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PHM603 > EXAM II - Principles > Flashcards

EXAM II - Principles Flashcards

1
Q

What are drugs effects? (2)

A

toxicodynamics on host and pharmacodynamics on bacteria

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2
Q

What are host effects? (2)

A

pharmacokinetics on drug and host defenses on bacteria

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3
Q

What are bacteria effects? (2)

A

resistance on drug and infection on host

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4
Q

What bacteria infects skin?

A

staphylococcus aureus

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5
Q

What bacteria infects the intestinal lining?

A

helicobacter pylori

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6
Q

What bacteria infects the urinary tract?

A

escherichia coli

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7
Q

What has no evidence based support for use?

A

combination therapy for carbapenem-resistant Gram-negatvie bacteria

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8
Q

What value denotes something that is bactericidal?

A

< 10^4 CFUs/mL

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9
Q

What are Gram-positive cocci in clusters?

A

coagulase negative (s. epidermidis) and coagulase positive (s. aureus)

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10
Q

What percents are MSSE and MRSE?

A

MSSE = 26%, MRSE = 74%

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11
Q

What percents are MSSA and MRSA?

A

MSSA = 50%, MRSA = 50%

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12
Q

How to treat susceptible staph versus resistant?

A

susceptible = nafcillin/dicloxacillin/cephalexin, resistant = vanco/daptomycin/linezolid/clindamycin/ceftaroline/TMPSMX

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13
Q

SPACE acronym stand for?

A

serratia, pseudomonas, acinetobacter/indole-positive, citrobacter, enterobacter

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14
Q

penicillins MOA?

A

bind to transpeptidase enzymes and prevent cell wall formation

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15
Q

penicillins spectrum of activity?

A

Gram + aerobes, some MSSA

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16
Q

cephalosporins MOA?

A

bind to transpeptidase enzymes and prevent cell wall formation

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17
Q

cephalosporins spectrum of activity?

A

ceftazidime - pseudomonas, cefepime - MRSA

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18
Q

What is the drug class of choice for ESBL producing organisms?

A

carbapenems

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19
Q

carbapenems spectrum of activity?

A

does not work on MRSA or atypicals

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20
Q

aminoglycosides MOA?

A

bind to 30S ribosomal subunit

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21
Q

What aminoglycoside is used in combination with cell wall active agents?

A

gentamicin

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22
Q

What are ADEs of aminoglycosides?

A

nephro/ototoxicity, neuromuscular blockade

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23
Q

aminoglycosides spectrum of activity?

A

does not work on Gram - anaerobes or atypicals

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24
Q

What class of drugs are bacteriostatic?

A

tetracyclines, macrolides, lincosamides, TMP/SMX, and oxazolidinones

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25
Q

tetracyclines MOA?

A

reversibly bind to 30S ribosomal subunit

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26
Q

tetracyclines ADEs?

A

GI, phototoxicity, Fanconi syndrome

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27
Q

tetracyclines spectrum of activity?

A

work on atypicals, no pseudomonas coverage

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28
Q

macrolides MOA?

A

reversibly bind to the 50S ribosomal subunit

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29
Q

macrolides ADEs?

A

GI, phlebitis

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30
Q

macrolides spectrum of activity?

A

work on atypicals, not staph or pseudomonas

31
Q

lincosamides MOA?

A

reversibly bind to the 50S ribosomal subunit

32
Q

lincosamides ADEs?

A

GI, pseudomembranous colitis

33
Q

lincosamides spectrum of activity?

A

No gram - or pseudomonas

34
Q

fluoroquinolones MOA?

A

inhibit DNA gyrase

35
Q

What drugs are affected by oral coadministration of di- and trivalent cations?

A

tetracyclines and fluoroquinolones

36
Q

fluoroquinolones ADEs?

A

GI, HA, seizures, QTc prolongation

37
Q

fluoroquinolones spectrum of activity?

A

pseudomonas and atypicals

38
Q

What class of drugs are first-line for MRSA infections?

A

glycopeptides

39
Q

glycopeptides MOA?

A

bind to the terminal residue in growing peptidoglycan chains and prevent cell wall formation

40
Q

glycopeptides ADEs?

A

nephro/ototoxicity, Red Man’s Syndrome, neutropenia, rash

41
Q

What is not indicated for pneumonia?

