ID 1 Flashcards
gram positive gram stain
dark purple (thick cell wall)
gram negative gram stain
pink (thin cell wall)
what organisms do not stain well
atypicals chlamydia legionella mycoplasma pneumonia mycobacterium tuberculosis
gram positive cocci in clusters
staphylococcus (mssa and mrsa)
gram positive cocci in pairs and chains
strep pneumoniae (diplococci)
strep spp. (pyogenes)
enterococcus spp. (including VRE)
gram positive rods
listeria
gram positive anaerobes
peptostrepococcus
actinomyces
clostridium spps.
gram neg cocci
neisseria
gram neg rods
gut ones proteus e coli klebsiella serratia enterobacter citrobacter
non gut ones
pseudomonas
h flu
providencia
gram neg. cocci bacilli
acinetobacter
bordetella pertussis
gram neg. diplococci
moraxella cat/
gram neg. anerobe
bacteroides fragilis
prevotella spp.
curved or spiral shaped gram neg. rods
h pylori campylobacter treponema boreelia leptospira
high risk cdiff (killing off of normal gi gut flora) can be fatal
clindamycin
folic acid synthesis inhibitors
sulfonamides
trimethoprim
dapsone
cell wall inhibitors
beta lactams (penicillins, cephalosporins, carbapenems)
monobactams (aztreonam)
vancomycin, dalbavancin, televancin, oritavancin
protein synthesis inhibitors
aminoglycosides macrolides tetrocyclines clindamycin linezolid,tedezolid quinupristin/dalfopristin
cell membrane inhibitors
polymyxins
daptomycin
telavancin
oritivancin
dna/rna inhibitors
FQs
metronidazole, tinidazole
rifampin
concentration dependant
quinolones
aminoglycosides
daptomycin
goal is a high peak
large dose long interval
time dependent
cephalosporins
penicillins
carbapenems
goal is maintain drug level for most of the dosing interval
shorter dosing interval
beta lactam antibiotics
cephalopsorins, penicillins, carbapenems
all have a beta lactam ring
all penicillins cover what
enterococcus
all penicillins do not cover
MRSA or atypicals
only penicillin for pseduomonas
pip/taz (zosyn)
amoxicillin on its own cannot cover mssa but it can if its added with ___
clavulanate (augmentin)
natural penicillins (Pen v potassium, pen g benzathine) cover
gram positive cocci (strep and enterococci but not staph) and gram positive anaerobes
aminopenicillins cover
amoxicillin and ampicillin
gram positive (strep, enterococci not staph, gram pos. anaerobes, and gram neg HNPE)
amoxicillin/clavulantate
and ampicillin sulfbactam cover
gram positive (strep, enterococci, mssa, gram pos. anaerobes, gram neg. HNPEK) and gram neg. anaerobes (bacteroides fragelis)
zosyn covers everything augmentin and unasyn covers plus
citrobacter, acinteobacter, provindencia, enterobacter, serratia (CAPES), pseudomonas
antistaphylococcal penicillins are
nafcillin, dicloxacillin and oxacillin
antistaphyloccal penicillins are great against
MSSA but lack but lack activity against enterococcus, gram negatives and anarobes
penicillin G benzathine brand
IM
Bicillin LA
not used IV can cause death
side effects penicillins
seizures with accumulation
GI upset
diarrhea
Rash (SJS, TEN)
ampicillin and unasyn dilute in
NS only
nafcillin is a ___
vesicant, administer through central line
avoid penicillins in what allergy
beta lactam
all penicillins increase the risk of ___
seizures
first line tx for strep throat
penicillin VK
first line tx mild non purulent skin infection (no abscess)
penicillin VK
first line tx acute otitis media
amoxicillin (90mg.kg/day) or augmentin (90mg/kg.day
drug of choice for infective endocarditis prophylaxis before dental procedure
amoxicillin 2 grams x1 (30-60 min before procedure)
penicillin drug used in h pylori tx
amoxicillin
first line for sinus infections
augmentin
no renal dose required for what two penicillins
dicloxacillin and oxacillin
drug of choice for syphillis
penicllin g benzathine (bicillin LA)
2.4 million units IM
pip/taz infusions short or long
extended infusions (4 hours can be used to maximize t>mic
cephalosporins do not cover what two things
atypicals or enterococcus
first generation cephalosporin has excellent ___ coverage and are preferred when used for ____
gram positive
MSSA
first gen cephs have limited gram neg. coverage what is it
