Term
|
Definition
gram(+) bugs including anaerobes
no gram (-) activity |
|
|
Term
|
Definition
|
|
Term
| Used for Ampicillin R enterococci |
|
Definition
| vancomycin, however now 50% are R to vanc |
|
|
Term
| Used for Penicillin R strep pneumo |
|
Definition
| Can use vanc, but a fluoroquinolone such as moxi or levo will work as long as it's not meningitis |
|
|
Term
|
Definition
| used for resistance strains of C. dificile in pseudomembranous colitis, however, Vanc is generally NOT absorbed through the GI tract. I.V. only for systemic infections |
|
|
Term
|
Definition
| False, it is a very large molecule |
|
|
Term
|
Definition
| Renal, so monitor renal fxn. |
|
|
Term
| Vanc side effects, give 4 |
|
Definition
Ototoxicity
Renal toxicity
Red- man syndrome
allergic rxns and rash |
|
|
Term
| Is Red man syndrome an allergic rxn? |
|
Definition
| NO, too quick a vanc injection gives a histamine reaction, so infuse it slowly |
|
|
Term
| Treatement of MDR strep pneumo infections |
|
Definition
|
|
Term
| treatment of Hospital infections caused by MRSA |
|
Definition
|
|
Term
| Treatment of ampicillin R enterococcal infections e.g. E. faecium |
|
Definition
|
|
Term
| Empiric therapy for bacterial meningitis |
|
Definition
treat with ceftriaxone + vanc: vanc added to cover PCN Resistance
add i.v. ampicillin to cover Listeria if < 2 years old |
|
|
Term
| Empiric therapy for febrile neutropenia |
|
Definition
a. pip/tazo or cefepime
add van when there is evidence of gram + infection or awaiting culture results |
|
|
Term
| Empiric therapy for Gram + bacteremia |
|
Definition
| Use Vanc until you know what bug is causing the infection |
|
|
Term
| #1 bug cultured from blood samples |
|
Definition
| coag negative staph and 90% it is S. epid due to contamination |
|
|
Term
| DOC for C. difficile intections |
|
Definition
metronidazole,
give 2 courses of po metro, if patient still has infection or inf is life threatening, treat with po. vanc |
|
|
Term
| Most freq used tetracyclines |
|
Definition
| tetracycline HCL, doxycycline, and minocycline |
|
|
Term
|
Definition
| inhibit protein synth by binding 30s A site blocking tRNA |
|
|
Term
| T/F, tetracyclines are bacterocidal |
|
Definition
|
|
Term
| Spectrum of tetracyclines |
|
Definition
65% of staph aureus are susceptible
covers strep, but no GBS, so doxycycline will not cover SSTIs caused by GBS |
|
|
Term
| Used in combination with amoxicillin or cephalexin to treat serious SSTIs. |
|
Definition
| Tetracyclines; amox or cephalexin are added to cover GBS and beta-hemolytic strep |
|
|
Term
| T/F tetracyclines have poor gram(-) activity |
|
Definition
|
|
Term
| Excellent activity against intracellular pathogens such as Mycoplasma, Chlamydia, and Rickettsia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Used for the treatment of Lyme disease, Borrelia burgdorferi and B. recurrentis |
|
Definition
|
|
Term
| Active against Yersinia pestic, Enamoeba histolytica and Plasmodium falciparum (malaria) |
|
Definition
|
|
Term
| Bacterial R mech for Tetracyclines |
|
Definition
| mutation which protects the drug binding site and/or and efflux pump. Doxy may still work. Tige overcomes both mech of Resistance |
|
|
Term
| Preparations of Tetracyclines available |
|
Definition
| all i.v. and p.o. except tigecylcine which is i.v. only |
|
|
Term
| Contraindications for P.O. tetracycline |
|
Definition
| p.o. with milk, multivitamins, Ca, Mg, Al, or Fe will chelate preventing drug abs. |
|
|
Term
| oral bioavailability of doxycycline and minocycline |
|
Definition
|
|
Term
| dosage of doxycycline and minocycline |
|
Definition
| long half-lives and slow elimination so 2x daily |
|
|
Term
|
Definition
highly conc in the bile so check LFT's,
minocycline is partially metabolized by the liver |
|
|
Term
| DOC for patients with renal dysfunction |
|
Definition
| Doxycycline b/c it is elim by fecal excretion |
|
|
Term
| Toxicity of Tetracyclines |
|
Definition
GI, esp with tige
tooth discoloration
photosensitization
hepatotoxic in large doses
superinfections |
|
|
Term
| Contraindications for tetracycline use |
|
Definition
| pregnant femails and children under 15 due to bone deformity due to Ca binding |
|
|
Term
| Superinfection side effects of Tetracyclines |
|
Definition
over growth of Clostridium difficile, staph, Candida leading to:
disturbed GI fxn
oral, anal, vaginal candidiasis
C. dif pseudm colitis - treat with metro |
|
|
Term
|
Definition
|
|
Term
| Impoprtant organisms in CAP Typical: |
|
Definition
extracellular
trep pneumo
H. influ
Morax catarrhalis |
|
|
Term
| Important organisms in CAP atypical: |
|
Definition
M. pneumo
Chlamydia spp.
