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BCGP Prep > BCGP Infection Disease > Flashcards

BCGP Infection Disease Flashcards

1
Q

C diff exotoxins are associated with

A

Toxin A: activates inflammatory cells that release cytokins
cause increase in permeability and loss of fluids

toxin B cytotoxins
cause further damage of GI mucosa after initial damage of toxin A

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2
Q

Name risk factors for C Diff

A

abx use (broad spectrum)
long term exposure or exposure to antimicrobials
age > 65
immune suppression
PPI/H2RA (increase acidity and more prone to c diff)
female
gi tract manipulation

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3
Q

S/Sx of C Diff

A 
>3 unformed stool in 24h 
severe abd cramps/pain
n/v
fever
anorexia 
malaise

serious compl:
pseudomembranous colitis
toxic megacolon

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4
Q

Name high risk abx associated with C Diff

A

clinda
extended spectrum cephs
FQ
aminopenicillins (amox/ampic)

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5
Q

name moderate risk abx associated with c diff

A

bactrim
macrolide
pcn

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6
Q

name low risk abx associated with c diff

A

vanco
AMG
flagyl

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7
Q

Is probiotics recommended to use for ppx/tx of c diff

Is loperamide recommended to be used for diarrhea?

A

limited data

no, data lacking

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8
Q

Classification of tx of of C diff

A

Non severe: WBC < 15000 AND Scr < 1.5
Severe: WBC > 15000 OR Scr >1.5
Fulminant: hypotension or shock ileus, megacolon

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9
Q

tx of c diff (1st episode)

A

non severe: vanco 125mg qid x10 days or
fidaxomicin 200mg bid x10d

                 may use flagyl 500mg tid x10d only if above 
                  agents not available

severe: vanco 125mg qid x10d or
fidaxomicin 200mg bid x10d

fulminant: vanco 500mg qid PLUS
metronidazole 500 IV q8h

add rectal vanco if ileus is present

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10
Q

tx of first recurrent c diff

A 
if metronidazole was used initially: vanco 125mg qid x10d
if standard vanco was used: 
    prolonged  or pulsed vanco
      vanco 125mg qid x10 then 
       125mg bid x7then 
       125mg qd x7 then 
       125mg q2-3d x2-8 weeks 
 or 
    fidox 200mg x10d
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11
Q

tx of 2nd or subsequent recurrence

A
  • pulse or tapered vanco
  • 125mg qid x10 followed by rifaximin 400mg tid x20days
  • fidox 200mg bid x10d
  • fecal microbiota transplantation (FMT)
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12
Q

cephalosporins MOA

A 
time dependent
does not depend on immune system
bactericidal 
time > MIC
inhibits cell wall 
inhibit PBP
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13
Q

Cephs covers PSA

A

gen 3: ceftazidime
gen 4: cefipime
gen 5: ceftolozane/taz
ceftaz/avibactab

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14
Q

cephs covers MRSA

A

ceftaroline

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15
Q

cephs covers ESBL

A

ceftolozane/tz

ceftaz/avibactam

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16
Q

cephs with good penetration to CNS

A 
cefuroxime
cefotaxime
ctx
ceftaz
cefipime
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17
Q

Carbapenems general info

A 
inhibit PBP 
works on ESBL ( E coli and Proteus) 
works on PSA (except ertapenem) 
No coverage for enterococcus or MRSA
IM option only for ertapenem
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18
Q

Specs on carbapenems

A

doripenem (Doribax)

ertapenem (Invanz) - not effective for PSA, required dose adjustment on CrCl < 30, QD dosage, IM/IV

imipenem/cilastin (Primaxin) - associated with high risk of seizure activity, cilastatin protecs kidneys from nephrotox

meropenem (merrem) - 2nd for risk of seizure

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19
Q

monobactams

A 
Aztreonam
bacteriocidal
inhibit PBP
MONObactam - covers only one type of bacteria - gr -
PSA coverage
available in IV/Nebs (cayston) 
SE: phlebitis and liever enz elevation
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20
Q

