ID 1 Flashcards
(255 cards)
1
Q
gram positive gram stain
A
dark purple (thick cell wall)
2
Q
gram negative gram stain
A
pink (thin cell wall)
3
Q
what organisms do not stain well
A
atypicals chlamydia legionella mycoplasma pneumonia mycobacterium tuberculosis
4
Q
gram positive cocci in clusters
A
staphylococcus (mssa and mrsa)
5
Q
gram positive cocci in pairs and chains
A
strep pneumoniae (diplococci)
strep spp. (pyogenes)
enterococcus spp. (including VRE)
6
Q
gram positive rods
A
listeria
7
Q
gram positive anaerobes
A
peptostrepococcus
actinomyces
clostridium spps.
8
Q
gram neg cocci
A
neisseria
9
Q
gram neg rods
A
gut ones proteus e coli klebsiella serratia enterobacter citrobacter
non gut ones
pseudomonas
h flu
providencia
10
Q
gram neg. cocci bacilli
A
acinetobacter
bordetella pertussis
11
Q
gram neg. diplococci
A
moraxella cat/
12
Q
gram neg. anerobe
A
bacteroides fragilis
prevotella spp.
13
Q
curved or spiral shaped gram neg. rods
A
h pylori campylobacter treponema boreelia leptospira
14
Q
high risk cdiff (killing off of normal gi gut flora) can be fatal
A
clindamycin
15
Q
folic acid synthesis inhibitors
A
sulfonamides
trimethoprim
dapsone
16
Q
cell wall inhibitors
A
beta lactams (penicillins, cephalosporins, carbapenems)
monobactams (aztreonam)
vancomycin, dalbavancin, televancin, oritavancin
17
Q
protein synthesis inhibitors
A
aminoglycosides macrolides tetrocyclines clindamycin linezolid,tedezolid quinupristin/dalfopristin
18
Q
cell membrane inhibitors
A
polymyxins
daptomycin
telavancin
oritivancin
19
Q
dna/rna inhibitors
A
FQs
metronidazole, tinidazole
rifampin
20
Q
concentration dependant
A
quinolones
aminoglycosides
daptomycin
goal is a high peak
large dose long interval
21
Q
time dependent
A
cephalosporins
penicillins
carbapenems
goal is maintain drug level for most of the dosing interval
shorter dosing interval
22
Q
beta lactam antibiotics
A
cephalopsorins, penicillins, carbapenems
all have a beta lactam ring
23
Q
all penicillins cover what
A
enterococcus
24
Q
all penicillins do not cover
A
MRSA or atypicals
25
only penicillin for pseduomonas
pip/taz (zosyn)
26
amoxicillin on its own cannot cover mssa but it can if its added with ___
clavulanate (augmentin)
27
natural penicillins (Pen v potassium, pen g benzathine) cover
gram positive cocci (strep and enterococci but not staph) and gram positive anaerobes
28
aminopenicillins cover
| amoxicillin and ampicillin
gram positive (strep, enterococci not staph, gram pos. anaerobes, and gram neg HNPE)
29
amoxicillin/clavulantate
| and ampicillin sulfbactam cover
gram positive (strep, enterococci, mssa, gram pos. anaerobes, gram neg. HNPEK) and gram neg. anaerobes (bacteroides fragelis)
30
zosyn covers everything augmentin and unasyn covers plus
citrobacter, acinteobacter, provindencia, enterobacter, serratia (CAPES), pseudomonas
31
antistaphylococcal penicillins are
nafcillin, dicloxacillin and oxacillin
32
antistaphyloccal penicillins are great against
MSSA but lack but lack activity against enterococcus, gram negatives and anarobes
33
penicillin G benzathine brand
| IM
Bicillin LA
| not used IV can cause death
34
side effects penicillins
seizures with accumulation
GI upset
diarrhea
Rash (SJS, TEN)
35
ampicillin and unasyn dilute in
NS only
36
nafcillin is a ___
vesicant, administer through central line
37
avoid penicillins in what allergy
beta lactam
38
all penicillins increase the risk of ___
seizures
39
first line tx for strep throat
penicillin VK
40
first line tx mild non purulent skin infection (no abscess)
penicillin VK
41
first line tx acute otitis media
```
amoxicillin (90mg.kg/day)
or augmentin (90mg/kg.day
```
42
drug of choice for infective endocarditis prophylaxis before dental procedure
amoxicillin 2 grams x1 (30-60 min before procedure)
43
penicillin drug used in h pylori tx
