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Infectious Disease > Infectious Disease Part 1: Background and Antibiotics by Drug Class > Flashcards

Infectious Disease Part 1: Background and Antibiotics by Drug Class Flashcards

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1
Q

Describe Gram-Positive Stain

A
  1. Appears dark purple
  2. Thick cell wall
  3. Crystal violet stain
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2
Q

Describe Gram-Negative Stain

A
  1. Appears pink
  2. Thin cell wall
  3. Safranin counterstain
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3
Q

If a patient has a gram stain that’s described as being Gram-Positive cocci clusters, what could be the possible species?

A
  1. Staphylococcus spp.

including MRSA, and MSSA

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4
Q

If a patient has a gram stain that’s described as being Gram-Positive cocci pairs & chains, what could be the possible species?

A
  1. Strep. Pneumoniae (diplococci)
  2. Streptococcus spp. (including strep pyogenes)
  3. Enterococcus spp. (including VRE)
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5
Q

If a patient has a gram stain that’s described as being Gram-Positive Rods, what could be the possible species?

A
  1. Listeria Monocytogenes
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6
Q

If a patient has a gram stain that’s described as being Gram-Positive Anaerobes, what could be the possible species?

A
  1. Peptostreptococcus
  2. Actinomyces spp.
  3. Clostridium spp.
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7
Q

If a patient has a gram stain that’s described as being Gram-Negative cocci, what could be the possible species?

A
  1. Neisseria spp.
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8
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that colonize gut “enteric”, what could be the possible species?

A
  1. Proteus Mirabilis
  2. E. Coli
  3. Klebsiella spp.
  4. Serratia spp.
  5. Enterobacter cloacae
  6. Citrobacter spp.
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9
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that DO NOT colonize gut, what could be the possible species?

A
  1. Pseudomonas Aerigunosa
  2. Haemophilus Infuenzae
  3. Providencia spp.
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10
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that are curved or spiral shaped, what could be the possible species?

A
  1. H. pylori, Campylobacter spp., Treponema spp.,

2. Borrelia spp., Leptospira spp.

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11
Q

If a patient has a gram stain that’s described as being Gram-Negative Coccobacilli, what could be the possible species?

A
  1. Acinetobacter Baumannii
  2. Bordetella Pertussis
  3. Moraxella Catarrhalis
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12
Q

If a patient has a gram stain that’s described as being Gram-Negative Anaerobes, what could be the possible species?

A
  1. Bacteroides fragilis

2. Prevotella spp.

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13
Q

What are some common resistant pathogens?

A

Hint: Kill Each and Every Strong Pathogen

  1. Klebsiella pneumoniae (ESBL,CRE)
  2. E.Coli ( ESBL,CRE)
  3. Acinetobacter baumannii
  4. Enterococcus Faecalis/Faecium (VRE)
  5. Staphylococcus areus (MRSA)
  6. Pseudomonas aeruginosa
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14
Q

What happens with C. diff infections?

A
  • Healthy GI flora is attacked by the antibiotic

- Overgrowth of resistant pathogens

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15
Q

What are the symptoms for C.diff infection?

A
  1. abdominal cramping
  2. Colitis
  3. diarrhea
    * symptoms can be fatal*
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16
Q

All antibiotics can cause C.diff infections. Which antibiotic has a BBW for it?

A

Clindamycin (Cleocin)

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17
Q

Which ABX are DNA/RNA inhibitors?

A

Hint: Quin Met Tiny Rapid

  1. Quinolones (DNA gyrase, topoisomerase IV)
  2. Metronidazole (Flagyl)
    Tinidazole (Tindamax)
  3. Rifampin
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18
Q

Which ABX are Cell Membrane inhibitors?

A

Hint: P - DOT

  1. Polymyxin (colistimethate)
  2. Daptomycin (Cubicin)
  3. Telavancin (Vibativ)
  4. Oritavancin (Orbactiv)
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19
Q

Which ABX are Protein Synthesis inhibitors?

A

Hint: CQ- MALT

  1. Clindamycin (Cleocin)
  2. Quinupristin/Dalfopristin
  3. Macrolides
  4. Aminoglycosides
  5. Linezolid, Tedizolid (Sivextro)
  6. Tetracyclines
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20
Q

Which ABX are Cell Wall inhibitors?

