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FNP4 Review > Abx > Flashcards

Abx Flashcards

1
Q

4 main Gram Positive Bugs

A

_Staphylococcus (Staph)
Streptococcus (Strep)
Enteroccous
C. difficile (Clostridioides difficile)

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2
Q

Gram-Negative Bugs

A

Just about everything else!

Neisseria gonorrhoeae
Neisseria meningitidis
E. coli, Shigella, Campylobacter, Salmonella
Pasteurella
Rickettsia, Borrelia
Proteus, Pseudomonas, Legionella, others

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3
Q

Gram-Positive Bug — Staphylococcus

A

Staphylococcus aureus (skin)
 Methicillin-susceptible Staphylococcus aureus (MSSA) (skin)
 Methicillin-resistant Staphylococcus aureus (MRSA) (skin)
* Staph saprophyticus (UTI, vagina)
* Staph epidermis (skin)

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4
Q

Gram-Positive Bug — Streptococcus

A
  • Strep pyogenes (throat)
  • Strep pneumoniae (lungs)
  • Strep viridans (dental abscess, endocarditis)
  • Strep agalactiae (Group B Strep)
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5
Q

Gram-Positive Bug — Enterococcus

A
  • Enterococcus faecalis (urinary tract)
  • Enterococcus faecium (urinary tract)
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6
Q

Other Gram-Positive Bugs

A
  • Clostridium difficile
  • Listeria monocytogenes (listeriosis): outbreaks in food or ice cream!
  • Propionibacterium acne (acne)
  • Corynebacterium diphtheriae (diphtheria)
  • Clostridium botulinum (botulism)
  • Clostridium tetani (tetanus)
  • Bacillus anthracis (anthrax)
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7
Q

So, if a patient says, “I’m allergic to penicillin,” can you safely prescribe a cephalosporin?

A

Maybe … IF you are PCN allergic, you’re EITHER allergic to the pink pentagon OR the blue box

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8
Q

If you are allergic to the pink pentagon, can you safely take a cephalosporin?

A

Yes, cephalosporins do not have a pink pentagon
90-98% of PCN-allergic patients are allergic to the pink pentagon and can safely take cephalosporins!

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9
Q

If you are allergic to the blue box in PCN, can you safely take a cephalosporin?

A

No both have a blue box
- 2-10% of patients who are allergic to PCN are allergic to the blue box AND will also be allergic to cephalosporins

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10
Q

When NOT to prescribe PCN with rx of reaction?

A

Anaphylaxis or Hives
Hives = IgE-mediated, Type I reaction
- Will get worse with repeated exposure

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11
Q

What if pt w/ PCN reaction was morbilliform rash?

A

Ok to give cephalosporin
- Red raised flat, all over body – but pt can sleep and are not miserable

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12
Q
  • Rash is macular or maculopapular, lesions are fixed, area expands over several days
  • May itch
  • More prevalent in children
  • More common with aminopenicillins (amoxicillin and ampicillin)
  • Usually T cell mediated
A

morbilliform rash

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13
Q

What happens when a patient who has mononucleosis is exposed to penicillin?

A

Don’t give mono pt a PCN drug. Can get morbilliform rash (aka. Morbilliform rash)

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14
Q

What is Beta-Lactamase?

A

An enzyme that smart bacteria learn how to produce
It destroys the beta-lactam ring on PCN and cephalosporins! And if you destroy the blue box … antibiotic won’t work!

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15
Q

Ampicillin, Amoxicillin, Penicillin G, Penicillin K Gram-Positive Organisms
- NOT Staphylococcus

Streptococcus Group A, B, C, G Enterococcus, Strep pneumoniae, Drug-resistant Strep pneumoniae (DRSP), C. botulinum (wound, not food)

A

Penicillin’s

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16
Q

Can amoxicillin really kill DRSP?
What dose for adults?
What dose for peds?

A

Yes amoxicillin can kill the drug resistant strep pneumonia
Adult- 1gram TID
Pedi- 90 mg/kg/ day (as long as it does not exceed adult dose)

17
Q

Amoxicillin/Clavulanic acid (Augmentin)

Gram-Positive, Gram-Negative Organisms
Beta-lactamase, NOT MRSA

Streptococcus Group A, B, C, G, Enterococcus, Strep pneumoniae, DRSP, MSSA H. influenzae, M. catarrhalis, E. coli, Neisseria, C. diphtheria

A

Extended-Spectrum PENICILLINS

18
Q

How would you know if a bug produced beta-lactamase?

