teh SE for?allergic reactions, phlebitis, oto/nephrotoxicity esp. with aminoglycosides, red man syndrome (not allergic rxn – flush face, neck, upper trunk, hypotension..NEUTROPENIA

-B/c of these how fast do you infuse?

Vancomycin

-slow infusion 500mg over 30 minutes or longer

Daptomycin-Cubicin

What is the Serotonin Syndrome Triad?

-what should we monitor for to have early detection?

-Triad of 1) mental status changes, 2)  autonomic hyperactivity/instability, and 3)  neuromuscular abnormalities

-for hyperreflexia, tremor, clonus (greater in lower extremities), tachycardia, diaphoresis, mydriasis, increased bowel sounds/diarrhea

Trimethoprim/sulfamethoxazole:  (Septra® or Bactrim®)

Wide coverage with Bactrim?

-What drug should we avoid while one Bactrim?

Yea...Gm +/- (no anaerobes) and PCP prophylaxis & treatment in AIDS, Toxoplasmosis

-Warfarin (drug interaction that increases bleeding risk)

Metronidazole

Fluoroquinolones

Which Gen of Fluoroquinolones covers Psueomonas?

-Which Fluoroquinolone am I?

    – renal, UTI, GNR
    – hepatic, NOT UTI, respiratory infections

       covers  Gm+/- including penicillin resistant 

       Streptococcus pneumoniae (PRSP), anaerobic

       coverage better than levofloxacin, SSTI,

       complicated intraabdominal infection, sinusitis
    – renal, UTI and respiratory infections covers   

       Gm+/- and PRSP, SSTI, sinusitis

-Ciprofloxacin (2nd Gen)

-Ciprofloxacin (2nd)

-Moxifloxacin (4th)

-Levofloxacin (3rd)

Urinary Antiseptics:  Nitrofuranation:  don’t use if CrCl is under ___

-How do we dose Streptogramins?

-What does it cover?

-What is its only available ROA?

-60

-Dose – 7.5mg/kg every 8 hours (D5W)

-Covers VRE (faecium), MRSA, MSSA

-IV

Which Antifungal am I? IV only and very broad antifungal spectrum, bactericidal to cell membrane
ADE: fever, chills (“shake and bake”- treat with acetaminophen and diphenhydramine 30 minutes before each dose), malaise, anemia, thrombophlebitis, nephrotoxic (saline load), wastes potassium & magnesium, renal tubular acidosis- RTA

-HOW IS IT DOSED?

Amphotericin B

-Dose: 0.3 to 1.2mg/kg/day

Which Antifungal am I.....Interferes with ergosterol synthesis (cell membrane) cytochrome P450 process (DI posa>vori/itra>fluco)

-Which one of these is the "primary antifungal"

-What is used for Aspergillus infections?

-Azoles

-Fluconazole

-Itra and Voriazole

Echinocandins

Staphylococci are catalase _____, gram _____

-What genus is this? anaerobic spore forming gram + rod

-Which Clostridium causes diarrhea (CDAD) and enterocolitis

-Which causes gas gangrene?

-positive, positive

-Clostridium

-C. difficile

-C. perfringens

DOC Gram Positives...

-Corynebacterium diphtheriae

Listeria monocytogenes

S. aureus is Coagulase _____.

-DOC for MRSA?

-What staph is Coag negative and causes UTIs?

Positive.

-DOC Vancomycin, linezolid, daptomycin

-S. saprophyticus

-PCN  (second choices

Cephalosporin 3>2>1 (Rocepherin)
Quinolones (not ciprofloxacin)
Vancomycin)

-DOC for E. faecium

-DOC for E. faecalis

-This is a VRE...so linezolid or Synercid®

-  penicillin or ampicillin + or – gentamicin or streptomycin

-Gram ______ cocci:
Neisseria gonorrhoeae and Neisseria meningitidis

-These are all what kind of Gram negative bacteria....Pseudomonas aeruginosa, Acinetobacter calcoaceticus-baumanii (we are having a lot of resistence problems), Burkholderia cepacia (CF patients), Stenotrophomonas maltophilia

-Negative

-Nosocomials

-N. gonorrhaea DOC?

-N. Meningitidis DOC?

-E. coli DOC?

-Ceftriaxone

-IV PCN

-3rd Gen Cephalosporin (Rocephrin)

Nosocomial Pneumonia is caused by what Serratia SPACE bug?

-DOC?

-Serratia marcescens

-Double cover (3rd generation cephalosporin, carbapenem, +/- gent, or quinolone )

I found this on a thread site so take with a grain of salt...

Serratia
Pseudomonas
Acinetobacter
Citrobacter
Enterobacter

-According to our lecturer a fever is anything over what?

-<____ neutrophils = increase bacterial and fungal infections

-Fever is >=100.5 F body temperature orally

-500

-Sputum is more reliable and indicative of infection if contains <___ epithelial cells and >___ PMNs is purulent sputum vs spit

-Urinalysis (UA) >___ WBC, nitrites, leukoesterase=Infection

-10 epithelials....25 PMN

-10

Age Factors and Abx:

Baby – kernicterus with sulfa drugs and _____, Gray baby syndrome with ________.

-Age >65 have decreased renal function so increased ADE of renally eliminated drugs such as  ___________& _______.

