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1) MTB ID Flashcards

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1
Q

Antibiotics for MSSA IV?

A

oxacillin/nafcillin or cefazolin

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2
Q

Antibiotics for MSSA oral?

A

dicloxacillin or cepalexin

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3
Q

Antibiotics for MRSA, severe infection?

A

vancomycin, linezolid, daptomycin, ceftaroline, tigecycline or telavancin

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4
Q

Linezolid causes

A

thrombocytopenia

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5
Q

daptomycin causes

A

myopathy and rising CPK

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6
Q

Antibiotics for MRSA, minor infection?

A

TMP/SMX
clindamycin
doxycycline

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7
Q

Antibiotics to use with penicillin allergy

A

cephalosporins with rash

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8
Q

Antibiotics for staph with anaphylaxis?

A

Macrolides (azithromycin, clarithromycin) or clindamycin

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9
Q

Antibiotics for severe infection and penicillin allergy?

A

vancomycin, linezolid, daptomycin, telavancin

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10
Q

Antibiotics for minor staph infection penicillin anaphylaxis allergy?

A

macrolides (azithromycin, clarithromycin), clindamycin, TMP/SMX

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11
Q

What is telavancin?

A

bacterial lipopolysaccharide

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12
Q

What is the mechanism for telavancin?

A

It inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of the peptidoglycan in the growing cell wall

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13
Q

What is the mechanism for ceftaroline?

A

inhibits cell wall growth by binding the penicillin binding protein

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14
Q

Linezolid mechanism

A

inhibits protein synthesis

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15
Q

TMP/SMX mechanism

A

folate antagonist

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16
Q

Medications specific for streptococcus

A

penicillin, ampicillin, amoxicillin

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17
Q

What are the gram negative bacilli?

A 
Escherichia coli
Enterobacter
Citrobacter
morganella
pseudomonas
serratia
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18
Q

Cephalosporins gram negative

A

cefepime

ceftazidime

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19
Q

penicillins gram negative

A

piperacillin

ticarcillin

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20
Q

monobactam gram negative

A

aztreonam

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21
Q

Quinolones gram negative

A

ciprofloxacin
levofloxacin
moxifloxacin
gemifloxacin

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22
Q

Aminoglycosides gram negative

A

gentamicin
tobramycin
amikacin

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23
Q

Carbapenems gram negative

A

Imipenem
meropenem
ertapenem
doripenem

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24
Q

Only carbapenem that does not cover pseudomonas?

