Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ID Therapeutics :') > Exam 2- bacteria all up in my... > Flashcards

Exam 2- bacteria all up in my... Flashcards

1
Q

Bacteria resistant mechanisms: (7)

A
  • genetic material from external sources
  • mutational events –> DNA replication
  • enzymatic inactivation (penicillins)
  • ribosomal protection
  • elimination of antibiotic target
  • decrease cell wall permeability (vancomycin, doptamicin)
  • effluc pumps (cipro_
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

examples of mutations:

A
  • up- regulate chromosomal B-lactamases
  • up-regulate multi-drug efflux
  • decrease permeability of membranes
  • alterations in DNA gyrase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acquisition of DNA elements (plasmid)

A
  • beta-lactamases

- aminoglycosides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gram + Aerobes Cocci examples

A

-clusters (staphylococci)
-pairs (s. pneumonia)
-chains (S. pyogenses, enteroccous
(these account for majority of infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gram + Aerobes Bacilli examples

A

-bacillus sp., corynebacterium sp., listeria monocyt. & nocardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what drugs are used for methicillin resistant staphylococci? (3)

A

VLD: vanco, linelozid, daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does SPACE stand for? (HARD to treat)

A

-S. marcescens, P. aerginosa, A. baumanni, Citobacter Enterobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

drug(s) to treat S.marcescens

A

-ceftriaxone & cefepime (IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

drug(s) to treat P.aerginosa

A

cefepime (tobramycin/cipro as alts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

drug(s) to treat A. baumanni

A

cefepime (ceftaroline - 5th gen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

drug(s) to treat Citrobacter

A

cefepime (ceftarolin- 5th gen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

drug(s) to treat Enterobacter

A

cefepime (ceftarolin - 5th gen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does PEKHEM stand for? (easier to treat)

A

Proteus marabilis, E. coli, Klebsiella, H. influnezae, Enterobecterialis, M. cutarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

drug(s) to treat Proteus marabilis

A

cephalexin, cefazolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

drug(s) to treat E. coli

A

cefazolin (gentamicin as alt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

drug(s) to treat Klebsiella

A

cefazolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

drug(s) to treat H. influenzae

A

cefoxitin, cefector & cefotetan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

drug(s) to treat Enterobecteriallis

A

cefoxitin, cefector & cefotetan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

drug(s) to treat M. cutarrhalis

A

cefriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Above diaphragm anaerobes

A
  • peptococcus, peptostreptococcus, prevetolla, vienolla

- -> treat with clinda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Below diaphragm anaerobes

A
  • C. perfringes, B. fragilis, fusobacterium

- -> treat with clinda or metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

drug(s) to treat Gram + cocci

A

1- penillin, ampicillin

2- macrolide (azithro), cefazolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

drug(s) to treat MSSA

A

1- cefazolin

2-macrolide (azithro), clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

drug(s) to treat MRSA

A

1- vanco

2-linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

drug(s) to treat enterococcus

A

1- ampicillin + genta

2- vanco + genta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

drug(s) to treat gram - bacilli

A

1- ceftraixone

2- genta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

%T>MIC (drugs, pattern, dosing goal)

A
  • penicillins, cephalosporins, carbapemens, macrolides
  • time dependent killing & minimal persistent effects
  • inc dose, prolonged/contentious infusion, shorter dosing interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cmax: MIC & AUC:MIC (drugs, pattern, dosing goal)

A
  • aminoglycosides, quinolines
  • concentration dependent & prolonged effects
  • extended interval dosing & maximize safe dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

AUC:MIC (drugs, pattern, dosing goal)

A
  • vancomycin, azithromycin & tetracycline

- time-dependent & prolonged/persistant effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are disease related changes to drug pkpd?

A

1- pH (more ionized = more hydrophilic)
2-organ blood flow
**3- “fluid shifts –> change in Vd
4- changes in albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Sepsis & changes in population pharmacokinetics (Vd & CL)

A
  • low CL & low volume of D = HIIGH concentration

- high CL & high volume of D = LOW concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what changes can we except in the critically ill? (in terms of PKPD)

A
  • decrease in cardiac output = reduced CL
  • increase in capillary “leakiness” = increase Vd
  • acute kidney injury = hyper filtration = increase CL
  • chronic kidney injury = reduced renal clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Antibiotics WITHOUT renal dose adjustment

A 
( CCOMMAND DE TitLe) 
Ceftriaxone 
Clindamycin 
Oxacillin 
Metronidazole 
Moxifloxacin 
Azithromycin 
Nafcillin 
Doxycycline 
Dalfopristin 
Erythromycin 
Tigecycline 
Linezolid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Drugs that have rapid development of resistance?

A
  • rifampin
  • clindamycin
  • quinolines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

pk/pd target for vancomycin?

