Lecture 2

Question 1

factors affecting empirical therapy

Answer 1

type of suspected infn, infn location, seriousness of infn, previous antimicrobial therapy, comorbidities

Question 2

gram positive

Answer 2

blue cocci

Question 3

gram negative

Answer 3

pink bacilli

Question 4

common gram + microorg

Answer 4

staph, strep, enterococcus

Question 5

Staph aureus

Answer 5

coagulase +, methicillin sensitive (MSSA) or resistant (MRSA) so PCN/cephalosporin will not be effective

Question 6

Staph epidermidis

Answer 6

opportunistic pathogen, coagulase -

Question 7

Staph saprophyticus

Answer 7

minor pathogen

Question 8

Strep Pyrogenes

Answer 8

pyogenic, strongly B-hemolytic, causes pharyngitis, resp and skin infn

Question 9

Strep Pneumoniae

Answer 9

causes pneumonia, sepsis, otitis media and meningitis, gram (+) cocci in pairs “diplococci”, causes a-hemolysis

Question 10

E. faecalis

Answer 10

80-90% of clinical isolated, major enterococcal organism in GI tract

Question 11

E. Faecium

Answer 11

5-10% of clinical isolates, increasingly Vanco-resistant

Question 12

gram - microorganism

Answer 12

Citrobacter sp, Pseudomonas aeruginosa, Acinetobacter sp. - all prone to developing MDR

Question 13

Pen G Aqueous

Answer 13

only administered IV/IM, acid labile-degraded orally

Question 14

Pen G Benzathine (Bicillin L-A)

Answer 14

long acting - one time tx of early syphilis

lasts for 15-30 days in body

Question 15

Pen G Wycillin

Answer 15

Lasts for hrs in body

Question 16

Pen G Benzathine and Pen G Procaine (Bicillin C-R)

Answer 16

used to tx certain Strep infn, easily confused with Pen G Benzathine
lasts 24 hrs

Question 17

Pen V

Answer 17

phenoxymethyl penicillin, acid stable

only for oral use in Na or K salts

Question 18

Nafcillin

Answer 18

used to tx serious MSSA bloodstream infn

hepatic ally metal so no adjustment for renal impairment

Question 19

Amoxacillin

Answer 19

-OH at para position improves oral abs

oral equivalent of ampicillin

Question 20

Carbenicillin

Answer 20

1st PCN with activity against P. aeruginosa

Question 21

Ticarcillin

Answer 21

2-4 x more activity against P. aeruginosa
rarely used alone due to B-lactamase hydrolysis
usually given IV with clavulante

Question 22

cephalosporins

Answer 22

most are active against Staph/Strep

MRSA are resistant to all cephalosporins

Question 23

cephamycins

Answer 23

2nd gen cephalosporins, sig activity over anaerobes

useful in and/GI sx prophylaxis

Question 24

3rd gen cephalosporins

Answer 24

PO mainly for kids

Question 25

ceftazidime

Answer 25

may accelerate acquired resistance

Question 26

ceftriaxone

Answer 26

used with azithromycin for CAP

Question 27

4th gen cephalosporins

Answer 27

widest spectrum of all cephalosporins useful against many MDR gram - bacilli 70-80% gram - bacilli resistant to ceftazidime are sensitive to 4th gen's

Question 28

carbapenems

Answer 28

``` broadest activity of B-lactam class due to improved B-lactamase stability excellent gram +, - and anaerobic coverage ```

Question 29

impenem (primaxin)

Answer 29

add Cilastin - prevents renal metab

Question 30

Dorpenem (doribax)

Answer 30

newest carbapenem, little coverage against P aeruginosa

Question 31

Metronidazole (Flagyl)

Answer 31

good oral abs, same PO/IV dose | hepatic ally metab (no renal adjustments)

Question 32

erythromycin

Answer 32

sig GI upset

Question 33

Clarithromycin

Answer 33

less GI upset than erythromycin

Question 34

Azithromycin

Answer 34

least GI upset, covers more atypical org's

Question 35

Telithromycin (Ketek)

Answer 35

ketolide/macrolide, inc risk of hypoglycemia in top 2 diabetes

Question 36

Vanco

Answer 36

glycopeptides, initially relegated to PCN allergic pt's | inc use in 80's

Question 37

TMP and SMX

Answer 37

block consecutive steps in bacterial folate syn used extensively for UTIs PO Dose UTIs: 1 DS tab q12h

Question 38

quinolones

Answer 38

fluorine derivatives greatly improved potency cidal inhibition of DNA -gyrase and topoisomerase IV most active against gram - org pseudomonas resistance emerges if used as mono therapy

Question 39

Ciprofloxacin

Answer 39

cystitis: 250 mg q12h x 3 d; IV 200 mg LRTI: 500-750 mg PO q12h x 7-14d; IV 400 mg

Question 40

Moxifloxacin (Avelox)

Answer 40

non-renally eliminated recently FDA approved for UTIs hepatic ally metab

Question 41

IV to PO

Answer 41

``` afebrile > 24h WBC normal or normalizing (NML 10000-12000) tolerating oral diet no nausea/vomiting no contraindications for PO ```