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* DIT each session > Day 3.3 Micro > Flashcards

Day 3.3 Micro Flashcards

1
Q

What do penicillins (and cephalosporins) do?

A

Disrupt the cell wall (so good for gram+, also some gram-)

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2
Q

What is a penicillinase?

A

Aka Beta-lactamase

Substance md by some bacteria that breaks down penicillin

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3
Q

Sometimes abx can be combined with a penicillinase (beta-lactamase) inhibitor to give them a wider spectrum. What are the inhibitors?

A

Clavulanic acid
Tazobactam
Sulbactam

Amoxicillin + clavulinic acid = augmenten, used for ear infections in kids
Ampicillin + sulbactam - unacyn
IV med used for surgical infections

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4
Q

What is the toxicity for Ampicillin and amoxicillin (the aminopenicillins)?

A

HPS rxn
Ampicillin rash in mono pts (EBV)
Pseudomembranous colitis (C. diff)

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5
Q

What are the clinical uses of penicillin?

A

Gram+:
S. pneumonia, S. pyogenes, Acintomyces, Gp B strep (esp moms in labor)
Gram+ rods: Clostridium, Bacilus, Listeria
Spirochetes: Syphilis (drug of choice)
Gram-neg cocci: Neisseria

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6
Q

How do gram-neg organisms cause resistance to penicillins?

A

Hydrolysis of Beta-lactam ring by bacterial penicillinases (beta-lactamases) in the periplasmic space. (Can use beta-lactamase inhibitors- clavulanic acid- to prevent this)

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7
Q

How do gram+ organisms cause resistance to penicillins?

A

They alter the B-lactam targets. (Alter PBPs- penicillin binding proteins)
S. pneumonia and S. aureus especially.

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8
Q

Augmenten

A

Amoxicillin + clavulanic acid

Used for ear infections in kids

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9
Q

Unasyn

A

Ampicillin + sulbactam

Used in surgery

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10
Q

Timentin

A

Ticarciliin + clavulanic acid

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11
Q

Zosyn

A

Piperacillin + tazobactam

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12
Q

Which drugs cause a disulfiram-like reaction?

A 
Anatabuse (disulfiram)
Certain cephalosporins
Metronidazole
1st gen sulfonureas
Procarbazine (chemo for Hodgkin's)
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13
Q

Treatment for Proteus, E. coli, K. Pnuemonia (UTI bugs)

A

1st gen cephalosporins- esp cephalexin

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14
Q

When are 1st gen cephalosporins used w/ aminopenicillins?

A

Prophylaxis is against Viridans in dental procedures

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15
Q

3rd gen cephalosporins provide less gram+ coverage- but can still be used for which gram+ organism?

A

S. pneumonia

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16
Q

What kind of drug is gentamycin?

A

Aminoglycoside.

Cephalosporins increase the nephrotoxicity of aminoglycosides like gentamycin.

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17
Q

If a pt has a bad infection and you don’t know what it is, what is a good antimicrobial to use?

A

Imipenem/cilastin; meropenem.
V broad spectrum, v powerful, beta-lactamase resistant.
Doesn’t work for MRSA tho.

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18
Q

Clinical use for vancomycin

A

serious gram+ multi-drug resistant organisms- S. aureus (MRSA) and C. diff (pseudomembranous colitis). Can use oral vanc for C. diff bc only need it to go to gut, not systemic.
Also Coagulase-negative endocarditis caused by S. epidermidis (IV drug users)

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19
Q

Which cephalosporin lasts the longest?

A

Longest half-life = ceftriaxone (3rd gen)

give 1x/day IV or IM

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20
Q

Disulfiram-like rxn

A

Disulfiram inhibits aldehyde dehydrogenase, so ethanol is not fully metabolized. Aldehyde accumulates and causes flushing, sweating, nausea/vom, headache

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21
Q

Rx for Pseudomonas (Gram-neg rod, aerobic, likes moist env and hospitals)

A

3rd gen- ceftazidime
4th gen- cefepime
aztreonam
ticarcillin, carbenicillin, piperacillin (ant-pseudomonals)

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22
Q

Aminoglycoside pretender

A

aztreonam

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23
Q

Clinical use for aztreonam

A

Klebsiella, E coli, Pseudomonas, Serratia.