Glycopeptides and lipoglycopeptides
drug list
MOA
SE vanco

A

vanco
telavancin

dalbavancin
oritavancin

Mainly covers MRSA and enterococcus
MOA: binds to D-alanyl-D-alanine and blocks glycopeptide polymerization (discrupt cell wall linkage)

Time dependant
BacterioCIDAL

VRE - D-alanyl-D-alanine changed to D-lactate - decrease affinity

Dalba and Orita - both have long t1/2 and and D5w only

Vanco - use ABW

SE vanco: infusion rate rash
nephro and ototox
thrombophlebitis

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21
Q

fosfomycin

A

bacterioCIDAL
inhibit cell wall synthesis
gr - (E coli)
enterococcus sp

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22
Q

macrolides gen info

list of drugs

A

concentration dependent
AUC/MIC
bacterioSTATIC
works on 50S ribosomes

azithromycin - available IV/po
clarithromycin - po, cyp3a4 I moderate, QT prolongation, gi se
erythomycin - po/iv, major CYP3A4 I, qt prolongration, GI se

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23
Q

list of biacterioSTATIC drugs

A 
ECSTaTIC about bacteriastatin
erythromycin
clarithromycin
sulfamet
trimetoprim
tcn
chloramphenicol
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24
Q

list of drugs that work on 30S/50S ribosomes

A

buy AT 30, CCELL for 50 dollarS

30: AMG and TCN
50: clinda, chloramphenicol, erythom, linezolid, lincomycin, streptomycin

with exception to linezolid and AMG - all are bacteriostatic

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25
Q

Which bacteria does macrolide cover?

A

gr+
gr - (incl leionella pna and MAC)
atypical (mycoplasma pna)

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26
Q

drugs that have good intracellular penetration

A

macrolides, FQ, TCN

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27
Q

which macrolide is used to treat H Pylori

A

clarithromycin

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28
Q

which macrolides have CYP3A4 interactions

A

clarithromycin (moderate)

erythromycin (major)

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29
Q

findoxomycin (Dificid)

A

macrolide, but inhibit protein sysntesis (not 50s)

only for C Diff

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30
Q

Which macrolides that may cause QT prolongation

A

erythromycin and clarithromycin

possible azithromycin

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31
Q

PCN parameters

A

bacteriocidal (kill on its own)
does not depend on immune system
time dependent
time >MIC

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32
Q

MOA of PCN

A

BL abx inhibit cell wall synth in bacteria by inhibiting enzyme transpeptidase (PBP) => cell lysis
peptidoglycan of bacterial cell wall

33
Q

pcn covers

A 
GR +       strep pyogenes
               strep viridans
               strep pneumo (some) 
GR -        N meningidis
               Pateurella multocida
Anaerobs:  clostrodium sp 
syphilis

NOT used for staph aureus

34
Q

PCN SE

A

n/v/seizures
HyperK with aq PCN G
rash/anaphylaxis

35
Q

Combo PCN Probenecib

A

decrease renal excretion, increase AUC

36
Q

Penicillinase resistant PCN (PRP) drugs

A

dicloxacillin
oxacillin
nafcillin

37
Q

PRP covers

A

narrowed to staph aureus and staph epiderm
MSSA

NO gram -, no MRSA
not for strep

38
Q

which PRP renally excreted

A

oxacillin

39
Q

PRP used for

A

skin and tissue infection

endocarditis (may be used with AMG for synergy)

40
Q

Aminopenicilllins drugs

A

amox

ampicillin

41
Q

Aminopenicillins coveres

A

more hydrophilic
exp gram - : H infl, E coli, Proteus
good activity against PCN resist pneumococci, enterociccus, Lysteria
some anaerobs

42
Q

Beta lactamase Inhibitors drugs

A

avibacatm
clav acid
sulbactam
tazobactam

43
Q

BL inhibitors covers:

