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NAPLEX > Chapter 22: Infectious Diseases I > Flashcards

Chapter 22: Infectious Diseases I Flashcards

1
Q

Common Bacterial Pathogens for CNS/Meningitis:

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Group B streptococcus/E. coli (young)
  • Listeria (young/old)
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2
Q

Common Bacterial Pathogens for Upper Respiratory:

A
  • Streptococcus pyogenes
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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3
Q

Common Bacterial Pathogens for Heart/Endocarditis:

A
  • Staphylococcus aureus, including MRSA
  • Staphylococcus epidermis
  • Streptococci
  • Enterococci
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4
Q

Common Bacterial Pathogens for Skin/Soft Tissue:

A
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Staphylococcus epidermidis
  • Pasteurella multocida = anaerobic GNR (in diabetes)
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5
Q

Common Bacterial Pathogens for Bone/Joint:

A
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococci
  • Neisseria gonorrhoeae
  • GNR (only in specific situations)
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6
Q

Common Bacterial Pathogens for Mouth

A
  • Mouth flora (Peptostreptococcus)
  • Anaerobic GNR (Prevotella, others)
  • Viridians group streptococci
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7
Q

Common Bacterial Pathogens for Lower Respiratory (Community):

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Atypicals: legionella, mycoplasma, chlamydophilia
  • Enteric GNR (alcoholics)
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8
Q

Common Bacterial Pathogens for Urinary Tract:

A
  • E. coli
  • Proteus
  • Klebsiella
  • Staphylococcus saprophyticus
  • Enterococci
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9
Q

Gram-positive organisms stain

A

-Have a thick cell wall and stain dark purple or bluish from the crystal violet stain

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10
Q

Gram-negative organisms stain

A

-Have a thin cell wall and take up the safranin counterstain, resulting in a pink or redish color

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11
Q

Atypical organism stain

A

Atypicals do not have a cell wall and do not stain well

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12
Q

Intrinsic Abx Resistance

A

The resistance is natural to the organism

E.g. E.coli is resistant to vanco because this abx is too large to penetrate the bacterial cell wall

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13
Q

Selection Pressure Resistance

A

Resistance occurs when abx kill off susceptible bacteria and leave more resistant strains to multiply

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14
Q

Acquired Resistance

A

Bacterial DNA containing resistant genes can be transferred between different species and/or picked up from dead bacterial fragments in the environment

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15
Q

Enzyme Inactivation Resistance

A

Enzymes produced by bacteria break down the antibiotic

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16
Q

Beta-lactamases

A

Produce beta-lactamases that break down beta-lactams before they can bind to their site of activity
-Beta-lactamase inhibitors are combined with some beta-lactams to extend or preserve their coverage

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17
Q

Extended-spectrum beta-lactamases (ESBL)

A

Are beta-lactamases that can break down all PCNs and most cephalosporins. These are treated with carbapenems or new cephalosporin/beta-lactamase inhibitors

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18
Q

Carbapenem-resistant Enterobacteriaceae (CRE)

A

Are multi-drug resistant (MDR) gram negative organisms that produce carbapenemase that break down PCN, most cephalosporins, and carbapenems.
Typically require Tx with polymixins

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19
Q

Common Resistant Pathogens

A 
Kill Each And Every Strong Pathogen
K- Klebsiella pneumoniae (ESBL, CRE) 
E- E. coli (ESBL, CRE)
A- Acinetobacter baumannii
E- Enterococcus faecalis and faecium (VRE)
S- Staphylococcus aureus (MSRA) 
P- Pseudomonas auruginosa
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20
Q

Folic Acid Synthesis Inhibitors

A
  • Sulfonamides
  • Trimethoprim
  • Dapsone
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21
Q

Cell Wall Inhibitors

A
  • Beta-lactams (PCNs, cephalosporins, carbapenems)
  • Monobactams (aztreonam)
  • Vancomycin, dalbavancin, telavancin, oritavancin
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22
Q

Protein Synthesis Inhibitors

A
  • Aminoglycosides
  • Macrolides
  • Tetracyclines
  • Clindamycin
  • Linezolid, tedizolid
  • Quinupristin/Dalfopristin
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23
Q