Legionella spp. |
|
|
Term
| DOC for rickettsial infections |
|
Definition
|
|
Term
|
Definition
doxycycline
tetracyclines cover all of the typical and atypical bugs causing CAP |
|
|
Term
| tetracycline MRSA coverage |
|
Definition
| doxycycline and minocycline cover 95% for community acquired MRSA strains |
|
|
Term
|
Definition
| Tetracyclines esp. minocycline |
|
|
Term
| Therapeutic use of Tigecycline |
|
Definition
| given i.v. for infections caused by MDR Acinetobacter spp, MRSA, and Stenotrophomonas maltophilia. Very low serum levels due to tolerability issues at higher doses. Avoid in bacteremic patients |
|
|
Term
| Macrolides, what are the drugs |
|
Definition
erythromycin i.v. hurts, p.o. severe n/v
clarithromycin p.o only
azithromycin i.v. and p.o. |
|
|
Term
|
Definition
inhibition of protein synthesis
binds to 50s subunit at the peptidyltransferase site inh transloc.
elongation stops and prot synth is terminated |
|
|
Term
| T/F Macrolides are bacteriocidal |
|
Definition
|
|
Term
| Macrolide spectrum of activity |
|
Definition
Moderate gram (+) activity includ S. pneumo
only 7% of Staph aur isolates are susceptible to macrolides at UHS |
|
|
Term
| Are Macrolides active against MRSA, VRE of enterococcus |
|
Definition
|
|
Term
| Macrolides with improved Gram (-) activity |
|
Definition
| clarithromycin and azithromycin |
|
|
Term
| Mechanism of Macrolide resistance |
|
Definition
"ribosomal protection" drug binding site has been modified by a bacterial methylase
also have drug efflux pumps |
|
|
Term
| What is the p.o. bioavail of erythromycin? |
|
Definition
acid labile which limits po bioavailability
Erthromycin esters are less acid labile and have better bioavailability |
|
|
Term
| Absorption of clarithromycin an azithromycin |
|
Definition
| GOOD and well absorbed bioavail = 0.5 |
|
|
Term
| Erythromycin and azithromycin excretion |
|
Definition
|
|
Term
|
Definition
| metabolized by the liver and the metabolites are excreted in the urine |
|
|
Term
| DOC's for atypical pathogens in CAP? Give order of preference, and rational |
|
Definition
azi > clari = erythro
high intracellular concentrations and penetration of most tissues except brain and CSF |
|
|
Term
| Best Macrolide to the treatment of CAP |
|
Definition
| Clarithromycin b/c it yields good intracellular and extracellular drug concentrations |
|
|
Term
|
Definition
| motility GI upset and cramping, clarithromycin metallic tast, and azithromy 2g will make you throw up |
|
|
Term
| Macrolide drug interactions? Give order of interference |
|
Definition
| All inhibit CYP450 and prevent hepatic metabolism of many other drugs. Eryth is worst, clarith is better, and azith has the least CYP450 interactions |
|
|
Term
| DOC for treatment of outpatient CAP |
|
Definition
| clarithromycin b/c clari produces high intracellular to cover atypical bugs and sufficient extracellular concentrations to cover the typical bugs |
|
|
Term
|
Definition
|
|
Term
|
Definition
intracellular
M. pneumo
Chlamydia
Legionella |
|
|
Term
| Gold standard for treat ment of legionella infections |
|
Definition