A

NO PSA:
augmentin
unasyn

PSA: zosyn, ceftaz/avibactam, ceftolazone/tazob

ESBL: ceftaz/avibactam, ceftolazone/tazob

if sending home with PSA: cipro, levo, oxflox, noflox

Gr +, Gr-, anaerobs, PSA and ESBL

44
Q

TCN general characteristics

A

Protein systensis Inhibitors
concetration dependant
AUC/MIC
bacteriostatic (ECSTaTIC about bacteriostatic)
inhibits 30S (buy AT 30 CCELL 50 dollarS)
require immune to work

includes: 
tcn
minocycline
doxycycline
tigecycline

avoid in peds < 8yo

45
Q

TCN specs and SE

A

TCN: oto/nephrotoxicity, phototoxicity, GI esoph ulcirations (with full glass of water)

Doxicycline: coveres MRSA, phototoxicity, may give with good

Minocycline: CA MRSA, empty stomach

may cause Idiopathic intracratnial HTN

46
Q

Which TCN must be renally adjusted

A

mino and TCN

47
Q

TCN discoloration

A

yellow - TCn

blue- mino

48
Q

General info on Glycylcyclines

A

Tigacycline (Tigacil)
iv only
used when AKI/ARF and TCn can be used
Soft skin infection

Gr +: MRSA
Gr -
atypical

increased mortality when use off label

49
Q

List all drugs that are protein synthesis inhibitors

A 
macrolides
ketolides
tcn
glycylcyclines
anaerobic agents
linezolid
streptogramins
aminoglycosides
50
Q

list of drugs in oxazolidinones drug class

A

linezolid (zyvox)

tedizolid (sivextro)

51
Q

General specs on oxazolidinones

A

bacteriostatic if treating enterococci and staphylococci
bacteriocidal if trep pneumo, b fragilis and c perfrigens

MOA: inhibit assembly of bacterial 23s of 50s subunit => prevent formation of 70s comples

have MAO propertioes => caution with serotonin syndrome

52
Q

oxazolidinones coverage

A

MRSA
MDRSP
VRE faecium
VRE faecalis

53
Q

oxazolidinones drug info

A 
linezolid: 
po/iv
compatible in d5w,ns,lr
good bioavailability
report myelosuppresion and thrombocytopenia if >2wk
given for:
soft tissue inf
CAP
HCAP/HAP
enterococcal
Tidezolid: 
skin soft inf ONLY
given qd over 1 hr
iv only 
ns only
54
Q

myelosupression with linezolid

A

> 2wks
reversable
if >4wks lactic acidosis and peripheral neuropathy

55
Q

drug class streptogramins

A

quinopristin/dalfopristin (30/70%)

MOA: binds to 50s
buy AT 30 CCELL at 50S

AMG, TCN. Clinda, chloamph, erythrom, linezolid, lincomycin, streptogramins

Coverage: VRE (not e faecalis (compare to linezolid)
MRSA
MDR Strep pneumo

Dosing: VRE: 7.5mg/kg IV q8h
Soft skin: 7.5mg/kg IV q12h

ADJUST hepatically

SE: phlebitis (PICC LINE ONLY) , hyperbilirubin, may use buffer (D5W), flush line before and after!

56
Q

list of drugs for AMG

A 
amikacins
gentamicin
tobramicin
neomicin
streptomicin
57
Q

Specs on AMG

A

cocncetration dependant
longer the exposure the higher the risk of SE
peac/MIC
bacterioCIDAL

Very               vanco
Finely             FQ
Proficient       PCN
At                    AMG
Cell                 cephs
Murder           metronidazole

MOA: binds to 30 and 50S

SE: nephrotoxicity

otic drops used only for otitis externa (swimmer ears)

58
Q

AMG covers

A

good gr _ (PSA and serratia)

gr+ little staph aureus

59
Q

dosing

A

must monitor peak and trough

gent + tobr: traditional
high peak - 1.5-2mg/kg q8h
lower peak 1-1.5mg/kg

use IBW or ABW in obese

amik: 5-7mg/kg q8h

renally adjusted:
>90 q8h
50-90 q12h
<50 q24h

extended interval - qd dosing - use random level to monitor 6-10 hours AFTER the dose - then use chart to adjust frequency

60
Q

AMG drug info:

