Bugs and Drugs Flashcards by Bronwyn Delacruz

most viral infections don’t need therapy. what’re the exceptions

HIV, HBV, HCV, CMV, HSC encephalitis, VZV

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some bacteiral diseases dont need abx. such as?

salmonella gastroenteritis, ecoli O157:H7

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What are the associated pathogens of cellulitis?

Usual: Streptococcus pyogenes (GAS), Staphylococcus aureus Water history: Vibrio vulnificus, Aeromonas hydrophila

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pathogens that cause community acquired pneumonia

typical: strep pneumo, haemophilus, moraxella ca.

atypical; legionella, myocplasma, chlamydia

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I MD SOAPS acronym for ID exposure history.

I= immunizations

M = meds and antibiotics

D= dietary– raw meat, bad meat, unpasteurized milk

S= sexual

O= occupational, incarceration, homeless

A = animals, arthropod, activities

P = place

S = sick contacts

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___ Pathogen: regularly cause disease in some proportion of susceptible individuals with apparently ___ defense systems e.g. Mycobacterium tuberculosis

___ (non-pathogen): organisms that are part of the normal human flora or environment that do not usually cause infection. E.g. Course 3 example: Neisseria species (not GC or N. meningitidis)

___ Pathogen: Organisms that have the ability to cause an infection when the immune defences are impaired.
E.g. Some are more virulent than others: S. pneumoniae, S. aureus; PJP etc

Primary Pathogen: regularly cause disease in some proportion of susceptible individuals with apparently intact defense systems e.g. Mycobacterium tuberculosis

Commensal (non-pathogen): organisms that are part of the normal human flora or environment that do not usually cause infection. E.g. Course 3 example: Neisseria species (not GC or N. meningitidis)
Opportunistic Pathogen: Organisms that have the ability to cause an infection when the immune defences are impaired.
E.g. Some are more virulent than others: S. pneumoniae, S. aureus; PJP etc

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Microbial Pathogens causing Infective Endocarditis on a NATIVE VALVE

The HACEK organisms include Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae

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Microbial Pathogens causing Infective Endocarditis on a PROSTHETIC VALVE

S. aureus (MSSA or MRSA)

Coagulase negative staphylococci
Enterococcus
Viridans streptococci

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HACEK organisms (all GNBs)

H aemophilus parainfluenzae and others

Aggregatibacter species*

Cardiobacterium hominis

Eikenella corrodens

Kingella kingae

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HACEK organisms originate from the ___ flora

oral-pharyngeal flora

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viridans strep, enterococcus originate from ___ flora

from gut flora

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all Bacilli are gram negative except the gram positive ones lol. what are the gram positive bacilli? (ABCDLMNOP)

A= actinomyces

B= bacillus anthraxus

C= clostridium

D = diphtheria

L= listeria

M= mycobacterium

N= nocardia

P= proprionibacterium

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all cocci are gram positive except the gram negative ones… NMV

neisseia Moraxella

veillonella.

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atypical pneumonia pathogens

Chlamydophila pneumoniae (no cell wall)
Mycoplasma pneumoniae (no cell wall)
Legionella pneumophila

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3 classes of fungi

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draw out this table from memory:

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echinocandins can treat ___ types of fungi

yeast type. candda, aspergillus

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IV administration: useful when absorption and distribution is ____ ___.

not predicctable. consider in critically ill or critical site of infection.

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Drugs where PO= IV:

Metronidazole

Fluoroquinolones

Doxycycline

Clindamycin

TMP/SXT

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CIDAL agents are generally needed for
__ infections, __ and ___ neutropenics

CIDAL agents are generally needed for
intravascular infections, meningitis and febrile neutropenics

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bactericidal agents (BV FAM)

beta lactams

vancomycin

fluoroquinolones

aminoglycosides

metronidazole

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bacteriostatic agents (MaCTeS)

Macrolides, clindamycin, tetracycline, sulfonamides

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All antibiotics have potential to cause
__, __, __ and __

All antibiotics have potential to cause
nausea, vomiting, diarrhea and rash

T/F penicillins cannot be given to breast feeding or pregnant women

false. penicillins are safe.

comorbidites that might affect dose differences of abx

renal or hepatic disease-a ffects metabolism of drugs

T/f when giving an antibiotic, you sohuld give the shortest course possible

true.

antibacterial classes that inhibits cell walls by binding termianl pentapeptide or PBP.

