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Infectious Disease Flashcards

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1
Q

Common drugs

MSSA

A
  1. Dicloxacillin, oxacillin, naficillin
  2. 1st gen cephs (cefazolin, cephalexin)
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2
Q

Common drugs

CA-MRSA SSTI

A
  1. Bactrim
  2. doxycycline
  3. clindamycin
  4. linezolid
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3
Q

Common drugs

VRE (E. faecalis)

A
  1. Pen G, ampicillin
  2. linezolid
  3. daptomycin
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4
Q

Common drugs

VRE (E. faecium)

A
  1. linezolid
  2. daptomycin
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5
Q

Common drugs

HNPEK

GNR (H. influenzae, Neisseria, Proteus, E.coli, Klebsiella)

A
  1. B-lactams/B-lactamase inhibitor (Avycaz, Zerbaxa)
  2. amoxicillin
  3. cephs (except 1st gen)
  4. carbapenems
  5. Bactrim
  6. AG
  7. FQ
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6
Q

Common drugs (DOC)

Atypicals

Legionella, Chlamydia, Mycoplasma, Mycobacterium tuberculosis

A
  1. macrolides (azithromycin, clarithromycin)
  2. doxycycline
  3. FQ
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7
Q

Common drugs

Pseudomonas

GNR

A
  1. Zosyn
  2. cefepime
  3. ceftazidime
  4. Avycaz, Zerbaxa
  5. carbapenem (except ertapenem)
  6. aztreonam
  7. cipro, levofloxacin
  8. AG
  9. colistimethate, polymyxin B
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8
Q

Common drugs

Acinetobacter baumannii

Gram (-) coccobacilli

A
  1. carbapenems (except ertapenem)
  2. Unasyn
  3. FQ
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9
Q

Common drugs

ESBL GNR

ES b-lactamase
E. coli, K. pneumoniae, Proteus mirabilis (PEK)

A
  1. carbapenems
  2. Avycaz, Zerbaxa
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10
Q

Common drugs

CRE GNR

A
  1. Avycaz
  2. colistimethate, polymyxin B
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11
Q

Common drugs

Bacteroides fragilis

aneaerobe

A
  1. metronidazole
  2. BL/B-lactamase inhib (Avycaz, Zerbaxa)
  3. cefotetan, cefoxitin (2nd gen cephs)
  4. carbapenem
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12
Q

Common drugs

Clostridium difficile

A
  1. Vancomycin (PO)
  2. Fidaxomicin (Dificid)
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13
Q

ABX - No renal dose adj

NOT CLeAReD

A
  1. naficillin
  2. oxacillin
  3. tigecycline
  4. clindamycin
  5. linezolid
  6. azithromycin (+ erythomycin)
  7. Rocephin (ceftriaxone)
  8. doxycycline
  9. metronidazole
  10. moxifloxacin
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14
Q

3rd ceph

ceftriaxone, cefotaxime

coverage AND DOC?

A
  1. MDR Strep. pneumoniae
  2. MDR HNPEK

DOC: sepsis, CAP, S. pneumoniae,

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15
Q

ceph/B-lactamase inhib combo

Avycaz, Zerbaxa

coverage?

A
  1. MDR Pseudomonas
  2. MDR GNR
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16
Q

Cephs

What do ALL cephs do not cover?

A
  1. Enterococci (E. faecalis, E. faecium)
  2. atypicals (Chlamydia, Mycobact…)
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17
Q

Cephs

Cephlasporins

Class effect?

A
  1. PCN allergy cross-sensitvity
  2. Seizure risk
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18
Q

Carbapenems

Carbapenems

Indication?

A
  1. Reserved for MDR GNR
  2. Pseudomonas
  3. ESBL grm (-)
  4. most grm (+)
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19
Q

Carbapenems

Carbapenem

Does not cover?

A
  1. atpicals
  2. MRSA
  3. VRE
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20
Q

Carbapenems

Ertapenem

Does not cover? (hint: PEA)

A
  1. Pseudomonas
  2. Enterococcus
  3. Acinetobacter
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21
Q

Carbapenem

Carbapenem

Class effect?

A
  1. CI: PCN allergy
  2. Seizure risks
  3. Monitor renal fxn
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22
Q

Monobactam

Aztreonam

Indication?