PEK
second gen cephs cover
HENPEKS
third gen cephs cover
pseudomonas -ceftaz,cefepime,zerbaxa
ceftriaxone and cefotaximine- cover more resis. strains of of strep
cefepime (4th gen) covers
broad gram neg. coverage (hnpek, capes, pseudomonas)
fifth gen ceph
ceftaroline (MRSA)
no ceftriaxone in ___
neonates (0-28 days)
1st gens to know
cefazolin
cephalexin (keflex)
2nd gens to know
cefuroxime
cefotetan (cefotan)
cefoxitin
cefprozil
3rd gens to know
cefdinir ceftriaxone cefotaxime cefixime cefpodoxime
ceftazidime (fortaz)
ceftaz/avibactam (avycaz)
ceftolozane/tazobactam (zerbaxa)
4th gen to know
cefepime (maxipime)
cefiderocol (fetroja)
5th gen to know
ceftaroline (teflaro)
no renal adjustment in what cephalosporin
ceftriaxone
cefotetan (2nd gen) can cause what type of reaction
disulfram with alcohol
if patient has a penicillin allergy on exam do not choose a ___
cephalosporin
exception pediatric patient with AOM
2 furry tan foxes
2nd gen cephs
+cefproxzil
cephalosporins have risk of ___
seizures
common use for keflex
skin infection (mssa) strep throat
common use for cefuroxime (2nd gen)
AOM, CAP, sinus infection
common use for cefdinir (3rd gen)
CAP, sinus infection
common use for cefazolin (1st gen) inpatient
surgical prophylaxis
common use for cefotetan and cefoxitin in patient
anaerobic coverage:bacteroides fragilis
surgical prophylaxis
common use for ceftriaxone and cefotaxime
cap, meningitis, spontaneous bacterial peritonitis, pylenonephritis
common use for ceftazidime (3rd gen) and cefipime (4th gen)
active against pseudomonas
common use for avycaz and zerbaxa (3rd gen)
MDR gram neg org. including pseudomonas
ceftarolone is used for
MRSA
carbapenems are all ___ only
IV
ertapenem does not cover ___
PEA
pseudomonas
acintobacter
enterococcus
carbapenems are very broad spectrum and generally reserved for MDR gram ___infections
negative
carbapenems are active against
most gram positive
negative (including esbl producing bacteria)
and anaerobes
no coverage of atypicals MRSA VRE
ertapenem dilute in __ only
NS
do carbapenems cover MRSA
no
do not use carbapenems in pts with what allergy
PCN
just like penicillin and cephalosporins, carbapenems have a __ risk because these are all beta lactams
seizure
common uses for carbapenems
polymicrobial infections- diabetic foot infections(moderate to severe)
empiric therapy when resistant organisms are suspected
resistant pseudomonas or acinetobacter infections (except ertapenem)
aztreonam is a what
monobactam
can aztreonam be used in a PCN allergy
yes, in fact it is primarily used when a beta lactam allergy is present
aztreonam covers many gram negatives including this special guy
pseudomonas
aztreonam has no coverage of what
anaerobes or gram positives
aztreonam is __ only
IV
there is also an inhaled form for CF
aminoglycosides mainly cover
gram negatives including pseudomonas
aminoglycosides kill gram negatives fast and are synergistic with what
beta lactams
notable toxicities for aminoglycosides
oto and nephrotoxicity
aminoglycosides bigger dose ___ frequently protects the kidneys
less
aminoglycosides are
gentamicin tobramycin amikacin streptomycin plazomicin
trough level goal for gent abd tobra
less than 2
aminoglycosides warnings
use caution in impaired renal fxn
elderly
taking other nephrotoxic drugs: amphotericn B,
cisplatin, polymixins, cyclosporine, loops, nsaids, radiocontrast dye, tacrolimus, vancomycin
when to draw aminoglycoside levels
draw a trough right before or 30 min before the 4th dose
draw a peak 30 min after the end of the infusion of the 4th dose
dosing for aminoglycosides
use actual weight if underweight
use actual or ideal for normal or overweight (follow protocol)
for obese must use adjusted bodyweight
gentamicin and tobramycin typical dose (traditional dosing)
1-2.5mg/kg dose
for aminoglycosides if crcl is 60 or greater give it every
8 hours for traditional dosing
quinolones inhibit ___ and ___
bacterial DNA topoisomerase IV and DNA gyrase
quinolones cover ___, ___ and finally ___
gram positive, negative and ATYPICALS
respiratory FQs
MGL
my good lungs