For pts who are allergic to penicillin, pts with renal insufficiency who can’t tolerate aminoglycosides

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24
Q

Red man syndrome

A

Diffuse whole-body flushing caused by vancomycin.

Prophylaxis: anti-histamines, slow infusion of vanc

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25
If otitis media is resistant to amoxicillin, what should you give?
Add clavulanic acid (Augmentin) | or use 3rd gen cefidinir
26
What increases the nephrotoxicity of aminoglycosides?
Cephalosporins
27
Rx for syphilis
Penicillin
28
Rx for gonorrhea
Single dose ceftriaxone
29
Rx for C. diff
Oral vanc or metronidazole
30
1st gen cephalosporins
cephalexin cefazolin for PEcK
31
2nd gen ceph
cefprozil | for HEN PEcKS
32
3rd gen ceph
cefdinir | ceftrixone
33
4th gen ceph
cefipime
34
Epiglottitis mgmt
mk pt comfortable and don't do anything avoid upsetting child and losing airway want ability to rapidly intubate
35
Epiglottitis px
``` Cherry red Omega sign Lean fwd to straighten airway Drooling bc can't swallow spit Thumb sign on xray d/t edema ```
36
Fitz-Hugh-Curtis syndrome
PID (from neisseria gonorrhea) that starts in lower genital tract but ascends to upper tract, ultimately affecting the liver capsule
37
Waterhouse-Friedrichson syndrome
Adrenal hemorrhage d/t meningiococcemia. | Bleeding causes adrenal insufficiency- hypotension, electrolyte imbalance, DIC
38
How do you prophylax close contacts of Neisseria meningococci?
Rifampin
39
What kind of proteases does Neisseria produce?
IgA proteases
40
Cause of epiglottitis
H. influenzae (Gram-neg cocco-baciliary rod)
41
What kind of protease does H. influenzae produce?
IgA protease
42
Hemophilus ducreyi
Painful genital ulcer- chancroid
43
Atypical pneumonia
Diffuse, lighter (NOT lobar like regular pneumonia). More interstitial areas. Caused by Legionella, Chlamydia, Mycoplasma.
44
Rx for atypical pneumonia
Macrolides- Erythromycin Azithomycin Zithromax
45
Pneumonia in cystic fibrosis is caused by which organism?
Pseudomonas aeruginosa
46
Drug use leading to endocarditis- which bacteria?
Gram-pos S. epidermidis | Gram-neg Pseudomonas aeruginosa
47
Bilateral Bell's Palsy (facial nerve paralysis)- 2 causes
Lyme dz | Guillan-Barre syndrome
48
Most common cause of Gram-neg sepsis?
E.coli | 2nd- Klebsiella
49
Septic arthritis in young adult
Neisseria gonorrhea
50
Cat scratch
Bartonella henselae
51
Dog/cat bite
Pasturella multocida
52
Cat feces
Toxoplasmosis | avoid if prego
53
Puppy feces
Yersinia enterocolitica
54
Animal urine
Leptospira
55
Rat bites
Spirillum minus
56
Proteus (mirabilis, vulgaris)
Motile, no distinct colonies can be grown. Common cause of UTI Carries urease: urea --> NH3 + CO2 --> ammonium/magnesium/phosphate stones --> staghorn caliculi
57
Osteomyelitis in sickle cell pts
Salmonella
58
Neisseria gonorrhea
urethritis, cervicitis, PID, epididymitis (same as chylamydia) Most common cause of septic arthritis in young sex-active pts Opthalmia neonatorum-vertical txmsn, sticky eye discharge, may cause blindness
59
How is opthalmia neonatorum prevented?
Erythomycin eye drops- give to everyone. | prevents n. gonorrhea vertical txmsn
60
Pseudomonas aeruginosa causes...
``` pneumonia (CF, immunocompromised) burn, wound infections corneal infections (contact lens) osteomyelitis in DM, IV drug abusers sepsis (v high mortality) extermal otitis (elderly, DM) hot tub folliculitis, endocarditis (IV-DA) UTI (foley) ```
61
What are the enterobacteraiceae?
