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CDM 3 Exam 1 > Lecture 1 - Clinical application of Abx and AST > Flashcards

Lecture 1 - Clinical application of Abx and AST Flashcards

1
Q

If Maculopapular rash then…

A
  1. avoid original drug
  2. Ok to use from different class of Beta-lactam

Ex. Rash with penicillin, avoid penicillin but OK to use cephalosporin

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2
Q

If get hives then….

A

Avoid all beta-lactams except aztreonam

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3
Q

If get anaphylaxis then…

A

avoid all beta lactase

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4
Q

If unspecified rash then….

A

assume the worst (ie hives) so avoid all except aztreonam

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5
Q

Maculopapular rash info

A
  1. Generally less severe, often not true drug allergy
  2. Symmetrical ruby red rash
  3. typically can use beta lactams not of the class associated with the rash
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6
Q

Uricarial Rash & Hives info

A

1.Generally more severe, associated w/ true allergy
2. Asymmetrical w/ darker borders + lighter centers
3. Cross reactivity rates can vary
4. Avoid other beta lactams except Aztreonam**

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7
Q

Anaphylaxis info

A
  1. severe/life threatening
  2. avoid all betalactams
  3. For true allergy, if pt needs, can be desensitized using graded dosing under close supervision**
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8
Q

Antibiotic Stewardship benefits

A
  1. can increase infection cure rates, while reducing….

Txm failure, Cdif infection, ADE, Abx resistance, Hospital costs + length of stay

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9
Q

Core elements of Hospital Abx Stewardship programs

A
  1. hospital leadership commitment
  2. accountability
  3. Pharmacy expertise
  4. action
  5. Tracking
  6. Reporting
  7. Education
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10
Q

Gram + Penicillin coverage

A

E.faecalis
Strep (Group A/B, Pneumoniae)

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11
Q

Gram - Penicillin coverage

A

Neisseria meningitidis

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12
Q

Anaerobes Penicillin coverage

A

Actinomyces
Clostridium spp
Peptostreptococci
Propionibacterium

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13
Q

Other Penicillin coverage

A

Treponema pallidum (Spirochete)
Leptospira spp (Spirochete)

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14
Q

Penicillin Clinical uses

A

Neurospychillis (T. pallidum)
Pharyngitis (Grp A Strep)
Pneumonia (PCN-S, S.pneumoniae)
Endocarditis (PCN-S strep)
Cellulitis (Grp A/B)

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15
Q

Aminopenicllin drugs

A

Ampicillin and Amoxicillin

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16
Q

Gram + Ampi/Amox coverage

A

E. Faecalis
Strep (Grp A/B, Pneumoniae)
Listeria monocytogenes

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17
Q

Gram - Ampi/Amox coverage

A

N. Meningitidis
H. Influenzae

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18
Q

Anaerobes Ampi/Amox coverage

A

Actinomyces
Clostridium spp
Peptostreptococci
Propionibacterium

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19
Q

Other Ampi/Amox coverage

A

Leptospirra spp (Spirochete)

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20
Q

Ampi/Amox Clinical uses

A

Meningitis (Amp; Listeria)

Endocarditis (Amp: E.faecalis)

Pneumonia, Sinusitis, Oropharyngeal infection, Otitis media (B-lactamase negative H.influ)

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21
Q

Penicillinase-Resistant Penicillins

A

Nafcillin + Oxacillin

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22
Q

Nafcillin & Oxacillin Gram + coverage

A

Strep spp. (Grp A/B, Pneumoniae)

** S. Aureus (MSSA)*

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23
Q

Nafcillin & Oxacillin Clinical uses

A

Meningitis (MSSA)
Endocarditis (MSSA)