A

when b-lactam allergy is present

No cross-sensitvity to PCN

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23
Q

Monobactam

Aztreonam

Coverage?

A
  1. Many gm (-)
  2. Pseudomonas
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24
Q

Monobactam

Aztreonam

Does not cover?

A
  1. gm (+)
  2. anaerobes
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25
# Aminoglycosides Aminoglycosides | Coverage?
1. gm (-) 2. Pseudomonas 3. gm (+) WHEN USED FOR SYNERGY WITH b-lactam or vancomycin | Primarily used as EMPIRIC tx when in combo w/ other abx (not monotx)
26
# Aminoglycosides Aminoglycosides | BBW?
1. nephrotoxcity (caution: renal imp.) 2. ototoxicity 3. neuromuscular bloackade
27
# Aminoglycosides Aminoglycosides | Monitoring? based on dosing?
1. renal fxn 2. traditional dosing - draw trough right before/30 min prior to 4th dose, draw peak 30 min after the end of 30-min infusion for the 4th dose 3. extended-interval dosing - draw random level
28
# Fluoroquinolones Fluoroquinolones | Class effect? (BBW, SE, DDI) (note: SPRING)
1. **BBW** - tendon rupture, peripheral neuropathy, CNS effects (seizures, tremor, hallucinations, etc) 2. SE - skin (photosensitvity), prolong QT, increase C. diff risk, glycemia (hyper/hypo) 3. DDI - multivitamin (polyvalent cations), antiacids, lanthum, sevelamer, QT prolonging drugs (e.g. azole, macrolides)
29
# Fluoroquinolones What FQs cover Pseudomonas?
Cipro, levofloxacin
30
# Macrolides (-mycins) Macrolides | Coverage?
1. atypicals (Legionella, Chlamydia, Mycoplasma, Mycobacterium)
31
# Macrolides (-mycin) Macrolides | Tx indication?
1. CA-URTI, LRTI 2. Chlamydia (atypical)
32
# Macrolides (-mycin) Macrolides | DDI?
1. Clarithromycin, erythromycin (CYP3A4 inhib) - do not use with simvastatin and lovastatin 2. warfarin 3. QT prolonging drugs (azoles, FQ)
33
# Macrolides (-mycins) Macrolides | Class effect
1. QT prolongation 2. hepatoxicity (liver) 3. GI upset
34
# Tetracyclines Tetracyclines | Coverage?
1. gm (-) 2. atypicals (Legionella, Chlamydia, Mycobact...) 3. Rickettsiae/tick-bourne dz
35
# Tetracyclines Tetracyclines | Class effect?
1. Do not use in pregnancy, breastfeeding, or children <8 yo 2. SE: photosensitivity
36
# Tetracyclines Doxycycline | First-line?
1. Lyme disease 2. Rocky mountain spotted fever (tick-bourne) 3. CAP 4. COPD exacerbations 5. VRE UTI 6. Chlamydia
37
# Tetracyclines Tetracyclines | DDI
1. multivitamins, antiacids (polyvalent cations) 2. bismuth salicylate (Pepto-bismul) 3. bile acid resins
38
# Sulfonamides TMP/SMX | Class effect?
1. CI: sulfa allergy, pregnancy/breasfeeding 2. Warnings - skin rxns (SJS, TTP), G6PD def (hemolysis risk) 3. SE - inc K, photosensitvity, hemolytic anemia, crystalluria (take with 8 oz water)
39
# Sulfonamides TMP/SMX | Coverage
1. MRSA 2. CA-MRSA 3. HPEK 4. Shigella, Salmonella, Stenotrophomonas 5. opportunistic infections (Toxiplasmosis, Pneumocystitis (PJP))
40
# Sulfonamides TMP/SMX | Does not cover?
1. Pseudomonas 2. Enterococcu 3. atypicals 4. anaerobes
41
# Sulfonamides TMP/SMX | DDI
1. CYP2C9 inhibitor - warfarin (inc INR).. use alternative 2. Other meds that cause hyperkalemia
42
# Gm (+) abx; no gm (-) Vancomycin | Covers?
1. ONLY COVERS GM (+) 2. MRSA 3. C. diff (PO only)