A

If pt had Abx within the last 90 days and is sick again – you can suspect that the organism making them sick produces beta lactamase.

19
Q

TMP-SMX (Bactrim, Septra) Gram-Negative Organisms
MRSA, E. coli ????
Staph: MSSA, MRSA, CA-MRSA, Not Strep, Not E. coli (USE IF COST IS AN ISSUE)

A

Sulfonamides

20
Q

Doxycycline, Minocycline, Vibramycin Gram-Negative Organisms
Atypicals, MRSA
Minocycline is good choice for MSSA and community-acquired-MRSA (CA-MRSA) Doxy/Mino good choices for atypical pathogens and lower resp tract pathogens H. flu, E. coli, Legionella, Mycoplasma, Chlamydophila, Rickettsia (tick- and tickborne infections

A

Tetracyclines

21
Q

1st- 3rd Cephalosporins bacteria coverage

A

First Generation= Gram +
Second Generation Gram + Gram -
Third Generation= Gram + Gram - Beta lactamase

22
Q

Cephalexin (Keflex), Cefadroxil (Duricef) Gram-Positive Organisms
Staph: MSSA, Strep

A

Cephalosporins 1st Generation

23
Q

Cefuroxime (Ceftin), Cefaclor (Ceclor), Cefprozil (Cefzil) Gram-Positive, Gram-Negative Organisms
Staph: MSSA, Streptococcus
H. flu, E. coli, Proteus mirabilis

A

Cephalosporins 2nd Generation

24
Q

Ceftibuten (Cedax), Cefixime (Suprax) Weak Gram-Positive, Gram-Negative Organisms
Beta-Lactamase Producers
Strep groups NOT Staph H. flu, M. cat, E. coli, Klebsiella, Salmonella, Shigella

A

Cephalosporins 3rd Generation

25
Q

Ceftriaxone (Rocephin), Cefdinir (Omnicef),
Cefpodoxime (Vantin), Cefditoren (Spectracef) Gram-Positive, Gram-Negative Organisms
Beta-Lactamase Producers
Strep Staph: MSSA H. flu, M. cat, E. coli, Salmonella, Shigella, Proteus mirabilis

A

Cephalosporins Extended-Spectrum 3rd Generation

26
Q

Azithromycin (Zithromax), Clarithromycin (Biaxin) Atypical pathogens
Staph: MSSA, ??? Strep,
NOT Enterococcus, Listeria
M. cat, Legionella sp., Chlamydophila, ? Mycoplasma

A

Macrolides- later generation

27
Q

2nd -4th generations of Fluroquinolones

A

2nd Generation= Gram -

3rd Generation Gram + Gram - Beta-lactamase producers, atypical pathogens, DRSP

4th Generation= Gram + Gram - (above the belt) Beta-lactamase producers, atypical pathogens, DRSP

28
Q

Ciprofloxacin (Cipro)
Gram-Negative Organisms, Atypical Pathogens
??? Strep,
NOT Enterococcus
NOT MRSA
NOT Staph

M. cat, H. flu, Shigella, ? E. coli,
Legionella, Chlamydophila Mycoplasma, Klebsiella

A

Fluroquinolone 2nd Generation

  • Doesn’t work for bugs “above the belt” = don’t give for respiratory
29
Q

Levofloxacin (Levaquin)

Gram-Positive, Gram-Negative, Atypical Pathogens, DRSP, Aerobes, Anaerobes
Staph: MSSA, Listeria
NOT MRSA
Strep: all, M. cat, H. flu, E. coli, Legionella, Chlamydophila, Mycoplasma, Klebsiella,± Pseudomonas

A

Fluroquinolone 3rd Generation

  • Idiot abx. – give to pt who cant afford tx failure
30
Q

Moxifloxacin (Avelox), Gemifloxacin (Factive), Delafloxacin* (Baxdela)

Gram-Positive, Gram-Negative (above the belt), Atypical Pathogens, DRSP
Staph: MSSA, Listeria,
Not urinary pathogens
Strep: all sp., M. cat, H. flu, Legionella, Chlamydophila, Mycoplasma, Klebsiella *Skin/skin structure inf (MRSA)

A

Fluroquinolone 4th Generation

31
Q

What is Nitrofurantoin (Macrobid) used for?

A

E. Coli, Bladder pathogens only

32
Q

Vancomycin
Gram-Positives, Anaerobes
MSSA, MRSA, CA-MRSA (usually), Streptococcus
C. difficile (oral)

A

Glycopeptide

(will concentrate in gut to tx infection)
125 mg oral tabs 3-4 x a day

FNP4 Review (5 decks)

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