A

ertapenem

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25
Piperacillin and ticarcillin also cover
streptococci and anaerobes
26
levofloxacin, gemifloxacin and moxifloxacin
excellent pneumococcal drugs
27
aminoglycosides
work synergistically with other agents to treat staph and enterococcus
28
Carbapenems cover
streptococcus and all MSSA
29
Tigecycline covers
MRSA, active gram negative, weaker than other anti-MRSA
30
4 classes of beta lactam antibiotics
penicillin cephalosporins carbapenem monobactam
31
best medication for abdominal anaerobes
metronidazole
32
Carbapenems piperacillin ticarcillin
equal in efficacy for abdominal anaerobes compared to metronidazole
33
cefoxitin | cefotetan
only cephalosporins that cover anaerobes
34
respiratory anaerobes
clindamycin
35
Medications with no anaerobic coverage
``` aminoglycosides aztreonam fluroquinolones oxacillin/nafcillin cephalosporins except cefoxitin and cefotetan ```
36
What 3 agents can you choose from for herpes simplex, varicella zoster?
acyclovir valacyclovir famciclovir
37
valganciclovir ganciclovir foscarnet coverage?
CMV and herpes simplex and varicella
38
what is the best long term therapy for CMV retinitis?
valganciclovir
39
adverse effects of valganciclovir and ganciclovir?
neutropenia and bone marrow suppression
40
adverse effects of foscarnet
renal toxicity
41
What are the oral agents for chronic hepatitis C?
telaprevir boceprevir simeprevir sofosbuvir
42
which oral agent for chronic hepatitis C does not need to be combined with interferon?
sofosbuvir
43
Treatment for influenza A and B
oseltamivir | zanamivir
44
Ribavirin is used for
- Hepatitis C in combination with interferon. | - RSV
45
What does ribavirin cause?
anemia
46
What are the treatment options for chronic hepatits B?
``` lamivudine interferon adefovir tenofovir entecavir telbivudine ```
47
What is the mechanism for sofosbuvir?
RNA polymerase inhibitor
48
What is the mechanism for simeprevir, boceprevir, telaprevir?
protease inhibitor that prevent viral maturation by inhibiting protein synthesis
49
Fluconazole treatment?
candida, cryptococcus, oral and vaginal candidiasis
50
Fluconazole will not treat what types of candida?
candida krusei or glabrata
51
Itraconazole
equal to fluconazole but less easy to use, rarely the best initial therapy
52
Voriconazole covers
all candida
53
What is the best agent for aspergillus?
Voriconazole
54
What is the adverse effect of voriconazole?
some visual disturbance
55
posaconazole covers
mucormycosis or mucorales
56
What are the echinocandins?
caspofungin micafungin anidulafungin
57
What is the echinocandins excellent for?
neutropenic fever
58
Echinocandins does not cover?
Cryptococcus
59
How does echinocandins compare to amphotericin for neutropenia and fever?
echinocandins are better with less mortality
60
What are the adverse effects for echinocandins?
they have no significant human toxicity because they affect / inhibit the 1,3 glucan synthesis
61
What is the mechanism for azole antifungals?
inhibits conversion of lanosterol to ergosterol (major component of the cell wall of fungi)
62
Amphotericin is effective against what?
all candida, cryptococcus, and aspergillus
63
What are the last 2 main indications for amphotericin?
cryptococcus | mucormycosis
64
Aspergillus treatment?
voriconazole
65
neutropenic fever
caspofungin
66
adverse effects of amphotericin?
renal toxicity - increased creatinine, hypokalemia, metabolic acidosis, fever, shakes, chills
67
Amphotericin is directly toxic to?
distal tubules results in RTA
68
What does distal RTA damage result in?
excess potassium and magnesium loss and hydrogen ion retention
69
What is the diagnostic test for osteomyelitis?
``` initial = x-ray 2nd = MRI accurate = bone biopsy and culture ```
70
Abnormal bone on x-ray=
must lose more than 50 percent of the calcium
71
earliest finding of osteomyelitis on an x-ray?
periosteal elevation
72
What is the best way to follow osteomyelitis response to therapy?
Sedimentation rate
73
What is the most common cause of osteomyelitis?
direct contiguous spread from overlying tissue
74
Sensitivity of MRI or bone scan?
they are equal in sensitivity
75
What does the sensitivity of MRI or bone scan in osteomyelitis mean?
that osteomyelitis can be excluded if they are normal
76
What is the difference between MRI or the bone scan in osteomyelitis?
MRI is far more specific
77
What is MRI based on?
Water content
78
Nuclear bone scan is based on what?
osteoblasts depositing technetium in tissue
79
How long to treat osteomyelitis with no fever and a normal white cell count?
sedimentation rate, elevated after 4-6 weeks then further treatment and possible surgical debridement
80
most common cause of osteomyelitis