43
# Gm (+) abx; no gm (-) Vancomycin | Class effect?
1. SE - redman syndrome (infusion rxn; no >1 g/hr), ototoxicity, nephrotoxicity
44
# Gm (+) abx; no gm (-) Vancomycin | Therapeutic drug levels?
1. AUC/MIC 400-600 2. Trough 15-20 (draw 30 min before 4th or 5th dose)
45
# Gm (+) abx; no gm (-) Daptomycin | Warnings?
1. **Inc CPK** - rhabdomyolysis, myopathy 2. False inc of PT/INR | Monitor CPK weekly
46
# Gm (+) abx; no gm (-) Daptomycin | Does not treat?
Pneumonia (inactivated by lung surfacants)
47
# Gm (+) abx; no gm (-) Daptomycin | Covers?
1. MRSA 2. VRE
48
# Gm (+) abx; no gm (-) Linezolid | Covers?
1. MRSA 2. VRE
49
# Gm (+) abx; no gm (-) Linezolid | Class effects?
1. CI - do not use within 2 weeks of MOA inhibitors 2. Warning - **myelosuppression** (thrombocytopenia, anemia, leukopenia), optic neuropathy, **serotonin syndrome**, hypoglycemia 3. SE - dec plts 4. Monitor CBC qweek
50
# Gm (+) abx; no gm (-) Clindamycin | Coverage?
1. most gm (+) 2. CA-MRSA 3. aneaerobes
51
# Gm (+) abx; no gm (-) Clindamycin | BBW?
CI - colitis (C. diff)
52
Metronidazole | Covers?
1. anaerobes 2. B. frag 3. protozoal organisms (bacterial vaginosis, trichomoniasis)
53
Metronidazole | Indication?
Used in combo for intra-abdominal infections
54
Metronidazole | Class effect?
1. CI - pregnancy (1st trimester), **alcohol** during treatment or within 3 days of d/c (disulfiram rxn) 2. SE - metallic taste
55
Metronidazole | Covers?
1. anaerobes
56
Community-acquired pneumonia (CAP) | Common pathogens?
1. S. pneumoniae 2. H. influezae 3. M. pneumoniae
57
Community-acquired pneumonia (CAP) | outpatient tx for healthy PTs
1. High-dose amoxicillin 2. Doxycycline 3. Macrolide | Usually PO meds
58
Community-acquired pneumonia (CAP) | outpatient tx for high-risk PTs
1. B-lactam (Augmentin OR ceph) + (macrolide OR doxycycline) 2. Respiratory FQ monotx (moxi, levofloxacin) | Usually PO meds
59
Community-acquired pneumonia (CAP) | inpatient tx in non-severe/general med unit PTs
1. B-lactam (Unasyn OR ceph) + (macrolide OR doxycycline) 2. Respiratory FQ monotx (moxi, levofloxacin) | Usually IV meds
60
Community-acquired pneumonia (CAP) | inpatient tx in severe/ICU PTs
1. B-lactam + macrolide 2. B-lactam + resp FQ | Usually IV meds; no FQ monotx
61
HAP/VAP | Definitions?
HAP - onset >48hrs after hospital admission VAP - onset >48 hours after start of mechanical ventilation
62
HAP/VAP | Common pathogens
1. S. aureus (+ MRSA) MDR GNR 2. Enterobacter 3. Pseudomonas 4. Acinetobacter 5. E. coli 6. Klebsiella
63
HAP/VAP | Tx in ALL pts
ALL PTs need abx for Pseudomonas AND MSSA E.g. 1. cefepime 2. Zosyn 3. cipro/levofloxacin
64
HAP/VAP | If at risk for MRSA?
ADD vancomycin (combo regimen)
65
HAP/VAP | If at risk for MDR GNR?
Need 2 abx for **Pseudomonas ** E.g. 1. **Zosyn + cipro/levo** + vanco 2. **Cefepime + gentamicin **+ linezolid | Typically MRSA risk is present as well
66
# DOC MSSA
Nafcillin/oxacillin
67
# DOC CA-MRSA
1. doxycycline 2. Bactrim
68
# DOC non-CA-MRSA
Vancomycin
69
# DOC Enterococcus
Ampicillin
70
# DOC ESBL
Carbapenems
71
Cephs that cover anaerobes/B. frag | TITANIC
1. Cefotetan 2. Cefoxitin | 2nd gen cephs

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