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CRRAB II Final > Antibiotic Review > Flashcards

Antibiotic Review Flashcards

1
Q

What is on your differential for pharyngitis?

A

Bacteria: Group A or C Streptococcus, Corynebacterium diphtheriae, Haemophilus influenzae
Yeast/Fungal: Candida
Virus: Coronavirus, Influenza, Rhinovirus, EBV, Coxsackie, Acute HIV
–> GERD (older adults)

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2
Q

What are the Modified Centor Criteria for Pharyngitis and Tonsillitis? (diagnosing strep. infection)

A
  • Absence of cough - 1
  • Age 3 -14 yrs - 1
  • Age 15-45 yrs - 0
  • Age older than 45 yrs - -1
  • Anterior cervical lymphadenopathy - 1
  • Fever - 1
  • Tonsillar erythema or exudates - 1
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3
Q

What does low sensitivity indicate?

A

People will have the disease and not test positive.

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4
Q

What might the low sensitivity of the rapid antigen detection strep test indicate?

A
  • May be due to variability in C-carbohydrate that the test looks for
  • You may not have had enough of the organism on the swab for it to test positive
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5
Q

What does Streptococcus pyogenes look like on gram stain?

A

Gram (+) - Purple cocci in chains

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6
Q

What can Ampicillin cause in Streptococcus pyogenes patients?

A

It can cause a rash which can incorrectly label the individual as having a penicillin allergy

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7
Q

What are the three best treatments for patients with a Group A Streptococcal Infection?

A
  1. Penicillin V
  2. Amoxicillin
  3. Penicillin G
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8
Q

What effect does EPI have on a patient’s vascular system?

A

Vasoconstricts

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9
Q

What adrenoceptor primarily mediates the vascular response?

A

Alpha1 (via PLC)

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10
Q

What effect does EPI have on the respiratory system?

A

Bronchodilates

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11
Q

Which adrenoreceptor primarily mediates the respiratory system?

A

Beta2

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12
Q

What can you do to check for penicillin allergy?

A

Skin test, if positive it indicates the presence of IgE antibodies to penicillin and excludes the use of other beta lactam antibiotics including cephalosporins

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13
Q

What is Aztreonam?

A

A monobactam that is safe to use in patients with penicillin allergies
-Not a good choice for Streptococcus pharyngitis bc Azteonam is effective against gram - only

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14
Q

What groups are bacteriostatic antibiotics not advisable to use?

A

Immunocompromised or life-threatening acute infections

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15
Q

What can penicillin allergy result in treatment with?

A

Inferior drugs (non-bactericidal drugs)

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16
Q

What does H. influenzae secrete that can impact Strep. pyogenes treatment?

A

Beta-lactamases!!

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17
Q

What patients have bacteremia and should be started on IV antibiotics?

A

Pts. with rigors, shakes, chills, high fever, night sweats

18
Q

What is antigenic shift?

A

Gene reassortment leading to altered surface proteins and antigenic profile.
-Create new subtypes

19
Q

What is antigenic drift?

A

Small gene mutations/changes leading to altered antibody-binding sites and escape from immunity.

20
Q

What is the most common cause of infection-related mortality in the US?

A

Influenza + Secondary Bacterial Pneumonia

21
Q

What about an influenza infection enhances bacterial growth?

A
  • Apoptosis of airway epithelial cells
  • Inhibition of mucocilliary clearance
  • Viral neuramidase
22
Q

What is pre-emptive treatment?

A

Treatment of patients who have clinical, imagining or other testing that provides evidence of disease

23
Q

What is the first line empiric treatment for Community Acquired Pneumonia in previously healthy patients without past antibiotic use?

A
  • Macrolide

- Doxycycline

24
Q

How should you treat outpatients with comorbidities or antibiotic use in the past three months with CAP?

A
  • Resp. fluoroquinolone (Levofloxacin, gemifloxacin, moxifloxacin)
  • Beta-lactam antibiotic (amoxicillin, augmentin, cefpodoxime)
  • -> Plus Macrolide
25
Q

What effect did the pneumovax shot have on resistance to macrolides?

A

It did not significantly decrease drug resistance serotypes. It decreased overall strep. pneumo. cases but all of the ones left were very drug resistant and difficult to treat

26
Q

What drugs are NOT effective against Mycoplasma pneumonia?

A

Beta-lactams - adheres to epithelial cells

27
Q

What drugs should you use to treat Mycoplasma pneumonia?

A

Doxycycline, Azithromycin

28
Q

How is Klebsiella Pneumoniae Carbapenemase (KPC) spread? What does it express?

A
  • Not spread through air but on health care providers hands

- Expresses extended spectrum beta-lactamase (ESBL)

29
Q

What pathogens cause the majority of US hospital infections and “escape” the currently antibiotic arsenal?

A 
ESKAPE
Enterococcus faecium
Staphylococcus aureus
Klebsiella pneumoniae
Acinetobacter baumannii
Pseudomonas aeruginosa
Enterobacter species
30
Q

What populations are Pseudomonas aeruginosa infections common in?

A

Cystic Fibrosis patients –> and hospital acquired pneumonia

31
Q

How many pseduomonas aeruginosa infections are multi drug resistant?

A

13% - due to efflux, biofilms and porins

32
Q

What should you use to treat pseudomonas aeruginosa (hospital acquired)?

A
  • Piperacillin (4th gen. penicilln)/tazobactam (blocks beta lactamases
  • Cefepime (4th gen cephalosporin)
  • Imipenem (carbapenem - can be nephrotoxic)/Cilastatin (protects kidney)
  • Aztreonam (monobactam - cell wall inhibitor)
33
Q

45 yr old man: HA, fever, malaise, nonproductive cough.

Ill several days after hunting and moving brush outside cabin in WI.

A

Blastomyces dermatitidis

34
Q

How is Blastomycosis spread?

A
  • Mold that is inhaled from the environment
  • Becomes yeast in the lung (more of a single cell form - button form)
  • Can potentially go from lungs to the blood and spread to the joints and other organs
35
Q

How can you prevent and test for Bastomycosis?

A
  • Prevent exposure by not spelunking, demolition or moving brush
  • Transmission doesn’t occur between humans
  • Urine antigen test (cross reacts with histoplasmosis)
36
Q

How does Histoplasma capsulate spread and where does it occur most?

A
  • Spreads via bat droppings

- Mississippi/Ohio river valleys

37
Q

How does Blastomyces dermatitidis spread? Where is it found?

A
  • Rotting wood
  • Eastern US
  • Broad based yeast
38
Q

What does Coccidiodes immitis cause? Where?

A

“Valley fever”

  • Endospores in spherule
  • SW US, dry climates
  • Pulmonary lesions may calcify
39
Q

What is the pathogenesis of Aspergillus fumigatus?

A

Ubiquitous fungi in the environment primarily infects the lungs:

  • Inhaled in resp. tract and enters through skin
  • Allergic bronchopulmonary aspergillosis-hypersensitivity
  • Brown mucous plugs - containing fungi and eosinophils
  • Asthma or cystic fibrosis
  • Aspergillomas (Fungal ball), Fungal sinusitis
  • Systemic disease in immunocompromised!!
40
Q

How do you treat Aspergillus fumigates lung infections?

A
  • If systemic = Voriconazole, but mortality rate is 45-80% bc patients are often neutropenic
  • Prednisone treatment may be sufficient for ABPS because the main problem we’re trying to control is the immune system’s response to the bug rather than the bug growth

CRRAB II Final (10 decks)

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