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Anti-microbial General Principles Flashcards

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1
Q

Which type typically attack the cell wall- bacteriocidal or bacteriostatic?

A

Bacteriocidal attack the cell wall to kill the organism

Bacteriostatic stop growth, work on proteins and ribosomal subunits

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2
Q

What is the minimum inhibitory concentration (MIC)?

A

Lowest concentration of ABX required to prevent growth

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3
Q

Can you compare the potency different ABX based on their MIC for a given organism?

A

No

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4
Q

What is minimum bactericidal concentration (MBC)?

A

Lowest concentration required to kill bacteria

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5
Q

MIC or MBC: Reported on the culture and sensitivity report?

A

MIC

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6
Q

What is concentration-dependent killing?

A

Want to get a high peak concentration and then allow concentration to drift down over time. Examples aminoglycosides and fluoroquinolones

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7
Q

What is time-dependent killing?

A

Want the MIC to be longer period of time. Trough values are typically important for ABX the are time dependent killing.
Example is beta lactams, monobactams, macrolides

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8
Q

Is post-antibiotic effect demonstrated in all antimicrobials?

A

Yes; demonstrated in virtually all antimicrobials

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9
Q

What is Post-antibiotic effect (PAE)?

A

ABX continue to suppress the growth of bacteria even after the ABX is no longer detectable

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10
Q

PAE decreased or increased in acidic environments?

A

Decreased in acidic (infected) media

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11
Q

T/F: Post-antibiotic effect is especially present in concentration dependent ABX?

A

True

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12
Q

What four things contribute to antimicrobial resistance?

A
  1. Overuse for inappropriate indications
  2. Broad Spectrum
  3. Poor infection control
  4. Inappropriate dose or duration
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13
Q

T/F: All gram positive bacteria have intrinsic resistance to vancomycin?

A

False, all gram negative bacteria

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14
Q

Intrinsic or Acquired resistance definition: reflects a genetic alteration in the bacteria that renders a once effective antimicrobial ineffective?

A

Acquired

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15
Q

What are the four mechanisms through which acquired resistance is achieved?

A
  1. Decreased permeability (Stops the ABX from entering the organism)
  2. Increased efflux pumps (form pumps to “kick out” ABX)
  3. Inactivation (ex. beta lactamase)
  4. Modification of antimicrobial target
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16
Q

T/F

The more board the spectrum, the greater chance of resistance

A

True

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17
Q

T/F

Continuous infusion has been shown to be more effective than intermittent boluses

A

FALSE

has not been shown

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18
Q

Should 2 ABX with different MOA be used?

A

Yes to inhibit emergence of resistant strains of an organism. Creates synergistic effect

Ex. beta lactam and aminoglycoside (BL breaks down bacterial cell wall and allows easier entry for aminoglycoside)

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19
Q

Treatment of an established infection with an effective therapy of ABX agents is based upon what three things?

A
  1. Delivery of a concentration of drug to the site of infection
  2. Concentration sufficient to kill or inhibit growth of the offending organism
  3. Sufficient period of time to eradicate the infection
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20
Q

What 5 clinical situations is bactericidal therapy considered necessary for clinical cure?

A
  1. CV infection (particularly endocarditis or prosthetic valves)
  2. Meningitis and cerebral abscess.
  3. Severe neutropenia
  4. Osteomyelitis
  5. Tx of prosthesis or vascular access related infections w/o removing the device
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21
Q

Vascular access devices typically grow what type of bacteria?

A

Gram Positive

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22
Q

Lung infections typically grow what type of bacteria?

A

Gram Negative

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23
Q

What is an antibiogram?

A

A chart demonstrating the resistance patterns in your specific hospital/facility/region and compares bacterial strains and how susceptible they are to each ABX available

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24
Q

What are examples of impaired host defense?

