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KCSU17 Patho/Pharm Submodule 1 > Antimicrobial OBJECTIVES > Flashcards

Antimicrobial OBJECTIVES Flashcards

1
Q

prophylactic coverage

A

attempt to prevent an infection before it is encountered

often done before surgery

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2
Q

empiric coverage

A

giving an antibiotic that will cover all of the most likely pathogens affiliated with a particular infection

not sure what it is so cover for all while getting a culture to narrow down

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3
Q

targeted coverage

A

give antibiotics for a specific pathogen

helps eliminate unnecessary and excessive coverage

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4
Q

broad spectrum

A

antibiotic that treats/covers a variety of organisms

typically both gram positives and gram negatives (and resistant organisms)

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5
Q

when would you use broad spectrum Abx?

A

used for empiric/initial treatment of suspected infection

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6
Q

narrow spectrum

A

antibiotic with limited pathogen coverage

may be due to nature of antibiotic or resistance issues

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7
Q

when would you use narrow spectrum Abx?

A

for treatment of specific pathogen (via culture or patient history)

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8
Q

bacteriostatic agents

A

antimicrobials that inhabit bacterial GROWTH

requires host immune system to eliminate bacteria that are there

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9
Q

bactericidal agents

A

antimicrobial that directly destroys the bacteria

used in patients who are immunocompromised (no immune system to fight what is left) or serious infections

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10
Q

bioavailability

A

% of a drug that gets into the body when given orally as compared to IV

drugs with high bioavailability have same IV doses and PO doses

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11
Q

what factors must be considered when prescribing antibiotics to the elderly?

A

different dosing due to

  1. muscle wasting
  2. renal dysfunction
  3. adverse events
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12
Q

reduced renal function and antibiotics

A

often found in elderly

may potentially underdose an antibiotic

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13
Q

elderly and adverse events

A

more susceptible

i.e. cephalosporins can cause hallucinations

must reduce the dose or we will overdose and do harm

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14
Q

steps in selecting an antibiotic regimen

A
  1. consider infection (site. common organism, PO/IV)
  2. consider patient (age, allergies, renal, CI)
  3. cost effective
  4. don’t be redundant – most coverage, no duplicate coverage, different targets)
  5. be convenient (appropriate dosing, PO are better)
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15
Q

goals of antimicrobial stewardship (4)

A
  1. reduce complications and risk of adverse events
  2. improve outcomes
  3. use more cost effective regimens
  4. reduce emergence of bacterial resistance
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16
Q

benefits of antimicrobial stewardship

A
  1. reduce C diff rates
  2. reduce resistance rates
  3. improve approbate use and clinical outcomes
  4. reduce cost of care (less spending on Abx, fewer readmissions, lower resistance rates, decrease complications)
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17
Q

why are beta lactams preferred over other antibiotics?

A

work quickly

potent

bactericidal

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18
Q

mechanism of action Beta lactams

A

cause bacterial cell wall

bactericidal, potent and rapidly kill bacteria

drug of choice when they are susceptible

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19
Q

drug of choice for syphilis

A

penicillin

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20
Q

drug of choice for MSSA bacteremia

A

IV Antistaaphyloccocal penicillin

nafcillin/oxacillin

21
Q

drug of choice for enterococcal infections

A

aminopenicillins

22
Q

beta lactamases

A

enzymes produced by bacteria that render beta lactam antibiotics ineffective

make bacteria more resistant to Abx

23
Q

Beta lactamase inhibitors increased spectrum by:

A

adding coverage of
Gram -,
staph species,
strep pneumoniae

24
Q

Beta lactamase inhibitors

A

drugs that inhibit beta lactamase in bacteria

25
Q

when would we use extended spectrum penicillins

A

severe or healthcare associated infections

+

concern for resistant gram negative organisms

(not used for targeted therapy, too broad)

26
Q

1st gen Cephalosporins use

A

prophylaxis (before surgery over skin)

epic uncomplicated cellulitis

targeted therapy if sensitivities are known

27
Q

which cephalosporins have aerobic coverage?

A

cefoxitin and cefotetan

2nd generation cephalosporins

used prophylactically during intra-abdominal surgeries

28
Q

3rd generation cephalosporins

A

ceftriazone

great overage of strep pneumoniae

ceftazidime –> pesudamonas

used for empiric and targeted

29
Q

4TH gen cephalosporins dont cover

A

ESBLs, Enterococcus, anaerobes or MRSA

30
Q

carbapenems

A

meropenem

broadest of all antibiotic classes

only thing they don’t cover is MRSA

31
Q

which antibiotic has the broadest spectrum?

A

carbapenems

32
Q

when do we used carbapenems

A

patients with nosocomial infections

reisitnat organisms are suspected

drug of choice for ESBL producing gram negatives

33
Q

what drugs can be given to a patient with allergies to Beta lactams?

A

carbapenems

monobactams (Azotreonam)

34
Q

monobactams

A

ONLY gram negatives (no gram +)

can be used safely in patients who report anaphylaxis to beta lactams

35
Q

antibiotics that require peak and trough blood levels

A

aminoglycosides, vancomycin

peak = efficacy, trough = toxicity

36
Q

which antibiotics have black box warnings?

A

fluroquinolones

clindamycin

37
Q

black box warning:

flouroquinolones

A

tendon rupture and/or inflammation

exacerbation of myasthenia gravis

38
Q

black box warning:

clindamycin

A

high propensity to cause C. diff

avoid in its at risk (elderly, cancer, freq. Abx use)

39
Q

antivirals effective against HSV

A

acyclovir and valacyclovir (DOC)

famciclovir

40
Q

who is at risk of CMV infection?

A

immunocompromised patients

  • HIV
  • transplant pts
  • cancer patients
41
Q

which antivirals are effective against respiratory viruses

A

oseltamivir and zanamivir

tamiflu, relenza

42
Q

which patients should receive influenza treatment?

A

patients who require hospitalization
has severe, complicated or progressive illness
high risk of complications

43
Q

Systemic Azoles

narrow to broad spectrum

A

Fluconazole < itraconazole < vorioconazole < Posconazole

`

44
Q

Aspergillis coverage

A

Voriconazole (DOC)
intraconazole

IV echinocandins

45
Q

terbinafine indications

A

PO

AKA Lamasil

onychomycosis

46
Q

terbinafine treatment

A

AKA Lamasil

6 weeks: fingernails
12 weeks: toenail

47
Q

how do you treat CMV?

A

ganciclovir (IV)

valganciclovir (PO)

48
Q

difference b/t echinocandins and azoles?

A

a: many drug interactions, increase hepatoxicity, PO or IV, more common
e: IV only, more broad, safer (less adverse event or toxicity)

49
Q

which anti fungal should be used for empiric treatment of fungemia and invasive candidasis

A

fluconazole

exhoniocandadiasis

KCSU17 Patho/Pharm Submodule 1 (12 decks)

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