ID Take two (Part 1) Flashcards by Isabella Mccrory

Gram Positive Cocci

Clusters: Staphylococcus (MSSA, MRSA)

Pairs/Chains: Strep Pneumonia, Streptococcus, Enterococcus

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Gram Positive Rods

Listeria
Corynebacterium

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Gram Positive Anaerobes

Peptostreptococcus
Propionibacterium
C. diff
Clostridium

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Atypical Organisms

Chlamydia
Legionella
Mycobacterium TB
Mycoplasma Pneumonia

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Gram Negative Cocci

Neisseria

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Gram Negative Rods: Curved or Spiral

H pylori
Camplyobacter
Borrelia
Treponema

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Gram Negative Rods: Non Gut Colonizing

Pseudomonas aeruginosa
Haemophillus Influenza
Providencia

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Gram Negative Rods: Gut Colonizing

E.Coli
Proteus Mirabillis
Klebsiella
Serratio
Enterobacter Cloacae
Citrobacter

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Gram Negative Anaerobes

Bacteroids Fragillis
Prevotella

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Gram Negative Coccobacilli

Acinetobacter
Bordetella Pertussis
Moraxella

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name the four different antibiotic resistance types

Intrinsic - natural

Selection Pressure - removes the good

Acquired

Enzyme Inactivation
ESBL, CRE

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Common Resistant Pathogens

Kill Each And Every Strong Pathogen

K: Klebsiella
E: E.Coli
A: Acinetobacter
E: Enterococcus (VRE, CRE)
S: Staphylococcus
P: Pseudomonas aeruginosa

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sulfonamides MOA

Folic Acid Inhibitors

(sulfonamides have an S, A, I in name)

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Dapsone MOA

Folic Acid Inhibitors

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Trimethoprim MOA

Folic Acid Inhibitor

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Beta Lactams and Monobactams MOA

Cell Wall Inhibitors

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Vancomycin
Dalbavancin
Telvancin
Oritavancin

MOA

Cell Wall Inhibitors

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Protein Synthesis Inhibitors

AMG
Macrolides
Tetracyclines
Clindamycin
Linezolid
Quinupristin

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Metronidazole and Tinidazole MOA

DNA/RNA inhibitors

Quinolones MOA

DNA/RNA Inhibitors

Inhibit DNA topoisomerase IV and DNA Gyrase

Rifampin MOA

DNA/RNA inhibitor

Cell Membrane Inhibitors

Polymyxins
Daptomycin

Telavancin + Oritavancin = Also cell wall inhibitors

Natural PCN cover: Gram Positive (Streptococcus, Enterococcus)

What Agents are those?

PCN VK (tab/susp)
PCN G Aqueous - IV

PCN G Benzathione (Bicillin LA)

  IM!!!!! IV has BBW for Cardio tox

Antistaphylococcal PCN Cover: Streptococcus and MSSA

They have NO RENAL ADJUSTMENTS

WHAT AGENTS ARE THOSE?

Dicloxacillin
Oxacillin

Nafacillin
- IV Vesicant: Need cold compress and Hyaluronidase

AminoPCN cover: Streptococcus, Enterococcus, And Postive Anaerobes WHEN paired with BLI: MSSA, Gram Negatives (HNPEK), and Gram negative anaerobes WHAT AGENTS ARE THOSE?

Amoxicillin --> Augmenting (14:1) Ampicillin --> Unasyn PO has ass bioA CI: history of cholestatic jaundice or hepatic dysfunction CrCl < 30 = NO ER Formulation or 875 mg of Augmentin Ampicillin requires NS for dilution

Extended Spectrum PCN cover: Streptococcus, Enterococcus, Mouth Flora, Gram Neg (HNPEK), Gram Neg Anaerobes, CAPES (gram negatives), Pseudomonas!!! WHAT AGENTS?

Zosyn (pipperacillin/tazobactam)

As a class, PCN have what SE and what DDI?

Seizures that occur with accumulation, GI uses, diarrhea, rash, hemolytic anemia Probenecid = Increase BL Levels

1st Generation Cephalosporins: Gram + (Preferred agent for MSSA if a cephalosporin is used), Gram - (PEK) WHAT AGENTS

Cefazolin Cephalexin (Keflex): 250 - 500 mg Q6-12H Cefadroxil Common uses: MSSA and Strep

2nd Generation Cephalosporins: Streptococcus Pneumonia, HNPEK Cefotetan + Cefoxitin have additive effects with Anaerobes (B.frag) NAME THE AGENTS

Cefuroxime Cefotetan (Cefotan) Cefactor, Cefoxitin, Cefprozil

Cefotetan Has What Side Chain?

