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Therapeutics > Antimicrobials & SSTIs > Flashcards

Antimicrobials & SSTIs Flashcards

1
Q

Therapeutic balance of ID
Maximize ____ and minimize ___

A

Maximize bacterial killing, safety, and efficacy
Minimize toxicity & resistance

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2
Q

ecological adverse effects of antibiotic therapy, specifically selection of drug-resistant organisms and the unwanted development of colonization or infection with MDR organisms

A

collateral damage

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3
Q

collateral damage risks associated with cephalosporin

A

-subsequent infections with VRE
-extended spectrum B-lactamase producing K. pneumoniae
-B-lactam resistant Acinetobacter species
-C. diff

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4
Q

the lowest concentration of an antibiotic that completely inhibits the growth of a microorganism in vitro

A

MIC

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5
Q

the lowest concentration of the antibiotic which results in a 99.9% reduction in colony forming units in a given time

A

MBC

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6
Q

species that is
-gram + cocci
-clusters (catalase -)
-coagulase +

A

S. aureus

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7
Q

species that is
-gram + cocci
-clusters (catalase -)
-coagulase -

A

S. epidermidis

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8
Q

species that is
-gram + cocci
-pairs (catalase +)
-alpha

A

S. pneumoniae

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9
Q

species that is
-gram + cocci
-chains
-beta

A

Group A strep (S. pyogenes)
Group B strep (S. agalactiae)
Group C, G, F strep

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10
Q

species that is
-gram + cocci
-chains
-gamma

A

enterococcus species
E. faecalis
E. faecium

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11
Q

drugs for MSSA (S. aureus, 50%)

A

nafcillin, oxacillin, dicloxacillin

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12
Q

drugs for MRSA (S. aureus, 50%)

A

vancomycin, linezolid, daptomycin, Bactrim, clindamycin

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13
Q

drugs for MSSE (S. epidermidis, 20%)

A

nafcillin, oxacillin, dicloxacillin (same as MSSA)

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14
Q

drugs for MRSA (S. epidermidis, 80%)

A

vancomycin, linezolid, daptomycin, Bactrim, clindamycin (same as MRSA)

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15
Q

drugs for PCN (S) S. pneumoniae (90%)

A

penicillin G/V, nafcillin

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16
Q

drugs for PCN (R) S. pneumoniae (10%)

A

vancomycin, Bactrim

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17
Q

drugs for PCN (S) streptococcus

A

penicillin G/V, nafcillin (same as S. pneumoniae)

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18
Q

drugs for PCN (R) streptococcus

A

vancomycin, Bactrim (same as S. pneumoniae)

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19
Q

drug options for enterococcus species (E. faecalis, E. faecium)

A
  1. ampicillin +/- gentamicin
  2. vancomycin +/- gentamicin
  3. linezolid, daptomycin
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20
Q

drug for gram positive aerobe cocci

A

clindamycin

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21
Q

drug for gram positive aerobe bacilli

A

metronidazole

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22
Q

gram - cocci PEK species

A

Proteus mirabilus
Escherichia coli
Klebsiella pneumoniae

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23
Q

gram - cocci HEM species

A

Haemophilus influenzae
Enterobacteriaceae (salmonella, shigella)
Monexella catanthalis

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24
Q

gram - cocci SPACE species

A

Serratia marcesens
Pseudomonas aeruginosa
Acinetobacter baumannii
Citrobacter
Enterobacter

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25
Q

cephalosporins that cover PEK bacteria

A

cefazolin, cephalexin, cefadroxil

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26
Q

cephalosporins that cover PEKHEM bacteria

A

1) cefuroxime, cefaclor
2) cephamycins, cefoxitin, cefotetan cefmetazole

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27
Q

cephalosporins that cover PEKHEM S_ACE bacteria

A

1)Ceftriaxone, cefpodoxime proxetil
anti-pseudomonal: ceftazidime, cefoperazone
2) cefepime
3) ceftaroline

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28
Q

which cephalosporin is best for SPACE organisms

A

ceftazidime

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29
Q

which drugs are used for pseudomonas

A

combinations including:
-piperacillin/tazobactam
-carbapenems (meropenem, imipenem)
-ceftazidime

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30
Q

PKPD indices for antibiotic effect

A

Cmax:MIC
%T>MIC
AUC:MIC

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31
Q

which drugs follow:
-time dependent killing
-min/mod persistent effects

A

penicillins
cephalosporins
carbapenems
macrolides
oxazolidinones

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32
Q

what is the PKPD index that influences time dependent killing and min/mod persistent effects

A

%T/MIC

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33
Q

which drugs follow:
-concentration dependence
-prolonged persistent effects

A

aminoglycosides
quinolones

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34
Q

which PKPD indices influence concentration dependence and prolonged persistent effects

A

Cmax:MIC
AUC:MIC

35
Q

which drugs follow:
-time dependent killing
-prolonged persistent effects

A

vancomycin
azithromycin
tetracycline

36
Q

which PKPD index influences time dependent killing and prolonged persistent effects

A

AUC:MIC

37
Q

how do pH changes alter PK

A

altered drug ionization

38
Q

how do changes in organ blood flow alter PK

A

altered drug CL

39
Q

how to fluid shifts alter PK

A

altered Vd

40
Q

how do changes in albumin alter PK

A

changes in free drug

41
Q

hydrophilic antimicrobials

A

aminoglycosides
beta lactams (carbapenems, cephalosporins, penicillins)
glycopeptides
lipopeptides