amoxicillin
44
first line for sinus infections
augmentin
45
no renal dose required for what two penicillins
dicloxacillin and oxacillin
46
drug of choice for syphillis
penicllin g benzathine (bicillin LA)
| 2.4 million units IM
47
pip/taz infusions short or long
extended infusions (4 hours can be used to maximize t>mic
48
cephalosporins do not cover what two things
atypicals or enterococcus
49
first generation cephalosporin has excellent ___ coverage and are preferred when used for ____
gram positive
| MSSA
50
first gen cephs have limited gram neg. coverage what is it
PEK
51
second gen cephs cover
HENPEKS
52
third gen cephs cover
pseudomonas -ceftaz,cefepime,zerbaxa
| ceftriaxone and cefotaximine- cover more resis. strains of of strep
53
cefepime (4th gen) covers
broad gram neg. coverage (hnpek, capes, pseudomonas)
54
fifth gen ceph
ceftaroline (MRSA)
55
no ceftriaxone in ___
neonates (0-28 days)
56
1st gens to know
cefazolin
| cephalexin (keflex)
57
2nd gens to know
cefuroxime
cefotetan (cefotan)
cefoxitin
cefprozil
58
3rd gens to know
```
cefdinir
ceftriaxone
cefotaxime
cefixime
cefpodoxime
```
ceftazidime (fortaz)
ceftaz/avibactam (avycaz)
ceftolozane/tazobactam (zerbaxa)
59
4th gen to know
cefepime (maxipime)
| cefiderocol (fetroja)
60
5th gen to know
ceftaroline (teflaro)
61
no renal adjustment in what cephalosporin
ceftriaxone
62
cefotetan (2nd gen) can cause what type of reaction
disulfram with alcohol
63
if patient has a penicillin allergy on exam do not choose a ___
cephalosporin
| exception pediatric patient with AOM
64
2 furry tan foxes
2nd gen cephs
| +cefproxzil
65
cephalosporins have risk of ___
seizures
66
common use for keflex
```
skin infection (mssa)
strep throat
```
67
common use for cefuroxime (2nd gen)
AOM, CAP, sinus infection
68
common use for cefdinir (3rd gen)
CAP, sinus infection
69
common use for cefazolin (1st gen) inpatient
surgical prophylaxis
70
common use for cefotetan and cefoxitin in patient
anaerobic coverage:bacteroides fragilis
| surgical prophylaxis
71
common use for ceftriaxone and cefotaxime
cap, meningitis, spontaneous bacterial peritonitis, pylenonephritis
72
common use for ceftazidime (3rd gen) and cefipime (4th gen)
active against pseudomonas
73
common use for avycaz and zerbaxa (3rd gen)
MDR gram neg org. including pseudomonas
74
ceftarolone is used for
MRSA
75
carbapenems are all ___ only
IV
76
ertapenem does not cover ___
PEA
pseudomonas
acintobacter
enterococcus
77
carbapenems are very broad spectrum and generally reserved for MDR gram ___infections
negative
78
carbapenems are active against
most gram positive
negative (including esbl producing bacteria)
and anaerobes
no coverage of atypicals MRSA VRE
79
ertapenem dilute in __ only
NS
80
do carbapenems cover MRSA
no
81
do not use carbapenems in pts with what allergy
PCN
82
just like penicillin and cephalosporins, carbapenems have a __ risk because these are all beta lactams
seizure
83
common uses for carbapenems
polymicrobial infections- diabetic foot infections(moderate to severe)
empiric therapy when resistant organisms are suspected
resistant pseudomonas or acinetobacter infections (except ertapenem)
84
aztreonam is a what
monobactam
85
can aztreonam be used in a PCN allergy
yes, in fact it is primarily used when a beta lactam allergy is present
86
aztreonam covers many gram negatives including this special guy
pseudomonas
87
aztreonam has no coverage of what
anaerobes or gram positives
88
aztreonam is __ only
IV
| there is also an inhaled form for CF
89
aminoglycosides mainly cover
gram negatives including pseudomonas
90
aminoglycosides kill gram negatives fast and are synergistic with what
beta lactams
91
notable toxicities for aminoglycosides
oto and nephrotoxicity
92
aminoglycosides bigger dose ___ frequently protects the kidneys
less
93
aminoglycosides are