A

neomicin - top or po, po not abs, used for hepatic enceph

amikacin - IV/IM - dosing ext and trad same

tobra/gent - IV/IM, gent nebs -
1.5-2mg/kg q8h or
ext 5-7mg/kg/day (dicrease se profile)

streptomicin - emergency prep IM

61
Q

FQ gen info

A

bacteriocidal

concentration dependent
Very               vanco
Finely             FQ
Proficient       PCN
At                    AMG
Cell                 cephs
Murder           metronidazole

MOA: work on DNA gyrase (inhibit topoisomerase II)

DDI - di and trivalent

Coverage: PSA (cipro and high dose of levo/nor/oflox
good atypical coverage

NO UTI for gemi and moxi

62
Q

drug info on FQ

A

delafloxacin - covers MRSA

cipro - po/iv PSA
not good for strep pneumo

nor/oflox - PSA

levo - PSA high doses

moxi/gemi - no UTI, no PSA,no MRSA

63
Q

SE FQ

A 
all - QT prolongation 
increase sizure risk with NSAID
tendon rupture (increased with >60yo+steroids)
64
Q

Clinda and lindomycin

A

protein synthesis inhibitors
bacteriocidal and static

gr+ anaerobic
inhibit 50S
compete with macrolide
covers CA MRSA
great for alt PCN

SE: c diff
diarrhea/n/v
neutropenia
hepatotoxicity

65
Q

metronidazole

A

bacteriocidal
rpodrug
gr - anaerob

se periopheral neuropathy
metalic tste
weak 2c9 i (warfarin)

66
Q

Uti diagnosis

A 
Urinalysis:
Bacteria
Wbc and leukocyte estrerase
Rbc (more systemic) 
Nitrites: (dicreased)
  Ecoli
  Klebsiela
  Proteus

Other bugs will not produce nitrates

> 100 000 one pathogen

67
Q

Uti treatment options

A 
Nitrofurantoin 
Bactrim 
Fosfomysin 
Fq
Beta lactams
68
Q

daptomycin

A

using Ca and insert into bacterial membrane
concentration dependant
bacteriacidal

MRSA
NOT FOR PNA - will bind to surfactant

monitor Ck/myopathy

69
Q

Bactrim

A

bacteriocidal
se bone marrow supression
pancreatitis

MRSA

major 2C9 inhibitor (warfarin)
substrate 3A4 and 2C9

70
Q

Nitrofurantoin

A

cell wall inhibitors
probenecid may inhibit excretion

se peripheral neuropathy

71
Q

RF for UTI

A 
female gender
immunosenescence
hormonal changes
neurologic disease
BPH
DM
personal hygiene
72
Q

UTI Sx

A

acute: localized

pyelonephritis: 
systemic s/sx
increase WBC
fever
flank pain
n/v
malaise

both may have altered mental status, behavioral changes, and change in eating habits

73
Q

UTI pathogens

A

Ecoli
Klebsiella and Proteus

Complicated:
Gr- : PSA as a MDR
GR+: MRSA or VRE

74
Q

name two types of PNA

A

CAP

HAP : occurs >48h of hospitalization, includes MDR

75
Q

Criteria to admit outpt to hospital due to PNA

A 
use CURB65
Confusion
Uricemia (BUN >20
RR >30
BP SBP<90 and DBP <60 
65 yo >/=

2+criteria

76
Q

Diagnosis of PNA

A

CXR
sputum and blood cultures may be considered but often do not yield positive results, used primarily in hospital
urine sample good for Legionella and Streptococcus antigens

77
Q

RF and comorbidities to assess MDR for PNA

A 
comorbidities: 
chronic Lung, Liver, Renal dz
DM
OH
asplenia
malignancies/immunosupression/meds
RF: 
comorbities
OH use
daycare
immunosupressive drugs
>65
abx within 3m
78
Q

CAP treatment

A

outpt:
macrolides OR doxycicline

outpt with comorb OR RF for MDR:
macrolides with b-lactams
OR
respiratory FQ

inpt, non ICU
macrolides with b-lactams
OR
respiratory FQ

inpt, ICU
      macrolides with b-lactams
                OR
      respiratory  FQ
consider MRSA +/- PSA

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