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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
Q

If otitis media is resistant to amoxicillin, what should you give?

A

Add clavulanic acid (Augmentin)

or use 3rd gen cefidinir

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26
Q

What increases the nephrotoxicity of aminoglycosides?

A

Cephalosporins

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27
Q

Rx for syphilis

A

Penicillin

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28
Q

Rx for gonorrhea

A

Single dose ceftriaxone

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29
Q

Rx for C. diff

A

Oral vanc or metronidazole

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30
Q

1st gen cephalosporins

A

cephalexin
cefazolin
for PEcK

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31
Q

2nd gen ceph

A

cefprozil

for HEN PEcKS

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32
Q

3rd gen ceph

A

cefdinir

ceftrixone

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33
Q

4th gen ceph

A

cefipime

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34
Q

Epiglottitis mgmt

A

mk pt comfortable and don’t do anything
avoid upsetting child and losing airway
want ability to rapidly intubate

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35
Q

Epiglottitis px

A 
Cherry red
Omega sign
Lean fwd to straighten airway
Drooling bc can't swallow spit
Thumb sign on xray d/t edema
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36
Q

Fitz-Hugh-Curtis syndrome

A

PID (from neisseria gonorrhea) that starts in lower genital tract but ascends to upper tract, ultimately affecting the liver capsule

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37
Q

Waterhouse-Friedrichson syndrome

A

Adrenal hemorrhage d/t meningiococcemia.

Bleeding causes adrenal insufficiency- hypotension, electrolyte imbalance, DIC

38
Q

How do you prophylax close contacts of Neisseria meningococci?

A

Rifampin

39
Q

What kind of proteases does Neisseria produce?

A

IgA proteases

40
Q

Cause of epiglottitis

A

H. influenzae (Gram-neg cocco-baciliary rod)

41
Q

What kind of protease does H. influenzae produce?

A

IgA protease

42
Q

Hemophilus ducreyi

A

Painful genital ulcer- chancroid

43
Q

Atypical pneumonia

A

Diffuse, lighter (NOT lobar like regular pneumonia). More interstitial areas.
Caused by Legionella, Chlamydia, Mycoplasma.

44
Q

Rx for atypical pneumonia

A

Macrolides-
Erythromycin
Azithomycin
Zithromax

45
Q

Pneumonia in cystic fibrosis is caused by which organism?

A

Pseudomonas aeruginosa

46
Q

Drug use leading to endocarditis- which bacteria?

A

Gram-pos S. epidermidis

Gram-neg Pseudomonas aeruginosa

47
Q

Bilateral Bell’s Palsy (facial nerve paralysis)- 2 causes

A

Lyme dz

Guillan-Barre syndrome

48
Q

Most common cause of Gram-neg sepsis?

A

E.coli

2nd- Klebsiella

49
Q

Septic arthritis in young adult

A

Neisseria gonorrhea

50
Q

Cat scratch

A

Bartonella henselae

51
Q

Dog/cat bite

A

Pasturella multocida

52
Q

Cat feces

A

Toxoplasmosis

avoid if prego

53
Q

Puppy feces

A

Yersinia enterocolitica

54
Q

Animal urine

A

Leptospira

55
Q

Rat bites

A

Spirillum minus

56
Q

Proteus (mirabilis, vulgaris)

A

Motile, no distinct colonies can be grown.
Common cause of UTI
Carries urease:
urea –> NH3 + CO2 –> ammonium/magnesium/phosphate stones –> staghorn caliculi

57
Q

Osteomyelitis in sickle cell pts

A

Salmonella

58
Q

Neisseria gonorrhea

A

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
Q

How is opthalmia neonatorum prevented?

A

Erythomycin eye drops- give to everyone.

prevents n. gonorrhea vertical txmsn

60
Q

Pseudomonas aeruginosa causes…

A 
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
Q

What are the enterobacteraiceae?

A 
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
Q

What does E.coli cause?