(enhanced coverage of strep pneumo and atypicals)
which two Fqs have enhanced gram neg. activity including activity against pseudomonas
cipro and levo
only FQ that cannot be used for UTIs
moxifloxacin
delafloxacin is approved for __ infections and has activity against __
skin infections MRSA
boxed warnings for FQs
tendon inflammation and rupture
peripheral neuropathy
seizures (CNS effects)
warnings with FQs
QT prolongation- highest risk with moxifloxacin
hypo or hyperglycemia
avoid systemic FQs in children and preg/breastfeeding due to musculoskeletal toxicity
photosensitivity/toxicity
do not put what fq through an NG tube
cipro oral suspension
cipro +dexamethasone ear drops called
ciprodex
levofloxacin brand name
levaquin
avelox generic
moxifloxacin
ocuflox eye drops generic
ofloxacin
avoid anything that can bind when taking a FQs including
antacids polyvalent cations (magnesium, aluminium, calcium, iron, zinc) multivitamins sucralafate bile acid resin
lanthanum carbonate (fosrenol)
sevelamer (renvela)
seperate by at least 2 hours before or 2-6 hours after
fqs can increase the effects of what blood thinner
warfarin
fq that is not renally adjusted
moxifloxacin
avoid FQs in __ and ___
children and pregnancy
counseling for FQs
avoid sun
seperate from cations
monitor BG if DM
Macrolides cover
atypicals (legionella, chlamydia, mycoplasma, mycobacterium)
Haemophilus
macrolides are treatment options for
community acquired respiratory tract infections
sexually transmitted diseases (chlamydia, gonorrhea)
macrolides include
azithromycin
clarithromycin
erythromycin
zpak dose
500 mg day 1
250 mg day 2-5
do not use lovastatin or simvastatin with what two macrolides
clarithromycin or erythromycin
azithromycin okay
warnings with macrolides
QT prolongation
hepatotoxicity
clarithromycin has a warning with ___ , increased mortality
coronary artery disease
clarithromycin and erythromycin are __ and ___ of cyp3a4
substrates and inhbitors
QT prolonging drugs to avoid combo with FQs and Macrolides
azole antifungals, antipsychotics, methadone
common uses for macrolides
CAP
alternative to beta lactam for strep throat
azithromycin can be used for what
COPD exacerbation monotherapy for chlamydia combo therapy for gonorrhea prophylaxis for MAC DOC for severe travelers diarrhea with dysentery
clarithromycin used for tx of
H. pylori
Erythromycin increases ___ ___ and is used for gastroparesis
gastric motility
zpak dosing
two 250mg pills once on day 1
then 250mg daily x 4 days
macrolides bind to the ___s subunit
50
tetracyclines bind to the __s subunit
30
tetracyclines cover
gram positive
negative
atypicals!
other unique pathogens (spirochettes, rickettsiae, bacillus anthracis
doxycycline indications
CAP tick borne/rickettsial diseases chylamdia gonorrhea mild skin infections caused by MRSA
minocycline is preferred tx for
acne
doxycyline brand
vibramycin
minocycline brand
minocin
solodyn
warning for tetracyclines who shouldnt take
children less than 8
pregnancy and breastfeeding
tetracycline with DILE
minocycline
should you avoid sun with tetracyclines
yes
iv:po ratio for tetracyclines
1:1
avoid ___ products with tetracyclines
dairy
avoid anything that can bind with tetracylines
antacids polyvalent cations (magnesium, aluminium, calcium, iron, zinc) multivitamins sucralafate bile acid resin
lanthanum carbonate (fosrenol)
sevelamer (renvela)
seperate by at least 2 hours before or 2-6 hours after
sulfonamides inhibit the folic acid ___
pathway
bactrim covers
mssa and mrsa
broad gram neg. coverage
what dose bactrim not cover
pseudomonas, enterococcus, atypicals, anaerobes
dose of bactrim is based on what component
TMP
single strength bactrim
400/80
s/t
double strength bactrim
800/160
s/t
uncomplicated UTI bactrim dose
1 double strength tablet twice a day for 3 days
800/160mg BID x 3 days
bactrim is CI in ___ ___
sulfa allergy
warnings with sulfameth
SJS/TEN, TTP (skin reactions)
G6PD deficiency! -dont use if known deficiency and d/c if hemolysis occurs
bactrim SEs
photosensitivity
hemolytic anemia (coombs test)
increase potassium
crystalluria (take with full glass of water)!