```
gentamicin
tobramycin
amikacin
streptomycin
plazomicin
```
94
trough level goal for gent abd tobra
less than 2
95
aminoglycosides warnings
use caution in impaired renal fxn
elderly
taking other nephrotoxic drugs: amphotericn B,
cisplatin, polymixins, cyclosporine, loops, nsaids, radiocontrast dye, tacrolimus, vancomycin
96
when to draw aminoglycoside levels
draw a trough right before or 30 min before the 4th dose
| draw a peak 30 min after the end of the infusion of the 4th dose
97
dosing for aminoglycosides
use actual weight if underweight
use actual or ideal for normal or overweight (follow protocol)
for obese must use adjusted bodyweight
98
gentamicin and tobramycin typical dose (traditional dosing)
1-2.5mg/kg dose
99
for aminoglycosides if crcl is 60 or greater give it every
8 hours for traditional dosing
100
quinolones inhibit ___ and ___
bacterial DNA topoisomerase IV and DNA gyrase
101
quinolones cover ___, ___ and finally ___
gram positive, negative and ATYPICALS
102
respiratory FQs
MGL
my good lungs
(enhanced coverage of strep pneumo and atypicals)
103
which two Fqs have enhanced gram neg. activity including activity against pseudomonas
cipro and levo
104
only FQ that cannot be used for UTIs
moxifloxacin
105
delafloxacin is approved for __ infections and has activity against __
skin infections MRSA
106
boxed warnings for FQs
tendon inflammation and rupture
peripheral neuropathy
seizures (CNS effects)
107
warnings with FQs
QT prolongation- highest risk with moxifloxacin
hypo or hyperglycemia
avoid systemic FQs in children and preg/breastfeeding due to musculoskeletal toxicity
photosensitivity/toxicity
108
do not put what fq through an NG tube
cipro oral suspension
109
cipro +dexamethasone ear drops called
ciprodex
110
levofloxacin brand name
levaquin
111
avelox generic
moxifloxacin
112
ocuflox eye drops generic
ofloxacin
113
avoid anything that can bind when taking a FQs including
```
antacids
polyvalent cations (magnesium, aluminium, calcium, iron, zinc)
multivitamins
sucralafate
bile acid resin
```
lanthanum carbonate (fosrenol)
sevelamer (renvela)
seperate by at least 2 hours before or 2-6 hours after
114
fqs can increase the effects of what blood thinner
warfarin
115
fq that is not renally adjusted
moxifloxacin
116
avoid FQs in __ and ___
children and pregnancy
117
counseling for FQs
avoid sun
seperate from cations
monitor BG if DM
118
Macrolides cover
atypicals (legionella, chlamydia, mycoplasma, mycobacterium)
| Haemophilus
119
macrolides are treatment options for
community acquired respiratory tract infections
| sexually transmitted diseases (chlamydia, gonorrhea)
120
macrolides include
azithromycin
clarithromycin
erythromycin
121
zpak dose
500 mg day 1
| 250 mg day 2-5
122
do not use lovastatin or simvastatin with what two macrolides
clarithromycin or erythromycin
azithromycin okay
123
warnings with macrolides
QT prolongation
| hepatotoxicity
124
clarithromycin has a warning with ___ , increased mortality
coronary artery disease
125
clarithromycin and erythromycin are __ and ___ of cyp3a4
substrates and inhbitors
126
QT prolonging drugs to avoid combo with FQs and Macrolides
azole antifungals, antipsychotics, methadone
127
common uses for macrolides
CAP
| alternative to beta lactam for strep throat
128
azithromycin can be used for what
```
COPD exacerbation
monotherapy for chlamydia
combo therapy for gonorrhea
prophylaxis for MAC
DOC for severe travelers diarrhea with dysentery
```
129
clarithromycin used for tx of
H. pylori
130
Erythromycin increases ___ ___ and is used for gastroparesis
gastric motility
131
zpak dosing
two 250mg pills once on day 1
| then 250mg daily x 4 days
132
macrolides bind to the ___s subunit
50
133
tetracyclines bind to the __s subunit
30
134
tetracyclines cover
gram positive
negative
atypicals!
