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Pharmacotherapeutics I > Introduction to Infectious Disease > Flashcards

Introduction to Infectious Disease Flashcards

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1
Q

Host flora

A

Occupy space and compete for nutrients
Stimulate cross-protective antibodies
Suppress growth of potentially pathogenic bacteria and fungi

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2
Q

Can normal flora become pathogenic

A

Yes

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3
Q

Colonization vs Infection

A

Colonization- organism present
Infection- organism present, organ damage, and inflammation.
Autoimmune disease- organ damage and inflammation

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4
Q

Monitoring Parameters

A 
Fever- >37 C (98.6 F) in adults
Erythema- redness of the skin
Purulence- discharge of pus
Swelling
Leukocytosis- elevated WBC
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5
Q

WBC- Leukocytes

A

1% of blood volume
Carry out immune system functions and recognize self from non-self.
Average life span 13-20 days

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6
Q

Differential WBCs

A 
Neutrophils- 50-70%
Lymphocytes 25-35%
Monocytes- 2-6%
Eosinophils- 0-6%
BBasophils- 0-3%
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7
Q

Granlocytes

A

Neutrophils, eosinophils, and basophils

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8
Q

Neutrophils mechanism

A

Prevent microorganism invasion, kill invading organisms
Attracted to site of infection by chemotactic factors. Then Phagocytize the microorganisms. Release toxic substances from granules within cell into vacuole containing organism.

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9
Q

Neutrophils

A

Contain multi-lobed nuclie (segs)
Production stimulated by interleukins and other colony stimulating factors (CSF)
Increased bands in circulation causing left shift

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10
Q

Segs

A

Term used to describe a mature working neutrophil, if found then you know they are actively trying to prevent infection

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11
Q

Bands

A

Immature neutrophil, increased means that more immature cells are being pushed out of the marrow (eukemia)

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12
Q

Absolute Neutrophil Count (ANC)

A

The lower the value the higher the risk of infection

WBC # x (%segs+%bands)

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13
Q

Neutropenia

A 
Not enough neutrophils
Mild= ANC 1000-1500/mm3
Moderate= ANC 500-1000mm3
Severe= ANC <500mm3
This gives an idea of how a pt can handle an infection process on their own.
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14
Q

Lymphocytes

A

Effector cells of immune system, recognize invaders, tag them for removal and kill them.
Make antibodies- Tcells 80% and B cells 20%

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15
Q

WBC-Monocytes

A

Serve to replenish tissue with macrophages prior to and during immune response

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16
Q

WBC- Eosinophils

A

Responsible for immuner processes against helminths and parasites (also involved in allergic rxn)

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17
Q

WBC- Basophils

A

Mediate inflammatory response

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18
Q

Gram stain- Gram (+) Cocci

A

chains- streptococcus pyrogens, viridans streptococcus
Pairs- streptococcus pneumoniae and enterococcus spp.
Clusters- coagulase-positive staphylococcus (S. aureus) Coagulase -negative Staphylococcus (S. epidermis)

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19
Q

Gram stain- Gram (+) Bacilli

A

Listeria and lactobacillus

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20
Q

Gram stain- Gram (-) Cocci

A

Neisseria menigitidis and Neisseria gonorrhoeae

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21
Q

Gram stain- Gram (-) Bacilli

A 
Escherichia Coli
Klebsiella Spp
Enterobacter spp
Proteus spp
serratia marcescens
Pseudomonas spp
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22
Q

Gram stain- Gram (-) Coccobaccili

A

Haemophilus influenzae

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23
Q

Cell wall- Gram Positive

A

Rigid, thick
Made up of mostly peptidoglycan (50-60%)
A series of cross-linking (transpeptidases) help to create the building blocks of the cell wall

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24
Q

Cell wall- Gram Negative

A

Cell wall thin layer-one or two glycan chains
Cell wall protected by lipoprotein outerlayer- which functions as a penetration barrier.
Lipopolysaccharide (LPS)
Matrix protein (porin)- important for regulating the influx of molecules
Phospholipids

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25
Cell walls- Walls of mycobacteria (Acid fast bacteria)
Contains peptidoglycan w/ polysaccharide and glycolipids | Associated with staining characteristics
26
Cell Walls- Cytoplasmic membrane
Osmotic barrier Energy production (electron transport-energy grandient- ATPases) Biosynthesis transport (nutrient uptake, enzyme secretion) Protein and lipid- lacks sterols
27
Antimicrobial Susceptibility- MIC
Minimun inhibitory concentration (MIC) lowest concentration of antibiotic that inhibits visible growth of bacteria. Want to shoot for 2-4x above this in treatment.
28
Antimicrobial Susceptibility- Breakpoints
Susceptible- isolates may be appropriately treated with the recommended doses Intermediate- isolates may be appropriately treated in body sites where the drug is physiologically concentrated or when a high dosage of a drug can be used Resistant- isolates are not inhibited by the achievable concentrations of a normal dose
29
Gram Positive cocci (Aerobic)- Staphylococcus
``` Staphylococcus aureus (Coag+)- MSSA, hospital or community acquired MRSA. Staphylococcus epidemidis(Coag -) Staphylococcus saprophyticus (Coag -) ```
30
Gram Positive cocci (Aerobic)- Enterococcus
Enterococcus Faecalis Enterococcus faecium Enterococcus durans
31
Gram Positive cocci (Aerobic)- B hemolytic
``` Streptococcus pyogenes (Grp A) Streptococcus agalactiae (Group B) Streptococcus bovis (nonenterococci, grp D) ```
32
Gram Positive cocci (Aerobic)- Viridans streptococci- alpha hemolytic
Streptococcus sanguis Streptococcus salivarius Streptococcus mitis Streptococcus mutans
33
Gram Positive cocci (Aerobic)- Streptococcus pneumoniae
Pneumococcus
34
Staphylococci- colinzation
Skin and nose
35
Staphylococci- Infections caused
``` Cellulitis, wounds, trauma Bacteremia/endocarditis Pneumonia Osteomyelitis UTI ```
36
Staphylococci- post surgery
Major players in post surgical infections. | Adhere to foreign material and catheters
37
Staphylococcal Resistance
Penicillin resistant- beta-lactamase production Methicillin resistant- MecA gene codes for Novel PBP2a (50% S. aureus and 70% CoNS are resistant) Methicilin-suspectible isolates are also susceptible to cephalosporins and carbapenems.
38
Streptococcus- Colinzation
Skin- grou A- S. pyogenes Mouth- viridans streptococcus, anaerobes (e.g. peptostreptococcuss) Nasopharynx- group A S. pyogenes Lower GI- group D- S. bovis, viridans streptococcus and anaerobes Female Genital tract- Group B- Agalactiae
39
Streptococcus- infections caused- cellulitis
Group A- S. pyogenes may result in Nec fascitis
40
Streptococcus- infections caused- Dental carries
Viridans Streptococcus
41
Streptococcus- infections caused- pharyngitis (Strep throat)
Group A- S. Pyogenes
42
Streptococcus- infections caused- bacteremia/endocarditis
Viridans Streptococcus
43
Streptococcus- infections caused- neonatal meningitis
Group B- S. Agalactiae
44
Streptococcus treatement
Penicillin | More resistance seen with alpha-hemolytic strep, specifically S. Mitis
45
Pneumococci
Alpha hemolytic
46
Pneumococci- colonization
Oropharynx and nasopharynx
47
Pneumococci- infections caused
Otitis media, sinusitis, bronchitis, Pneumoni (CAP Community required pneumonia), and meningitis
48
Pneumococci- Asplenia
Without the spleen patients are at risk for fulminant sepsis syndrome. Lack filtration mechanism of spleen macrophages Cannot clear encapsulated organisms- S. pneumoniae, H. influenzae, and N. menigitidis
49
Pneumococci- treatment
Penicillin resistant strains due to PBP alterations 3rd generation cephalosporins (ceftriaxone) May de-escalate with cultures and sensitivities
50
Enterococci- colonization
Gastrointestinal tract and female genital tract | Resistance is the best defence
51
Enterococci- infection