bactrim big interaction with what drug
WARFARIN
can cause a significant increase in INR
common used for bactrim
CA-MRSA skin infections
UTI
pneumocysitis pneumonia (PCP)
ratio of SMx/TMP
5:1
5 looks like an s
S also comes before T
single strength has 80 mg tmp
DS has 160 mg TMp
if patient is on WARFARIN consider different abx than ___
bactrim!
bactrim will increase the INR
also watch potassium with bactrim if taking other drugs that increase potassium
vancomycin inhibits
cell wall synthesis
vancomycin only covers gram
positive MRSA streptococci enterocci and cdiff - oral route only for c diff
vancomycin dose and trough
15-20mg/kg based on total body weight! every 8 -12 h9ours
used what weight for vanc dosing
total body weight
first line for MRSA infections
vancomycin
consider an alternative MRSA drug when MRSA MIC for vanc is
2 or greater
for vancomycin if the crcl is 20-49 increase the dosing interval to
every 24 hours
vancomycin dose for c diff
PO only
125-500mg QID x 10 days (upper end for severe complicated disease)
vancomycin warnings
oto and nephrotoxic
infusion related reactions: redman syndrome
redman syndrome with vancomycin how to avoid
do not infuse faster than 1 gram per hour
vancomycin trough for uti and skin infections
10-15
vanc. trough for serous mrsa infections (bacteremia, endocarditis, sepsis, pneumonia, osteomyelitis, meningitis)
15-20
nephrotoxicity increases with vanc. with use of other nephrotoxic drugs like
amphotericin b cisplatin polymixins cyclosporine tacrolimus loops NSAIDs radiocontrast dye
lipoglycopeptides are what
-vancins
vancins are very similar to what
vancomycin
vancins are approved for what
skins and soft tissue infections including MRSA
vancins are CI with the use of IV
UFH
telavancin has a specific boxed warning for __ risk
fetal risk and nephrotoxicity
like vancomycin, vancins can cause this syndrome
red man syndrome (give over 60 minutes)
you cannot put daptomycin in ____
dextrose
daptomycin is ___ dependent and a __ inhibitor
concentration
cell membrane
daptomycin activity
mostgram positive including MRSA and enterococci (e faceleis and faecium)
daptomycin brand
cubucin
do not use daptomycin to treat
pneumonia, drug is inactivated by lung surfactant
unique side effect for daptomycin
increases CPK (muscle thing) might have muscle pain and weakness
think about how using with statins can increase muscle toxicity
daptomycin can only be put in
normal saline
warnings for daptomycin
myopathy and rhabdomyolysis
can also falsely increase PT and INR
linezolid and tedizolid bind to the __ unit
50 s
linezolid and tedizolid have similar coverage to ___ but also cover VRE (e faecium and e faecalis)
vancomycin
cover MRSA
linezolid brand name
zyvox
zyvox (linezolid) CI
do not use with or within 2 weeks of MAO inhbitors
linezolid iv to po
1:1
linezolid comes
iv po
avoid __foods with linezolid
tyramine
warnings with linezolid
duration related myleosupression (thrombocytopenia)
peripheral and optic neuropathy
serotonin syndrome
hypoglycemia
SEs with linezolid
can decrease platelets
do you shake linezolid suspension
no
brand name for quinpristin/dalfopristin
synercid
synercid (quinpristin/dalfopristin) binds to the __ subunit
50s
synercid use is limited bc its not well
it is approved for complicated skin and soft tissue infections
tolerated arthralgias/myalgias infusion reactions edema hyperbilirubinemia
synercid does cover
gram positive bacteria including MRSA
enterococcus including VRE but not e faecalis
synercid can only be diluted in
dextrose
tigecyline covers almost ___but
everything
the 3 P’s (pseudomonas, proteus, providencia)
why is tigecyclines use limited/ boxed warning
increased risk of death
tigecycline binds to the __subunit
30s
what color should the reconstituted tigecycline be
tangerine (yellow orange)
polymyxins boxed warning toxicity
nephrotoxicity! of course
but also neurotoxicity which can lead to respiratory paralysis
two drugs in the polymyxin class
