Antifungals lecture Flashcards
Narrow spectrum meds
Penicillin
Erythromycin
Nitrofurantoin
Clindamycin
PEN C
Broad spectrum meds
Ampicillin
Cephalopsporins
Aminoglyocosides
Tetracyclines
FQs
A CAT FQs (Fucks)
Concentration-dependent ABX
Aminoglycosides and FQs
“concentrate as Ami FuQs”
Time-dependent ABX
Beta-lactams
Monobactams
Macrolides
BMM
Post Antibiotic Effect can be _______ in an ________ media.
decreased
acidic (infected)
ABX resistance is due to….
Broad Spectrum
Overuse for inappropriate indications
Poor infection control
Inappropriate dose, duration
Example of Intrinsic Antimicrobial Resistance….
Vanc cannot treat gram (-)
Only gram (+)
How do bacteria create Acquired Resistance
- Decreased cell permeability
-Increased efflux pumps
-Inactivation
-Modify antimicrobial target
What does an Antibiogram communicate?
Tells about susceptibility rates
Major Nosocomial Infections are?
Urinary
Respiratory
Blood
“URB”
Highly associated with the use of DEVICES
Catheter related infections position risk
Femoral > IJ > Subclavian
What organism are non-tunneled caths usually colonized with?
Gram (+)
Candida, enterococcus, Staph,
Cause of C-Diff and which drug?
Antibiotic Therapy
CLINDAMYCIN!!!!!
(2nd place is betalactams)
Pathogenesis is toxin-mediated by which toxins?
-Enterotoxin A
-Cytotoxin B
Diagnosis is confirmed through detection of these.
Other risk factors for C-Diff
-PPIs and H-2 inhibitors (Acid suppression therapy)
-Handwashing!
Tx of C-Diff?
-Oral Vanco (won’t leave GI)
Tx course = 10-14 days
-Dificid
-GI lab (fecal microbiata transplant, 99% cure)
______ of SSIs are preventable when using EBP strategies.
HALF
SSI prophylaxis depends on?
-Risk of infection (wound classification)
-Patient-related factors
-Bacterial milieu
-Hospital infection rate for procedure
-Factors relating to wound itself
SSI not necessary to continue past ________.
Post-op day 1
SSI prophylaxis ABX is usually…..
1st gen Cephalosporin (Ancef)
-low cost
-broad spectrum
-low drug interactions
Is there a need for SSI prophylaxis for Class 1 wound?
NO!
SSI prophylaxis rec for infected tissue or receiving prosthetic cardiac valves?
Include antistaphylococcal ABX for cellulitis and osteomyelitis
SSI prophylaxis timing for Ancef and Vanco?
Ancef = 30-60 minutes
Vanco = 60-120 minutes
When to redose Ancef?
At 2 half-lives! (1.8 hours)
= 3.6 hours for redose!!!
Redose for 1.5L of blood loss or > 3 hours procedure
Does extended duration of ABX reduce SSI?
NO!
What are the Beta-lactams?
-Penicillins
-Cephalopsporins
-Monobactams
-Carbapenems
“People Can Make Cars”
What is Beta-lactamase?
Bacteria will use this enzyme to break apart betalactam ring of penicillin.
What do beta-lactamase inhibitors do? “bactams”
-Sacrifice themselves to betalactamase
-They have NO antibiotic effect (Sulbactam, Tazobactam)
Penicillin coverage
Strep A and B
Beta-lactams ADRs?
Hypersensitivity, GI upset, and AKI
Amoxicillin Vs Augmentin?
Augmentin overcomes beta-lactamse!
-It covers MSSA
What does Amoxicillin/Clavulanate (Augmentin) add on that Amoxicillin (Amoxil) does not?
MSSA!!!!
Is Staph susceptible to Augmentin or Amoxicil?
Augmentin!!!!
Ampicillin is similar to Amoxil but adds ________ and ________. (not the same!)
Enterococci and L. monocytogenes
What are the Antistaphylococcal PCNs?
-Oxacillin, Nafcillin, Dicloxacillin
Do not need beta-lactamse inhibitor !!!!!!
NOT MRSA THOUGH
Patients who report PCN allergy had ____ odds of SSI.
50%
-Vanc only covers gram (+)!
_____ and _____ rates are higher in patients with reported PCN allergy.
MRSA and C-Diff
Will Amoxicillin/Clavulanate overcome beta-lactamase?
YES!
Antistaphylococcal PCNs don’t need_______.
beta-lactamase inhibitor
still covers staph
Risk for Piperacillin/Tazo (Zosyn)?
Hypokalemia
Zosyn adds on gram (-)
MOST Beta-lactams are what?
CEPHALOSPORINS
ESBLs are resistant to
Penicillins plus Cephalosporins up until 3rd gen!
Cephalosporin MOA?
Same as PCNs, Bactericidal
-less susceptible to penicillinases
Cephalosporin coverage from 1st gen to 5th gen?
Gram (+) to (-)
Which Cephalosporin covers for MRSA?
Only 5th Gen!
-broad spectrum against gram (-)
-Ceftaroline (Teflaro)
-Fetroja
Example of 1st Gen Cephalosporin?
(Cephazolin) Ancef (IV)
Keflex (PO)
2nd gen Cephalopsporins add _______? (Cefoxitin, Cefaclor)
Respiratory coverage
Can you use Cephalosporins interchangeably?
Nope
Example of good 3rd gen Cephalosporin?
Ceftazidime (Fortaz)
TAZMANIAN DEVIL more destructive
What does Ceftazidime (Fortaz) cover for?
-Staph and most strep
-MOST gram (-) with GOOD PSEUDOMONAL COVERAGE!