1. beta lactams (PCCM) - penicillin - cephalosprin - carbapenems - mono bactam 2. glycopeptides - aztreonam - vancomycin

inhibits protein synthesis (AMLOT) antibacterial classes and give examples

1. aminoglycosides (gentamycin, tobramycin) 2. macrolides (clarithromycin, azithromycin) 3. lincosamide (clindamycin) 4. tetracycline (doxy-cycline) 5. oxazolidinone (linezolid)

antibcaterial class that disrupts DNA and NA synthesis. Give examples (RiFTN)

1. fluoroquinolone (cipro) 2. rifampin 3. TMP SXT (Septra) 4. Nitromidazoless (metronidazole)

antibacterial class that disrupts metabolsim/respiration

nitrofurantoin (macrobid)

Can you name 4 mechanisms that organisms can develop to impart resistance to antibiotics?

1. antibiotic structure alteraion 2. target alteration 3. deny entry to the antibiotic 4. pump out antibiotic

mechanisms of baceria altering the antibiotic

- produce enzymes that modify the antibiotic into an inactive state. - secreed by the bacteria into their surroundings. ex/ beta lactamases, or aminoglycoside modifying enzymes.

2 methods that bacteria can alter the antibiotic target

- bacteria can change the protein or molecule on which the drug is acting.

the "deny entry" mechanism of resistance is mostly done by \_\_\_\_

gram negatives. antibiotics can pass through porins, but bacteria may alter the porins to prevent antibiotic entry. may also get pumped out.

mechanism of resistance :even after antibiotic has entered the bacteria, __ \_\_\_ allow the drug to be pumped back into the extracellular space

efflux pumps. used in the cell membranes of both Gram +'s and Gram -'s e.g. many bacteria vs. tetracycline e.g. Streptococcus vs. erythromycin e.g. Pseudomonas vs. a lot of antibiotics

Regarding beta-lactams, which of following statements is FALSE A. They bind to transpeptidase to inhibit cross linking of peptidoglycan. B. Penicillin is more narrow spectrum than Ampicillin. C. Beta-lactam and Beta-lactamase inhibitor combinations broaden the spectrum of activity of beta-lactam drugs. D. 1st generation cephalosporins have good gram positive coverage. E. Pipercillin-tazobactam and meropenem will solve all your problems. F. Beta-lactams can have significant adverse effects.

A is TRUE: beta lactams prevent cell wall synthesis. inhibits the cross linking of peptidoglycan by binding to the penicillin binding protein. B is TRUE. Penicillin (narrower)--\> ampicillin --\> piperacillin C is true. beta lactamases can be a mechansim of resistance in bacteria that alter the beta lactam antibiotics. getting a beta lactamase inhibitor would prevent resistance. D is TRUE. 1st gen cepharlosporins are more gram positive coverage than 4th gen. **E is FALSE. PIPTAZ is pretty good, but NO ATYPICAL COVERAGE (mycoplasma, mrsa, enterococcus)** F is true. Every antibiotic can have bad side effects. Comparatively though, it is decently safe and cant be given to pregnant women.

Anti-Staphylococcal Penicillins:

Cloxacillin, naficillin, methicillin

the combo pip taz is a powerful abx. what is tazobactam?

a beta lactamase inhibitor. Beta-lactamase inhibitor acts as a decoy to bind to beta- lactamase and allow beta-lactam to do it’s usual job to stop PG synthesis

T/F cephalosporins cover ENTEROCOCCUS, MRSA AND “ATYPICAL” PNEUMONIA PATHOGENS

false.DO NOT COVER: ENTEROCOCCUS, MRSA AND “ATYPICAL” PNEUMONIA PATHOGENS

cons of beta lactams

- common allergic - Aes include nephrotoxicity

Methicillin resistant S. aureus (MRSA): alteration in __ \_\_\_ ___ (PBP2) This alteration confers resistance to all ß-lactams (beta-lactamase inhibitors no help here!)