A

Hint: BMV

  1. Beta lactams (penicillins, cephalosporins, carbapenems)
  2. Monobactams (aztreonam)
  3. Vancomycin, dalbavancin (Dalvance), telavancin, oritavancin
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21
Q

Which ABX are Folic Acid Synthesis Inhibitors?

A

Hint: STD

  1. Sulfonamides
  2. Trimethoprim*
  3. Dapsone (Aczone)
    * Often combined with SMX to overcome resistance
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22
Q

Hydrophilic Agents Characteristics

A
  1. Small VD
  2. Renal elimination
  3. Low intracellular concentrations
  4. Increased clearance in sepsis
  5. Poor-moderate bioavailability
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23
Q

What are the hydrophilic agents?

A

Hint: BAG-PD

  1. Beta lactams
  2. Aminoglycosides
  3. Glycopeptides
  4. Daptomycin
  5. Polymixins
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24
Q

sLipophilic Agents Characteristic

A
  1. Large Vd
  2. Hepatic metabolism
  3. Achieve intracellular concentrations
  4. Clearance changed minimally in sepsis
  5. Excellent bioavailability
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25
What are the Lipophilic Agents?
Hint: Quin Made Really Light Chicken Tacos 1. Quinolones 2. Macrolides 3. Rifampin 4. Linezolid 5. Chloramphenicol 6. Tetracycline
26
BETA-LACTAM ABX: PENICILLINS Natural Penicillins 1. What are they? 2. What do they cover?
1. Penicillin G | 2. Covers Gram-Positive cocci, Gram-Positive anaerobes
27
BETA-LACTAM ABX: PENICILLINS Aminopenicillins 1. What are they? 2. What do they cover?
1. Amoxicillin, Ampicillin | 2. Adds Gram-negative coverage (HNPEK)
28
BETA-LACTAM ABX: PENICILLINS Aminopenicillins + Beta-Lactamase Inhibitor 1. What are they? 2. What do they cover?
1. Amoxicillin/Clavulanate, ampicillin/sulbactam | 2. Adds MSSA, more resistant strains of HNPEK, Gram-negative anaerobes (B. fragilis)
29
BETA-LACTAM ABX: PENICILLINS Extended Spectrum + Beta Lactamase Inhibitor 1. What are they? 2. What do they cover?
1. Piperacillin/tazobactam | 2. Adds CAPES, Pseudomonas
30
BETA-LACTAM ABX: PENICILLINS Antistaphylococcal 1. What are they? 2. What do they cover?
1. Nafcillin, Oxacillin | 2. Covers MSSA and Streptococci ONLY
31
BETA-LACTAM ABX: PENICILLINS Class Trend?
1. They all cover enterococcus (accept antistaphylococcal PCNs) 2. Do not cover atypicals or MRSA
32
SELECT PENICILLINS (DRUG TABLE) Natural Penicillins 1. PO: 2. IV: 3: IM:
1. PO: Penicillin V Potassium 2. IV: Penicillin G Aqueous 3: IM: Penicillin G Benzathine (Bicillin L-A)
33
SELECT PENICILLINS (DRUG TABLE) Aminopenicillins 1. PO: 2. IV:
1. PO: Amoxicillin (Moxatag) | 2. IV: Ampicillin
34
SELECT PENICILLINS (DRUG TABLE) Aminopenicillins + Beta-Lactamase Inhibitor 1. PO: 2. IV:
1. PO: Amoxicillin/Clavulanate (Augmentin) | 2. IV: Ampicillin/Sulbactam (Unasyn)
35
SELECT PENICILLINS (DRUG TABLE) Extended Spectrum + Beta Lactamase Inhibitor 1. IV:
1. IV: Piperacillin/Tazobactam (Zosyn)
36
SELECT PENICILLINS (DRUG TABLE) Antistaphylococcal 1. PO: 2. IV:
1. PO: Dicloxacillin | 2. IV: Nafcillin, Oxacillin
37
PENICILLINS Class effects?
1. Beta-Lactam allergy 2. Risk of seizures 🚨 If patient has either of these avoid PCNs 🚨
38
PENICILLINS Penicillin VK Outpatient Oral indications?
1. Strep throat | 2. Mild skin infections
39
PENICILLINS Amoxicillin (Moxatag) Outpatient Oral indications?
1. Acute Otitis Media (90 mg/kg/day) 2. Infective endocarditis prophylaxis 3. H. pylori
