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EBM Dr. Freshie > EBM Session 4 > Flashcards

EBM Session 4 Flashcards

1
Q

What are the natural vs synthetic macrolides?

A

Erythromycin is a naturally occuring macrolide.

Azithromycin and Clarithromycin are both semisynthetic agents.

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2
Q

What is the MoA of macrolides?

A

Bind the the 50S ribosomal subunit inhibiting translation.
Low doses: Bacterialstatic
High doses: Bacterialcidal.

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3
Q

what is the spectrum of activity for erythromycin?

A

Staph (except for MRSA) and strep.

Few activity vs gram negative and anaerobes.

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4
Q

What are the side effects commonly seen with erythromycin?

A

Thrombophlebitis
Hepatotoxicity with cytochrome p450.
Nausea, vomiting, diahrrea.

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5
Q

What is the dosing regimen for erythromycin?

A

250-500 mg QID PO
or
1g q6h IV in 100mL solution defused slowly.

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6
Q

What is the spectrum of activity for azithromycin (Zithromax)?

A

Significantly good against gram positive staph and strep with very little activity vs gram negative organisms.

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7
Q

What is the dosage for azithromycin (Zithromax)?

A

500mg two pills day 1 and then 250mg for four days.

“Known as the Z-pack”

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8
Q

What is important to note about azithromycin when taking other drugs?

A

Can be given in patients with penicillin allergies!

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9
Q

what are the antibiotic options for a patient with penicillin allergy?

A

Tetracyclines (e.g. doxycycline), quinolones (e.g. ciprofloxacin), macrolides (e.g. clarithromycin), aminoglycosides (e.g. gentamicin) and glycopeptides (e.g. vancomycin) are all unrelated to penicillins and are safe to use in the penicillin allergic patient.

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10
Q

Which drug class cross reacts with penicillin allergies?

A

Cephalosporins

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11
Q

What is the mechanism of action for tetracyclines?

A

Protein synthesis inhibitor by binding onto the 30s ribosome.

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12
Q

What is the spectrum of activity for tetracycline?

A

Staph and Strep
Not enterococci
Only Minocycline is good against MRSA.

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13
Q

what are the two best tetracyclines for use in patients with a MRSA infection?

A

Minocycline

Doxycycline

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14
Q

What is the dosage for tetracycline?

A

250-500 mg four times a day PO

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15
Q

What is the dosage for minocycline and doxycycline?

A

100mg q12h PO

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16
Q

What is the MoA of clindamycin?

what about its spectrum of activity?

A

binds the 50s unit

Predisposes for C.diff

17
Q

What is the dosage for clindamycin?

A

600-900 mg q8h IV
or
150-300 mg BID or TID PO for outpatient.

It is hepatically cleared!!

18
Q

What is flagyl, how does it work, and what is its spectrum of activity?

A

Flagyl is metronidazole
Works by inhibiting nucleic acid synthesis.
Effective against gram neg anaerobes with less activity against gram positive anaerobes.

19
Q

What is the dosage for flagyl?

A

500mg TID or QID.

Parental: 15 mg/kg loading dose + 7.5 mg/kg q6-q8.

20
Q

Wagner ulcer grading

A

0: non open, some evidence of healed lesions
1: Superficial ulcer
2: Deeper ulcer to tendon, bone, joint capsule
3: Deeper tissues involved with abscess, osteo, tendinitis
4: Forefoot gangrene
5: Rearfoot gangrene

21
Q

What is the gold standard for diagnosing osteo?

A

Bone biopsy

bone exposure, ulcer area >2cm and positive probe to bone results.

22
Q

What lab tests are useful in diagnosing osteo?

A

ESR >70
Elevated WBC = Poor sensitivity
Swab culture: No diagnostic utility.

23
Q

How long does osteo lag behind in radiographs?

A

X-rays lag about 7-14 days behind the infection.

24
Q

what are the pros of utilizing MRI in the diagnosis of osteomyelitis?

A

Excellent for diagnosis of diabetic foot OM of neuropathic ulceration etiology

however

Preoperative MRI is not effective in the dx of diabetic foot OM in ischemic ulcers.

25
Q

Dosage for augmentin

A

500mg Amoxicillin with 125 mg clavulunic acid every 8 hours.

Pinicillin allergies use: Clindamycin 300mg 6 hourly with a fluoroquinolone cipro 500mg BID

26
Q

What is the current treatment guideline for diabetics with OM?

A

Surgical debridement with 2-4 weeks of antimicrobial therapy and 4-8 weeks if they have positive margins.

EBM Dr. Freshie (6 decks)

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