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ID abx Flashcards

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1
Q

Gram +

A 
Staph
Strep
Listeria
Bacillus
Cornybacterium
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2
Q

Gram -

A 
E coli
Klebsiella
Proteus
Pseudomonas
Enterobacter
Haemophilus
Neisseria
Salmonella
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3
Q

Anarobes

A

Closteridium

Bacteroides

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4
Q

Bacterial cell wall target

A

beta-lactams

glycopeptides

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5
Q

Protein synthesis target

A 
aminoglycosides
tetracyclines
marcolides
clindamycin
oxazolidinones
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6
Q

cell membrane target

A

daptomycin

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7
Q

beta lactam drugs

A

PNC
cephalosporins
carbapenems
monobactams

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8
Q

Glycopeptide abx

A

vanco

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9
Q

beta-lactam MOA

A

inhibits transpeptidation, blocks crosslinking of peptidoglycan units

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10
Q

Penicillin G

A
  • Gram + and spirochetes
  • acid sensitive (no oral)
  • least toxic and expensive
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11
Q

Pen V

A
  • chemical modification of Pen G
  • Oral okay
  • covers mouth flora and strep throat
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12
Q

B-lactamase resistant pens

A
  • methicillin, nafcillin and OXACILLIN
  • active against MSSA
  • mostly used in cellulitis (strep)
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13
Q

Aminopenicillins

A
  • amoxicillin
  • augmentin
  • ampicillin
  • ampicillin-Sulbactam (Unasyn)
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14
Q

Amoxicillin

A
  • oral, tastes good (kids)

- otitis media and sinusitis

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15
Q

Augmentin

A
  • amox + clavulante
  • beta lactamse producing Moraxella and H. influ
  • used to tx failed otitis or sinusitis
  • clavulanate inhibits b-lactamase
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16
Q

ampicillin

A
  • IV only

- used for listeria and enterococcus

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17
Q

ampicillin-Sulbactam (Unasyn)

A

if worried about b-lactam producing bacteria

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18
Q

Carboxy/ureido PCN’s

A
  • extended spec
  • Ticarcillin-clavulante (Timentin)
  • Pipercillin-tazobacgtam (Zosyn)
  • covers Pseudomonas, bacteroides and enterobacter
  • Anaerobic (intra abd and gyno infx)
  • Can be used for life/limb threatening skin infx (gram + and -)
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19
Q

Which PNC is best for MSSA?

A

Oxacillin

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20
Q

Which PNC is best for a strep throat?

A

Amox +/- clav (if they don’t improve)

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21
Q

Which PNC is best for pseudomonas?

A

Pipercillin or Ticarcillin

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22
Q

Which PNC is best for enterococcus?

A

ampicillin

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23
Q

which PNC is best for intra-abd infx?