| any macrolide, but alos levo and moxifloxacin |
|
|
Term
| Treatment of Myco avium, Chlamydia, Mycoplasma, though not Myco tb. |
|
Definition
| Macrolides, erythromycin, clarithromycin, or azithromycine |
|
|
Term
|
Definition
|
|
Term
| Macrolides for treatment of pediatric otitis media |
|
Definition
|
|
Term
|
Definition
| a 1st gen ketolide/ 3rd gen macrolide with a black box warning |
|
|
Term
|
Definition
| Binds to the 50S subunit at the peptidytransferase site, which, inhibits translocation - stops protein synth |
|
|
Term
| T/F clindamycin is Bactericidal |
|
Definition
|
|
Term
| Clindamycin Spectrum of activity |
|
Definition
good for Gram + inhibits toxin production
SSTIs caused by S. aureus and B-hemolytic strep |
|
|
Term
| Can you use clindamycin for someone with a PCN allergy |
|
Definition
|
|
Term
| T/F Clindamycin has good gram - activity and covers VRE |
|
Definition
|
|
Term
| Used to treat aspiration pneumonia |
|
Definition
| Clindamycin b/c it has good Gram + anaerobe coverage |
|
|
Term
| You can use Clindamycin for GI surgery? |
|
Definition
| NO, decreasing susceptibility of gram (-) anaerobes |
|
|
Term
| Can clindamycin be given P.O.? |
|
Definition
| YES good p.o. bioavailability |
|
|
Term
| Clindamycin penetrates most body fluids and tissues except ? |
|
Definition
|
|
Term
| Metabolism of Clindamycin |
|
Definition
|
|
Term
|
Definition
Rash, diarrhea due to bowel flora change
AND C. dif is historically linked to clindamycin |
|
|
Term
| Treat pseudomembranous colitis with? |
|
Definition
|
|
Term
| DOC for aspiration pneumonia |
|
Definition
| Clindamycin b/c good for Gram (+) anaerobic |
|
|
Term
| Other Therapeutic uses of Clindamycin which are similar to the rest of the macrolides |
|
Definition
| SSTIs, PCN allergic patients, acne, community acquired MRSA. |
|
|
Term
| Treatment of Osteomyelitis |
|
Definition
|
|
Term
| Treatment of infection in patients with diabetes mellitus |
|
Definition
|
|
Term
| What is a fluoroquinalone? and name the major ones |
|
Definition
it is a fluorinated derivative of nalidixic acide (toxic, lab only)
levofloxacin
moxifloxacin
ciprofloxacin |
|
|
Term
|
Definition
Inhibit DNA synthesis by inhibitin Topo II and IV
Topo II allows normal gene transcr and DNA repl
Topo IV req for the sep of replicated DNA |
|
|
Term
|
Definition
| rapidly bactericidal = concentration dependent killing |
|
|
Term
| General FQ spectrum of activity |
|
Definition
| Good against Gram (-) but limited effectiventss against gram (+) |
|
|
Term
| Gram (+) relative FQ activity |
|
Definition
| moxi = gemi > levo > cipro |
|
|
Term
| Relative Antipseudomonal activity of FQs |
|
Definition
| levo = cipro >> moxi = gemi |
|
|
Term
| Relative gram (-) activity of FQs |
|
Definition
|
|
Term
| Anaerobic activity of FQ's |
|
Definition
moxi > levo = cipro
do NOT use FQ's for anaerobi infections:
use pip-tazo or combine FQ with metronidazole |
|
|
Term
| Are FQ's good for intracellular paths |
|
Definition
YES, e.g. atyp paths causing CAP which are?
Mycoplasm
Legionells
Chlamydia |
|
|
Term
| Can you use FQ's for MRSA |
|
Definition
NO, 50% R in S.A.