A

AUC:MIC ratio > 400 (set it up and solve for x)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

AUC:MIC is dependent on”

A
  • the daily dose a pt receives
  • the patient-specific clearance
  • the bacterial-specific MIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do we determine the patient-specific clearance?

A
  • trough (worst)
  • calculation of AUC using peaks & trough (meh)
  • Bayesian estimation (BEST!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Purulent SSTIs

A
  • caused by staph aureus

- painful, fluctuant, red, nodules, often topped with pustules, rims of erythematous swelling (localized)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mild, moderate & severe purulent SSTIs:

A

mild: no signs of infection
moderate: with systemic signs of infection
severe: failed I&D + oral antibiotics, septic or immunocompromised pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the treatment criteria of purulent SSTIs?

A

-DRAIN THAT SHIT!
-gram stain & culture if I&D performed
+ abx IF pt has systemic signs of infection (moderate & severe), is immunocompromised or doesn’t respond to I&D
(5-10 day duration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

SIRS criteria

A
  • temp > 38 or <36
  • tachypnea (>24)
  • tachycardia (>90)
  • WBC >12k, < 4k
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When do we want to treat empirically for MRSA?

A

hx of multiple/recent hospitalizations, antimicrobial use, previous documented MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MRSA tx for purulent SSTI use (Oral & IV)

A

Oral: BACTRIM (doxycycline, Linezolid)
IV: VANCO (daptomycin, ceftaroline, dalbavencin/ortavincin –> if pt has a hx of vanco intolerence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

MSSA tx for purulent SSTI use (oral & IV)

A

Oral: dicloxicillin, cephalexin, clindamycin
IV: (if they cant do oral): ampicillin/sulbactam, naficillin/oxacillin, cefazolin or clindamycin
(move from IV to PO)

45
Q

Non-purulent SSTI signs:

A

Cellulitis/Erysiplelas

  • red, warm, swollen & painful
  • Caused by STREPTOCOCCUS (groups B)–> some severe by S. aureus
46
Q

Non-purulent SSTI risk factors

A

-dry skin, fragile skin, obesity, previous skin trauma, previous cellulitis, edema from venous insufficiency, tinea pedis (athletes foot)

47
Q

Treatment guidelines for non-purulent SSTIs

A

-ANTIBIOTICS! do not drain!

48
Q

how to treat mild non-purulent SSTIs & duration

A 
-ORAL- 5 days, as long as pt responds 
#1s- amoxicillin & cephalexin
-pen V, amox/clav
(b-lactam allergies: clindamycin) 
( bactrim & doxy: can be used but meh)
49
Q

how to treat moderate ( 1 systemic sign of infection) non-purulent SSTI & duration

A

IV (in hospital 10-14 days) IV –> PO
-#1s: cefazolin & ceftriaxone
-pen G (reserve tho)
(severe pen allergies: clinda & vanco, linezolid, daptomycin)

50
Q

how to treat severe (2 + systemic signs of infection) non-purulent SSTI

A

–> emergency surgery! empiric: vanco + piper/tazo
IV (in hospital 10-14 days) IV –> PO
-#1s: cefazolin & ceftriaxone
-pen G (reserve tho)
(severe pen allergies: clinda & vanco, linezolid, daptomycin)

51
Q

Objective signs of necrotizing fasciitis

A
  • severe systemic symptoms: fevered, altered mental state

- fast temporal progression - see the severe tissue destruction happen in ~24-48 hrs

52
Q

Subjective signs of necrotizing fasciitis

A

-pain out of proportion

53
Q

Physical exam when it comes to necrotizing fasciitis

A
  • edema & tenderness beyond the redness
  • “wooden-hard” induration of subq tissue
  • crepitus: can hear crackling sound under skin
  • skin necrosis: death to tissues
  • imaging may show gas in soft tissues, edema along fascia
  • DONT WAIT- OPERATE!
54
Q

Clinical settings that are often associated with NF

A
  • abdominal trauma/surgery
  • decubitus ulcers
  • IVDU- injection sites
  • spread from genital site
55
Q

Broad spectrum (MRSA, gram -, gram + and anerobes) for NF

A
  • vanco + piper/tazobac
  • vanco + carbapenem (mero, imi, dori)
  • vanco + cefepime + metro/clinda
  • vanco _ cipro + metro/clinda
  • -> clinda 900mg IV sometimes added too
56
Q

Streptococcus tx in NF

A

pen G + clinda

57
Q

MRSA tx in NF

A

vanco

58
Q

MSSA tx in NF

A

oxacillin/nafcillin or cefazolin

59
Q

Clostridium tx in NF

A

clinda + pen G

60
Q

Treatment of Bite wounds

A

ampicillin/sulbactam (IV) or Amox/clauv (PO)

