Lecture 2 Flashcards Preview

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Flashcards in Lecture 2 Deck (41)
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1
Q

factors affecting empirical therapy

A

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

2
Q

gram positive

A

blue cocci

3
Q

gram negative

A

pink bacilli

4
Q

common gram + microorg

A

staph, strep, enterococcus

5
Q

Staph aureus

A

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

6
Q

Staph epidermidis

A

opportunistic pathogen, coagulase -

7
Q

Staph saprophyticus

A

minor pathogen

8
Q

Strep Pyrogenes

A

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

9
Q

Strep Pneumoniae

A

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

10
Q

E. faecalis

A

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

11
Q

E. Faecium

A

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

12
Q

gram - microorganism

A

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

13
Q

Pen G Aqueous

A

only administered IV/IM, acid labile-degraded orally

14
Q

Pen G Benzathine (Bicillin L-A)

A

long acting - one time tx of early syphilis

lasts for 15-30 days in body

15
Q

Pen G Wycillin

A

Lasts for hrs in body

16
Q

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

A

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

17
Q

Pen V

A

phenoxymethyl penicillin, acid stable

only for oral use in Na or K salts

18
Q

Nafcillin

A

used to tx serious MSSA bloodstream infn

hepatic ally metal so no adjustment for renal impairment

19
Q

Amoxacillin

A

-OH at para position improves oral abs

oral equivalent of ampicillin

20
Q

Carbenicillin

A

1st PCN with activity against P. aeruginosa

21
Q

Ticarcillin

A

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

22
Q

cephalosporins

A

most are active against Staph/Strep

MRSA are resistant to all cephalosporins

23
Q

cephamycins

A

2nd gen cephalosporins, sig activity over anaerobes

useful in and/GI sx prophylaxis

24
Q

3rd gen cephalosporins

A

PO mainly for kids

25
Q

ceftazidime

A

may accelerate acquired resistance

26
Q

ceftriaxone

A

used with azithromycin for CAP

27
Q

4th gen cephalosporins

A

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

28
Q

carbapenems

A
broadest activity of B-lactam class due to improved B-lactamase stability
excellent gram +, - and anaerobic coverage
29
Q

impenem (primaxin)

A

add Cilastin - prevents renal metab

30
Q

Dorpenem (doribax)

A

newest carbapenem, little coverage against P aeruginosa

31
Q

Metronidazole (Flagyl)

A

good oral abs, same PO/IV dose

hepatic ally metab (no renal adjustments)

32
Q

erythromycin

A

sig GI upset

33
Q

Clarithromycin

A

less GI upset than erythromycin

34
Q

Azithromycin

A

least GI upset, covers more atypical org’s

35
Q

Telithromycin (Ketek)

A

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

36
Q

Vanco

A

glycopeptides, initially relegated to PCN allergic pt’s

inc use in 80’s

37
Q

TMP and SMX

A

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

38
Q

quinolones

A

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

39
Q

Ciprofloxacin

A

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

40
Q

Moxifloxacin (Avelox)

A

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

41
Q

IV to PO

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