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Therapeutics V Spring 2019 (P3 Spring) > Kays - Exam 1 > Flashcards

Flashcards in Kays - Exam 1 Deck (154):
1

Gram positive bacteria stain _____

(positive) purple

2

Gram negative bacteria stain _______

red

3

difference between bacili and cocci

bacili: rod shape
cocci: little circles

4

which bacteria are lactose fermenting

CEEK:
Citrobacter
Enterobacter
Escherichia coli
Klebsiella

5

Which drugs/things can MASK a fever

Antipyretics
Corticosteroids
Antimicrobial therapy
an overwhelming infection can mask a fever

6

Systemic Signs of an infection:
Fever: Temp > _____

38 degrees Celsius/ 100.4 Farenheit

7

Systemic Signs of an infection:
Increased White blood count (> ________ /mm^3)

> 10,500

8

Normal WBC?

4,500 - 10,500/mm^3

9

Systemic Signs of an infection:
Tachy or Brady cardia/pnea

Tachy!!
HR > 90 beats/min
R > 20 breaths/min

10

Systemic Signs of an infection:
Hypo or hyper tension?

hypo! (SBP < 90 mmHg or an MAP < 70)

11

Normal WBC Differential:
Mature Neutrophils: _____%

50-70%

12

Normal WBC Differential:
Immature neutrophils: ____%

0 -5%

13

Normal WBC Differential:
Eosinophils: ____ %

0-5%

14

Normal WBC Differential:
Basophils: ____%

0 -2%

15

Normal WBC Differential:
Lymphocytes: _____%

15-40%

16

Normal WBC Differential:
Monocytes: _____%

2-8%

17

Which WBCs are Agranulocytes

Lymphocytes and Monocytes

18

Which WBCs are Granulocytes

the "Phils"
Neutrophils, Eosinophils, Basophils

19

Other names for mature neutrophils

PMNs, Polys, Segs

20

Other names for immature neutrophils

bands

21

Leukocytosis means ??

increased neutrophils (+/- bands)

22

Presence of immature forms of neutrophils means what?

aka a left shift = indication of bone marrow response to the infection

23

Leukocytosis generally means ______ infection

bacteria

24

Lymphocytosis generally means _________ infection

viral, fungal, or tuberculosis

25

Monocytosis usually associated with?

tuberclosis or lymphoma

26

Eosinophillia usually associated with?

ALLERGIC REACTIONS! oar protozoal/parasitic infections

27

CD4 or CD8?
depleted in HIV infection

CD4

28

CD4 or CD8?
bind to and directly kill tumor cells

CD8

29

CD4 or CD8?
help with antibody production and secrete lymphokines

CD4

30

ESR and CRP when elevated = _______ but not for sure ________

means inflammation; not always meaning infection tho...

31

Normal ESR value?

0 - 15 mm/hr (males)
0 - 20 mm/hr (females)

32

Normal CRP value?

0 - 0.5 mg/L

33

What is PCT

procalcitonin/precursor of calcitonin

34

Normal value of PCT

< 0.05 ug/L

35

PCT is more or less specific than ESR or CRP for bacterial infections

MORE! good for finding out if bacterial infection (PCT is not related to viral infections !)

36

What PCT value is suggestive of sepsis

2 - 10 ug/L

37

What PCT value means sepsis/systemic bacterial infection

> 10

38

what PCT value means other condition/localized infection

0.25 - 2 ug/L

39

Sensitivity or Specificity?
positive result in presence of disease/infection

Sensitivity

40

Sensitivity or Specificity?
false positive rate

specificity

41

Sensitivity or Specificity?
negative result in absence of disease/infection

specificity

42

Sensitivity or Specificity?
False negative rate

sensitivity

43

to give the drug abacavir -- what genetic test must be done

HLA-B5701 = hypersensitivity

44

Empiric vs directed therapy?

Empiric: BROAD SPECTRUM before pathogen idenitifie

Directed: after pathogen identified/susceptibility results are known; DE-ESCALATE to agent with narrowest effective spectrum of activity

45

Want to move pts from IV to PO therapy when clinically stable and functioning GI tract annnnd ahve agents with good oral bioavaliability--- what are cases where you should NOT

if CNS infection, endocarditis (lil Owen!), and Staph aureus bactermemia

46

what are the 3 primary reasons for combination antimicrobial therapy?

broad spectrum for polymicrobial infections
synergistic bactericidal activity
prevent emergence of resistance (ex: HIV drug therapy)

47

disadvantages of combo microbial therapy?

increased cost
greater risk of drug toxicity
superinfection with resistant bacteria
antagonism of drugs to each other

48

what 3 main things should be used to figure out empiric therapy

-knowledge of the likely pathogen (body site, where infection started (hospital)
- anticipated susceptibility pattern (antiobiogram)
- info from pt history/PE (prior abx use, travel hx/other sick ppl at home)

49

bactericidal vs bacteriostatic

cidal:KILLS organism....
static: inhibits bacterial replication

50

what are 3 main ways that an antibiotic can be bactericidal

act on cell wall
act on cell membrane
or act on bacterial DNA

51

Antimicrobial Tissue Concentrations = mean of ________ and _____ concentrations

extracellular AND intracellular!