-ceftriaxone (Rocephin)....chloramphenicol (because baby does not have a functioning liver and cannot eliminate teh drug)

-aminoglycosides & carbapenems

-What 2 commonly Rxd drugs does RIFAMPIN interact with?

-Beta-lactams are ___-dependent

-The proper route is _____ for CNS, osteomyelitis, infective endocarditis(IE)

-Birth control and WARFARIN

-time

-intravenous (IV)

Gonnorhea should DOC?

-what should we stay away from to Tx if we can?

-Since Chylamydia often coexists...what should we use for co-Tx?

-Cephalosporin

-FQ...they are becoming resistent.

- azithromycin po 2Gm x1 or doxycycline 100mg bid x7days

What is the difference between early and latent phase syphillis?

-How are they detected?

-Both are asymmtomatic, but early latent phase is infectious (first 4-10 weeks after secondary infection)

-Serologic Testing

How long does primary syphillis incubate before you get the painless chancre?

-Jarish-Herxheimer reaction – NOT allergic reaction to penicillin but action of penicillin on ______

-10 to 90 days (mean 3 weeks).

-Spirochetes (Treponema pallidum) (RESULTS IN FLU-LIKE SYMPTOMS)

Syphillitic Tx:  VDRL or RPR (quantitative nontreponemal tests) see ______ change in titer considered necessary to show clinically significant difference

-Neurosyphilis examine CSF every ______ until cell count normal

-fourfold (1:16 to 1:4 or 1:8 to 1:32)

-6 months

7

-Azithromycin

-Doxycycline

HSV-2:  Recurrent: prodrome ~__% tingling, burning, itching prior to lesion appearance

-Trich: Men frequently asymptomatic & spontaneous cure, greater M>W transmission rate?

-When should males be cultured?

-Women should have PCR or wet mount slide prepared...what might the protozoan look like?

-50

-True

-First voided urine

-Flagellated, pear-shaped.

Metronidazole 2 g orally in a single dose

OR
Tinidazole 2 g orally in a single dose

Both: Bitter metallic taste, anorexia, N/V, diarrhea
No ethanol for 24 hrs after metronidazole and 72 hrs for tinidazole

-HPV strands:  __&__ = genital warts (vaginal, anal, urethral meatus, and external genital warts), ___&___ = 70% of cervical cancers

-What does Gardasil protect against?

-6 & 11

-type 16 & 18

-The above four strains (and that's it)

until 65 yo who has more UTIs (m or f?)

-how many UTI's until you are considered recurrent?

-Significant abacteriuria distinguish infection vs contaminant with clean-catch ______ organisms per ml urine

-Females...equal after 65 yo

-3 or more a year.

-100,000

-85%,  (uncomplicated S. saprophyticus 5-15%, K. pneumoniae, P. spp., P. aeruginosa, Enterococcus spp...consider S. epidermidis as well (BUT IT CAN BE CONTAMINANT)

-50% (others include above (as resistant), VRE and Candida)

UTI Tx times:

Uncomplicated cystitis:
 __ to __ days

 Uncomplicated pregnant: __ days
UTI in males
___ days
Acute pyelonephritis
___ days
Prostatitis
__ to __  weeks

For uncomplicated Cystitis: Most effective drugs are ______ eliminated

-What are 3 major complications with untreated UTI in Pregnancy?

-How are they Txd?

-Renally

-Untreated = LBW, prematurity, stillbirth

-Amoxicillin/clavulanate (Augmentin®)
Bactrim (TMP/SMZ)  (Avoid in the 3rd trimester hyperbilirubinemia)

Cephalexin

Nitrofurantoin

UTI: Which Abx can we absolutely not have?

-In Males: what is Acute cystitis often associated with?

-Male UTI Tx empirically with?

-NO FQ, tetracyclines in pregnancy

-Bladder obstruction (BPH, stones, instrumentation)

-FQ, SMZ-TMP

How do you Tx Assymptomatic Bacteruria in NON-PREGNANT and ELDERLY PEEPS??

-For PYELONEPHRITIS:   E. coli is most likely pathogen, other gram negatives  DOC?

-For PYELONEPHRITIS if your culture comes back Gram Positive...what is most likely culprit?

-You don't Treatment has little effect on natural course of infection

-FQ or SMZ/TMP for E. coli

-Enterococcus faecalis  (DOC Ampicillin QID or Augmentin if Beta-lactamase positive.

What seperates moderate/severe from mild pyelonephritis

-How to Tx?

-Dehydration, nausea/vomiting
Hypotension/sepsis

-Check em in and put em on IV Abx...if afebrile x 24 hours you can do PO and check em out

Sev/Mod Pyelonephritis

single therapy?

Double coverage?

-Quinolone (14 days...unless Pseudomonas)

-Extended-spectrum penicillin x 14 days
 (Zosyn®)
(Timentin®)

  PLUS
Aminoglycoside x 3 days
Gentamicin
Tobramycin

-Indwelling urinary catheters
Acquire UTI at rate of __% incidence per day

-If you have a Symptomatic UTI related to CATHEDAR insertion...how should you Tx?

-Prostatitis DOC?

5%...Traumatic insertions, poor insertion technique

-As complicated UTI

-TMP-SMX, quinolones(not moxifloxacin as it is not excreted through the ureter)