first lecture- intro - vanco Flashcards
gram positive cocci
staph
strep
entero
gram pos anaerobes (two categories)
cocci: (found in mouth)
-peptostrep
-pepto
—
bacilli:
-C. diff
-C perfringens
gram neg bacilli
enterobacteriaceae i.e. E.coli
Aneaerobes –> bacteroides fragilis
Aerobes–> pseudo
what is a gram neg bacilli anaerobe
bacteroides fragillis
atypical pathogens
chlamydia
legionella
mycoplasma pneumoiae
If you see pneumonia and something about the A/C unit what bacteria should you think of?
legioneres pneumoniae
what is a sample antibiogram used for
shows the population in an area what bacteria mainly sensitive/resistant to by percentages
antibiotic sensitivity testing vs E-test for antibiotic MIC
e-test: strips have varying levels of conc. as the zone of conc. increases, the zone of inhibition increases too signifying that the drug works for it
Extended spectrum beta lactamases
carbapenems can be the last resource since they’re resistant to the beta lactamase– treat for pseudo (THE BIG GUNS)
they share things in common to overcome abx and be resistant/harder to treat—> bad bacteria
Klebsiella spp
E. coli
Psudo
Acinetobacter baumannii
explain concentration dependent vs time dependent
conc: the higher the drug concentration given, the greater the killer
has Post-antibiotic effect
time: killing extent remains stable at a particular drug conc., goes below MIC –> NO PAE, have to give drug continuously for it to work
what are beta lactam antibiotics (4)
- penicillin
- cephalosporin
- carbapenems
- monobactams
which antibiotics affect the cell wall and are NOT B lactams
- bacitracin
- vancomycin
- daptomycin
beta lactamase inhibitors
sulbactam –> ampicillin
tazobactam –> pipercillin
clavulanale/clauvinic acid –> amoxicillin
MOA of betalactamase
bacteriacidal
what is the drug of choice for syphillis, gas gangrene, and menigococcus
Penicillin G
penicillin G has good coverage for gram + cocci and anaerobic activity EXCEPT
has NO staph coverage and no bacteroides coverage
Penicillin G important to monitor for what
allergic rxn –> anaphylaxis
why be cautious of giving lipid base via what type of administration?
IV bc of embolisms
what is the go to aminopenicillin
amoxicillin
what drug decreases effectiveness of oral contraceptives? Explain.
estrogens half life usually extends with BC preventing you from getting pregnant. but amoxicillin shortens this and you can accidentally become pregnant
which. drug causes abnl prolongation of prothrombin time when pt is on anticoagulants?
increase in bleeding on a pt on Warfarin
what drug has side effects of hepatic dysfxn, jaundice C. Diff infxn, Stevens-Johnson syndrom, TEN, nephritis, anemia
Aminopenicillins- i.e. amoxicillin
what are are monitoring levels of penicillins
renal, hepatic, platelets
what is a beta lactamase
it cleaves ring so it cannot bind to PBP –> making body resistant to penicillin
what is the drug of choice when getting bit by a dog/human?
apparently clindamycin too (from kahoot)
what is the drug of choice fro skin tissue and diabetic foot
aminopencillin WITH beta-lactamase inhibitors such as AUGMENTIN or unasyn
which drug is designed solely* to cover S.auerus (MSSA)
penicillinase-resistant Penicillins
-nafcillin, oxacillin, dicloxacillin
what is the go to tx for MRSA
vancomycin
aminopencillin WITH beta-lactamase inhibitors such as AUGMENTIN or unasyn cover for
MSSA
which penicillin has the most BROAD coverage and whats an important thing that will cover
antipseudomonal penicillin *piperacillin/tazobactam (Zosyn)* -- psuedo --- broad so polymicrobial infxn
all PNC are ___ dependent killers
time
what type of betalactam antibiotic is good for cerebrospinal fluid penetration
cephalosporins
which betalactam does NOT cover for enterococcus
cephalosporins
which cephalosporins have antipseudomonal activity
3rd: ceftazidime (Forfaz), 4th: cefepime (maxipime), and 5th: Ceftolozane/tanzo (zerbaxa)
Which ceph is the black sheep and why?
ceftazidimine (forfaz); treats for psudomonas but it gains FAST resistance against it so not preferred
compare cefepime (maxipime) with piperacillin/tazobactam (Zosyn)
both antipseudo
- zosyn covers anaerobes and enterococci
- cefepime does NOT cover anaerobes and enterococci
which betalactam has mostly renal elimination
cephalosporins
which drug is gram pos, some gram neg coverage and is mainly given before surgeries to prevent infection
1st gen: cefazolin (ancef)
what cepholosporin is the go to aka the GOAT that has good strep coverage aka given to pt with fever/sepsis
3rd gen: ceftriaxone (rocephin) IV and cefdinir (omnicef) PO
what drug would you not give the first 30 days of life
3rd gen: ceftriaxone (rocephin
what drug would you give to a neonate with fever/sepsis; what gen is this
3rd gen: cefotaxime (claforan) IV
why is ceftriaxone (rocephin) convenient
time dependent drug but long enough half life that just needs to be given once a day
- no need to worry about renal dosing
what type of bacteria are gut flora killers
anaerobes in gram neg
define empiric coverage
broad spectrum to narrow once culture results are given to treat infxn
what is neutropenic fever and what would you give to treat?
4th gen ceph: Cefepime (Maxipime)
- its when pt is immunosuppresssed and cant fight fever on own
which cephalosporin covers for MRSA
community acquired pneumonia where MRSA develops
what does monobactam cover
gram neg
- pseudomonas aeurginosa
- enterobacteriacea activity
all of the carbapenems cover for pseudomonas except
ertapenem
which medication should be monitored when there is renal failure causing seizures
Imipenem
what are the most broad spectrum beta lactam
carbapenems BIG GUNS
which betalactam is resistant to hydrolysis from B lactamase, drug of choice for (ESBL) and MDR
carbapenems
carbaoebens hace ___ penetration
CNS, good for meningitis
what is the MOA for vancomycin
binds to 2 D-Ala directly on peptide to block cross-linking
difficult to develop a resistance
if vancomycin is not a beta lactam abx then it is
glycopeptide antibiotic
vancomycin is such a large structure so it does not absorb via ____ administration and need to be given ____
orally and need to be given IV (systemically)
when is the only time vancomycin will be given by mouth
when treating for C.diff
vancomycin generally covers
gram positive
vancomycin is given to treat
MRSA pen allergies infxns C diff endocarditis, osteomyelitis surgical prophylaxis (allergy)
when would you give a low trough vs a high trough of vancomycin
depending on the site of infection youd choose a concentration
i.e. IV vanco is systemic so when treating for bacteremia itll go directly into bloodstream so dont need high troughs vs meningitis or pneumonia, it needs higher troughs to penetrate those sites of infxns
—
low trough when the MIC is low,
high mic may need alternative theray
loading dose is given when…
to rapidly reach target trough
whats critical elimination for vancomycin
renal clearance
vancomycin has high toxicity where thus needs to be monitored?
otoxicity
nephrotoxicity
what can be a reaction when infusing vancomycin too quickly?
Red Man Syndrome
what is the trough for vancomycin
3-4 doses