Methicillin resistant S. aureus (MRSA): alteration in **penicillin binding protein (PBP2)** This alteration confers resistance to all ß-lactams (beta-lactamase inhibitors no help here!)

• PBP alterations primarily used by gram __ organisms

**• PBP alterations primarily used by gram positive organisms**

Regarding Vancomycin, which of the following statements are TRUE? A. Vancomycin sterically inhibit cross-linking of peptidoglycan. B. Vancomycin covers E. coli and Pseudomonas (gram negatives). C. Vancomycin is a STATIC antibiotic . D. Vancomycin does not require monitoring of blood level concentrations.

**A is true. it inhibits cell wall synthesis** b. false-- mostly gram positive coverage c. false, it's a cidal d. false. vanco needs to be monitored becuase it can cause nephrotoxicity.

T/F: vancyomycin can kill many resistant gram positive organisms: MSSA and MRSA, coagulase negative staph, enterococcus, S. pneumoniae, C.dif

true.

ALL antimicrobials with a protein synthesis inhibition mechanism of action are BACTERIOSTATIC except for the \_\_\_.

aminoglycosides

Regarding macrolides, which of the following statements is false? A. Macrolides have good atypical bacterial spectrum of activity. B. Macrolides can be used to treat CAP in inpatient and outpatient setting. C. Macrolides are not associated with prolonged QT intervals.

A. Macrolides have good atypical bacterial spectrum of activity. TRUE. B. Macrolides can be used to treat CAP in inpatient and outpatient setting. False need IV. C. Macrolides are not associated with prolonged QT intervals. FALSE: • Diarrhea (erythromycin), drug interactions, prolonged QT intervals are side effects.

resistance phenomenon of macrolides

resistance to one = resistant to all in the class. Efflux and target modification common mechanism of resistance.

macrolid side effects: • Diarrhea (erythromycin), drug interactions, prolonged\_\_\_ intervals

• Diarrhea (erythromycin), drug interactions, prolonged QT intervals

Regarding Clindamycin: Which of the following statements is FALSE? A. Clindamycin has anaerobic coverage. B. Clindamycin’s bioavailability PO  IV C. Clindamycin could be used to treat MRSA endocarditis.

ALL OF THESE ARE TRUE??? A. Clindamycin has anaerobic coverage. TRUE. B. Clindamycin’s bioavailability PO=IV. TRUE. good oral bioavailability. C. Clindamycin could be used to treat MRSA endocarditis. TRUE. can treat MRSA and nec fasc.

Regarding Tetracyclines, which of the following statements if FALSE? A. Tetracyclines cover “atypical pathogens”. B. Tetracyclines can be used safely in pregnancy and kids.

B is false. it cannot be used in pregnancy.

the ___ \_\_\_ is the most common mechanism of resistance against tetracycline

efflux pump.

Regarding Fluoroquinolones, which of the following statements is TRUE? A. Ciprofloxacin has good Streptococcus pneumoniae coverage but not Pseudomonas coverage. B. FQ PO bioavailability ≈ IV C. FQ do not have any serious side effects

A is FALSE. levo!! cipro is better for gram negative. B. TRUE. C. FALSE. always has side effects

examples of fluoroquinolones. mechanism of actions?

MOA: DNA synthesis inhibition by blocking DNA gyrase/topoisomerase - ciprofloxacin (gram negative drug)-- good for UTI or GI - levofloxacin : better gram positive and atypical pneumonia pathogens (pseudomonas, mycoplasma, chalmydia, legionella) - moxifloxacin: similar coverage to levo EXCEPT pseudomonas

fluoroquinolones are bacterio\_\_\_

cidal.

rewrite this

good antibiotics for a suspected infective endocarditis (native valve)

recall that native valves often can get infected by S. aureus, viridans strep, enterococcus, and HACEk. if you don't have the cultures back, do broad coverage. VANCO AND CEFTRIAXONE! Can gover gram positive, MSSA, MRSA, enterococci