other unique pathogens (spirochettes, rickettsiae, bacillus anthracis
135
doxycycline indications
```
CAP
tick borne/rickettsial diseases
chylamdia
gonorrhea
mild skin infections caused by MRSA
```
136
minocycline is preferred tx for
acne
137
doxycyline brand
vibramycin
138
minocycline brand
minocin
| solodyn
139
warning for tetracyclines who shouldnt take
children less than 8
| pregnancy and breastfeeding
140
tetracycline with DILE
minocycline
141
should you avoid sun with tetracyclines
yes
142
iv:po ratio for tetracyclines
1:1
143
avoid ___ products with tetracyclines
dairy
144
avoid anything that can bind with tetracylines
```
antacids
polyvalent cations (magnesium, aluminium, calcium, iron, zinc)
multivitamins
sucralafate
bile acid resin
```
lanthanum carbonate (fosrenol)
sevelamer (renvela)
seperate by at least 2 hours before or 2-6 hours after
145
sulfonamides inhibit the folic acid ___
pathway
146
bactrim covers
mssa and mrsa
| broad gram neg. coverage
147
what dose bactrim not cover
pseudomonas, enterococcus, atypicals, anaerobes
148
dose of bactrim is based on what component
TMP
149
single strength bactrim
400/80
| s/t
150
double strength bactrim
800/160
| s/t
151
uncomplicated UTI bactrim dose
1 double strength tablet twice a day for 3 days
800/160mg BID x 3 days
152
bactrim is CI in ___ ___
sulfa allergy
153
warnings with sulfameth
SJS/TEN, TTP (skin reactions)
| G6PD deficiency! -dont use if known deficiency and d/c if hemolysis occurs
154
bactrim SEs
photosensitivity
hemolytic anemia (coombs test)
increase potassium
crystalluria (take with full glass of water)!
155
bactrim big interaction with what drug
WARFARIN
| can cause a significant increase in INR
156
common used for bactrim
CA-MRSA skin infections
UTI
pneumocysitis pneumonia (PCP)
157
ratio of SMx/TMP
5:1
5 looks like an s
S also comes before T
single strength has 80 mg tmp
DS has 160 mg TMp
158
if patient is on WARFARIN consider different abx than ___
bactrim!