40
PENICILLINS Amoxicillin/Clavulanate (Augmentin) Outpatient Oral indications?
1. Acute Otitis Media (90 mg/kg/day) | 2. Lowest dose of clavulanate
41
PENICILLINS Penicillin G Benzathine (Bicillin L-A) Inpatient Oral indications?
1. Syphilis 2. Never use IV ** IM only**
42
PENICILLINS Piperacillin/Tazobactam (Zosyn) Inpatient Oral indications?
1. Only penicillin active against Pseudomonas | 2. Extended-infusion common
43
PENICILLINS Nafcillin, Oxacillin, Dicloxacillin Inpatient Oral indications?
1. MSSA and streptococcus (MRSA) | 2. **No renal adjustment needed**
44
CEPHALOSPORINS 1st Generation 1. IV: 2. PO: 3. Coverage:
1. IV: Cefazolin 2. PO: Cephalexin (Keflex) 3. Coverage: Staphylococci, Streptococci, PEK, mouth anaerobes
45
CEPHALOSPORINS 2nd Generation 1. IV/IM/PO: 2. Coverage:
1. IV/IM/PO: Cefuroxime (Ceftin) 2. Coverage: - Better Gram-negative activity (HNPEK) - Cefotetan and Cefoxitin have anaerobic activity (B. fragilis)
46
CEPHALOSPORINS 3rd Generation Group 1: 1. IV: 2. PO: 3. Coverage: Group 2: 1. IV: 2. Coverage:
GROUP 1: 1. IV: Ceftriaxone 2. PO: Cefdinir 3. Coverage: Less Staphylococci coverage, but better Streptococci coverage GROUP 2: 1. IV: Ceftazidime, Ceftazidime/Avibactam 2. Coverage: Pseudomonas
47
CEPHALOSPORINS 4th Generation 1. IV: 2. Coverage:
1. IV: Cefepime | 2. Coverage: Broad-spectrum: Gram-positives, HNPEK, CAPES, *Pseudomonas*
48
CEPHALOSPORINS 5th Generation 1. IV: 2. Coverage:
1. IV: Ceftaroline (Teflaro) | 2. Coverage: Similar to ceftriaxone but with MRSA coverage
49
CEPHALOSPORINS Class trends?
1. No Enterococcus coverage | 2. Do not cover atypicals
50
CEPHALOSPORINS Class Effects?
1. Beta-Lactam allergy 2. Risk of seizures 🚨 If patient has either of these avoid PCNs 🚨
51
CEPHALOSPORINS Outpatient (Oral) 1st Generation: Cephalexin Indications?
1. Strep throat | 2. MSSA skin infections
52
CEPHALOSPORINS Outpatient (Oral) 2nd Generation: Cefuroxime Indications?
1. Acute Otitis Media 2. CAP 3. Sinus Infections
53
CEPHALOSPORINS Outpatient (Oral) 3rd Generation: Cefdinir Indications?
1. CAP | 2. Sinus Infection
54
CEPHALOSPORINS Inpatient (Parenteral) 1st Generation: Cefazolin Indications?
1. Surgical Prophylaxis
55
CEPHALOSPORINS Inpatient (Parenteral) 2nd Generation: Cefotetan, Cefoxitin Indications?
1. Surgical Prophylaxis (GI Procedures) | 2. Cefotetan: Disulfram-like reactions
56
CEPHALOSPORINS Inpatient (Parenteral) 3rd Generation: Ceftriaxone and Cefotaxime
1. CAP 2. Meningitis 3. SBP 4. Pyelonephritis **Ceftriaxone**: no renal dose adjustment, 🚨 DO NOT USE IN NEONATES🚨
57
CEPHALOSPORINS Inpatient (Parenteral) 5th Generation: Ceftaroline Coverage?
1. MRSA
58
CARBAPANEMS Class Effects?
1. ESBL-producing organisms 2. Pseudomonas (except Ertapenem) 3. Beta-lactam allergy and seizures 4. All IV **(NS only for ertapenem)**
59
CARBAPANEMS What do they NOT cover?
1. Atypicals 2. VRE 3. MRSA 4. *ErtAPenem does not cover PEA
60
CARBAPANEMS What are the common uses?
1. Polymicrobial Infections | 2. Empiric treatment when MDR pathogens suspected
61
MONOBACTAMS Aztreonam 1. Formulation? 2. Who can use it? 3. Coverage?
1. IV ONLY 2. Can be used in pts with beta-lactam allergy 3. Gram-negative coverage, including Pseudomonas
62
AMINOGLYCOSIDES Coverage?
1. Gram-negatives, including Pseudomonas | 2. Synergy for Gram positives (Staphylococci/Enterococci)
63
AMINOGLYCOSIDES Dosing 1. Traditional? 2. Extended Interval?
