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Flashcards in Anti-bacterial therapy Deck (74):
1

what is a bactericidal?

eradicates the bacteria
-dependent on concentration
-critical to use the appropriate dose
-preferred for meningitis and UTI (immune system is not able to resolve these cases on their own)

2

what is a bacteriostatic?

inhibits bacterial replication and allows host to eradicate it
-dependent on time

3

what are common causative agents of UTI?

E. coli (90%), other gram neg bacilli (may be MDR), staph. saprophyticus,group B strep

4

what info should you get when treating for UTI?

prior UTIs
prior antimicrobials
exposure to or symptoms of STDs

5

what are the empiric treatments for UTIs?

TMP-SMX (3 dys-bacteriostatic)
Fluoroquinolone (3 dys)

Less preferred bc they take longer
Nitrofurantoin (7 dys)
Amox/Clav (7 dys)

6

what are common causative agents of cellulitis?

S. aureus
group A strep
group B strep

7

what info should you get when treating for cellulitis?

prior infections
MRSA risk profile
human/animal bite
comorbidities

8

what are the empiric treatments for cellulitis?

dicloxacillin (MRSA gap)
TMP-SMX (GAS gap)
Clindamycin (MRSA gap)
doxycycline (less MRSA experience)
linezolid (cost, side effect profile)
fluoroquinolone and rifampin (less exp, drug interactions, resistance)

9

what info should you getn when treating URI?

prior episodes/treatment
recent travel
sick contacts
animal exposures
TB risk/HIV risk
Occupation

10

what would you use to treat URI?

most are viral
bacterial pathogen likelihood increases with more severe symptoms
-beta-lactam (penicillin/cephalosporin)
-macrolid
-lincomycin

11

what would you use to treat LRI?

empirical recommendations are more evidence based
-Health pts
---doxycycline
---macrolide (not if high local resistance)
-co morbidities/recent antibiotic use
---"respiratory" fluoroquinolone
---Amox/clav combination

12

what separates penicillin and cephalosporins?

penicillin is 5 member ring whereas the other is 6 member ring

13

what is the MOA of penicillin?

bactericidal-need the right concentration
inhibits bacterial cell wall synthesis

14

what do you use penicillin for?

Staph (coagulase-negative)
strep pyrogenes
other gram positives (enterococcus)

15

what would you use for uncomplicated otitis media?

amoxicillin

16

what would you use for pre-partum GBS prophylaxis?

ampicillin

17

what would you use for S bacterial endocarditis prophylaxis?

Penicillin V

18

what would you use for H. pylori treatment?

amoxicillin

19

when would you use anti-staph penicillin?

coagulase-negative staph
MSSA
beta-lactamase producing strep
***bacterial endocarditis

20

what are the broadened spectrum penicillin?

amox/clavulanate (augmentin)
ampicillin/sulbactam (unasyn)
piperacillin/tazobactam (zosyn)

21

what are the extended spectrum penicillins?

ticarcillin
mezlocillin
azlocillin
piperacillin (only one that is mostly used today)
***only given in the hospital

22

why are cephalosporins better than penicillin?

more dosage options
better bio availability

23

what is the MOA of cephalosporins?

bactericidal
inhibit bacterial dihydropeptidase

24

what are the 1st generation cephs?

cefazolin
cephalexin
cefadroxil

25

what are the 2nd gen cephs?

cefoxitin
cefuroxime

26

what are the 3rd gen cephs?

ceftriaxone
cefpodoxime

27

what are teh 4th gen cephs?

cefipime
ceftaroline (pseuod)

28

which ceph will cover MRSA in vitro?

ceftaroline

29

what do 1st gen cephs work against?

non-beta lactamase producing gram positive, no anaerobes
-same coverage as penicillin but better bio availability

30

what do 2nd gen cephs work against?

non-BL producing organism, more gram N, less gram P, more anaerobes
-indicated in clean-contaminated surgical procedures

31

what do 3rd gen cephs work against?

more resistance to BL producing organisms
more gram P, more gram N, no anaerobes

32

what indications does ceftriaxone have?

