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Therapeutics 3 > Intro to ID > Flashcards

Intro to ID Flashcards

1
Q

S. pneumoniae

A

GRAM + Cocci, pair
Aerobic
Community Acquired pneumonia, meningitis, sinusitis, and bacteremia

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2
Q

Group A Strep (GAS)

S. Pyogenes

A

GRAM+ Cocci, chain
Aerobic
Skin/soft tissue infections (SSTI), Upper Respiratory Infection (URI)

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3
Q

Staph aureus (including MRSA)

A

GRAM+ Cocci, cluster
Aerobic
SSTI, bacteremia/line infections, pneumonia, endocarditis, osteomyelitis
MRSA is a rising problem
Typical skin flora, but commonly associated with sepsis and line infections in hospital due to improper sterilization of line site.
Treat bacteremia for 14 days
B-lactams are not reliable empiric therapy for MRSA. Vanco usually first line
MSSA - use B-lactams over vanco

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4
Q

Enterococcus

faecalis or faecium

A 
GRAM+ Cocci
faecalis = single, pair, or chain
faecium = pair or chain
Aerobic
UTI, intra-abdominal infections, and endocarditis
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5
Q

S. epidermidis

Coagulase-negative Staph

A

GRAM+ cocci, cluster
Aerobic
Typically not pathogenic

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6
Q

Nesseria

A

GRAM- Cocci
Aerobic
URI

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7
Q

Moraxella catarrhalis

A

GRAM- cocci
Aerobic
Respiratory infections

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8
Q

H. influenza

A

GRAM- Rod
Aerobic
URI, community acquired pneumonia

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9
Q

H. Pylori

A

GRAM- Rod
Aerobic
Stomach/Gut

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10
Q 
Enterobacteriaceae
E. coli
Klebsiella sp.
Proteus sp.
Enterobacter sp.
Citrobacter sp.
A

GRAM- Baccili, oxicase negative, gut colonizing rods
Aerobic
UTI, IA, health care acquired pneumonia, bacteremia

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11
Q

Non-fermenting
Pseudomonas
Acinetobacter
Stenotrophomonas

A

GRAM- Cocco-bacilli, bacilli, or rods
Aerobic
HCAP, diabetic foot infections, nosocomial infections

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12
Q

Bacteroides sp

A

GRAM-
Anaerobic
IA, colitis, “Aspiration” pneumonia

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13
Q

Clostridium difficile or perfringens

A

GRAM- bacilli, spore forming
Anaerobic
IA, colitis, “aspiration” pneumonia

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14
Q

Legionella sp.

A

Atypical infection

CAP, worst offender of Legionella infection, STD’s

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15
Q

Mycoplasma sp

A

Atypical infection

STD

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16
Q

Chlamydia

A

Atypical infection

STD

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17
Q

Penicillin

A

Covers GRAM+
DOC for GAS, S. pyogenes, Treponemia
Not very good anymore because of resistance. Must test S. pneumonia for susceptibility before using

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18
Q

Amoxicillin and Ampicillin

A

Covers GRAM+

Only effective for GRAM- organisms that do not product beta-lactamases

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19
Q

Nafcillin (IV)
Dicloxacillin (PO)
(Methicillin class)

A

Covers GRAM+
DOC for GAS, S. pyogenes, MSSA
Known as the “Anti-Staph” class, Dicloxicillin is under used!

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20
Q

Augmentin (PO)

ampicillin/sulbactam (IV)

A

Broad Spectrum, covers GRAM+/-, Anaerobes, and MSSA

Beta-lactamase inhibitor doesn’t improve pseudomonas coverage

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21
Q

Ticarcillin/clavulanate

Pipercillin/tazobactam

A

Broad Spectrum, covers GRAM+/-, Anaerobes, and MSSA

Beta-lactamase inhibitors provide good GRAM- coverage (esp pseudomonas)

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22
Q

Imipenem/Cilastin
Meropenem
Doripenem

A

Broad Spectrum, covers GRAM+/-

Not good for MRSA and Non-fermenting GRAM- (pseudomonas, acinetobacter, stenotrophomonas)

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23
Q

Ertapenem

A

Broader Spectrum, covers GRAM+/- and Anaerobes

No efficacy against pseudomonas, but good for diabetic and long-term infections

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24
Q

Aztreonam

A

GRAM-, including pseudomonas

Good for use in PCN allergy!!

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25
Cephalexin (PO) | Cefazolin (IV)
Expected to cover MSSA, GAS, S. pyogenes, and E. coli Poor S. pneumonia coverage 1st Gen
26
Cefuroxime (IV/PO)
Expected to cover H. influenza, S. pneumonia, and MSSA | Gen 2A
27
Cefotetan (IV)
``` Expected to cover Gut GRAM- poor coverage on anaerobes, increasing resistance supply problems Can increase INR Gen 2B ```
28
Ceftriaxone (IV/IM)
``` Good GRAM- coverage DOC for S. pneumonia Renally cleared Does not cover Pseudomonas 3A Gen ```
29
Ceftazadime (IV)
Expected to cover Pseudomonas and other GRAM- Poor GRAM+ coverage Can induce resistance 3B Gen
30
Cefepime (IV)
Expected to cover Pseudomonas and other GRAM- organisms Improved GRAM+ coverage (MSSA) Reports of neurotoxicity, monitor 4th Gen
31
Ceftaroline (IV)
Covers Enterococcus | 5th Gen
32
Typical beta-lactam antibiotic ADRs (Penicillins, carbapenems, cephalosporins)
Allergic reaction/Rash Diarrhea Occasional neutropenia/thrombocytopenia Intestinal Nephritis (Rare, more common with Nafcillin) May be seen as allergy-induced renal failure Seizures (more common with Imipenem) Drug fever (overall Rare) Suprainfection (more common with carbapenems)
33
Macrolide antibiotic coverage and uses
Excellent: Atypical infections Good: H. influenza, M. catarrhalis Decent: S. pneumonia Uses: URI and CAP
34
Macrolide antibiotic ADRs
``` Azith: Fever, different chemical class than others GI problems QT prolongation Inhibits CYP system, watch drug interactions ```
35
Ciprofloxacin
Excellent GRAM- coverage Poor GRAM+ coverage (not good for CAP) Inhibition of CYP1A2 (theophylline) Rising resistance rates!!!
36
Levofloxacin
Enhanced GRAM+ coverage with same GRAM- coverage as cipro | Excellent Atypical coverage (better than macrolides)
37
Moxifloxacin
Enhanced GRAM+ coverage with same GRAM- coverage Excellent Atypical Coverage (better than macrolides) Not effective for UTIs because it doesn't enter urine (use "above the belt")
38
Use of fluoroquinolones in pseudomonas infections
This is the ONLY oral agent that covers pseudomonas!! Cipro only covers GRAM-, so not effective for some pseudomonas cases (Ex: CAP) Levo/Moxi have improved GRAM+ coverage, useful against all pseudomonas
39
fluoroquinolone ADRs
Tendonitis/tendon rupture Glucose disturbances QTC prolongation Photosensitivity
40
Aminoglycoside Coverage
Covers Aerobic GRAM- | Reserved for "SPACE" drugs
41
SPACE drugs
``` Serratia Pseudomonas Acinetobacter Citrobacter Enterobacter ```
42
Aminoglycoside Toxicities
Nephrotoxicity - usually reversible, incidence declining Ototoxicity - can induce deafness or balance problems. Usually irreversible, difficult to monitor Paralytic at high doses - minimized through once daily dosing
43
Antibiotics used in double-coverage
Beta-lactams + aminoglycosides for the first 3-5 days | Why? SPACE bugs are serious systemic infections, need to limit resistance developed!
44
Vanco coverage
Cell Wall antibiotic, similar to beta-lactams Good GRAM+ coverage (MRSA and C. diff) **Increasing MRSA resistance
45
Vanco ADRs
Red Man Syndrome (flushing) - caused by histamine, give antihistamine to block reaction. can prevent or reverse by slowing the infusion Nephrotoxicity and Ototoxicity - overall rare, more common at high doses Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)
46
When should metronidazole be used?
Gold standard for anaerobes such as B fragilis | DOC for C. diff
47
Metronidazole ADRs
neuropathies metallic taste disulfaram-like rxn (EtOH)
48
what does a positive D Test indicate?
potential for clindamycin resistance to develop over course of treatment for MRSA
49
clindamycin coverage
Anaerobes and GRAM+ good for aspiration pneumonia and MRSA bad for bacteremias and endocarditis because it is bacteriostatic
50
clindamycin ADRs
rash | can cause C. diff infection
51
Doxycycline coverage
GRAM+ (MRSA and varying S. pneumonia) GRAM- Some Atypical Used in COPD bacterial exacerbations, MRSA, and SSTI
52
Doxycycline ADRs
N/V Rash phototoxicity
53
Linezolid coverage
Broad GRAM+, good for MRSA
54
Linezolid ADRs
thrombocytopenia N/V/D Headache neuropathies Mild MAOI, potential for drug interactions (serotonin syndrome, etc.) **Not well tolerated, do not use beyond 4 weeks!! Likely to develop neuropathies, lactic acidosis, and maybe blindness past this.
55
Daptomycin coverage
Broad GRAM + with bactericidal activity good for MRSA, bacteremias, and endocarditis ***DO NOT USE WITH PNEUMONIAS
56
Daptomycin ADRs
Rhabdomyolysis | Reduce dose with statins
57
Tigecycline Coverage
Very broad spectrum GRAM+ (including MRSA and VRE) GRAM - (acinetobacter and stenotrophomonas) Anaerobes ***DO NOT USE WITH PSEUDOMONAS AND PROTEUS
58
Tigecycline ADRs
N/V
59
Televancin Coverage
aerobic and anaerobic, GRAM+
60
Televancin ADRs
N/V Metallic taste Insomnia
61
Pearls to Prevent Antimicrobial Resistance
``` Vaccinations Remove unnecessary indwelling catheters Determine the appropriate time to stop Vanco Know local antibiograms Wash hands ```
62
Best choices for anaerobes
Metronidazole Clindamycin Beta-Lactamase inhibitors Carbapenems
63
Worst choices for anaerobes
fluoroquinolones some cephalosporins tetracyclines macrolides
64
SMZ/TMP ADRs
``` Allergy Rash (SJS) Agranulocytosis anemia drug interactions ```
65
why is it important to note intra-abdominal abscesses on a CT?
Often means anaerobes are present (most often many GRAM-, anaerobes, and enterococcus (if healthcare-acquired)) Start with broad-spectrum therapy, narrow when cultures are available Probably requires surgical intervention

Therapeutics 3 (8 decks)

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