A

pipercillin, ticarcillin or ampicillin

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24
Q

Cephalosporin coverage

A
  • 1st, 2nd, 3rd and 4th
  • Each gen has expanded gram - spec
  • more gram - coverage
  • less gram + coverage (except for 4th)
  • MOA same as PNC
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25
1st gen cephalosporins
- Cefazolin (Ancef) IV and Cephalexin (Keflex) PO - covers mostly gram + cocci - surgical prophylaxis - MSSA (but not MRSA) - Streptococcus pyogenes (pharyngitis and cellulitis) - few gram (-) Ecoli, klebsiella, proteus
26
2nd gen cephalosporins
- Cefoxitin (mefoxin) and Cefaclor (Ceclor) - less gram + coverage - more so agasint H. flu, enterobacter, morazella, klebsiella, Neisseria, E coli, protus - increased anaerobic coverage (Mefoxin) e. g. intra-abd infx and PID - Think ABD and PELVIC infx
27
3rd gen cephalosporins
- Ceftriaxone (Rocephin) and Cefotaxime (Claforan) - less gram + but okay for strep - wider gram - spec: Neisseria, H influ, Moraxella, Shigella, Salmonella - Hospitalized CAP - Good CSF penetration - Meningitis tx
28
4th gen cephalosporins
- Cefepime (maxipime) - Nosocmial infx - good spec for gram - (adds psudomonas) - unlike others still maintains gram + (MSSA and strep) - Ideal for suppressed immune system
29
Carbapenems
- Imipenem (primaxin), meropenem (merrem), ertapenem (invanz). - MOA same as PNC - Broadest spec of B-lactams - gram +/- aerobes and anaerobes - good tissue penetration - B-lactamase resistance - Good for mixed aerobic/anaerboic and nosocmial infc - sepsis tx (critically ill)
29
Carbapenems
- Imipenem (primaxin), meropenem (merrem), ertapenem (invanz). - MOA same as PNC - Broadest spec of B-lactams - gram +/- aerobes and anaerobes - good tissue penetration - B-lactamase resistance - Good for mixed aerobic/anaerboic and nosocmial infc - sepsis tx (critically ill)
30
Monobactams
- Aztrenam (Azactam) - gram - only - anaerobes (spares some gut flora - Good empiric tx when combined with gram + abx - Good for pts w/ PNC allergies
30
Which cephalosporin or bactam is good for MSSA?
1st gen ceph (cefazolin/cephalexin)
30
Which cephalosporin or bactam is good for MSSA?
1st gen ceph (cefazolin/cephalexin)
31
Which cephalosporin or bactam is good for pseudomonas?
- carbapenems (imipenem/meropenem) | - 4th gen ceph
31
Tetracyclines
- Tetracycline, doxy, tigecycline - wide spec good against intracellular organisms (Rickettsia, Chlamydia, Lyme dz) and cell wall deficient organisms (Mycoplasma) - Bacteriostatic - discoloration of peds teeth
31
Monobactams
- Aztrenam (Azactam) - gram - only - anaerobes (spares some gut flora) - Good empiric tx when combined with gram + abx - Good for pts w/ PNC allergies
31
Which cephalosporin or bactam is good for UTIs?
hospitalized pt: 3rd gen ceph | outpatient: 1st gen ceph
31
Which cephalosporin or bactam is good for gram - only?
Aztreonam (Azactam)
31
Which cephalosporin or bactam is good for neutropenic fever?
4th gen ceph or Imipenem if they can't take that.
31
Which cephalosporin or bactam is good for sever PNC allergy?
Aztreonam (Azactam)
31
Which cephalosporin or bactam is good for sepsis?
Carbapenems (Imipenem/Meropenem)
31
Glycopeptide Abx MOA
inhibits transpeptidation like b-lactams but binds directly to Ala-Ala and blocks access of PBP's to these residues inhibiting peptidoglycan synthesis.
31
Vanco
- gram + only - reserved for drug resistant abx (MRSA, sensitive enterococcus, strep) - oral for C diff (after metronidazole tx failure)
31
Inhibitors of protein synthesis
Aminoglycosides, tetracyclines, marcolides, clindamycin, oxazolidinones.
31
Aminoglycosides
- Gentamicin and Tobramicin - Bactericidal against gram - - no activity against anaerobes - IV only - Toxicity (renal, CN VIII) - Concentration dependent and hard to dose - post abx effect (1-3 hrs) - synergy with b-lactams
31
Aminoglycosides active against...
- P. aeruginosa - Tularemia - Enterococci + beta lacta - Yersinia (plague)
31
Tigecycline
Good for drug resistant organisms MRSA, VRE Bacteroides and Clostridium (severe intra abd infx), severe skin infx.
31
MRSA 1st and 2nd line
Vanco | Tigecycline
31
Quinolones
- Cipro, Levofloxacin, Moifloxacin - Inhibits DNA replication - Blocks DNA gyrase and topoisomerase
34
Folate Inhibitors
- Sulfonamides and Trimethoprim (Bactrim) - Bacteria must synthesize folate for DNA - Humans can't make folate
38
Which abx is best for C diff?
- Metronidazole | - Vanco (2nd line after failed metro tx or severe case)
39
Which tx best for a UTI?
Cipro or Bactrim
40
Which tx best for VRE enterococcus?
(vanco resistant) | Daptomycin
41
Which best for atypical pneumonia?
3rd gen quinolones | macrolides
42
Which abx is a glycopeptide?
Vancomycin
43
Which is best for anaerobic infx?
Metronidazole
45
Which is best for gram - only infection?
aminoglycosides
50
Inhibitors of Nucleic acid synthesis
- Quinolones: ciprofloxacin, Levofloxacin, Moxifloxacin - Folate Inhibitors: Sulfonamides, Trimethoprin - Metronidazole
51
Quinolones
- Cipro, Levofloxacin, Moifloxacin - Inhibits DNA replication - Blocks DNA gyrase and topoisomerase
52
2nd gen Quinolones
-Cipro Expanded gram - coverage -tx for travelers diarrhea, UTI and prostatitis -Covers gram - such as H. influ, P. aeruginosa, E coli, Enterobacter, Proteus, Klebsiella, Shigella and Salmonella -Good Pseudomonas coverage -Poor MRSA, entercocci and pneumococci (gram +) coverage
54
Cell wall damage abx
- Daptomycin (Cubicin) - Depolarizes lipid cell membrane - Enterococci (VRE), MRSA, S. pyogenes - severe soft tissue infx - Not for pneumonia - Watch for rhabdo (CPK)
55
Sulfonamide + Trimethoprim
Bactrim. Blocks folate production at two different steps and prevents resistance. -Coverage for MRSA skin infx, streptococcus, Listeria, UTI's and PCP (PJP) prophylaxis/tx in AIDS pts
62
Which is best for MRSA?
Vanco
64
Which is best for MRSA?
1st line Vanco | 2nd line tigecycline
65
Cefazolin and Cephalexin treat...
cellulitis, pharyngitis and simple UTI
66
Cefoxitin and Cefaclor treat...
abd and pelvis infx
67
Ceftriaxone and Cefotaxime are
3rd gen cephs
68
Marcolides
- Erythromycin, Azithromycin and Clarithromycin | - Bacteriostatic
69
Erythromycin
- mostly gram + - similar to Pen V (strep and staph) - Good choice for PNC allergies
70
Azithromycin
- Enhanced gram - - Chlamydia and Mycoplasma - CAP, otitis, sinusitis - Strep resistance increasing
71
2nd gen Quinolones
- Ciprofloxacin - Expanded gram - such as H. influ, P. aeruginosa, E. coli, Enterobacter, proteus, Klebsiella, shigella, salmonella - Good pseudomonas coverage - poor MRSA, enterococci and pneumococci (poor gram + coverage) - Tx: travelers diarrhea, UTI, prostatitis.
72
Bactrim
- Folate inhibitor - Sulfonamide + Trimethoprim - Blocks folate at 2 different steps - Coverage for MRSA skin infx, Streptococcus, Listeria, UTI's and PCP prophylaxis/tx in AIDS pts
73
Metronidazole (Flagyl)
- Induction of DNA strand breaks - bacteria and protozoans - anaerobic only: C diff, bacterial vaginalis, Trichomonas vaginalis, giardia, amoeba
74
Daptomycin (Cubicin)
- cell wall damage - Enterococci (VRE), MRSA and S. pyogenes - severe soft tissue infx - NOT for pneumonia - watch for rhabdo (CPK)

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