bactrim will increase the INR
also watch potassium with bactrim if taking other drugs that increase potassium
159
vancomycin inhibits
cell wall synthesis
160
vancomycin only covers gram
```
positive
MRSA
streptococci
enterocci
and
cdiff - oral route only for c diff
```
161
vancomycin dose and trough
15-20mg/kg based on total body weight! every 8 -12 h9ours
162
used what weight for vanc dosing
total body weight
163
first line for MRSA infections
vancomycin
164
consider an alternative MRSA drug when MRSA MIC for vanc is
2 or greater
165
for vancomycin if the crcl is 20-49 increase the dosing interval to
every 24 hours
166
vancomycin dose for c diff
PO only
| 125-500mg QID x 10 days (upper end for severe complicated disease)
167
vancomycin warnings
oto and nephrotoxic
| infusion related reactions: redman syndrome
168
redman syndrome with vancomycin how to avoid
do not infuse faster than 1 gram per hour
169
vancomycin trough for uti and skin infections
10-15
170
vanc. trough for serous mrsa infections (bacteremia, endocarditis, sepsis, pneumonia, osteomyelitis, meningitis)
15-20
171
nephrotoxicity increases with vanc. with use of other nephrotoxic drugs like
```
amphotericin b
cisplatin
polymixins
cyclosporine
tacrolimus
loops
NSAIDs
radiocontrast dye
```
172
lipoglycopeptides are what
-vancins
173
vancins are very similar to what
vancomycin
174
vancins are approved for what
skins and soft tissue infections including MRSA
175
vancins are CI with the use of IV
UFH
176
telavancin has a specific boxed warning for __ risk
fetal risk and nephrotoxicity
177
like vancomycin, vancins can cause this syndrome
red man syndrome (give over 60 minutes)
178
you cannot put daptomycin in ____
dextrose
179
daptomycin is ___ dependent and a __ inhibitor
concentration
| cell membrane
180
daptomycin activity
```
mostgram positive including MRSA
and enterococci (e faceleis and faecium)
```
181
daptomycin brand
cubucin
182
do not use daptomycin to treat
pneumonia, drug is inactivated by lung surfactant
183
unique side effect for daptomycin
increases CPK (muscle thing) might have muscle pain and weakness
think about how using with statins can increase muscle toxicity
184
daptomycin can only be put in
normal saline
185
warnings for daptomycin
myopathy and rhabdomyolysis
| can also falsely increase PT and INR
186
linezolid and tedizolid bind to the __ unit
50 s
187
linezolid and tedizolid have similar coverage to ___ but also cover VRE (e faecium and e faecalis)
vancomycin
| cover MRSA
188
linezolid brand name
zyvox
189
zyvox (linezolid) CI
do not use with or within 2 weeks of MAO inhbitors
190
linezolid iv to po
1:1
191
linezolid comes
iv po
192
avoid __foods with linezolid
tyramine
193
warnings with linezolid
duration related myleosupression (thrombocytopenia)
peripheral and optic neuropathy
serotonin syndrome
hypoglycemia
194
SEs with linezolid
can decrease platelets
195
do you shake linezolid suspension
no
196
brand name for quinpristin/dalfopristin
synercid
197
synercid (quinpristin/dalfopristin) binds to the __ subunit
50s
198
synercid use is limited bc its not well
| it is approved for complicated skin and soft tissue infections
```
tolerated
arthralgias/myalgias
infusion reactions
edema
hyperbilirubinemia
```
199
synercid does cover
gram positive bacteria including MRSA
| enterococcus including VRE but not e faecalis
200
synercid can only be diluted in
dextrose
201
tigecyline covers almost ___but
everything
| the 3 P's (pseudomonas, proteus, providencia)
202
why is tigecyclines use limited/ boxed warning
increased risk of death
203
tigecycline binds to the __subunit
30s
204
what color should the reconstituted tigecycline be
tangerine (yellow orange)
205
polymyxins boxed warning toxicity
nephrotoxicity! of course
but also neurotoxicity which can lead to respiratory paralysis
206
two drugs in the polymyxin class
```
colistimethate sodium (colistin)
polymyxin b sulfate
```
both injection
207
polymyxins cover gram negatives and due to the risks that they carry (neuro and nephrotoxicity) they are reserved for
