Term
| What is an empiric treatment? |
|
Definition
| Tx started before identifying pathogen. Have to treat during acute phase |
|
|
Term
| What are causes of drug fever? |
|
Definition
Beta lactams
Sulfonamides
Nitrofurantoins |
|
|
Term
| What is the normal body temperature? |
|
Definition
|
|
Term
|
Definition
Normal - 4,500 - 10,000
"Left Shift" - Ratio of immature/mature neutrophil cells indicates infection - more immature cells |
|
|
Term
| What other tests indicate inflammation? |
|
Definition
- ESR - a test for osteomyelitis
- CRP
- Cytokines |
|
|
Term
| What changes establish infection severity? |
|
Definition
- Hemodynamic - blood circulation, HR, BP
- Cellular - glucose, ESR, CRP
- Respiratory - Acidosis/Alkalosis
- Hematological - Prothrombin, APPT, DIC
- Neurologic - psychosis, disorientation, confusion |
|
|
Term
| What is the difference between colonization and infection? |
|
Definition
- Colonization - normal flora, a defense mechanism. In skin, GI, and genital tract.
- Infection - Become immunocompromised, pathogenic organisms |
|
|
Term
| What are the most likely infections of various areas of the body? |
|
Definition
- Abdomen – Gram(-) enterics and anaerobes
- Respiratory – gram(-) bacilli and staph
- Urinary tract – gram(-) rods such as Klebsiella, E. coli, proteus
- Skin – S. epi and S. aureus |
|
|
Term
| What staining techniques are used to ID cultures? |
|
Definition
- Gram stain - +(purple) or -(pink)
- Ziehl-Neelsen stain - for acid fast/TB
- India Ink - certain fungi
- KOH - fungi
- Giemsa stains - parasites |
|
|
Term
| What drugs are markers for MRSA? |
|
Definition
|
|
Term
| What is the difference between qualitative and quantitative testing? |
|
Definition
- Qualitative - Disk diffusion
- Quantitative - MIC by broth dilution, Etest, automated systems |
|
|
Term
|
Definition
| A quantitative measure - can determine heteroresistance by looking at subcolonies |
|
|
Term
| What automated systems look at MIC? |
|
Definition
- Vitek
- Microscan Walkaway
- Phoenix
- Sensititre
**Faster, but require manual inoculation and quality control. Not all organisms work in machine. |
|
|
Term
| What are fastidious organisms? |
|
Definition
Slow growing, must be tested by hand
- H. influenzae
- N. gonorrhea
- S. Pneumoniae
- Anaerobes
- Mycobacteria |
|
|
Term
| What is the double disk diffusion test (D-test)? |
|
Definition
| Testing for MRSA and a patient is Eryth-R and Clinda-S -- If D test is positive by Clinda susceptibility forming a D pattern, do NOT use Clinda |
|
|
Term
|
Definition
| Using an E test, if ESBL(-), an elliptical shape will form. If interrupted, CANNOT use Cefs |
|
|
Term
| What are limitations to MIC testing? |
|
Definition
Protein binding - albumin.
Media
**CLSI standardizes methods |
|
|
Term
| What are the breakpoints of MIC? |
|
Definition
- Susceptible - Will affect majority of the time
- Intermediate - might have to use a higher dose
- Resistant - no activity |
|
|
Term
|
Definition
| 90% of the time there is an infection, there is successful tx. 60% of the time there is resistance, there is successful tx. |
|
|
Term
|
Definition
Lists general susceptibilities of antibiotics to bacteria - want over 80
**Try to give the most economically appropriate antibiotic |
|
|
Term
|
Definition
- Allergy - have to know rxn
- Age - liver disease, chloramphenicol
- Organ fxn - renal dosing
- Metabolic abnormalities
- Pregnancy
- Concomitant drugs, disease states |
|
|
Term
| What causes failure of therapy? |
|
Definition
- Drug selection - inappropriate dose/route
- Host factors
- Pathogen resistance |
|
|
Term
| What are the phases in pharmacokinetics? |
|
Definition
- Absorption/infusion
- Distribution/alpha phase
- Elimination/beta phase |
|
|
Term
|
Definition
Want to maintain drug above MIC, below mutation window
**Want AUC:MIC ratio under the curve and time > MIC |
|
|
Term
| What is antimicrobial stewardship? |
|
Definition
Working between infection control and antibiotic management.
Collateral damage leads to resistance |
|
|
Term
| What increases the risk of antimicrobial resistance? |
|
Definition
- nosocomial infections
- Receiving prior antibiotics
- high rate of antibiotic use
- duration of exposure |
|
|
Term
| What is selection pressure? |
|
Definition
- Dose CANNOT be subtherapeutic
- Sterile procedure
- Effective diagnosis/Tx
- Optimize dose |
|
|
Term
| Who endorses stewardship guidelines? |
|
Definition
- Recommendations by IDSA and SHEA
- Endorsed by: ASHP, AAP, IDSOBGYN, PIDS, SHM, SIDP |
|
|
Term
| What are the goals of stewardship? |
|
Definition
- Primary - optimize outcomes while minimizing unintended consequences: toxicity, Selection for pathogens, resistance
- Secondary - Reduce costs without impacting QoC |
|
|
Term
| What are training requirements for ID pharmacists? |
|
Definition
- Developed by SIDP and ACCP
- Complete PGY1 and 2
- Need certification and an exam
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