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Antimicrobial Flashcards

1
Q

List GRAM POSITIVE COCCI

A

Gram Positive Cocci

Staphylococcus

Streptococcus

Enterococcus

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2
Q

AEROBIC

GRAM POSITIVE BACILLI

A

“IM GRAM POSITIVE “

“Rhodo Likes Bacic Cory”

Ryan – Rhodococcus sp.

Likes – L. Monocytogenes

BACIC- - Bacillus anthracis

Cory – Corynebacterium sp.

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3
Q

GRAM NEGATIVE

AEROBIC COCCI

A

Almost all cocci are positive except

N. Gonorrhoeae

N. Meningitidis

N. Catarrhalis

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4
Q

GRAM NEGATIVE

AEROBIC BACILLI

A

SPACE

KEHPS

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5
Q

Gram POSITIVE ANAEROBES

COCCI/RODS

A

+ COCCI

“PEPTO”

+ RODS

C.DIFF

C. PERFRINGENS

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6
Q

GRAM (-) ANAEROBES

A

B. FRAGILIS

FUSOBACTERIUM SPP

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7
Q

ATYPICAL

A
  • CHLAMYDIA
  • MYCOPLASMA
  • LEGIONELLA
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8
Q

What are the very common bacteria?

A

Strep A to F is skin flora.

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9
Q

What’s common in abdominal cases?

A

enterococcus

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10
Q

What are time-dependent antibiotics?

A

Carbapenem

Cephalosporin

Penicillin

Aztreonam

– beta lactams –

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11
Q

Example of drugs that are concentration-dependent

A

Daptomycin

Aminoglycosides

Metronidazole

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12
Q

Medication sample for both properties

(AUC/MIC)

A

  • Fluroquinolones*
  • Linezolid*
  • Macrolides*
  • Polymyxins*
  • Tetracycline*
  • Tigecycline*
  • Vancomycin*
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13
Q

What are the Beta-lactams?

A

Beta-Lactam Antibiotics

works on the cell wall on the microbe and disrupt cell wall structure.

Penicillin

Cephalosporin

Carbapenems

Monobactams

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14
Q

Anti-Staphylococcal Penicillins

Oxacillin, Nafcillin, Dicloxacillin

A

Some staphylococcus aureus

Some Staph epidermidis

No enterococcus - GI BUG

NAFCILLIN –> DRUG OF CHOICE FOR MSSA

USED FOR HOSPITAL SETTINGS

CLINICAL: Having Nafcillin as an intraop atbx for a GI procedure is not enough because it does not have an enterococcus coverage.

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15
Q

Amino-penicillin

Ampicillin

A

Clinical:

Meningitis guidelines recommend Ampicillin

it has good Listeria coverage and good CNS penetration

—> not picked for gram-negative because of resistance

–> DO NOT USE FOR ABDOMINAL COVERAGE

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16
Q

Beta-lactamase Inhibitors

Amoxicillin-clavulanate (Augmentin®) Ampicillin-sulbactam (Unasyn®)

A

Anaerobic coverage: Bacteroides [massive bowel perf]

ampicillin- sulbactam has a robust coverage !!

NO C.DIFF COVERAGE

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17
Q

Piperacillin-tazobactam (Zosyn®)

A

Pseudomonal activity!!!

drug of choice among penicillins.

–> almost the same as ampicillin-sulbactam except the pseudomonal coverage

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18
Q

Your patient is undergoing debridement for a superficial wound this antibiotic is enough to cover it.

A

First Generation Cephalosporins

Cefazolin IV– in the OR we use this gram + skin flora, MSSA

abscess debridement

will never cover anaerobes

GRAM (-) [UTI]

e. coli

Klebsiella

Proteus

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19
Q

Second Generation Cephalosporins

Cefuroxime (Ceftin®) – PO/IV Cefoxitin (Mefoxin®) - IV

A

Cefoxitin (Mefoxin®) - IV

NOT AS GOOD FOR MSSA

COVERS ANAEROBS REALLY WELL

GYN CASE

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20
Q

Third Generation Cephalosporins

Ceftazidime (Fortaz®) – IV Ceftriaxone (Rocephin®) – IV Cefpodoxime (Vantin®) – PO Cefdinir (Omnicef®) - PO

A

Ceftriaxone –> used for PNA tx

gram + similar NOT AS GOOD FOR MSSA

ceftazidime –> covers Pseudomonas!

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21
Q

Fourth Generation Cephalosporins

Cefepime (Maxipime®) – IV

A

Cefepime –> gram negative

Pseudomonas aeruginosa

if there’s resistance usually cefepime can take care of some of those

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22
Q

Ceftaroline

A

PNA usually gram negative rods and happen to have an MRSA infection on top of it

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23
Q

Ceftolozone / tazobactam

Ceftazidime/ avibactam

A
  • superbug (invasive) Klebsiella infection
  • CARBAPENEM - RESISTANT ENTEROBACTERIACEAE
  • PSEUDOMONAS AEURUGINOSA
  • EXTENDED SPECTRUM BETA LACTAMASE PRODUCING ORGANISMS
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24
Q

CarbaPENEMs

Ertapenem (Invanz®) – IV, IM

Meropenem (Merrem®) – IV Imipenem/cilastatin (Primaxin®) – IV Doripenem (Doribax®) - IV

WILL IT COVER PSEUDOMONAS?