A

daptomycin

42
Q

What drug is first-line for pneumocystis carinii pneumonia?

A

TMP/SMX

43
Q

trimotheprim/sulfamethoxazole MOA?

A

folate pathway inhibitor

44
Q

trimethoprim/sulfamethoxazole ADEs?

A

GI, rash, anemia, crystalluria, neutropenia

45
Q

nitroimidazoles MOA?

A

reduces to toxic intermediate that form DNA adducts

46
Q

nitroimidazole ADEs?

A

GI, disulfiram reaction, metallic taste

47
Q

nitroimidazole spectrum of activity?

A

Gram - anaerobes

48
Q

oxazolidinones MOA?

A

bind to 50S ribosomal subunit

49
Q

What generation cephalosporin has CSF penetration?

A

third (cefotaxime, ceftriaxone, cefixime, cefpodoxime, cefoperazone)

50
Q

What generation cephalosporin has MRSA activity?

A

fifth (ceftaroline)

51
Q

What is the formula for AUC of a given dose?

A

AUCdose = t_infusion * ((c_max + c_min)/2) + ((c_max - c_min)/k)

52
Q

What is the dosing goal of penicillins, cephalosporins, carbapenems, macrolides, and oxazolidiones?

A

prolonged infusion time, continuous infusion, shorter dosing interval, increase dose

53
Q

What is the key parameter of penicillins, cephalosporins, carbapenems, macrolides, and oxazolidiones?

A

%T>MIC

54
Q

What is the dosing goal of aminoglycosides and fluoroquinolones?

A

extended interval dosing, maximize safe dose

55
Q

What is the key parameter of aminoglycosides and fluoroquinolones?

A

Cmax:MIC, AUC:MIC

56
Q

What is the dosing goal of vancomycin, azithromycin, and tetracycline?

A

optimize safe dose

57
Q

What is the key parameter of vancomycin, azithromycin, and tetracycline?

A

AUC:MIC

58
Q

What antibiotics do not require renal adjustment? (12)

A

metronidazole, azithromycin, nafcillin, tigecycline, oxacillin, linezolid, doxycycline, moxifloxacin, erythromycin, quinupristin/dalfopristin, ceftriaxone, clindamycin

59
Q

What is the foremost factor controlling PD?

A

the bacteria species

60
Q

What is the AUC MIC for vancomycin?

A

> 400 mg*h/L

61
Q

What is the trough goal for vancomycin?

A

10-15 mcg/mL

62
Q

purulent SSTI treatment (mild)?

A

I&D

63
Q

purulent SSTI treatment (moderate, empiric)?

A

I&D, TMP/SMX, doxycycline

64
Q

purulent SSTI treatment (moderate, defined)?

A

I&D, MRSA = TMP/SMX, MSSA = dicloxacillin, cephalexin

65
Q

purulent SSTI treatment (severe, empiric)?

A

I&D, vanco/daptomycin, linezolid, telavancin, ceftaroline

66
Q

purulent SSTI treatment (severe, defined)?

A

I&D, MRSA = empiric options, MSSA = nafcillin, cefazolin, clindamycin

67
Q

nonpurulent SSTI treatment (mild)?

A

oral penicillin, cephalosporin, dicloxacillin, clindamycin

68
Q

nonpurulent SSTI treatment (moderate)?

A

intravenous penicillin, ceftriaxone, cefazolin, clindamycin

69
Q

nonpurulent SSTI treatment (severe, emergent surgical inspection/debridement)?

A

rule out necrotizing process

70
Q

nonpurulent SSTI treatment (severe, empiric)?

A

vancomycin PLUS piperacillin/tazobactam

71
Q

How long is the duration of therapy for purulent SSTIs?

A

5-10 days following I&D

72
Q

purulent SSTIs classifications? (3)

A

mild = not systemic, moderate = systemic signs, severe = septic/immunocompromised/failed I&D and therapy treatment

73
Q

What are the criteria for SIRS? (4)

A

at least two required: temp <36 or >38, tachypnea >24, tachycardia >90, WBC >120000 or <4000

74
Q

How long is the duration of therapy for non-purulent SSTIs?

A

mild = 5 days, moderate-severe = 10-14 days

PHM603 (3 decks)

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