-alts: 2nd/3rd gen cephalosporins + metronidazole or levoflox + metronidazole (when allergy to amox)

61
Q

Classical findings of diabetic foot infection

A

-redness, warmth, swelling, pain, purulent drainage

62
Q

Secondary findings of diabetic foot infection

A

-non-purulent secretions, discolored granulation of tissues & foul odor

63
Q

The foot in diabetic foot infection

A

-hammer toes, bunions, calluses & charcot foot

64
Q

The wound in diabetic foot infection

A
  • depth & tissues involved, requires debridement of necrotic tissues, looking for abscesses, sinus tract, foreign bodies, prone to bone infection
  • -Xray for all- MRI if bone disease is suspected
65
Q

Mild criteria for diabetic foot infection & tx

A

erythema .5-2 cm, PO 1-2 weeks
MSSA (strep)- cephalexin, amox/clav (clindamycin)
MRSA: TMP/SMX, doxycycline

66
Q

Moderate & severe criteria for diabetic foot infection & tx

A

MOD(1-3 weeks): erythema >2 cm or involving structures deeper than the skin
SEV (3-4 weeks): local infection with 2+ SIRS
-MSSA, strep, gram - anaerobes: 1- AMP/SULB, 2-cefoxitin, 3-moxifloxacin (ceftriaxone + metronidizole, cipro + clinda, ertapenem)
MRSA: vanco
Pseudomonas: piper/tazo, cefepime
everything: vanco+ pipera/tazo

67
Q

Risk factors for for diabetic foot infection (MRSA & Pseudomonas)

A

MRSA: hx of MRSA, high local prevalaence, recent antimicrobial use & severe infection
Pseudomonas: warm climate, FREQUENT exposure to water, high local prevalence and recent antimicrobial use

68
Q

Pseudomonas tx in diabetic foot infection

A

piper/tazo, cefepime

69
Q

Risk factors for UTIs

A
  • no known reason
  • pregnancy, male gender, badly controlled diabetes
  • renal insufficiency
  • short-term urinary tract catheter, asymptomatic bacteriuria
  • long term urinary tract catheter treatment
70
Q

Uncomplicated UTI

A
  • normal urinary tract
  • normal voiding function dispenses bacteria
  • -> e. coli, staph saprophyticus
71
Q

Complicated UTI (risk factors & implications)

A

-congenital or acquired abnormality that prevents normal dispensing of bacteria from the urinary tract
Risk factors: lack of response to tx, severity of illness, commorbidities, origin of pt
Clinical implications: recurrence, SIRS/sepsis, antimicrobial resistance, immunosuppression, catheters

72
Q

Cystitis (bladder) symptoms

A

-dysuria
-frequency/urgency
-hematuria
Diagnose with UA & urine gram stain & culture

73
Q

Pyelonephritis (kidney) symptoms

A

-dysuria, frequency/urgency, hematuria
-CVA tenderness
-fever, chills
Diagnose with UA, urine gram stain & culture, CBC or blood culture

74
Q

Important things to look for in a UA

A
  • WBC (0-5)
  • RBC (0-5)
  • leukocytes easterase (-)
  • nitrates (-)
  • protein (-)
  • bacteria (-)
75
Q

3 thresholds of significant bacteriuria

A
  • traditional: >10^5
    men: >10^3
    women: > 10^2
76
Q

clinical urinary tract infection

A

-significant bacteriuria PLUS pyuria (pus) & signs/symptoms of infection

77
Q

when do we treat UTIs?

A
  • *do not treat asymptomatic!

exceptions: pregnancy, prior to invasive urinary tract procedures or prior to renal transplantation

78
Q

how to treat women with acute, uncomplicated cystitis (3)

A

1- nitrofurantoin 100mg BID x5d
2- Bactrim 160/800 BID x3
3- fosfomycin 3mg PO single dose

79
Q

Nitrofurantoin

A

-use for gram -, e. coli, Klebsiella
-CI with CrCL <60
AEs: GI, neuropathy, pulmonary toxicity & hepatoxicity

80
Q

Treatment for subclinical pyelonephritis

A

-pt appears to have uncomplicated cystitis
-suspected with failure of single or multi-dose regimen
at risk: diabetics, immunocompromised, h/o cystitis, pyelonephritis

81
Q

acute pyelonephritis out patient tx

A

1- ciprofloxacin 500mg bid x7d
2-once daily quinolone: ciprofloxacin 1000mg ER x7, levofloxacin 750mg x5d
3-*bactrim bid x14d
4-oral beta lactam (less effective)

82
Q

severe pyelonephritis tx in hospital

A

-symptoms of upper tract infection + marked systemic response,
1) quinolone IV (cipro)
2) aminoglycosides (gentamicin) +/- ampicillin
3)** cephalosporin or penicillin +/- gentamicin
duration 10-14 days

83
Q

UTIs in pregnancy treatment

A

1) amox/clauv x 7 days
2) cephalexin x3-7 days
3) amoxicilin x 7days (only if sensitivity is known)
(nitrofurantoin x7 & bactrim x3- avoid in last trimester or close to delivery)

84
Q

what 2 drugs do you want to avoid in UTI if a pt is close to delivery?