Opportunistic UTI Bacteremia/Endocarditis Intra-abdominal infections
52
Gram Negative (aerobic)
Rods- Enterobacter spp, escherichia coli, klebsiella pneumoniae, proteus vulgaris, proteus mirabilis, serratia marcenena, pseudonomas aeruginosa, cocc/coccobaccilli
53
Enterobacteraciae
GI tract colonization Exposure comes from soil, water, vegetation LPS cell wall component and endotoxin.
54
Enterobacteraciae- infections
``` UTI Intra-abdominal infections Bacteremia Nosocomial pneumonia Diabetic foot infections ```
55
Enterobacteraciae- resistance
Prevalent More common in hospital-acquired infections Tx guided by in vitro susceptibility
56
Pseudomonas aeruginosa
Not considered normal flora (sold, water, vegetation) Can colonize upper respiratory tract of immunocompromised patients- cystic fibrosis, COPD Opportunistic- immunocompromised pt, broad spectrum ABX, ventilation equiptment
57
Pseudomonas- infections
``` Nosocomial infections Hospital acquired pneumonia (HAP) Febrile neutropenia Skin and soft tissue infections (burns, trauma, post-surgical) UTI ```
58
SPACE Organisms- double covering
``` Double covering- Tx w/ 2 ABX Serratia Psuedomonas Acinetobacter Citrobacter Enterobacter More adverse effects, no more resistance ```
59
Gram (-) Cocci/Coccobacilli- Haemophilus Influenzae
Encapsulated- more virulent, not regular colonizer, causes meningitis No capsule- Colonizes upper respiratory tract, causes otitis media, sinusitis, CAP
60
Gram (-) Cocci/Coccobacilli- Neisseria Menigitidis
Humans only nature host Colonizes oro/nasopharynx Encapsulated Causes meningitis and less commonly pneumonia
61
Polysaccharide capsule (PS)
Eludes immune system Requires speen for elimination PS capsule is target for vaccines- Hib vaccine and meningococcal vaccine
62
Anaerobes- above diaphragm
``` Petpstreptococcus spp (gram + cocci) Actinomyces spp (gram + rod) Fusobacterium (gram - rod) ```
63
Anaerobes- below diaphragm
``` Bacteroides fragilis (gram - rod) Lactobacillus (gram + rod) Clostridium spp (gram + rod) ```
64
Gram negative isolates
Usually penicillinase prodcuers
65
Anaerobes- colinization
Upper and lower Gi and vagnial colonizers.
66
Anaerobes- infection
Intra-abdominal infection, aspiration pneumonia, endometritis, PID, diabetic lower extremity infections, dental carries, head and neck.
67
Atypicals
Not normal colonizers Not able to gram stain Mutiply intracellularly Result in CAP
68
Atypicals- organisms
Mycoplasma pneumonia Legionella pneumophilia Chlamydophila pneumoniae
69
Atypicals
``` Even Some Super Killers Have Pretty Nice Capsules Escherichia Coli Streptococcus Pneumoniae Salmonella Klebsiella pneumoniae Haemophilus influenzae Pseudomonas geruginosa Neisseria meningitidis Cryptococcuss neofromans (yeast) ```
70
9 classes of bacterial pathogens- Streptococci
Group A strep, viridans strep
71
9 classes of bacterial pathogens- Streptococcus pneumoniae
Streptococcuss pneumoniae
72
9 classes of bacterial pathogens- Enterococcuss
usually faecalis
73
9 classes of bacterial pathogens- Staphylococci
S. aureus, coagulase-negative
74
9 classes of bacterial pathogens- atypical bacteria
Mycoplasma, chlamydia, legionella
75
9 classes of bacterial pathogens- Haemophilus influenzae
haemophilus influenzae
76
9 classes of bacterial pathogens- Gram negative rods
E. coli, Klebsiella, Proteus, ect
77
9 classes of bacterial pathogens- Pseudomonas aeruginosa
Psuedomonas aeruginosa
78
9 classes of bacterial pathogens- Anaerobes
Bacteriodes, clostridia, pervotella
79
Nine Important "Classes" of Bacterial Pathogens
``` Streptococci Streptococcus Pneumoniae Enterococcus Staphylococci Atypical bacteria Haemophilus Influenzae Gram negative rods Peudomonas Aeruginosa Anaerobes ```

Pharmacotherapeutics I (23 decks)

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