``` Family of gram-neg rods: E. coli Salmonella Shigella Klebsiella Enterobacter Serratia Proteus ``` ``` All have O (somatic) Ag K (capsular) Ag is related to virulance H (flagellar) Ag is on motile species All ferment glucose All are oxidase negative. ```
62
What does E.coli cause?
diarrhea UTI neonatal meningitis/pneumonia/sepsis
63
4 types of E. coli
EIEC - invades intestinal mucosa | EHEC, ETEC, EPEC - do not invade
64
EIEC
enteroinvasive E.coli invades intestinal wall, so get fever and bloody diarrhea. has shiga-like toxin (verotoxin) which inhibits 60S ribosome
65
ETEC
``` traveler's diarrhea Rx: TMP-SMX or fluroquinolones (cipro) similar to cholera- rice water diarrhea no intestinal wall invastion- so no fever, bloody labile toxin and stabile toxin ```
66
EHEC
``` O157:H7 hamburger meat get HUS shiga-like toxin. dysentery- bloody diarrhea does NOT ferment sorbitol like other E.coli ```
67
What is HUS
``` Hemolytic-uremic syndrome. Triad: 1. Anemia (hemolysis) 2. Renal failure (uremia = high lvl of nitrogen waste in blood) 3. Thrombocytopenia (low plt) ```
68
EPEC
no toxin adheres to apical surf and flattens villi, so prevents absorption Diarrhea usu in daycare kids
69
Salmonella
most common cause of food-assocd diarrhea in developed countries (poultry, eggs, reptiles) S. enterica, S. enteritidis Avoid Abx!! bc can prolong the carrier state of salmonella in GI tract infections
70
What causes typhoid fever?
Salmonella typhi
71
Shingella
Bacterial dysentery can be caused by Shigella flexneri, sonnei, dystenteriae
72
Shigella flexneri
Assoc w Reiter's Reactive arthritis (can't see, pee, climb a tree)
73
Campylobacter jejuni
``` Oxidase+ comma-shaped gram-neg grows in 42C (hot CAMPfire) mjr cause of diarrhea in kids fecal-oral poultry, meat, unpasterized milk precursor to Guillan-Barre ```
74
What gram-neg has aerosol txmsn, not person-person
Legionella pneumophilia
75
What enz to obligate anaerobes lack?
Catalase Superoxide dismutase so susceptible to oxidate dmg Clostridium, Bacteroides, Acintomyces
76
Osteomyelitis in DM
pseudomonas
77
Aspiration pneumonia (alcoholic)
Klebsiella pneumonia
78
Common cause UTI and pneumonia
Klebsiella pneumonia
79
Treatment for gonorrhea?
Single dose ceftriaxone
80
What drugs inhibit protein synth?
30S: Aminoglycosides Tetracycline ``` 50S: Chloramphenicol, Clindamycin Erythromycin Lincomycin Linezolid ```
81
Discoloration of teeth and inhibition of bone growth in kids
Tetracyclines
82
Drugs with ototoxicity and nephrotoxicity
Aminoglycosides Vancomycin Loop duretics Cisplatin (chemo)
83
Gray baby Gray man Red man
Gray baby = chloramphenicol Gray man = amiodarone (anti-arrhythmia) Red man = vancomycin
84
What drugs should be avoided in pts with sulfa allergy
``` Sulfonamides TMP-SMX Sulfasalazine Sulfonylureas Sumatriptan Acetazolamide (diurectic- CA inhibitor) Furosemide Thiazide Probenecid (gouty arthritis) Celecoxib (COX-2 inhibitor) ```
85
Most common causes of UTI
E.coli #1 | Proteus, Klebsiella, Pneumonia
86
Abx that treat UTI
Aminopenicillins Cephalosporins Nitrofurantoin Sulfonamides
87
Drugs w photosensitive rxns
SAT for a photo: Sulfonamides Amiodarone (anti-arrhythmic) Tetracyclines
88
Drugs that cause Stevens-Johnson syndrome
Penecillins Sulfa Drugs Seizure Drugs- ethosuxamide, lamtrigine, carbamazepine, phenobarbital, phenytoin Allopurinol (for gout)
89
Drugs used for Anaerobic infections
Metronidazole Clindamycin Imipenem/cilastatin Meropenem
90
Drugs that are used for Pseudomonas
``` polymyxins fluroquinolones cefepime aztreonam (aminoglycoside pretender) aminoglycosides extended-spectrum penicillins (ticarcillin, carbemicillin, piperacillin) ```

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