MDR gram negative pathogens in combo with other abx
208
which abx can cause gray syndrome
chloramphenicol
209
clindamycin is a ___ that binds to the ___s subunit
lincosamide
| 50s
210
clindamycin what does it cover
anaerobes
| gram positives including MRSA
211
clindamycin brands
cleocin
topicals (cleocin t, clindagel)
212
clindamycin doesnt require what
renal dose adjustment
213
clindamycin boxed warning
colitis (c.diff)
214
major SE with clindamycin
GI (NVD)
215
d test used for what antibiotic
clindamycin
216
how is dtest used with clindamycin
should be performed on staph aureus that is susceptible to clindamycin but resistant to erythromycin
a flattened zone between the disks indicates inducible clindamycin resistance and clindamycin should not be used
217
common uses for clindamycin
purulent and nonpurulent skin infections
| beta lactam alternative for dental abscesses
218
metranidazole has activity against ___ and ___
anaerobes and protozoal infections
219
metronidazole is used for
```
bacterial vaginosis
trichomoniasis
giardiasis
amebiasis
c diff
combos for intra abdominal infections
```
220
brand for metronidazole
flagyl
221
iv to po metronidazole
1:1
222
metronidazole is CI in
pregnancy (1st trimester)
| use of alcohol during tx and 3 days after tx (disulfram rxn)
223
metronidazole and cefotetan have what in commmon
disulfram reaction
224
SE of metronidazole
metallic taste
225
fidaxomicin brand name
dificid
226
what is fidaxomicin used for
c diff (not effective for systemic infections)
227
metronidazole can increase the INR watch with ____
WARFARIN
just like bactrim
228
rifaximin is structurally related to what and covers what
rifampin
ecoli
229
notes about rifaximin (xifaxan)
not for systemic infections
| used off label for cdiff and tx of hepatic encephalopathy
230
rifaximin is used for
travelers diarrhea
decrease recurrence of hepatic encephalopathy (lactulose is first line)
irritable bowel syndrome w/ diarrhea (IBS-D)
231
urinary agents
fosfomycin
| nitrofuranitoin
232
fosfomycin use
```
single dose (3 grams po x 1 mixed in water)
female uncomplicated uti
```
233
macrobid used for
uncomplicated uti only
234
macrobid dose
100 mg bid x 5 days
235
macrobid CI
crcl <60
236
warnings with macrobid
hemolytic anemia
| caution in G6PD def.
237
macrobid SEs
GI upset take with food
| brown urine discoloration (harmless)
238
DOC for uncomplicated UTI is
macroBID (BID)
239
mupirocin (bactroban) is a topical used to eliminate ___
MRSA
240
doc MSSA
```
dicloxacillin
nafcillin
oxacillin
cefazolin,cephalexin
augmentin, unasyn
doxycyclin, minocycline
bactrim
```
241
CA-MRSA skin and soft tissue
bactrim
doxycycline/minocycline
clindamycin (d test first)
linezolid
242
severe SSTI requiring IV or hospital (cover mrsa and strep)
vancomycin (consider alt if mic 2 or greater)
linezolid, tedizolid
daptomycin
ceftaroline
others
-vancins
synercid
tigecycline
243
nosocomial MRSA
vancomycin
linezolid
daptomycin (not in pneumonia)
others:
rifampin (not alone)
telavancin
244
VRE (e. faecalis)
Pen G or ampicillin
linezolid
daptomycin
other tigecycline
245
VRE (e faecium)
linezolid
daptomycin
other
synercid
tigecycline
246
DOC pseudomonas
```
pip/taz
cefepime
ceftaz
ceftaz/avibactam (avycaz)
ceftolozane/tazobactam (zerbaxa)
carbapenems (except ertapenem)
cipro,levofloxacin
aztreonam
aminoglycosides
colisitmethate, polymyxin B
```
247
DOC acinetobacter
carbapenems (except ertapenem)
248
doc HNPEK
augmentin
249
DOC bacteroides fragilis
metronidazole
augmentin
cefotetan, cefoxitin
carbapenems
250
cdiff DOC
oral vanc
| fidaxomycin
251
atypicals DOC
azithromycin
doxycycline
FQs
252
drugs to fridge after reconstitution
penicillin vk
ampicillin
augmentin
cephalexin (keflex)
253
drugs to not fridge
```
CEFDINIR
azithromycin
clarithromycin
doxycycline
ciprofloxacin
etc
```
254
drugs that dont require renal dose adjustment
```
antistaphylococcal pcns
ceftriaxone
clindamycin
doxycycline
macrolides (azithromycin and erythromycin only)
metronidazole
moxifloxacin
linezolid
```
255
avoid calcium rich foods with ___
FQs
