EXAM II - Principles Flashcards
What are drugs effects? (2)
toxicodynamics on host and pharmacodynamics on bacteria
What are host effects? (2)
pharmacokinetics on drug and host defenses on bacteria
What are bacteria effects? (2)
resistance on drug and infection on host
What bacteria infects skin?
staphylococcus aureus
What bacteria infects the intestinal lining?
helicobacter pylori
What bacteria infects the urinary tract?
escherichia coli
What has no evidence based support for use?
combination therapy for carbapenem-resistant Gram-negatvie bacteria
What value denotes something that is bactericidal?
< 10^4 CFUs/mL
What are Gram-positive cocci in clusters?
coagulase negative (s. epidermidis) and coagulase positive (s. aureus)
What percents are MSSE and MRSE?
MSSE = 26%, MRSE = 74%
What percents are MSSA and MRSA?
MSSA = 50%, MRSA = 50%
How to treat susceptible staph versus resistant?
susceptible = nafcillin/dicloxacillin/cephalexin, resistant = vanco/daptomycin/linezolid/clindamycin/ceftaroline/TMPSMX
SPACE acronym stand for?
serratia, pseudomonas, acinetobacter/indole-positive, citrobacter, enterobacter
penicillins MOA?
bind to transpeptidase enzymes and prevent cell wall formation
penicillins spectrum of activity?
Gram + aerobes, some MSSA
cephalosporins MOA?
bind to transpeptidase enzymes and prevent cell wall formation
cephalosporins spectrum of activity?
ceftazidime - pseudomonas, cefepime - MRSA
What is the drug class of choice for ESBL producing organisms?
carbapenems
carbapenems spectrum of activity?
does not work on MRSA or atypicals
aminoglycosides MOA?
bind to 30S ribosomal subunit
What aminoglycoside is used in combination with cell wall active agents?
gentamicin
What are ADEs of aminoglycosides?
nephro/ototoxicity, neuromuscular blockade
aminoglycosides spectrum of activity?
does not work on Gram - anaerobes or atypicals
What class of drugs are bacteriostatic?
tetracyclines, macrolides, lincosamides, TMP/SMX, and oxazolidinones
tetracyclines MOA?
reversibly bind to 30S ribosomal subunit
tetracyclines ADEs?
GI, phototoxicity, Fanconi syndrome
tetracyclines spectrum of activity?
work on atypicals, no pseudomonas coverage
macrolides MOA?
reversibly bind to the 50S ribosomal subunit
macrolides ADEs?
GI, phlebitis
macrolides spectrum of activity?
work on atypicals, not staph or pseudomonas
lincosamides MOA?
reversibly bind to the 50S ribosomal subunit
lincosamides ADEs?
GI, pseudomembranous colitis
lincosamides spectrum of activity?
No gram - or pseudomonas
fluoroquinolones MOA?
inhibit DNA gyrase
What drugs are affected by oral coadministration of di- and trivalent cations?
tetracyclines and fluoroquinolones
fluoroquinolones ADEs?
GI, HA, seizures, QTc prolongation
fluoroquinolones spectrum of activity?
pseudomonas and atypicals
What class of drugs are first-line for MRSA infections?
glycopeptides
glycopeptides MOA?
bind to the terminal residue in growing peptidoglycan chains and prevent cell wall formation
glycopeptides ADEs?
nephro/ototoxicity, Red Man’s Syndrome, neutropenia, rash
What is not indicated for pneumonia?
daptomycin
What drug is first-line for pneumocystis carinii pneumonia?
TMP/SMX
trimotheprim/sulfamethoxazole MOA?
folate pathway inhibitor
trimethoprim/sulfamethoxazole ADEs?
GI, rash, anemia, crystalluria, neutropenia
nitroimidazoles MOA?
reduces to toxic intermediate that form DNA adducts
nitroimidazole ADEs?
GI, disulfiram reaction, metallic taste
nitroimidazole spectrum of activity?
Gram - anaerobes
oxazolidinones MOA?
bind to 50S ribosomal subunit
What generation cephalosporin has CSF penetration?
third (cefotaxime, ceftriaxone, cefixime, cefpodoxime, cefoperazone)
What generation cephalosporin has MRSA activity?
fifth (ceftaroline)
What is the formula for AUC of a given dose?
AUCdose = t_infusion * ((c_max + c_min)/2) + ((c_max - c_min)/k)
What is the dosing goal of penicillins, cephalosporins, carbapenems, macrolides, and oxazolidiones?
prolonged infusion time, continuous infusion, shorter dosing interval, increase dose
What is the key parameter of penicillins, cephalosporins, carbapenems, macrolides, and oxazolidiones?
%T>MIC
What is the dosing goal of aminoglycosides and fluoroquinolones?
extended interval dosing, maximize safe dose
What is the key parameter of aminoglycosides and fluoroquinolones?
Cmax:MIC, AUC:MIC
What is the dosing goal of vancomycin, azithromycin, and tetracycline?
optimize safe dose
What is the key parameter of vancomycin, azithromycin, and tetracycline?
AUC:MIC
What antibiotics do not require renal adjustment? (12)
metronidazole, azithromycin, nafcillin, tigecycline, oxacillin, linezolid, doxycycline, moxifloxacin, erythromycin, quinupristin/dalfopristin, ceftriaxone, clindamycin
What is the foremost factor controlling PD?
the bacteria species
What is the AUC MIC for vancomycin?
> 400 mg*h/L
What is the trough goal for vancomycin?
10-15 mcg/mL
purulent SSTI treatment (mild)?
I&D
purulent SSTI treatment (moderate, empiric)?
I&D, TMP/SMX, doxycycline
purulent SSTI treatment (moderate, defined)?
I&D, MRSA = TMP/SMX, MSSA = dicloxacillin, cephalexin
purulent SSTI treatment (severe, empiric)?
I&D, vanco/daptomycin, linezolid, telavancin, ceftaroline
purulent SSTI treatment (severe, defined)?
I&D, MRSA = empiric options, MSSA = nafcillin, cefazolin, clindamycin
nonpurulent SSTI treatment (mild)?
oral penicillin, cephalosporin, dicloxacillin, clindamycin
nonpurulent SSTI treatment (moderate)?
intravenous penicillin, ceftriaxone, cefazolin, clindamycin
nonpurulent SSTI treatment (severe, emergent surgical inspection/debridement)?
rule out necrotizing process
nonpurulent SSTI treatment (severe, empiric)?
vancomycin PLUS piperacillin/tazobactam
How long is the duration of therapy for purulent SSTIs?
5-10 days following I&D
purulent SSTIs classifications? (3)
mild = not systemic, moderate = systemic signs, severe = septic/immunocompromised/failed I&D and therapy treatment
What are the criteria for SIRS? (4)
at least two required: temp <36 or >38, tachypnea >24, tachycardia >90, WBC >120000 or <4000
How long is the duration of therapy for non-purulent SSTIs?
mild = 5 days, moderate-severe = 10-14 days