1. Traditional: 1 - 2.5 mg/kg IV Q8H | 2. Extended Interval: 4 -7 mg/kg IV Q24H
64
AMINOGLYCOSIDES Dosing 1. What is monitored for traditional dosing? 2. What is monitored for extended interval dosing?
1. Peaks and troughs | 2. Draw a random level and use nomogram
65
AMINOGLYCOSIDES What needs to be monitored?
1. Renal Function | 2. Serum Levels
66
AMINOGLYCOSIDES Good News?
Kill Gram-negative, synergistic with beta-lactams for Gram-positive infections, low resistance and cost
67
AMINOGLYCOSIDES Bad News?
Toxicities: renal damage and ototoxicity
68
AMINIGLYCOSIDES Smart Idea when using them?
Concentration-dependent killing ➡ give larger doses less frequently (extended - interval dosing) ➡ allow the kidneys to recover
69
AMINOGLYCOSIDES Traditional Dosing: Target Drug 1. When should the Trough be drawn? 2. When should the Peak be drawn?
1. 30 min before 4th dose | 2. 30 min after the end of 4th dose infusion
70
AMINOGLYCISIDES Gentamicin/Tobramycin 1. Peak? 2. Trough?
1. 5-10 mcg/mL | 2. <2 mcg/mL
71
QUINILONES Are they concentration-dependent killing?
Yes
72
QUINOLONES Boxed Warnings?
1. Tendon Rupture 2. Peripheral Neuropathy 3. CNS effects (including seizures) 4. Use last-line (only if no alternatives)
73
QUINOLONES Warnings?
1. QT Prolongations 2. Hypo and Hyperglycemia 3. Psychiatric disturbances 4. Photosensitivity 5. Avoid use in children (risk vs. benefit)
74
QUINOLONES Interactions?
1. Chelation with divalent cations (Fe2+, Ca2+,Mg2+)
75
QUINOLONES Respiratory Quionolones 1. Coverage 2. What are they?
1. active against S. pneumoniae 2. Hint: My Good Lungs - Levofloxacin - Gemifloxacin - Moxifloxacin (IV:PO=1:1, not renally adjusted, 🚨do not use for UTIs🚨)
76
QUINOLONES Antipseudomonal Quinolones 1. What are they? 2. Indications?
1. - Levofloxacin (IV:PO=1:1) - Ciprofloxacin 2. - Pseudomonas infections - UTI - Intra-abdominal infections - Traveler's diarrhea
77
QUINOLONES Profile Review Tips?
1. Caution in patients with CVD, ⬇K/Mg, use of other QT-prolonging drugs 2. Avoid if seizure history or using an antiepileptic drug 3. Avoid in children 4. Watch for tendon rupture, neuropathy, CNS/psychiatric side effects
78
MACROLIDES Agents in class?
1. Azithromycin (Zithromax) 2. Clarithromycin (Biaxin) 3. Erythromycin (E.E.S)
79
MACROLIDES Coverage?
1. Atypical pathogens (Legionella, Chlamydia, Mycoplasma, Mycobacterium avium) 2. H. influenzae 3. S. pneumoniae
80
MACROLIDES Common Uses?
1. CAP | 2. Strep throat
81
MACROLIDES Azithromycin Indications?
1. COPD exacerbations 2. Chlamydia 3. Gonorrhea 4. MAC prophylaxis
82
MACROLIDES Clarithromycin Indications?
1. H. Pylori
83
MACROLIDES Erythromycin Indications?
1. increase gastric motility
84
MACROLIDES Azithromycin Dosing (Z-Pak)
500 mg (two 250 mg tabs) on day 1, then 250 mg daily x 4 days
85
MACROLIDES Safety Issues 1. QT prolongation: 2. Drug interactions:
1. QT prolongation: caution with CVD, ⬇ K/Mg, use of other QT-prolonging drugs 2. Clarithromycin/erythromycin contraindicated with simvastatin/lovastatin
86
TETRACYCLINES Agents in class?
1. Doxycycline (Vibramycin) 2. Minocycline (Minocin, Solodyn) 3. Tetracycline
87
TETRACYCLINES Coverage?
1. S. aureus (including CA-MRSA) 2. H. influenzae, Moraxella, atypiclas +/- S. pneumo 3. Rickettsiae 4. H. pylori 5. VRE
88
TETRACYCLINES Common Uses:
1. CA-MRSA skin infections | 2. Acne
89
TETRACYCLINES Doxycycline Indications:
1. Tick-borne infections 2. CAP 3. COPD exacerbations 4. sinusitis 5. VRE 6. UTI 7. Chlamydia 8. Gonorrhea
90
TETRACYCLINES Tetracycline Indications:
1. H. pylori treatment
91
TETRACYCLINES Safety Issues
1. Avoid use in children age < 8 years, pregnancy and breastfeeding 2. Photosensitivity 3. Interaction with divalent cations 4. IV:PO = 1:1 5. Minocycline: DILE
92
SULFONAMIDES 1. What is dose based on? 2. Dose for Uncomplicated UTI?
1. Dose based on TMP | 2. 1 DS tablet PO BID x 3 days
93
SULFONAMIDES Contraindications?
Do not use if sulfa allergy, pregnant or breastfeeding
94
SULFONAMIDES Warnings:
1. Skin reactions (including SJS/TEN) | 2. G6PD deficiency
95
SULFONAMIDES Side effects?
1. Photosensitivity 2. ⬆ K 3. Hemolytic anemia (positive Coombs test) 4. Crystalluria
96
SULFONAMIDES SMX/TMP (oral) Common Uses
1. Ca-MRSA infections 2. UTI 3. Pneumocystis pneumonia
97
SULFONAMIDES SMX/TMP (oral) 5: 1 Ratio SMX/TMP 1. SS tablet = 2. DS tablet =
1. SS tablet = 80 mg TMP | 2. DS tablet = 160 mg TMP
98
SULFONAMIDES SMX/TMP (oral) Sulfa Allergy reactions?
1. Rash/Hives common | 2. Can cause severe SJS reactions (SJS/TEN)
99
SULFONAMIDES SMX/TMP (oral) What happens when used with warfarin?
⬆ INR
100
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin Coverage?
1. Gram-positives (MRSA) 2. Streptococci 3. Enterococci 4. C. difficile (PO only)
101
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin Dosing?
IV: 15-20 mg/kg Q8-12H, using TBW **Dose/interval adjustment in renal failure**
102
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin Monitoring?
1. Scr and avoid other nephrotic or ototoxic drugs | e. g., furosemide, aminoglycosides, cisplatin
103
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin Indications?
1st line for MRSA infections | e.g., pneumonia, meningitis, bacteremia, some skin infections
104
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin target trough for severe infections?
15 - 20 mcg/mL
105
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin What can occur with rapid infusion?
1. Red man syndrome
106
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS Vancomycin PO indication?
Only for C. difficile infections - 125 mg QID x 10 days
107
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS What toxicity can Vancomycin cause?
1. Ototoxicity | 2. Nephrotoxicity
108
ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS If the MIC for vancomycin is >2 what happens?
You do NOT use the vancomycin
109
LIPOGLYCOPEPTIDES What are the agents?
1. Telavancin 2. Oritavancin 3. Dalbavancin
110
LIPOGLYCOPEPTIDES Coverage?
similar to IV vancomycin
111
LIPOGLYCOPEPTIDES Indications?
1. Approved for skin infections | 2. Televancin approved for HAP/VAP
112
LIPOGLYCOPEPTIDES What can they all cause?
Redman syndrome
113
LIPOGLYCOPEPTIDES Which ones are single-dose regimens?
1. Oritavancin | 2. Dalbavancin
114
LIPOGLYCOPEPTIDES Boxed Warnings?
1. Fetal risk 2. Nephrotoxicity 3. ⬆ mortality compared to vancomycin in pneumonia trials (patients with CrCl = 50 mL/min)
115
LIPOGLYCOPEPTIDES Contraindications 1. Televancin: 2. Oritavancin:
1. concurrent use of IV UFH | 2. use of IV UFH for 5 days after
116
LIPOGLYCOPEPTIDES Warnings 1. Televancin: 2. Oritavancin:
1. falsely ⬆ aPPT/PT/INR | 2. ⬆ PT/INR (up to 12 hours) and ⬆ aPTT (up to 120 hours)

Infectious Disease (1 decks)

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