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24
Q

Vancomycin Gram + Coverage

A

Strep spp (Grp A/B, Pneumoniae)
S. aureus (MSSA + MRSA)
E. Faecalis

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25
Daptomycin/Linezolid Gram + coverage
Strep spp (Grp A/B, Pneumoniae) S. aureus (MSSA + MRSA) E. Faecalis VRE ***
26
Anaerobes coverage Vancomycin/ Daptomycin
P.acnes Peptostreptococci
27
Anaerobes coverage Linezolid
Clostridium Bacteroides** P.acnes Peptostreptococci
28
Clinical uses Vancomycin
Meningitis ( S.pneumoniae, MRSA) HAP/VAP (MRSA) Bacteremia (MRSA)
29
Clinical uses Daptomycin
Bacteremia (VRE) UTI (VRE) Intra-abdominal infection (VRE) Bacteremia (MRSA)
30
Clinical uses Linezolid
HAP/VAP (MRSA) UTI (VRE) Intrabdominal infections (VRE) Bacteremia (MRSA)
31
B-lactam/B-lactam inhib combos
Ampicillin/Sulbactam Amoxicillin/Clav Piperacillin/Tazobactam
32
Ampicillin/Sulbactam & Amoxicillin/Clav Clinical uses
UTI (E.coli susceptible) HAP/VAP (Acinetobacter; Amp/Sulb only**) SSTI (Mixed Gram +/- susceptible, anaerobes) Pneumonia/Sinusitis/Otitis media (B-lact + H.influ)
33
Ampicillin/Sulbactam & Amoxicillin/Clav Gram + coverage
E.Faecalis Strep spp. (Grp A/B, pneumoniae) S. aureus (MSSA)
34
Ampicillin/Sulbactam & Amoxicillin/Clav Gram - coverage
E.coli; Proteus mirabilis H.Influ; M.catarrhalis Acinetobacter (Amp/sulb)***
35
Ampicillin/Sulbactam & Amoxicillin/Clav Anaerobes coverage
Actinomcyes Clostridium Peptostreptococci Propionibacterium B.fragilis F.necrophorum
36
Piperacillin/Tazobactam has added coverage for what gram -
Pseudomonas
37
Piperacillin/Tazobactam Clinical uses
HAP/VAP (P.aeruginosa) UTI (E.coli, Proteus, Klebsiella, Pseudomonas) SSTI (mix gram - / gram +, pseudomonas, anaerobes) Intra-abd infection ( Enterobacter, Pseudomonas)
38
1st gen Cephalosporins
Cefazolin** Cefadroxil Cephalexin
39
Cefazolin Clinical uses
Endocarditis (MSSA) UTI (MSSA, E.Coli, Proteus) Cellulitis (Grp A/B, MSSA)
40
1st gen Cephalosporins Gram + coverage
Strep spp. (Grp A/B, pneumoniae) S. aureus (MSSA)
41
1st gen Cephalosporins Gram - coverage
E. coli Proteus mirabilis K.pneumoniae
42
1st gen Cephalosporins Anaerobe coverage
P.acnes Peptostreptococci
43
2nd Gen Cephalosporins
Cefuroxime Cefprozil Cefaclor
44
2nd Gen Cephalosporins Gram + coverage
Strep spp. (Grp A/B, pneumoniae) S. aureus (MSSA)
45
2nd Gen Cephalosporins Gram - coverage
E.coli P.mirabilis K.pneumoniae H.infl M.catarrhalis
46
2nd Gen Cephalosporins Anaerobes
P. acnes Peptostreptococci
47
Cefuroxime Clinical uses
Pneumonia/Sinusitis/Otitis media (MSSA, S.pneumoniae, H.influ) UTI (E.coli, Proteus)
48
3rd gen Cephalosporins
Ceftriaxone + Cefotaxime Ceftazidime
49
3rd gen Cephalosporins Gram + coverage
Strep. spp (Grp A/B, Pneumoniae) S.aureus (MSSA)** but not Ceftazidime
50
3rd gen Cephalosporins Gram - coverage
E.coli P. mirabilis K.pneumoniae H.influ M.catarrhalis Pseudomonas Serratia Enterobacter Stenotrophomonas = ceftazidime only***
51
3rd gen Cephalosporins Anaerobes coverage
P.acnes Peptostreptococci
52
How does Ceftazidime differ from other 3rd gen?
Covers Stenotrophomonas but doesn't cover MSSA
53
Ceftriaxone Clinical uses
Meningitis (S.pneuomoniae) HAP/VAP ( S.pneuomoniae, Enterobacteriaceae) UTI ( E.coli, Proteus, Klebsiella) Intra-abd infection (Enterobacteriaeae, Pseudomonas) Bacteremia (Enterobacteriaceae)
54
Ceftazidime Clinical uses
HAP/VAP (Pseudomonas, Stenotrophomonas) UTI ( E.coli, Proteus, Klebsiella) Intra-abd infection (Enterobacteriaeae, Pseudomonas)
55
Cefotaxime uses
Bacteremia (Enterobacteriaceae) UTI ( E.coli, Proteus, Klebsiella) Intra-abd infection (Enterobacteriaeae, Pseudomonas)
56
4th Gen cephalosporin
