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AGPC 4 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What is the distinguishing feature of Gram- bacteria?

A

thin cell wall (10% of cell envelope), so do not retain the purple Gram stain and are counter-stained pink by safranin

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2
Q

What is the distinguishing feature of Gram+ bacteria?

A

thick mesh-like cell wall made of peptidoglycan (50–90% of cell envelope), and as a result are stained purple by crystal violet

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3
Q

What category of bacteria are found in the colon?

A

only Gram-

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4
Q

What category of bacteria cause UTIs?

A

Gram- due to infection from colon

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5
Q

Which are the Gram+ bacteria?

A
  • Strep pneumoniae (= Pneumococcus)
  • Strep group A beta hemolyticus (= Strep pyogenes)
  • Staph aureus (MSSA, MSRA)
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6
Q

Which are the Gram- bacteria?

A
  • Hemophylus influenza (H. flu)
  • Pseudomonas
  • E.coli
  • Proteus
  • Klebsiella
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7
Q

Which are the atypical bacteria?

A
  • Mycoplasma
  • Moraxella catarrhalis
  • Legionella
  • Chlamydia pneumoniae (C. pneumoniae)
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8
Q

Which bacteria is the primary cause of pharyngitis?

A

Strep group A beta hemolyticus (= Strep pyogenes) - may also cause skin infections, rheumatic fever, and post-streptococcal glomerulonephritis

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9
Q

Why do we treat pharyngitis?

A

to prevent rheumatic fever

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10
Q

What types of infections are caused by Strep pneumoniae (= Pneumococcus)?

A

otitis, sinusitis, and pneumonia - NOT pharyngitis

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11
Q

What is the mechanism of injury to heart valves with rheumatic fever?

A

antibodies that develop after infection with Strep pyogenes attack bacteria but also affect heart muscles due to structural mimcry

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12
Q

What complication can occur when the skin is infected with Strep pyogenes?

A

post-streptococcal glomerulonephritis => Abx given to treat skin infection will NOT prevent this complication

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13
Q

Which categories of bacteria can cause otitis, sinusitis, and pneumonia?

A

Gram+ (Strep pneumoniae), Gram- (H. influenzae), and atypical (mycoplasma, Chlamydia pneumoniae) => need coverage for all three to treat

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14
Q

What is the most common cause of pneumonia across all populations?

A

Strep pneumoniae

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15
Q

Why doesn’t vaccination prevent all pneumonia?

A

(1) there are 83 serotypes and the vaccine covers only a limited number and (2) vaccines only prevent invasive disease (bacteria that spread from the site of infection to the blood and other sites)

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16
Q

Which category of bacteria causes skin infections?

A

only Gram+ (Strep and Staph)

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17
Q

Which categories of bacteria cause non-purulent cellulitis (redness only)?

A

Strep and sensitive Staph

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18
Q

Which categories of bacteria cause purulent cellulitis (with pus)?

A

MRSA

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19
Q

What do you need to consider when treating otitis externa in swimmers and conjunctivitis in contact wearers?

A

need to provide coverage for pseudomonas

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20
Q

What is amoxicillin?

A

penicillin with an added amino group - can provide coverage for UTIs and otitis media in children

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21
Q

What are the major side effects of amoxicillin?

A

rash and diarrhea

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22
Q

What is the major use of cephalosporins?

A

provide coverage for non-purulent Staph (e.g., Keflax), but NOT MRSA => 2nd and 3rd generations also provide some coverage for Gram- bacteria

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23
Q

What are the major side effects of cephalosporins?

A

rash and diarrhea

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24
Q

Which patients should not receive cephalosporins?

A

patients with an anaphylactic reaction (hypotension and inability to breathe) to penicillin => CAN be given if reaction is only a rash

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25
Which Abx's can be used to treat MRSA?
B C and D (Bactrim, Clindamycin, Doxycycline)
26
Which patients should not receive Bactrim?
pregnant women (Bactrim is a folate antagonist)
27
Which types of infections are caused by Strep and Staph?
skin, osteomyelitis, septic joint, endocarditis, otitis externa, conjunctivitis
28
What is the likely etiology for diabetic patients w/ osteomyelitis?
polymicrobial
29
When should doxycycline be used?
esoteric (uncommon) infections - provides unreliable coverage for Gram- and Strep infections
30
What are the major side effects of doxycycline?
photosensitivity and tooth discoloration in children < 8 years old => do not give to pregnant women, women who are breastfeeding, and children
31
Which Abx is the most common cause of C diff?
clindamycin (C in C diff => think clindamycin)
32
Which categories of Abx's provide the broadest coverage (cover all classes of organisms)?
macrolides and fluroquinolones => widest coverage = prolongation of QT interval (torsades de pointes)
33
What is the most common side effect of macrolides?
diarrhea
34
What are common side effects of fluroquinolones?
tendonitis and stunted bone development in children (do not give to children and pregnant women)
35
What are the components of Augmentin?
Amoxicillin and Clavulanic acid
36
What are the benefits of Augmentin over penicillin and amoxicillin?
protects against bacteria with beta lactamase (enzymes produced by bacteria that provide multi-resistance to β-lactam antibiotics) => expands Gram- coverage
37
Which Abx provides the narrowest coverage?
penicillin - only Gram+ => best for pharyngitis
38
Which is the best Abx to prescribe for Gram+ coverage
levofloxacin (Levaquin) or amoxicillin
39
Which is the best Abx to prescribe for Gram- coverage?
ciprofloxacin (Cipro)
40
Which Abx class are the -floxacins?
fluroquinolones
41
What are the forms of penicillin?
G (long acting - IM => think G = gluteus) and VK (oral => think V = eat your Vegetables)
42
Which Abx should be given to treat otitis media?
amoxicillin in small children (not strong Gram- coverage) and augmentin in older children, adults, and with sinusitis (has stronger Gram- coverage)
43
Which class of antibiotics should be given to treat skin infections?
cephalosporins (Ceftriaxone, Cefalexin, Cefixime) - includes coverage for Staph
44
Which antibiotic should be given for anaerobic bacterial infections?
colon (below diaphragm) give metronidazole/Flagyl and cavities (above the diaphragm) give clindamycin
45
What is the coverage for penicillin?
Strep pyogenes (Strep group A beta hemolyticus) and Treponema pallidum => does not cover Gram-, Staph spp., atypicals
46
What is the coverage for Amoxicillin?
Strep, sensitive strains of E coli, Proteus => does not cover Staph spp, atypicals
47
What is the coverage for Amoxicillin with clavulanate (Augmentin)?
Strep, H. flu, Moraxella => does not cover Pseudomonas, Staph, atypicals
48
What is the coverage for cephalosporins?
Gram+ (Staph and Strep), some Gram- (E coli, Proteus, Klebsiella) => does not cover MRSA, Pseudomonas, atypicals
49
What is the coverage for macrolides (Erythromycin, Azithromycin, Clarithromycin)?
Gram+, Gram- (H flu, Moraxella), atypicals (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella) => does not cover Pseudomonas, MRSA
50
What is the coverage for the respiratory fluoroquinolones (gemifloxacin, levofloxacin, moxifloxacin)?
Gram+ (Strep pneumoniae), Gram- (H flu), atypicals => does not cover Pseudomonas, MRSA
51
What is the coverage for non-respiratory fluroquinolones (Ciprofloxacin)?
mostly Gram-, Pseudomonas => less effective against Gram+ and anaerobes, not effective against MRSA
52
What is the coverage of Clindamycin?
only Gram+ (Staph, including MRSA, and Strep), anaerobic bacteria above the diaphragm (dental infections and peritonsillar abscess) => does not cover Gram-
53
What is the coverage of tetracyclines (Doxycycline)?
Gram+ (including MRSA), Gram- (H flu), atypical (Rickettsia, Borrelia, Chlamydia spp, Mycoplasma pneumoniae, Vibrio cholerae) => unreliable coverage against Gram- and Strep
54
What is the coverage of TMP-SMX (Bactrim)?
Gram+ (including MRSA), Gram- => unreliable coverage against Gram- and Strep, does not cover Pseudomonas and anaerobes
55
What is the first choice Abx for Strep group A beta hemolyticus (Strep pyogenes)?
Penicillin VK (PO) or Penicillin G (IM)
56
What is the first choice Abx for Strep pneumoniae/H flu?
Amoxicillin (otitis) and Amoxicillin/Clavulanate (Augmentin) (sinusitis)
57
What is the coverage for metronidazole?
anaerobes below the diaphragm (C. diff - drug of choice), bacterial vaginosis, abdominal infections
58
What is the Abx of choice for bacterial pharyngitis?
Strep pyogenes => Penicillin VK (PO) in adults and Amoxicillin in children => clindamycin, macrolides for penicillin allergy
59
What is the Abx of choice for otitis media?
Strep pneumoniae, H. flu, M. catharalis => Amoxicillin (high dose) => macrolides or respiratory fluroquinolones for penicillin allergy
60
What is the Abx of choice for acute bacterial rhinosinusitis?
Strep pneumoniae, H. flu, M. catharalis => Amoxicillin/clavulanate (Augmentin) => respiratory fluroquinolones for penicillin allergy
61
What is the Abx of choice for otitis externa?
Staph aureus, Pseudomonas (in swimmers) => non-respiratory fluroquinolones
62
What is the Abx of choice for non-viral acute bronchitis?
Chalmydia pneumoniae, Mycoplasma => routine use of Abx is not recommended
63
Which are the 3 main Gram+ bacteria?
Staph, Strep, Enterococcus => less common: listeria (food outbreaks), propionibacterium (organism that causes inflammation in acne), corynebacterium diphtheria, Clostridium botulinum (botulism), Clostridium tetani (tetanus), Clostridium difficile, Bacillus anthracis (antrhax)
64
What is the only type of Staph that grows "below the belt"?
Staph saprophyticus - causes UTIs and vagina infections => most common in patients with multiple sexual partners
65
What is the best antibiotic to treat Strep agalactiae (Group B Strep)?
ampicillin
66
What types of infections are caused by enterococcus?
UTIs
67
What is a beta lactam?
an antibiotic with a beta lactam ring - any penicillin or cephalosporin
68
When can patients with penicillin allergy safely take cephalosporins?
when they are allergic to the core of the antibiotic and not the beta lactam ring => if allergic to the beta lactam ring, cannot take penicillins or cephalosporins (only around 2-10% of patients with penicillin allergy)
69
What types of reactions indicate a Type I IgE mediated allergic reaction?
anaphylaxis and hives - always indicate true allergy
70
What is a morbilliform rash?
macular or maculopapular lesions that are fixed, pinpoint, and expand over several days - not an IgE mediated reaction => not a true allergy
71
Which antibiotic should be avoided in patients with Mono?
ampicillin - leads to morbilliform rash (rash can occur up to 1 year following Mono infection if given ampicillin)
72
What is beta lactamase?
an enzyme that bacteria learn how to produce which destroys the beta lactam ring in antibiotics
73
What is DRSP?
drug resistant strep pneumoniae - treat with high dose Augmentin XR
74
Which types of organisms can penicillins kill?
most Gram+ - but NOT staphylococcus
75
What are the penicillins?
ampicillin, amoxicillin, penicillin G and K
76
What is the extended spectrum penicillin?
Augmentin (amoxicillin + clavulanic acid)
77
What types of organisms can Augmentin kill?
Gram+, Gram-, beta-lactamase => NOT MRSA
78
How would you know if an organism produced beta lactamase?
always suspect if PT has had treatment failure on an Abx within the past 90 days
79
What is the sulfonamide Abx?
TMP-SMX (Bactrim, Septra)
80
What types of organisms can Bactrim/Septra kill?
Gram- and MRSA => NOT Gram+ or E coli (not a good choice for UTIs caused by E coli due to high drug resistance)
81
What are the tetracyclines?
doxycycline, minocycline, vibramycin
82
What types of organisms do the tetracyclines kill?
Gram- and atypicals - good choice for MSSA and MRSA
83
What are the 1st generation cephalosporins?
cephalexin (Keflex) and cefadroxil (Duricef) - kill Gram+ (skin infections)
84
What are the 2nd generation cephalosporins?
cefuroxime (Ceftin), cefaclor (Ceclor), cefprozil (Cefzil) - kill Gam+ and Gram- but NOT beta lactamase producers
85
What are the 3rd generation cephalosporins?
ceftibuten (Cedax) and cefixime (Suprax) - weak on Gram+, Gram-, and beta lactamase producers => does NOT kill Staph
86
What are the 4th generation cephalosporins?
ceftriaxone (Rocephin), cefdinir (Omnicef), ceofpodoxime (Vantin), cefditoren (Spectracef) - kill Gram+, Gram-, and beta lactamase producers
87
What are the macrolide antibiotics?
erythromycin, azithromycin (Z pac), clarithromycin (Biaxin) - kill atypical pathogens => do NOT give Z pac for Strep
88
What is the main 2nd generation fluoroquinolone?
ciprofloxacin (Cirpo) - kills Gram- and atypicals
89
Which antibiotics should be used with atypical organisms?
(1) macrolides, (2) tetracyclines, and (3) Cipro
90
What is the main 3rd generation respiratory fluoroquinolone?
levofloxacin (Levaquin) - broad spectrum antibiotic that kills many types of bugs => reserve for use in PTs who cannot afford treatment failure
91
What are the 4th generation respiratory fluoroquinolones?
moxifloxacin (Avelox), gemifloxacin (Factive), gatifloxacin (Zymar ophth) - broad spectrum antibiotic that kills many types of bugs => reserve for use in PTs who cannot afford treatment failure (Avelox provides coverage for GI pathogens)
92
What is the first choice Abx for UTIs?
nitrofurantoin (Macrobid) - MSSA, MRSA, Strep, and E coli => concentrates in bladder, not in skin - cannot be used for skin infections
93
What is the first choice Abx for C diff?
metronidazole (Flagyl) - only kills anaerobes (C diff is Gram+ but an anaerobe)
94
What types of organisms can be killed with lincosamide (Clindamycin)?
Gram+, aerobes, anaerobes
95
What types of organisms does lnezoli (Zyvox) kill?
Gram+
96
When is Vancomycin used?
to treat C diff if Flagyl has failed - also treats Staph and Strep

AGPC 4 (22 decks)

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