colistimethate sodium (colistin) polymyxin b sulfate
both injection
polymyxins cover gram negatives and due to the risks that they carry (neuro and nephrotoxicity) they are reserved for
MDR gram negative pathogens in combo with other abx
which abx can cause gray syndrome
chloramphenicol
clindamycin is a ___ that binds to the ___s subunit
lincosamide
50s
clindamycin what does it cover
anaerobes
gram positives including MRSA
clindamycin brands
cleocin
topicals (cleocin t, clindagel)
clindamycin doesnt require what
renal dose adjustment
clindamycin boxed warning
colitis (c.diff)
major SE with clindamycin
GI (NVD)
d test used for what antibiotic
clindamycin
how is dtest used with clindamycin
should be performed on staph aureus that is susceptible to clindamycin but resistant to erythromycin
a flattened zone between the disks indicates inducible clindamycin resistance and clindamycin should not be used
common uses for clindamycin
purulent and nonpurulent skin infections
beta lactam alternative for dental abscesses
metranidazole has activity against ___ and ___
anaerobes and protozoal infections
metronidazole is used for
bacterial vaginosis trichomoniasis giardiasis amebiasis c diff combos for intra abdominal infections
brand for metronidazole
flagyl
iv to po metronidazole
1:1
metronidazole is CI in
pregnancy (1st trimester)
use of alcohol during tx and 3 days after tx (disulfram rxn)
metronidazole and cefotetan have what in commmon
disulfram reaction
SE of metronidazole
metallic taste
fidaxomicin brand name
dificid
what is fidaxomicin used for
c diff (not effective for systemic infections)
metronidazole can increase the INR watch with ____
WARFARIN
just like bactrim
rifaximin is structurally related to what and covers what
rifampin
ecoli
notes about rifaximin (xifaxan)
not for systemic infections
used off label for cdiff and tx of hepatic encephalopathy
rifaximin is used for
travelers diarrhea
decrease recurrence of hepatic encephalopathy (lactulose is first line)
irritable bowel syndrome w/ diarrhea (IBS-D)
urinary agents
fosfomycin
nitrofuranitoin
fosfomycin use
single dose (3 grams po x 1 mixed in water) female uncomplicated uti
macrobid used for
uncomplicated uti only
macrobid dose
100 mg bid x 5 days
macrobid CI
crcl <60
warnings with macrobid
hemolytic anemia
caution in G6PD def.
macrobid SEs
GI upset take with food
brown urine discoloration (harmless)
DOC for uncomplicated UTI is
macroBID (BID)
mupirocin (bactroban) is a topical used to eliminate ___
MRSA
doc MSSA
dicloxacillin nafcillin oxacillin cefazolin,cephalexin augmentin, unasyn doxycyclin, minocycline bactrim
CA-MRSA skin and soft tissue
bactrim
doxycycline/minocycline
clindamycin (d test first)
linezolid
severe SSTI requiring IV or hospital (cover mrsa and strep)
vancomycin (consider alt if mic 2 or greater)
linezolid, tedizolid
daptomycin
ceftaroline
others
-vancins
synercid
tigecycline
nosocomial MRSA
vancomycin
linezolid
daptomycin (not in pneumonia)
others:
rifampin (not alone)
telavancin
VRE (e. faecalis)
Pen G or ampicillin
linezolid
daptomycin
other tigecycline
VRE (e faecium)
linezolid
daptomycin
other
synercid
tigecycline
DOC pseudomonas
pip/taz cefepime ceftaz ceftaz/avibactam (avycaz) ceftolozane/tazobactam (zerbaxa) carbapenems (except ertapenem) cipro,levofloxacin aztreonam aminoglycosides colisitmethate, polymyxin B
DOC acinetobacter
carbapenems (except ertapenem)
doc HNPEK
augmentin
DOC bacteroides fragilis
metronidazole
augmentin
cefotetan, cefoxitin
carbapenems
cdiff DOC
oral vanc
fidaxomycin
atypicals DOC
azithromycin
doxycycline
FQs
drugs to fridge after reconstitution
penicillin vk
ampicillin
augmentin
cephalexin (keflex)
drugs to not fridge
CEFDINIR azithromycin clarithromycin doxycycline ciprofloxacin etc
drugs that dont require renal dose adjustment
antistaphylococcal pcns ceftriaxone clindamycin doxycycline macrolides (azithromycin and erythromycin only) metronidazole moxifloxacin linezolid
avoid calcium rich foods with ___
FQs
