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STEP 2 by day > 10 May Antibiotics > Flashcards

10 May Antibiotics Flashcards

1
Q

Primary use for Penicillin G or VK

A

Syphilis

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2
Q

What drugs are used for methicillin sensitive staph. aureus?

A

Nafcillin
Dicloxacillin
Oxacillin

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3
Q

On the gram (+) side, what is the to of the ladder if vancomycin is not available or not effective?

A

Linezolid

Expensive, oral and IV

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4
Q

What are the first drugs meant to expand penicillin coverage to gram (-)?

A

Amoxicillin
Ampicillin
These should be used for g(-) coverage though we know that amoxicillin covers strep throat

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5
Q

What are the beta-lactamase inhibitors and their most common combinations?

A

Tazobactam + Piperacillin = Zosyn
Sulbactam + Ampicillin = Unasyn
Clavulanate + Amoxicillin = Augmentin

These beta-lactamase inhibitors are used to expand the coverage of gram(-) drugs to gram(+) as well
Zosyn is broad spectrum and covers most everything except MRSA and fungus

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6
Q

Why was piperacillin developed?

A

To treat Pseudomonas which is gram (-) and resistant to amoxicillin and ampicillin

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7
Q

When using zosyn, what are you saying you are covering?

A

Pseudomonas

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8
Q

What is the top of the ladder on the gram(-) side?

A

Carbapenems

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9
Q

What are the carbapenems?

A

Imipenem/cilastatin (causes seizures, must have cilastatin)
Meropenem
Ertapenem

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10
Q

What are the most common first and second generation cephalosporins and what are they used for?

A

First: cefazolin (IM/IV), cephalexin (oral)
Second: Cefoxitin (IM/IV), Cefaclor (oral), Cefuroxime (IM/IV)
These have g(+) coverage and are used for skin infections

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11
Q

What are most common 3rd gen cephalosporins? When used?

A

Cefotaxime (IM/IV)
Ceftriaxone (IM/IV) (Rocephin)
Omnicef (Oral)

g(-) and g(+) coverage

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12
Q

What is 4th gen cephalosporin and when used?

A 
Cefepime (IV)
Pseudomonas
Only g(-) coverage
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13
Q

Describe coverage of the fluoroquinolones through the generations

A

Each generation retains the properties of the one before. Think of baseball diamond.
First and second more g(-), 3rd more g(+)

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14
Q

What are the most common drugs in three generations of fluoroquinolones?

A

First: Norfloxacin
Second: Cipro, Levo
Third: Moxi

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15
Q

What is the coverage of ciprofloxacin? Primary use?

A

As a second generation fluoroquinolone, it has great gram(-) coverage and no g(+) coverage
Often used for UTI’s

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16
Q

What is the coverage of levofloxacin? Use?

A

As a second generation fluoroquinolone, it has great gram(-) coverage and no g(+) coverage
Often used for soft tissue infections

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17
Q

What is the coverage of moxifloxacin? Use?

A

As a third generation fluoroquinolone, it has great gram(-) coverage and also g(+) coverage
Often used for pneumonia

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18
Q

What are the two drugs for anaerobes?

A

Clindamycin for anywhere but the abdomen and genital

Metronidazole for abdomen and genital/groin

19
Q

What is the treatment for CAP?

A

1) Moxifloxacin (IV or Oral) (avoid if possible to prevent resistance)
2) Ceftriaxone + azithromycin (beta-lactam + macrolide) (used if inpatient)
3) Azithromycin alone (used if sent home)

20
Q

What is the treatment for HCAP?

A

Covering MRSA and pseudomonas

Vanc + Zosyn

21
Q

What is the treatment for meningitis?

A

Ceftriaxone + Vancomycin +/- steroids +/- ampicillin

For Step 2, everyone gets steroids, only immune compromised get ampicillin

22
Q

What is the treatment for UTI?

A 
Amoxicillin: pregnant
Nitrofurantoin: woman
Bactrim: if no renal failure
Ceftriaxone: IV only, inpatient management of pyelonephritis
Ciprofloxacin: ambulatory pyelonephritis
23
Q

What is the treatment for cellulitis?

A

Covering for MRSA or Strep
Vancomycin
Clindamycin
Bactrim

24
Q

Cefazolin

A

1st gen cephalosporin
g(+) coverage
IV/IM
Often used for surgery prophylaxis and skin infections because covers g(+) well

25
Q

Cephalexin

A 
1st gen cephalosporin (Keflex)
g(+) coverage
Oral
One of most common used in USA
Used for g(+) infections of bone, middle ear, lungs and skin
Also used for endocarditis prophylaxis
26
Q

What bug can alkalinize the urine and cause struvite crystals in urine and large kidney stones? G(+) or (-)?

A

Proteus mirabilis

Gram (-)

27
Q

What are the gram (-) bugs killed by first gen cephalosporins?

A

PEcK
Proteus
E. coli
Klebsiella

28
Q

What are the 3 notable 2nd gen cephalosporins?

A

Cefoxitin
Cefaclor
Cefuroxime

29
Q

What are the g(-) coverage of 2nd gen cephalosporins?

A 
PEcK HENS
Proteus
E. coli
Klebsiella
H. flu
Enterobacter
Neisseria
Serratia
30
Q

Cefoxitin

A

2nd gen cephalosporin

31
Q

Cefaclor

A

2nd gen cephalosporin

32
Q

Cefuroxime

A

2nd gen cephalosporin

Unique in that can cross the BBB

33
Q

What are the most common 3rd generation cephalosporins?

A

Cefotaxime
Ceftriaxone
Cefdinir
Ceftazidime

34
Q

What are 3rd gen cephalosporins generally used for?

A

Serious g(-) infections that are resistant to other beta-lactams

35
Q

Cefotaxime

A

3rd gen cephalosporin
Can cross BBB
Covers most g(-) except pseudomonas, and most g(+) except enterococcus

36
Q

Ceftriaxone

A

3rd gen cephalosporin
Rocephin
Single IM injection for gonorrhea
Crosses BBB

37
Q

Cefdinir

A

3rd gen cephalosporin
Treats pneumonias, bronchitis, ear infections, sinusitis, pharyngitis, tonsillitis, skin infections
Can make red stool in kids

38
Q

Ceftazidime

A 
3rd gen cephalosporin
Great g(-) and g(+) coverage
Treats pseudomonas
39
Q

What is the 4th gen cephalosporin and its primary use?

A

Cefepime

Pseudomonas

40
Q

What are common uses for bactrim?

A 
UTI
MRSA Skin infections
Traveler's diarrhea
Respiratory infections
Cholera
41
Q

How does bactrim work?

A

Inhibits folate synthesis at two locations by synergistic effect of both drugs

42
Q

What is the empiric treatment for spontaneous bacterial peritonitis?

A

Usually a 3rd generation cephalosporin

43
Q

What is used for SBP prophylaxis?

A

Fluoroquinolones

STEP 2 by day (15 decks)

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