Usuall y not active against MRSA |
|
|
Term
| What do you use to treat MRSA? |
|
Definition
P.o. clindamycin, trim-sulfa, or doxycycline;
i.v. vanc for serious MRSA.
inpatient SSTIs use Doxy + i.i. cefazolin. dox covers MRSA and cefazolin covers GBS |
|
|
Term
| DOC for MDR Strep pneumo. |
|
Definition
| FQ, use levo, moxi, and gemi |
|
|
Term
| Can you use cipro for S. pneum inf. ? |
|
Definition
NO remember:
g+ activity moxi = gemi > levo> cipro |
|
|
Term
| Where do FQ resistant Strep pneumo infections originate: |
|
Definition
Nursing Homes, so do not use FQ's
Treat them with???
pip-tazo or cefepime, or even add a aminoglycoside like gentamicin ... or an antipseudomonal FQ |
|
|
Term
| What are the anti-pseudomonal FQ's? |
|
Definition
| levo mostly as 50% are cipro R |
|
|
Term
| DOC for outpatient treatment of CAP |
|
Definition
|
|
Term
| DOC for inpatient treatment of CAP |
|
Definition
|
|
Term
| why do you use these different drugs for in and out patient CAP, FQ and macrolides respectively? |
|
Definition
| CDC guidelines discourage the use of FQ' to treat outpatient CAP b/c it will lead to increased resistance of Strep pneumo to the FQ's |
|
|
Term
| Are FQ's effective against Enterococcus or VRE? |
|
Definition
|
|
Term
| What are the anti-pseudomonal FQ drugs? Are they best for pseudomonal infection treatment? |
|
Definition
Cipro and levo can be used but they are no longer reliable.
Use an antipseudomonal B lactam like Pip-tazo |
|
|
Term
| What UTI's are FQ's effective treatment for? |
|
Definition
| Mostly outpatient E.coli UTIs. Res is becoming a problem in hospitals. Use Nitrofurantoin. |
|
|
Term
| Drug effective against 75% of E. coli strains at UH |
|
Definition
|
|
Term
| General administration and absorption of FQs? |
|
Definition
F = 0.9 so p.o. == i.v.
Oral FE, Ca, Al and Mg supp and antacids chelate FQ decreasing GI absorption |
|
|
Term
| Dairy and antacids affect which FQ? |
|
Definition
| Cipro bioavailability is decreased |
|
|
Term
| Dairy does not affect which FQ's? |
|
Definition
| levofloxacin and gemifloxacin |
|
|
Term
| Can you treat UTI's with moxi? Why? Why not? What else is there? |
|
Definition
can't use moxi as only a small amount of it ends up in the urine, mostly hepatic metabolism
Use levo or cipro as they are eliminated renally |
|
|
Term
|
Definition
Damage growing cartilage - no kids
Tendon rupture
Phototoxicity - cirpo
Q-T prolongation - amplifideed with sotalol or amiodarone, CONTRAindicated |
|
|
Term
| 1st line drugs for inpatient treatment of CAP |
|
Definition
| ceftriaxone + a macrolide like clarithromycin |
|
|
Term
| Can you use FQ for nursing home patients with CAP |
|
Definition
|
|
Term
| Explain the difference between complicated and uncomplicated UTIs and what drug you'd use to treat? |
|
Definition
FQ's are 1st line for complicated UTIs
Uncompl is infection in a structurally and neurologically normal urinary tract
Complicated - cath, neph abnormal, hospit patients, upper UTI,
again no FQ's for nursing home patients |
|
|
Term
| What systemic infection can you use FQ's to treat? |
|
Definition
|
|
Term
| DOC for MDR S. pneumo (not meningitis)? |
|
Definition
| levo or moxi as they have enhanced Gram (+) activity |
|
|
Term
| Can you use cipro for MDR S. pneumo? |
|
Definition
|
|
Term
|
Definition
| Diarrhea from salmonella, shigella, campy, and E. coli |
|
|
Term
| Can you use FQ's for SSTI's |
|
Definition
| NO, 50% of all MRSA are FQ Resist |
|
|