Cell Membrane Inhibitors

A
  • Polymixin
  • Daptomycin
  • Telavancin
  • Oritavancin
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24
Q

Hydrophilic Abx

A
  • Beta-lactams
  • Aminoglycosides
  • Glycopeptides
  • Daptomycin
  • Polymixins
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25
Q

Hydrophilic Abx PK parameters

A
  1. Small Vd
  2. Renal eliminations (dose adjustments)
  3. Low intracellular concentrations (not active against atypicals)
  4. Increased clearance and/or distribution in sepsis (consider loading doses)
    5, Poor to moderate bioavailability
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26
Q

Lipophilic Abx

A
  • Quinolones
  • Macrolides
  • Rifampin
  • Linezolid
  • Tetracyclines
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27
Q

Lipophilic Abx PK parameters

A
  1. Large Vd (excellent tissues penetration including, bone, lung and brain)
  2. Hepatic metabolism
  3. Achieve intracellular concentrations (active against atypicals)
  4. Clearance/distribution is minimally changed in sepsis
  5. Excellent bioavailability (IV:PO ratio is often 1:1)
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28
Q

HNPEK

A 
Haemophilus
Neisseria
Proteus
E.coli
Klebsiella

Gram negative

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29
Q

CAPES

A 
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
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30
Q

Beta-lactams MOA

A

PCN, Cephalosporins, and Carbapenem
Inhibit cell wall synthesis by binding to penicillin-binding proteins (PBPs), this prevents the final step of peptidoglycan synthesis in bacterial cell walls.

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31
Q

Natural Penicillins Activity

A

-Active against gram-positive cocci (streptococci and enterococci) and gram-positive anaerobes (mouth flora). No gram-negative activity

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32
Q

Natural Penicillin Drugs

A
  • Penicillin VK

- Penicillin G Benzathine (Bicillin L-A) IM 1.2-2.4 million units once

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33
Q

Antistaphylococcal Penicillins Activity

A

Cover Streptococci and have enhanced activity against MSSA

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34
Q

Antistaphylococcal Penicillins Drugs

A

Dicloxacillin
Nafcillin (injections
Oxacillin

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35
Q

Aminopenicillins Activity

A

Streptococci
Enterococci
Gram-positive anaerobes (mouth flora)
Gram-negative HNPE

-Combined with a beta-lactamase inhibitor they have added activity against MSSA, HNPEK and B. fragilis

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36
Q

Aminopenicillin Drugs

A

Amoxicillin (Moxatag) (has chewable)
Amox/Clavulantate (augmenting) (has chewable)
Ampicillin (has injections)
Amp/Sulbactam (Unasyn) (only injection) (Both ampicillins must be diluted in NS only)

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37
Q

ESBL Activity

A 
MSSA
HNPEK
B. fragilis
CAPES 
Pseudomonas Aeruginosa
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38
Q

ESBL Drug

A

Piperacillin/Tazobactam (Zosyn)
Injection
Extended infusions (over 4 hours)

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39
Q

Penicillins should be avoided in which patients?

A

People with beta-lactam allergies (except syphilis during pregnancy and HIV patients with poor compliance)
People at risk of seizures

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40
Q

Outpatient Oral Pen VK used for?

A

1st line for strep-throat and mild non-purulent skin infections (no abscess)

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41
Q

Outpatient Oral Amox use for?

A

1st line for acute otitis media (90mg/kg/day)
Infective endocarditis prophylaxis
H. pylori

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42
Q

Outpatient Oral Amox/Clav used for?

A

1st line for acute otitis media (90mg/kg/day) and for sinus infections
Use lowest dose of clav to decrease diarrhea

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43
Q

Outpatient Oral Dicloxacillin used for?

A

MSSA only

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44
Q

Inpatient Parenteral Pen G used for?

A

Drug of choice for syphilis (IM 2.4 million units once)

NOT for IV can cause death

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45
Q

Inpatient Parenteral Nafcillin and Oxacillin used for?

A

MSSA only

Nafcillin is a vesicant- use through central line only, if extravasation use cold packs and hyaluronidase injections

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46
Q

Inpatient Parenteral Piperacillin/Tazobactam used for?