52

Gram Positive vs Gram negative Cell wall comparison:
has lots of peptidoglycan

Positive

53

Gram Positive vs Gram negative Cell wall comparison:
has porins

negative

54

Gram Positive vs Gram negative Cell wall comparison:
has lipopolysaccharide outer membrane (LPS/endotoxi)

negative

55

Gram Positive vs Gram negative Cell wall comparison:
has beta lactamases on the outside of the cell/towards environinment

gram positive

56

Gram Positive vs Gram negative Cell wall comparison:
has beta lactamases in periplasmic space

negative

57

what are PBPs?

pencillin binding proteins:
aka enzymes vital for cell wall synthesis, cell shape, and structural integrity

58

what is the most important PBP and why

transpeptidase:
it catalyzes final cross link between sugar and peptide in peptidoglycan molecule

59

3 types of genetic exchange that leads to resistance

conjugation
transduction
transformation

60

what is conjugation (genetic exchange shit)

direct contact or mating via sex pilli **most common

61

what is transduction (genetic exchange shit)

genes transferred via bacteriophages (viruses) between bacteria

62

what is transformation (genetic exchange shit)

uptake of "free floating" DNA from the environment then gets integrated into the hosts DNA

63

Plasmids or transposons:
transferred from organism to organism
self replicating
extrachromosomal DNA

plasmid

64

3 main mechanisms of bacterial resistance

enzymatic inactivation
alteration of target site
altered permeability of bacterial cell

65

what are examples of abx resistance via enzymatic inacivation

beta lactamases
aminoglycoside modifying enzyme

66

what are examples of abx resistance via alteration target site

PBPs
cell wall precursors
ribosomes
DNA gyrase/topoisomerase

67

what are examples of abx resistance via altered permeability of bacterial cell

efflux pumps
porin changes

68

what are beta lactamases/how do they work

they inactivate beta lactam abxs
work by hydrolzying/splitting amide bond = inactivate drug

69

what gene in beta lactamases are we to know

AmpC

70

what does ESBL stand for

Extended spectrum beta lactamases

71

which bacteria typically contain AmpC

SPICE
(serratia, pseudomonas, indole-positive proteus, citrobacter, enterobacter)

72

what drugs are beta lactamase inhibitors

tazobactam
clavulanic acid
sulbactam ---- resistance to the SPICE organisms has happened!!

avibactam = lactamase inhibited in SPICE by this drug does happen tho

73

how is AmpC induced?

the gene is normally repressed, when a beta lactam is present the gene gets DEPRESSED which cause beta lactamase production

when inducer is removed then the gene gets repressed again

74

what abxs are strong inducers of AmpC

Penicillin G
Ampicillin
1st gen cephalosporings
Cefoxitin

*Clavulanic acid = potent induce of AmpC beta lactamases

75

SPICE are typically constitutively making beta lactamases....
avoid using what abx because of developed resistance?

avoid 3rd gen cephalosporins

76

ESBLs seen most frequently in what bacteria

Klebsiella pneumoniae
and
E.Coli

77

ESBLs are _____ mediated and tend to hydrolyze _______ and ______

plasmid mediated;
hydrolyze PCNs and cephalosporins

78

what drug may be useful for the CTX-M enzyme of ESBLs

tazobactam

79

what is normally the treatment of choice for ESBLs

carbapenems

80

what are the 3 most important carbapenemases

KPC (klebsiella pneumoniae carbapenemase)
Oxa-type (seen in acinetobacter)
NDM (new delhi metallo beta lactamases)

81

T or F: CRE can last in the body for only 6 months

falseeee
carbampenemase resistant enzymes can last in the body for 12 months!! aka bacteria can get spread allllll over

82

NDM-1 is resistant to all antibiotics except what?

