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Infectious Disease > HIPSHER Antibiotics Q1-18 > Flashcards

HIPSHER Antibiotics Q1-18 Flashcards

1
Q

List the factors that should be considered when choosing an antimicrobial regimen

A
  1. Consider the Site, severity, organisms suspected, does it require a bactericidal agent
  2. Consider the pt: Allergies*, age, renal function, co-morbids
  3. Avoid redundancy
  4. Cost effective
  5. Convenience: (Use PO agents ASAP when able) Home infusions that require infrequent dosing
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2
Q

What are common colonizers/contaminants in cultures that are not ultimately the true culprit/problem in the infection?

A

Coag Negative staph and diphtheroids

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3
Q

How do you get the most reliable diabetic foot ulcer, lung and urine culture/samples?

A

Diabetic Ulcer - surgical culture that is deep

Lung - bronchoscopy to avoid mouth flora

Urine - mid stream

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4
Q

When should and should you not hold antibiotics until a specimen is obtained?

A

DO NOT WAIT TO START ABX IF SEPTIC/UNSTABLE

infections requiring surgery & long-term abx therapy, abx should be withheld in stable pts until accurate surgical samples can be obtained
○ = Example: prosthetic joint, post-op infections after spinal surgery w/ hardware replacement, osteomyelitis

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5
Q

What infections require empiric anaerobe coverage?

A

Intra-abdominal, DM foot ulcers, Gas gangrene, aspiration pneumonia, dental infection, pelvic, inflammatory dz

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6
Q

What agents empirically cover anaerobes?

A

ampicillin-sulbactam

pip-tazo

all carbapenems

clindamycin

metronidazole

moxifloxacin

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7
Q

What infections need to be empirically covered for pseudomonas?

A

Nosocomial pneumonia,

nosocomial UTI

post-op meningitis (following neuro sx)

severe DM foot ulcer

puncture wound through the shoe

burns

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8
Q

What agents empirically covers pseudomonas?

A

pip-tazo
ceftazidime

cefepime

cipro,

levaquin

all carbapenems except ertapenem

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9
Q

What infections require empiric MRSA coverage?

A

purulent cellulitis

post-op wound infx

nosocomial pneumonia

nosocomial meningitis

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10
Q

What agents empirically cover MRSA?

A

clindamycin
bactrim doxycycline
linezolid vancomycin

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11
Q

What infections require empiric enterococcus coverage?

A

Intra-abdominal infx (especially bilary tract)

UTI

CLABSI - central line associated blood stream infection

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12
Q

What agents empirically cover enterococcus?

A 
o	PCN
o	augmentin
o	pip-tazo
o	ampicillin-sulbactam
o	vanco
o	daptomycin
o	linezolid
o	ciprofloxacin, levofloxacin, nitrofurantoin for UTI
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13
Q

What MOA are beta lactams and what are their ADRs?

A

MOA: bactericidal to cell wall

ADR: rash, drug fever, thrombocytopenia, sz

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14
Q

What is a contraindication of PCN?

A

previous allergic rx or anaphylaxis to other beta-lactam classes

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15
Q

What is a contraindication of Aminopenicillins + B-lactamase inhibitors?

A

empiric intra-abdominal infections due to increasing Bacteriodes resistance

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16
Q

What is a CI to Cephalosporin (3rd gen) Cefazidime?

A

: empiric coverage of GN infections (increasing resistance

17
Q

What is a CI to Carbapenems?

A

lowers the sz threshold, avoid in head trauma or seizure history

18
Q

What is a CI to monobactams?

A

overall costly, assoc. with phlebitis and increased LFTS… try to not use if really needed

19
Q

What drugs are in the drug class of PCN?

A

• Penicillin: potent bactericidal
o Pencillin G IV
o PenVK PO
o Benzathine penicillin IM

20
Q

What drugs are in the drug class anti-staph PCN?

A

• Anti-staphylococcal PCN
o Nafcillin
o Oxacillin
o Dicloxacillin

21
Q

What drugs are in the drug class aminopenicillins?

A

o Ampicillin

o Amoxicillin

22
Q

What is the extended spectrum PCN?

A

Pip-Taz (Zosyn)

23
Q

What are the B-lactam/Beta lactamase Inhibitors?

A

o Ampicillin-Sulbactam [Unasyn]

o Amoxicillin-Clavulanate [Augmentin]

24
Q

What species does cephalosporins not cover?

A

enterococcus and anarobes

25
Q

What ARDs are associated with cephalosporins?

A
  • Fever
  • Rash
  • Seizures
  • Biliary sludge
26
Q

What are the 2 first generation cephalosporins and what microbes do they cover and when are they indicated?

A

• Cefazolin [Ancef]

Cephalexin [Keflex]

Antimicrobial spectrum:
• MSSA
• Strep

Indications:
• Surgical prophylaxis
• Non-purulent skin infections

27
Q

Recall the cephalosporins which are second generation, their antimicrobial spectrum, and their most common uses

A
  • Cefoxitin [Mefoxitin] - IV
  • Cefuroxime [Ceftin] - IV and PO (*MC for treatment for 2nd gen)
  • Cefaclor [Ceclor] - PO

Antimicrobial spectrum:
• Same as 1st generation (MSSA, strep species and some GN)
• Improved GN activity

Indications:
• Surgical prophylaxis if they cover anaerobes
• URI

28
Q

. Recall the cephalosporins which are third generation by trade and generic name, their antimicrobial spectrum and their most common uses.

A
  • Ceftriaxone [Rocephin] -IV (MC used IV agent)
  • Cefuroxime [Ceftin] - IV and PO
  • Cefaclor [Fortaz]

Antimicrobial spectrum:
• Coverage varies, depends on the agent
• Generally - MSSA and other strep species, great Strep pneumo coverage and overall more GN coverage than 1st and 2nd gen
• Ceftriaxone is MC used IV agent
• Ceftazidime - Pseudomonas but does not have good GP activity

Indications:
• Empiric UTI
• Pneumonia
• Meningitis

29
Q

Recall the cephalosporins which are 4th gen and their antimicrobial spectrum.

A

• Cefepime [Maxipime]

Antimicrobial spectrum:
• Good GP and GN coverage, including Pseudomonas
• Doesn’t work for ESBL, enterococcus, MRSA or anaerobes

30
Q

Recall the cephalosporins which are 5th gen and their antimicrobial spectrum.

A

• Ceftaroline [Teflaro]

Antimicrobial spectrum:
• Good GN and GP coverage
• Only cephalosporin that covers MRSA
• No Pseudomonas coverage

31
Q

Recall the carbapenems, their antimicrobial spectrum, and their adverse events

A
  • Imipenem/Cilastatin [Primaxin]
  • Meropenem [Merrem]
  • Ertapenem [Invanz]

Antimicrobial spectrum - broadest of all abx classes
• Covers GP and GN, ESBL’s and anaerobes

ADE:
• Seizures - especially imipenem
• Fever
• Rash

32
Q
  1. Recall the antimicrobial spectrum of Monobactam [Azotrenam].
A

• Covers ONLY GN (including Pseudomonas)

Infectious Disease (7 decks)

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