A

-nitro & bactrim

85
Q

pyelonephritis in pregos (tx)

A

-IV b-lactams- ceftriaxone, cefazolin (switch to PO - 14days)
DO NOT USE: quinolones (cipro) , tetracyclines or sulfonamides

86
Q

prevention of pyelonephritis in pregos with UTI

A

-monitor urine cultures, treat asymptomatic bacteriuria

87
Q

Presentation of UTIs in males

A

rare: dysuria, frequency

common in old men: dysuria, frequency, fever, lower abdominal pain

88
Q

acute bacterial prostatitis (males) PE, labs

A
  • prostate is tender & swollen

labs: pyuria, bacteria

89
Q

acute bacterial prostatitis tx

A
  • 2-4 weeks
  • *bactrim PO
  • gentamicin/ampicillin (if enterococcus)
  • quinilones (reserve)
90
Q

chronic bacterial prostatitis tx

A

4-6 weeks

  • bactrim PO
  • quinilones
  • suppressive therapy 1/2 the normal dose chronically
91
Q

when to treat candiduria & drugs

A
  • high risk pts or undergoing urologic procedures
  • fluconazole 200mg x2weeks
  • ampho B deoxycholate x1-7 days OR flucytosine x7-10d (glaberta only)
92
Q

Mild water loss

A
  • alert, restless
  • increased thirst
  • moist to slightly dry mucous membranes
  • normal/slightly decreased urinary output
93
Q

moderate water loss

A
  • lethargic, restless
  • low volume (low BP, high HR)
  • dry mucus membrane
  • delayed cap refill
  • dark urine
94
Q

severe water loss

A

-drowsy, limp, LOC
-bradycardia
-cyanotic
-skin “tenting”
-no urine production
EMERGENCY!

95
Q

general risk factors for C.diff

A
  • age >65
  • GI surgery
  • tube feeding
  • immunocompromised
  • length of stay in hospital
  • ICU admission
  • chemo
  • antibiotics
96
Q

lowest risk of C.diff

A
  • aminoglycosides (gentamicin)
  • vancomycin
  • metronidazole
97
Q

lower risk of C.diff

A
  • erythromycin
  • ampicillin/amox/pip-tazo
  • tetracyclines
98
Q

highest risk of C. diff

A
  • clindamycin
  • cephalosporins
  • carbapenems
  • quinolones
99
Q

AB-associated diarrhea without colitis

A

~6 loose bms/day

  • crampy lower abd/discomfort
  • slight lower abdominal tenderness
100
Q

AB-associated colitis w/o pseudomembranes

A

10+ loose bm/day, fecal laukocytes, occult blood

  • Nausea, anorexia, fever, malaise, dehydration, leukocytosis
  • abdominal distention, tenderness
101
Q

pseudomembranous colitis

A

> 10 loose bm/day, fecal leukocytes, occult blood

  • Nausea, anorexia, fever, malaise, dehydration, electrolyte imbalance, leukocytosis
  • marked abdominal tenderness, distention
102
Q

toxic megacolon

A
  • life- threatening complication of CDI, distention of colon,
  • ileus: gut shuts down, no diarrhea
103
Q

Clinical diagnosis of CDI

A

> 3 unformed stools in 24 hrs PLUS

    • stool test OR
  • pseudomembranous colitis diagnosed by colonoscopy
104
Q

golden standard for CDI testing

A

1-EIA detection of GHD

2- cell cytotoxicity assay or toxigenic culture as confirmation

105
Q

CDI: initial, non-severe criteria & tx

A

-WBC < 15k AND Scr <1.5
-vanco 125mg QID x10
-fidaxomicin 200mg PO BID x10
(metronidazole 500mg PO TID x10)

106
Q

CDI: initial, severe criteria & tx

A
  • WBC > 15k OR Scr >1.5
  • vanco 125mg PO QID x10
  • fidaxomicin 200mg PO BID x10d
107
Q

CDI: severe, complicated criteria & tx

A
  • hypotension, shock, ileus, megacolon

- vancomycin 5000mg PO or NG QID PLUS metronidazole 500mg IV Q8hr if ileus is present

108
Q

second reoccurrence of CDI

A
  • vanco tapered to vanco pulsed

or: vacno 125mg QID x10 then rifaximin 400mg TID x20d

ID Therapeutics :') (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions