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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
Q

Which Abx’s can be used to treat MRSA?

A

B C and D (Bactrim, Clindamycin, Doxycycline)

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26
Q

Which patients should not receive Bactrim?

A

pregnant women (Bactrim is a folate antagonist)

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27
Q

Which types of infections are caused by Strep and Staph?

A

skin, osteomyelitis, septic joint, endocarditis, otitis externa, conjunctivitis

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28
Q

What is the likely etiology for diabetic patients w/ osteomyelitis?

A

polymicrobial

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29
Q

When should doxycycline be used?

A

esoteric (uncommon) infections - provides unreliable coverage for Gram- and Strep infections

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30
Q

What are the major side effects of doxycycline?

A

photosensitivity and tooth discoloration in children < 8 years old => do not give to pregnant women, women who are breastfeeding, and children

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31
Q

Which Abx is the most common cause of C diff?

A

clindamycin (C in C diff => think clindamycin)

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32
Q

Which categories of Abx’s provide the broadest coverage (cover all classes of organisms)?

A

macrolides and fluroquinolones => widest coverage = prolongation of QT interval (torsades de pointes)

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33
Q

What is the most common side effect of macrolides?

A

diarrhea

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34
Q

What are common side effects of fluroquinolones?

A

tendonitis and stunted bone development in children (do not give to children and pregnant women)

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35
Q

What are the components of Augmentin?

A

Amoxicillin and Clavulanic acid

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36
Q

What are the benefits of Augmentin over penicillin and amoxicillin?

A

protects against bacteria with beta lactamase (enzymes produced by bacteria that provide multi-resistance to β-lactam antibiotics) => expands Gram- coverage

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37
Q

Which Abx provides the narrowest coverage?

A

penicillin - only Gram+ => best for pharyngitis

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38
Q

Which is the best Abx to prescribe for Gram+ coverage

A

levofloxacin (Levaquin) or amoxicillin

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39
Q

Which is the best Abx to prescribe for Gram- coverage?

A

ciprofloxacin (Cipro)

40
Q

Which Abx class are the -floxacins?

A

fluroquinolones

41
Q

What are the forms of penicillin?

A

G (long acting - IM => think G = gluteus) and VK (oral => think V = eat your Vegetables)

42
Q

Which Abx should be given to treat otitis media?

A

amoxicillin in small children (not strong Gram- coverage) and augmentin in older children, adults, and with sinusitis (has stronger Gram- coverage)

43
Q

Which class of antibiotics should be given to treat skin infections?

A

cephalosporins (Ceftriaxone, Cefalexin, Cefixime) - includes coverage for Staph

44
Q

Which antibiotic should be given for anaerobic bacterial infections?

A

colon (below diaphragm) give metronidazole/Flagyl and cavities (above the diaphragm) give clindamycin

45
Q

What is the coverage for penicillin?

A

Strep pyogenes (Strep group A beta hemolyticus) and Treponema pallidum => does not cover Gram-, Staph spp., atypicals

46
Q

What is the coverage for Amoxicillin?

A

Strep, sensitive strains of E coli, Proteus => does not cover Staph spp, atypicals

47
Q

What is the coverage for Amoxicillin with clavulanate (Augmentin)?

A

Strep, H. flu, Moraxella => does not cover Pseudomonas, Staph, atypicals

48
Q

What is the coverage for cephalosporins?

A

Gram+ (Staph and Strep), some Gram- (E coli, Proteus, Klebsiella) => does not cover MRSA, Pseudomonas, atypicals

49
Q

What is the coverage for macrolides (Erythromycin, Azithromycin, Clarithromycin)?

A

Gram+, Gram- (H flu, Moraxella), atypicals (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella) => does not cover Pseudomonas, MRSA

50
Q

What is the coverage for the respiratory fluoroquinolones (gemifloxacin, levofloxacin, moxifloxacin)?

A

Gram+ (Strep pneumoniae), Gram- (H flu), atypicals => does not cover Pseudomonas, MRSA

51
Q

What is the coverage for non-respiratory fluroquinolones (Ciprofloxacin)?

A

mostly Gram-, Pseudomonas => less effective against Gram+ and anaerobes, not effective against MRSA

52
Q

What is the coverage of Clindamycin?

A

only Gram+ (Staph, including MRSA, and Strep), anaerobic bacteria above the diaphragm (dental infections and peritonsillar abscess) => does not cover Gram-

53
Q

What is the coverage of tetracyclines (Doxycycline)?

A

Gram+ (including MRSA), Gram- (H flu), atypical (Rickettsia, Borrelia, Chlamydia spp, Mycoplasma pneumoniae, Vibrio cholerae) => unreliable coverage against Gram- and Strep

54
Q

What is the coverage of TMP-SMX (Bactrim)?

A

Gram+ (including MRSA), Gram- => unreliable coverage against Gram- and Strep, does not cover Pseudomonas and anaerobes

55
Q

What is the first choice Abx for Strep group A beta hemolyticus (Strep pyogenes)?

A

Penicillin VK (PO) or Penicillin G (IM)

56
Q

What is the first choice Abx for Strep pneumoniae/H flu?

A

Amoxicillin (otitis) and Amoxicillin/Clavulanate (Augmentin) (sinusitis)

57
Q

What is the coverage for metronidazole?

A

anaerobes below the diaphragm (C. diff - drug of choice), bacterial vaginosis, abdominal infections

58
Q

What is the Abx of choice for bacterial pharyngitis?

A

Strep pyogenes => Penicillin VK (PO) in adults and Amoxicillin in children => clindamycin, macrolides for penicillin allergy

59
Q

What is the Abx of choice for otitis media?

A

Strep pneumoniae, H. flu, M. catharalis => Amoxicillin (high dose) => macrolides or respiratory fluroquinolones for penicillin allergy

60
Q

What is the Abx of choice for acute bacterial rhinosinusitis?

A

Strep pneumoniae, H. flu, M. catharalis => Amoxicillin/clavulanate (Augmentin) => respiratory fluroquinolones for penicillin allergy

61
Q

What is the Abx of choice for otitis externa?

A

Staph aureus, Pseudomonas (in swimmers) => non-respiratory fluroquinolones

62
Q

What is the Abx of choice for non-viral acute bronchitis?

A

Chalmydia pneumoniae, Mycoplasma => routine use of Abx is not recommended

63
Q

Which are the 3 main Gram+ bacteria?

A

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
Q

What is the only type of Staph that grows “below the belt”?

A

Staph saprophyticus - causes UTIs and vagina infections => most common in patients with multiple sexual partners

65
Q

What is the best antibiotic to treat Strep agalactiae (Group B Strep)?

A

ampicillin

66
Q

What types of infections are caused by enterococcus?

A

UTIs

67
Q

What is a beta lactam?

A

an antibiotic with a beta lactam ring - any penicillin or cephalosporin

68
Q

When can patients with penicillin allergy safely take cephalosporins?

A

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
Q

What types of reactions indicate a Type I IgE mediated allergic reaction?

A

anaphylaxis and hives - always indicate true allergy

70
Q

What is a morbilliform rash?

A

macular or maculopapular lesions that are fixed, pinpoint, and expand over several days - not an IgE mediated reaction => not a true allergy

71
Q

Which antibiotic should be avoided in patients with Mono?

A

ampicillin - leads to morbilliform rash (rash can occur up to 1 year following Mono infection if given ampicillin)

72
Q

What is beta lactamase?

A

an enzyme that bacteria learn how to produce which destroys the beta lactam ring in antibiotics

73
Q

What is DRSP?

A

drug resistant strep pneumoniae - treat with high dose Augmentin XR

74
Q

Which types of organisms can penicillins kill?

A

most Gram+ - but NOT staphylococcus

75
Q

What are the penicillins?

A

ampicillin, amoxicillin, penicillin G and K

76
Q

What is the extended spectrum penicillin?

A

Augmentin (amoxicillin + clavulanic acid)

77
Q

What types of organisms can Augmentin kill?

A

Gram+, Gram-, beta-lactamase => NOT MRSA

78
Q

How would you know if an organism produced beta lactamase?

A

always suspect if PT has had treatment failure on an Abx within the past 90 days

79
Q

What is the sulfonamide Abx?

A

TMP-SMX (Bactrim, Septra)

80
Q

What types of organisms can Bactrim/Septra kill?

A

Gram- and MRSA => NOT Gram+ or E coli (not a good choice for UTIs caused by E coli due to high drug resistance)

81
Q

What are the tetracyclines?

A

doxycycline, minocycline, vibramycin

82
Q

What types of organisms do the tetracyclines kill?

A

Gram- and atypicals - good choice for MSSA and MRSA

83
Q

What are the 1st generation cephalosporins?

A

cephalexin (Keflex) and cefadroxil (Duricef) - kill Gram+ (skin infections)

84
Q

What are the 2nd generation cephalosporins?

A

cefuroxime (Ceftin), cefaclor (Ceclor), cefprozil (Cefzil) - kill Gam+ and Gram- but NOT beta lactamase producers

85
Q

What are the 3rd generation cephalosporins?

A

ceftibuten (Cedax) and cefixime (Suprax) - weak on Gram+, Gram-, and beta lactamase producers => does NOT kill Staph

86
Q

What are the 4th generation cephalosporins?

A

ceftriaxone (Rocephin), cefdinir (Omnicef), ceofpodoxime (Vantin), cefditoren (Spectracef) - kill Gram+, Gram-, and beta lactamase producers

87
Q

What are the macrolide antibiotics?

A

erythromycin, azithromycin (Z pac), clarithromycin (Biaxin) - kill atypical pathogens => do NOT give Z pac for Strep

88
Q

What is the main 2nd generation fluoroquinolone?

A

ciprofloxacin (Cirpo) - kills Gram- and atypicals

89
Q

Which antibiotics should be used with atypical organisms?

A

(1) macrolides, (2) tetracyclines, and (3) Cipro

90
Q

What is the main 3rd generation respiratory fluoroquinolone?

A

levofloxacin (Levaquin) - broad spectrum antibiotic that kills many types of bugs => reserve for use in PTs who cannot afford treatment failure

91
Q

What are the 4th generation respiratory fluoroquinolones?

A

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
Q

What is the first choice Abx for UTIs?

A

nitrofurantoin (Macrobid) - MSSA, MRSA, Strep, and E coli => concentrates in bladder, not in skin - cannot be used for skin infections

93
Q

What is the first choice Abx for C diff?

A

metronidazole (Flagyl) - only kills anaerobes (C diff is Gram+ but an anaerobe)

94
Q

What types of organisms can be killed with lincosamide (Clindamycin)?

A

Gram+, aerobes, anaerobes

95
Q

What types of organisms does lnezoli (Zyvox) kill?

A

Gram+

96
Q

When is Vancomycin used?

A

to treat C diff if Flagyl has failed - also treats Staph and Strep

AGPC 4 (22 decks)

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