Cefepime
57
Cefepime Gram + coverage
Strep. spp (Grp A/B, pneumoniae) S. aureus (MSSA)
58
Cefepime Gram - coverage
E. coli P.mirabilis K. pneumoniae H.influ M.catarrhalis Pseudomonas Serratia Enterobacter Citrobacter
59
Cefepime Anaerobic coverage
P.acnes Peptostreptococci
60
Clinical uses Cefepime
Meningitis (P.aeruginosa) Bacteremia (MSPACE, Pseudomonas) HAP/VAP (MSPACE, Pseudomonas) UTI (MSPACE, Pseudomonas) Intra-abd infections (MSPACE, Pseudomonas)
61
5th gen Cephalosporin
Ceftaroline
62
Ceftaroline Gram + coverage
Strep spp. (All species) S. aureus (MSSA + MRSA)***
63
Ceftaroline Gram - coverage
E.coli P.mirabilis K.pneumoniae H.influ M.catarrhalis
64
Ceftaroline Anaerobes coverage
P.acnes Peptostreptococci
65
Clinical uses Ceftaroline
Bacteremia (MRSA, combo therapy) Pneumonia (MRSA) SSTI (Mixed MRSA + enterobacteriaceae)
66
New Cephalosporins
Ceftazidime/Avibactam Ceftolozane/Tazobactam Cefiderocol
67
New Cephalosporins Gram + coverage
Strep spp
68
New Cephalosporins Gram - coverage
E.coli P.mirabilis K.pneumoniae - inc MDRO H.influ M.catarrhalis Pseudomonas Acinetobacter Stenotrophomonas (Cefiderocol)** - inc MDRO
69
New Cephalosporin Anaerobe coverage
P.acnes Peptostreptococci (Except Cefiderocol***) B.Frag (Ceftolozaone/tazo only**)
70
New Cephalosporin Clinical uses
HAP/VAP (MDR Gram -) UTI (MDR Gram -) Intra-adb infection (MDR Gram -) Bacteremia ( MDR Gram -)
71
Aztreonam Gram - coverage
E.coli P.Mirabilis K.Pneumoniae H. influ M.catarrhalis Pseudomonas Serratia Enterobacter Citrobacter
72
Aztreonam Clinical uses
Penicillin Allergy Ventriculitis or Meningitis ( Enterobacteriaceae or P.aerug) HAP/VAP (MDR or P.aeruginosa) UTI (MDR or Pseudomonas) Intra-abd infect (MDR or Pseudomonas) + metronidazole +/- vanco
73
Carbapenems Gram + coverage
Streptococcus spp. (Grp A/B, pneumoniae) Staphylococcus aureus (MSSA) Enterococcus faecalis (except ertapenem*)
74
Carbapenem Gram - coverage
E. coli; Proteus mirabilis; K. pneumoniae – including ESBL* H. influenzae; M. catarrhalis Serratia; Enterobacter; Citrobacter Pseudomonas (except ertapenem*)
75
Carbapenem Anaerobe coverage
P.acnes Peptostreptococci
76
Carbapenem Clinical uses
Meningitis (ESBL, MSPACE, P.aeruginosa)** except -ertapenem HAP/VAP (ESBL, MSPACE,P. aeruginosa) UTI (ESBL, MSPACE, P.aeruginosa) Kidney only*** Intra-abd infection (ESBL, MSPACE, Pseudomonas Bacteremia (ESBL, MSPACE, Pseudomonas)
77
Fluoroquinolones
Cipro Levo Moxi Dela
78
Delafloxacin Gram + coverage
Strep spp (Grp A/B, pneumoniae) S.aureus MSSA/MRSA E.faecalis
79
Delafloxacin/Levo/Cipro Gram - coverage
E. coli; Proteus mirabilis; K. pneumoniae H. influenzae; M. catarrhalis Serratia; Enterobacter; Citrobacter Pseudomonas
80
Which Gram - does Moxifloxacin not cover?
Pseudomonas
81
Anaerobes coverage Delafloxacin
B.frag P.acnes Peptrostreptococci
82
Fluoroquinolone w/ best Anaerobe coverage
Moxifloxacin
83
Fluoroquinolone coverage for "other" bugs?
Mycobacteria = TB Atypical
84
Clinical uses Fluoroquinolones
Oropharyngeal (Moxi) CAP (s.pneu + H.influ) all except cipro UTI (enterobacteriaceae) all except moxi Intra-ab infection (Enterobacteriaceae, Pseudomonas) all except moxi Osteomyelitis
85
Clinical uses Tetracyclines
HAP/VAP (MDr Acinetobacter) all except doxy SSTI (MRSA) - doxy Intra-ab infection (mixed Gram +/-)
86
Azithromycin Gram + coverage
Strep spp. (Grp A/B, strep pneumoniae)
87
Azithromycin Gram - coverage
H. influenzae
88
"Other" coverage w/ Azithromycin
Atypical
89
Azithromycin Clinical uses
STDs (Chlamydia) CAP (Atypical, combo w/ B-lactam) Sinusitis, Bronchitis (susceptible S.pneu/H.influ)

CDM 3 Exam 1 (10 decks)

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