A

diarrhea
UTI
neonatal meningitis/pneumonia/sepsis

63
Q

4 types of E. coli

A

EIEC - invades intestinal mucosa

EHEC, ETEC, EPEC - do not invade

64
Q

EIEC

A

enteroinvasive E.coli
invades intestinal wall, so get fever and bloody diarrhea.
has shiga-like toxin (verotoxin) which inhibits 60S ribosome

65
Q

ETEC

A 
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
Q

EHEC

A 
O157:H7
hamburger meat
get HUS
shiga-like toxin.
dysentery- bloody diarrhea
does NOT ferment sorbitol like other E.coli
67
Q

What is HUS

A 
Hemolytic-uremic syndrome.
Triad:
1. Anemia (hemolysis)
2. Renal failure (uremia = high lvl of nitrogen waste in blood)
3. Thrombocytopenia (low plt)
68
Q

EPEC

A

no toxin
adheres to apical surf and flattens villi, so prevents absorption
Diarrhea usu in daycare kids

69
Q

Salmonella

A

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
Q

What causes typhoid fever?

A

Salmonella typhi

71
Q

Shingella

A

Bacterial dysentery can be caused by Shigella flexneri, sonnei, dystenteriae

72
Q

Shigella flexneri

A

Assoc w Reiter’s Reactive arthritis (can’t see, pee, climb a tree)

73
Q

Campylobacter jejuni

A 
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
Q

What gram-neg has aerosol txmsn, not person-person

A

Legionella pneumophilia

75
Q

What enz to obligate anaerobes lack?

A

Catalase
Superoxide dismutase
so susceptible to oxidate dmg
Clostridium, Bacteroides, Acintomyces

76
Q

Osteomyelitis in DM

A

pseudomonas

77
Q

Aspiration pneumonia (alcoholic)

A

Klebsiella pneumonia

78
Q

Common cause UTI and pneumonia

A

Klebsiella pneumonia

79
Q

Treatment for gonorrhea?

A

Single dose ceftriaxone

80
Q

What drugs inhibit protein synth?

A

30S:
Aminoglycosides
Tetracycline

50S:
Chloramphenicol, Clindamycin
Erythromycin
Lincomycin
Linezolid
81
Q

Discoloration of teeth and inhibition of bone growth in kids

A

Tetracyclines

82
Q

Drugs with ototoxicity and nephrotoxicity

A

Aminoglycosides
Vancomycin
Loop duretics
Cisplatin (chemo)

83
Q

Gray baby
Gray man
Red man

A

Gray baby = chloramphenicol
Gray man = amiodarone (anti-arrhythmia)
Red man = vancomycin

84
Q

What drugs should be avoided in pts with sulfa allergy

A 
Sulfonamides
TMP-SMX
Sulfasalazine
Sulfonylureas
Sumatriptan
Acetazolamide (diurectic- CA inhibitor)
Furosemide
Thiazide
Probenecid (gouty arthritis)
Celecoxib (COX-2 inhibitor)
85
Q

Most common causes of UTI

A

E.coli #1

Proteus, Klebsiella, Pneumonia

86
Q

Abx that treat UTI

A

Aminopenicillins
Cephalosporins
Nitrofurantoin
Sulfonamides

87
Q

Drugs w photosensitive rxns

A

SAT for a photo:
Sulfonamides
Amiodarone (anti-arrhythmic)
Tetracyclines

88
Q

Drugs that cause Stevens-Johnson syndrome

A

Penecillins
Sulfa Drugs
Seizure Drugs- ethosuxamide, lamtrigine, carbamazepine, phenobarbital, phenytoin
Allopurinol (for gout)

89
Q

Drugs used for Anaerobic infections

A

Metronidazole
Clindamycin
Imipenem/cilastatin
Meropenem

90
Q

Drugs that are used for Pseudomonas

A 
polymyxins
fluroquinolones
cefepime
aztreonam (aminoglycoside pretender)
aminoglycosides
extended-spectrum penicillins (ticarcillin, carbemicillin, piperacillin)

* DIT each session (34 decks)

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