NMTT or 1-MTT and increased bleeding and can cause disulfiram like rxn with EtOH

3rd Gen Group 1 cephalosporins: Streptococci, MSSA, HNPEK, Gram + Anaerobes WHAT AGENTS ARE THESE?

Cefdinir Cefotaxime Ceftriaxone - No renal Adjustments, CI hyperbilirubinemia, in neonates do not use with Ca containing products if <28 d old. Precipitates form Cefditonen, Cefixime (Suprax), Cefpodoxime, Ceftibuten

3rd Generation Group 2 Cephalosporins: Lack gram positive activity but covers PSEUDOMONAS WHAT AGENTS ARE THESE?

Ceftazidime - Fortaz + Avibactam = Avycaz (Some CRE activity)

4th generation Cephalosporins: Broad Gram "-" coverage (HNPEK, CAPS, Pseudomonas) WHAT AGENTS

Cefepime

5th Generation Cephalosporin: HNPEK, MRSA, Broad Gram + Coverage What agents???

Ceftaroline (teflaro)

Other than Avycaz what other Cephalosporin has a BL-I added to it?

Ceftolozane/Tazobactam (Zerbaxa) Similar to gen 3 group 2 + MDR Pseudomonas, MDR gram "-" rods

Hydrophilic Agents! -Small Vd - Renal Elimination - Low Intracellular Conc - increased Cl +/- distribution in sepsis - Poor BioA What agents!!!

BL AMG Vanco Dapto Polymyxins

Lipophilic Agents! - Large Vd - Hepatic Metabolism - good with atypical - CL +/- distribution minimally changes in sepsis - IV: Po is usually 1:1 What agents!!!

Quinolones Macrolides Tetracyclines Rifampin Linezolid

Cmax: MIC (Conc. Dependent)

AMG Quinolones Daptomycin (large doses with long intervals)

AUC: MIC (exposure dependent)

Vancomycin, Macrolides, Tetracyclines, Polymyxins

Time > MIC (time dependent)

Beta Lactams

Carbapenems - reserved for MDR Gram Negative agents (ESBL, No coverage with MRSA, VRE, Atypical No PCN allergies! Accumulation leads to seizure + confusion DRESS Decrease VPA

Doripenem Imipenem/Cilastatin Meropenem!!! ErtAPenem (INVANZ) PEA: no pseudomonas, enterococcus, acinetobacter Stable in NS ONLY Imipenem has the highest seizure risk

Monobactams - Aztreonam

Used when BL allergy is present Many gram "-" (Pseudomonas) NO GRAM POSITIVE or anaerobic activity PEK HNPEK CAPES Pseudomonas

Aminoglycosides (Cover gram "--" pseudomonas included ) Extended interval OVERVIEW

uses higher doses to attain higher peaks and gives less accumulation, less nephrotoxin risk, more cost effective 4-7 mg/kg/dose, frequency is determines by a monogram (gentamicin, tobramycin, amikacin)

Aminoglycosides (Cover gram "--" pseudomonas included) Traditional Dosing

IBW! if overweight then use AjBW, If underweight use TBW obtain peak and trough in regards to 4th dosing Gentamycin and Tobramycin 1-2.5 mg/kg/dose Trough: <2 mcg/mL, Synergy < 1mcg/mL

BBW with aminoglycosides

Nephro and Ototoxicity, Neuromuscular blockade + respiratory paralysis should be avoided CAUTION in elderly, renal impaired, other nephrotoxic drugs

Quinolones - atypical coverage - concentration dependent

Levofloxacin, Moxifloxacin, Gemifloxacin = Respiratory (S.Pneu) Ciprofloxacin and Levofloxacin = Pseudomonas Delafloxacillin = MRSA (SSTI) Moxi = No renal adjustments

Quinolones BBW / SE / DDI

BBW: tendon inflammation or rupture, peripheral neuropathy, CNS effects (seizures) QT prolonging (moxi highest), Hypoglycemia/Hyperglycemia Avoid in pregnancy/lactation, Kids Can cause Photsensitivity DDI: antacids + other polyvalent, Lanthanum, Renvela by at least 2 hours Cipro 1A2 inhibitors = increase theophylline levels