staphylococcus
81
treatment for osteomyelitis
oxacillin or nafcillin IV for 4-6 weeks
82
MRSA is treated with
vancomycin, linezolid, ceftaroline or daptomycin
83
What are the other causes osteomyelitis?
gram negative bacilli = salmonella and pseudomonas
84
What is the only form of osteomyelitis that can be successfully treated with oral antibiotics?
salmonella and pseudomonas
85
What must be done before treating orally?
bone biopsy
86
What is the treatment plan for chronic osteomyelitis?
you can obtain the biopsy, move the clock forward and treat what you find on the culture
87
How does otitis externa present?
with itching and drainage from the external auditory canal
88
What is otitis externa a form of?
its a form of cellulitis of the skin of the external auditory canal
89
What is otitis externa associated with?
swimming
90
Why is otitis externa associated with swimming?
it washes out the acidic environment normally found in the external auditory canal
91
Any diagnostic test for otits externa?
no specific tests | diagnosis is based on exam
92
What is the treatment for otitis externa?
ofloxacin ciprofloxacin polymyxin/neomycin - add topical hydrocortisone to decrease swelling and itching
93
If the otitis externa topical treatment what else might be added?
adding acetic acid and water soulution to reacidify the ear can help eliminate the infection
94
What is the function of cerumen?
make the external auditory canal acidic
95
what is the function of acid wax in the ear?
acid wax suppresses bacteria - cerumen blocks water and pseudomonas likes to grow in water
96
What is malignant otitis externa?
its really osteomyelitis of the skull from pseudomonas in a patient with diabetes
97
What might otitis externa lead to?
it might lead to a brain abscess and destruction of the skull
98
What is the diagnostic test for malignant otitis externa?
initial is CT or MRI
99
What is the most accurate test for malignant otitis externa?
biopsy
100
What is the treatment for malignant otitis externa?
surgical debridement and antibiotics active against pseudomonas
101
What are some antibiotics active against Pseudomonas?
``` ciprofloxacin piperacillin cefepime carbapenem aztreonam ```
102
How do quinolone antibiotics work?
by inhibiting DNA gyrase (topoisomerase)
103
DNA gyrase
unwinds DNA so it can be replicated
104
What are the key features of otitis media?
``` redness bulging decreased hearing loss of light reflex immobility of the tympanic membrane ```
105
Diagnostic testing for otitis media?
no radiologic test
106
What is the best initial treatment for otitis media?
amoxicillin for 7-10 days | longer for younger patients and shorter for older patients
107
What is the next step after amoxicillin for otitis media?
perform the most accurate = tympanocentesis and aspirate of the tympanic membrane for culture - rarely necessary
108
What is otitis media caused by?
Caused by swelling of the Eustachian tube - narrowest portion - isthmus - becomes inflammed, it blocks the egress of secretions
109
What are the most common causes of otitis media?
pneumococcus nontypeable Haemophilus Moraxella
110
What do you do if otitis media does not improve on amoxicillin after 3 days?
``` amoxicillin-clavulanate cefdinir ceftibuten cefuroxime cefprozil cefpodoxime ```
111
What are the causes of sinusitis?
Viral is most common | Bacterial are streptococcus pneumoniae, H. influenzae and Moraxella catarrhalis
112
What is the diagnostic test for sinusitis?
X-ray
113
What is the most accurate test for sinusitis?
sinus aspirate for culture
114
What is the treatment for sinusitis?
amoxicillin/clavulanate if there is fever and pain, symp despite 7 days of decongestants and purulent nasal discharge
115
What do you add for sinusitis?
add inhaled steroids
116
What is clavulanic acid?
beta lactamase inhibitor
117
What is the mechanism for clavulanic acid?
the enzyme destrys the clavulanic acid instead of the penicilllin
118
What is the diagnosis for pharyngitis?
pain/sore throat, exudate, adenopathy, no cough/hoarseness
119
What is the diagnositic test for pharyngitis?
rapid strep test
120
What is the most accurate test for pharyngitis?
culture
121
What is the treatment for pharyngitis?
-penicillin or amoxicillin
122
What is the treatment for pharyngitis in a penicillin allergy patient?
azithromycin clarithromycin -use cephalexin if allergy is a just a rash
123
Patient presentation for influenza
``` arthralgia myalgia cough headache fever sore throat feeling of tiredness ```
124
What is the diagnostic test for influenza?
viral rapid antigen detection - testing a nasopharyngeal swab
125
What is the treatment for influenza?
oseltamivir or zanamivir

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