A 
Only penicillin active against Pseudomonas
Extended infusions (4hr) can be used to maximize T>MIC
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47
Q

Penicillins boxed warnings, CI, SE

A

Boxed warning: Pen G IM only
CI: CrC; <30ml/min do not use ER po amox or amox/clav or 875mg amox/clav
SE: seizure, GI upset, diarrhea, rash (SJS/TEN) hemolytic anemia (+ Coombs test)

48
Q

1st Gen Cephalosporin Activity

A

Excellent coverage against gram-positive cocci (streptococci and staphylococci), preferred when cephalosporin is used for MSSA
Some activity against PEK (gram neg)

49
Q

1st Gen Cephalosporin Drugs

A

Cefazolin (ancef)

Cephalexin (keflex) (PO 250-500mg q6-12h)

50
Q

2nd Gen Cephalosporin Activity

A

Type 1: cefuroxime that covers staphylococci and HNPEK

Type 2: Cefotetan and cefoxitin have added gram neg coverage of anaerobes (b. frag)

51
Q

2nd Gen Cephalosporin Drugs

A

Cefuroxine (ceftin)
Cefotetan (cefotan) (contains a side chain that can increase the risk of bleeding and cause a disulfiram-like rxn to alcohol)

52
Q

3rd Gen Cephalosporin Activity: Group 1

A

Includes ceftriaxone and and cefotaxime which covers resistant streptococci (s. pneumonia and veridans), staphylcocci (MSSA), gram pos anaerobes, and resistant strains of HNPEK

53
Q

3rd Gen Cephalosporin Activity: Group 2

A

Includes ceftazidime, which lacks gram pos activity but covers pseudomonas

54
Q

3rd Gen Cephalosporin Drugs: Group 1

A

Cefdinir (omnicef)
Ceftriaxone (rocephin) (CI in hyperbilirubinemic neonates, causes biliary sludging and kernicterus)
Cefotaxime

55
Q

3rd Gen Cephalosporin Drugs: Group 2

A

Ceftazidime (Fortaz)

56
Q

4th Gen Cephalosporin Activity

A

Only cefepime, which has broad spectrum gram neg activity (HNPEK, CAPES, and pseudomonas and gram pos anaerobes

57
Q

4th Gen Cephalosporin Drugs

A

Cefepime

58
Q

5th Gen Cephalosporin Activity

A

Only ceftaroline which has gram neg activity similar to ceftriaxone but broad gram pos activity; only beta-lactam that covers MRSA

59
Q

5th Gen Cephalosporin Drug

A

Ceftaroline fosamil (Teflaro)

60
Q

Cephalosporin warnings, SE

A

Warnings: Caution with PCN allergy (<10%, higher risk with 1st gen)
SE: Seizures (with accumulation) GI upset, diarrhea, rash, hemolytic anemia (+coombs test)

61
Q

Ceftazidime/avibactam use

A

Some activity against some CRE and MDR gram neg

62
Q

Cephalosporin Drug Interactions

A

Cefuroxime and cefpodoxime should be separated from short-acting antacids by 2 hours. H2RAs and PPIs should be avoided
Do not administer ceftriaxone with calcium containing IV fluids (will form precipitate)

63
Q

Cephalosporin class effects

A

Due to cross reactivity do not choose a cephalosporin on the exam if a pt has a PCN allergy (except acute otitis media in kids)
Risk of seizures of accumulation

64
Q

Cephalosporin Outpatient Oral Uses: 1st gen

A

Cephalexin (keflex)
Skin infections (MSSA)
Strep throat

65
Q

Cephalosporin Outpatient Oral Uses: 2nd gen

A

Cefuroxime
Acute otitis media
CAP
Sinus infection (if indicated)

66
Q

Cephalosporin Outpatient Oral Uses: 3rd gen

A

Cefdinir
CAP
Sinus infection (if indicated)

67
Q

Cephalosporin Inpatient Parenteral Uses: 1st gen

A

Cefazolin

Surgical Prophylaxis

68
Q

Cephalosporin Inpatient Parenteral Uses: 2nd gen

A 
Cefotetan and Cefoxitin
Anaerobic coverage (B. fragilis)
Surgical prophylaxis (colorectal procedures)
69
Q