A

GREAT SKIN FLORA COVERAGE

– THE REASON WHY WE USE THIS IN PRACTICE IS BECAUSE

OF RESISTANCE AND ITS GRAM NEGATIVE PROPERTIES

– BELLY CASE ITLL BE JUST FINE

only ERTAPENEM WILL NOT COVER PSEUDOMONAS

25
**FLUOROQUINOLONES** Ciprofloxacin (Cipro®) – IV, PO Levofloxacin (Levaquin®) – IV, PO
**_you can use if you have beta-lactam allergy_** **_ATYPICAL COVERAGE_** - Chlamydia and Chlamydophila Mycoplasma Pneumoniae Legionella spp **GRAM NEGATIVE: CIPROFLOXACIN IS MOSTLY GRAM NEGATIVE** _**PSEUDOMONAS\***_ _**STENOTROPHOMONAS MALTOPHILIA\***_
26
Your _patient has PCN, Cephalosporin, and Carbapenem allergy_. He grew pseudomonas on his gram stain what antibiotic can you use?
**Aztreonam** its a _beta-lactam_ but can be used when people has **severe allergy to PCN** super narrow; cover gram negatives
27
Drug of choice for **MRSA**
**VANCOMYCIN**
28
DOES IV VANC COVER C. DIFF?
## Footnote **NO.** **_ONLY PO VANC_** **IT NEVER GETS ABSORBED**
29
When will **Daptomycin** be used?
it covers **_MRSA_** **_VRE_** **-- inactivated by lung surfactant**
30
Your patient grew MRSA. Upon a careful review of his chart, you noted that he had a severe anaphylactic reaction to Vanco. What medication will you use? While typing your orders the lab called you for the same patient and notified you that the same patient grew VRE what will you use?
**Daptomycin**
31
Your patient has a massive **bowel perforation.** gram stains grew: **_Enterococci**_ and _**Bacteroides spp._** what antibiotic will you use?
**Ampicillin- Sulbactam**
32
Your patient that had a massive bowel perf. He is scheduled for surgery , upon reading his gram stains you noted that it grew **Enterococci**, **Bacteroides spp.** , and **Pseudomonas** what antibiotic will you use among the penicillin class?
**Piperacillin - tazobactam**
33
WHICH ***_CEPHALOSPORIN_*** WILL COVER **ENTEROCOCCUS?**
**NONE** **_NO CEPHALOSPORIN WILL EVER COVER ENTEROCCOCUS AT ALL_**
34
The IV drug of choice for C.Diff
**Metronidazole**
35
Your patient grew **MRSA a**nd **VRE** in his lungs what will you use to treat it? He is on his way to get GI surgery.
***TIGECYCLINE*** Covers MRSA and covers VRE covers: bacteroides fragilis and many other anaerobs
36
your patient is taking MAOIs and is growing MRSA and VRE what medication will you avoid?
## Footnote **Linezolid**
37
Adverse SE of **Aminoglycosides**
Renal injury and ototoxocity
38
Adverse SE **Amphotericin**
## Footnote **Renal dysfunction**
39
Overdose of Beta Lactams
**SEIZURE**
40
SE; CEFTRIAXONE
**BILIARY SLUDGING**
41
**ASSOCIATED WITH C, DIFF RISK**
**CLINDA**
42
what do you monitor when you start **Dapto?**
monitor for **CPK** may cause **Rhabdo**
43
big problem for **Fluoroquinolones**
**QTc prolongation** and c. diff risk
44
If a patient has thrombocytopenia what would you expect to see if you put them on a course of **Linezolid**
platelets getting even lower due to **bone marrow suppression**
45
SE: Metronidazole
Dark urine, peripheral neuropathy, disulfuram -- like reaction with ingestion of alcohol - vomiting
46
**Macrolides** causes?
**Qtc prolongation** , i*nhibition of CYP 450* (erythromycin, clarithromycin)
47
## Footnote **Polymyxins**
Renal dysfunction * causes **acute neuromuscular blockade** * **similar structure to Ach**
48
## Footnote **SE: Trimethoprim/ Sulfamethoxazole**
hyperkalemia, thrombocytopenia, leukopenia, rash
49
**Pharmacokinetics** Daptomycin Micafungin Nitrofurantoin Oral Vanco Polymyxins Tigecycline
50
## Footnote **What are the drugs that treat MSSA?**
51
Only **Cephalosporin** that covers **MRSA**
**CEFTAROLINE**
52
**WHAT ARE THE DRUGS THAT TREAT MRSA?** **What is the drug of choice?**
**_IV Vanc is drug of choice for MRSA_** * **CEFTAROLINE** * **DAPTOMYCIN** * **LINEZOLID** * **TIGECYCLINE**
53
**What are the drugs that treat VRE**
Daptomycin (DOC) - can cause *_Rhabdo_* Linezolid (DOC) Tigecycline -- *doesn't concentrate in blood [not good for super sick person]*
54
BURN THIS IN YOUR BRAIN **PSEUDOMONAS COVERAGE**
Beta-lactamase Inhibitor Monobactams Cephalosporins Carbapenems Fluoroquinolones Aminoglycosides Polymyxins
55
What **covers anaerobes?** esp. belly cases
56
If you had an intraabdominal case, which one would be reasonable? What are your usual organisms? What will be your antibiotic therapy? review chart!
**Ceftriaxone IV +- Metronidazole IV/PO** Alternative: Levofloxacin IV/PO +- Metronidazole review chart!
57
know this chart Intraabdominal infections
58
What is reasonable management for intraoperative **bowel perp**
59
**Community-Acquired PNA drug of choice**

Anesthesia Pharm (25 decks)

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