OM with effusion
CAP
meningitis (accumulates well in the brain)
NOT recommended for surgical prophylaxis

33

what do 4th gen cephs work against?

similar to 3rd gen, but have better resistance to BL producing organisms, no anaerobes
***mostly used to limit serious infections in the inpt setting

34

what are the MOA of fluoroquinolones?

bactericidal
inhibits bacterial DNA synthesis

35

what are indications for fluor?

good against staph, NOT strep, good against gram negative (non BL producing), NOT anaerobes

36

which fluor are good agents against strep?

levofloxicin
moxifloxacin

37

which fluor is a good agent against anaerobes?

moxifloxacin

38

what should you use for uncomplicated uTI?

cipro

39

what are benefits of fluors?

broad spectrum
once a day
all orally available

40

why would you not use fluor for meningitis?

it does not penetrate BBB

41

which antibiotic requires renal adjustment?

fluoro
penicillin
cephs

42

would you use fluor for URI?

no, not evidence based

43

which are the macrolides?

erythromycin
azithromycin
clarithromycin

44

what is the MOA of macrolides?

bacteriostatic
inhibits bacterial protein synthesis which prevents replication

45

what do macrolides work against?

gram P organisms (strep, listeria, clostridium), good atypical coverage **mycoplasma, legionella, chlamydia), NOT staph, NOT gram N, NOT anaerobic

46

what are clinical indications of macrolides?

mono outpatient therapy for CAP, combo inpatient therapy w/ ceftriaxone for CAP
atypical pneumonia
GU infections cause by chlamydia
some URI

47

which antibiotics are the worst for GI flora?

macrolides

48

what are the tetracycline agents?

tetracycline
doxycycline
minocycline
tigecycline (glycylcycline)

49

what is the MOA of tetras?

bacteriostatic
inhibits bacterial protein synthesis

50

what are drawbacks of tetras?

rapid development of resistance and toxicities

51

what are clinical indications of tetras?

rickettsial infections (Lymes, RMSF)
prophylaxis, intra-abdominal, gyn infections (Dox)
2a infections caused by acne (Mino)
serious infections by susceptible bacteria -hail mary (Tige)

52

who is contraindicated for tetras?

children (staining of bone and teeth), expecting mothers

53

what is the agent for lincomycin?

clindomycin

54

what is the MOA of lincomycin?

bacteriostatic
inhibits protein synthesis

55

what are the clinical uses of lincomycin?

gram P infections by some strains of strep and staph (alt to beta lactam)
anaerobic infections (gut, pelvis)

56

what are clinical side effects of lincomycin?

severe enterocolitis (1-2% pseudomembranous colitis)
sig resistance among gram P

57

what are agents of sulfonamides?

sulfamethoxazole
trimethoprim
TMP-SMX (bactrim)
sulfaisoxazole (gantrisin)

58

what is the MOA of sulfonamides?

bacteriostatic
inhibits bacterial folic acid synthesis

59

what are the clinical indications for sulfonamides?

peds URI
PCP pneumonia treatment
topical bacterial infections for burns (silvadine)
ocular infections

60

what are drawbacks for using sulfonamides?

rash/exfoliation
folic acid deficiency
allergy

61

what are agents of nitrofurantoin?

macrodantin
macrobid

62

what are clinical indications of nitrofurantoin?

alt for uncomplicated UTI caused by gram N (E. coli, Klebsiella, Proteus)

63

who is contraindicated for nitrofurantoin?

CrCl of less than 50
-have to be secreted from kidneys into the blood
-won't be absorbed w/o good kidney function

64

what are clinical indications of metronidazole?

excellent against bacteroids, clostridium, helicobacter, trichomonas,****drug of first choice for c. diff

65

what are clinical indications of rifampin?

bactericidal
TP and
meningitis caused by gram P (pneumococcus) b/c of CNS penetration
good mycobacterial in combination with other agents (isoniazid, ethambutol)

66

what are drawbacks of using rifampin?

hepatotoxic
numerous drug interactions
lost of resistance has limited uses

67

what is the MOA of aminoglycosides?

bacteriostatic
inhibits protein synthesis

68

what are drawbacks of using aminoglycosides?

have to adjust to renal function
ototoxic with long term use

69

what is the MOA of vancomycin?

bactericide
must be given IV (large molecule)

70

what are clinical indications of vanc?

*****effective against MRSA but resistance is rising
****used to treat c. diff if metronidazole isn't working

71

what are drawbacks of using vanc?

renal and ototoxic

72

what is linezolid used for?

MRSA,!! VRE!!!

73

what is a drawback of using linezolid?

food-drug interactions effects metabolism of serotonin and catecholamines

74

what is daptomycin used for?

bactericidal
**MRSA (skin/soft tissue), **MSSA, anti staph, maybe against VRE
IV only
***inpatient use against serious gram P infections

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