Cephalosporin Inpatient Parenteral Uses: 3rd gen

A 
Ceftriaxone and Cefotaxime
CAP
Meningitis
SBP
Pyelonephritis
70
Q

Cephalosporin Inpatient Parenteral Uses: active against Pseudomonas

A

Ceftazidime (3rd gen)

Cefepime (4th gen)

71
Q

Cephalosporin Inpatient Parenteral Uses: Ceftaroline

A

Only beta-lactam with active coverage for MRSA
CAP
Skin and Soft Tissue Infections

72
Q

Carbapenems

A

They are very broad spectrum abx that are generally reserved for MDR gram neg infections. Cover ESBL producing bacteria but have no coverage of atypical pathogens, MRSA and VRE

73
Q

Ertapenem

A

Ivanz
Remember does not have activity against PEA (pseudomonas, enterococcus, acinetobacter)
Stable in NS only

74
Q

Meropenem

A

Merrem

Carbapenem

75
Q

Carbapenems warnings

A

Do not use in patients with PCN allergy
Seizures
Monitor renal function

76
Q

Carbapenems Common Uses

A

Polymicrobial infections (severe diabetic foot infections)
Empiric therapy when resistant organism suspected
Resistant pseudomonas or acinetobacter (except ertapenem)
All are IV only

77
Q

Monobactam MOA

A

Aztreonam

Inhibits cell-wall synthesis by binding to PBPs and preventing peptidoglycan synthesis in bacterial cell walls.

78
Q

Aztreonam Uses

A

Primarily used when allergy to beta-lactams is present can also be used with PCN allergy
Covers many gram negative including pseudomonas.
No gram positive of anaerobic activity

79
Q

Aminoglycoside Uses

A

Kill gram-negative, including pseudomonas.

Gentamycin and streptomycin used for synergy in combo with a beta-lactam or vanco for gram positive infections

80
Q

Aminoglycoside Dosing Strategies

A

Tradition dosing uses lower doses more frequently.
Extended-interval dosing uses higher doses less frequently. With this there is less accumulation, lower risk of nephrotoxicity and decreased cost

81
Q

Aminoglycoside Drugs

A

Gentamicin
Tobramycin
Amikacin

82
Q

Aminoglycoside Dosing weight

A
  • If underweight use total body weight

- If obese use adjusted body weight

83
Q

Aminoglycoside Traditional Dosing

A

Tradition Dosing:
Gent and tobramycin: 1-2.5 mg/kg/dose (trough goal <2mcg/ml for gram neg in gent)
Renal dose Adjustment (traditional)
CrCl >= 60 q8h

84
Q

Aminoglycoside Extended Interval Dosing

A

Gent and tobramycin
4-7mg/kg
Frequency is determined by a nomogram but starts at q24h

85
Q

Quinolones MOA

A

Inhibit bacterial DNA topoisomerase IV and DNA gyrase inside the bacteria.
Quinolones have concentration dependent antibacterial activity and have broad spectrum of activity against gram pos, gram, neg, and atypicals

86
Q

Respiratory Quinolones

A

Levofloxacin, Moxifloxacin, and Gemifloxacin

Due to enhanced coverage of S. pneumoniae and aytipcals

87
Q

Antipseudomonal Quinolones

A

Cipro and Levofloxacin (levaquin)

88
Q

Moxifloxacin

A

Avelox
Has enhanced gram positive and anaerobic activity.
CANNOT be used for UTIs
No renal dose adjustments

89
Q

Delafloxacin

A

Active against MRSA and is preferred quinolone

90
Q

Quinolones boxed warnings and warnings

A

Boxed:
Tendon inflammation/rupture
Peripheral neuropathy
Seizures

Warnings: 
QT prolongation (highest with moxi) 
Hypo and hyperglycemia
Psychiatric disturbances
Photosensitivyt
Avoid in children, pregnancy, and breastfeeding
91
Q

Quinolone Drug Interactions

A

Antacids and other polyvalent cations (Mg, Al, Ca, Fe, Zn) can chelate and inhibit quinolone absorption
Lanthanum carbonate and sevelamer can decrease serum concentration of quinolones (separate by 2hr)

