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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
Which bacteria does macrolide cover?
gr+ gr - (incl leionella pna and MAC) atypical (mycoplasma pna)
26
drugs that have good intracellular penetration
macrolides, FQ, TCN
27
which macrolide is used to treat H Pylori
clarithromycin
28
which macrolides have CYP3A4 interactions
clarithromycin (moderate) | erythromycin (major)
29
findoxomycin (Dificid)
macrolide, but inhibit protein sysntesis (not 50s) | only for C Diff
30
Which macrolides that may cause QT prolongation
erythromycin and clarithromycin | possible azithromycin
31
PCN parameters
bacteriocidal (kill on its own) does not depend on immune system time dependent time >MIC
32
MOA of PCN
BL abx inhibit cell wall synth in bacteria by inhibiting enzyme transpeptidase (PBP) => cell lysis peptidoglycan of bacterial cell wall
33
pcn covers
``` GR + strep pyogenes strep viridans strep pneumo (some) GR - N meningidis Pateurella multocida Anaerobs: clostrodium sp syphilis ``` NOT used for staph aureus
34
PCN SE
n/v/seizures HyperK with aq PCN G rash/anaphylaxis
35
Combo PCN Probenecib
decrease renal excretion, increase AUC
36
Penicillinase resistant PCN (PRP) drugs
dicloxacillin oxacillin nafcillin
37
PRP covers
narrowed to staph aureus and staph epiderm MSSA NO gram -, no MRSA not for strep
38
which PRP renally excreted
oxacillin
39
PRP used for
skin and tissue infection | endocarditis (may be used with AMG for synergy)
40
Aminopenicilllins drugs
amox | ampicillin
41
Aminopenicillins coveres
more hydrophilic exp gram - : H infl, E coli, Proteus good activity against PCN resist pneumococci, enterociccus, Lysteria some anaerobs
42
Beta lactamase Inhibitors drugs
avibacatm clav acid sulbactam tazobactam
43
BL inhibitors covers:
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
TCN general characteristics
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
TCN specs and SE
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
Which TCN must be renally adjusted
mino and TCN
47
TCN discoloration
yellow - TCn | blue- mino
48
General info on Glycylcyclines
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
List all drugs that are protein synthesis inhibitors
``` macrolides ketolides tcn glycylcyclines anaerobic agents linezolid streptogramins aminoglycosides ```
50
list of drugs in oxazolidinones drug class
linezolid (zyvox) | tedizolid (sivextro)
51
General specs on oxazolidinones
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
oxazolidinones coverage
MRSA MDRSP VRE faecium VRE faecalis
53
oxazolidinones drug info
``` 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
myelosupression with linezolid
>2wks reversable if >4wks lactic acidosis and peripheral neuropathy
55
drug class streptogramins
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
list of drugs for AMG
``` amikacins gentamicin tobramicin neomicin streptomicin ```
57
Specs on AMG
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
AMG covers
good gr _ (PSA and serratia) | gr+ little staph aureus
59
dosing
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
AMG drug info:
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
FQ gen info
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
drug info on FQ
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
SE FQ
``` all - QT prolongation increase sizure risk with NSAID tendon rupture (increased with >60yo+steroids) ```
64
Clinda and lindomycin
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
metronidazole
bacteriocidal rpodrug gr - anaerob se periopheral neuropathy metalic tste weak 2c9 i (warfarin)
66
Uti diagnosis
``` 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
Uti treatment options
``` Nitrofurantoin Bactrim Fosfomysin Fq Beta lactams ```
68
daptomycin
using Ca and insert into bacterial membrane concentration dependant bacteriacidal MRSA NOT FOR PNA - will bind to surfactant monitor Ck/myopathy
69
Bactrim
bacteriocidal se bone marrow supression pancreatitis MRSA major 2C9 inhibitor (warfarin) substrate 3A4 and 2C9
70
Nitrofurantoin
cell wall inhibitors probenecid may inhibit excretion se peripheral neuropathy
71
RF for UTI
``` female gender immunosenescence hormonal changes neurologic disease BPH DM personal hygiene ```
72
UTI Sx
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
UTI pathogens
Ecoli Klebsiella and Proteus Complicated: Gr- : PSA as a MDR GR+: MRSA or VRE
74
name two types of PNA
CAP | HAP : occurs >48h of hospitalization, includes MDR
75
Criteria to admit outpt to hospital due to PNA
``` use CURB65 Confusion Uricemia (BUN >20 RR >30 BP SBP<90 and DBP <60 65 yo >/= ``` 2+criteria
76
Diagnosis of PNA
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
RF and comorbidities to assess MDR for PNA
``` comorbidities: chronic Lung, Liver, Renal dz DM OH asplenia malignancies/immunosupression/meds ``` ``` RF: comorbities OH use daycare immunosupressive drugs >65 abx within 3m ```
78
CAP treatment
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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