Antimicrobials Flashcards by Sarah Horvath

minimum inhibitory concentration is the lowest concentration required to ____

prevent growth

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minimum bactericidal concentration is the lowest required to ____

kill

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T/F For most infections, bactericidal is better than bacteriostatic.

FALSE.

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The more broad the spectrum, the ___ rate of resistance.

higher

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T/F PAE is decreased in acidic (infected) media

TRUE

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a beta lactam +aminoglycoside is a common example of

syngergism

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examples of secondary impaired host defenses:

neutropenia, aspleenia, malignancy, HIV, immunosuppressant therapy

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pregnant patients have an ___ volume of distribution and GFR, so their risk of complications from an infection are ____

increased, increased

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which meds are OK for pregnant patients

PEC - penicillins, erthromycin, cephalosporins

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Which med in a pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury

tetracycline

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November 2017 update canadian study showed increased risk of congenital malformations in the first trimester for ____ but no increased risks for ____

pcn, ancef

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how many people reporting a pcn allergy are truly allergic to cephalosporins?

5% or less

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T/F according to CDC data, nosocomial infections are on the rise.

False. there has been a reduction

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rank central line infection rates by site

fem>IJ>subclavian

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what are the two biggest offenders for C diff?

clinda & ancef/keflex.

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what is the go to drug to treat c. diff

PO vanco

deficit (fidaxomicin)

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how do you treat someone with an ongoing original infection who then gets c diff/

treat infection with appropriate broad spectrum abx.

continue c. diff therapy also and extend the course for 5-10 days after the completion of the other abx.

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T/F Half of SSIs are preventable using evidence based strategies

TRUE

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what is the recordation for patients at a high or mod risk undergoing procedures involving infected tissues or receiving prosthetic cardiac valves

include anti staphylococcal and for cellulite and osteomyelitis

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vanco and florquinolones (cipro, levoquin) need to be started within the first ___min of incision

120

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why is giving someone vanco for SSI prophy not as good as giving ancef?

bc it only covers gram+ bacteria. patients with a reported PCN allergy have a 50% increased odds of SSI, attributable to second-line abx.

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MOA of beta lactams

cell wall synthesis inhibitor. bind to the penicillin binding protein (PBP)

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are beta lactams bactericidal or bacteriostatic?

bactericidal

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which drug class is paired with beta lactam’s to fight resistance

beta-lactamase inhibitors. also known as suicide inhibitors.

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what are 3 beta-lactamas inhibitors?

sulbactam, tazobactam, clavulanic acid.

are aminoglycosides and fluoroquinolone time dependent or concentration dependent?

concentration

are bata lactams, mono-bantams, and macrolides time or concentration dependent

time

what are the biggest offenders of c-diff

1-clinda | 2- ancef/keflex

is is estimated that ___ of SSI's are preventable using evidence based strategies

50%

which wound class is atraumatic, no break in sterile technique, resp GI, GU tracts not entered.

clean 1

which wound class is surgery in areas known to harbor bacteria with no spillage of contents

clean-contaminated 2

which wound class is there a major break in sterile technique, surgery on traumatic wounds, gross GI spillage, entrance into an infected biliary or GU tract

contaminated 3

which wound class = infection existed before the surgery, old wound w devitalized tissue, perf viscera

dirty infected 4

vancomycin and flurquinolones (cipro, levoquin) need to be started within the first ___min of incision. everything else including ancef and cleomyocin - ___ min

120 60

the disadvantage of vancomycin is that it only overs gram ___ bacteria

+ does not kill gram - (like e. coli)

what is the MOA of beta lactams

cell wall synthesis inhibitor | when the bacteria cell cant repair its cell wall, it bursts open. so beta lactams are bactericidal.

