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Pharm 2 > Class 13 Deck 1 > Flashcards

Class 13 Deck 1 Flashcards

1
Q

What is the difference between bacteriocidal and bacteriostatic?

A
  • Bacteriosidal = Kill bacteria

- Bacteriostatic = Inhibit bacteria growth

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2
Q

What is the Minimum Inhibitory Concentration (MIC)?

A

-Lowest concentration of antibiotic required to inhibit growth

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3
Q

What is the Maximum Bactericidal Concentration (MBC)?

A

-Concentration required to kill 99.99% of the inoculum

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4
Q

What is concentration dependent killing?

A

-Antibiotics that increase extent of killing with increased concentrations (aminoglycosides)

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5
Q

What is time dependent killing?

A

-Clinical effectiveness is related to duration of exposure not greater concentrations.

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6
Q

What is the post antibiotic effect?

A

-Antibiotics continue to suppress bacteria growth after drug is no longer detectable

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7
Q

Post antibiotic effect (PAE) can be decreased in what type of environment?

A

-Acidic (infected)

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8
Q

During the PAE phase, bacteria are more susceptible to killing by ______.

A

Leukocytes (body doing the work)

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9
Q

Antibiotics with concentration-dependent killing and significant PAEs, it is more important to have very _____ _____ and allow the ______ to decrease to less than MIC (Let PAE do the work) this is the basis daily dosing of what drug?

A
  • High Peak
  • Trough
  • Amoniglycosides
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10
Q

Sometimes the presence of an ______ may allow a drug to ______ when it otherwise wouldn’t. What is an example?

A
  • Infection, penetrate

- Meningitis

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11
Q

What local factors may modify the efficacy of the drug?

A
  • Poorly drained infection (Low ph/O2 tension/ pus)
  • Mixed infection
  • Infected hematoma
  • Foreign body
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12
Q

Food or substances containing what can alter GI absorption?

A

-Divalent metal ions

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13
Q

What are the mechanisms for acquired resistance?

A
  • Decreased permeability
  • Increased effux pumps
  • Inactivation
  • Modification of antimicrobial target
  • Development of pathways that bypass target
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14
Q

What is increased effux?

A

-Drug gets into cell but bacteria pumps it out.

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15
Q

What drugs are effected by effux?

A
  • Macrolides
  • Fluroquinolones
  • Beta Lactams
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16
Q

What is the predominant mechanism of acquired resistance of antimicrobials?

A

-Inactivation

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17
Q

Beta lactams are inactivated by what?

A

-Beta lactamases

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18
Q

Modification in the penicillin binding proteins account for methicillin resistance in _______ and penicillin resistance in _______ and _______

A
  • staphylococcus

- pneumococci and enterococci

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19
Q

What are the three reasons to use multidrug therapy?

A
  • Polymicrobial infections
  • Emergence of resistance
  • Synergy
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20
Q

What broad spectrum antibiotics can cover multiple organism infections?

A
  • Ampicillin-sublactam

- Imipenen-cilastin

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21
Q

How should resistance be inhibited? What is an example of this?

A
  • Administration of 2 antibiotics w/ different MOAs

- TB

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22
Q

What are the synergy combination responses?

A
  • Antagonism (1+1=0.5)
  • Indifferent (1+1=1)
  • Inbetween (1+1=1.5)
  • Additive (1+1=2)
  • Synergistic (1+1=3)
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23
Q

Treatment of infection with antimicrobial use can be narrowed down to what three things?

A
  • Delivery of drug to infection
  • High enough concentration
  • Sufficient time to inhibit/kill bacteria
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24
Q

What 5 infections require bactericidial therapy?

A
  • CV infection (endocarditis)
  • Meningitis/Cerebral abscess
  • Neutropenic patients
  • Osteomylitis
  • Prothesis/vascular access infection w/o removing device
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25
Q

What 3 things should be known to make proper therapy choices?

A
  • Patient
  • Invading microbe
  • Antimicrobial agents
26
Q

What information should be known about the patient?

A
  • Where exposed

- Previous antibiotic treatments

27
Q

What are some examples of impaired host defenses against SPECIFIC INFECTION types?

A
  • Anatomical (ulcerations)

- Secondary (Neutropenia, aspleenia, Malignancy, HIV, immunosupressant therapy)

28
Q

What can increase a patients risk for infection complications? and what should you consider?

A
  • Prothesis or foreign bodies (Heart valves, grafts)

- front loading antibiotic therapy

29
Q

How are preggos at risk for infection complications?

A
  • Pharmacokinetics are altered
  • Increased VD and GFR
  • Little or not safety data on ABX
30
Q

What ABX is OK for preggos?

A
  • PCN, Cephalosporins and erythomycin

- except ticarcillin

31
Q

What ABX should be used only if necessary in preggos?