-less gram (+) than other 3rd gens.
What is more broad spectrum? Ceftriaxone (Rocephin) or Ceftazidime (Fortaz)?
Fortaz is more broad spectrum!
Rocephin has NO Pseudomonal coverage
Ceftriaxone (Rocephin) specific side effect?
-Diarrhea and biliary sludging
-Precipitates with Ca++
4th Gen Cephalopsorin?
Cefepime
-still resistant to ESBLs
What 4th gen Cephalosporins are reserved for ESBL profilers?
-Cefepime
Ceftolozane/tazobactam (Zerbexa)
5th Gen Cephalosporin example? Coverage?
Ceftaroline (Teflaro)
-1st beta-lacatam to cover MRSA!
What does Cefiderocol (Fetroja) cover?
(5th Gen Ceph)
1st to cover A. baumanni complex
-Covers Acenobacter!!!
1st Gen names?
Ceph “A”
except Cefaclor (2nd)
4th Gen names?
Have “pi” in name!
No “a” after Ceph
5th gen names?
if “rol” is in name!
3rd gen names?
Ends with Me, One, or Ten!
except cefuroxime
Carbapenems action and coverage?
throw grenade, destroy everything
-covers most aerobic and anaerobic gram (+) and (-) including pseudomonas
Carbapenems ADR risk?
Risk on all package inserts?
SEIZURES!
Carbapenem with HIGHEST seizure risk?
Primaxin! (Imipenem/Cilastatin)
Which Carabapenem has lower incidence for seizures?
Meropenem (Meronem) / Vaborbactam
Treatment of choice for ESBLs?
CARBAPENEMS!
How does Vanco work? what what type of dependence?
Inhibits the peptidoglycan formation, disrupts cell wall synthesis, BACTERICIDAL!
CONCENTRATION DEPENDENT - DRAW TROUGH
If MRSA is expected then ______ is used.
Vanco
How is Vanco dosed?
Concentration Based Dosing
Skin/soft tissue - 5/10 mcg/ml
Sepsis, endocarditis- 10-15 mcg/ml
Etc….
Vanco ADRs?
RED-MAN SYNDROME (SLOW DOWN INFUSION RATE!)
-nephrotoxicity, ototoxicity, thrombocytopenia
Vanco, Dapto, and Linezolid are gram ()???
Positive (+)
Vanco picked first
Daptomycin (Cubicin) coverage? and risks?
-Broad spectrum gram (+) including VRE
-given for Vanco resistant gram (+)
Choose Vanco more often unless resistant (more side effects with Cubicin)INFUSION REACTIONS!
Linezolid (Zyvox) coverage
Broad gram (+) including MRSA, VRE, Enterococci faecalis
-ribosomal subunit inhibiting type.
Linezolid (Zyvox) ADRs and special considerations
ADRs: Anemia, leukopenia, pancytopenia, thrombocytopenia, myelosupression
Special considerations: Drug interactions with MOA w/ potential for Serotonin Syndrome
CHECK CBCs AND DRUG INTERACTIONS!!!!
Macrolides suffix and coverage?
“Mycins”
-good for LONG TERM Tx, Good gram (-)
-Covers respiratory
Macrolides ADRs?
-QT prolongation and
-DRUG INTERACTIONS!
How do Fluoroquinolones work?
inhibit DNA synthesis
FQs risks?
FQs suffix?
MANY DRUG INTERACTIONS!
“floxacins”
FQs ADRs?
GI, arthropathies, QT Prolongations, CNS excitement, muscle weakness (MG) ACHILLES TENDON RUPTURE
High risk side effects of FQs?
-Tendonitis
-Neurologic
-Hypoglycemia
-Morbidity/Mortality
LOTS OF SIDE EFFECTS!
Tetracyclines (“cyclines”) things to know…
Don’t give to kids!
-inhibits bone growth and can cause YELLOW TEETH!
-LOTS OF ADRs, LFTS
-3rd line for MRSA
-penetrates skin/tissue
Tigecycline (TCNs) symptom
High incidence of VOMITING
Aminoglycosides (Things to Think about?)
-Oto and nephrotoxic!
-Can affect NEUROMUSCULAR BLOCKADE!
-Draw troughs and think about KIDNEYS
Things to check when taking Bactrim?
Check KIDNEYS, CBCs, and SKIN! (Stevens Johnson syndrome)
Bactrim uses
Alternative to Vanco for MRSA and VRE
Nitrofurantoin (Macrobid) Use?
Suppression of Chronic UTIs!
-uropathogens
Clindamycin (Cleocin) coverage and considerations
Covers ANAEROBES
-ADRs = HIGHEST C-Diff risk and neuromuscular blockade issues
Metronidazole (Flagyl) coverage and considerations
-Covers ALL ANAEROBES (Very Broad)
ADRS- pancreatitis, peripheral neuropathy
VERY TOXIC
Rifampin Uses, Interactions and ADRS
LOTS OF DRUG INTERACTIONS (last a long time)
-ORANGE-RED BODY FLUIDS!
FOR TB AND PROSTHETICS!
ABX to avoid in Pregnancy
Metronidazole, Rifampin, Trimethoprim, FQs, Tetracyclines
-POTENTIAL TO INJUR FETUS
Side effects from Antivirals (Acyclovir)
CNS effects!
-Post-op delirium, tremors
What to use for severe fungal infection?
Amphoteracin B
-can cause K and Mg wasting
What to consider when taking “Azoles” Fluconazole (Diflucan)?
DRUG INTERACTIONS!
What do Fungin drugs cover?
-Candida and non-candida