_____ breaks a bond in the B-lactam ring of pcn to disable the molecule. Bacteria with this enzyme can resist the effects of pcn and other b-lactam abx.

beta-lactamase

which agent is associated with jarisch-herxheimer reaction

pcn

oxacillin, nafcillin, dicloxacillin are ____ specific except MRSA and MRSE

staph

as you go from 1st gen to 3rd gen, add a lot more ____

gram negatives

ticarcillin and piperacillin causes ___kalemia

hypo

what is the MOA of cephalosporins

bactericidal, breaking apart the cell wall

cefazolin, cephalexin = __ gen cepahlosporins

cefoxitin = __ gen cepahlosporins

ceftazidime , ceftriaxone = __ gen cepahlosporins

cefepime = __ gen cepahlosporins

ceftobiprole, ceftaroline = __ gen cepahlosporins

which 2 drugs are anti-pseudomonal

ceftazidime and cefoperazone

T/F 3rd gen cephalospines can be used to tx meningitis bc they crosss the CNS. (ceftazidime, cefoperzone)

TRUE

what is the max does of ceftazidime

6g/day

which drug causes biliary slugging and precipitates with calcium

ceftriaxone

which drugs are associated with interstitial nephritis

beta lactams at high dose they are really eliminated, so are cephalosporins

which 5th gen cephalosporin covers MRSA, gram pos, broad-spectrum (technically a beta-lactam that covers MRSA)

by definition it shouldn't, but it does

carbapenems are the drug of choice for ____

ESBL's

imipenem/cilastatin (primaxin) has a high risk of ___

seizures

meropenem has a higher or lower risk of seizures than primaxin?

lower

red mans, nephrotoxicity, ototoxitiy, TTP is associated with

vanco

T/F Red mans is an infusion rate reaction so you can treat it by slowing the rate (1g/hr) and antihistamines

TRUE

which drug works at ribosomal subunits

linezolid (zyvox)

which drug has the risk of myelosuppression (anemia, leukopenia, pancytopenia, thrombocytopenia)

linezolid

linezolid has a drug interaction with ___ which leads to the potential for _____

MAO, serotonin syndrome

macrolide = ____ = prolonged QT

azithromycin

macrolide = _____ = significant GI toxicity = ____ of cyp3A4

clarithromycin, inhibitor

which drug is good for PUD

biaxin

which drug class is associated with GI, arthopathies, qt prolongations, CNS excitement, altered glucose homeostasis

fluoroquinolones

use of what drug class increases morbidity and mortality

fluoroquinolones

what is the drug of choice for bacterial GI infections (travelers)

cipro

which drug is associated w efflux pump resistance

levofloxacin

which fluoroquinolone covers MRSA but is not associated with qt prolongation or photosensitivity

delafloxacin (baxdela)

are tetracyclines bacteriostatic or bacteriocidal?

static. mRNA.. inhibits protein synthesis

dont give ___ to kids <12

tetracyclines like doxy

which drugs "pick up a lot of gram pos and gram neg, wide VOD, risks with children, drug interactions"

tetracyclines

order the ahminoglycosides and their effects on neuromuscular blockade

neo/strep > kana > ami > gent > tobra ns k a g t

which drug is used for people with severe liver disease and portal hypertension because it binds up and breaks down ammonia

neomycin

gent is mostly gram ___ with some synergistic gram ____

negative, positiive

trimethoprim/sulfamethoxole (bactrim/septra) are ____ on their own but ____ when they come together

bacteriostatic | bactericidal

sulfamethoxole (bactrim) is eliminated by ___, carries the risks of.....

pancytopenia, neutropenia, TTP, stevens johnson

which drug carries the risk of peripheral neuritis, pulm complications, hepatic damage, blood dycrasias

nitrofurantoin (macrobid, macrodantin)

clinda has the ____ c diff risk

highest

which drug causes pancreatitis, peripheral neuropathy, ataxia, confusion, encephalopathy, tremors

flagyl

rifampin is mostly used for?

TB and prosthetics

which drug is a potent inducer of the CYP450 system

rifampin

mono therapy, seem in rifampin leads to

rapid resistance

which drug class causes hallucinations

acyclovir

whats important about amphoteracin B? antifungal

- can cause renal failure - high rates of infusion reactions - loss of K/mg (risk arrhythmias) - anemias

fluconazole is a potent ___ of CYP3A4

inhibitor

azole antifungals = ___ drug interactions

severe. | esp with voriconazole

echinocandin antifungals cause ____ damage

liver