Colistin

83

best way to treat CRE bugs?

is serine carbapenemase: ceftazidime + avibactam

if the NDM-1/metallo-b lactamase = use aztreonam

84

what 4 things can predispose someone to an infection

FLORA: alteration to normal flora of host
BARRIERS: disruption to barriers (skin, cilia, pH changes)
AGE
IMMUNOSUPPRESION: due to malnutrition, underlying disease, hormones (pregnancy or corticosteroids), drugs (cytotoxic agents)

85

what does MIC stand for and its definition

minimum inhibitory concentration
lowest concentration of abx that prevents VISIBLE growth

86

what does MBC stand for and its definition

minimum bactericidal concentration: lowest concentration resulting > 99.9% decrease in initial inoculum

87

what is an Etest

epsilometer test: abx on entire strip with a continuous gradient of the drug:
an eliptical shape will form -- "largest death area" = where most drug is...
MIC found where the inhibition ellipse intersects with the strip

88

what is agar dilution

agar with two fold dilutions of abx in it;
bacteria inoculated on to them;
MIC will be agar plate with the lowest concentration and no growth of an organism

89

what is broth dilution

two fold dilutions of abx in liquid broth;
MIC will be lowest concentration of the drug that prevents visible growth

90

T or F: broth in broth dilution method has no protein in it

true (note because there is protein in the body tho and like drug protein binding shit)

91

Definition: susceptible (for breakpoints)

isolated bacteria is inhibited by usually achievable concentrations when normal dosing regimens are used

92

Definition: S-DD (susceptible dose dependent)

susceptibility is dependent on the dosing regimen used (need higher doses!!)

93

Definition: intermediate (for breakpoints)

we guessin'
treatment MAY be successful when max doses are used or if drug is concentrated at the site of infection
MIC approaches achievable blood or tissue concentrations

94

How are MIC breakpoints (aka interpretive criteria) established

clinical pharmacology of the drug
clinical/bacteriologic response from human studies

95

Tolerance in susceptibility tests is defined as ??

MBC >/= to 32 x MIC
(rarely identified clinically bc MBCs not routinely determined)

96

what is the inoculum effect

a laboratory phenomenon that is described as a significant increase in the minimal inhibitory concentration of an antibiotic when the number of organisms inoculated is increased

97

what is MIC(50) and how do you find it

abx concentration that inhibits 50% of bacteria tested
ex: if you have 100 samples --- put them in MIC order and find the MIC value that inhibits at least 50% of bacteria?

98

what is MIC(90) and how do you find it

abx concentration that inhibits 90% of bacteria tested
ex: if you have 100 samples --- put them in MIC order and find the MIC value that inhibits at least 90% of bacteria?

99

what is Geometric mean MIC and how do you find it...

the antilog of the mean of the log MICs....... wut is math

100

what is modal MIC and how do you find it

simply the most frequent MIC

101

definition of synergy:

activity of antimicrobial combo is greater than that expected from additive activity of the individual agents

102

definition of antagonism: (synergy testing)

activity of an antimicrobial combo is less than that expected from the additive activity of the individual agents

103

Definitions additivity or indifference: (synergy testing)

neither synergy or antagonism

104

two different tests for testing synergy

checkboard test (grid of using two diff abx in broth, less growth/more clear plates = synergy..)
and
time kill curves (showing effect of drugs alone vs together vs control)

105

what does PAE stand for and what is the definition

post antibiotic effect
after abx removed, there is still some inhibitory effects on the bacterial growth still

106

PAE is a phenomenon in in vivo or in vitro

vitro!!
not vivo!! the body has WBCs and stuff to also have extra effects after abx

107

antibiotic stewardship wants rapid diagnostic testing to increase why

they want to detect resistant bugs faster

108

what are some molecular diagnostic techniques for rapid diagnostic

PCR
PNA-FISH
LAMP
MALDI-TOF
Verigene/BioFire

109

aminoglycoside modifying enzyme mechanisms? (3 total)

acetylation
nucleotidylation
phosphorylation

110

aminoglycoside modifying enzyme:
they modify the structure by transferring an indicated chemical group to a ___________
this will impair ______ and/or _______

to a specific side chain
impair cellular uptake/binding to ribosome

111

There is a bifunctional enzyme that modifies aminoglycosides:
mainly seen in what bacteria?
the enzyme leads to high level resistance to ______ but not _______

mainly seen in ENTEROCOCCI
resistance to gentamicin
not resistant to streptomycin tho

112

Resistance mechanisms:
what are examples of Altered target sites - PBPs

1 - S. Pneumoniae resistant to PCN and Cephalosporins

2 - Staphylococci is resistant to Methicillin via mecA gene

113

Methicillin resistance is seen in what abx because of what gene?

staphylococci are resistant because of mecA gene

114

the mecA gene encodes for production of a new PBP that is called ______

PBP2A or PBP2'

115

how does vancyomyocin normally work as an antibiotic?

inhibits cell wall synthesis --
does this by binding to D-alanine-D-alanine terminus of pentapeptide (a peptidoglycan precursor)

116

what bacteria is known to have vancomyocin resistance through the VanA gene

S. Aureus = VRSA

117

how does the VanA gene cause resistance

causes the D-Ala-D-Ala part becomes D-Ala-D-Lac and vancomyocin can't bind to the D-Ala-D-lac part

118

Altered ribosomal targets lead to resistance in what antibiotics

macrolides, azalides, aminoglycosides, tetracyclines, clindamycin

119

Altered DNA gyrase/topoisomerases lead to resistance to the drug class(es) of _______?
and this resistance is seen in what bugs most?

fluoroquinolones
seen in S. Pneumoniae and gram negative

120

what are some drugs that have had reported chromosomal/plasmid mediated resistance with efflux pumps occur?