A
  1. Anatomical (ulceration)
  2. Neutropenia
  3. Aspleenia
  4. Malignancy
  5. HIV
  6. Immunosuppresant therapy
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25
How are the pharmacokinetics of pregnant patients changed?
Increased volume of distribution and increased GFR
26
T/F: Penicillins, Tetracyline, Cephalosporins, and Erythromycin are all considered safe for pregnant patients?
False; Tetracycline should always be avoided
27
What medications are to be avoided in pregnant patients?
1. Metranidazole 2. Ticarcillin 3. Rifampin 4. Trimethoprim 5. Fluoroquinolones 6. Tetracyclines
28
Canadian Population Study determined which three ABX had no increased risk to fetus or mother?
Amoxil, Cephalosporins, Macrobid
29
Why is tetracycline contraindicated in pregnant patients?
Associated with acute fatty necrosis of liver, pancreatitis, and possible renal injury
30
If patient contracted itchy red areas with previous ABX treatment, should that medication be used again?
Yes; as long as not raised rash
31
Per 2018 CDC data, ____in____ hospitalized patients will develop an infection?
1 in 31
32
Rank central line location sites from most likely to least likely to get infected
Femoral>I.J.>Subclavian Risk increase the further the site is from the heart
33
What is the disease associated with altered bowel flora?
Pseudomembranous enterocolitis caused from Clostridium difficile over growth
34
What two toxins mediate C.Diff pathogenesis?
1. Enterotoxin A | 2. Cytotoxin B
35
How is C Diff diagnosis confirmed?
With detection of one of the toxins
36
What percent of successfully treated C Diff patients have relapse infection?
10%
37
What is treatment for C.Diff?
1. Oral Vanco (1st line treatment for mild, mod, sever) 2. Dificid (fidaxomicin) (1st line treatment for mild, mod,severe) 3. Fecal Transplant Don't use Flagyl anymore d/t SE's (more than 2 rounds and get neuro damage)
38
Which ABX has the highest risk of developing C Diff? Second Highest risk? Rarely?
1st Cleocin 2nd Cephalosporins Rarely- Vancomycin and Flagyl
39
T/F: PPI and H2 Antagonist therapy does not increase risk of developing C Diff?
False; while PPI is associated with higher risk, both increase risk of developing C Diff infection
40
What is the "best way" (per emily) to cure C Diff?
Fecal Transplant (99% cure rate)
41
What happens if an obese patient donates feces for fecal transplant?
The recipients have been shown to increase weight
42
What percentage of Surgical Site Infections (SSI) are considered preventable?
50%
43
Why is cefazolin chosen so frequently for SSI?
1. Low cost 2. Broad spectrum 3. Low incidence of allergic reaction
44
Gross GI spillage is an example of what wound class?
Class III
45
Perforated viscera or old wound with devitalized tissus is an example of what wound class?
Class IV
46
Surgery in areas known to harbor bacteria is an example of what wound class?
Class II
47
Surgery on traumatic wounds is an example of what wound class?
Class III
48
T/F: Class IV wound is the only wound class that REQUIRE ABX?
False; Class III and Class IV are required, while Class II should be considered
49
Which organism is most common species on clean wounds?
Staphylococcal
50
What are recommendations for patients at high or moderate risk undergoing procedures involving infected tissues or receiving prosthetic cardiac valves?
1. Include anti-staphylococcal ABX for cellulites and osteomyelitis 2. Coverage for active infections (i dont even know wtf this slide means)
51
What are recommendations for fungal infection prophylaxis?
Little data to support it Difficult to prove fungal infection Issue complicated by fluconazole resistant C Albicans emerging and other changing resistant fungal species
52
(Per Emily) When should ancef be given for SSI?
60 mins prior to incision
53
(Per Emily) when should vanco be given for SSI?
120 mins prior to incision
54
What is typical dose of vancomycin?
15mg/kg on Actual Body Weight up to around 2.5g
55
Elderly and morbidly obese patients have a volume of distribution close to __, so if we are using .7 to dose them with Vanco we are ____ them
1 | underdosing
56
What two ABX's should be given to pregnant patients only if necessary?
Aminoglycosides | Isoniazid
57
What reactions are considered "true allergic reactions" to ABX?
Anaphylaxis Steven-Johnson syndrome Allergic interstitial nephritis
58
3 most common types of nosocomial infections
Urinary Respiratory Blood
59
T/F Antibiotic impregnated catheters will always decrease risk of bactermia
FALSE may decrease the risk....proven to be not that great
60
What percentage of the population are natural carriers of c.diff?
10% they are at a higher risk of infection
61
T/F You can get c.diff infection with a single dose on Ancef
True
62
What surgical wound class is atraumatic, has no break in sterile technique and no entry into the respiratory, GI, GU tracts?
Class I
63
If a procedure is long, you want to redose your prophylactic ABX after __ half-lives
2 So, Ancef (t= 2hrs) after 4 hours Cleocin (t =3hrs) after 6 hours Vanco (t = 8hrs) after 16 hours

Pharm 2 (19 decks)

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