A
  • Aminoglycosides (cranial nerve dysfunction)

- Isoniazid (Retardation, myoclonus, seizures)

32
Q

What 6 drugs should be avoided in preggos?

A
  • Metranidazol
  • Ticarcillin
  • Tetracyclines
  • Trimethoporin
  • Rifampin
  • Fluroquinolones
33
Q

What does tetracyclines do to fetus?

A
  • Fatty necrosis of liver
  • Panreatitis
  • renal innjury
34
Q

What can increase risk of taking a specific ABX drugs?

A
  • Previous reaction to the ABX

- Decreased renal/hepatic function

35
Q

Decreased renal function can have what effect with aminoglycosides? PCN/Imipenem? Ticarcillin/Mezlocillin/Pipercillin?

A
  • 8th cranial nerve (ototoxicity)
  • Seizures
  • Bleeding (platelet dysfunction)
36
Q

80% of all nosocomial infections occur where?

A
  • Resp system (24%) from vents
  • Blood (17%) from IV catheters
  • Urniary tract (36%) From foleys
37
Q

IV catheters are a common cause of what?

A
  • Bactermia

- Fungemia

38
Q

How is catheter infection defined?

A
  • 1 positive blood culture from cath and perpherial site
  • Clinical manifestation of infection
  • No other apparent source
39
Q

What central line sites are at greatest risk for infection?

A

Femoral > I.J. > Subclavian

40
Q

What is the initial therapy for catheter related infections? and why?

A
  • Vancomycin

- High prevalence of MRSA and staph epidermidis in noscomial infections

41
Q

When would gram negative rod coverage w/ catheter related infections be appropriate?

A
  • infection at other body site

- CV instability

42
Q

How should staph epidermidisa and enterocococcus be treated?

A

Remove catheter and short course of ABX

43
Q

Staph aureus often disseminates and can cause what destructive infections?

A
  • Osteomylitis

- Endocarditis

44
Q

How should staph aureus be treated?

A
  • Prolonged ABX therapy

- Look for metaststic lesions

45
Q

Candida fungemia requires what?

A
  • Looking for metastatic infections

- If non found remove cath and use fluconazole

46
Q

What drug is usually used for surgical prophylaxis? and why?

A

-1st gen cephalosporin (cefazolin)

47
Q

What are the 4 would classes?

A
  • Class I: Clean
  • Class II: Clean-Contaminated (surgery in area known to have bacteria)
  • Class III: Contaminated (Break in sterile technique)
  • Class IV: Dirty-Infected (infection before surgery)
48
Q

What is the most common infection from clean wounds? and what should be administered?

A
  • Staphylococcal

- Some do not require prophalyxis

49
Q

Clean-Contaminated and contaminated requires what? (including hyst and urinary tract procedures)

A

Prophylactic ABX

50
Q

Patients w/ UTI’s should have what ABX?

A

-ABX against gram negative bacilli (Fluorquinolones, aminoglycosides, 3rd gen cephlasporins)

51
Q

Biliary tract and urinary tract should have what type of ABX?

A
  • Ampicillin-sublactam

- Piperacillin-tazobactam

52
Q

What is the SCIP mandate for prophylactic ABX?

A

-All patients 18 and up have parenteral ABX
-Must be administered w/i one hour prior to incision
(fluroquinolone & Vanco w/i 2 hours)

53
Q

Bacteremia resulting from ______ is much more likely to cause IE than from bacteremia associated with a dental, GI, or GU procedure.

A

-Daily activities

54
Q

What are the new guidelines for infective endocarditis?

A

-ABX Prophylaxis for those with the highest risk of adverse outcomes should they develop IE, rather than those at highest risk of developing IE.

55
Q

What 4 cardiac conditions are at greatest risk for adverse outcomes with IE?

A
  • Prosthetic cardiac valve
  • Previous IE
  • Congentital heart disease
  • Cardiac transplant who develop valvulopathy
56
Q

What procedures have increased risk for developing bacteremia subsequent IE?

A
  • Dental

- Respiratory tract procedures

57
Q

What bacteria is the most common cause of endocarditis?

A

-Streptococcus viridans

58
Q

What is the preferred prophylaxis for dental or respiratory procedures?

A
  • PO amoxicillin
  • IV ampicillin/cefazolin in unable to take PO
  • PO cephalexin/Clindamycin/Azithromycin if allergic to PCN
59
Q

Post op pneumonia is NOT community acquired and usually needs what ABX?

A

-Clindamycin (similar to erythromycin but more active against anaerobes)

60
Q

What is the leading cause of noscomial GI infection?

A

-C-Diff

61
Q

What causes C-Diff?

A
  • ABX by altering normal bowel flora

- Enterotoxin A and Cytotoxin B

62
Q

What is the ABX of choice in C-Diff?

A
  • Metronidazole

- Vanc if not responsive to metronidazole

Pharm 2 (23 decks)

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