92
Q

Ciprofloxacin Drug Interactions

A

Strong Cyp1a2 inhibitor, weak 3A4 inhibitor and p-gp substrate. Can increase levels of caffeine, theophylline, and tizanidine

93
Q

Macrolides MOA

A

Bind to the 50S subunit, resulting in inhibition of RNA dependent protein synthesis

94
Q

Macrolides Uses

A

Atypicals
Community-acquired upper and lower respiratory tract infections
Chlamydia, gonorrhea

95
Q

Azithromycin dosing

A

Z-pak 500mg on day 1, then 1 tab qd for 4 days

Tri-pak 500mg qd for 3 days

96
Q

Clarithyromycin

A

Biaxin

97
Q

Erythromycin

A

E.E.S, Ery-tab, Erythrocin

98
Q

Macrolide CI, Warnings, SE

A

CI: Clarith and Eryth do not use with lovastatin or simvastatin
Warnings: QT prolongation, hepatotoxicity
SE: GI upset

99
Q

Common Uses for Azithromycin

A 
COPD exacerbations
Chlamydia
Gonorrhea
Prophylaxis for MAC
Severe travelers' diarrhea
100
Q

Common Uses for Clarithromycin

A

H. Pylori

101
Q

Common Uses for Erythromycin

A

Increases gastric motility and is used for gastroparesis

102
Q

Tetracyclines MOA

A

Inhibit bacterial protein synthesis by reversibly binding to to the 30S ribosomal subunit

103
Q

Tetracyclines Coverage

A

Gram positive, gram negative, atypicals

104
Q

Doxycycline Coverage

A

Vibramycin
CAP, COPD exacerbations
Tick-borne/rickettsial diseases (Lyme disease, Rocky Mountain Spotted fever)
Chlamydia, Gonorrhea
Mild skin infections caused by CA-MRSA, and VRE UTIs
*no renal dose adjustment

105
Q

Minocycline

A

Minocin, Solodyn
Used for acne
Can cause DILE

106
Q

Tetracyclines Warnings and Notes

A

Warnings: Children <8 yrs, pregnancy and breastfeeding
Photosensitivity
Notes: IV:PO ratio is 1:1
Doxy sit upright for at least 30 minutes after dose

107
Q

Tetracyclines Drug Interactions

A

Antacids and other polyvalent cations, sucralfate, bismuth subsalicylate, and bile acid resins can chelate and inhibit absorption

108
Q

Trimethoprim MOA

A

inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in inhibition of the folic acid pathway

109
Q

Sulfamethoxazole/trimethoprim activity

A

Many including shigella, salmonella and stenophomonas.
Some opportunistic infections (pneumocystis, toxoplasmosis) but does NOT have activity against pseudomonas, enterococci, atypicals, or anaerobes

110
Q

SMX/TMP dosing

A

Based on TMP
Uncomplicated UTI 1 DS tab po bid f3d
Pneumocystis Pneumonia (PCP) prophylaxis 1 DS or SS qd

111
Q

SMX/TMP CI, warnings, SE

A

CI: sulfa allergy
Warnings: skin rxn (SJS/TEN), thrombocytopenic purpura (TTP), G6PD deficiency
SE: photosensitivity, increased k, hemolytic anemia (+ coombs test), crystalluria (take with 8oz of water)

112
Q

SMX/TMP strength

A

SS: SMX 400mg/ TMP 80mg
DS: SMX 800mg/ TMP 160mg

113
Q

SMX/TMP drug interactions

A

Increase INR if used in combo with warfarin

Risk for hyperkalemia is increased in patients with renal dysfunction or if used in combo with ARAs

114
Q

SMX/TMP common uses

A

CA-MRSA skin infections
UTI
PCP

115
Q

IV Abx that do not need refrigeration

A
  • Metronidazole (flagyl)
  • Moxifloxacin (avelox)
  • SMX/TMP
  • Acyclovir
116
Q

Abx that do not need renal dose adjustment

A
  • Antistaphylococcal PCNs (dicloxacillin, nafcillin)
  • Ceftriaxone
  • Clindamycin
  • Doxycycline
  • Macrolides (azith and eryth)
  • Metronidazole
  • Moxifloxacin
  • Linezolid

NAPLEX (45 decks)

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