42
Q

lipophilic antimicrobials

A

fluoroquinolones
glyclcycline
ketolides
lincosamides
macrolides
metronidazole
streptogramins
tetracyclines

43
Q

how do hydrophilic drugs alter PK

A

tissue distribution limited to extracellular space
inc LD and inc/dec MD

44
Q

how do lipophilic drugs alter PK

A

tissue distribution with intracellular accumulation
no change to LD or MD

45
Q

how does infection in blood alter PK

A

inc Vd and CL

46
Q

how does infection in lung alter PK

A

impaired permeability

47
Q

how does infection in soft tissue alter PK

A

variable by composition

48
Q

how does infection in bone alter PK

A

impaired permeability

49
Q

how does infection in the CNS alter PK

A

impaired permeability

50
Q

fluid shifts in sepsis do what to CL, Vd, and drug conc?

A

can lead to high or low Vd, impaired or augmented CL, and too high or too low drug conc

51
Q

antibiotics that do not need renal dose adjustment

A

ceftriaxone
clindamycin
oxacillin
moxifloxacin
metronidazole
azithromycin
nafcillin
doxycycline
erythromycin
dalfopristin/quinupristin
tigecycline
linezolid

52
Q

decisions for which drug to use should be made based off

A

S, R, or I…. NOT the number

53
Q

greater outcomes were seen for fluoroquinolones with an AUC:MIC

A

> 125

54
Q

target AUC24,ss:MIC for vancomycin

A

> 400 ng*h/L

55
Q

types of purulent infections

A

cutenous abscess, furuncle, carbuncle

56
Q

presentation of purulent infection

A

painful, fluctuant red nodules, topped with pustule, rim of erythematous swelling

57
Q

common microbial cause of purulent infection

A

S. aureus

58
Q

General treatment approach for purulent infections

A

must do I&D
antibiotics if there are systemic signs of infection, do not respond to I&D, etc (SIRS criteria, mod to sev)

59
Q

IV drugs for purulent MRSA infections (empiric)

A

vancomycin, daptomycin, ceftaroline, dalbavancin/oritavancin

60
Q

oral drugs for purulent MRSA infections (empiric)

A

Bactrim, doxycycline, linezolid

61
Q

IV drugs for purulent MSSA infections (de-escalate)

A

ampicillin/sulbactam, nafcillin/oxacillin, cefazolin

62
Q

oral drugs for purulent MSSA infections (de-escalate)

A

amox/clav, dicloxacillin, cephalexin, clindamycin

63
Q

duration of therapy purulent infection

A

5-10 days following I&D

64
Q

types of nonpurulent infection

A

cellulutis, erysipelas

65
Q

presentation of nonpurulent infection

A

red, warm, swollen, painful

66
Q

common microbial cause of nonpurulent infection

A

streptococcus species, some S. aureus

67
Q

general treatment approach for nonpurulent infection

A

antibiotics
oral for mild
oral or IV for moderate
IV for severe

68
Q

oral drugs for nonpurulent infection (strep)

A

penicillin VK, amoxicillin, amox/clav, cephalexin, clindamycin (allergy)

69
Q

IV drugs for nonpurulent infection (strep)

A

penicillin G, cefazolin, ceftriaxone, clindamycin (allergy)

severe allergy- clindamycin, vancomycin, linezolid, daptomycin

70
Q

treatment duration for nonpurulent infection

A

5 days if mild, 10-14 if mod-sev

71
Q

deep infection involving the superficial fascia comprising all tissue between the skin and muscle

A

necrotizing fasciitis

72
Q

microbial causes of necrotizing fasciitis

A

mono: S. pyogenes, S. aureus, Clostridium
poly: mixed aerobic/anaerobic

73
Q

general treatment approach for necrotizing fasciitis

A

surgery
broad spectrum antibiotics started then de-escalated

74
Q

drug for necrotizing fasciitis that covers MRSA

A

vancomycin +

75
Q

drug for necrotizing fasciitis that covers gram -

A

pip-tazo, carbapenems, cefepime +, ciprofloxacin +

76
Q

drug for necrotizing fasciitis that covers anaerobes

A

pip-tazo, carbapenems, metronidazole, clindamycin

77
Q

microbial species common in infected animal bites

A

pasturella species

78
Q

oral and IV drugs for bite wounds

A

IV- ampicillin/sulbactam
Oral- amox/clav
Alt- 2nd/3rd gen cephalosporins + metronidazole, levofloxacin + metronidazole

79
Q

presentation for DFIs

A

redness, warmth, swelling, tenderness, pain, purulent drainage (from ulcer) (need 2 or more to be infected)

80
Q

microbes that cause DFIs

A

gram + cocci: staphylococcus and streptococcus
gram - bacilli: pseudomonas
anaerobes: may be seen in mod-sev

81
Q

mild oral therapy for DFI

A

MSSA/strep- cephalexin, amox/clav, clindamycin
MRSA- bactrim, doxycycline

82
Q

mod-severe IV therapy for DFI

A

MSSA/strep/gram neg/anaerobes- amp/sulbact, cefoxitin, ceftriaxone + metro, cipro + clindamyc, moxifloxacin, ertapenem
MRSA- vancomycin, linezolid, daptomycin
pseudomonas- pip/tazo, cefepime

83
Q
A

Therapeutics (20 decks)

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