Macrolizes/Azalides

Carbapenems

121

what bug has had reported efflux pump resistance to macrolides/azalides

S.Pneumoniae

122

what bug has had reported efflux pump resistance to carbapenems

P.Aerugonisa

123

For efflux pump resistance:
for P.Aerugonisa that has resistance to Carabapenems:
which carabapenem drug is best to use? (because it does not get effluxed out...)

IMIPENEM is best!! (definitely not pumped out as much as meropenem)

124

P.Aeruginosa has multidrug efflux pumps... which drug(s) were bolded/in every single multidrug efflux pump...

Ciprofloxain/Levofloxain

125

Porins will typically allow a drug to go through it when the drug is (small or large?) (more or less negative)(hydrophobic or hydrophillic?)

go through when small, less negative charges(aka it prefers zwitterionic charge); hydrophillic

126

Mutations in porins seen most commonly in what bugs?

Enterobacteriaceae bois and P.Aeruginosa

127

what resistance mechanisms are most common for beta lactam drugs

hydrolysis (aka beta lactamase);
altered target site;
efflux

128

resistance mechanisms for aminoglycosides?

aminoglycoside modifying enzymes.....
altered target site...
efflux

129

what resistance mechanisms are most common for glycopeptides (aka vancomyocin)

altered cell wall precursors (D-Ala-D-Lac)

130

Intrinsic Resistance:
what bug has intrinsic resistance to beta lactams?

mycoplasma

131

Intrinsic Resistance:
what bug has intrinsic resistance to vancomyocin?

gram negative (because they got no peptidoglycan)

132

Intrinsic Resistance:
what bug has intrinsic resistance to cephalosporins

enterococci

133

Intrinsic Resistance:
what bug has intrinsic resistance to aminoglycosides

anaerobes

134

P.Aeruginosa: Common resistance mechanisms?

ESBLs
Efflux Pump
Reduced outer membrane permeability

135

K.Pneumoniae Common resistance mechanisms?

Carbapnemases

136

E.Coli: Common resistance mechanisms?

ESBL

137

S. Aureus: Common resistance mechanisms?

Methicillin Resistance - mecA gene
Vanc resistance

138

Enterococci: Common resistance mechanisms?

vancomyocin resistance via altered cell wall precursors

139

what PK/PD parameter do aminoglycosides use?

peak/mic

140

what PK/PD parameter do Beta lactams use?

Time above MIC

141

what PK/PD parameter does Daptomyocin use?

AUC(0-24)/MIC or Peak/MIC

142

what PK/PD parameter do Fluoroquinolones use?

AUC(0-24)/MIC

143

what PK/PD parameter does vancomycoin use?

AUC(0-24)/MIC

144

which abx are time dependent

beat lactams
vancomyocin

145

what abx are concentration dependent

aminoglycosides
daptomyocin
fluoroquinolones

146

For beta lactam abx: what are the goal %'s for time above MIC for GRAM NEGATIVES:
carabapenems: > _____%
PCNs: > ____%
cephalosporins: > ____ %

40%
50%
60%

147

For beta lactam abx: what are the goal %'s for time above MIC for GRAM POSITIVES?

> 40%

148

Goal AUC/MIC ratio for Fluoroquinolones?

> 100 for Gram negative bugs
> 30 for Gram Positive (maybe > 100...?)

149

Goal Peak/MIC ratio for aminoglycosides

8 - 10

150

Goal AUC/MIC ratio for vancomyocin

400 - 600

151

High risk for nephrotoxicity with vancomyocin when AUC is in the range of _________

600 - 700 or higher of course!

152

what are all the lactose fermenting bacteria

CEEK + VAP
citrobacter, enterobacter, e.col, kleibsella
+
vibrio cholerae, pasturella multicoda, aeromonas hydrophilia

153

what bacteria are known as "atypical bacteria"? (the cell walls are difficult to stain--- or maybe mycoplasma aka no cell wall)

chlamydophila pneumoniae
chlamydia trachomatis
legionella pneumophilia
mycoplasma pneumoniae

154

what bacteria is gram variable bacilli

gardenerella vaginalis